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Abruzzese E, Trawinska MM, De Fabritiis P, Bernardi S. SOHO State of the Art Updates and Next Questions: Chronic Myeloid Leukemia and Pregnancy: "Per Aspera Ad Astra". Clin Lymphoma Myeloma Leuk 2024; 24:214-223. [PMID: 38151389 DOI: 10.1016/j.clml.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
Chronic myeloid leukemia (CML) has evolved from an invariably fatal disease to a chronic disorder that can be treated with targeted drugs and allows survival expectations approaching age-matched controls. Thus, pregnancy and conception in CML should not be precluded anymore; however, to ensure the well-being of both the mother and the developing fetus careful planning and management are required. Tyrosine Kinase Inhibitors (TKIs) are not genotoxic or carcinogenic but can pose a risk to the developing fetus, due to their teratogenic potential. The risk depends on the TKI and the stage of fetal development during exposure. Teratogenic risk is high in the first trimester of pregnancy when the baby's organs and structures are forming (5-12 weeks). If a female patient is on therapy it is advisable to stop therapy at the first positive pregnancy test (3-5 weeks) to maximize the length of treatment-free, and ideally to not treat until delivery. If needed, the medication plan during pregnancy may be adjusted. Interferons can be used at any time, imatinib and nilotinib have a reduced placental crossing and could be carefully used after 16 weeks, whereas dasatinib crosses the placenta and can induce problems throughout the whole gestation. Management of pregnancy in CML is complex. This manuscript is an update of the state of the art allowing healthcare providers to be informed of the different situations that can occur and their governance.
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Affiliation(s)
- Elisabetta Abruzzese
- Hematology, S. Eugenio Hospital, ASL Roma2, Tor Vergata University, Rome, Italy.
| | | | - Paolo De Fabritiis
- Hematology, S. Eugenio Hospital, ASL Roma2, Tor Vergata University, Rome, Italy
| | - Simona Bernardi
- Department of Clinical and Experimental Sciences, University of Brescia, Unit of Blood disease and Bone Marrow Transplantation, Brescia, Italy
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Bassan R, Chiaretti S, Della Starza I, Spinelli O, Santoro A, Paoloni F, Messina M, Elia L, De Propris MS, Scattolin AM, Audisio E, Marbello L, Borlenghi E, Zappasodi P, Mauro E, Martinelli G, Mattei D, Fracchiolla N, Bocchia M, De Fabritiis P, Bonifacio M, Candoni A, Cassibba V, Di Bartolomeo P, Latte G, Trappolini S, Guarini A, Vitale A, Fazi P, Piciocchi A, Rambaldi A, Foà R. Pegaspargase-modified risk-oriented program for adult acute lymphoblastic leukemia: results of the GIMEMA LAL1913 trial. Blood Adv 2023; 7:4448-4461. [PMID: 37276451 PMCID: PMC10440455 DOI: 10.1182/bloodadvances.2022009596] [Citation(s) in RCA: 2] [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] [Received: 12/21/2022] [Revised: 04/17/2023] [Accepted: 05/21/2023] [Indexed: 06/07/2023] Open
Abstract
Pediatric-inspired chemotherapy is the standard of care for younger adults with Philadelphia chromosome-negative acute lymphoblastic leukemia/lymphoma (Ph- ALL/LL). In LAL1913 trial, the Gruppo Italiano Malattie EMatologiche dell'Adulto added pegaspargase 2000 IU/m2 to courses 1, 2, 5, and 6 of an 8-block protocol for patients aged from 18 to 65 years, with dose reductions in patients aged >55 years. Responders were risk stratified for allogeneic hematopoietic cell transplantation (HCT) or maintenance per clinical characteristics and minimal residual disease (MRD). Of 203 study patients (median age, 39.8 years), 91% achieved a complete remission. The 3-year overall survival, event-free, and disease-free survival (DFS) rates were 66.7%, 57.7%, and 63.3%, respectively, fulfilling the primary study end point of a 2-year DFS >55%. Although based on the intention-to-treat, the DFS being 74% and 50% in the chemotherapy (n = 94) and HCT (n = 91) assignment cohorts, respectively, a time-dependent analysis proved the value of HCT in patients who were eligible (DFS HCT 70% vs no HCT 26%; P <.0001). In multivariate analysis, age and MRD were independent factors predicting DFS rates of 86% (age ≤ 40 and MRD-negative), 64%-65% (MRD-positive or age > 40) and 25% (age > 40 and MRD-positive); P < .0001. Grade ≥2 pegaspargase toxicity was mainly observed at course 1, contributing to induction death in 2 patients but was rare thereafter. This program improved outcomes of patients with Ph- ALL/LL aged up to 65 years in a multicenter national setting. This trial was registered at www.clinicaltrials.gov as #NCT02067143.
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Affiliation(s)
- Renato Bassan
- Complex Operational Unit of Hematology, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Sabina Chiaretti
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Irene Della Starza
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
- Centro Dati Fondazione GIMEMA Franco Mandelli, Rome, Italy
| | - Orietta Spinelli
- Complex Structure of Hematology, AO Papa Giovanni XXIII, Bergamo; and Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Alessandra Santoro
- Division of Hematology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | - Monica Messina
- Centro Dati Fondazione GIMEMA Franco Mandelli, Rome, Italy
| | - Loredana Elia
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Maria Stefania De Propris
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Anna Maria Scattolin
- Complex Operational Unit of Hematology, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Ernesta Audisio
- Complex Structure of Hematology, AO Città della Salute e della Scienza, Torino, Italy
| | - Laura Marbello
- Complex Structure of Hematology, Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - Erika Borlenghi
- Operational Unit of Hematology, AO Spedali Civili, Brescia, Italy
| | - Patrizia Zappasodi
- Complex Structure of Hematology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Elisa Mauro
- Complex Operational Unit of Hematology, AOU Policlinico S. Marco, University of Catania, Catania, Italy
| | - Giovanni Martinelli
- Institute of Hematology "Seragnoli", Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Daniele Mattei
- Complex Structure of Hematology, ASO S. Croce e Carle, Cuneo, Italy
| | - Nicola Fracchiolla
- Complex Operational Unit of Onco-Hematology, Fondazione IRCCS Cà Granda Ospedale Maggiore, Milan, Italy
| | - Monica Bocchia
- Complex Operational Unit of Hematology, AO Senese Policlinico Le Scotte, Siena, Italy
| | - Paolo De Fabritiis
- Complex Operational Unit of Hematology, Ospedale S. Eugenio ASL Roma 2, University of Tor Vergata, Rome, Italy
| | - Massimiliano Bonifacio
- Department of Medicine, Complex Operational Unit of Hematology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Anna Candoni
- Department of Hematology, Azienda Ospedaliero-Universitaria, Udine, Italy
| | | | | | - Giancarlo Latte
- Section of Clinical Hematology, Ospedale S. Francesco, Nuoro, Italy
| | | | - Anna Guarini
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Antonella Vitale
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Paola Fazi
- Centro Dati Fondazione GIMEMA Franco Mandelli, Rome, Italy
| | | | - Alessandro Rambaldi
- Complex Structure of Hematology, AO Papa Giovanni XXIII, Bergamo; and Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Robin Foà
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
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Abruzzese E, Bocchia M, Trawinska MM, Raspadori D, Bondanini F, Sicuranza A, Pacelli P, Re F, Cavalleri A, Farina M, Malagola M, Russo D, De Fabritiis P, Bernardi S. Minimal Residual Disease Detection at RNA and Leukemic Stem Cell (LSC) Levels: Comparison of RT-qPCR, d-PCR and CD26+ Stem Cell Measurements in Chronic Myeloid Leukemia (CML) Patients in Deep Molecular Response (DMR). Cancers (Basel) 2023; 15:4112. [PMID: 37627140 PMCID: PMC10452239 DOI: 10.3390/cancers15164112] [Citation(s) in RCA: 2] [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] [Received: 07/03/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
A Deep Molecular Response (DMR), defined as a BCR::ABL1 transcript at levels ≤ 0.01% by RT-qPCR, is the prerequisite for the successful interruption of treatment among patients with Chronic Myeloid Leukemia (CML). However, approximately 50% of patients in Treatment-Free Remission (TFR) studies had to resume therapy after their BCR::ABL1 transcript levels rose above the 0.1% threshold. To improve transcript detection sensitivity and accuracy, transcript levels can be analyzed using digital PCR (dPCR). dPCR increases BCR::ABL1 transcript detection sensitivity 10-100 fold; however, its ability to better select successful TFR patients remains unclear. Beyond the role of the immune system, relapses may be due to the presence of residual leukemic stem cells (LSCs) that are transcriptionally silent. Flow cytometry can be used to identify and quantify circulating bone marrow Ph+ LSCs CD34+/CD38- co-expressing CD26 (dipeptidylpeptidase-IV). To date, the significance of circulating Ph+ LSCs in TFR is unclear. The aim of this work is to compare and examine the values obtained using the three different methods of detecting minimal residual disease (MRD) in CML at RNA (RT-qPCR and dPCR) and LSC (flowcytometry) levels among patients in TFR or exhibiting a DMR. The twenty-seven patients enrolled received treatment with either imatinib (12), dasatinib (6), nilotinib (7), bosutinib (1), or interferon (1). Twelve patients were in TFR, while the rest exhibited a DMR. The TFR patients had stopped therapy for less than 1 year (3), <3 years (2), 6 years (6), and 17 years (1). Blood samples were collected and tested using the three methods at the same time. Both d-PCR and LSCs showed higher sensitivity than RT-qPCR, exhibiting positive results in samples that were undetectable using RT-qPCR (17/27). None of the patients tested negative with d-PCR; however, 23/27 were under the threshold of 0.468 copies/μL, corresponding to a stable DMR. The results were divided into quartiles, and the lowest quartiles defined the lowest MRD. These data were strongly correlated in 15/27 patients, corresponding to almost half of the TFR patients. Indeed, the TFR patients, some lasting up to 17 years, corresponded to the lowest detectable DMR categories. To the best of our knowledge, this is the first attempt to analyze and compare DMRs in a CML population using standard (RT-qPCR) and highly sensitive (dPCR and LSCs) methods.
