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Candoni A, Lazzarotto D, Papayannidis C, Piccini M, Nadali G, Dargenio M, Riva M, Fracchiolla N, Mellillo L, Dragonetti G, Del Principe MI, Cattaneo C, Stulle M, Pasciolla C, De Marchi R, Delia M, Tisi MC, Bonuomo V, Sciumè M, Spadea A, Sartor C, Griguolo D, Buzzatti E, Basilico CM, Sarlo C, Piccioni AL, Cerqui E, Lessi F, Olivieri A, Fanin R, Luppi M, Pagano L. Prospective multicenter study on infectious complications and clinical outcome of 230 unfit acute myeloid leukemia patients receiving first-line therapy with hypomethylating agents alone or in combination with Venetoclax. Am J Hematol 2023; 98:E80-E83. [PMID: 36651870 DOI: 10.1002/ajh.26846] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Affiliation(s)
- Anna Candoni
- Section of Hematology, Department of Medical and Surgical Sciences, Azienda Ospedaliera Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy
| | - Davide Lazzarotto
- Division of Hematology and Stem Cell Transplantation, ASUFC, University of Udine, Udine, Italy
| | - Cristina Papayannidis
- Institute of Hematology and Medical Oncology "L. and A. Seragnoli", University of Bologna, Bologna, Italy
| | - Matteo Piccini
- Division of Hematology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giampaolo Nadali
- Division of Hematology, AOUI, Policlinico GB Rossi, Verona, Italy
| | | | - Marta Riva
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, Milan, Italy
| | - Nicola Fracchiolla
- U.O. Oncoematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lorella Mellillo
- Division of Hematology, Foggia and IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giulia Dragonetti
- Division of Hematology, Polo Onco-Ematologico, Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | | | - Roberta De Marchi
- Onco Hematology, Department of Oncology, Veneto Institute of Oncology IOV, IRCCS, Padova, Italy
| | - Mario Delia
- Hematology and Bone Marrow Transplantation Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico-University of Bari, Bari, Italy
| | - Maria Chiara Tisi
- Cell Therapy and Hematology, San Bortolo Hospital, Vicenza. 7 U.O. Oncoematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Mariarita Sciumè
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, Milan, Italy
| | - Antonio Spadea
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Chiara Sartor
- Institute of Hematology and Medical Oncology "L. and A. Seragnoli", University of Bologna, Bologna, Italy
| | | | - Elisa Buzzatti
- Hematology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Claudia Maria Basilico
- Division of Hematology, ASST Sette Laghi, Ospedale Circolo e Fondazione Macchi, Varese, Italy
| | - Chiara Sarlo
- Hematology and Stem Cell Transplantation Unit, University Campus Bio-Medico, Rome, Italy
| | - Anna Lina Piccioni
- Dipartimento di Ematologia, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Elisa Cerqui
- Section of Hematology, Spedali Civili, Brescia, Italy
| | - Federica Lessi
- Hematology Unit, Department of Medicine (DIMED), Azienda Ospedaliera Universitaria di Padova, Padova, Italy
| | - Attilio Olivieri
- Division of Hematology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Renato Fanin
- Division of Hematology and Stem Cell Transplantation, ASUFC, University of Udine, Udine, Italy
| | - Mario Luppi
- Section of Hematology, Department of Medical and Surgical Sciences, Azienda Ospedaliera Universitaria di Modena, Università di Modena e Reggio Emilia, Modena, Italy
| | - Livio Pagano
- Division of Hematology, Polo Onco-Ematologico, Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Di Giusto S, Toffoletti E, Bonifacio M, Binotto G, Miggiano MC, Calistri E, Stulle M, Ermacora A, Stella R, Scaffidi L, D'Amore F, Scotton G, Griguolo D, De Matteis G, Bertorelle R, Krampera M, Semenzato G, Fanin R, Damiani D, Tiribelli M. BCR::ABL1 levels at first month after TKI discontinuation predict subsequent maintenance of treatment-free remission: A study from the "GRUPPO TRIVENETO LMC". Cancer Med 2022; 12:3180-3184. [PMID: 36208021 PMCID: PMC9939132 DOI: 10.1002/cam4.5158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/16/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Abstract
We analyzed BCR::ABL1 expression at stop and in the first month after discontinuation in 168 chronic myeloid leukemia patients who stopped imatinib or 2nd generation tyrosine kinase inhibitors (2G-TKIs) while in sustained deep molecular response. Patients were divided among those who maintained response (group 1, n = 123) and those who lost major molecular response (group 2, n = 45). Mean BCR::ABL1 RNA levels 1 month after discontinuation were higher in group 2 than in group 1 (p = 0.0005) and the difference was more evident 2 months after stop (p < 0.0001). The same trend was found both for imatinib and 2G-TKIs. A receiver operating characteristic (ROC) analysis to determine a threshold value of BCR::ABL1 at 1 month after discontinuation identified a cut-off value of 0.0051%, with 92.2% specificity, 31.7% sensitivity and a likelihood ratio of 4.087.
