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Rago A, Palumbo G, Tordi A, Bianchi S, Offidani M, di Toritto TC. A synchronous therapy with daratumumab and enzymatic replacement therapy (ERT) in a patient with Gaucher disease and multiple myeloma. Ann Hematol 2023; 102:2977-2978. [PMID: 37432414 DOI: 10.1007/s00277-023-05319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/12/2023] [Indexed: 07/12/2023]
Affiliation(s)
- A Rago
- Haematology Unit, ASL ROMA 1, Rome, Italy.
| | - G Palumbo
- Department of Translational and Precision Medicine, Haematology, A.O.U Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - A Tordi
- Haematology Unit, ASL ROMA 1, Rome, Italy
| | - S Bianchi
- Department of Translational and Precision Medicine, Haematology, A.O.U Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Offidani M, Boccadoro M, Di Raimondo F, Petrucci MT, Tosi P, Cavo M. Expert Panel Consensus Statement for Proper Evaluation of First Relapse in Multiple Myeloma. Curr Hematol Malig Rep 2020; 14:187-196. [PMID: 31077067 DOI: 10.1007/s11899-019-00507-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW A working group of six expert physicians convened to assess the spectrum of multiple myeloma relapse presentations, discussed the features that can define the disease as aggressive and not aggressive, and established whether this information could help in selecting treatment together with the characteristics of disease and of patients and type of prior therapy. RECENT FINDINGS The working group agreed that relapse should be distinguished between biochemical and clinical according to IMWG. Moreover, the expert panel defined "aggressive disease" as a clinical condition that requires therapy able to induce a rapid and as deep as possible response to release symptoms and to avoid impending danger of new events. According to this definition, relapse was considered aggressive if it presents with at least one of the following features: doubling of M protein rate over 2 months, renal insufficiency, hypercalcemia, extramedullary disease, elevated LDH, high plasma cell proliferative index, presence of plasma cells in peripheral blood, or skeletal-related complications. Moreover, the panel agreed that this classification can be useful to choose therapy in first relapse together with other patient, disease, and prior therapy characteristics. So, this item was included in a new therapeutic algorithm. The treatment choice in MM at relapse is wider than in the past with the availability of many new therapeutic regimens leading to increased diversity of approaches and relevant risk of inappropriate treatment decisions. A practical classification of relapses into aggressive or non-aggressive, included in a decisional algorithm on MM management at first relapse, could help to make the appropriate treatment decisions.
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Affiliation(s)
- M Offidani
- Clinica di Ematologia, A.O.U. Ospedali Riuniti di Ancona, via Conca, 71, 60126, Ancona, Italy.
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - F Di Raimondo
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - M T Petrucci
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - P Tosi
- Hematology Unit, Infermi Hospital Rimini, Rimini, Italy
| | - M Cavo
- Institute of Hematology Seragnoli, DIMES, University of Bologna, Bologna, Italy
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Bringhen S, Milan A, D'Agostino M, Ferri C, Wäsch R, Gay F, Larocca A, Offidani M, Zweegman S, Terpos E, Goldschmidt H, Cavo M, Ludwig H, Driessen C, Auner HW, Caers J, Gramatzki M, Dimopoulos MA, Boccadoro M, Einsele H, Sonneveld P, Engelhardt M. Prevention, monitoring and treatment of cardiovascular adverse events in myeloma patients receiving carfilzomib A consensus paper by the European Myeloma Network and the Italian Society of Arterial Hypertension. J Intern Med 2019; 286:63-74. [PMID: 30725503 DOI: 10.1111/joim.12882] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The novel proteasome inhibitor carfilzomib alone or in combination with other agents is already one of the standard therapies for relapsed and/or refractory multiple myeloma (MM) patients and produces impressive response rates in newly diagnosed MM as well. However, carfilzomib-related cardiovascular adverse events (CVAEs) - including hypertension (all grades: 12.2%; grade ≥3: 4.3%), heart failure (all grades: 4.1%; grade ≥3: 2.5%) and ischemic heart disease (all grades: 1.8%; grade ≥3: 0.8%) - may lead to treatment suspensions. At present, there are neither prospective studies nor expert consensus on the prevention, monitoring and treatment of CVAEs in myeloma patients treated with carfilzomib. METHODS An expert panel of the European Myeloma Network in collaboration with the Italian Society of Arterial Hypertension and with the endorsement of the European Hematology Association aimed to provide recommendations to support health professionals in selecting the best management strategies for patients, considering the impact on outcome and the risk-benefit ratio of diagnostic and therapeutic tools, thereby achieving myeloma response with novel combination approaches whilst preventing CVAEs. RESULTS Patients scheduled to receive carfilzomib need a careful cardiovascular evaluation before treatment and an accurate follow-up during treatment. CONCLUSIONS A detailed clinical assessment before starting carfilzomib treatment is essential to identify patients at risk for CVAEs, and accurate monitoring of blood pressure and of early signs and symptoms suggestive of cardiac dysfunction remains pivotal to safely administer carfilzomib without treatment interruptions or dose reductions.
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Affiliation(s)
- S Bringhen
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - A Milan
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza di Torino, Rete Oncologica Piemontese, University of Torino, Torino, Italy
| | - M D'Agostino
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - C Ferri
- University of L'Aquila, MeSVA Department - San Salvatore Hospital, Division of Internal Medicine & Nephrology, Coppito, Italy
| | - R Wäsch
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - F Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - A Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - M Offidani
- Clinica di Ematologia, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - S Zweegman
- Amsterdam UMC, Vrije Universiteit Amsterdam, VU University Medical Center, Department of Hematology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - E Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - H Goldschmidt
- University Clinic Heidelberg, Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - M Cavo
- 'Seràgnoli' Institute of Hematology and Medical Oncology, University of Bologna, Bologna, Italy
| | - H Ludwig
- 1. Medical Department and Oncology, Wilhelminenspital Wien, Vienna, Austria
| | - C Driessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - H W Auner
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - J Caers
- Department of Hematology, Domaine University Liege, Liege, Belgium
| | - M Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany
| | - M A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - H Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - P Sonneveld
- Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - M Engelhardt
- Department of Medicine I, Hematology, Oncology & Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Gay F, Oliva S, Petrucci MT, Montefusco V, Conticello C, Musto P, Catalano L, Evangelista A, Spada S, Campbell P, Ria R, Salvini M, Offidani M, Carella AM, Omedé P, Liberati AM, Troia R, Cafro AM, Malfitano A, Falcone AP, Caravita T, Patriarca F, Nagler A, Spencer A, Hajek R, Palumbo A, Boccadoro M. Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: a pooled analysis. Leukemia 2016; 31:1727-1734. [PMID: 28008174 DOI: 10.1038/leu.2016.381] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 12/22/2022]
Abstract
In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.