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Affiliation(s)
- Elisabetta Abruzzese
- Hematology Unit, S. Eugenio Hospital, ASL Roma 2, Tor Vergata University, 00144 Rome, Italy; (M.M.T.); (P.D.F.)
| | - Monica Bocchia
- Chair of Hematology, University of Siena, Azienda Ospedaliera Universitaria, 53100 Siena, Italy; (M.B.); (D.R.); (A.S.); (P.P.)
| | - Malgorzata Monika Trawinska
- Hematology Unit, S. Eugenio Hospital, ASL Roma 2, Tor Vergata University, 00144 Rome, Italy; (M.M.T.); (P.D.F.)
| | - Donatella Raspadori
- Chair of Hematology, University of Siena, Azienda Ospedaliera Universitaria, 53100 Siena, Italy; (M.B.); (D.R.); (A.S.); (P.P.)
| | - Francesco Bondanini
- Laboratory Medicine Unit, S. Eugenio Hospital, ASL Roma 2, 00144 Rome, Italy;
| | - Anna Sicuranza
- Chair of Hematology, University of Siena, Azienda Ospedaliera Universitaria, 53100 Siena, Italy; (M.B.); (D.R.); (A.S.); (P.P.)
| | - Paola Pacelli
- Chair of Hematology, University of Siena, Azienda Ospedaliera Universitaria, 53100 Siena, Italy; (M.B.); (D.R.); (A.S.); (P.P.)
| | - Federica Re
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.R.); (A.C.); (M.F.); (M.M.); (D.R.)
| | - Alessia Cavalleri
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.R.); (A.C.); (M.F.); (M.M.); (D.R.)
| | - Mirko Farina
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.R.); (A.C.); (M.F.); (M.M.); (D.R.)
| | - Michele Malagola
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.R.); (A.C.); (M.F.); (M.M.); (D.R.)
| | - Domenico Russo
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.R.); (A.C.); (M.F.); (M.M.); (D.R.)
| | - Paolo De Fabritiis
- Hematology Unit, S. Eugenio Hospital, ASL Roma 2, Tor Vergata University, 00144 Rome, Italy; (M.M.T.); (P.D.F.)
| | - Simona Bernardi
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy; (F.R.); (A.C.); (M.F.); (M.M.); (D.R.)
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Efficace F, Patriarca A, Luppi M, Potenza L, Caocci G, Tafuri A, Fazio F, Cartoni C, Petrucci MT, Carmosino I, Moia R, Margiotta Casaluci G, Boggione P, Colaci E, Giusti D, Pioli V, Sparano F, Cottone F, De Fabritiis P, Ardu NR, Niscola P, Capodanno I, Leporace AP, Pelliccia S, Lugli E, La Sala E, Rigacci L, Santopietro M, Fozza C, Siragusa S, Breccia M, Fazi P, Vignetti M. Physicians’ Perceptions of Clinical Utility of a Digital Health Tool for Electronic Patient-Reported Outcome Monitoring in Real-Life Hematology Practice. Evidence From the GIMEMA-ALLIANCE Platform. Front Oncol 2022; 12:826040. [PMID: 35372079 PMCID: PMC8968922 DOI: 10.3389/fonc.2022.826040] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/03/2022] [Indexed: 12/19/2022] Open
Abstract
Digital health tools are increasingly being used in cancer care and may include electronic patient-reported outcome (ePRO) monitoring systems. We examined physicians’ perceptions of usability and clinical utility of a digital health tool (GIMEMA-ALLIANCE platform) for ePRO monitoring in the real-life practice of patients with hematologic malignancies. This tool allows for the collection and assessment of ePROs with real-time graphical presentation of results to medical staff. Based on a predefined algorithm, automated alerts are sent to medical staff. Participating hematologists completed an online survey on their experience with the platform. Of the 201 patients invited to participate between December 2020 and June 2021 (cut-off date for current analysis), 180 (90%) agreed to enter the platform and had a median age of 57 years. Twenty-three hematologists with a median age of 42 years and an average of 17 years of experience in clinical practice were surveyed. All hematologists agreed or strongly agreed that the platform was easy to use, and 87%, agreed or strongly agreed that ePROs data were useful to enhance communication with their patients. The majority of physicians (78%) accessed the platform at least once per month to consult the symptom and health status profile of their patients. The frequency of access was independent of physician sex (p=0.393) and years of experience in clinical practice (p=0.404). In conclusion, our preliminary results support the clinical utility, from the perspective of the treating hematologist, of integrating ePROs into the routine cancer care of patients with hematologic malignancies.
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Affiliation(s)
- Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
- *Correspondence: Fabio Efficace,
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Mario Luppi
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Leonardo Potenza
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, Businco Hospital, University of Cagliari, Cagliari, Italy
| | | | - Francesca Fazio
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Claudio Cartoni
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Gloria Margiotta Casaluci
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Paola Boggione
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Elisabetta Colaci
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Davide Giusti
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Pioli
- Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Sparano
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Francesco Cottone
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | | | | | | | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Elisabetta Lugli
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Edoardo La Sala
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Luigi Rigacci
- U.O. di Ematologia e Trapianti di cellule Staminali. A.O.S. S. Camillo-Forlanini, Rome, Italy
| | - Michelina Santopietro
- U.O. di Ematologia e Trapianti di cellule Staminali. A.O.S. S. Camillo-Forlanini, Rome, Italy
| | - Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sergio Siragusa
- Policlinico Paolo Giaccone, Unit of Haematology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, Palermo, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Paola Fazi
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Marco Vignetti
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
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Fazio F, Franceschini L, Tomarchio V, Rago A, Garzia MG, Cupelli L, Bongarzoni V, Andriani A, Gumenyuk S, Tafuri A, Siniscalchi A, Piciocchi A, De Fabritiis P, De Rosa L, Caravita di Toritto T, Annibali O, Cantonetti M, Petrucci MT. Daratumumab combined with dexamethasone and lenalidomide or bortezomib in relapsed/refractory multiple myeloma (RRMM) patients: Report from the multiple myeloma GIMEMA Lazio group. eJHaem 2022; 3:121-128. [PMID: 35846211 PMCID: PMC9175681 DOI: 10.1002/jha2.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Francesca Fazio
- Department of Translational and Precision Medicine, Hematology Azienda Policlinico Umberto I Sapienza University of RomeSapienza Università di Roma
| | | | | | - Angela Rago
- ASL RM/A UOSD Ematologia Asl Roma 1 Rome Italy
| | - Maria Grazia Garzia
- Department of Hematology, Hematology San Camillo Forlanini Hospital Rome Italy
| | - Luca Cupelli
- Department of Hematology, Hematology Ospedale Sant'Eugenio Rome Italy
| | - Velia Bongarzoni
- Department of Hematology San Giovanni‐Addolorata Hospital Rome Italy
| | | | - Svitlana Gumenyuk
- Haematology and Stem Cell Transplant Regina Elena National Cancer Institute Rome Italy
| | | | | | - Alfonso Piciocchi
- Data Center, Italian Group for Adult Hematologic Diseases, (GIMEMA) Rome Italy
| | | | - Luca De Rosa
- Hematology and Bone Marrow Transplantation Unit Azienda Ospedaliera San Camillo‐Forlanini Rome Italy
| | | | - Ombretta Annibali
- Department of Haematology Campus Bio‐Medico University of Rome Rome Italy
| | | | - Maria Teresa Petrucci
- Department of Translational and Precision Medicine, Hematology Azienda Policlinico Umberto I Sapienza University of RomeSapienza Università di Roma
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6
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Chiaretti S, Messina M, Della Starza I, Piciocchi A, Cafforio L, Cavalli M, Taherinasab A, Ansuinelli M, Elia L, Albertini Petroni G, La Starza R, Canichella M, Lauretti A, Puzzolo MC, Pierini V, Santoro A, Spinelli O, Apicella V, Capria S, Di Raimondo F, De Fabritiis P, Papayannidis C, Candoni A, Cairoli R, Cerrano M, Fracchiolla N, Mattei D, Cattaneo C, Vitale A, Crea E, Fazi P, Mecucci C, Rambaldi A, Guarini A, Bassan R, Foà R. Philadelphia-like acute lymphoblastic leukemia is associated with minimal residual disease persistence and poor outcome. First report of the minimal residual disease-oriented GIMEMA LAL1913. Haematologica 2021; 106:1559-1568. [PMID: 32467145 PMCID: PMC8168510 DOI: 10.3324/haematol.2020.247973] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
Early recognition of Philadelphia-like (Ph-like) acute lymphoblastic leukemia (ALL) cases could impact on the management and outcome of this subset of B-lineage ALL. In order to assess the prognostic value of the Ph-like status in a pediatric-inspired, minimal residual disease (MRD)- driven trial, we screened 88 B-lineage ALL cases negative for major fusion genes (BCR-ABL1, ETV6-RUNX1, TCF3-PBX1 and KTM2Ar) enrolled in the GIMEMA LAL1913 front-line protocol for adult BCR/ABL1-negative ALL. The screening - performed using the “BCR/ABL1-like predictor” - identified 28 Ph-like cases (31.8%), characterized by CRLF2 overexpression (35.7%), JAK/STAT pathway mutations (33.3%), IKZF1 (63.6%), BTG1 (50%) and EBF1 (27.3%) deletions, and rearrangements targeting tyrosine kinases or CRLF2 (40%). The correlation with outcome highlighted that: i) the complete remission rate was significantly lower in Ph-like compared to non-Phlike cases (74.1% vs. 91.5%, P=0.044); ii) at time point 2, decisional for transplant allocation, 52.9% of Ph-like cases versus 20% of non-Ph-like were MRD-positive (P=0.025); iii) the Ph-like profile was the only parameter associated with a higher risk of being MRD-positive at time point 2 (P=0.014); iv) at 24 months, Ph-like patients had a significantly inferior event-free and disease-free survival compared to non-Ph-like patients (33.5% vs. 66.2%, P=0.005 and 45.5% vs. 72.3%, P=0.062, respectively). This study documents that Ph-like patients have a lower complete remission rate, event-free survival and disease-free survival, as well as a greater MRD persistence also in a pediatric-oriented and MRD-driven adult ALL protocol, thus reinforcing that the early recognition of Ph-like ALL patients at diagnosis is crucial to refine risk-stratification and to optimize therapeutic strategies. Clinicaltrials gov. Identifier: 02067143.
