1
|
Adorno G, Zinno F, Bruno A, Lanti A, Ballatore G, Masi M, Cudillo L, Del Poeta G, Riccitelli A, Del Principe M, Pepe R, Marchitelli E, Morosetti M, Meloni C, Isacchi G, Amadori S. Femoral Catheters: Safety and Efficacy in Peripheral Blood Stem Cell Collection. Int J Artif Organs 2018. [DOI: 10.1177/039139889902201009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Central venous access is necessary in patients candidate for peripheral blood stem cell (PBSC) collection. We report our experience with a dual lumen femoral catheter (Gamcath, 11 french), initially designed for hemodialysis. We studied 147 patients and performed 488 collections after mobilization with either G-CSF alone or chemotherapy + G-CSF, when the white blood cell count exceeded 1 × 109 /L, or when a measurable population of CD34+ cells (20 / μL) was detected in peripheral blood. All patients received systemic anticoagulation with a low weight heparin and ultrasound examination was performed after the removal of the catheter. Seven patients developed thrombosis (4.7%), ten experienced hematomas at the site of catether placement (6.8%) despite prophylactic platelet transfusions, while only one patient (0.6%) had a catheter-related infection. In conclusion, the short-term use of large bore femoral catheters in setting up PBSC collection seems to be associated with minimal risk of infection and low thrombotic incidence.
Collapse
Affiliation(s)
- G. Adorno
- Department of Hematology University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - F. Zinno
- Department of Immunohematology and University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - A. Bruno
- Department of Hematology University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - A. Lanti
- Department of Immunohematology and University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - G. Ballatore
- Department of Immunohematology and University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - M. Masi
- Department of Hematology University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - L. Cudillo
- Department of Hematology University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - G. Del Poeta
- Department of Hematology University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - A. Riccitelli
- Department of Hematology University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - M.I. Del Principe
- Department of Hematology University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - R. Pepe
- Angiology Service, St. Eugenio Hospital, Roma - Italy
| | | | - M. Morosetti
- Surgery, University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - C. Meloni
- Surgery, University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - G. Isacchi
- Department of Immunohematology and University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| | - S. Amadori
- Department of Hematology University of Roma Tor Vergata St. Eugenio and Bambino Gesù Hospitals
| |
Collapse
|
2
|
Benedetti D, Tissino E, Pozzo F, Bittolo T, Caldana C, Perini C, Martorelli D, Bravin V, D’Agaro T, Rossi FM, Bomben R, Santinelli E, Zaja F, Pozzato G, Chiarenza A, Di Raimondo F, Del Poeta G, Rossi D, Gaidano G, Dal Bo M, Gattei V, Zucchetto A. NOTCH1 mutations are associated with high CD49d expression in chronic lymphocytic leukemia: link between the NOTCH1 and the NF-κB pathways. Leukemia 2017; 32:654-662. [DOI: 10.1038/leu.2017.296] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/23/2017] [Accepted: 09/08/2017] [Indexed: 12/16/2022]
|
3
|
Tissino E, Benedetti D, Herman S, ten Hacken E, Ahn I, Chaffee K, Bayer E, Haerzschel A, Gutjahr J, Postorino M, Santinelli E, Ayed A, Zaja F, Chiarenza A, Chigaev A, Sklar L, Burger J, Ferrajoli A, Shanafelt T, Wiestner A, Del Poeta G, Hartmann T, Gattei V, Zucchetto A. INSIDE-OUT VLA-4 INTEGRIN ACTIVATION IS MAINTAINED IN IBRUTINIB-TREATED CHRONIC LYMPHOCYTIC LEUKEMIA EXPRESSING CD49D: CLINICAL RELEVANCE. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- E. Tissino
- Centro di Riferimento Oncologico, I.R.C.C.S; Clinical and Experimental Onco-Hematology Unit; Aviano Italy
| | - D. Benedetti
- Centro di Riferimento Oncologico, I.R.C.C.S; Clinical and Experimental Onco-Hematology Unit; Aviano Italy
| | - S.E. Herman
- Hematology Branch; National Heart, Lung, and Blood Institute, NIH, Bethesda; Maryland USA
| | - E. ten Hacken
- Department of Medical Oncology; Dana Farber Cancer Institute; Boston Massachusetts USA
| | - I.E. Ahn
- Hematology Branch; National Heart, Lung, and Blood Institute, NIH, Bethesda; Maryland USA
| | - K.G. Chaffee
- Department of Health Sciences Research; Mayo Clinic College of Medicine; Rochester Minnesota USA
| | - E. Bayer
- Oncologic Center, Paracelsus Medical University; Laboratory for Immunological and Molecular Cancer Research, 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases and Rheumatology; Salzburg Austria
| | - A. Haerzschel
- Oncologic Center, Paracelsus Medical University; Laboratory for Immunological and Molecular Cancer Research, 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases and Rheumatology; Salzburg Austria
| | - J.C. Gutjahr
- Oncologic Center, Paracelsus Medical University; Laboratory for Immunological and Molecular Cancer Research, 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases and Rheumatology; Salzburg Austria
| | - M. Postorino
- Division of Hematology; S. Eugenio Hospital and University of Tor Vergata; Rome Italy
| | - E. Santinelli
- Division of Hematology; S. Eugenio Hospital and University of Tor Vergata; Rome Italy
| | - A. Ayed
- Department of Health Sciences Research; Mayo Clinic College of Medicine; Rochester Minnesota USA
| | - F. Zaja
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari "Carlo Melzi" DISM; Azienda Ospedaliera Universitaria S. Maria Misericordia; Udine Italy
| | - A. Chiarenza
- Division of Hematology; Ferrarotto Hospital; Catania Italy
| | - A. Chigaev
- Department of Pathology and Cancer Center; University of New Mexico; Albuquerque New Mexico USA
| | - L.A. Sklar
- Department of Pathology and Cancer Center; University of New Mexico; Albuquerque New Mexico USA
| | - J.A. Burger
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - A. Ferrajoli
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - T.D. Shanafelt
- Department of Health Sciences Research; Mayo Clinic College of Medicine; Rochester Minnesota USA
| | - A. Wiestner
- Hematology Branch; National Heart, Lung, and Blood Institute, NIH, Bethesda; Maryland USA
| | - G. Del Poeta
- Division of Hematology; S. Eugenio Hospital and University of Tor Vergata; Rome Italy
| | - T.N. Hartmann
- Oncologic Center, Paracelsus Medical University; Laboratory for Immunological and Molecular Cancer Research, 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases and Rheumatology; Salzburg Austria
| | - V. Gattei
- Centro di Riferimento Oncologico, I.R.C.C.S; Clinical and Experimental Onco-Hematology Unit; Aviano Italy
| | - A. Zucchetto
- Centro di Riferimento Oncologico, I.R.C.C.S; Clinical and Experimental Onco-Hematology Unit; Aviano Italy
| |
Collapse
|
4
|
Pozzo F, Bittolo T, Vendramini E, Bomben R, Bulian P, Rossi F, Zucchetto A, Tissino E, Degan M, D'Arena G, Di Raimondo F, Zaja F, Pozzato G, Rossi D, Gaidano G, Del Poeta G, Gattei V, Dal Bo M. NOTCH1
MUTATED CHRONIC LYMPHOCYTIC LEUKEMIA CELLS ARE CHARACTERIZED BY a MYC
-RELATED OVEREXPRESSION OF NUCLEOPHOSMIN-1 AND RIBOSOME ASSOCIATED COMPONENTS. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- F. Pozzo
- Clinical and Experimental Onco-Hematology Unit; Centro di Riferimento Oncologico, I.R.C.C.S; Aviano Italy
| | - T. Bittolo
- Clinical and Experimental Onco-Hematology Unit; Centro di Riferimento Oncologico, I.R.C.C.S; Aviano Italy
| | - E. Vendramini
- Clinical and Experimental Onco-Hematology Unit; Centro di Riferimento Oncologico, I.R.C.C.S; Aviano Italy
| | - R. Bomben
- Clinical and Experimental Onco-Hematology Unit; Centro di Riferimento Oncologico, I.R.C.C.S; Aviano Italy
| | - P. Bulian
- Clinical and Experimental Onco-Hematology Unit; Centro di Riferimento Oncologico, I.R.C.C.S; Aviano Italy
| | - F.M. Rossi
- Clinical and Experimental Onco-Hematology Unit; Centro di Riferimento Oncologico, I.R.C.C.S; Aviano Italy
| | - A. Zucchetto
- Clinical and Experimental Onco-Hematology Unit; Centro di Riferimento Oncologico, I.R.C.C.S; Aviano Italy
| | - E. Tissino
- Clinical and Experimental Onco-Hematology Unit; Centro di Riferimento Oncologico, I.R.C.C.S; Aviano Italy
| | - M. Degan
- Clinical and Experimental Onco-Hematology Unit; Centro di Riferimento Oncologico, I.R.C.C.S; Aviano Italy
| | - G. D'Arena
- Onco-Hematology Department; IRCCS “Centro di Riferimento Oncologico della Basilicata”; Rionero in Vulture Italy
| | - F. Di Raimondo
- Division of Hematology; Ferrarotto Hospital; Catania Italy
| | - F. Zaja
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari; Azienda Ospedaliera Universitaria S. Maria Misericordia; Udine Italy
| | - G. Pozzato
- Department of Internal Medicine and Hematology; Maggiore General Hospital; Trieste Italy
| | - D. Rossi
- Hematology; Institute of Oncology Research and Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - G. Gaidano
- Division of Hematology-Department of Translational Medicine; University of Eastern Piedmont; Novara Italy
| | - G. Del Poeta
- Division of Hematology; S.Eugenio Hospital and University of Tor Vergata; Rome Italy
| | - V. Gattei
- Clinical and Experimental Onco-Hematology Unit; Centro di Riferimento Oncologico, I.R.C.C.S; Aviano Italy
| | - M. Dal Bo
- Clinical and Experimental Onco-Hematology Unit; Centro di Riferimento Oncologico, I.R.C.C.S; Aviano Italy
| |
Collapse
|
5
|
Pozzo F, Bittolo T, Vendramini E, Bomben R, Bulian P, Rossi FM, Zucchetto A, Tissino E, Degan M, D'Arena G, Di Raimondo F, Zaja F, Pozzato G, Rossi D, Gaidano G, Del Poeta G, Gattei V, Dal Bo M. NOTCH1-mutated chronic lymphocytic leukemia cells are characterized by a MYC-related overexpression of nucleophosmin 1 and ribosome-associated components. Leukemia 2017; 31:2407-2415. [PMID: 28321119 DOI: 10.1038/leu.2017.90] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/13/2017] [Accepted: 03/16/2017] [Indexed: 12/24/2022]
Abstract
In chronic lymphocytic leukemia (CLL), the mechanisms controlling cell growth and proliferation in the presence of NOTCH1 mutations remain largely unexplored. By performing a gene expression profile of NOTCH1-mutated (NOTCH1-mut) versus NOTCH1 wild-type CLL, we identified a gene signature of NOTCH1-mut CLL characterized by the upregulation of genes related to ribosome biogenesis, such as nucleophosmin 1 (NPM1) and ribosomal proteins (RNPs). Activation of NOTCH1 signaling by ethylenediaminetetraacetic acid or by coculture with JAGGED1-expressing stromal cells increased NPM1 expression, and inhibition of NOTCH1 signaling by either NOTCH1-specific small interfering RNA (siRNA) or γ-secretase inhibitor reduced NPM1 expression. Bioinformatic analyses and in vitro activation/inhibition of NOTCH1 signaling suggested a role of MYC as a mediator of NOTCH1 effects over NPM1 and RNP expression in NOTCH1-mut CLL. Chromatin immunoprecipitation experiments performed on NOTCH1 intracellular domain (NICD)-transfected CLL-like cells showed the direct binding of NOTCH1 to the MYC promoter, and transfection with MYC-specific siRNA reduced NPM1 expression. In turn, NPM1 determined a proliferation advantage of CLL-like cells, as demonstrated by NPM1-specific siRNA transfection. In conclusion, NOTCH1 mutations in CLL are associated with the overexpression of MYC and MYC-related genes involved in protein biosynthesis including NPM1, which are allegedly responsible for cell growth and/or proliferation advantages of NOTCH1-mut CLL.