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Affiliation(s)
- Sara Di Giusto
- Division of Hematology and BMTAzienda Sanitaria Universitaria Friuli CentraleUdineItaly
| | - Eleonora Toffoletti
- Division of Hematology and BMTAzienda Sanitaria Universitaria Friuli CentraleUdineItaly,Department of Medical AreaUniversity of UdineUdineItaly
| | | | - Gianni Binotto
- Department of Medicine, Hematology and Clinical ImmunologyUniversity of PaduaPaduvaItaly
| | | | | | - Manuela Stulle
- Hematology UnitAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Anna Ermacora
- Division of Internal MedicineAzienda Ospedaliera S. Maria AngeliPordenoneItaly
| | - Rossella Stella
- Division of Hematology and BMTAzienda Sanitaria Universitaria Friuli CentraleUdineItaly
| | - Luigi Scaffidi
- Department of Medicine, Section of HematologyUniversity of VeronaVeronaItaly
| | - Fabio D'Amore
- Department of Medicine, Hematology and Clinical ImmunologyUniversity of PaduaPaduvaItaly
| | - Giorgia Scotton
- Department of Medicine, Hematology and Clinical ImmunologyUniversity of PaduaPaduvaItaly
| | - Davide Griguolo
- Hematology UnitAzienda Sanitaria Universitaria Giuliano‐IsontinaTriesteItaly
| | - Giovanna De Matteis
- Department of Life Sciences, Section of BiochemistryUniversity of VeronaVeronaItaly
| | | | - Mauro Krampera
- Department of Medicine, Section of HematologyUniversity of VeronaVeronaItaly
| | - Gianpietro Semenzato
- Department of Medicine, Hematology and Clinical ImmunologyUniversity of PaduaPaduvaItaly
| | - Renato Fanin
- Division of Hematology and BMTAzienda Sanitaria Universitaria Friuli CentraleUdineItaly,Department of Medical AreaUniversity of UdineUdineItaly
| | - Daniela Damiani
- Division of Hematology and BMTAzienda Sanitaria Universitaria Friuli CentraleUdineItaly,Department of Medical AreaUniversity of UdineUdineItaly
| | - Mario Tiribelli
- Division of Hematology and BMTAzienda Sanitaria Universitaria Friuli CentraleUdineItaly,Department of Medical AreaUniversity of UdineUdineItaly
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De Bellis E, Imbergamo S, Candoni A, Liço A, Tanasi I, Mauro E, Mosna F, Leoncin M, Stulle M, Griguolo D, Pravato S, Trentin L, Lazzarotto D, Di Bona E, Bassan R, Lucchini E, Poiani M, Palmieri C, Zaja F. Venetoclax in combination with hypomethylating agents in previously untreated patients with acute myeloid leukemia ineligible for intensive treatment: a real-life multicenter experience. Leuk Res 2022; 114:106803. [PMID: 35150967 DOI: 10.1016/j.leukres.2022.106803] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 01/22/2023]
Abstract
The addition of venetoclax to hypomethylating agents (HMA-V) improved the outcome of patients with newly diagnosed acute myeloid leukemia (AML) ineligible for intensive treatment. The aim of our study was to confirm data reported in literature, in a real-life multicenter experience. We retrospectively evaluated 56 naïve AML patients who received HMA-V at 8 different collaborating Hematology Units in the North-East of Italy, from September 2018 to October 2020. Patients received azacitidine or decitabine at standard dose, adding venetoclax starting from cycle 1-3. The median time-to-response was 2 cycles and composite complete remission rate (CCR) was 67.9%. Thirteen out of 38 responders (34.2%) relapsed, with a median response duration of 13.7 months. Transfusion independence (TI) was obtained in 27 (87.0%) and 28 (90.3%) out of 31 patients for red blood cells and platelets, respectively. Median OS was 12.3 months (95% CI, 8.1-16.5), and median PFS was 11.3 months (95% CI, 4.6-17.9). Cytogenetic risk was the only variable impacting on survival, while no differences were observed stratifying patients by age, bone marrow blasts, WHO classification or type of HMA. In conclusion, our real-life multicenter experience indicates that HMA-V treatment allows achieving good response rates in naïve AML patients, ineligible for intensive chemotherapy.