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Affiliation(s)
- Sabina Chiaretti
- Hematology, Dept of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Monica Messina
- Dept of Translational and Precision Medicine, Sapienza University and GIMEMA Data Center, Rome, Italy
| | - Irene Della Starza
- Dept of Translational and Precision Medicine, Sapienza University and GIMEMA Data Center, Rome, Italy
| | - Alfonso Piciocchi
- GIMEMA Data Center, Fondazione GIMEMA Franco Mandelli Onlus, Rome, Italy
| | - Luciana Cafforio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Marzia Cavalli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Akram Taherinasab
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Michela Ansuinelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Loredana Elia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Roberta La Starza
- Department of Medicine, Hematology and Bone Marrow Transplantation Unit, University of Perugia, Italy
| | - Martina Canichella
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alessia Lauretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maria Cristina Puzzolo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Valentina Pierini
- Department of Medicine, Hematology and Bone Marrow Transplantation Unit, University of Perugia, Italy
| | - Alessandra Santoro
- Div of Hematology and Bone Marrow Transplantation,Ospedali Riuniti Villa Sofia-Cervello, Palermo,Italy
| | - Orietta Spinelli
- Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Valerio Apicella
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Saveria Capria
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Francesco Di Raimondo
- Dept. of General Surgery and Medical-Surgical Specialties, University of Catania, Italy
| | | | - Cristina Papayannidis
- Seragnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Anna Candoni
- Clinica di Ematologia e Unita' di terapie Cellulari Carlo Melzi, Udine, Italy
| | | | - Marco Cerrano
- Dept of Oncology, Division of Hematology, Presidio Molinette, Torino, Italy
| | - Nicola Fracchiolla
- UOC Oncoematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Italy
| | - Daniele Mattei
- Department of Hematology, Ospedale S. Croce, Cuneo, Italy
| | - Chiara Cattaneo
- Department of Hematology, ASST Spedali Civili, Brescia, Italy
| | - Antonella Vitale
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Enrico Crea
- GIMEMA Data Center, Fondazione GIMEMA Franco Mandelli Onlus, Rome, Italy
| | - Paola Fazi
- GIMEMA Data Center, Fondazione GIMEMA Franco Mandelli Onlus, Rome, Italy
| | - Cristina Mecucci
- Dept. of Medicine, Hematology and Bone Marrow Transplantation Unit, University of Perugia, Italy
| | - Alessandro Rambaldi
- Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Renato Bassan
- Hematology Unit, Ospedale dell'Angelo and Ospedale Ss Giovanni e Paolo, Mestre Venezia, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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7
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Arcese W, Cerretti R, Sarmati L, Cudillo L, De Angelis G, Mariotti B, Bruno A, Mangione I, Rapanotti C, Andreani M, De Fabritiis P, Dentamaro T, Cupelli L, Mengarelli A, Marchesi F, Tirindelli MC, Annibali O, Tafuri A, Ferrari A, Cedrone M, Anaclerico B, Adorno G, Miccichè S, Andreoni M, Picardi A. Matched-Pair Analysis of Transplant from Haploidentical, Unmanipulated Bone Marrow Donor versus HLA Identical Sibling for Patients with Hematologic Malignancies. Biol Blood Marrow Transplant 2020; 26:1113-1118. [PMID: 32068095 DOI: 10.1016/j.bbmt.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/22/2019] [Revised: 01/22/2020] [Accepted: 02/03/2020] [Indexed: 12/19/2022]
Abstract
A matched-pair analysis of transplant-related outcomes was carried out in 116 of 255 consecutive patients who received transplants from an HLA identical sibling (n = 58) or haploidentical related donor (n = 58). The 2 patient series were matched with 9 variables: period of transplant, patient and donor age, sex, diagnosis, disease phase, conditioning regimen, donor-recipient sex, and cytomegalovirus (CMV) status combinations. As graft-versus-host disease (GVHD) prophylaxis, all patients received the standard cyclosporine and methotrexate association with the addition of anti-thymocyte globulins, mycophenolate mofetil, and basiliximab in haploidentical, unmanipulated bone marrow recipients. Anti-infectious management, transfusion policy, and supportive care were identical for all patients. By comparing the 2 patient series, no statistically significant difference was observed for the cumulative incidence of advanced acute and extensive chronic GVHD, transplant-related mortality, and relapse. With a median follow-up of 3.5 years, the 5-year disease-free survival was 37% ± 6% and 36% ± 6% for HLA identical sibling and haploidentical recipients, respectively. The results of transplant from HLA identical siblings and haploidentical donors are comparable. Regardless of the HLA matching, other factors known to affect the transplant outcomes, such as donor-recipient age, sex, and CMV status combinations, might drive the search for the best donor.
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Affiliation(s)
- William Arcese
- Hematology, Stem Cell Transplant Unit, University Tor Vergata, Rome, Italy.
| | - Raffaella Cerretti
- Hematology, Stem Cell Transplant Unit, University Tor Vergata, Rome, Italy.
| | - Loredana Sarmati
- Clinical Infectious Diseases, University Tor Vergata, Rome, Italy.
| | - Laura Cudillo
- Hematology, Stem Cell Transplant Unit, University Tor Vergata, Rome, Italy.
| | | | - Benedetta Mariotti
- Hematology, Stem Cell Transplant Unit, University Tor Vergata, Rome, Italy.
| | - Antoine Bruno
- Hematology, Stem Cell Transplant Unit, University Tor Vergata, Rome, Italy.
| | - Ilaria Mangione
- Hematology, Stem Cell Transplant Unit, University Tor Vergata, Rome, Italy.
| | - Cristina Rapanotti
- Hematology, Stem Cell Transplant Unit, University Tor Vergata, Rome, Italy.
| | - Marco Andreani
- Laboratory of Immunogenetics and Transplant Biology, Bambino Gesù Hospital.
| | | | | | | | | | | | | | | | | | | | | | | | | | - Silvia Miccichè
- Hematology, Stem Cell Transplant Unit, University Tor Vergata, Rome, Italy.
| | - Massimo Andreoni
- Clinical Infectious Diseases, University Tor Vergata, Rome, Italy.
| | - Alessandra Picardi
- Hematology, Stem Cell Transplant Unit, University Tor Vergata, Rome, Italy.
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8
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Latagliata R, Niscola P, Fianchi L, Aloe Spiriti MA, Maurillo L, Carmosino I, Cesini L, Sarlo C, Piccioni A, Campagna A, De Luca ML, De Benedittis D, Mancini M, Breccia M, Criscuolo M, Buccisano F, Voso MT, Avvisati G, Tafuri A, De Fabritiis P, Foà R, Girmenia C. Pulmonary infections in patients with myelodysplastic syndromes receiving frontline azacytidine treatment. Hematol Oncol 2020; 38:189-196. [PMID: 31891213 DOI: 10.1002/hon.2710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/05/2019] [Revised: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 12/31/2022]
Abstract
Pulmonary infections (PIs) are a major complication of patients with myelodysplastic syndromes (MDS). We retrospectively evaluated 234 MDS patients treated with azacytidine (AZA). The total number of AZA cycles was 2886 (median 8 cycles per patient). There were 111 episodes of PI (3.8% of AZA cycles) in 81 patients (34.6%). PIs were considered of fungal origin in 27 cases (24.3%), associated to bacteremia in 11 cases (9.9%), to influenza infection in two cases (1.8%) and of unknown origin in the remaining 71 cases (64.0%). Forty-five PI episodes were documented in cycles 1 to 4 of AZA (5.1% of 875 cycles) and the remaining 66 episodes beyond the fourth cycle (3.2% of 2011 cycles) (P = .017). Overall, a fungal PI was documented in 13/875 (1.5%) cycles 1 to 4 and in 13/2011 (0.6%) cycles beyond the fourth cycle (P = .001). A baseline chronic pulmonary disease was significantly associated to a higher risk of severe PIs. In the survival analysis, cases of PI in patients who progressed to acute leukemia (PAL) were excluded, in view of the predominant influence of PAL on the outcome of the patients. A PI unrelated to PAL documented during the first 4 AZA cycles was an independent factor predicting lower survival (OR, 2.13; 95% CI, 1.37-3.33; P = .001). In conclusion, PIs are common in MDS patients receiving AZA, in particular during the first cycles of treatment and are associated with an unfavorable outcome. The results of our study raise the issue of the need of a tailored infection prevention strategy.