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Affiliation(s)
- F Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - S Oliva
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M T Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Roma, Roma, Italy
| | - V Montefusco
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - C Conticello
- Division of Hematology, Azienda Policlinico 'Vittorio Emanuele', University of Catania, Catania, Italy
| | - P Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Potenza, Italy
| | - L Catalano
- Hematology, Department of Clinical Medicine and Surgery, AOU Federico II, Napoli, Italy
| | - A Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - S Spada
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - P Campbell
- Haematology Department, Cancer Services, Barwon Health, Geelong, Australia
| | - R Ria
- Department of Biomedical Science, University of Bari 'Aldo Moro' Medical School, Internal Medicine 'G. Baccelli' Policlinico, Bari, Italy
| | - M Salvini
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Offidani
- Hematology Department, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - A M Carella
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Martino-Ist, Genova, Italy
| | - P Omedé
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Liberati
- Department of Oncohematology, AO S.Maria di Terni, Terni, Italy
| | - R Troia
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Cafro
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - A Malfitano
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A P Falcone
- Division of Hematology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - T Caravita
- UOC Ematologia S. Eugenio ASL RM2 Roma, Roma, Italy
| | - F Patriarca
- Department of Hematology, Azienda Ospedaliera-Universitaria di Udine, DISM, Università di Udine, Udine, Italy
| | - A Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Spencer
- Department of Clinical Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - R Hajek
- Blood Cancer Research Group, Department of Haematooncology, Faculty Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - A Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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Hájek R, Masszi T, Petrucci MT, Palumbo A, Rosiñol L, Nagler A, Yong KL, Oriol A, Minarik J, Pour L, Dimopoulos MA, Maisnar V, Rossi D, Kasparu H, Van Droogenbroeck J, Yehuda DB, Hardan I, Jenner M, Calbecka M, Dávid M, de la Rubia J, Drach J, Gasztonyi Z, Górnik S, Leleu X, Munder M, Offidani M, Zojer N, Rajangam K, Chang YL, San-Miguel JF, Ludwig H. A randomized phase III study of carfilzomib vs low-dose corticosteroids with optional cyclophosphamide in relapsed and refractory multiple myeloma (FOCUS). Leukemia 2016; 31:107-114. [PMID: 27416912 PMCID: PMC5220126 DOI: 10.1038/leu.2016.176] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/16/2016] [Accepted: 04/28/2016] [Indexed: 02/07/2023]
Abstract
This randomized, phase III, open-label, multicenter study compared carfilzomib monotherapy against low-dose corticosteroids and optional cyclophosphamide in relapsed and refractory multiple myeloma (RRMM). Relapsed and refractory multiple myeloma patients were randomized (1:1) to receive carfilzomib (10-min intravenous infusion; 20 mg/m2 on days 1 and 2 of cycle 1; 27 mg/m2 thereafter) or a control regimen of low-dose corticosteroids (84 mg of dexamethasone or equivalent corticosteroid) with optional cyclophosphamide (1400 mg) for 28-day cycles. The primary endpoint was overall survival (OS). Three-hundred and fifteen patients were randomized to carfilzomib (n=157) or control (n=158). Both groups had a median of five prior regimens. In the control group, 95% of patients received cyclophosphamide. Median OS was 10.2 (95% confidence interval (CI) 8.4-14.4) vs 10.0 months (95% CI 7.7-12.0) with carfilzomib vs control (hazard ratio=0.975; 95% CI 0.760-1.249; P=0.4172). Progression-free survival was similar between groups; overall response rate was higher with carfilzomib (19.1 vs 11.4%). The most common grade ⩾3 adverse events were anemia (25.5 vs 30.7%), thrombocytopenia (24.2 vs 22.2%) and neutropenia (7.6 vs 12.4%) with carfilzomib vs control. Median OS for single-agent carfilzomib was similar to that for an active doublet control regimen in heavily pretreated RRMM patients.
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Affiliation(s)
- R Hájek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - T Masszi
- St István and St László Hospital of Budapest, Budapest, Hungary
| | | | | | - L Rosiñol
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - A Nagler
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - K L Yong
- University College London Cancer Institute, London, UK
| | - A Oriol
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - J Minarik
- University Hospital Olomouc and Medical Faculty of Palacky, University Olomouc, Olomouc, Czech Republic
| | - L Pour
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - M A Dimopoulos
- National and Kapodistrian University of Athens, Athens, Greece
| | - V Maisnar
- Charles University Teaching Hospital, Hradec Králové, Czech Republic
| | - D Rossi
- Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - H Kasparu
- Hospital Elisabethinen Linz, Linz, Austria
| | | | - D B Yehuda
- Hadassah Medical Center, Jerusalem, Israel
| | - I Hardan
- Meir Medical Center, Kfar-Saba, Israel
| | - M Jenner
- Southampton General Hospital, Hampshire, UK
| | - M Calbecka
- Nicolaus Copernicus Hospital, Toruń, Poland
| | - M Dávid
- University of Pécs, Pécs, Hungary
| | - J de la Rubia
- University Hospital La Fe and Universidad Católica de València 'San Vicente Mártir', València, Spain
| | - J Drach
- Medical University of Vienna, Vienna, Austria
| | - Z Gasztonyi
- Petz Aladár Megyei Oktató Kórház, Vasvári Pál, Hungary
| | - S Górnik
- Zamojski Szpital Niepubliczny, Zamosc, Poland
| | - X Leleu
- Hopital Huriez, CHRU, Lille, France
| | - M Munder
- University Medicine Mainz, Mainz, Germany
| | - M Offidani
- Clinica di Ematologia Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
| | - N Zojer
- Center for Oncology, Hematology with Outpatient Department and Palliative Care, Wilhelminenspital, Vienna, Austria
| | - K Rajangam
- Onyx Pharmaceuticals, Inc., an Amgen subsidiary, South San Francisco, CA, USA
| | - Y-L Chang
- Onyx Pharmaceuticals, Inc., an Amgen subsidiary, South San Francisco, CA, USA
| | - J F San-Miguel
- Clínica Universidad de Navarra-CIMA-IDISNA, Navarra, Spain
| | - H Ludwig
- Wilhelminen Cancer Research Institute, Vienna, Austria
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6
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Larocca A, Bringhen S, Petrucci MT, Oliva S, Falcone AP, Caravita T, Villani O, Benevolo G, Liberati AM, Morabito F, Montefusco V, Passera R, De Rosa L, Omedé P, Vincelli ID, Spada S, Carella AM, Ponticelli E, Derudas D, Genuardi M, Guglielmelli T, Nozzoli C, Aghemo E, De Paoli L, Conticello C, Musolino C, Offidani M, Boccadoro M, Sonneveld P, Palumbo A. A phase 2 study of three low-dose intensity subcutaneous bortezomib regimens in elderly frail patients with untreated multiple myeloma. Leukemia 2016; 30:1320-6. [PMID: 26898189 DOI: 10.1038/leu.2016.36] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/19/2016] [Accepted: 02/02/2016] [Indexed: 12/16/2022]
Abstract
This phase 2 trial evaluated three low-dose intensity subcutaneous bortezomib-based treatments in patients ⩾75 years with newly diagnosed multiple myeloma (MM). Patients received subcutaneous bortezomib plus oral prednisone (VP, N=51) or VP plus cyclophosphamide (VCP, N=51) or VP plus melphalan (VMP, N=50), followed by bortezomib maintenance, and half of the patients were frail. Response rate was 64% with VP, 67% with VCP and 86% with VMP, and very good partial response rate or better was 26%, 28.5% and 49%, respectively. Median progression-free survival was 14.0, 15.2 and 17.1 months, and 2-year OS was 60%, 70% and 76% in VP, VCP, VMP, respectively. At least one drug-related grade ⩾3 non-hematologic adverse event (AE) occurred in 22% of VP, 37% of VCP and 33% of VMP patients; the discontinuation rate for AEs was 12%, 14% and 20%, and the 6-month rate of toxicity-related deaths was 4%, 4% and 8%, respectively. The most common grade ⩾3 AEs included infections (8-20%), and constitutional (10-14%) and cardiovascular events (4-12%); peripheral neuropathy was limited (4-6%). Bortezomib maintenance was effective and feasible. VP, VCP and VMP regimens demonstrated no substantial difference. Yet, toxicity was higher with VMP, suggesting that a two-drug combination followed by maintenance should be preferred in frail patients.