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Affiliation(s)
- Eleonora De Bellis
- Hematology Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy; Department of Biomedicine and Prevention, PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy.
| | - Silvia Imbergamo
- Hematology Section, Department of Medicine, Azienda Ospedale Università Padova, Italy
| | - Anna Candoni
- Division of Hematology and SCT, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Albana Liço
- Hematology Department, San Bortolo Hospital, Azienda ULSS8 "Berica" of Vicenza, Vicenza, Italy
| | - Ilaria Tanasi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Endri Mauro
- Hematology Section, Dipartimento di Medicina Specialistica, Ca' Foncello Hospital, Treviso, Italy
| | - Federico Mosna
- Ematologia e CTMO - Ospedale Regionale "S. Maurizio", Comprensorio Sanitario di Bolzano, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Matteo Leoncin
- Hematology Unit, Azienda Ulss3 Serenissima, Ospedale dell'Angelo, Venezia-Mestre, Italy
| | - Manuela Stulle
- Hematology Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Davide Griguolo
- Hematology Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Stefano Pravato
- Hematology Section, Department of Medicine, Azienda Ospedale Università Padova, Italy
| | - Livio Trentin
- Hematology Section, Department of Medicine, Azienda Ospedale Università Padova, Italy
| | - Davide Lazzarotto
- Division of Hematology and SCT, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Eros Di Bona
- AULSS7 Pedemontana, U.O.C. Oncoematologia, Bassano del Grappa (VI), Italy
| | - Renato Bassan
- Hematology Unit, Azienda Ulss3 Serenissima, Ospedale dell'Angelo, Venezia-Mestre, Italy
| | - Elisa Lucchini
- Hematology Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Monica Poiani
- Hematology Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Clara Palmieri
- Presidio Ospedaliero Ospedale Maggiore, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | - Francesco Zaja
- Hematology Unit, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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4
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De Bellis E, Imbergamo S, Candoni A, Liço A, Tanasi I, Mauro E, Mosna F, Leoncin M, Stulle M, Griguolo D, Pravato S, Trentin L, Lazzarotto D, Di Bona E, Sancetta R, Lucchini E, Poiani M, Palmieri C, Zaja F. Corrigendum to “Venetoclax in combination with hypomethylating agents in previously untreated patients with acute myeloid leukemia ineligible for intensive treatment: a real-life multicenter experience” [Leukemia Res. 114 (March 2022) 106803]. Leuk Res 2022; 115:106811. [DOI: 10.1016/j.leukres.2022.106811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Soverini S, Martelli M, Bavaro L, De Benedittis C, Papayannidis C, Sartor C, Sorà F, Albano F, Galimberti S, Abruzzese E, Annunziata M, Russo S, Stulle M, Imovilli A, Bonifacio M, Maino E, Stagno F, Maria Basilico C, Borlenghi E, Fozza C, Mignone F, Minari R, Stella S, Baccarani M, Cavo M, Martinelli G. Next-generation sequencing improves BCR-ABL1 mutation detection in Philadelphia chromosome-positive acute lymphoblastic leukaemia. Br J Haematol 2021; 193:271-279. [PMID: 33403687 DOI: 10.1111/bjh.17301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/06/2020] [Indexed: 01/30/2023]
Abstract
BCR-ABL1 kinase domain mutation testing in tyrosine kinase inhibitor (TKI)-resistant Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukaemia (ALL) patients is routinely performed by Sanger sequencing (SS). Recently, next-generation sequencing (NGS)-based approaches have been developed that afford greater sensitivity and straightforward discrimination between compound and polyclonal mutations. We performed a study to compare the results of SS and NGS in a consecutive cohort of 171 Ph+ ALL patients. At diagnosis, 0/44 and 3/44 patients were positive for mutations by SS and NGS respectively. Out of 47 patients with haematologic resistance, 45 had mutations according to both methods, but in 25 patients NGS revealed additional mutations undetectable by SS. Out of 80 patients in complete haematologic response but with BCR-ABL1 ≥0·1%, 28 (35%) and 52 (65%) were positive by SS and NGS respectively. Moreover, in 12 patients positive by SS, NGS detected additional mutations. NGS resolved clonal complexity in 34 patients with multiple mutations at the same or different codons and identified 35 compound mutations. Our study demonstrates that, in Ph+ ALL on TKI therapy, NGS enables more accurate assessment of mutation status both in patients who fail therapy and in patients with minimal residual disease above 0·1%.