Collapse
Affiliation(s)
- F Pozzo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - T Bittolo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - E Vendramini
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - R Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - P Bulian
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - F M Rossi
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - A Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - E Tissino
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - M Degan
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - G D'Arena
- Department of Onco-Hematology, IRCCS 'Centro di Riferimento Oncologico della Basilicata', Rionero in Vulture, Italy
| | - F Di Raimondo
- Division of Hematology, Ferrarotto Hospital, Catania, Italy
| | - F Zaja
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari 'Carlo Melzi' DISM, Azienda Ospedaliera Universitaria S Maria Misericordia, Udine, Italy
| | - G Pozzato
- Department of Internal Medicine and Hematology, Maggiore General Hospital, University of Trieste, Trieste, Italy
| | - D Rossi
- Hematology, Institute of Oncology Research and Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - G Gaidano
- Department of Translational Medicine, Division of Hematology, University of Eastern Piedmont, Novara, Italy
| | - G Del Poeta
- Division of Hematology, S Eugenio Hospital and University of Tor Vergata, Rome, Italy
| | - V Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - M Dal Bo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| |
Collapse
|
6
|
Del Poeta G, Postorino M, Pupo L, Del Principe MI, Dal Bo M, Bittolo T, Buccisano F, Mariotti B, Iannella E, Maurillo L, Venditti A, Gattei V, de Fabritiis P, Cantonetti M, Amadori S. Venetoclax: Bcl-2 inhibition for the treatment of chronic lymphocytic leukemia. Drugs Today (Barc) 2016; 52:249-60. [PMID: 27252989 DOI: 10.1358/dot.2016.52.4.2470954] [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] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Venetoclax (ABT-199) is a small-molecule selective oral inhibitor of the antiapoptotic protein Bcl-2 that promotes programmed cell death of chronic lymphocytic leukemia (CLL) cells regulating the release of proapoptotic factors, such as Smac/Diablo, apoptosis-inducing factor (AIF) and cytochrome c. In April 2016, the U.S. Food and Drug Administration (FDA) granted accelerated approval to venetoclax for patients diagnosed with CLL with 17p deletion, as detected by an FDA-approved test, who have received at least one prior therapy. This review will focus on the mechanism of action, preclinical studies and clinical development of venetoclax both as a monotherapy and in combination with other drugs for CLL in the current milieu of therapy dominated by novel tyrosine kinase inhibitors such as ibrutinib and idelalisib.
Collapse
Affiliation(s)
- G Del Poeta
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy.
| | - M Postorino
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - L Pupo
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - M I Del Principe
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - M Dal Bo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - T Bittolo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - F Buccisano
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - B Mariotti
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - E Iannella
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - L Maurillo
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - A Venditti
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - V Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - P de Fabritiis
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - M Cantonetti
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| | - S Amadori
- Hematology, Dipartimento di Biomedicina e Prevenzione, Universit à degli Studi di Roma Tor Vergata, Rome, Italy
| |
Collapse
|
7
|
Pozzo F, Bittolo T, Arruga F, Bulian P, Macor P, Tissino E, Gizdic B, Rossi FM, Bomben R, Zucchetto A, Benedetti D, Degan M, D'Arena G, Chiarenza A, Zaja F, Pozzato G, Rossi D, Gaidano G, Del Poeta G, Deaglio S, Gattei V, Dal Bo M. NOTCH1 mutations associate with low CD20 level in chronic lymphocytic leukemia: evidence for a NOTCH1 mutation-driven epigenetic dysregulation. Leukemia 2015; 30:182-9. [PMID: 26165233 DOI: 10.1038/leu.2015.182] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/25/2015] [Accepted: 06/29/2015] [Indexed: 02/07/2023]
Abstract
In chronic lymphocytic leukemia (CLL), NOTCH1 mutations have been associated with clinical resistance to the anti-CD20 rituximab, although the mechanisms behind this peculiar behavior remain to be clarified. In a wide CLL series (n=692), we demonstrated that CLL cells from NOTCH1-mutated cases (87/692) were characterized by lower CD20 expression and lower relative lysis induced by anti-CD20 exposure in vitro. Consistently, CD20 expression by CLL cells was upregulated in vitro by γ-secretase inhibitors or NOTCH1-specific small interfering RNA and the stable transfection of a mutated (c.7541-7542delCT) NOTCH1 intracellular domain (NICD-mut) into CLL-like cells resulted in a strong downregulation of both CD20 protein and transcript. By using these NICD-mut transfectants, we investigated protein interactions of RBPJ, a transcription factor acting either as activator or repressor of NOTCH1 pathway when respectively bound to NICD or histone deacetylases (HDACs). Compared with controls, NICD-mut transfectants had RBPJ preferentially complexed to NICD and showed higher levels of HDACs interacting with the promoter of the CD20 gene. Finally, treatment with the HDAC inhibitor valproic acid upregulated CD20 in both NICD-mut transfectants and primary CLL cells. In conclusion, NOTCH1 mutations are associated with low CD20 levels in CLL and are responsible for a dysregulation of HDAC-mediated epigenetic repression of CD20 expression.
Collapse
Affiliation(s)
- F Pozzo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - T Bittolo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - F Arruga
- Immunogenetics Unit, Human Genetics Foundation (HuGeF), Torino, Italy
| | - P Bulian
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - P Macor
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - E Tissino
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - B Gizdic
- Immunogenetics Unit, Human Genetics Foundation (HuGeF), Torino, Italy
| | - F M Rossi
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - R Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - A Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - D Benedetti
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - M Degan
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - G D'Arena
- Onco-Hematology Department, Centro di Riferimento Oncologico della Basilicata, I.R.C.C.S., Rionero in Vulture, Italy
| | - A Chiarenza
- Division of Hematology, Ferrarotto Hospital, Catania, Italy
| | - F Zaja
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari 'Carlo Melzi' DISM, Azienda Ospedaliera Universitaria S. Maria Misericordia, Udine, Italy
| | - G Pozzato
- Department of Internal Medicine and Hematology, Maggiore General Hospital, University of Trieste, Trieste, Italy
| | - D Rossi
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - G Gaidano
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - G Del Poeta
- Division of Hematology, S. Eugenio Hospital and University of Tor Vergata, Rome, Italy
| | - S Deaglio
- Immunogenetics Unit, Human Genetics Foundation (HuGeF), Torino, Italy.,Department of Medical Sciences, University of Torino, Torino, Italy
| | - V Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| | - M Dal Bo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano (PN), Italy
| |
Collapse
|
8
|
Buccisano F, Maurillo L, Piciocchi A, Del Principe MI, Sarlo C, Cefalo M, Ditto C, Di Veroli A, De Santis G, Irno Consalvo M, Fraboni D, Panetta P, Palomba P, Attrotto C, Del Poeta G, Sconocchia G, Lo-Coco F, Amadori S, Venditti A. Minimal residual disease negativity in elderly patients with acute myeloid leukemia may indicate different postremission strategies than in younger patients. Ann Hematol 2015; 94:1319-26. [PMID: 25869029 DOI: 10.1007/s00277-015-2364-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/22/2015] [Indexed: 11/29/2022]
Abstract
In the present analysis, we evaluated whether in elderly acute myeloid leukemia (AML) patients (>60 years), minimal residual disease (MRD) assessed by flow cytometry may have a role in guiding choice of postremission strategies. We analyzed 149 young and 61 elderly adults who achieved morphological CR after induction course of EORTC/GIMEMA protocols. Elderly patients reached a postconsolidation MRD negative status less frequently than younger ones (11 vs 28 %, p = 0.009). MRD negativity resulted in a longer 5-year disease-free survival (DFS) both in elderly (57 vs 13 %, p = 0.0197) and in younger patients (56 vs 31 %, p = 0.0017). Accordingly, 5-year cumulative incidence of relapse (CIR) of both elderly (83 vs 42 %, p = 0.045) and younger patients (59 vs 24 % p = NS) who were MRD positive doubled that of MRD negative ones. Nevertheless, CIR of MRD negative elderly patients was twofold higher than that of younger MRD negative ones (42 vs 24 %, p = NS). In conclusion, elderly patients in whom chemotherapy yields a MRD negative CR have duration of DFS and rate of CIR significantly better than those who remain MRD positive. Nonetheless, the high CIR rate observed in the elderly suggests that MRD negativity might have different therapeutic implications in this population than in the younger counterpart.
Collapse
Affiliation(s)
- F Buccisano
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università di Roma "Tor Vergata", Roma, Italia,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
D'Arena G, Rossi G, Minervini M, Savino L, D'Auria F, Laurenti L, Del Principe M, Deaglio S, Biagi A, De Martino L, De Feo V, Statuto T, Musto P, Del Poeta G. Circulating Regulatory T Cells in “Clinical” Monoclonal B-Cell Lymphocytosis. Int J Immunopathol Pharmacol 2011; 24:915-23. [DOI: 10.1177/039463201102400410] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Regulatory T-cells (Tregs) constitute a small subset of cells involved in antitumour immunity and are generally increased in patients with chronic lymphocytic leukemia (CLL). No data is available on Tregs in monoclonal B-cell lymphocytosis (MBL), a disease entity characterized by less than 5000/μL circulating clonal B-cells in absence of other features of lymphoproliferative disorders. We used multicolour flow cytometry to evaluate the number of circulating Tregs in 56 patients with “clinical” MBL, 74 patients with previously untreated CLL and 40 healthy subjects. MBL patients showed a lower absolute number of Tregs, compared to CLL patients, but slightly higher than controls. Moreover, the absolute cell number of Tregs directly correlated both with more advanced Rai/Binet clinical stages and peripheral blood B-cell lymphocytosis. Of note, the absolute number of Tregs was found lower in MBL patients than in CLL patients staged as 0/A Rai/Binet. The study showed that Tregs increase gradually from normal subjects to “clinical” MBL patients and are significantly higher in CLL patients as compared to MBL patients. Moreover, a significant direct relationship was found between higher Treg values and a higher tumor burden expressed by B-lymphocytosis or more advanced clinical stages. In light of this data, MBL seems to be a preliminary phase preceding CLL. The progressive increase of Treg numbers might contribute both to the clinical evolution of MBL to overt CLL and to CLL progression.
Collapse
Affiliation(s)
- G. D'Arena
- Department of Onco-Hematology, IRCCS “Centro di Riferimento Oncologico della Basilicata” (CROB), Rionero in Vulture
| | - G. Rossi
- Hematology and Stem Cell Transplantation Unit, IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo
| | - M.M. Minervini
- Hematology and Stem Cell Transplantation Unit, IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo
| | - L. Savino
- Hematology and Stem Cell Transplantation Unit, IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo
| | - F. D'Auria
- Department of Onco-Hematology, IRCCS “Centro di Riferimento Oncologico della Basilicata” (CROB), Rionero in Vulture
| | - L. Laurenti
- Hematology Chair, Catholic University of Sacred Heart, Rome
| | | | - S. Deaglio
- Laboratory of Immunogenetics, University of Turin, Turin
| | - A. Biagi
- Hematology Chair, University of Tor Vergata, Rome
| | - L. De Martino
- Department of Pharmacology, University of Salerno, Salerno, Italy
| | - V. De Feo
- Department of Pharmacology, University of Salerno, Salerno, Italy
| | - T. Statuto
- Hematology Chair, University of Tor Vergata, Rome
| | - P. Musto
- Department of Onco-Hematology, IRCCS “Centro di Riferimento Oncologico della Basilicata” (CROB), Rionero in Vulture
| | - G. Del Poeta
- Hematology Chair, University of Tor Vergata, Rome
| |
Collapse
|
10
|
Mauro FR, Ciolli S, Di Raimondo F, Del Poeta G, Forconi F, Cuneo A, Cortellezzi A, Nobile F, Brugiatelli M, Massaia M, Molica S, Trentin L, Rizzi R, Orsucci L, Mura MA, Alietti A, Runggaldier EJ, Gamba E, Guarini A, Foa R. A phase II study of chlorambucil plus rituximab followed by maintenance versus observation in elderly patients with previously untreated chronic lymphocytic leukemia: Results of the induction phase. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
11
|
Zauli G, di Iasio MG, Secchiero P, Dal Bo M, Marconi D, Bomben R, Del Poeta G, Gattei V. Exposure of B cell chronic lymphocytic leukemia (B-CLL) cells to nutlin-3 induces a characteristic gene expression profile, which correlates with nutlin-3-mediated cytotoxicity. Curr Cancer Drug Targets 2009; 9:510-8. [PMID: 19519319 DOI: 10.2174/156800909788486777] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
By analyzing the cDNA obtained from 16 B-cell chronic lymphocytic leukemia (B-CLL) patient samples, we found that Nutlin-3, a small molecule inhibitor of MDM2/p53 interaction, induced a characteristic gene expression profile (GEP) signature in 13 out of 16 B-CLL samples. The lack of Nutlin-3-induced GEP signature in 3 out of 16 B-CLL samples was not due to p53 deletion and/or mutation, as demonstrated by FISH analysis and p53 sequencing. Of note, the 3 B-CLL samples in which Nutlin-3 did not elicit the GEP signature were also less susceptible to Nutlin-3-mediated cytotoxicity with respect to the remaining 13 B-CLL samples. However, the partial lack of response in these p53 wild-type B-CLL samples was not due to defects in the ability of Nutlin-3 to promote p53 induction, as confirmed by the rapid accumulation of p53 protein at Western blot analysis in response to Nutlin-3 in all samples examined. Upon exposure to Nutlin-3, the genes up-regulated with the highest score in the majority of B-CLL cells were all known p53-target genes, including genes involved in apoptotic pathways, such as FAS and BAX, as well as MDM2. Taken together, our data indicate that the ability of Nutlin-3 to induce a characteristic GEP signature correlates with its cytotoxic potential in p53 wild-type B-CLL cells. However, in some p53 wild-type B-CLL samples, the response to Nutlin-3 cannot be predicted on the basis of FISH analysis or p53 sequencing.