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Affiliation(s)
- A Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - S Bringhen
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - M T Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, 'Sapienza' University, Rome, Italy
| | - S Oliva
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - A P Falcone
- IRCCS Casa Sollievo della Sofferenza, Unità di Ematologia, San Giovanni Rotondo, Italy
| | - T Caravita
- UOC Ematologia, Ospedale S Eugenio, Roma, Italy
| | - O Villani
- Unit of Hematology and Stem Cell Transplantation, IRCCS, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (Pz), Italy
| | - G Benevolo
- SC Ematologia, Dipartimento di Ematologia ed Oncologia, AO Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Liberati
- AO S Maria di Terni, SC Oncoematologia, Terni, Italy
| | - F Morabito
- UOC di Ematologia AO Cosenza, Cosenza, Italy
| | - V Montefusco
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Passera
- Division of Nuclear Medicine, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - L De Rosa
- Hematology and SCT Unit, Osp SCamillo, Rome, Italy
| | - P Omedé
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - I D Vincelli
- Azienda Ospedaliera Bianchi Melacrino Morelli, Divisione di Ematologia, Reggio Calabria, Italy
| | - S Spada
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - E Ponticelli
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - D Derudas
- UO Ematologia e Centro Trapianti, Ospedale Oncologico di Riferimento Regionale 'Armando Businco', Cagliari, Italy
| | - M Genuardi
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - T Guglielmelli
- Divisione di Medicina Interna ed Ematologia, AUO San Luigi Gonzaga, Orbassano, Italy
| | - C Nozzoli
- SODc Ematologia, AOU Careggi, Florence, Italy
| | - E Aghemo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - L De Paoli
- Division of Hematology, Department of Translational Medicine Amedeo Avogadro University, Ospedale Maggiore della Carità, Novara, Italy
| | - C Conticello
- Division of Hematology, Azienda Policlinico-OVE, University of Catania, Catania, Italy
| | - C Musolino
- UOC Ematologia, Azienda Ospedaliera Universitaria, G Martino, Messina, Italy
| | - M Offidani
- Clinica di Ematologia AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - P Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - A Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
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7
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Zamagni E, Nanni C, Gay F, Pezzi A, Patriarca F, Bellò M, Rambaldi I, Tacchetti P, Hillengass J, Gamberi B, Pantani L, Magarotto V, Versari A, Offidani M, Zannetti B, Carobolante F, Balma M, Musto P, Rensi M, Mancuso K, Dimitrakopoulou-Strauss A, Chauviè S, Rocchi S, Fard N, Marzocchi G, Storto G, Ghedini P, Palumbo A, Fanti S, Cavo M. 18F-FDG PET/CT focal, but not osteolytic, lesions predict the progression of smoldering myeloma to active disease. Leukemia 2015; 30:417-22. [DOI: 10.1038/leu.2015.291] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/17/2015] [Accepted: 09/29/2015] [Indexed: 12/29/2022]
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8
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Offidani M, Corvatta L, Maracci L, Liberati AM, Ballanti S, Attolico I, Caraffa P, Alesiani F, Caravita di Toritto T, Gentili S, Tosi P, Brunori M, Derudas D, Ledda A, Gozzetti A, Cellini C, Malerba L, Mele A, Andriani A, Galimberti S, Mondello P, Pulini S, Coppetelli U, Fraticelli P, Olivieri A, Leoni P. Efficacy and tolerability of bendamustine, bortezomib and dexamethasone in patients with relapsed-refractory multiple myeloma: a phase II study. Blood Cancer J 2013; 3:e162. [PMID: 24270324 PMCID: PMC3880441 DOI: 10.1038/bcj.2013.58] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 09/25/2013] [Indexed: 11/25/2022] Open
Abstract
Bendamustine demonstrated synergistic efficacy with bortezomib against multiple myeloma (MM) cells in vitro and seems an effective treatment for relapsed-refractory MM (rrMM). This phase II study evaluated bendamustine plus bortezomib and dexamethasone (BVD) administered over six 28-day cycles and then every 56 days for six further cycles in patients with rrMM treated with ⩽4 prior therapies and not refractory to bortezomib. The primary study end point was the overall response rate after four cycles. In total, 75 patients were enrolled, of median age 68 years. All patients had received targeted agents, 83% had 1–2 prior therapies and 33% were refractory to the last treatment. The response rate⩾partial response (PR) was 71.5% (16% complete response, 18.5% very good PR, 37% partial remission). At 12 months of follow-up, median time-to-progression (TTP) was 16.5 months and 1-year overall survival was 78%. According to Cox regression analysis, only prior therapy with bortezomib plus lenalidomide significantly reduced TTP (9 vs 17 months; hazard ratio=4.5; P=0.005). The main severe side effects were thrombocytopenia (30.5%), neutropenia (18.5%), infections (12%), neuropathy (8%) and gastrointestinal and cardiovascular events (both 6.5%). The BVD regimen is feasible, effective and well-tolerated in difficult-to-treat patients with rrMM.
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Affiliation(s)
- M Offidani
- Clinica di Ematologia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
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9
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Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia 2013; 28:222-5. [PMID: 23958922 DOI: 10.1038/leu.2013.241] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- P Musto
- Scientific Direction, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - V Simeon
- Laboratory of Pre-clinical and Translational Research, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - M C Martorelli
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - M T Petrucci
- Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy
| | - N Cascavilla
- Division of Hematology and Stem Cell Transplantation, Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - F Di Raimondo
- Division of Hematology, Department of Biomedical Sciences, Azienda Ospedaliera Ferrarotto, University of Catania, Catania, Italy
| | - T Caravita
- Department of Hematology, Azienda Ospedaliera S. Eugenio, Tor Vergata University, Rome, Italy
| | - F Morabito
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - M Offidani
- Hematology Clinic, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - A Olivieri
- Hematology and Medicine Clinic, Marche Polytechnic University, Ancona, Italy
| | - G Benevolo
- Hematology 2, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - R Mina
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - R Guariglia
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - G D'Arena
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - G Mansueto
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - N Filardi
- Unit of Hematology, San Carlo Hospital, Potenza, Italy
| | - F Nobile
- Division of Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - A Levi
- Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy
| | - A Falcone
- Division of Hematology and Stem Cell Transplantation, Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - M Cavalli
- Division of Hematology, Department of Biomedical Sciences, Azienda Ospedaliera Ferrarotto, University of Catania, Catania, Italy
| | - G Pietrantuono
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - O Villani
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - S Bringhen
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - P Omedè
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - R Lerose
- Pharmacy Unit, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - L Agnelli
- Department of Clinical Sciences and Community Health, University of Milan; Hematology 1, Fondazione Ca' Grande Ospedale Maggiore Policlinico, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - K Todoerti
- Laboratory of Pre-clinical and Translational Research, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - A Neri
- Department of Clinical Sciences and Community Health, University of Milan; Hematology 1, Fondazione Ca' Grande Ospedale Maggiore Policlinico, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - M Boccadoro
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - A Palumbo
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
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Guglielmelli T, Bringhen S, Rrodhe S, Gay F, Cavallo F, Berruti A, Montefusco V, Piro E, Benevolo G, Petrucci MT, Caravita T, Offidani M, Corradini P, Boccadoro M, Saglio G, Palumbo A. Previous thalidomide therapy may not affect lenalidomide response and outcome in relapse or refractory multiple myeloma patients. Eur J Cancer 2011; 47:814-8. [PMID: 21334196 DOI: 10.1016/j.ejca.2010.12.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 12/23/2010] [Accepted: 12/23/2010] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Lenalidomide is a thalidomide analogue, designed to have improved efficacy and tolerability over the parent drug. The aim of this retrospective analysis is to evaluate the impact of thalidomide therapy on lenalidomide response and outcome in relapse or refractory multiple myeloma patients. PATIENTS AND METHODS A total of 106 relapsed or refractory multiple myeloma patients received lenalidomide 25mg plus dexamethasone as salvage therapy; 80 patients progressed on thalidomide treatment (thalidomide-resistant) and 26 patients discontinued thalidomide in at least partial remission (thalidomide-sensitive). Median time from diagnosis to lenalidomide treatment was 57 months. Median prior lines of therapies were 3, range 1-6. 62% of patients were previously treated with autologous stem cell transplantation, and 71% with bortezomib-based regimens. RESULTS In the thalidomide-resistant and -sensitive groups, the at least partial response rates were 56.2% and 61.5% (P = .45), including at least VGPR rates of 16.2% and 11.5%; the median progression free survival was 10 and 12 months (P=.12) and the median overall survival was 17 and 18.5 months (P = .50), respectively. CONCLUSION Lenalidomide may be equally effective in heavily pre-treated multiple myeloma patients who are thalidomide-resistant or thalidomide-sensitive to a previous therapy.