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Affiliation(s)
- Simona Soverini
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Margherita Martelli
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Luana Bavaro
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Caterina De Benedittis
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Cristina Papayannidis
- Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia, Università degli Studi di Bologna, Bologna, Italia
| | - Chiara Sartor
- Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia, Università degli Studi di Bologna, Bologna, Italia
| | - Federica Sorà
- Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Albano
- Hematology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Sara Galimberti
- Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Sabina Russo
- Internal Medicine Unit, AOU Policlinico di Messina, Messina, Italy
| | - Manuela Stulle
- Hematology Unit, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Annalisa Imovilli
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | | | - Elena Maino
- Hematology Unit, Ospedale Dell'Angelo, Mestre, Italy
| | - Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico V. Emanuele, Catania, Italy
| | - Claudia Maria Basilico
- ASST dei Sette Laghi, Presidio di Varese Ospedale Circolo Fondazione Macchi, Varese, Italy
| | | | - Claudio Fozza
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Flavio Mignone
- Department of Science and Innovation Technology (DISIT), University of Piemonte Orientale, Alessandria, Italy
| | | | - Stefania Stella
- Department of Clinical and Experimental Medicine and Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | | | - Michele Cavo
- Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia, Università degli Studi di Bologna, Bologna, Italia
| | - Giovanni Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
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Bonifacio M, Scaffidi L, Binotto G, Miggiano MC, Danini M, Minotto C, Griguolo D, Marin L, Frison L, D'Amore F, Basso M, Sartori R, Tinelli M, Stulle M, Fortuna S, Bonalumi A, Bertoldero G, De Biasi E, Ruggeri M, Semenzato G, Fanin R, Pizzolo G, Krampera M, Tiribelli M. Safety and efficacy of switching from branded to generic imatinib in chronic phase chronic myeloid leukemia patients treated in Italy. Leuk Res 2018; 74:75-79. [PMID: 30308414 DOI: 10.1016/j.leukres.2018.09.018] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/15/2018] [Accepted: 09/29/2018] [Indexed: 12/18/2022]
Abstract
The use of generic drugs after patent expiration of their originators is a relative novelty in the treatment of chronic cancer patients in Western countries. In this observational study we analyzed a cohort of 294 Italian chronic phase chronic myeloid leukemia patients treated frontline with branded imatinib (Glivec®) for at least 6 months and then uniformly switched to generic imatinib upon requirement of health authorities in early 2017. Median age at diagnosis was 57 years (range 19-87). Sokal risk was low/intermediate/high in 55%, 32% and 8% of cases, respectively. Median duration of branded imatinib treatment was 7.4 years (range 0.5-16.7). At a median follow-up of 7.5 months after switch to generic imatinib, 17% of patients reported new or worsening side effects, but grade 3-4 non-hematological adverse events were rare. Six patients switched back to branded imatinib, with improvement in the side effect profile, and 4 pts moved to bosutinib or nilotinib for resistance/intolerance. The majority of patients were in major (26%) or deep molecular response (66%) at the time of switch. Molecular responses remained stable, improved or worsened in 61%, 25% and 14% of patients, respectively. We conclude that switch to generic imatinib for patients who have been receiving branded imatinib appears to be effective and safe. Molecular responses may continue to improve over time. Some patients experienced new or worsened side effects but less than 5% of the whole cohort needed to switch back to branded imatinib or move to other treatments. Savings were around 3 million Euros.