Collapse
Affiliation(s)
- G Zauli
- Department of Morphology and Embryology, Human Anatomy Section, University of Ferrara, Via Fossato di Mortara 66, 44100 Ferrara, Italy
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Siniscalchi A, Fratoni S, Santeusanio G, Del Poeta G, de Fabritiis P, Caravita T. Cutaneous involvement in multiple myeloma and bortezomib. Ann Hematol 2009; 88:1137-9. [PMID: 19259673 DOI: 10.1007/s00277-009-0717-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 02/18/2009] [Indexed: 11/27/2022]
|
13
|
Del Poeta G, Bruno A, Del Principe MI, Venditti A, Maurillo L, Buccisano F, Stasi R, Neri B, Luciano F, Siniscalchi A, de Fabritiis P, Amadori S. Deregulation of the mitochondrial apoptotic machinery and development of molecular targeted drugs in acute myeloid leukemia. Curr Cancer Drug Targets 2008; 8:207-22. [PMID: 18473734 DOI: 10.2174/156800908784293640] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Apoptosis plays a key role in the control of rapidly renewing tissues, such as the hematopoietic system and leukemia cells invariably have abnormalities in one or more apoptotic pathways, determining a survival advantage of these cells and the development of drug resistance. These defects are also frequently associated with a low rate of response to standard chemotherapy and with a poor survival in acute myeloid leukemia (AML). The major form of apoptosis proceeds through the mitochondrial pathway, with the mitochondrial outer membrane permeabilization, leading to the release of proteins normally found in the space between the inner and outer mitochondrial membranes (cytochrome C, AIF and others). Higher levels of anti-apoptosis proteins bcl-2, bcl-x(L), Mcl-1 block permeabilization of the membrane and are reported in AML patients presenting a poor outcome. On the contrary, activated pro-apoptotic bax or bad proteins allow this permeabilization and are correlated to a good prognosis in AML. Defects in the mitochondrial pathway induce multidrug-resistance and confer important prognostic information in AML. High ratios of bcl-2 to bax protein confer a poor prognosis with decreased rates of complete remission and overall survival. The prognostic information from the ratio of the proteins is greater than bcl-2 levels alone. Recently, we confirmed the impressive impact of the bax/bcl-2 ratio, determined by flow cytometry, on AML prognosis (complete remission and overall survival) in 255 AML patients. Bcl-2 down regulation might lower the apoptotic threshold of leukemic cells and, through this mechanism, favor response to chemotherapy. Phase II studies of oblimersen (antisense Bcl-2), cytarabine and daunorubicin or oblimersen plus gentuzumab, a cytotoxic antibody directed against CD33+ cells in relapsed AMLs, showed promising results. Defects in apoptosome proteins, such as APAF-1, are frequent in AML and treatment with 5-aza-2'-deoxycytidine, a specific inhibitor of DNA methylation, restored APAF-1 expression in leukemic cells. In conclusion, targeted therapies that are designed to induce apoptosis in leukemic cells, are the most promising anti-leukemia strategies. The elucidation of the apoptotic machinery and of its defects in AML lays the basis for developing new drugs able to trigger apoptosis and overcome therapy resistance.
Collapse
Affiliation(s)
- G Del Poeta
- Cattedra di Ematologia, Università Tor Vergata, Ospedale S.Eugenio, P.le Umanesimo, 10, 00144 Roma, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Gattei V, Bulian P, Del Principe MI, Zucchetto A, Niscola P, Bomben R, Dal Bo M, Buccisano F, Amadori S, Del Poeta G. Correlation of high CD49d expression with disease progression and need for therapy in chronic lymphocytic leukemia (CLL) patients. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7091] [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
7091 Background: CD49d mediates interaction of lymphocytes with microenvironmental components. We and others reported the correlated expression of CD49d and CD38 by CLL cells, and the complementary value of these molecules in predicting overall survival for CLL patients. However, nothing is known on the relationship of CD49d with other prognosticators and its impact in predicting disease progression and need for therapy in CLL. Methods: The study includes 232 CLLs (median age 64 yrs), all characterized for Rai stages, lymphocyte doubling time (LDT), CD49d, CD38 and ZAP-70 expression, serum levels for sCD23 and beta2-microglobulin (beta2-m), IgVH mutations (139/232), cytogenetics (151/232; FISH for 17p, 11q, 13q, 12). CD49d was measured in CD19/CD5 cells by three-color flow cytometry, choosing a 30% cut-off to discriminate CD49d-low vs. CD49d-high CLLs. NCI-working group criteria were used for CLL diagnosis, progression and therapy need. Results: Median time-to-progression (TTP) was 136 and 56 months in CD49d-low and CD49d-high CLL patients (p=0.00008), respectively; similarly, median time-to-treatment (TTT) was 108 and 46 months for the same patient groups (p=0.000008). Correlations were also observed among CD49d and CD38 (p=2.2x10exp-16) or ZAP-70 (p=0.00009) expression, sCD23 serum level (p=0.0017), LDT (p=0.0037), Rai stages (p=0.019), cytogenetics (p=0.011), IgVH mutations (p=0.00008). TTT and TTP were significantly shorter in CLLs in advanced Rai stages, or with high CD38 and ZAP-70 or low IgVH mutations. Within these cases, significantly longer TTP/TTT were observed in subsets expressing low CD49d. Serum levels of sCD23 and beta2-m, LDT, and FISH analyses had also predictive value for progression and treatment in our series. Within the better prognosis groups (i.e. <70 U/ml sCD23, 12 months, or a normal karyotype), high CD49d expression identified a subset of patients with significantly shorter TTP/TTT. Overall, the capability of CD49d to predict disease progression and need for therapy was statistically significant in younger patients (<64 y.o.; 115 cases; p=0.0001), but not in those older than 64 yrs (117 cases; p=0.09). Conclusions: We propone to include evaluation of CD49d expression in the prognostic assessment of CLL patients. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- V. Gattei
- Centro di Riferimento Oncologico, Aviano, Italy; University of Tor Vergata, Rome, Italy
| | - P. Bulian
- Centro di Riferimento Oncologico, Aviano, Italy; University of Tor Vergata, Rome, Italy
| | - M. I. Del Principe
- Centro di Riferimento Oncologico, Aviano, Italy; University of Tor Vergata, Rome, Italy
| | - A. Zucchetto
- Centro di Riferimento Oncologico, Aviano, Italy; University of Tor Vergata, Rome, Italy
| | - P. Niscola
- Centro di Riferimento Oncologico, Aviano, Italy; University of Tor Vergata, Rome, Italy
| | - R. Bomben
- Centro di Riferimento Oncologico, Aviano, Italy; University of Tor Vergata, Rome, Italy
| | - M. Dal Bo
- Centro di Riferimento Oncologico, Aviano, Italy; University of Tor Vergata, Rome, Italy
| | - F. Buccisano
- Centro di Riferimento Oncologico, Aviano, Italy; University of Tor Vergata, Rome, Italy
| | - S. Amadori
- Centro di Riferimento Oncologico, Aviano, Italy; University of Tor Vergata, Rome, Italy
| | - G. Del Poeta
- Centro di Riferimento Oncologico, Aviano, Italy; University of Tor Vergata, Rome, Italy
| |
Collapse
|
15
|
Ratei R, Karawajew L, Lacombe F, Jagoda K, Del Poeta G, Kraan J, De Santiago M, Kappelmayer J, Björklund E, Ludwig WD, Gratama JW, Orfao A. Discriminant function analysis as decision support system for the diagnosis of acute leukemia with a minimal four color screening panel and multiparameter flow cytometry immunophenotyping. Leukemia 2007; 21:1204-11. [PMID: 17410192 DOI: 10.1038/sj.leu.2404675] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Despite several recommendations for standardization of multiparameter flow cytometry (MFC) the number, specificity and combinations of reagents used by diagnostic laboratories for the diagnosis and classification of acute leukemias (AL) are still very diverse. Furthermore, the current diagnostic interpretation of flow cytometry readouts is influenced arbitrarily by individual experience and knowledge. We determined the potential value of a minimal four-color combination panel of 13 monoclonal antibodies (mAbs) with a CD45/sideward light scatter-gating strategy for a standardized MFC immunophenotyping of the clinically most relevant subgroups of AL. Bone marrow samples from 155 patients with acute myeloid leukemia (AML, n=79), B-cell precursor acute lymphoblastic leukemia (BCP-ALL, n=29), T-cell precursor acute lymphoblastic leukemia (T-ALL, n=12) and normal bone marrow donors (NBMD, n=35) were analyzed. A knowledge-based learning algorithm was generated by comparing the results of the minimal panel with the actual diagnosis, using discriminative function analysis. Correct classification of the test sample according to lineage, that is, BCP-ALL, T-ALL, AML and differentiation of NBMD was achieved in 97.2% of all cases with only six of the originally applied 13 mAbs of the panel. This provides evidence that discriminant function analysis can be utilized as a decision support system for interpretation of flow cytometry readouts.
Collapse
Affiliation(s)
- R Ratei
- Department of Hematology, Oncology and Tumor Immunology, Robert-Roessle-Clinic at the HELIOS Klinikum Berlin, Charité Medical School, Berlin, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Buccisano F, Maurillo L, Gattei V, Del Poeta G, Del Principe MI, Cox MC, Panetta P, Consalvo MI, Mazzone C, Neri B, Ottaviani L, Fraboni D, Tamburini A, Lo-Coco F, Amadori S, Venditti A. The kinetics of reduction of minimal residual disease impacts on duration of response and survival of patients with acute myeloid leukemia. Leukemia 2006; 20:1783-9. [PMID: 16838027 DOI: 10.1038/sj.leu.2404313] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [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: 11/08/2022]
Abstract
UNLABELLED We assessed by multiparametric flow cytometry the levels of minimal residual disease (MRD) in 100 adult patients with acute myelogenous leukemia (AML) achieving complete remission after intensive chemotherapy. The aim of the study was to determine the optimal threshold, in terms of residual leukemic cells, and the time point of choice, that is, post-induction (post-Ind) or post-consolidation (post-Cons), able to better predict outcome. By applying the maximally selected log-rank statistics, the threshold discriminating MRD- from MRD+ cases was set at 3.5 x 10(-4) residual leukemic cells, a level that allowed the identification of distinct subgroups of patients, both at post-Ind and post-Cons time points. Post-Cons MRD- patients had a superior outcome in terms of relapse rate, overall survival (OS) and relapse-free survival (RFS) (P<0.001, for all comparisons), regardless of the MRD status after induction. In particular, patients entering MRD negativity only after consolidation showed the same outcome as those achieving early negativity after induction. Multivariate analysis, including karyotype, age, MDR1 phenotype, post-Ind and post-Cons MRD levels, indicated that the post-Cons MRD status independently affected relapse rate, OS and RFS (P<0.001, for all comparisons). IN CONCLUSION (1) the threshold of 3.5 x 10(-4) is valid in discriminating risk categories in adult AML and (2) post-Cons MRD assessment is critical to predict disease outcome.