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Affiliation(s)
- Roberto Latagliata
- Hematology, Dipartimento Medicina Traslazionale e di Precisione, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Luana Fianchi
- Hematology, Univerità Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Ida Carmosino
- Hematology, Dipartimento Medicina Traslazionale e di Precisione, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Laura Cesini
- Hematology, Dipartimento Medicina Traslazionale e di Precisione, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Chiara Sarlo
- Hematology, University Campus Biomedico, Rome, Italy
| | | | - Alessia Campagna
- Hematology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Lucia De Luca
- Hematology, Dipartimento Medicina Traslazionale e di Precisione, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Daniela De Benedittis
- Hematology, Dipartimento Medicina Traslazionale e di Precisione, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marco Mancini
- Hematology, Dipartimento Medicina Traslazionale e di Precisione, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Massimo Breccia
- Hematology, Dipartimento Medicina Traslazionale e di Precisione, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | - Agostino Tafuri
- Hematology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Robin Foà
- Hematology, Dipartimento Medicina Traslazionale e di Precisione, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Corrado Girmenia
- Hematology, Dipartimento Medicina Traslazionale e di Precisione, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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9
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Barcellini W, Zaninoni A, Fattizzo B, Giannotta JA, Lunghi M, Ferrari A, Leporace AP, Maschio N, Scaramucci L, Cantoni S, Chiurazzi F, Consonni D, Rossi G, De Fabritiis P, Gaidano G, Zanella A, Cortelezzi A. Predictors of refractoriness to therapy and healthcare resource utilization in 378 patients with primary autoimmune hemolytic anemia from eight Italian reference centers. Am J Hematol 2018; 93:E243-E246. [PMID: 29981267 DOI: 10.1002/ajh.25212] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Wilma Barcellini
- UO Ematologia; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Anna Zaninoni
- UO Ematologia; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Bruno Fattizzo
- UO Ematologia; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | | | - Monia Lunghi
- SCDU Ematologia, Dipartimento di Medicina Traslazionale; Università del Piemonte Orientale Amedeo Avogadro; Novara Italy
| | - Antonella Ferrari
- UO Ematologia, Ospedale Sant'Andrea; Facoltà di Medicina e Psicologia, Università "Sapienza"; Rome Italy
| | - Anna Paola Leporace
- UO Ematologia, Ospedale Sant'Andrea; Facoltà di Medicina e Psicologia, Università "Sapienza"; Rome Italy
| | - Nilla Maschio
- UO Trasfusionale e immunologia; Centro Regionale Malattie del Sangue; Castelfranco Veneto Italy
| | | | - Silvia Cantoni
- SC Ematologia; Niguarda Cancer Center, ASST Niguarda; Milan Italy
| | | | - Dario Consonni
- UO Epidemiologia; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | | | | | - Gianluca Gaidano
- SCDU Ematologia, Dipartimento di Medicina Traslazionale; Università del Piemonte Orientale Amedeo Avogadro; Novara Italy
| | - Alberto Zanella
- UO Ematologia; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Agostino Cortelezzi
- UO Ematologia; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
- Università degli Studi di Milano; Milan Italy
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10
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Mayer F, Faglioni L, Agabiti N, Fenu S, Buccisano F, Latagliata R, Ricci R, Spiriti MAA, Tatarelli C, Breccia M, Cimino G, Fianchi L, Criscuolo M, Gumenyuk S, Mancini S, Maurillo L, Nobile C, Niscola P, Piccioni AL, Tafuri A, Trapè G, Andriani A, De Fabritiis P, Voso MT, Davoli M, Zini G. A Population-Based Study on Myelodysplastic Syndromes in the Lazio Region (Italy), Medical Miscoding and 11-Year Mortality Follow-Up: the Gruppo Romano-Laziale Mielodisplasie Experience of Retrospective Multicentric Registry. Mediterr J Hematol Infect Dis 2017; 9:e2017046. [PMID: 28698789 PMCID: PMC5499502 DOI: 10.4084/mjhid.2017.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/05/2017] [Indexed: 01/25/2023] Open
Abstract
Data on Myelodysplastic Syndromes (MDS) are difficult to collect by cancer registries because of the lack of reporting and the use of different classifications of the disease. In the Lazio Region, data from patients with a confirmed diagnosis of MDS, treated by a hematology center, have been collected since 2002 by the Gruppo Romano-Laziale Mielodisplasie (GROM-L) registry, the second MDS registry existing in Italy. This study aimed at evaluating MDS medical miscoding during hospitalizations, and patients' survival. For these purposes, we selected 644 MDS patients enrolled in the GROM-L registry. This cohort was linked with two regional health information systems: the Hospital Information System (HIS) and the Mortality Information System (MIS) in the 2002-2012 period. Of the 442 patients who were hospitalized at least once during the study period, 92% had up to 12 hospitalizations. 28.5% of patients had no hospitalization episodes scored like MDS, code 238.7 of the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM). The rate of death during a median follow-up of 46 months (range 0.9-130) was 45.5%. Acute myeloid leukemia (AML) was the first cause of mortality, interestingly a relevant portion of deaths is due to cerebro-cardiovascular events and second tumors. This study highlights that MDS diagnosis and treatment, which require considerable healthcare resources, tend to be under-documented in the HIS archive. Thus we need to improve the HIS to better identify information on MDS hospitalizations and outcome. Moreover, we underline the importance of comorbidity in MDS patients' survival.
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Affiliation(s)
- Flavia Mayer
- Department of Epidemiology, Lazio Regional Health Service(Italy)
| | - Laura Faglioni
- Hematology Dep. Az. Osp. San Giovanni-Addolorata Rome(Italy)
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service(Italy)
| | - Susanna Fenu
- Hematology Dep. Az. Osp. San Giovanni-Addolorata Rome(Italy)
| | | | - Roberto Latagliata
- Dep of Cellular Biotechnology and Hematology, University “La Sapienza” Rome (Italy)
| | - Roberto Ricci
- Dep of Cellular Biotechnology and Hematology, University “La Sapienza” Rome (Italy)
| | | | | | - Massimo Breccia
- Dep of Cellular Biotechnology and Hematology, University “La Sapienza” Rome (Italy)
| | - Giuseppe Cimino
- Dep. of Cellular Biotechnology and Hematology, University of Rome “Sapienza”–Polo Pontino, Latina(Italy)
| | - Luana Fianchi
- Hematology Institute Università Cattolica del Sacro Cuore Rome (Italy)
| | | | - Svitlana Gumenyuk
- Hematology and Stem Cell Transplantation Unit, Regina Elena National Cancer Institute Rome (Italy)
| | - Stefano Mancini
- Hematology Unit Az. Osp. San Camillo-Forlanini, Rome (Italy)
| | | | | | | | | | - Agostino Tafuri
- Hematology Unit Sant’ Andrea Univ. “La Sapienza “ Rome (Italy)
| | - Giulio Trapè
- Hematology Unit Az. Osp. Belcolle Viterbo (Italy)
| | | | | | | | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service(Italy)
| | - Gina Zini
- Hematology Institute Università Cattolica del Sacro Cuore Rome (Italy)
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11
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Abruzzese E, Trawinska MM, Gaspardone A, Morocutti A, De Fabritiis P. Hodgkin’s lymphoma in a man with dilated cardiomyopathy and paraneoplastic ataxia: a therapeutical challenge. Hematol Rep 2017; 9:6944. [PMID: 28702159 PMCID: PMC5494442 DOI: 10.4081/hr.2017.6944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 03/21/2017] [Indexed: 11/22/2022] Open
Abstract
Hodgkin’s lymphoma is a cancer of the lymphatic system. We report the case of a man with Hodgkin’s lymphoma and cardiomyopathy, for which the dilemma was whether to use the standard protocol - putting the patient at risk of worsening of heart failure, but giving him a good chance of full recovery - or not. The standard protocol was given and the patient made a full recovery without cardiac complications.