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Affiliation(s)
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Italy
| | - Gianni Binotto
- Padua School of Medicine, Department of Medicine, Hematology and Clinical Immunology, Padua, Italy
| | | | - Marco Danini
- Hematology Departmental Unit, P. Cosma Hospital, Camposampiero, Padua, Italy
| | - Claudia Minotto
- Department of Medical Specialities, Oncology and Onco-Haematology Unit, Mirano, Venice, Italy
| | - Davide Griguolo
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Italy
| | - Luciana Marin
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Italy
| | - Luca Frison
- Padua School of Medicine, Department of Medicine, Hematology and Clinical Immunology, Padua, Italy
| | - Fabio D'Amore
- Padua School of Medicine, Department of Medicine, Hematology and Clinical Immunology, Padua, Italy
| | - Marco Basso
- Hematology Department, Castelfranco Veneto Regional Hospital, Castelfranco Veneto, Treviso, Italy
| | - Roberto Sartori
- Hematology Department, Castelfranco Veneto Regional Hospital, Castelfranco Veneto, Treviso, Italy
| | - Martina Tinelli
- Department of Internal Medicine, G Fracastoro Hospital, San Bonifacio, Verona, Italy
| | - Manuela Stulle
- Hematology Division, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Stefania Fortuna
- Department of Internal Medicine, Alto Vicentino Hospital, Santorso, Vicenza, Italy
| | - Angela Bonalumi
- Department of Medicine, Section of Hematology, University of Verona, Italy
| | - Giovanni Bertoldero
- Department of Medical Specialities, Oncology and Onco-Haematology Unit, Mirano, Venice, Italy
| | - Ercole De Biasi
- Hematology Departmental Unit, P. Cosma Hospital, Camposampiero, Padua, Italy
| | - Marco Ruggeri
- Hematology Department, San Bortolo Hospital, Vicenza, Italy
| | - Gianpietro Semenzato
- Padua School of Medicine, Department of Medicine, Hematology and Clinical Immunology, Padua, Italy
| | - Renato Fanin
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Italy
| | - Giovanni Pizzolo
- Department of Medicine, Section of Hematology, University of Verona, Italy
| | - Mauro Krampera
- Department of Medicine, Section of Hematology, University of Verona, Italy
| | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Italy
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7
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Tiribelli M, Bonifacio M, Binotto G, Iurlo A, Cibien F, Maino E, Guella A, Festini G, Minotto C, De Biasi E, De Marchi F, Scaffidi L, Frison L, Bucelli C, Medeot M, Calistri E, Sancetta R, Stulle M, Orofino N, Krampera M, Gherlinzoni F, Semenzato G, Pizzolo G, Ambrosetti A, Fanin R. Excellent outcomes of 2G-TKI therapy after imatinib failure in chronic phase CML patients. Oncotarget 2018; 9:14219-14227. [PMID: 29581839 PMCID: PMC5865665 DOI: 10.18632/oncotarget.24478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/30/2018] [Indexed: 12/26/2022] Open
Abstract
Second-generation tyrosine kinase inhibitors (2G-TKIs) dasatinib and nilotinib produced historical rates of about 50% complete cytogenetic response (CCyR) and about 40% major molecular response (MMR) in chronic myeloid leukaemia (CML) patients failing imatinib. Direct comparisons between dasatinib and nilotinib are lacking, and few studies addressed the dynamics of deep molecular response (DMR) in a "real-life" setting. We retrospectively analyzed 163 patients receiving dasatinib (n = 95) or nilotinib (n = 68) as second-line therapy after imatinib. The two cohorts were comparable for disease's characteristics, although there was a higher rate of dasatinib use in imatinib-resistant and of nilotinib in intolerant patients. Overall, 75% patients not in CCyR and 60% patients not in MMR at 2G-TKI start attained this response. DMR was achieved by 61 patients (37.4%), with estimated rate of stable DMR at 5 years of 24%. After a median follow-up of 48 months, 60% of patients persisted on their second-line treatment. Rates and kinetics of cytogenetic and molecular responses, progression-free and overall survival were similar for dasatinib and nilotinib. In a "real-life" setting, dasatinib and nilotinib resulted equally effective and safe after imatinib failure, determining high rates of CCyR and MMR, and a significant chance of stable DMR, a prerequisite for treatment discontinuation.