Collapse
Affiliation(s)
- F Buccisano
- Department of Biopatologia e Diagnostica per Immagini, Policlinico Tor Vergata and Ospedale S Eugenio, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Buccisano F, Maurillo L, Del Poeta G, Del Principe M, Mazzone C, Fraboni D, Panetta P, Gattei V, Lo Coco F, Amadori S, Venditti A. The kinetics of reduction of minimal residual disease impacts on duration of response and survival of patients with acute myeloid leukemia. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6533] [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
6533 Background: Multiparametric flow-cytometry is frequently used to assess the levels of minimal residual disease (MRD) in acute myeloid leukemia (AML) patients achieving complete remission after intensive chemotherapy. In our previous experience, MRD negativity after consolidation cycle, as defined by a level of bone marrow residual leukemic cells ≤3.5x10−4, was associated with a significantly longer relapse free survival (RFS) and overall survival (OS). The aims of the present study were to confirm, in a larger series of patients, the prognostic relevance of the post consolidation MRD assessment and to validate the threshold of 3.5x10−4. Methods: 100 patients affected with AML were entered into the EORTC/GIMEMA protocols AML10/AML12 (age <61 yrs) or AML13/AML15 (age >61 yrs), consisting in intensive induction and consolidation cycles. Median age was 52 years (range 18–78), all FAB subtypes were represented with the exception of APL cases. A Maximally Selected Rank Statistic analysis was used to select the best threshold. Results: The statistical test confirmed that the level of 3.5×10−4 residual leukemic cells was the most significant in discriminating categories of risk. In fact, levels of MRD measured at the post-consolidation time-point identified 2 distinct subgroups: 36 patients MRD negative and 56 MRD positive. MRD negative patients had a better outcome in terms of relapse rate (P<0.001), OS (P=0.039) and RFS (P=0.008), regardless of MRD status after induction. In fact, patients entering MRD negativity only after consolidation showed the same outcome as those achieving early negativity after induction. The multivariate analysis, including karyotype, age, MDR1 phenotype and post induction and post consolidation MRD levels, indicated that the post-consolidation MRD status was an independent factor affecting relapse rate (P<0.001), OS (P=0.039) and RFS (P=0.008). Conclusions: We conclude that 1) the threshold of 3.5x10−4 is valid in discriminating risk categories in AML; 2) MRD assessment at post-consolidation check-point is critical to predict disease outcome. The incorporation in clinical trials of flow-cytometric MRD determination may allow a more accurate risk stratification of AML patients. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- F. Buccisano
- Tor Vergata University Hospital, Rome, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - L. Maurillo
- Tor Vergata University Hospital, Rome, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - G. Del Poeta
- Tor Vergata University Hospital, Rome, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - M. Del Principe
- Tor Vergata University Hospital, Rome, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - C. Mazzone
- Tor Vergata University Hospital, Rome, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - D. Fraboni
- Tor Vergata University Hospital, Rome, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - P. Panetta
- Tor Vergata University Hospital, Rome, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - V. Gattei
- Tor Vergata University Hospital, Rome, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - F. Lo Coco
- Tor Vergata University Hospital, Rome, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - S. Amadori
- Tor Vergata University Hospital, Rome, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - A. Venditti
- Tor Vergata University Hospital, Rome, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| |
Collapse
|
18
|
Gattei V, Benedetti D, Marconi D, Dal Bo M, Zucchetto A, Del Poeta G, Steffan A, Bomben R, Campanini R, Degan M. Gene and surface-antigen expression profilings concordantly identify alpha4-integrin/CD49d as a marker for unmutated (UM) bad prognosis B-cell chronic lymphocytic leukemia (B-CLL). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10076 Background: The highly heterogeneous clinical courses of B-CLL can be foreseen by investigating IgVH gene mutations or expression of specific prognosticators. Gene and surface-antigen expression profilings (GEP and SEP) have been both employed for identifying molecules of prognostic relevance in B-CLL. Methods: i) GEP - Purified B-CLL cells from 19 UM and 38 mutated (M) cases were investigated for differential GEP by using a two-color Operon Human Genome Oligo Set 2.1 platform with normal B cells as common reference and by applying, after data pre-processing, the LIMMA (Linear Model for MicroArray) package with two combined cutoffs (Bayesian log-odds>1; adjusted p value for false discovery rate <10e−4); ii) SEP - B-CLL cells from 60 UM and 101 M cases were investigated for the expression of 36 surface markers by flow cytometry. Results: i) GEP - 77 probes (32 duplicates) were overexpressed in M B-CLLs (UM/M log-ratio range −0.79/−3.62; p range 6.72e−5/3.6e−10) and 81 probes (46 duplicates) in UM B-CLLs (UM/M log-ratio range 0.87/4.57; p range 9.49e−5/3.01e−12); the CD49d gene was overexpressed in UM cases with UM/M log-ratio of 3.21 (p=8.3e-10). ii) SEP - Six markers significantly discriminated UM to M B-CLLs (t-test, p<10ed-3) and separated most UM (49/60) from M B-CLLs by hierarchical clustering; among them, CD49d was significantly overexpressed in UM cases (median % positive cells 71.2±36 vs. 10.0±31; p=2.1e−10). By applying standardized log-rank statistics in 95 pts, all with CD49d expression and survival data, 30% of positive cells was judged optimal cutoff for identifying two groups with different survivals, 41 CD49dhigh pts showing worse prognosis than 54 CD49dlow cases (p=7.4×10e−5). Similarly, 46 UM B-CLLs had shorter survival than 77 M cases (p=1.4×10e−5). By combining IgVH mutations and CD49d expression, 42 concordant M/CD49dlow pts had better prognosis than 25 concordant UM/CD49dhigh cases (p=1.8×10e−5); noteworthy, among 28 discordant cases, 16 with a M/CD49dhigh phenotype had survival similar to bad prognosis cases. Conclusions: CD49d is a novel prognosticator for B-CLL. Given its high expression level in bad prognosis subsets, CD49d may be a promising therapeutic target. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- V. Gattei
- Centro di Riferimento Oncologico, Aviano, Italy; University of Bologna, Bologna, Italy; S. Eugenio Hospital, University of Tor Vergata, Rome, Italy
| | - D. Benedetti
- Centro di Riferimento Oncologico, Aviano, Italy; University of Bologna, Bologna, Italy; S. Eugenio Hospital, University of Tor Vergata, Rome, Italy
| | - D. Marconi
- Centro di Riferimento Oncologico, Aviano, Italy; University of Bologna, Bologna, Italy; S. Eugenio Hospital, University of Tor Vergata, Rome, Italy
| | - M. Dal Bo
- Centro di Riferimento Oncologico, Aviano, Italy; University of Bologna, Bologna, Italy; S. Eugenio Hospital, University of Tor Vergata, Rome, Italy
| | - A. Zucchetto
- Centro di Riferimento Oncologico, Aviano, Italy; University of Bologna, Bologna, Italy; S. Eugenio Hospital, University of Tor Vergata, Rome, Italy
| | - G. Del Poeta
- Centro di Riferimento Oncologico, Aviano, Italy; University of Bologna, Bologna, Italy; S. Eugenio Hospital, University of Tor Vergata, Rome, Italy
| | - A. Steffan
- Centro di Riferimento Oncologico, Aviano, Italy; University of Bologna, Bologna, Italy; S. Eugenio Hospital, University of Tor Vergata, Rome, Italy
| | - R. Bomben
- Centro di Riferimento Oncologico, Aviano, Italy; University of Bologna, Bologna, Italy; S. Eugenio Hospital, University of Tor Vergata, Rome, Italy
| | - R. Campanini
- Centro di Riferimento Oncologico, Aviano, Italy; University of Bologna, Bologna, Italy; S. Eugenio Hospital, University of Tor Vergata, Rome, Italy
| | - M. Degan
- Centro di Riferimento Oncologico, Aviano, Italy; University of Bologna, Bologna, Italy; S. Eugenio Hospital, University of Tor Vergata, Rome, Italy
| |
Collapse
|
19
|
Iaria G, Iorio B, Anselmo A, De Luca L, Tariciotti L, Ielpo B, Muzi F, Lucchesi C, D'Andria D, Orlando G, Del Poeta G, Poggi E, Piazza A, Tisone G. Graft failure due to hemolytic uremic syndrome recurrence. Transplant Proc 2006; 38:1020-1. [PMID: 16757250 DOI: 10.1016/j.transproceed.2006.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The hemolytic uremic syndrome (HUS) is a severe disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. We herein report our experience with a 43-year-old female patient who underwent a second cadaveric kidney transplantation in February 2005, for adult-onset HUS. The first renal transplantation, which was performed in 1996, required removal after 3 weeks for probable recurrence of HUS. The immunosuppressive regimen for the second transplant included basiliximab, tacrolimus, mycophenolate mofetil, and steroids. On postoperative day (POD) 7, she received steroid treatment for an acute rejection episode with improved renal function. On POD 19 due to worsening renal function, a graft biopsy showed HUS recurrence, thus we instituted hemodialysis and then plasmapheresis treatments. At two months after transplantation, the patient continued under plasmapheresis treatment due to clinical evidence of HUS. On POD 80, cytomegalovirus infection was diagnosed and intravenous gancyclovir treatment started for 3 weeks. After 110 days from transplant, a deterioration in renal function was evident: the graft was swollen and painful with Doppler ultrasound showing patency of both the renal artery and vein but, low blood flow. After 2 weeks of hemodialysis, the patient underwent transplantectomy. In adult-onset HUS the recurrence rate reduces graft survival, particularly among patients undergoing second transplantation.
Collapse
Affiliation(s)
- G Iaria
- Clinica Chirurgica Università Tor Vergata, Ospedale S.Eugenio Roma
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Zucchetto A, Bomben R, Dal Bo M, Bulian P, Benedetti D, Nanni P, Del Poeta G, Degan M, Gattei V. CD49d in B-cell chronic lymphocytic leukemia: correlated expression with CD38 and prognostic relevance. Leukemia 2006; 20:523-5; author reply 528-9. [PMID: 16408095 DOI: 10.1038/sj.leu.2404087] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
21
|
Stasi R, Stipa E, Del Poeta G, Amadori S, Newland AC, Provan D. Long-term observation of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis treated with rituximab. Rheumatology (Oxford) 2006; 45:1432-6. [PMID: 16632482 DOI: 10.1093/rheumatology/kel098] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.9] [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: 02/06/2023] Open
Abstract
OBJECTIVE Rituximab, a chimeric anti-CD20 monoclonal antibody, has been shown to be quite effective in the treatment of immune disorders resulting from autoantibodies. We prospectively studied the long-term effects of rituximab in 10 patients with anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis refractory to conventional therapy (n=3) or in second or subsequent relapse (n=7). METHODS The median age of patients was 53 yrs (range 38-70 yrs). Eight were classified as Wegener's granulomatosis, and two as microscopic polyangiitis. Clinical activity was assessed using the Birmingham Vasculitis Activity Score modification for Wegener's granulomatosis. Treatment consisted of intravenous infusions of rituximab given at the dose of 375 mg/m2 weekly for four consecutive weeks. RESULTS All patients experienced a rapid clinical improvement following the administration of rituximab, with nine complete responses and one partial response at 6 months. With a median follow-up of 33.5 months (range 26-45 months), three patients have thus far relapsed. Retreatment with the monoclonal antibody at the same dose and schedule resulted in a new sustained response in all these patients. Rituximab therapy resulted in prolonged B-cell depletion. The ANCA titres decreased significantly in all patients, with eight out of 10 becoming ANCA-negative and three remaining ANCA-negative even after B-cell recovery. Infusion-related side effects were observed in one patient, but were of mild intensity and did not require discontinuation of treatment. CONCLUSIONS Rituximab is an effective and well-tolerated treatment for patients with ANCA-associated vasculitis and should be strongly considered in severely affected patients who do not respond to standard therapy or in those in whom cytotoxic therapy bears a high risk of morbidity.
Collapse
Affiliation(s)
- R Stasi
- Department of Medical Sciences, Regina Apostolorum Hospital, Via San Francesco, 50, 00041 Albano Laziale, Italy.