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Affiliation(s)
- T Guglielmelli
- Department of Clinical and Biological Sciences, University of Turin and San Luigi Hospital, Orbassano, Turin, Italy.
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11
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Pagano L, Caira M, Offidani M, Martino B, Candoni A, Valentini CG, Specchia G, Nosari A, Tosti ME, Leone G, Luppi M, Aversa F. Adherence to international guidelines for the treatment of invasive aspergillosis in acute myeloid leukaemia: feasibility and utility (SEIFEM-2008B study). J Antimicrob Chemother 2010; 65:2013-8. [DOI: 10.1093/jac/dkq240] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Boccadoro M, Bringhen S, Gaidano G, Ria R, Offidani M, Patriarca F, Nozzoli C, Musto P, Petrucci M, Palumbo AP. Bortezomib, melphalan, prednisone, and thalidomide (VMPT) followed by maintenance with bortezomib and thalidomide (VT) for initial treatment of elderly multiple myeloma patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8013] [Citation(s) in RCA: 2] [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
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13
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Pagano L, Fianchi L, Fanci R, Candoni A, Caira M, Posteraro B, Morselli M, Valentini C, Farina G, Mitra M, Offidani M, Sanguinetti M, Tosti M, Nosari A, Leone G, Viale P. Caspofungin for the treatment of candidaemia in patients with haematological malignancies. Clin Microbiol Infect 2010; 16:298-301. [DOI: 10.1111/j.1469-0691.2009.02832.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Offidani M, Corvatta L, Malerba L, Marconi M, Leoni P. Infectious Complications in Adult Acute Lymphoblastic Leukemia (ALL): Experience at One Single Center. Leuk Lymphoma 2009; 45:1617-21. [PMID: 15370214 DOI: 10.1080/10428190410001683660] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Literature provides no specific data concerning the type and the risk factors for infection in adult patients with acute lymphoblastic leukemia (ALL). We retrospectively analyzed 97 adult ALL patients who underwent conventional chemotherapy during a 14-year period with the aim to assess the incidence and the factors affecting onset and outcome of infections. We found that during induction therapy 50% of patients developed infection, mainly caused by gram-negative bacteria and with a mortality rate of 11%. In multivariate analysis age > 60 years was significantly associated with more infections (P = 0.04) and higher related mortality (P = 0.03). Moreover, in 22% of patients infectious complications occurred during consolidation or maintenance therapy. Mortality rate of these infections, mostly due to opportunistic pathogens, was 16%. Factors affecting mortality was the cumulative dose of methylprednisolone given during induction therapy ( < or = 2600 mg = 31% vs. > 2600 mg = 69%; P = 0.03). Among neutropenic patients, adults with ALL represent a peculiar population since they frequently develop gram negative infections during induction and opportunistic infections during post-remission treatments. Advanced age and high-dose methylprednisolone result the major risk factors for infection related mortality in the former therapeutic phase and in the latter one, respectively.
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Affiliation(s)
- M Offidani
- Clinica di Ematologia, Università Politecnica delle Marche, Azienda Ospedaliera Umberto I, Ancona, Italy.
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15
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Palumbo AP, Falco P, Corradini P, Crippa C, Patriarca F, Rossini F, Offidani M, Liberati AM, Petrucci MT, Boccadoro M. Bortezomib, pegylated-lyposomal-doxorubicin and dexamethasone (PAD) as induction therapy prior to reduced intensity autologous stem cell transplant (ASCT) followed by lenalidomide and prednisone (LP) as consolidation and lenalidomide alone as maintenance. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Pagano L, Caira M, Nosari A, Van Lint MT, Candoni A, Offidani M, Aloisi T, Irrera G, Bonini A, Picardi M, Caramatti C, Invernizzi R, Mattei D, Melillo L, de Waure C, Reddiconto G, Fianchi L, Valentini CG, Girmenia C, Leone G, Aversa F. Fungal infections in recipients of hematopoietic stem cell transplants: results of the SEIFEM B-2004 study--Sorveglianza Epidemiologica Infezioni Fungine Nelle Emopatie Maligne. Clin Infect Dis 2007; 45:1161-70. [PMID: 17918077 DOI: 10.1086/522189] [Citation(s) in RCA: 299] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 07/06/2007] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The purpose of our study was to evaluate the incidence and outcome of invasive fungal infection (IFI) among patients who underwent autologous or allogeneic hematopoietic stem cell transplantation (HSCT) at 11 Italian transplantation centers. METHODS This cohort-retrospective study, conducted during 1999-2003, involved HSCT patients admitted to 11 tertiary care centers or university hospitals in Italy, who developed IFIs (proven or probable). RESULTS Among 3228 patients who underwent HSCT (1249 allogeneic HSCT recipients and 1979 autologous HSCT recipients), IFI occurred in 121 patients (overall incidence, 3.7%). Ninety-one episodes (2.8% of all patients) were due to molds, and 30 (0.9%) were due to yeasts. Ninety-eight episodes (7.8%) occurred among the 1249 allogeneic HSCT recipients, and 23 (1.2%) occurred among the 1979 autologous HSCT recipients. The most frequent etiological agents were Aspergillus species (86 episodes) and Candida species (30 episodes). The overall mortality rate was 5.7% among allogeneic HSCT recipients and 0.4% among autologous HSCT recipients, whereas the attributable mortality rate registered in our population was 65.3% (72.4% for allogeneic HSCT recipients and 34.7% for autologous HSCT recipients). Etiology influenced the patients' outcomes: the attributable mortality rate for aspergillosis was 72.1% (77.2% and 14.3% for allogeneic and autologous HSCT recipients, respectively), and the rate for Candida IFI was 50% (57.1% and 43.8% for allogeneic and autologous HSCT recipients, respectively). CONCLUSIONS IFI represents a common complication for allogeneic HSCT recipients. Aspergillus species is the most frequently detected agent in these patients, and aspergillosis is characterized by a high mortality rate. Conversely, autologous HSCT recipients rarely develop aspergillosis, and the attributable mortality rate is markedly lower. Candidemia was observed less often than aspergillosis among both allogeneic and autologous HSCT recipients; furthermore, there was no difference in either the incidence of or the attributable mortality rate for candidemia among recipients of the 2 transplant types.
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Affiliation(s)
- L Pagano
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italia.
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17
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Olivieri A, Scortechini I, Capelli D, Montanari M, Lucesole M, Gini G, Troiani M, Offidani M, Poloni A, Masia MC, Raggetti GM, Leoni P. Combined administration of alpha-erythropoietin and filgrastim can improve the outcome and cost balance of autologous stem cell transplantation in patients with lymphoproliferative disorders. Bone Marrow Transplant 2004; 34:693-702. [PMID: 15300235 DOI: 10.1038/sj.bmt.1704643] [Citation(s) in RCA: 9] [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: 11/09/2022]
Abstract
We compared the use of G-CSF plus EPO in a group of 32 multiple myeloma and lymphoma patients with historical controls receiving G-CSF alone. Haemopoietic reconstitution was significantly faster in patients receiving G-CSF+EPO (group B), with a median time of 10 days to achieve an ANC count >0.5 x 10(9)/l, compared to 11 days in the historical group (A). The median duration of severe neutropenia (ANC count <100/ml) was significantly shorter in group B compared to group A; platelet counts >20 x 10(9) and >50 x 10(9)/l were achieved at days + 13 and + 17, respectively in group B, compared to days + 14 and + 24, respectively, in group A (P = 0.015, 0.002) patients. The transfusion requirement was reduced in group B, with 0 (0-6) RBC units and 1 (0-5) platelet unit transfused in group B vs 2 RBC (0-9) and 2 platelet units (0-8) in group A. Median days of fever, antibiotic therapy and hospital stay were reduced in group B (9.5 days vs 22). The mean cost of autotransplantation per group A patient was 23,988 Euro, compared with 18,394 Euro for a group B patient. Our study suggests that the EPO + G-CSF combination not only accelerates engraftment kinetics, but can also improve the clinical course of ASCT.