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12
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Chiaretti S, Vitale A, Vignetti M, Piciocchi A, Fazi P, Elia L, Falini B, Ronco F, Ferrara F, De Fabritiis P, Luppi M, La Nasa G, Tedeschi A, Califano C, Fanin R, Dore F, Mandelli F, Meloni G, Foà R. A sequential approach with imatinib, chemotherapy and transplant for adult Ph+ acute lymphoblastic leukemia: final results of the GIMEMA LAL 0904 study. Haematologica 2016; 101:1544-1552. [PMID: 27515250 DOI: 10.3324/haematol.2016.144535] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/09/2016] [Indexed: 01/09/2023] Open
Abstract
In the GIMEMA LAL 0904 protocol, adult Philadelphia positive acute lymphoblastic leukemia patients were treated with chemotherapy for induction and consolidation, followed by maintenance with imatinib. The protocol was subsequently amended and imatinib was incorporated in the induction and post-remission phase together with chemotherapy. Due to the toxicity of this combined approach, the protocol was further amended to a sequential scheme based on imatinib plus steroids as induction, followed by consolidation with chemotherapy plus imatinib and, when applicable, by a hematopoietic stem cell transplant. Fifty-one patients (median age 45.9 years) were enrolled in the final sequential protocol. At the end of induction (day +50), 96% of evaluable patients (n=49) achieved a complete hematologic remission; after consolidation, all were in complete hematologic remission. No deaths in induction were recorded. Overall survival and disease-free survival at 60 months are 48.8% and 45.8%, respectively. At day +50 (end of imatinib induction), a more than 1.3 log-reduction of BCR-ABL1 levels was associated with a significantly longer disease-free survival (55.6%, 95%CI: 39.0-79.3 vs. 20%, 95%CI: 5.8-69.1; P=0.03), overall survival (59.1%, 95%CI: 42.3-82.6 vs. 20%, 95%CI: 5.8-69.1; P=0.02) and lower incidence of relapse (20.5%, 95%CI: 7.2-38.6 vs. 60.0%, 95%CI: 21.6-84.3; P=0.01). Mean BCR-ABL1 levels remained significantly higher in patients who subsequently relapsed. Finally, BCR-ABL1p190 patients showed a significantly faster molecular response than BCR-ABL1p210 patients (P=0.023). Though the study was not powered to evaluate the role of allogeneic stem cell transplant, allografting positively impacted on both overall and disease-free survival. In conclusion, a sequential approach with imatinib alone in induction, consolidated by chemotherapy plus imatinib followed by a stem cell transplant is a feasible, well-tolerated and effective strategy for adult Philadelphia positive acute lymphoblastic leukemia, leading to the best long-term survival rates so far reported. (clinicaltrials.gov identifier: 00458848).
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Affiliation(s)
- Sabina Chiaretti
- Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto 1, "Sapienza" University of Rome, Italy
| | - Antonella Vitale
- Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto 1, "Sapienza" University of Rome, Italy
| | | | | | | | - Loredana Elia
- Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto 1, "Sapienza" University of Rome, Italy
| | | | - Francesca Ronco
- Hematology Unit, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Felicetto Ferrara
- Division of Hematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Naples, Italy
| | - Paolo De Fabritiis
- Hematology Unit and Department of Pharmacy Services, Sant'Eugenio Hospital, Rome, Italy
| | - Mario Luppi
- Hematology Division, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgio La Nasa
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Italy
| | - Alessandra Tedeschi
- Department of Oncology/Hematology, Niguarda Cancer Center, Niguarda Ca' Granda Hospital, Milano, Italy
| | | | - Renato Fanin
- Division of Hematology and Bone Marrow Transplantation, University Hospital, Udine, Italy
| | - Fausto Dore
- Department of Biomedical Sciences, University of Sassari, Italy
| | | | - Giovanna Meloni
- Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto 1, "Sapienza" University of Rome, Italy
| | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto 1, "Sapienza" University of Rome, Italy
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13
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Amadori S, Suciu S, Selleslag D, Aversa F, Gaidano G, Musso M, Annino L, Venditti A, Voso MT, Mazzone C, Magro D, De Fabritiis P, Muus P, Alimena G, Mancini M, Hagemeijer A, Paoloni F, Vignetti M, Fazi P, Meert L, Ramadan SM, Willemze R, de Witte T, Baron F. Gemtuzumab Ozogamicin Versus Best Supportive Care in Older Patients With Newly Diagnosed Acute Myeloid Leukemia Unsuitable for Intensive Chemotherapy: Results of the Randomized Phase III EORTC-GIMEMA AML-19 Trial. J Clin Oncol 2016; 34:972-9. [PMID: 26811524 DOI: 10.1200/jco.2015.64.0060] [Citation(s) in RCA: 253] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare single-agent gemtuzumab ozogamicin (GO) with best supportive care (BSC) including hydroxyurea as first-line therapy in older patients with acute myeloid leukemia unsuitable for intensive chemotherapy. PATIENTS AND METHODS In this trial, patients at least 61 years old were centrally randomized (1:1) to receive either a single induction course of GO (6 mg/m(2) on day 1 and 3 mg/m(2) on day 8) or BSC. Patients who did not progress after GO induction could receive up to eight monthly infusions of the immunoconjugate at 2 mg/m(2). Randomization was stratified by age, WHO performance score, CD33 expression status, and center. The primary end point was overall survival (OS) by intention-to-treat analysis. RESULTS A total of 237 patients were randomly assigned (118 to GO and 119 to BSC). The median OS was 4.9 months (95% CI, 4.2 to 6.8 months) in the GO group and 3.6 months (95% CI, 2.6 to 4.2 months) in the BSC group (hazard ratio, 0.69; 95% CI, 0.53 to 0.90; P = .005); the 1-year OS rate was 24.3% with GO and 9.7% with BSC. The OS benefit with GO was consistent across most subgroups, and was especially apparent in patients with high CD33 expression status, in those with favorable/intermediate cytogenetic risk profile, and in women. Overall, complete remission (CR [complete remission] + CRi [CR with incomplete recovery of peripheral blood counts]) occurred in 30 of 111 (27%) GO recipients. The rates of serious adverse events (AEs) were similar in the two groups, and no excess mortality from AEs was observed with GO. CONCLUSION First-line monotherapy with low-dose GO, as compared with BSC, significantly improved OS in older patients with acute myeloid leukemia who were ineligible for intensive chemotherapy. No unexpected AEs were identified and toxicity was manageable.
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Affiliation(s)
- Sergio Amadori
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands.
| | - Stefan Suciu
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Dominik Selleslag
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Franco Aversa
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Gianluca Gaidano
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Maurizio Musso
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Luciana Annino
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Adriano Venditti
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Maria Teresa Voso
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Carla Mazzone
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Domenico Magro
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Paolo De Fabritiis
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Petra Muus
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Giuliana Alimena
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Marco Mancini
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Anne Hagemeijer
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Francesca Paoloni
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Marco Vignetti
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Paola Fazi
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Liv Meert
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Safaa Mahmoud Ramadan
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Roel Willemze
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Theo de Witte
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
| | - Frédéric Baron
- Sergio Amadori, Adriano Venditti, and Maria Teresa Voso, Tor Vergata University; Luciana Annino, San Giovanni Addolorata Hospital; Paolo De Fabritiis, St Eugenio Hospital; Giuliana Alimena and Marco Mancini, Sapienza University; Francesca Paoloni, Marco Vignetti, and Paola Fazi, GIMEMA Foundation, Roma; Franco Aversa, University Hospital, Parma; Gainluca Gaidano, University of Eastern Piedmont, Novara; Maurizio Musso, La Maddalena Clinic, Palermo; Carla Mazzone, Annunziata Hospital, Cosenza; Domenico Magro, Pugliese-Ciaccio Hospital, Catanzaro; Safaa Mahmoud Ramadan, European Institute of Oncology, Milano, Italy; Stefan Suciu and Liv Meert, EORTC Headquarters, Brussels; Dominik Selleslag, AZ St Jan, Brugge; Anne Hagemeijer, KULeuven, Leuven; Frédéric Baron, Centre Hospitalier Universitaire, Liège, Belgium; Petra Muus and Theo de Witte, Radboudumc, Nijmegen; and Roel Willemze, University Medical Center, Leiden, the Netherlands
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Picardi A, Mengarelli A, Marino M, Gallo E, Benevolo M, Pescarmona E, Cocco R, Fraioli R, Tremante E, Petti MC, De Fabritiis P, Giacomini P. Up-regulation of activating and inhibitory NKG2 receptors in allogeneic and autologous hematopoietic stem cell grafts. J Exp Clin Cancer Res 2015; 34:98. [PMID: 26361968 PMCID: PMC4567793 DOI: 10.1186/s13046-015-0213-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/25/2015] [Indexed: 11/10/2022]
Abstract
Background Hematopoietic Stem Cell Transplantation (HSCT) is known to induce the inhibitory immune receptor NKG2A on NK cells of donor origin. This occurs in allogeneic recipients, in both the haploidentical and HLA-matched settings. Methods To gain further insight, not only NKG2A, but also the activating receptors NKG2C and NKG2D were assessed by flow cytometry. Immunophenotyping was carried out not only on CD56+ but also on CD8+ lymphocytes from leukemia and lymphoma patients, receiving both HLA-matched (n = 7) and autologous (n = 5) HSCT grafts. Moreover, cognate NKG2 ligands (HLA-E, MICA, ULBP-1, ULBP-2 and ULBP-3) were assessed by immunohistochemistry in diagnostic biopsies from three autotransplanted patients, and at relapse in one case. Results All the NKG2 receptors were simultaneously up-regulated in all the allotransplanted patients on CD8+ and/or CD56+ cells between 30 and 90 days post-transplant, coinciding with, or following, allogeneic engraftment. Up-regulation was of lesser entity and restricted to CD8+ cells in the autotransplantation setting. The phenotypic expression ratio between activating and inhibitory NKG2 receptors was remarkably similar in all the patients, except two outliers (a long survivor and a short survivor) who surprisingly displayed a similar NKG2 activation immunophenotype. Tumor expression of 2 to 3 out of the 5 tested NKG2 ligands was observed in 3/3 diagnostic biopsies, and 3 ligands were up-regulated post-transplant in a patient. Conclusions Altogether, these results are consistent with a dual (activation-inhibition) NK cell re-education mode, an innate-like T cell re-tuning, and a ligand:receptor interplay between the tumor and the immune system following HSCT including, most interestingly, the up-regulation of several activating NKG2 ligands. Turning the immune receptor balance toward activation on both T and NK cells of donor origin may complement ex vivo NK cell expansion/activation strategies in unmanipulated patients. Electronic supplementary material The online version of this article (doi:10.1186/s13046-015-0213-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alessandra Picardi
- Hematology, University of Roma Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | - Andrea Mengarelli
- Hematology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Mirella Marino
- Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Enzo Gallo
- Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Maria Benevolo
- Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Edoardo Pescarmona
- Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Roberta Cocco
- Laboratory of Clinical Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. .,Present address: Laboratory of Clinical Pathology, ASL Lanciano-Vasto-Chieti, Via Anello 66016, Guardiagrele, CH, Italy.