| | | | | | | | | | | |
Collapse
|
22
|
Niscola P, Del Principe MI, Maurillo L, Venditti A, Buccisano F, Piccioni D, Amadori S, Del Poeta G. Fulminant B hepatitis in a surface antigen-negative patient with B-cell chronic lymphocytic leukaemia after rituximab therapy. Leukemia 2005; 19:1840-1. [PMID: 16094417 DOI: 10.1038/sj.leu.2403914] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
23
|
Bomben R, Dal Bo M, Zucchetto A, Zaina E, Nanni P, Sonego P, Del Poeta G, Degan M, Gattei V. Mutational status of IgV(H) genes in B-cell chronic lymphocytic leukemia and prognosis: percent mutations or antigen-driven selection? Leukemia 2005; 19:1490-2. [PMID: 15944717 DOI: 10.1038/sj.leu.2403830] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
MESH Headings
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Mutation
- Prognosis
- RNA, Neoplasm/analysis
- Survival Analysis
Collapse
|
24
|
Gattei V, Degan M, Russo S, Bomben R, Dal Bo M, Rupolo M, Buccisano F, Del Poeta G, Sonego P, Zucchetto A. Immunophenotypic clustering of B-Cell chronic lymphocytic leukemia (B-CLL) reveals a good prognosis disease subset characterized by the coordinated over-expression of CD62L, CD54, CD49c, CD25 And CD55. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6567] [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: 11/20/2022] Open
Affiliation(s)
- V. Gattei
- Centro di Riferimento Oncologico, Aviano (PN), Italy; University of Tor Vergata, Rome, Italy; Department of Physics, University of Bologna, Bologna, Italy
| | - M. Degan
- Centro di Riferimento Oncologico, Aviano (PN), Italy; University of Tor Vergata, Rome, Italy; Department of Physics, University of Bologna, Bologna, Italy
| | - S. Russo
- Centro di Riferimento Oncologico, Aviano (PN), Italy; University of Tor Vergata, Rome, Italy; Department of Physics, University of Bologna, Bologna, Italy
| | - R. Bomben
- Centro di Riferimento Oncologico, Aviano (PN), Italy; University of Tor Vergata, Rome, Italy; Department of Physics, University of Bologna, Bologna, Italy
| | - M. Dal Bo
- Centro di Riferimento Oncologico, Aviano (PN), Italy; University of Tor Vergata, Rome, Italy; Department of Physics, University of Bologna, Bologna, Italy
| | - M. Rupolo
- Centro di Riferimento Oncologico, Aviano (PN), Italy; University of Tor Vergata, Rome, Italy; Department of Physics, University of Bologna, Bologna, Italy
| | - F. Buccisano
- Centro di Riferimento Oncologico, Aviano (PN), Italy; University of Tor Vergata, Rome, Italy; Department of Physics, University of Bologna, Bologna, Italy
| | - G. Del Poeta
- Centro di Riferimento Oncologico, Aviano (PN), Italy; University of Tor Vergata, Rome, Italy; Department of Physics, University of Bologna, Bologna, Italy
| | - P. Sonego
- Centro di Riferimento Oncologico, Aviano (PN), Italy; University of Tor Vergata, Rome, Italy; Department of Physics, University of Bologna, Bologna, Italy
| | - A. Zucchetto
- Centro di Riferimento Oncologico, Aviano (PN), Italy; University of Tor Vergata, Rome, Italy; Department of Physics, University of Bologna, Bologna, Italy
| |
Collapse
|
25
|
Abruzzese E, Bocchia M, Trawinska M, Morino L, Iuliano F, Orlandi G, Panetta P, Del Poeta G, Lauria F, Amadori S. Peptide-vaccine treatment associated with imatinib in patients with residual CML disease is able to induce both immunologic response and molecular remission. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.2517] [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: 11/20/2022] Open
Affiliation(s)
- E. Abruzzese
- Tor Vergata University, S. Eugenio Hospital, Rome, Italy; Hematology, Siena, Italy; Hematology, Catanzaro, Italy
| | - M. Bocchia
- Tor Vergata University, S. Eugenio Hospital, Rome, Italy; Hematology, Siena, Italy; Hematology, Catanzaro, Italy
| | - M. Trawinska
- Tor Vergata University, S. Eugenio Hospital, Rome, Italy; Hematology, Siena, Italy; Hematology, Catanzaro, Italy
| | - L. Morino
- Tor Vergata University, S. Eugenio Hospital, Rome, Italy; Hematology, Siena, Italy; Hematology, Catanzaro, Italy
| | - F. Iuliano
- Tor Vergata University, S. Eugenio Hospital, Rome, Italy; Hematology, Siena, Italy; Hematology, Catanzaro, Italy
| | - G. Orlandi
- Tor Vergata University, S. Eugenio Hospital, Rome, Italy; Hematology, Siena, Italy; Hematology, Catanzaro, Italy
| | - P. Panetta
- Tor Vergata University, S. Eugenio Hospital, Rome, Italy; Hematology, Siena, Italy; Hematology, Catanzaro, Italy
| | - G. Del Poeta
- Tor Vergata University, S. Eugenio Hospital, Rome, Italy; Hematology, Siena, Italy; Hematology, Catanzaro, Italy
| | - F. Lauria
- Tor Vergata University, S. Eugenio Hospital, Rome, Italy; Hematology, Siena, Italy; Hematology, Catanzaro, Italy
| | - S. Amadori
- Tor Vergata University, S. Eugenio Hospital, Rome, Italy; Hematology, Siena, Italy; Hematology, Catanzaro, Italy
| |
Collapse
|
26
|
Venditti A, Maurillo L, Buccisano F, Del Poeta G, Mazzone C, Tamburini A, Del Principe MI, Consalvo MI, De Fabritiis P, Cudillo L, Picardi A, Franchi A, Lo-Coco F, Amadori S, Coco FL. Pretransplant minimal residual disease level predicts clinical outcome in patients with acute myeloid leukemia receiving high-dose chemotherapy and autologous stem cell transplantation. Leukemia 2003; 17:2178-82. [PMID: 14576731 DOI: 10.1038/sj.leu.2403138] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A total of 31 adult patients with AML entered in the EORTC/GIMEMA AML-10 trial, who received autologous stem cell transplantation (ASCT) after induction and consolidation chemotherapy, were prospectively evaluated for minimal residual disease (MRD) by multidimensional flow cytometry (MFC). Using a cutoff level of 3.5 x 10(-4) leukemic cells pre-ASCT, 12 patients (39%) were stratified to MRD high-risk group and 19 (61%) into MRD low-risk group. During follow-up, all patients who were in the high-risk group relapsed at a median time of 7 months; in the low-risk group, five patients relapsed at a median time of 11 months and 14 remained in remission for 56 (range 7-80) months (P=0.00004). Longitudinal MFC determinations post-ASCT showed increased MRD levels in three of the five patients who underwent subsequent relapse, while disease recurrence was unpredicted in the remaining two cases. The pre-ASCT MRD status was the factor most strongly associated with relapse risk in the multivariate analysis (P=0.0014). We conclude that: (1) pre-ASCT MRD status predicts successful outcome in patients receiving ASCT; (2) high-dose chemotherapy conditioning regimen followed by ASCT has no impact on the unfavorable prognostic value of high pre-ASCT MRD level; and (3) sequential MRD monitoring post-ASCT may allow the prediction of impending relapse.
Collapse
Affiliation(s)
- A Venditti
- Cattedra di Ematologia, Divisione di Ematologia, Università di Roma Tor Vergata, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Pagano L, Pulsoni A, Tosti ME, Mele A, Mele L, Corvatta L, Miraglia E, Almici C, Manna A, Del Poeta G, Lanza F, Masini L, Recchia A, Equitani F, Leone G, Mandelli F. Acute leukemia following a previous malignancy: do acute lymphoid leukemia and acute myeloid leukemia have common risk factors? Hematol J 2002; 1:329-32. [PMID: 11920210 DOI: 10.1038/sj.thj.6200058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2000] [Accepted: 05/20/2000] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Within the framework of the GIMEMA Study Group, the characteristics of acute lymphoid leukemia and acute myeloid leukemia occurring in patients who have suffered a previous malignancy were studied. Assessment was also made of the clinical course, laboratory features and overall outcome of these conditions. MATERIALS AND METHODS A four-year, multi-center retrospective study was conducted to evaluate the effect of treatment for previous hematological malignancy on the development of secondary leukemia. The study collected in the GIMEMA Archive of Adult Acute Leukemia 3934 new cases of acute leukemia (2964 AML, 901 ALL, 60 acute biphenotypic leukemia). Among these cases, data were evaluated from patients with a personal history of a previous malignancy, and included inquiring into demographic data, history of neoplastic diseases in the 1st degree relatives, type and treatment of the previous malignancy, latency until the development of a secondary acute leukemia diagnosis, laboratory features, treatment and outcome at the onset of secondary acute leukemia. RESULTS Approximately 200 (5.1%) patients presented a previous malignancy. Twenty-one were affected by ALL and 179 by AML. The proportion of patients with secondary AML was higher than that of patients with secondary ALL (179/2964 vs 21/901, O.R. 2.69-95% C.I. 1.66-4.39, P<0.001). The median latency, from the onset of the previous malignancy to the development of secondary ALL was 27 months and to the development of secondary AML was 52 months (P<0.05). Furthermore, of patients who previously received chemotherapy more developed a second AML (66/127 sAML vs 5/21 sALL; O.R. 3.46-95% C.I. 1.10-11.56, P<0.01). CONCLUSION In most cases, chemotherapy treatment for a previous malignancy can play a role in the development of secondary AML. In almost all cases of secondary ALL, the role of previous drugs does not appear to be relevant. On the basis of our analysis, performed systematically for the first time on a large adult series of acute leukemia, we conclude that in these patients a biological predisposition to cancer may be suspected.
Collapse
Affiliation(s)
- L Pagano
- Department of Hematology, Catholic University, Largo Francesco Vito 1, I-00168 Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Del Poeta G, Maurillo L, Venditti A, Buccisano F, Epiceno AM, Capelli G, Tamburini A, Suppo G, Battaglia A, Del Principe MI, Del Moro B, Masi M, Amadori S. Clinical significance of CD38 expression in chronic lymphocytic leukemia. Blood 2001; 98:2633-9. [PMID: 11675331 DOI: 10.1182/blood.v98.9.2633] [Citation(s) in RCA: 209] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
B-cell chronic lymphocytic leukemia (B-CLL) follows heterogeneous clinical courses, and several biological parameters need to be added to the current clinical staging systems to predict which patients will experience an indolent or an aggressive outcome. This study analyzed CD38 expression by flow cytometry and soluble APO1/Fas (sAPO1/Fas), Bcl-2 (sBcl-2), and CD23 (sCD23) proteins by immunoenzymatic methods to evaluate their effect on the clinical course of 168 unselected B-CLL patients. Intermediate/high risk modified Rai stages were characterized by a higher CD38(+) B-cell number (P =.0002) and higher sCD23 levels (P <.0001). Moreover, CD38(+) B-cell percentages were significantly and directly associated both with beta(2)-microglobulin and sCD23 concentrations (P <.0001 and P =.002, respectively). Both a higher tumor burden (lymphadenopathy/splenomegaly) and a lymphocyte doubling time less than 12 months were significantly associated with higher CD38(+) percentages (P <.0001 and P =.0001, respectively). With regard to clinical outcome, progression-free survival was significantly longer (75% versus 37% at 5 years; P =.00006) in patients with lower CD38(+) B-cell percentages. Furthermore, the risk of partial or no response to fludarabine increased with increasing CD38 expression (P =.003), and a shorter overall survival (50% versus 92% at 8 years; P <.00001) characterized patients with more than 30% CD38(+) B-cell number. The predictive value of CD38 expression was maintained among the patients within the Rai intermediate risk group and was confirmed in multivariate analysis. Thus, the percentage of CD38(+) B cells appears to be an accurate predictor of clinical outcome and therefore could be used to indicate when more novel chemotherapeutic approaches are needed.
Collapse
MESH Headings
- ADP-ribosyl Cyclase
- ADP-ribosyl Cyclase 1
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD
- Antigens, Differentiation/metabolism
- B-Lymphocytes/immunology
- B-Lymphocytes/metabolism
- Biomarkers, Tumor/metabolism
- Cohort Studies
- Disease Progression
- Female
- Flow Cytometry
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Membrane Glycoproteins
- Middle Aged
- NAD+ Nucleosidase/metabolism
- Predictive Value of Tests
- Prognosis
- Prospective Studies
- Severity of Illness Index
- Survival Analysis
Collapse
Affiliation(s)
- G Del Poeta
- Cattedra e Divisione di Ematologia, Università Tor Vergata, Ospedale S.Eugenio, Roma, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Visani G, Bernasconi P, Boni M, Castoldi GL, Ciolli S, Clavio M, Cox MC, Cuneo A, Del Poeta G, Dini D, Falzetti D, Fanin R, Gobbi M, Isidori A, Leoni F, Liso V, Malagola M, Martinelli G, Mecucci C, Piccaluga PP, Petti MC, Rondelli R, Russo D, Sessarego M, Specchia G, Testoni N, Torelli G, Mandelli F, Tura S. The prognostic value of cytogenetics is reinforced by the kind of induction/consolidation therapy in influencing the outcome of acute myeloid leukemia--analysis of 848 patients. Leukemia 2001; 15:903-9. [PMID: 11417475 DOI: 10.1038/sj.leu.2402142] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [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: 11/08/2022]
Abstract
We studied the impact of cytogenetics and kind of induction/consolidation therapy on 848 adult acute myeloid leukemia (AML) patients (age 15-83). The patients received three types of induction/consolidation regimen: standard (daunorubicin and cytosine arabinoside (3/7); two cycles); intensive (idarubicin, cytosine arabinoside and etoposide (ICE), plus mitoxantrone and intermediate-dose Ara-C (NOVIA)); and low-dose (low-dose cytosine arabinoside). CR patients under 60 years of age, if an HLA-identical donor was available received allogeneic stem cell transplantation (allo-SCT); otherwise, as part of the program, they underwent autologous (auto)-SCT. CR rates significantly associated with 'favorable' (inv(16), t(8;21)), 'intermediate' ('no abnormality', abn(11q23), +8, del(7q)) and 'unfavorable' (del (5q), -7, abn(3)(q21q26), t(6;9), 'complex' (more than three unrelated cytogenetic abnormalities)) karyotypes (88% vs 65% vs 36%, respectively; P = 0.0001). These trends were confirmed in all age groups. On therapeutic grounds, intensive induction did not determine significant increases of CR rates in any of the considered groups, with respect to standard induction. Low-dose induction was associated with significantly lower CR rates. Considering disease-free survival (DFS), multivariate analysis of the factors examined (including karyotype grouping) showed that only age > 60 years significantly affected outcome. However, in cases where intensive induction was adopted, 'favorable' karyotype was significantly related to longer DFS (P = 0.04). This was mainly due to the favorable outcome of t(8;21) patients treated with intensive induction. Patients receiving allo-SCT had significantly longer DFS (P = 0.005); in particular, allo-SCT significantly improved DFS in the 'favorable' and 'intermediate' groups (P = 0.04 and P = 0.048, respectively). In conclusion our study could provide some guidelines for AML therapy: (1) patients in the 'favorable' karyotype group seem to have a longer DFS when treated with an intensive induction/consolidation regimen, adopted before auto-SCT instead of standard induction; this underlines the importance of reinforcement of chemotherapy, not necessarily based on repeated high-dose AraC cycles. Allo-SCT, independently of induction/consolidation therapy, should be considered an alternative treatment; (2) patients in the 'intermediate' karyotype group should receive allo-SCT; (3) patients in the 'unfavorable' karyotype group should be treated using investigational chemotherapy, considering that even allo-SCT cannot provide a significantly longer DFS, but only a trend to a better prognosis.