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Affiliation(s)
- A Olivieri
- Clinica di Ematologia, Università Politecnica delle Marche, Ospedale Torrette di Ancona, Via Conca 1 ZIP Code, 60020, Italy.
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18
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Pagano L, Pulsoni A, Tosti ME, Caramatti C, Cerri R, Falcucci P, Fazi P, Fianchi L, Martino B, Mattei D, Offidani M, Pacilli L, Pogliani EM, Rotoli B, Specchia G, Visani G, Vignetti M, Voso MT, Leone G, Mandelli F. Second malignancy after treatment of adult acute myeloid leukemia: cohort study on adult patients enrolled in the GIMEMA trials. Leukemia 2004; 18:651-3. [PMID: 14749702 DOI: 10.1038/sj.leu.2403276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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19
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Offidani M, Mele A, Corvatta L, Marconi M, Malerba L, Olivieri A, Rupoli S, Alesiani F, Leoni P. Gemcitabine alone or combined with cisplatin in relapsed or refractory multiple myeloma. Leuk Lymphoma 2002; 43:1273-9. [PMID: 12152996 DOI: 10.1080/10428190290026330] [Citation(s) in RCA: 9] [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: 10/28/2022]
Abstract
Gemcitabine is a pyrimidine nucleoside analog with antitumor activity against solid tumor malignancies and leukemia. We evaluated its activity as a single agent and combining it with cisplatin in relapsed-refractory multiple myeloma (MM). Sixteen patients with advanced MM received intravenous gemcitabine 1250 mg/mq (days 1, 8 and 15) as a single agent for a total of 3 monthly courses. The responders received another three courses, and the non-responders received three courses of gemcitabine 1000 mg/mq (days 1, 8 and 15) plus cisplatin 80 mg/mq (day 1). No grade 4 hematological toxicity was seen after gemcitabine treatment, whereas > or = 3 grade neutropenia and thrombocytopenia were seen in 21 and 13% of the gemcitabine-cisplatin infusions, respectively. Non-hematological toxicity was negligible for both the regimens. After three courses of gemcitabine as a single agent, th e response rate was 31% (1 complete response, 1 partial response and 3 minimal response). Eight patients (50%) achieved stable disease and 3 (19%) had disease progression. Ten patients received gemcitabine-cisplatin and were evaluable for the response. Two patients progressed, four maintained stable disease whereas four patients, unresponsive to gemcitabine, obtained a response (3 partial response and 1 minimal response). With a median follow-up of 13 months (range 8-17.5), 7 patients (44%) died, 5 (31%) had disease progression, 1 (6%) relapsed, 1 was still in partial response (+11 months) and 2 (13%) had a stable disease. Median time to treatment failure (TTF) was 8 months (CI95%: 7.6-8.4) and median overall survival (OS) was 16 months (CI95%: 10-22). These results showed that gemcitabine and gemcitabine-cisplatin were feasible regimens and well tolerated in advanced relapsed-refractory MM. The response rates, the TTF and OS were similar to other salvage chemotherapy regimens; nevertheless, the quality of response was modest particularly after gemcitabine alone. Better results might be obtained combining gemcitabine with other chemotherapy compounds or with biologically based therapies.
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Affiliation(s)
- M Offidani
- Clinica di Ematologia, Ancona University, Umberto I Hospital, Italy.
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20
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Offidani M, Corvatta L, Olivieri A, Mele A, Brunori M, Montanari M, Rupoli S, Scalari P, Leoni P. A predictive model of varicella-zoster virus infection after autologous peripheral blood progenitor cell transplantation. Clin Infect Dis 2001; 32:1414-22. [PMID: 11317241 DOI: 10.1086/320157] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2000] [Revised: 09/15/2000] [Indexed: 11/03/2022] Open
Abstract
Varicella-zoster virus (VZV) frequently causes severe infections in patients who have undergone bone marrow transplantation. The frequency of, characteristics of, and risk factors for this infection were studied in 164 patients undergoing autologous peripheral blood progenitor cell transplantation (PBPCT). Twenty-six patients (15.8%) developed VZV infection, and the actuarial risk was 10% at 1 year. No patient had visceral dissemination or died because of VZV, although one-third of the patients developed postherpetic neuralgia. By multivariate analysis, a CD4(+) lymphocyte count of <200 cells/microL (P<.0001; odds ratio [OR], 2.0) and a CD8(+) lymphocyte count of <800 cells/microL (P=.0073; OR, 2.0) at day 30 after transplantation were factors associated with VZV infection. Patients with both these adverse factors had an actuarial risk of VZV of 48% at 1 year. Patients with deficiency in both CD4(+) and CD8(+) lymphocytes are at high risk of VZV infection. These patients should be considered as candidates for preventive therapy, but whether for antiviral therapy or vaccination remains to be investigated.
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Affiliation(s)
- M Offidani
- Department of Hematology, Ancona University School of Medicine, Ancona, Italy.
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21
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Capelli D, Santini G, De Souza C, Poloni A, Marino G, Montanari M, Lucesole M, Brunori M, Massidda D, Offidani M, Leoni P, Olivieri A. Amifostine can reduce mucosal damage after high-dose melphalan conditioning for peripheral blood progenitor cellautotransplant: a retrospective study. Br J Haematol 2000; 110:300-7. [PMID: 10971385 DOI: 10.1046/j.1365-2141.2000.02149.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Amifostine (WR-2721; Ethyol) is a well-known cytoprotector, but a possible role in preventing extrahaematological toxicity after high-dose therapy (HDT) has never been investigated. We compared two historical groups of patients who either received (group A, n = 35) or did not receive (group B, n = 33) amifostine (740 mg/m2) before high-dose (HD) melphalan, followed by autologous infusion of peripheral blood progenitor cells (PBPCs). Amifostine was well tolerated at this dose level. Emesis grade 1-2 was the most important side-effect, but the interruption of infusion was never required. The incidence and median duration of severe mucositis (grade 3-4) was 21% and 0 d (range 0-11 d) in group A and 53% and 7 d (range 0-11 d) in group B. The duration of analgesic therapy was also significantly lower in group A (0 d; range 0-12) than in group B (6 d, range 0-20) (P = 0.0001). Severe diarrhoea (3% vs. 25%; P = 0.01) and emesis (9% vs. 34%; P = 0.01) were also reduced in group A in comparison with group B. No differences were observed between the two groups for haematological recovery. This retrospective study strongly suggests that amifostine can reduce severe mucositis and the use of analgesic drugs in this setting. A randomized study is warranted to confirm these preliminary results.
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Affiliation(s)
- D Capelli
- Department of Haematology, University of Ancona, Torrette Hospital, Ancona, Italy.