| | - Rocco Fraioli
- Laboratory of Immunology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Elisa Tremante
- Laboratory of Immunology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Maria Concetta Petti
- Hematology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Paolo De Fabritiis
- Hematology, University of Roma Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | - Patrizio Giacomini
- Laboratory of Immunology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
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Tirindelli MC, Flammia GP, Bove P, Cerretti R, Cudillo L, De Angelis G, Picardi A, Annibali O, Nobile C, Cerchiara E, Dentamaro T, De Fabritiis P, Lanti A, Ferraro AS, Sergi F, Di Piazza F, Avvisati G, Arcese W. Fibrin Glue Therapy for Severe Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2014; 20:1612-7. [DOI: 10.1016/j.bbmt.2014.06.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/13/2014] [Indexed: 11/15/2022]
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16
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Abruzzese E, Trawinska MM, Perrotti AP, De Fabritiis P. Tyrosine kinase inhibitors and pregnancy. Mediterr J Hematol Infect Dis 2014; 6:e2014028. [PMID: 24804001 PMCID: PMC4010610 DOI: 10.4084/mjhid.2014.028] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [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: 01/15/2014] [Accepted: 03/10/2014] [Indexed: 11/09/2022] Open
Abstract
The management of patients with chronic myeloid leukemia (CML) during pregnancy has become recently a matter of continuous debate. The introduction of the Tyrosine Kinase Inhibitors (TKIs) in clinical practice has dramatically changed the prognosis of CML patients; in fact, patients diagnosed in chronic phase can reasonably expect many years of excellent disease control and good quality of life, as well as a normal life expectancy, including the necessity to address issues relating to fertility and pregnancy. Physicians are frequently being asked for advice regarding the need for, and/or the appropriateness of, stopping treatment in order to conceive. In this report, we will review the data published in terms of fertility, conception, pregnancy, pregnancy outcome and illness control for TKI treated CML patients, as well as how to manage a planned and/or unplanned pregnancy.
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Scaramucci L, Giovannini M, Niscola P, Tendas A, Perrotti A, De Fabritiis P. Reciprocal absence of cross-resistance between eltrombopag and romiplostim in two patients with refractory immune thrombocytopenic purpura. Blood Transfus 2014:1-3. [PMID: 24887225 DOI: 10.2450/2014.0246-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
| | | | | | - Andrea Tendas
- Haematology Division, Sant'Eugenio Hospital, Rome, Italy
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Amadori S, Suciu S, Stasi R, Salih HR, Selleslag D, Muus P, De Fabritiis P, Venditti A, Ho AD, Lübbert M, Thomas X, Latagliata R, Halkes CJ, Falzetti F, Magro D, Guimaraes JE, Berneman Z, Specchia G, Karrasch M, Fazi P, Vignetti M, Willemze R, de Witte T, Marie JP. Sequential Combination of Gemtuzumab Ozogamicin and Standard Chemotherapy in Older Patients With Newly Diagnosed Acute Myeloid Leukemia: Results of a Randomized Phase III Trial by the EORTC and GIMEMA Consortium (AML-17). J Clin Oncol 2013; 31:4424-30. [DOI: 10.1200/jco.2013.49.0771] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This randomized trial evaluated the efficacy and toxicity of sequential gemtuzumab ozogamicin (GO) and standard chemotherapy in older patients with newly diagnosed acute myeloid leukemia (AML). Patients and Methods Patients (n = 472) age 61 to 75 years were randomly assigned to induction chemotherapy with mitoxantrone, cytarabine, and etoposide preceded, or not, by a course of GO (6 mg/m2 on days 1 and 15). In remission, patients received two consolidation courses with or without GO (3 mg/m2 on day 0). The primary end point was overall survival (OS). Results The overall response rate was comparable between the two arms (GO, 45%; no GO, 49%), but induction and 60-day mortality rates were higher in the GO arm (17% v 12% and 22% v 18%, respectively). With median follow-up of 5.2 years, median OS was 7.1 months in the GO arm and 10 months in the no-GO arm (hazard ratio, 1.20; 95% CI, 0.99 to 1.45; P = .07). Other survival end points were similar in both arms. Grade 3 to 4 hematologic and liver toxicities were greater in the GO arm. Treatment with GO provided no benefit in any prognostic subgroup, with the possible exception of patients age < 70 years with secondary AML, but outcomes were significantly worse in the oldest age subgroup because of a higher risk of early mortality. Conclusion As used in this trial, the sequential combination of GO and standard chemotherapy provides no benefit for older patients with AML and is too toxic for those age ≥ 70 years.
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Affiliation(s)
- Sergio Amadori
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Stefan Suciu
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Roberto Stasi
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Helmut R. Salih
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Dominik Selleslag
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Petra Muus
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Paolo De Fabritiis
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Adriano Venditti
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Anthony D. Ho
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Michael Lübbert
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Xavier Thomas
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Roberto Latagliata
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Constantijn J.M. Halkes
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Franca Falzetti
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Domenico Magro
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - José E. Guimaraes
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Zwi Berneman
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Giorgina Specchia
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Matthias Karrasch
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Paola Fazi
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Marco Vignetti
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Roel Willemze
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Theo de Witte
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
| | - Jean-Pierre Marie
- Sergio Amadori and Adriano Venditti, Tor Vergata University Hospital; Paolo De Fabritiis, St Eugenio Hospital; Roberto Latagliata, University Sapienza; Paola Fazi and Marco Vignetti, Gruppo Italiano Malattie Ematologiche dell'Adulto, Roma; Franca Falzetti, University Hospital, Perugia; Domenico Magro, Pugliese Hospital, Catanzaro; Giorgina Specchia, University Hospital, Bari, Italy; Stefan Suciu and Matthias Karrasch, European Organisation for Research and Treatment of Cancer, Brussels; Dominik Selleslag
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Malagola M, Skert C, Vignetti M, Piciocchi A, Martinelli G, Alimena G, Mecucci C, Testoni N, Iacobucci I, Clavio M, Gobbi M, Candoni A, Damiani D, Bocchia M, Lauria F, Zaccaria A, Mazza P, Visani G, Peli A, Colombi C, Cancelli V, Mancini M, Foà R, Martelli M, Cantore N, Di Raimondo F, Petrini M, De Fabritiis P, Fioritoni G, Nobile F, Fabbiano F, Specchia G, Baccarani M, Lo Coco F, Amadori S, Mandelli F, Russo D. A simple prognostic scoring system for newly diagnosed cytogenetically normal acute myeloid leukemia: retrospective analysis of 530 patients. Leuk Lymphoma 2011; 52:2329-35. [PMID: 21745171 DOI: 10.3109/10428194.2011.596965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We retrospectively analyzed the data of 337 patients with cytogenetically normal (CN) acute myeloid leukemia (AML), aged ≤ 65 years (training set). A prognostic index score (PIS) was calculated by totaling the score derived from the regression coefficients of each clinical variable, significantly associated with prognosis by multivariate analysis. The variables that were independent prognostic factors for event-free survival (EFS) and overall survival (OS) in the training set were: age ≥ 50 years, secondary AML and white blood cell count (WBC) ≥ 20 × 10(9)/L. The patients of the training set were stratified into three groups: low-, intermediate- and high-risk. The median EFS was 25, 12 and 7 months in the low-, intermediate- and high-risk groups (p < 0.0001), respectively. The median OS was not reached in the low-risk group and was 19 and 10 months in the intermediate- and high-risk groups (p < 0.0001). This PIS was validated in a series of 193 patients with CN-AML. The median EFS was 66, 16, and 3 months (p < 0.0001) and the median OS was 66, 16, and 5 months in the three risk groups, respectively (p < 0.0001). This PIS may be useful for clinical decision-making in CN-AML and may be prospectively integrated with the newest biological markers which at present are not routinely assessed and need prognostic validation.
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Affiliation(s)
- Michele Malagola
- Chair of Hematology, Unit of Blood Disease and Cell Therapy, Spedali Civili Hospital, Brescia, Italy.