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Affiliation(s)
- Mario Tiribelli
- Division of Hematology and Bone Marrow Transplantation, Department of Medical Area, ASUI Udine, Udine, Italy
| | | | - Gianni Binotto
- Department of Medicine, Hematology Section, Padua University School of Medicine, Padua, Italy
| | - Alessandra Iurlo
- Hematology Division, IRCCS Ca' Granda-Maggiore Policlinico Hospital Foundation, Milan, Italy
| | | | - Elena Maino
- Hematology Unit, Dell'Angelo Hospital, Venezia-Mestre, Italy
| | - Anna Guella
- Hematology Unit, Santa Chiara Hospital, Trento, Italy
| | - Gianluca Festini
- Division of Clinical Hematology, AOU Ospedali Riuniti, Trieste, Italy
| | - Claudia Minotto
- Department of Medical Specialities, Oncology and Onco-Hematology Unit, Venice, Italy
| | - Ercole De Biasi
- Hematology Unit, P. Cosma Hospital, Camposampiero, Padua, Italy
| | - Federico De Marchi
- Division of Hematology and Bone Marrow Transplantation, Department of Medical Area, ASUI Udine, Udine, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Luca Frison
- Department of Medicine, Hematology Section, Padua University School of Medicine, Padua, Italy
| | - Cristina Bucelli
- Hematology Division, IRCCS Ca' Granda-Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Marta Medeot
- Division of Hematology and Bone Marrow Transplantation, Department of Medical Area, ASUI Udine, Udine, Italy
| | | | | | - Manuela Stulle
- Division of Clinical Hematology, AOU Ospedali Riuniti, Trieste, Italy
| | - Nicola Orofino
- Hematology Division, IRCCS Ca' Granda-Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Mauro Krampera
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | | | - Gianpietro Semenzato
- Department of Medicine, Hematology Section, Padua University School of Medicine, Padua, Italy
| | - Giovanni Pizzolo
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Achille Ambrosetti
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Renato Fanin
- Division of Hematology and Bone Marrow Transplantation, Department of Medical Area, ASUI Udine, Udine, Italy
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8
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Biolo G, Stulle M, Bianco F, Mengozzi G, Barazzoni R, Vasile A, Panzetta G, Guarnieri G. Insulin action on glucose and protein metabolism during L-carnitine supplementation in maintenance haemodialysis patients. Nephrol Dial Transplant 2007; 23:991-7. [PMID: 18045815 DOI: 10.1093/ndt/gfm664] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Impaired protein anabolism and insulin resistance are characteristic features of maintenance haemodialysis patients. We have used a randomised, matched-paired, double-blind, placebo-controlled experimental design to determine the capability of intravenous L-carnitine supplementation to modify insulin resistance and protein catabolism in non-diabetic patients with end-stage renal disease (ESRD) undergoing chronic haemodialysis treatment. METHODS L-carnitine (20 mg x kg(-1)) (n = 9) or placebo (n = 10) were given intravenously at the end of seven consecutive dialysis sessions. Whole-body protein and glucose metabolism were assessed on interdialytic days by the L[1-(13)C]leucine and the [2,2-(2)H(2)]glucose kinetic models in the postabsorptive state and during euglicemic hyperinsulinemic clamp studies at baseline and at the end of the treatment period. RESULTS L-carnitine supplementation was associated with lower (P < 0.05) rates of leucine oxidation (-11 +/- 12%) and appearance from proteolysis (-6 +/- 2%) during the clamp studies than after placebo supplementation. The rates of glucose appearance in the postabsorptive state did not change significantly in the patients receiving L-carnitine treatment. Insulin-mediated glucose disappearance was improved by L-carnitine only in those patients (n = 5) (+18 +/- 3%, P < 0.05 vs placebo group, n = 5) with greater baseline insulin resistance, selected according to the median value of insulin sensitivity before treatment. CONCLUSIONS L-carnitine supplementation was associated with protein-sparing effects in maintenance haemodialysis patients during hyperinsulinemia.
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Affiliation(s)
- Gianni Biolo
- Department of Clinical Morphological Technological Sciences, Division of Internal Medicine, University of Trieste, Trieste, Italy.