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22
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Offidani M, Corvatta L, Olivieri A, Rupoli S, Frayfer J, Mele A, Manso E, Montanari M, Centurioni R, Leoni P. Infectious complications after autologous peripheral blood progenitor cell transplantation followed by G-CSF. Bone Marrow Transplant 1999; 24:1079-87. [PMID: 10578158 DOI: 10.1038/sj.bmt.1702033] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Infectious complications after autologous peripheral blood progenitor cell transplantation (PBPCT) have been reported in a few studies including small patient numbers. The present study was performed to assess the incidence, types, outcome and factors affecting early and late infections in 150 patients aged 18 to 68 years (median 46.5) who underwent high-dose therapy, with G-CSF. Patients were kept in reverse isolation rooms and received antimicrobial chemoprophylaxis with oral quinolone and fluconazole. One hundred and fifteen patients (76.7%) developed fever (median 3 days, range 1-29); 20 patients (55.5%) had Gram-positive and 13 (36. 2%) Gram-negative bacterial infections. There were no fungal infections or infection-related deaths. Mucositis grade II-IV (P = 0. 0001; odds ratio 3.4) and >5 days on ANC <100/microl (P = 0.0001; odds ratio 2.3) correlated with development of infection. Only days with ANC <100/microl affected infection outcome (P = 0.0024) whereas the antibiotic regimen did not. After day +30 there were four cases of bacterial pneumonitis (2.7%), one case of fatal CMV pneumonia (0. 8%) and 20 of localized VZV infection (13.3%). Reduction of neutropenia duration with PBPCT and G-CSF is not enough to prevent early infectious complications since only a few days of severe neutropenia and mucositis are related to development of early infections. However, no infection-related deaths were seen. Although Gram-positive organisms were the major cause of bacteremia, a glycopeptide in the empirical antibiotic regimen did not affect infection outcome. In PBPCT recipients, early and late opportunistic infections were notably absent, which was at variance with what was seen with bone marrow recipients. Efforts should be made to prevent mucositis and neutropenia and identify new strategies of antibacterial prophylaxis.
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Affiliation(s)
- M Offidani
- Department of Hematology, Ancona University School of Medicine, Ancona, Italy
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23
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Rupoli S, Barulli S, Guiducci B, Offidani M, Mozzicafreddo G, Simonacci M, Filosa G, Giacchetti A, Ricotti G, Brandozzi G, Cataldi I, Serresi S, Ceschini R, Bugatti L, Offidani A, Giangiacomi M, Brancorsini D, Leoni P. Low dose interferon-alpha2b combined with PUVA is an effective treatment of early stage mycosis fungoides: results of a multicenter study. Cutaneous-T Cell Lymphoma Multicenter Study Group. Haematologica 1999; 84:809-13. [PMID: 10477454] [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: 02/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The early stages of mycosis fungoides (MF) can be treated but not cured by photochemotherapy (PUVA) alone; some recent studies of the effect of a combination of human interferon-alpha (IFN(alpha)) and PUVA reported a high degree of response. The aim of our study was to evaluate the activity of a low dose of IFN-alpha2b combined with PUVA. DESIGN AND METHODS Twenty-five patients were included: 16 men and 9 women aged between 23-80 years; 19 patients ahd stage I and 6 stage II disease. In the induction phase, the dose of IFNalpha was gradually raised over 6-8 weeks to the target dose of 18 MU/week; in the maintenance phase, the combination with PUVA allowed IFNalpha to be reduced to a maximum dose of 6 MU/week; in this way the cumulative administration of IFNalpha and PUVA was considerably lower than in similar combination protocols. Treatment success was analyzed in terms of freedom from treatment failure (FFTF). RESULTS After the induction phase 9/25 patients (36%) achieved complete remission (CR) and 15/25 (56%) achieved partial remission (PR). One to five months from the beginning of the maintenance phase, a CR was recorded in 19/25 patients (76%) and a PR in 5/25 patients (20%) accounting for an overall response rate of 96%. The median of FFTF was not reached; probability of FFTF was 82% at 12 months and 62% at 24 months. Disease free survival projected to 48 months was 75%. INTERPRETATION AND CONCLUSIONS Even with low doses of IFNalpha plus PUVA it is possible to achieve excellent clinical responses,many of which are long-lasting, in patients with early MF.
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Affiliation(s)
- S Rupoli
- Clinica di Ematologia Ospedale Generale Regionale 60020, Torrette di Ancona, Italy.
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Mele A, Offidani M, Corvatta L, Leoni P. [Idiopathic thrombocytopenic purpura: diagnostic-therapeutic approach in adults, children and pregnant women]. Recenti Prog Med 1999; 90:482-7. [PMID: 10544671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Idiopathic thrombocytopenic purpura (ITP) is an acquired haematologic disorder, common among children and adults, with unknown etiology and autoimmune pathogenesis. Nowadays, appropriate diagnostic and treatment strategies are still uncertain; therefore, the attending physicians behaviour in front of thrombocytopenic patients remains heterogeneous. Through a Medline research, we selected eighteen scientific works with practical application. Some of these studies tried to settle the diagnostic-therapeutic approach to thrombocytopenic patient by adopting specific guidelines developed by skilled medical panels. In this review we describe the main features of ITP in adults, in children and pregnant women and we also synthetize the diagnostic-therapeutic behaviours for which there is a sufficient agreement in order to standardize ITP patients management reducing unsuitable diagnostic tests and therapies and the costs too.
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Affiliation(s)
- A Mele
- Clinica di Ematologia Università Ospedale Regionale Torrette, Ancona
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Olivieri A, Corvatta L, Montanari M, Brunori M, Offidani M, Ferretti GF, Centanni M, Leoni P. Paroxysmal atrial fibrillation after high-dose melphalan in five patients autotransplanted with blood progenitor cells. Bone Marrow Transplant 1998; 21:1049-53. [PMID: 9632280 DOI: 10.1038/sj.bmt.1701217] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Among the drugs used in conditioning regimens for stem cell transplantation, high-dose melphalan (HDM) plays an important role for both its strong myeloablative effect and for its favourable dose-response ratio. Here we report five cases of high frequency atrial fibrillation (AF) developing after HDM. Duration of the arrhythmia was always very short, beginning at variable intervals after the administration of HDM, in the absence of other factors potentially able to trigger AF. In all patients sinus rhythm was restored within 72 h and the follow-up did not show any cardiac damage. To the best of our knowledge, this side-effect has never been reported to occur after HDM.
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Affiliation(s)
- A Olivieri
- Clinica di Ematologia, Università di Ancona, Italy
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26
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Olivieri A, Offidani M, Montanari M, Ciniero L, Cantori I, Ombrosi L, Masia CM, Centurioni R, Mancini S, Brunori M, Leoni P. Factors affecting hemopoietic recovery after high-dose therapy and autologous peripheral blood progenitor cell transplantation: a single center experience. Haematologica 1998; 83:329-37. [PMID: 9592983] [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: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE While the minimum number of CD34+ cells required for complete and long-lasting engraftment is quite well established, there is not general agreement about the optimal number of CD34+ per kg needed in order to obtain engraftment as rapidly as possible. In the present study we assess factors affecting hemopoietic recovery and the optimal peripheral blood progenitor cell (PBPC) number for rapid engraftment in patients treated with high-dose therapy. DESIGN AND METHODS We enrolled 80 consecutive patients affected by hematologic and non-hematologic malignancies treated with a median of 10 chemotherapy courses (range 3-38). PBPC collection was performed after mobilization with high-dose chemotherapy and G-CSF 5 micrograms/kg/day. The circulating and harvested CD34+ cells were recognized in the cytofluorimetric CD45+/CD14- lymphocyte gate. After myeloablative therapy, PBPC infusion was followed by G-CSF 5 micrograms/kg/day from day +5 until WBC > or = 5.0 x 10(9)/L. Univariate and multivariate Cox analyses were performed to investigate factors affecting hemopoietic recovery. The Kaplan-Meier probabilities of hemopoietic reconstitution were compared by log-rank test to assess the optimal CD34+ cell number for rapid engraftment. RESULTS We performed a median of two apheresis (range 1-4) per patient and we infused a median of 6.1 x 10(6) CD34+ cells/kg (range 0.5-30.5). Absolute neutrophil count (ANC) > 0.5 x 10(9)/L was reached after 11 days (range 8-15). The only factor affecting granulocyte recovery proved to be the CD34+ cell number; 5.0 to 7.8 x 10(6) CD34+ cells/kg allowed a significantly faster granulocyte recovery than < 2.5 x 10(6) CD34+ cells/kg (p = 0.0312). Platelet transfusion independence (> 20 x 10(9)/L) and 50 x 10(9)/L platelets were reached after 12 (range 8-24) and 15 days (range 9-40), respectively. The CD34+ cell number was also the only factor affecting platelet recovery; the number of 5.0 to 7.8 CD34+ cells/kg allowed a significantly faster platelet recovery than the lower dose, whereas a higher number did not. No late graft failures were observed. Patients receiving 5.0 to 7.8 x 10(9) CD34+ cells/kg had a significantly shorter duration of neutropenia, fewer platelet transfusions and less time spent in hospital than those receiving lower number did, whereas patients transplanted with a higher number had no advantage. INTERPRETATION AND CONCLUSIONS When G-CSF is employed both for PBPC mobilization and after PBPC transplantation, the CD34+ cell number is the only factor that affects hemopoietic recovery. Moreover, > 5.0 x 10(6) CD34+ cells/kg is the optimal number for obtaining rapid platelet recovery and reducing the costs of HDT but there is no advantage exceeding the threshold of 7.8 x 10(6) CD34+ cells/kg.