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Tendas A, Niscola P, Barbati R, Abruzzese E, Cuppelli L, Giovannini M, Scaramucci L, Fratoni S, Ales M, Neri B, Morino L, Dentamaro T, De Fabritiis P. Tattoo related pyoderma/ectyma gangrenous as presenting feature of relapsed acute myeloid leukaemia: an exceptionally rare observation. Injury 2011; 42:546-7. [PMID: 20883993 DOI: 10.1016/j.injury.2010.08.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 08/10/2010] [Indexed: 02/02/2023]
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Niscola P, Palombi M, Fratoni S, Trawinska MM, Scaramucci L, Giovannini M, Perrotti A, De Fabritiis P. Unusual sequence of lymphoid disorders: follicular lymphoma subsequent to Hodgkin lymphoma and transformed into diffuse large B-cells non Hodgkin lymphoma. Acta Oncol 2010; 48:1073-4. [PMID: 19308758 DOI: 10.1080/02841860902829213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Del Poeta G, Del Principe MI, Maurillo L, Rossi FM, Buccisano F, Ammatuna E, Simotti C, Zucchetto A, Catalano G, Bulian P, Bruno A, Venditti A, De Fabritiis P, Gattei V, Amadori S. Spontaneous apoptosis and proliferation detected by BCL-2 and CD71 proteins are important progression indicators within ZAP-70 negative chronic lymphocytic leukemia. Leuk Lymphoma 2009; 51:95-106. [DOI: 10.3109/10428190903350421] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Scaramucci L, Perrotti A, Niscola P, Fratoni S, Palombi M, Piccioni D, Cupelli L, Tendas A, Dentamaro T, Del Poeta G, De Fabritiis P. Hodgkin disease subsequent to follicular lymphoma on maintenance rituximab. Leuk Lymphoma 2009; 48:1878-80. [PMID: 17786731 DOI: 10.1080/10428190701509814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Niscola P, Tendas A, Scaramucci L, Fratoni S, Giovannini M, Ales M, Cupelli L, Natale G, Dentamaro T, De Fabritiis P. Isolated bone involvement of a single lumbar vertebra body as unusual presentation of relapsing Hodgkin's lymphoma. Acta Oncol 2009; 48:1085-6. [PMID: 19449222 DOI: 10.1080/02841860902968060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Majolino I, Davoli M, Carnevalli E, Locasciulli A, Di Bartolomeo P, Scimè R, Corradini P, Selleri C, Narni F, Musso M, Bregni M, Olivieri A, De Fabritiis P, Pogliani L, Arbelaez JED, Ruscio C, Bacigalupo A. Reduced intensity conditioning with thiotepa, fludarabine, and melphalan is effective in advanced multiple myeloma. Leuk Lymphoma 2007; 48:759-66. [PMID: 17454635 DOI: 10.1080/10428190601186150] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fifty-three patients with multiple myeloma (MM) underwent an allogeneic stem cell transplant (HSCT) from their HLA identical siblings using a reduced-intensity conditioning consisting of thioteopa 5 mg/kg, fludarabine 90 mg/m(2), and melphalan 80 mg/m(2). Their median age was 52 years (range 38 - 68) and the interval from diagnosis 12 months. Forty-three patients (82%) had advanced disease and 33 had previously been treated with high-dose therapy with one (N = 21), or more (N = 12) autologus transplants. Ten (18%) had their allograft programmed after induction chemotherapy. The majority (N = 44) received peripheral blood as stem cell source. Acute graft-versus-host disease (GVHD) grade II - IV developed in 45%, but grade III - IV in only 5%. Cumulative incidence of chronic GVHD was 64%. Sixty-two per cent were in complete remission (CR) following transplantation. Transplant-related mortality was 13%. Relapse incidence was 32%. With a median follow-up of 22 months, 3-year overall survival is 45% and progression free survival (PFS) 37%. The thiotepa, fludarabine, and melphalan conditioning regimen can produce remissions in the majority of MM patients with a limited transplant mortality rate. When used as first line treatment the results of transplantation appear even more encouraging.
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Affiliation(s)
- Ignazio Majolino
- Hematology and Bone Marrow Transplantation Unit, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy.
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26
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Abruzzese E, Gozzetti A, Galimberti S, Trawinska MM, Caravita T, Siniscalchi A, Cervetti G, Mauriello A, Coletta AM, De Fabritiis P. Characterization of Ph-negative abnormal clones emerging during imatinib therapy. Cancer 2007; 109:2466-72. [PMID: 17503437 DOI: 10.1002/cncr.22699] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Imatinib is a tyrosine kinase-specific inhibitor widely used for the treatment of chronic myeloid leukemia (CML). Studies reported the occurrence of additional cytogenetic abnormalities in the Philadelphia chromosome (Ph)-negative cell population emerging after treatment-induced suppression of the Ph-positive clone. These abnormalities were described in a relatively high proportion of patients treated with imatinib compared with the anecdotal reports of similar cases in patients treated with other drugs. However, the origin of these abnormalities as well as their biological and clinical significance are unknown. METHODS The study involved 13 cases of patients diagnosed with CML carrying cytogenetic abnormalities in their Ph-negative cell population after imatinib treatment. The presence of the markers within the CD34+ stem cell compartment and the cell culture growth were analyzed and patients were followed over time. RESULTS CD34+ cells express the cytogenetic markers present in Ph- cells, suggesting a possible involvement of the stem cell population. Cultured cells showed normal growth in all but 1 patient. No growth advantage was demonstrated for the Ph-negative or the Ph-positive clone after cell culture. CONCLUSIONS After follow-up of up to 49 months, none of the patients had evolved to myelodysplasia or acute leukemia. Hypothesis regarding the biological and clinical significance of these abnormalities are formulated.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Benzamides
- Cell Separation
- Cells, Cultured
- Chromosome Aberrations
- Female
- Humans
- Imatinib Mesylate
- In Situ Hybridization, Fluorescence
- Karyotyping
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/drug therapy
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/genetics
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/pathology
- Male
- Metaphase
- Middle Aged
- Piperazines/therapeutic use
- Prognosis
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Pyrimidines/therapeutic use
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27
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Maurillo L, Buccisano F, Spagnoli A, Del Poeta G, Panetta P, Neri B, Del Principe MI, Mazzone C, Consalvo MI, Tamburini A, Ottaviani L, Fraboni D, Sarlo C, De Fabritiis P, Amadori S, Venditti A. Monitoring of minimal residual disease in adult acute myeloid leukemia using peripheral blood as an alternative source to bone marrow. Haematologica 2007; 92:605-11. [PMID: 17488683 DOI: 10.3324/haematol.10432] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To date, bone marrow (BM) is the most common source of cells to use in order to assess minimal residual disease (MRD) in acute myeloid leukemia (AML). In the present study, we investigated whether peripheral blood (PB) could be an alternative source of cells for monitoring MRD in AML. DESIGN AND METHODS Fifty patients with AML were monitored for MRD after the achievement of complete remission. Using multiparametric flow cytometry we compared the levels of MRD in 50 and 48 pairs of BM and PB after induction and consolidation, respectively. RESULTS After induction and consolidation therapy, the findings in BM and PB were significantly concordant (r=0.86 and 0.82, respectively, p<0.001 for both comparisons). The cut-off value of residual leukemic cells in PB which correlated with outcome was 1.5x10 (-4). Thirty-three of 43 (77%) patients with >1.5x10 (-4)residual leukemic cells in PB after induction had a relapse, whereas the seven patients with lower levels did not (p=0.0002). After consolidation, 38 patients had a level of MRD >1.5x10 (-4)and 31 (82%) had a relapse; nine out of the remaining ten patients, whose levels of MRD were below 1.5x10 (-4), are still relapse-free (p=0.00006). In multivariate analysis, PB MRD status at the end of consolidation was found to have a significant effect on relapse-free survival (p=0.036). INTERPRETATION AND CONCLUSIONS These preliminary results indicate that: (i) PB evaluation can integrate BM assessment for MRD detection in patients with AML; (ii) PB MRD status at the end of consolidation therapy may provide useful prognostic information.
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Affiliation(s)
- Luca Maurillo
- Dept. of Hematology, Policlinico Tor Vergata and Ospedale S.Eugenio, Rome, Italy
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28
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Abruzzese E, Del Poeta G, Barbato R, Fratoni S, Trawinska MM, Zangrilli D, Coletta AM, Patroi IM, Francesconi F, Santeusanio G, De Fabritiis P, Amadori S. Complete regression of cutaneous lesions of refractory Ph+ ALL after 4 weeks of treatment with BMS-354825. Blood 2006; 107:4571-2. [PMID: 16717133 DOI: 10.1182/blood-2005-11-4707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Niscola P, Scaramucci L, Romani C, Giovannini M, Maurillo L, del Poeta G, Cartoni C, Arcuri E, Amadori S, De Fabritiis P. Opioids in pain management of blood-related malignancies. Ann Hematol 2006; 85:489-501. [PMID: 16572325 DOI: 10.1007/s00277-005-0062-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Accepted: 12/01/2005] [Indexed: 10/24/2022]
Abstract
Opioids are basic analgesics used in the treatment of moderate to severe pain in patients affected by blood-related malignancies. They should be sequentially administered according to the World Health Organisation scale for cancer pain. Initial treatment and titration with opioids should be based on immediate-release preparations, to be administered at appropriate intervals in order to relieve pain and to satisfy the individual opioid requirement. Once a relatively good pain control has been achieved, a slow release formulation at equivalent doses can be given. Most patients can be adequately managed using oral formulation opioids. However, a small group, such as those presenting severe mucositis or requiring a rapid pain relief, should be managed by intravenous continuous infusion and/or by a patient-controlled analgesia system; while for patients in the community, there are distinct advantages to using the subcutaneous route. Other available routes of administration for opioids, can be used in selected circumstances, including rectal, transdermal, epidural, intrathecal and intramuscular. The invasive neuraxial route has a very limited role in patients with haematological malignancies, given the high risk of infection and bleeding. Through a close observation and a careful management, opioid-related side effects can be effectively prevented and treated. This article reviews the principles of opioid therapy and how opioids can be adapted for patients with pain due to haematological malignancies.