Collapse
Affiliation(s)
- G Visani
- Seràgnoli Institute of Hematology and Medical Oncology, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Cox MC, Panetta P, Venditti A, Abruzzese E, Del Poeta G, Cantonetti M, Amadori S. New reciprocal translocation t(6;10) (q27;q11) associated with idiopathic myelofibrosis and eosinophilia. Leuk Res 2001; 25:349-51. [PMID: 11248333 DOI: 10.1016/s0145-2126(00)00136-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Idiopathic myelofibrosis (IM), is a chronic myeloproliferative disorder (MPD) characterised by marrow fibrosis, extramedullary haematopoiesis and a leuco-erythroblastic picture of the peripheral blood. Cytogenetic data of IM is scarce: no specific karyotypic anomalies have been yet described. Trisomy 1q, del(13q), del(20q) and trisomy 8, appear in two-thirds of the cases with chromosome aberrations. We report on a 41-year-old patient diagnosed with IM associated with eosinophilia, bearing a novel translocation t(6;10)(q27;q11) as the sole chromosome anomaly. The patient, progressed to AML-M5a within 18 months from diagnosis. Recently new specific chromosomal translocations have been described in chronic MPD. These findings have allowed the classification of new syndromes with defined molecular abnormalities. The case we describe, because of the peculiar clinical features and the association with a previously unreported chromosomal translocation, might be a noteworthy addition.
Collapse
Affiliation(s)
- M C Cox
- Department of Hematology, Tor Vergata University, Ospedale S'Eugenio, P.le dell'Umanesimo 10, 00144, Roma, Italy.
| | | | | | | | | | | | | |
Collapse
|
31
|
Maurillo L, Del Poeta G, Venditti A, Buccisano F, Battaglia A, Santinelli S, Caravita T, Epiceno AM, Del Moro B, Tamburini A, Picardi A, Suppo G, Catalano G, Bruno A, Amadori S. Quantitative analysis of Fas and bcl-2 expression in hematopoietic precursors. Haematologica 2001; 86:237-43. [PMID: 11255269] [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: 02/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We investigated the expression of bcl-2 and CD95 (Apo1-/Fas) on CD34+ cells obtained from bone marrow (BM), mobilized peripheral blood (MPB), and umbilical cord blood (UCB) samples. The expression of bcl-2 and Fas was then compared with that of other markers usually associated with immaturity; functional tests using the agonistic antibody anti- Fas CH11 were also carried out. DESIGN AND METHODS The analysis was performed by flow cytometry on purified CD34+ cells in a three (CD95 PE, CD34 APC and CD71 FITC) and in a four (CD38 PE, HLA-DR PerCP, CD34 APC and bcl-2 FITC) fluorescence assay. RESULTS The results were expressed as mean fluorescence index (MFI); bcl-2 expression was significantly higher (p < 0.001) in BM (3.73 +/- 0.63) than in MPB (2.47 +/- 0.39) and UCB (2.38 +/- 0.58); Fas was significantly less expressed (p < 0.001) in UCB (1.27 +/- 0.78) than in MBP (3.63 +/- 2.19) and BM (4.56 +/- 1.69). CD34 expression was significantly (p < 0.001) brighter in UCB compared to in MBP and BM, while CD38 and CD71 were significantly (p = 0.005 and p < 0.001, respectively) more expressed in BM than in MPB and UCB. Fas values were directly correlated to CD38; both Fas and bcl-2 were directly related to CD71 and inversely to CD34. Culture assays showed that hematopoietic precursor cells from BM, MPB and UCB had a low susceptibility to undergo Fas-mediated apoptosis. INTERPRETATION AND CONCLUSIONS In conclusion, bcl-2 and Fas are less expressed in UCB than in MPB and BM; early hematopoietic precursor cells are relatively resistant to CD95-triggered apoptosis; the observed correlation between Fas/bcl-2 and markers of immaturity suggests that they may be determinants of commitment in early hematopoietic precursors.
Collapse
Affiliation(s)
- L Maurillo
- Cattedra di Ematologia, Università Tor Vergata, Divisione di Ematologia, Ospedale S. Eugenio, piazzale Umanesimo 10, 00144 Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Venditti A, Buccisano F, Del Poeta G, Maurillo L, Tamburini A, Cox C, Battaglia A, Catalano G, Del Moro B, Cudillo L, Postorino M, Masi M, Amadori S. Level of minimal residual disease after consolidation therapy predicts outcome in acute myeloid leukemia. Blood 2000; 96:3948-52. [PMID: 11090082] [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: 02/18/2023] Open
Abstract
We used flow cytometry to quantify minimal residual disease (MRD) in 56 patients with acute myeloid leukemia (AML) expressing a leukemia-associated phenotype. Thirty-four patients aged 18 to 60 years were entered into the AML-10 protocol (induction, consolidation, and autologous stem-cell transplantation [ASCT]), whereas 22 patients older than 60 years received the AML-13 protocol (induction, consolidation, and consolidation II). After induction, the level of MRD that was best associated with treatment outcome was 4.5 x 10(-4) residual leukemic cells. However, the outcome in patients with at least 4.5 x 10(-4) cells (n = 26) was not significantly different from that in patients with fewer leukemic cells (n = 30); there were 15 (58%) relapses in the first group and 12 (40%) relapses in the second. After consolidation, the most predictive MRD cutoff value was 3.5 x 10(-4) cells: 22 patients had an MRD level of 3.5 x 10(-4) cells or higher and 17 (77%) of these patients had relapse, compared with 5 of 29 patients (17%) with lower MRD levels (P <.001). An MRD level of 3.5 x 10(-4) cells or higher after consolidation was significantly correlated with poor or intermediate-risk cytogenetic findings, a multidrug resistance 1 (MDR1) phenotype, short duration of overall survival, and short duration of relapse-free survival (P =.014,.031,.00022, and.00014, respectively). In multivariate analysis, this MRD status was significantly associated with a high frequency of relapse (P <.001) and a short duration of overall (P =.025) and relapse-free survival (P =.007). ASCT did not alter the prognostic effect of high MRD levels after consolidation: the relapse rate after transplantation was 70%. Thus, we found that an MRD level of 3.5 x 10(-4) cells or higher at the end of consolidation strongly predicts relapse and is significantly associated with an MDR1 phenotype and intermediate or unfavorable cytogenetic findings. (Blood. 2000;96:3948-3952)
Collapse
Affiliation(s)
- A Venditti
- Cattedra di Ematologia, Università di Roma Tor Vergata, Divisione di Ematologia, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Bruno A, Del Poeta G, Venditti A, Stasi R, Adorno G, Aronica G, Buccisano F, Tamburini A, Caravita T, Ragusa D, Ballatore G, Masi M, Tribalto M, Amadori S. Automated haematology analysers in acute and chronic leukaemias. Acta Haematol 2000; 100:61-2. [PMID: 9691150 DOI: 10.1159/000040866] [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: 11/19/2022]
|
34
|
Cox MC, Scanzani A, Del Poeta G, Venditti A, Panetta P, Derme V, Sgro R, Masi M, Amadori S. A novel t(11;12)(q23-24;q24) in a case of minimally-differentiated acute myeloid leukemia (AML-M0). Cancer Genet Cytogenet 2000; 118:76-9. [PMID: 10731597 DOI: 10.1016/s0165-4608(99)00179-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute myeloid leukemia with minimal signs of myeloid differentiation (AML-M0) is a recent addition to the FAB group classification. Chromosome data is scarce, but existing reports describe a high incidence of complex karyotypes and myelodysplastic syndrome-like chromosome alterations, while single chromosome translocations have rarely been reported. We describe the case of a 60-year-old woman diagnosed with AML-M0 with a novel translocation t(11;12)(q23-24;q24) as the sole karyotypic marker. Fluorescence in situ hybridization analysis to assess MLL gene splitting did not show rearrangement of this oncogene.
Collapse
Affiliation(s)
- M C Cox
- Department of Hematology, "Tor Vergata" University, St. Eugenio Hospital, Rome, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Venditti A, Tamburini A, Buccisano F, Scimò MT, Del Poeta G, Maurillo L, Cox MC, Abruzzese E, Tribalto M, Masi M, Amadori S. A phase-II trial of all trans retinoic acid and low-dose cytosine arabinoside for the treatment of high-risk myelodysplastic syndromes. Ann Hematol 2000; 79:138-42. [PMID: 10803936 DOI: 10.1007/s002770050569] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Twenty-two patients with high-risk myelodysplastic syndrome (HRMDS) were treated with a 10-day course of oral all trans retinoic acid (45 mg/m2) and s.c. low-dose cytosine arabinoside (LDARAc) given at the dose of 20 mg twice per day. The courses were repeated monthly until response or progression, in the case of response, the therapy was administered until relapse. Morphologic diagnoses were refractory anemia with excess blasts (RAEB) in nine, RAEB in transformation (RAEB-t) in nine, and chronic myelomonocytic leukemia (CMMoL) in four patients; in all cases, bone-marrow blast infiltration was greater than 10% (median 20%, range 12-30%). When the international prognostic scoring system was applied, all the cases qualified as intermediate/high-risk categories. Nineteen patients were males and three were females; the median age was 69 years (range 25-90 years); three patients had previously been treated with conventional chemotherapy, and one of them had also undergone autologous bone-marrow transplantation. The criteria of response were defined as follows: (1) complete response: normalization of blood counts and bone-marrow blasts (<5%), and (2) partial response: decrease in bone-marrow blast infiltration by 50%, and two of the following parameters - improvement in hemoglobin level by 1.5 g/dl or decrease by 50% in transfusional requirement, increase by 50% in absolute neutrophil count, and increase by 50% in platelet count. Overall, 7 (32%) of 22 patients achieved a response, with 5 (23%) being classified as complete responders and 2 (9%) as partial responders. Fifteen (68%) patients did not achieve any response, and 14 died of progressive disease or infectious disease. The overall median survival was 8 months (range 1-27 months), whereas the median survival of responders was 16 months (range 8-27 months); the median duration of response was 11 months (range 2-21 months). Moderate to severe hematological toxicity and infections were the most common side effects. In conclusion, it seems that the association of ATRA and LDARA-C may be effective in approximately 30% of HRMDS patients. Optimizing this approach might be pursued by selecting, on a biological basis, those cases more likely to respond or by incorporating other differentiating agents or growth factors.
Collapse
Affiliation(s)
- A Venditti
- Hematology, University o Tor Vergata, St. Eugenio Hospital, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Tribalto M, Amadori S, Cudillo L, Caravita T, Del Poeta G, Meloni G, Avvisati G, Petrucci MT, Pulsoni A, Leone G, Sica S, Martelli M, Tabilio A, Fioritoni G, Majolino I, Mandelli F. Autologous peripheral blood stem cell transplantation as first line treatment of multiple myeloma: an Italian Multicenter Study. Haematologica 2000; 85:52-8. [PMID: 10629592] [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: 02/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The outcome of patients with multiple myeloma (MM) has not changed markedly since the introduction of melphalan and prednisone. In recent years several studies have investigated the role of intensive therapy followed by infusion of autologous peripheral blood stem cells (PBSC) together with the administration of hematopoietic growth factors. In this study we evaluated the feasibility and efficacy of a PBSC transplantation program for patients with de novo MM in a multicenter setting. DESIGN AND METHODS In a non-randomized controlled trial 52 patients with de novo MM from 6 Italian centers underwent a three phase treatment strategy including 3 cycles of VAD-like chemotherapy for initial debulking, followed by high-dose cyclophosphamide (HD-CY) and collection of PBSC, that were transplanted after a conditioning regimen with melphalan plus busulfan. Maintenance treatment was a conventional dose of interferon, given until relapse. Actuarial survival and response duration curves were plotted according to Kaplan and Meier's method; the groups were compared using the log rank test. Response rates were compared by the c(2) test; multivariate analysis was performed according to the stepwise regression model. RESULTS Overall 39/52 (75%) of patients responded, with a complete remission (CR) rate of 31%. After a median follow-up of 55 months, median duration of event-free survival (EFS) and overall survival (OS) are 21 and 57 months, with 24% and 48% probabilities of being event-free and alive after 6 years, respectively. Among the group of 39 responders, CR was significantly associated with prolonged response and survival (2 deaths and 6 relapses/16 patients) as compared with PR (11 deaths and 15 relapses/23 patients), and remained the only significant variable also in a multivariate analysis. Myelosuppression did not protract beyond one week in transplanted patients; extra-hematologic toxicity was very low. INTERPRETATION AND CONCLUSIONS This multicenter study confirms the feasibility of an aggressive approach to de novo MM patients. Additional confirmation is given of the increased rate of CR, and the significant prolonged survival observed in complete responders. In this experience the association melphalan plus busulfan was shown to be effective, at least as part of conditioning regimens, in the transplant strategy.