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Affiliation(s)
- A Olivieri
- Department of Hematology, University of Ancona, Italy
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27
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Offidani M, Olivieri A, Montillo M, Rupoli S, Centurioni R, Alesiani F, Marchegiani G, Pieroni S, Catarini M, Pelliccia G, Altilia F, Leoni P. Two dosage interferon-alpha 2b maintenance therapy in patients affected by low-risk multiple myeloma in plateau phase: a randomized trial. Haematologica 1998; 83:40-7. [PMID: 9542322] [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: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The role of interferon (IFN) in the remission phase of multiple myeloma (MM) is still an open question, particularly for its scheduling and the subset of patients who could benefit from this approach. The present randomized multicenter study was designed to compare two schedules of IFN maintenance therapy in order to assess the difference in effectiveness and tolerance. DESIGN AND METHODS This prospective randomized multicenter study was attempted to assess the best schedule of IFN administration in the maintenance treatment of MM in plateau phase with regard to progression free survival (PFS) and toxicity. The second aim was defining the difference between the two schedules in overall survival (OS) and identifying the critical dose of IFN therapy needed to prolong plateau phase and survival. We enrolled 52 patients affected with low-risk MM (i.e. with serum beta 2-microglobulin < 6.0 mg/L and serum albumin > 3.0 g/dL); 27 patients (group A) were randomly assigned to receive IFN alpha-2b 3 megaunits (MU) subcutaneously three times a week and 25 patients (group B) 3 MU/day until disease progression. RESULTS Median progression free survival (PFS) was 11.9 months in group A and 38.3 months in group B (p = 0.0038). Median survival was 63.2 months in group A and 61.9 months in group B (p = 0.489). However, those patients who were given an IFN dose > or = 30 MU/month experienced a significantly longer PFS and survival than the other patients. Seventeen patients (32.7%) discontinued therapy and sixteen patients (30.8%) reduced IFN alpha-2b dose because of severe side effects without having a significant difference between the two schedules. INTERPRETATION AND CONCLUSIONS Our results show that patients treated with IFN alpha 3 MU/day had a significantly longer remission duration than patients treated with IFN alpha 3 MU three times weekly. Moreover, an IFN dose is probably critical for obtaining a longer survival in patients affected with low-risk MM. Since the patients' discomfort during a IFN maintenance therapy was frequently experienced the quality of their lives should be carefully taken into account.
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Affiliation(s)
- M Offidani
- Clinica di Ematologia, Ancona University, Ospedale Torrette, Torrette di Ancona, Italy
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28
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Olivieri A, Offidani M, Cantori I, Ciniero L, Ombrosi L, Masia MC, Brunori M, Montroni M, Leoni P. Addition of erythropoietin to granulocyte colony-stimulating factor after priming chemotherapy enhances hemopoietic progenitor mobilization. Bone Marrow Transplant 1995; 16:765-70. [PMID: 8750267] [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: 02/02/2023]
Abstract
Hemopoietic progenitor cell mobilization intended for autotransplantation is now feasible in many patients, following the administration of single cytokines (G-CSF, GM-CSF, IL-3) or their combination. Erythropoietin (EPO) is a cytokine which showed an interesting activity also on non-erythroid progenitors, however the clinical relevance of this activity has not been sufficiently investigated yet. This retrospective study has attempted to assess the effectiveness of the combination of EPO plus G-CSF after priming chemotherapy to increase the number of blood progenitor cells, as compared to the results obtained by G-CSF alone. Thirty-four patients underwent priming chemotherapy followed by cytokine administration: 18 patients received G-CSF 5 micrograms/kg/day and 16 patients G-CSF plus EPO 50 U/kg/day. The two groups were homogeneous as regards the main clinical characteristics which are thought to affect BPC mobilization. As for hemopoietic progenitor cell mobilization, we observed that the combination of EPO and G-CSF was more effective in comparison with G-CSF alone, with a median of 1.9-fold for circulating MNC, 4.0-fold for CFU-GM, 4.7-fold for BFU-E and 2.8-fold increase for CD34+ cells. The results of apheresis collections revealed that the same group of patients showed better results for total blood progenitor cells/kg. The difference was statistically significant both for BPC mobilization and collection. Our findings suggest that EPO has a synergistic activity with G-CSF in mobilizing hemopoietic progenitors; the good results obtained, despite our pretreated patients, suggest that this cytokine combination has both biologic and clinical relevance.
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Affiliation(s)
- A Olivieri
- Clinica di Ematologia, Università di Ancona, Italy
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29
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Dessi-Fulgheri P, Catalini R, Sarzani R, Sturbini S, Siragusa N, Guazzarotti F, Offidani M, Tamburrini P, Zingaretti O, Rappelli A. Angiotensin converting enzyme gene polymorphism and carotid atherosclerosis in a low-risk population. J Hypertens 1995; 13:1593-6. [PMID: 8903616] [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: 02/02/2023]
Abstract
OBJECTIVES Angiotensin converting enzyme (ACE) insertion/deletion (I/D) polymorphism has been shown to be an independent risk factor for myocardial infarction and other cardiovascular diseases. The aim of the study was to investigate the relationship between ACE genotype and carotid atherosclerosis evaluated by ultrasonography. PATIENTS AND METHODS ACE I/D polymorphism was determined in 240 low-risk patients (mean age 53.6 +/- 7 years) in relation to traditional risk factors and the degree of carotid atherosclerosis. Intimal-medial thickness was measured at the level of the common carotid artery, bifurcation and internal carotid on both sides. Patients were defined as normal (n = 47, intimal-medial thickness <1.0 mm), thickened (n = 56, intimal-medial thickness > or = 1.0 and < or = 1.3 mm in the thickest wall) or with an atherosclerotic plaque (n = 137, intimal-medial thickness >1.3 mm for at least one level of examination). Age, sex, body mass index, blood pressure levels and prevalence of other risk factors were similar in the three groups. I/D polymorphism was determined by polymerase chain reaction using specific primers and genomic DNA from leukocytes as template. Plasma ACE levels, plasma renin activity and plasma aldosterone were evaluated in all patients by standard procedures. RESULTS No significant differences were found in humoral parameters, ACE, genotype distribution and the corresponding allele frequency among the three groups of patients. Only ACE plasma levels were significantly higher in the DD and ID genotypes compared with the II genotype (DD 14.27 +/- 5.05 IU/ml, ID 12.70 +/- 4.31 IU/ml; II 8.04 +/- 3.45 IU/ml). The mean intimal-medial thickness was similar in all three genotypes. CONCLUSION Although ACE genotype has been shown to be related to coronary atherosclerosis, the present data do not indicate that the DD genotype is associated with carotid atherosclerosis. However, further studies of larger populations are needed to clarify whether genetic ACE polymorphism is associated with carotid atherosclerosis.