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9
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Barazzoni R, Zanetti M, Stulle M, Mucci MP, Pirulli A, Dore F, Panzetta G, Vasile A, Biolo G, Guarnieri G. Higher total ghrelin levels are associated with higher insulin-mediated glucose disposal in non-diabetic maintenance hemodialysis patients. Clin Nutr 2007; 27:142-9. [PMID: 17854954 DOI: 10.1016/j.clnu.2007.06.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 06/20/2007] [Accepted: 06/23/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Insulin resistance is common in maintenance hemodialysis (MHD) and it can contribute to exceedingly high mortality in MHD patients. Ghrelin is a gastric hormone whose total plasma concentration is increased in MHD. Emerging data suggest a potential role of ghrelin to modulate intermediate metabolism but the metabolic impact of ghrelin in chronic kidney disease is unknown. The current study aimed at assessing the potential relationships between ghrelin and insulin sensitivity in MHD. METHODS Total (T-Ghr) and acylated (A-Ghr) ghrelin as well as insulin-mediated glucose disposal [(M): hyperinsulinemic-euglycemic clamp] were measured in non-diabetic non-obese ambulatory MHD patients (n=19, 16 Males). C-reactive protein (CRP) was also measured since systemic inflammation is associated with insulin resistance in non-renal patients and inflammation is negatively modulated by ghrelin in experimental models. RESULTS Compared to control subjects (C: n=9, 7 Males), MHD had similar body fat and resting energy expenditure but reduced M and increased CRP (P<0.05). MHD also had higher T-(P<0.05) but not A-Ghr. M was associated positively with T-Ghr and negatively with CRP in linear regression analysis in MHD. In stepwise multiple regression analysis only T-Ghr remained associated with M (P<0.05) in a model including A-Ghr and CRP. CONCLUSIONS Insulin sensitivity is associated negatively with systemic inflammation and positively with total plasma ghrelin in non-diabetic MHD patients. Based on available knowledge these results suggest a potential novel role of ghrelin in preserving insulin sensitivity in MHD.
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Affiliation(s)
- Rocco Barazzoni
- Clinica Medica-Department of Clinical, Morphological and Technological Sciences (DSCMT), Italy.
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10
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Biolo G, Ciocchi B, Stulle M, Bosutti A, Barazzoni R, Zanetti M, Antonione R, Lebenstedt M, Platen P, Heer M, Guarnieri G. Calorie restriction accelerates the catabolism of lean body mass during 2 wk of bed rest. Am J Clin Nutr 2007; 86:366-72. [PMID: 17684207 DOI: 10.1093/ajcn/86.2.366] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Muscle inactivity and low energy intake commonly occur in persons with acute or chronic disease, in astronauts during space flight, and during aging. OBJECTIVE We used a crossover design to investigate the effects of the interactions of inactivity and calorie restriction on whole-body composition and protein kinetic regulation in 9 healthy volunteers. DESIGN Lean body mass (LBM) was measured by using dual-energy X-ray absorptionmetry before and at the end of 14-d periods of bed rest (B) and controlled ambulation (A) in patients receiving eucaloric (E) or hypocaloric (H) (approximately 80% of total energy expenditure) diets. Whole-body leucine kinetics were determined at the end of the 4 study periods by using a standard stable-isotope technique in the postabsorptive state and during a 3-h infusion of a 0.13 g x kg LBM(-1) x h(-1) amino acid mixture. RESULTS In the postabsorptive state, we found a significant (P = 0.04) bed rest x hypocaloric diet interaction for the rate of leucine oxidation, an index of net protein catabolism (A+E: 0.23 +/- 0.01; B+E: 25 +/- 0.01; A+H: 0.23 +/- 0.01; B+H: 0.28 +/- 0.01 micromol x min(-1) x kg LBM(-1)). Bed rest significantly (P < 0.01) decreased amino acid-mediated stimulation of nonoxidative leucine disappearance, an index of protein synthesis (A+E: 35 +/- 2%; B+E: 30 +/- 2%; A+H: 41 +/- 3%; B+H: 32 +/- 2%). B+H decreased LBM by 1.10 +/- 0.1 kg, which is significantly (P < 0.01) greater than the decrease seen with A+E, A+H, or B+E. CONCLUSION Calorie restriction enhanced the catabolic response to inactivity by combining greater protein catabolism in the postabsorptive state with an impaired postprandial anabolic utilization of free amino acids.
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Affiliation(s)
- Gianni Biolo
- Department of Clinical, Technological and Morphological Sciences, Division of Internal Medicine, University of Trieste, Italy.
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Biolo G, Ciocchi B, Stulle M, Piccoli A, Lorenzon S, Dal Mas V, Barazzoni R, Zanetti M, Guarnieri G. Metabolic consequences of physical inactivity. J Ren Nutr 2005; 15:49-53. [DOI: 10.1053/j.jrn.2004.09.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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12
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Ciocchi B, Heer M, Lebenstedt M, Barazzoni R, Zanetti M, Stulle M, Platen P, Guarnieri G, Biolo G. Inactivity impairs amino acid-induced protein anabolism. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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