Collapse
Affiliation(s)
- M Tribalto
- Divisione di Ematologia, Ospedale S. Eugenio, piazzale dell'Umanesimo, 00144 Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Venditti A, Battaglia A, Del Poeta G, Buccisano F, Maurillo L, Tamburini A, Del Moro B, Epiceno AM, Martiradonna M, Caravita T, Santinelli S, Adorno G, Picardi A, Zinno F, Lanti A, Bruno A, Suppo G, Franchi A, Franconi G, Amadori S. Enumeration of CD34+ hematopoietic progenitor cells for clinical transplantation: comparison of three different methods. Bone Marrow Transplant 1999; 24:1019-27. [PMID: 10556963 DOI: 10.1038/sj.bmt.1702013] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Three different methods for determination of CD34+ cells in G-CSF-mobilized peripheral blood were compared. The methods were: the Milan/Mulhouse protocol, the ISHAGE guidelines for CD34+ cells enumeration and our own protocol. The procedure we have adopted is essentially a Milan/Mulhouse protocol-derived methodology combined with a multiparametric approach using the PAINT-A-GATE software analysis program. The samples were collected from 70 patients affected by acute leukemia, non-Hodgkin's lymphoma, Hodgkin's lymphoma, myeloma and breast cancer who were scheduled to receive autologous PBSC transplantation. PBSC collection was performed following mobilization with subcutaneous G-CSF at 5-10 microg/kg/day. A minimum target of 2 x 10(6)/kg CD34+ cells was considered an acceptable harvest to ensure a safe transplant. On average, three aphereses per patient were performed and a total of 204 apheresis samples were analyzed. Regression analysis of the percentage and absolute number of CD34+ cells, as calculated with each method, achieved an excellent correlation in spite of methodological differences. In fact, both CD34+dim and CD34+CD45- events were included in our gating strategy. In the setting of a triple staining associating CD34, CD38 and CD45, we identified a variable fraction of CD34+CD38+CD45- cells which would be otherwise undetected due to its CD45 negativity. To this end, we used a new technology referred to as laser-scanning cytometry (LSC) which allowed the isolation and morphological identification of CD34+CD45- cells. By comparing CD34+CD45+ and CD34+CD45- cells, we found that they share a common morphology, thus confirming the hypothesis that the latter are to be considered for CD34+ cell calculation. The median number of CD34+ cells/kg, as calculated by the three methods, was: 4.79 x 10(6)/kg (range 1-570) for the Milan/Mulhouse protocol, 3.9 x 10(6)/kg (range 0.8-498) for the ISHAGE one, and 5.17 x 10(6)/kg (range 2-599) for our protocol. The median time to ANC and PLT engraftment was 11 (range 9-24) and 20 (range 10-70) days, respectively. Our protocol achieved the best correlation between CD34+ cells/kg and time to ANC/PLT recovery according to the Spearman's rank test (r = -40 and P < 0. 015 for ANC, r= -46 and P = 0.005 for PLT). We conclude that (1) CD45 does not appear the ideal partner of HPCA-2 for determination of hematopoietic progenitors in mobilized peripheral blood; and (2) for clinical application, a single staining with 8G12 appears simple, reliable and feasible when rigorous procedures for sample preparation and acquisition are followed and an adequate software for multiparametric analysis is available.
Collapse
Affiliation(s)
- A Venditti
- Cattedra di Ematologia, Università 'Tor Vergata', Divisione di Ematologia, Ospedale S Eugenio, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Adorno G, Zinno F, Bruno A, Lanti A, Ballatore G, Masi M, Cudillo L, Del Poeta G, Riccitelli A, Del Principe MI, Pepe R, Marchitelli E, Morosetti M, Meloni C, Isacchi G, Amadori S. Femoral catheters: safety and efficacy in peripheral blood stem cell collection. Int J Artif Organs 1999; 22:710-2. [PMID: 10585136] [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: 02/14/2023]
Abstract
Central venous access is necessary in patients candidate for peripheral blood stem cell (PBSC) collection. We report our experience with a dual lumen femoral catheter (Gamcath, 11 french), initially designed for hemodialysis. We studied 147 patients and performed 488 collections after mobilization with either G-CSF alone or chemotherapy + G-CSF, when the white blood cell count exceeded 1 x 10(9)/L, or when a measurable population of CD34+ cells (20/microL) was detected in peripheral blood. All patients received systemic anticoagulation with a low weight heparin and ultrasound examination was performed after the removal of the catheter. Seven patients developed thrombosis (4.7%), ten experienced hematomas at the site of catheter placement (6.8%) despite prophylactic platelet transfusions, while only one patient (0.6%) had a catheter-related infection. In conclusion, the short-term use of large bore femoral catheters in setting up PBSC collection seems to be associated with minimal risk of infection and low thrombotic incidence.
Collapse
Affiliation(s)
- G Adorno
- Department of Hematology, University of Roma Tor Vergata St. Eugenio Hospital, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Del Poeta G, Venditti A, Stasi R, Aronica G, Cox MC, Buccisano F, Tamburini A, Bruno A, Maurillo L, Battaglia A, Suppo G, Epiceno AM, Del Moro B, Masi M, Amadori S, Papa G. P-glycoprotein and terminal transferase expression identify prognostic subsets within cytogenetic risk classes in acute myeloid leukemia. Leuk Res 1999; 23:451-65. [PMID: 10374859 DOI: 10.1016/s0145-2126(98)00191-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical and biological features were assessed in 204 consecutive de novo adult acute myeloid leukemia (AML) patients who received intensive chemotherapy regimens. Multiparameter flow cytometric assays both of the multidrug resistance (MDR-1)-associated P-glycoprotein (PGP) using the UIC2 monoclonal antibody (MoAb), and of terminal transferase (TdT) were performed. Cytogenetic findings were obtained from 196 patients with high resolution banding. At onset, UIC2 and TdT positivities were detected in 58.5% and 24% of cases, respectively. There were strict correlations either between UIC2 negativity and FAB M3 or between TdT and FAB M0-M1 (P = 0.001 and < 0.0001, respectively). On the other hand, age was significantly associated with cytogenetic risk classes (P < 0.0001). CD34 positivity was highly correlated with TdT expression (P < 0.0001). Moreover, CD7 and CD11b were significantly represented in UIC2+ subset (P < 0.0001). Rhodamine 123 (Rh 123) efflux was significantly higher in 75 UIC2 positive patients compared to 65 UIC2 negative ones (P < 0.001). As regards to cytogenetics, TdT positivity was strongly related either to t(9;22) or single/associated anomalies of chromosome 7; on the other hand, most or all cases with t(8;21) or t(15;17) were UIC2 or TdT negative, respectively. The rate of first complete remission (CR) differed both between UIC2+ and UIC2- cases and between TdT+ and TdT- ones (40% versus 72%, P < 0.001; and 36% versus 61%, P = 0.001, respectively). The survival rates (Kaplan-Meier method) were significantly shorter either in UIC2+ or in TdT+ patients (P = 0.005 and = 0.011, respectively). UIC2 and TdT negative cases showed longer remission duration (P = 0.03 and = 0.22, respectively). The additional effect of UIC2 and TdT on prognosis allowed us to identify two subsets of patients, the first [UIC2- TdT-] at better and the second [UIC2+ TdT+] at worse clinical outcome compared to single UIC2 and TdT cases, concerning CR (P < 0.001), survival (P < 0.0001) and CR duration (P = 0.007). The combinations [UIC2+ TdT-] and [UIC2- TdT+] showed an intermediate clinical course. A strong difference was found between poor risk and intermediate/favorable risk cytogenetic classes with regard to CR rate (P < 0.0001), overall survival and CR duration (P < 0.001). Nevertheless, within the poor risk class, UIC2 positivity was able to identify patients at worst prognosis with regard to CR (P = 0.005), survival (P = 0.02) and CR duration (P = 0.015). On the other hand, UIC2 and TdT negativity allowed us to distinguish patients with longer survival (P = 0.012 and = 0.04, respectively) and CR duration (P = 0.04 and = 0.025, respectively) within the intermediate/favorable risk class. The independent prognostic value of UIC2, TdT and cytogenetic risk classes was confirmed in multivariate analysis. These results suggest that PGP and TdT expressions, together with cytogenetic findings, may represent a basic predictor of chemotherapeutic failure in AML.
Collapse
Affiliation(s)
- G Del Poeta
- Cattedra e Divisione di Ematologia, Universita Tor Vergata, Ospedale S. Eugenio, Roma, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Del Poeta G, Venditti A, Aronica G, Buccisano F, Tamburini A, Epiceno AM, Amadori S. Quantitative analysis of P-glycoprotein, bcl-2 and transferrin receptor allows the stratification of acute myeloid leukemia patients within different prognostic risk classes. Eur J Histochem 1998; 41 Suppl 2:11-2. [PMID: 9859760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- G Del Poeta
- Cattedra e Divisione Ematologia, Università Tor Vergata, Ospedale S: Eugenio, Roma
| | | | | | | | | | | | | |
Collapse
|
41
|
Venditti A, Del Poeta G, Buccisano F, Tamburini A, Cox-Froncillo MC, Bruno A, Del Moro B, Maria Epiceno A, Masi M, Amadori S, Stasi R. Biological features of acute myeloid leukemia in the elderly. Blood 1998; 92:697-9. [PMID: 9657774] [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: 02/08/2023] Open
|
42
|
Stasi R, Del Poeta G, Venditti A, Masi M, Stipa E, Cox MC, Amadori S. Prognostic value of cytogenetics and multidrug resistance (MDR1) in elderly patients with acute myeloid leukemia. Blood 1998; 92:695-7. [PMID: 9657773] [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: 02/08/2023] Open
|
43
|
Venditti A, Del Poeta G, Buccisano F, Tamburini A, Cox-Froncillo MC, Aronica G, Bruno A, Del Moro B, Epiceno AM, Battaglia A, Forte L, Postorino M, Cordero V, Santinelli S, Amadori S. Prognostic relevance of the expression of Tdt and CD7 in 335 cases of acute myeloid leukemia. Leukemia 1998; 12:1056-63. [PMID: 9665190 DOI: 10.1038/sj.leu.2401067] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We have analyzed the expression of Tdt and CD7 in 335 cases of unequivocal acute myeloid leukemia (AML). Tdt was expressed in 80 (25%) of 321 evaluable cases. Twenty-six of 77 (34%) Tdt+ patients assessable for response, entered complete remission (CR) vs 121 of 209 (58%) Tdt- cases (P < 0.001). CD7 was expressed in 102 of 332 (30%) evaluable cases; 37 of 93 assessable (40%) CD7+ patients attained a CR as compared to 114/204 (56%) CD7- (P = 0.013). Duration of survival was significantly shorter for patients with CD7+ or Tdt+ AML (P = 0.006 and 0.001, respectively). In a multivariate analysis, Tdt was found to significantly adverse achievement of CR (P = 0.018), while CD7 affected duration of CR (P = 0.037). Overall the expression of either Tdt or CD7 correlated with a relatively high expression of CD34 (P < 0.001), GP-170 (P = 0.003), lymphoid antigens (LyAg) (P < 0.001), t(9;22) or anomalies of chromosome 5/7 (P < 0.001). Finally, we pooled the patients into four phenotypic classes, according to the presence of Tdt, CD7 or both: [Tdt-CD7-], [Tdt+CD7-], [Tdt-CD7+] and [Tdt+CD7+]. The category [Tdt+CD7+] was characterized by a more unfavorable outcome as suggested by a lower rate of CR (P < 0.001) and a shorter duration of survival as compared to cases [Tdt-CD7-], [Tdt+CD7-] and [Tdt-CD7+] (P = 0.002). This figure is consistent with the frequent convergence in the subset [Tdt+CD7+] of GP-170 positivity (P = 0.003), translocation t(9;22), anomalies of chromosome 5 and/or 7 (P < 0.001) and signs of lineage infidelity (deviant expression of lymphoid antigens) (P < 0.001). We conclude that the expression of Tdt or CD7 is associated with an unfavorable outcome and that the combination of both defines a clinical subset with a poorer prognosis due to the significantly higher association with MDR phenotype, and 'poor prognostic' chromosomal abnormalities.
Collapse
Affiliation(s)
- A Venditti
- Cattedra di Ematologia, Università Tor Vergata, Divisione di Ematologia, Ospedale S Eugenio, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Stasi R, Venditti A, Del Poeta G, Conforti M, Brunetti M, Bussa S, Amadori S, Pagano A. Role of human leukocyte interferon-alpha in the treatment of patients with polycythemia vera. Am J Med Sci 1998; 315:237-41. [PMID: 9537637 DOI: 10.1097/00000441-199804000-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Eighteen patients with polycythemia vera who were less than 60 years old received human leukocyte interferon-alpha subcutaneously at a starting dose of 3 MU three times a week. The interferon dose was escalated to 6 MU three times a week if it was well tolerated and disease was not controlled after 3 months of treatment at the lower dose. Hematologic response was defined as complete if the hematocrit was maintained at less than 45% in the absence of phlebotomy and partial if the hematocrit was kept at 45% to 50%, associated with a 50% or greater reduction of phlebotomy requirements; no response was defined as a response less than a partial response. Complete disease control was achieved in 11 patients, with partial control in a further six cases. One patient failed to respond. Median duration of response was 16 months (range 5 to 43 months), with 15 patients still under treatment. Therapy with human leukocyte interferon-alpha significantly improved (p <.01) phlebotomy requirements, the degree of splenomegaly, pruritus scores, iron stores and mean red cell volume values, and platelet and leukocyte counts. Interferon treatment did not produce remarkable side effects and no patient withdrew from the study because of intolerance. We conclude that subcutaneous human leukocyte interferon-alpha is an effective and well-tolerated therapy in the management of polycythemia vera-associated myeloproliferation and pruritus in patients less than 60 years old.