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Olivieri A, Offidani M, Ciniero L, Cantori I, Ombrosi L, Mancini S, Masia MC, Scalari P, Leoni P. DHAP regimen plus G-CSF as salvage therapy and priming for blood progenitor cell collection in patients with poor prognosis lymphoma. Bone Marrow Transplant 1995; 16:85-93. [PMID: 7581135] [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: 01/26/2023]
Abstract
We studied 14 patients affected by lymphoma to assess the toxicity, efficacy and mobilization capability of salvage DHAP regimen followed by G-CSF 5 micrograms/kg/day. Ten patients were affected by intermediate-grade NHL and 4 by HD; all of them were in relapse or in PR. We administered a total of 34 courses of DHAP plus G-CSF (median 2 per patient; range 1-5) and did not observe either life-threatening extrahematologic toxicity or severe infections during the short neutropenic period. A significant tumor burden reduction was observed in 86% of patients (50% CR, 36% PR). A total of 35 aphereses were performed (median 3 per patient; range 1-5). The hemopoietic progenitors showed a very rapid increase from day +11 with a synchronous and impressive peak on day +13. We collected a median of 2.6 x 10(6)/kg CD34+ cells, 10 x 10(4)/kg CFU-GM, 5 x 10(4)/kg BFU-E and 0.5 x 10(4)/kg CFU-GEMM per apheresis. All patients transplanted with PBPC had a rapid and sustained hematological recovery. The DHAP regimen followed by G-CSF proved to be a very effective and well-tolerated schedule for debulking disease before transplantation and for enhancing progenitor cell mobilization.
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Affiliation(s)
- A Olivieri
- Department of Hematology, University of Ancona, Italy
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Olivieri A, Offidani M, Ciniero L, Poloni A, Masia MC, Salvi A, Leoni P. Optimization of the yield of PBSC for autotransplantation mobilized by high-dose chemotherapy and G-CSF: proposal for a mathematical model. Bone Marrow Transplant 1994; 14:273-8. [PMID: 7527687] [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: 01/25/2023]
Abstract
We analyzed the results of 71 leukapheresis procedures performed in 21 patients to identify the best predictive factors affecting the yield of peripheral blood progenitors after high-dose chemotherapy followed by G-CSF administration. An average of 1 +/- 1 x 10(8) MNC/kg, 5 +/- 6 x 10(4) CFU-GM/kg and 4 +/- 6 x 10(6) CD34+ cells/kg was collected for each leukapheresis. When we defined > or = 5 x 10(4)/kg as the minimum number of CFU-GM per procedure for a 'satisfactory' collection, multiparameter analysis of clinical features and laboratory findings showed that the only factors that predicted the numbers of CFU-GM collected were prior treatment with the MOPP regimen and the number of mononuclear cells identified in the basophil channel of the H*1 = Technicon. A logistic regression analysis performed to generate a mathematical model revealed four predictive factors: the number of previous cycles of chemotherapy, previous MOPP chemotherapy, the interval from latest chemotherapy and the number of mononuclear cells/microliter. This model was valuable in defining the optimal time for the first leukapheresis procedure. In contrast, the number of circulating CD34+ cells did not correlate with CFU-GM numbers collected whereas the numbers of mononuclear cells did provide a simple and reliable index. Thus the principal factor affecting the efficiency of peripheral blood stem cell collection was prior therapy with MOPP.
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Affiliation(s)
- A Olivieri
- Department of Hematology, University of Ancona, Italy
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Olivieri A, Offidani M, Ciniero L, Poloni A, Tedeschi A, Refe MC, Strusi AS, Leoni P. PBSC collection after high dose chemotherapy followed by G-CSF in patients with malignancies: analysis of results regarding factors affecting the yield of hemopoietic progenitors. Int J Artif Organs 1993; 16 Suppl 5:57-63. [PMID: 7516918] [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: 01/25/2023]
Abstract
High-dose non ablative chemotherapy followed by growth factors efficiently mobilizes and amplifies Peripheral Blood stem Cells (PBSC). Cytofluorimetric PBSC monitoring reduces the number of leukapheresis needed to collect sufficient amounts of progenitors to restore hemopoiesis after myeloablative therapy. Twenty-eight patients, affected by lymphoproliferative disorders, were primed with non myeloablative chemotherapy followed by G-CSF 5 micrograms/kg/die subcutaneously, until leukapheresis. A total number of 90 leukaphereses was performed (median: 3 per patient) using blood cell separator CS 3000 Plus Baxter; we collected 1 +/- 0.8 x 10(8)/kg mononuclear cells (MNC), 6 +/- 9 x 10(4)/kg CFU-GM and 4 +/- 5 x 10(6) CD34+ cells for each procedure. The statistical analysis showed that the number of progenitors collected was dependent on the age, number and type of previous chemotherapies and interval between the last chemotherapy and the priming; the type of priming, type and status of disease, sex, and bone marrow involvement were not significant. Duration of neutropenia after megachemotherapy was very short; in two cases platelet support was necessary and only two patients needed hospitalization. Our experience shows that high-dose non ablative chemotherapy followed by G-CSF is safe and yields large amounts of PBSC; several factors influence the quality of collections mainly regarding age and the previous treatment.
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Affiliation(s)
- A Olivieri
- Clinic of Hematology, University of Ancona, Italy
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Olivieri A, Leoni P, Ciniero L, Offidani M, Montillo M, Ziarati H, Centurioni R, Brianzoni F, Salvi A, Danieli G. [Differentiating agents in myelodysplastic syndromes. Analysis of personal cases]. Recenti Prog Med 1993; 84:168-76. [PMID: 8465097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The Myelo-Dysplastic Syndromes are a heterogeneous group of diseases which includes patients with different prognosis. There is no agreement about the management and the therapeutic strategy must be based on many individual parameters, particularly the age of the patients and their performance status. The therapeutic options range from no cytotoxic therapy for low-risk patients up to more aggressive treatment for high-risk patients, with disappointing results except for the very few cases eligible for allogenic bone marrow transplantation. The leukaemic cell can be induced to differentiate, so losing its self-maintenance potential; different drugs such as Interferon, vitamin D3, retinoids and arabinosyl-cytosine (low doses) have shown a differentiating action on myeloid blasts in "vitro". We summarize the general strategy in the treatment of myelo-dysplastic syndromes based on literature data, and on our results about the efficacy and tolerance of a combination of the above mentioned differentiating drugs, in a group of 27 elderly patients affected by myelodysplastic syndrome with poor prognosis. We obtained 14 objective responses (52%), and the median overall survival of these patients have been compared with that of 25 patients with severe myelodysplastic syndrome treated with a conventional regimen. In the 27 patients receiving the differentiating combination the median survival was found to be 14.7 months, versus 8.4 months for the control group. The results obtained are encouraging about the tolerance and the efficacy of this combination in elderly patients with a poor MDS prognosis. Further randomized studies are necessary to establish whether this treatment can really improve the survival in this group of patients.
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MESH Headings
- Aged
- Anemia, Myelophthisic/classification
- Anemia, Myelophthisic/metabolism
- Anemia, Refractory, with Excess of Blasts/classification
- Anemia, Refractory, with Excess of Blasts/metabolism
- Colony-Stimulating Factors/metabolism
- Cytarabine/metabolism
- Female
- Humans
- Leukemia, Myelomonocytic, Acute/classification
- Leukemia, Myelomonocytic, Acute/metabolism
- Leukemia, Myelomonocytic, Chronic/classification
- Leukemia, Myelomonocytic, Chronic/metabolism
- Macrophage Colony-Stimulating Factor/metabolism
- Male
- Middle Aged
- Myelodysplastic Syndromes/classification
- Myelodysplastic Syndromes/metabolism
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Affiliation(s)
- A Olivieri
- Istituto di Clinica Medica Generale e Terapia Medica, Università, Ancona
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