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Affiliation(s)
- Pasquale Niscola
- Hematology Division, Sant'Eugenio Hospital, Tor Vergata University, Via dell'Umanesimo 10, 00144, Rome, Italy.
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30
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Breccia M, Mandelli F, Petti MC, D'Andrea M, Pescarmona E, Pileri SA, Carmosino I, Russo E, De Fabritiis P, Alimena G. Clinico-pathological characteristics of myeloid sarcoma at diagnosis and during follow-up: report of 12 cases from a single institution. Leuk Res 2004; 28:1165-9. [PMID: 15380340 DOI: 10.1016/j.leukres.2004.01.022] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [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: 01/14/2004] [Accepted: 01/26/2004] [Indexed: 11/17/2022]
Abstract
The aim of this study was to describe the presenting features, the frequency and outcome of myeloid sarcoma (MS) diagnosed in our Institution from January 1995 to December 2000. Twelve MS were seen and the frequency account for only 2% of all acute myeloid leukemia (AML) patients observed in our department in the same period. Median age was 45 years (range: 4-84). All had been initially misdiagnosed as malignant lymphoma (ML) and a median of 2.9 months (range: 1-6) elapsed between the misdiagnosis and the correct of MS, effectuated in our department. At that time, a bone marrow examination revealed a myelodysplastic condition in seven patients, an infiltration by blast cells >30% in two patients, and normal features in the other three. In the non-leukemic patients a median of 5 months (range: 2-44 months) elapsed between the diagnosis of MS and acute leukemia. In all, 10 patients received intensive treatment. A total of seven patients (70%) achieved MS complete remission (CR). Patients who presented isolated skin localization and received only radiotherapy, obtained a MS-CR, but subsequently developed AML. Only in patients who were treated within 4 months from the initial ML diagnosis we achieved complete remission of both MS and leukemia, whereas in patients who were treated after this time, we obtained a complete disappearance of MS without response at the bone-marrow level, irrespectively of the specific therapy regimen. Median survival time from MS diagnosis was 7 months (range: 1-49 months), and only one patient is still alive, 49 months after bone marrow transplantation. Our data stress the importance of an accurate and prompt identification of this rare form of AML, and suggest that, even in patients with isolated MS, the early administration of AML-like intensive chemotherapy followed by bone marrow transplantation might reduce the risk of subsequently developing systemic disease.
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Affiliation(s)
- Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy.
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31
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De Fabritiis P, Dentamaro T, Picardi A, Cudillo L, Masi M, Amadori S. Recombinant factor VIIa for the management of severe hemorrhages in patients with hematologic malignancies. Haematologica 2004; 89:243-5. [PMID: 15003905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
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32
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Gaspardone A, De Fabritiis P, Scaffa R, Nardi P, Palombi F, Versaci F, Chiariello L. [Stem cell mobilization after coronary artery bypass grafting]. Ital Heart J Suppl 2004; 5:23-8. [PMID: 15253141] [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: 04/30/2023]
Abstract
BACKGROUND Recently, the role of stem cells as a potential therapeutic tool for ischemic heart disease has been evaluated by a number of experimental and clinical studies. Although preliminary clinical data appear to be promising, the precise pathophysiological role of stem cell mobilization during acute myocardial ischemia remains uncertain. The present study was aimed at assessing factors affecting stem cell mobilization after coronary artery bypass grafting used as a clinical model of controlled myocardial ischemia. METHODS Eighteen patients (16 men, 2 women, mean age 66 +/- 8 years) with three-vessel coronary artery disease undergoing coronary artery bypass grafting were included in the study; 24 age- and sex-matched healthy subjects served as controls. On admission, 10 patients had stable angina and 8 had unstable angina. Clinical history and instrumental evidence of previous myocardial infarction were present in 11 patients. Venous peripheral blood was sampled at baseline and 6, 24, 48 and 72 hours after coronary surgery. Duration of cardiac arrest and extracorporeal circulation were recorded as well as the release of total creatine kinase (CK), CK-MB, troponin I and C-reactive protein. CD34+ stem cells were analyzed by flow cytometry according to published methods. RESULTS In patients with ischemic heart disease the peripheral concentration of CD34+ cells was higher than that of control subjects (0.202 +/- 0.30 vs 0.068 +/- 0.059%, p = 0.03). However, patients with stable and unstable angina had similar concentration of CD34+ cells (0.171 +/- 0.33 vs 0.241 +/- 0.275%, p = 0.63) as well as patients with and without previous myocardial infarction (0.134 +/- 0.19 vs 0.245 +/- 0.352%, p = 0.4). Coronary artery bypass grafting caused a non-significant increase in concentration of CD34+ cells at 24 hours which was similar in patients with stable and unstable angina. Finally, no significant correlation was found between peripheral concentration of CD34+ cells and aortic clamping and extracorporeal circulation duration, peak release of total CK, CK-MB, troponin I and C-reactive protein. CONCLUSIONS Peripheral concentration of CD34+ stem cells is higher in patients with ischemic heart disease than in healthy controls but it is similar in patients with stable and unstable coronary syndromes. Peripheral mobilization of CD34+ cells is not correlated with the duration and severity of ischemic insult induced by surgical cardiac arrest. These preliminary findings suggest that CD34+ cell mobilization may be modulated more by tonically active than phasic factors.
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33
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Petrucci MT, Avvisati G, La Verde G, De Fabritiis P, Ribersani M, Palumbo G, De Felice L, Rusignuolo A, Simone F, Meloni G, Mandelli F. Intermediate-dose cyclophosphamide and granulocyte colony-stimulating factor is a valid alternative to high-dose cyclophosphamide for mobilizing peripheral blood CD34+ cells in patients with multiple myeloma. Acta Haematol 2003; 109:184-8. [PMID: 12853690 DOI: 10.1159/000070967] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Accepted: 02/03/2003] [Indexed: 11/19/2022]
Abstract
Peripheral blood stem cells (PBSC) are widely used in the setting of dose-intensive chemotherapies in patients with multiple myeloma (MM). Although the granulocyte colony-stimulating factor (G-CSF), following chemotherapy or not, is considered the standard growth factor for mobilizing PBSC, the optimal chemotherapeutic regimen still remains to be defined. Cyclophosphamide (CTX) is an effective drug in the treatment of MM which is capable of mobilizing PBSC if followed by growth factors, even though administration of high-dose CTX (7 g/m(2)) results in severe toxicity requiring hospitalization and increasing costs. We have retrospectively analyzed the results obtained in 38 newly diagnosed MM patients treated with 1.2 g/m(2) CTX on days 1 and 3 combined with 40 mg dexamethasone daily for 4 days. The results were compared with those obtained in 25 newly diagnosed MM patients treated with 7 g/m(2) CTX. A higher number of CD34+ cells/kg was collected during the first leukapheresis and a statistically significant lower consumption of G-CSF was observed following two doses of 1.2 g/m(2) CTX compared to the 7 g/m(2) CTX dose. The possibility of treating patients with day-hospital regimens, with a satisfactory yield of hematopoietic cells harvested, may have relevant economic implications for treatment strategies in MM patients.
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Affiliation(s)
- Maria Teresa Petrucci
- Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Università La Sapienza, Roma, Italia.
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34
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Pagano L, Mele L, Fianchi L, Rutella S, Piscitelli R, Leone G, Pulsoni A, De Fabritiis P, Foà R, Mandelli F, Visani G, Piccaluga P, Di Bona E, Cerri R, Risso M, Tosti ME, Venditti A. Immunophenotypic analysis in 119 patients with acute myeloid leukemia following a previous malignancy: a comparison with the immunophenotype of 231 de novo AML. Haematologica 2003; 88:225-7. [PMID: 12604416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
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35
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Petti MC, Fazi F, Gentile M, Diverio D, De Fabritiis P, De Propris MS, Fiorini R, Spiriti MAA, Padula F, Pelicci PG, Nervi C, Lo Coco F. Complete remission through blast cell differentiation in PLZF/RARalpha-positive acute promyelocytic leukemia: in vitro and in vivo studies. Blood 2002; 100:1065-7. [PMID: 12130525 DOI: 10.1182/blood-2001-12-0368] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [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: 11/20/2022] Open
Abstract
Acute leukemia with the t(11;17) expressing the PLZF-RARalpha gene fusion is a rare variant of acute promyelocytic leukemia (APL) that has been associated with poor clinical response to all-trans retinoic acid (ATRA) treatment. However, some recent reports have put into question the absolute refractoriness of this leukemia to ATRA. We describe here a patient with PLZF/RARalpha APL who was treated at relapse with ATRA and low-dose hydroxyurea. Complete hematologic remission was obtained through differentiation of leukemic blasts, as proven by morphologic, immunophenophenotypic, and genetic studies carried out in sequential bone marrow samples. Moreover, in vitro studies indicated that blast differentiation was potentiated by the addition of the histone deacetylase inhibitor tricostatin A, but not of hydroxyurea, to ATRA. Our findings indicate that the maturation block may be overcome and terminal differentiation obtained in this leukemia subset and support the view that sensitivity/refractoriness of this form to ATRA should be revisited.
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Affiliation(s)
- Maria C Petti
- Hematology section, Regina Elena Cancer Institute, Department of Cellular Biotechnology, University La Sapienza, Rome, Italy
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