Collapse
Affiliation(s)
- R Stasi
- Department of Medical Sciences, Regina Apostolorum Hospital, Albano Laziale, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Venditti A, Buccisano F, Del Poeta G, Battaglia A, Tamburini A, Bruno A, Adorno G, Caravita T, Santinelli S, Del Moro B, Epiceno AM, Ballatore G, Amadori S. Multiparametric analysis for the enumeration of CD34+ cells from bone marrow and stimulated peripheral blood. Int J Mol Med 1998; 1:67-70. [PMID: 9852200 DOI: 10.3892/ijmm.1.1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Determination of CD34+ cells was performed in bone marrow and G-CSF mobilised peripheral blood samples. We adopted three different protocols of analysis: the Milan/Mulhouse protocol, the ISHAGE guidelines for CD34+ cell determination and our own protocol based upon the use of PAINT-A-GATEPRO software analysis program. An excellent correlation was demonstrated between the three methods (r2 0.98); however the analysis of variance showed a statistically significant difference between the results generated with the three methods (P=0.001). The differences between the three procedures are discussed with a special focus on the value of CD34+dim cells and the role of CD45 in the setting of a double staining. We have in fact identified a minor subset (CD34+CD38+CD45-) which would go unrecognised based upon its CD45 negativity.
Collapse
Affiliation(s)
- A Venditti
- Cattedra di Ematologia, Universita 'Tor Vergata', Divisione di Ematologia, Ospedale S. Eugenio, Piazzale Umanesimo 10, 00144 Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Cox MC, Maffei L, Buffolino S, Del Poeta G, Venditti A, Cantonetti M, Aronica G, Aquilina P, Masi M, Amadori S. A comparative analysis of FISH, RT-PCR, and cytogenetics for the diagnosis of bcr-abl-positive leukemias. Am J Clin Pathol 1998; 109:24-31. [PMID: 9426514 DOI: 10.1093/ajcp/109.1.24] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Philadelphia (Ph) chromosome-positive leukemias, with the bcr-abl gene translocation, have a dismal prognosis. The identification of Ph-positive patients is vitally important because only aggressive therapeutic approaches, such as allogeneic bone marrow transplantation, may result in long-term disease-free survival. Routine diagnostic methods, such as Southern blot analysis and cytogenetics, may lead to false-negative results. Reverse transcriptase-polymerase chain reaction (RT-PCR) analysis is considered the most sensitive tool for the detection of the bcr-abl translocation, and it is widely used alone or in combination with karyotyping or Southern blot analysis to identify Ph-positive cases. In this study, we used fluorescence in situ hybridization (FISH) with BCR and ABL double-color probes for detecting Ph-positive leukemias. The FISH results were compared with the results of cytogenetic and RT-PCR analyses in 75 patients with leukemia or other myeloproliferative syndromes (chronic myeloid leukemia, 30; acute lymphoblastic leukemia, 24; acute myelogenous leukemia, 6; essential (hemorrhagic) thrombocythemia, 12; chronic myelomonocytic leukemia, 2; and polycythemia vera, 1). FISH analysis proved to be simple, extremely reliable and sensitive; bcr-abl fusion detection was successful in the presence of all types of molecular junctions i.e., (b2a2, b3a2, and e1a2). Furthermore, a Ph-positive case that proved fusion negative by RT-PCR was identified as positive by FISH. The sensitivity of RT-PCR and FISH related to Ph-positive cases were 97% and 100%, respectively. Regarding specificity, in 4 (5%) of 75 patients, RT-PCR provided false-positive results. Cross-contamination was identified because a new specimen was harvested and reanalyzed when FISH, cytogenetics, and RT-PCR results were contradictory. We believe FISH is an optimal diagnostic method to detect bcr-abl translocation that can be used alone or to validate the results of RT-PCR analysis.
Collapse
MESH Headings
- Bone Marrow/chemistry
- Chromosome Banding
- Fluorescent Dyes/analysis
- Fusion Proteins, bcr-abl/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Karyotyping
- Leukemia/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myelomonocytic, Chronic/genetics
- Leukocytes/chemistry
- Myeloproliferative Disorders/genetics
- Oncogene Proteins/genetics
- Polycythemia Vera/genetics
- Polymerase Chain Reaction
- Protein-Tyrosine Kinases
- Proto-Oncogene Proteins
- Proto-Oncogene Proteins c-abl/genetics
- Proto-Oncogene Proteins c-bcr
- RNA, Neoplasm/analysis
- Thrombocythemia, Essential/genetics
- Translocation, Genetic
Collapse
Affiliation(s)
- M C Cox
- Department of Hematology, University of Tor Vergata, Ospedale S'Eugenio, Rome, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Pisani F, Del Poeta G, Aronica G, Venditti A, Caravita T, Amadori S. In vitro down-regulation of bcl-2 expression by all-trans retinoic acid in AML blasts. Ann Hematol 1997; 75:145-7. [PMID: 9402847 DOI: 10.1007/s002770050332] [Citation(s) in RCA: 18] [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: 02/05/2023]
Abstract
Using flow cytometry, we have investigated the effects of 0.5 microM all-trans-retinoic acid (ATRA) on bcl-2 expression in the blast cells of 25 acute myeloblastic leukemia (AML) patients and the HL-60 cell line after incubation for 6 days. We observed a significant decrease of bcl-2 expression after treatment with ATRA in 12 of 25 AML samples and the HL-60 cells. The mean fluorescence intensity (MFI) ratio for the bcl-2 levels of the ATRA responders (n = 12) was reduced to 7.9 +/- 4.8 following incubation with ATRA compared with 10.9 +/- 6.5 (mean +/- SD) for control samples incubated without ATRA (p = 0.011). There was no significant difference between the baseline bcl-2 MFI ratio in the ATRA responders (11.14 +/- 7, n = 12) and the non responders (14.18 +/- 11.3, n = 13; p = 0.432). The down-regulation of bcl-2 expression by ATRA was not significantly associated with CD34-negative or -positive AML. There was no correlation between AML subtypes and regulation of bcl-2 expression by ATRA. Complete remission and overall survival were not significantly improved in bcl-2 down-regulated cases. Our data confirm that ATRA can down-regulate the bcl-2 expression in AML blasts. Because many chemotherapeutic agents also operate through the activation of programmed cell death and bcl-2 levels are positively associated with resistance to apoptosis, ATRA can be used in combination chemotherapy to increase the chemosensitivity of some patients with AML.
Collapse
Affiliation(s)
- F Pisani
- Department of Hematology, University Tor Vergata, St. Eugenio Hospital, Rome, Italy
| | | | | | | | | | | |
Collapse
|
48
|
Del Poeta G, Venditti A, Aronica G, Stasi R, Cox MC, Buccisano F, Bruno A, Tamburini A, Suppo G, Simone MD, Epiceno AM, Del Moro B, Masi M, Papa G, Amadori S. P-glycoprotein expression in de novo acute myeloid leukemia. Leuk Lymphoma 1997; 27:257-74. [PMID: 9402325 DOI: 10.3109/10428199709059682] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [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: 02/05/2023]
Abstract
Detection of the multidrug resistance P-glycoprotein (PGP) phenotype was performed at the time of diagnosis in 223 patients with acute myeloid leukemia (AML) by flow cytometry using C219 Monoclonal Antibody (MoAb). On the other hand, JSB1 MoAb was tested in 173 of these samples. At onset, PGP was detected in 57.4% of cases with C219 and 75.9% of cases with JSB1. There was no correlation between PGP expression and sex, age, marrow blast percentage or extramedullary disease. On the contrary, strict correlations were noted either between C219 negativity and FAB M3 subtype or between C219 positivity and FAB M5 group (P = 0.003). Significant correlation was found between PGP phenotype and CD7, as 143 of 223 samples had similar patterns of staining with C219 (P < 0.0001). Finally, there was a close relationship between C219 and JSB1 positivity: all the C219+ cases were positive for JSB1 (P < 0.0001). Concerning the karyotype, most patients with monosomy or del (7) were MDR positive; on the other hand, most patients with t(8;21) or t(15;17) were MDR negative. Rh123 accumulation studies showed a significant decrease of mean fluorescence intensities both in C219 and in JSB1 positive cases in comparison with PGP negative ones (P < 0.001). A significant decrease of remission induction rates (CR) was highlighted both between C219+ and C219- and between JSB1+ and JSB1- cases (32.1% v 62.1% and 32.6% v 73.8%, respectively, with P < 0.0001). The overall survival and the remission duration (CCR) were significantly shorter both in C219+ and in JSB1+ patients with no relationship to age. Furthermore, a higher rate of early relapses was noted among MDR+ when compared with MDR- patients both for C219+ and JSB1+ cases. The combination (C219- JSB1+) identified a subset of patients with an intermediate prognosis. On multivariate analysis, C219 and JSB1 were confirmed to be independent prognostic factors for achievement of CR, overall survival and CCR. In conclusion, the assessment of MDR phenotype by flow cytometry is a crucial prognostic factor of treatment outcome in AML.
Collapse
Affiliation(s)
- G Del Poeta
- Cattedra e Divisione Ematologia, Universita' Tor Vergata, Roma, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Stasi R, Brunetti M, Bussa S, Venditti A, Del Poeta G, Conforti M, Scimò MT, Cudillo L, Adorno G, Cecconi M, Amadori S, Pagano A. Efficacy and safety of human leucocyte interferon-alpha treatment in patients younger than 60 years of age with polycythaemia vera. J Intern Med 1997; 242:143-7. [PMID: 9279291 DOI: 10.1046/j.1365-2796.1997.00162.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To evaluate the therapeutic activity and toxicity of human leucocyte interferon-alpha (lIFN-alpha) in patients with polycythaemia vera (PV) aged less than 60 years. DESIGN An open clinical study. SETTING Department of Medical Sciences, Regina Apostolorum Hospital, Albano Laziale, and Chair of Haematology, University of Rome 'Tor Vergata', S. Eugenio Hospital, Rome, Italy. SUBJECTS Fourteen patients with PV and aged < 60 years who had active disease as indicated by the need for phlebotomy and/or cytoreductive therapy. INTERVENTIONS lIFN-alpha administered subcutaneously at the starting dose of 3 MU thrice weekly. The interferon dose could be escalated to six MU thrice weekly if it was well tolerated and disease was not controlled after three months of treatment at the lower dose. MAIN OUTCOME MEASURES Change in phlebotomy requirements, spleen size, pruritus score and haematological parameters after 6 months of treatment. Evaluation of lIFN-alpha side effects. RESULTS Complete or partial disease control was achieved in 13 patients. Six patients achieved a complete response (CR) and four a partial response (PR) after 3 months of therapy. Dose escalation in partial or nonresponders resulted in two patients switching from a status of PR to CR, and three other patients achieving a partial response after being unresponsive to the lower dosage. Human leucocyte interferon-alpha therapy significantly improved (P < 01) phlebotomy requirements, the degree of splenomegaly, pruritus scores, iron stores and MCV values, and platelet and leucocyte counts. A mild flu-like syndrome (low-grade fever, nausea and myalgias) appeared during the early phase of therapy in the majority of patients, but no patient had to discontinue lIFN-alpha because of intolerance. CONCLUSIONS Subcutaneous human leucocyte interferon-alpha appears an effective and well tolerated therapy in the management of PV-associated myeloproliferation and pruritus in patients aged less than 60 years.
Collapse
Affiliation(s)
- R Stasi
- Department of Medical Sciences, Regina Apostolorum Hospital, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Stasi R, Bruno A, Venditti A, Del Poeta G, Aronica G, Cox MC, Maffei L, Catalano G, Zangrilli D, Amadori S. A microgranular variant of acute promyelocytic leukemia with atypical morpho-cytochemical features and an early myeloid immunophenotype. Leuk Res 1997; 21:575-80. [PMID: 9279368 DOI: 10.1016/s0145-2126(97)00094-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This report describes a unique case of acute promyelocytic leukemia (APL) showing elusive morphologic features, an atypical pattern of cytochemical reactions, and a previously unreported immunophenotype consistent with a very early myeloid form: CD13 (+), CD33 (+), CD9 (+), CD2 (+), HLA-DR (-), CD34 (+), CD117 (+), and TdT (+). The diagnosis of AML M3 variant was made only after genotypic analyses revealed the PML/RAR alpha rearrangement associated with the typical (15;17) (q22;q21) translocation. This example of 'asynchronous differentiation' emphasizes the need for a multiparameter approach to the diagnosis of acute leukemia.
Collapse
Affiliation(s)
- R Stasi
- Chair of Hematology, University of Rome Tor Vergata, S. Eugenio Hospital, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|