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Pinto VM, Romano N, Balocco M, Carrara P, Lamagna M, Quintino S, Castaldi A, Forni GL. Reduction of extramedullary erythropoiesis and amelioration of anemia in a β-thalassemia patient treated with thalidomide. Am J Hematol 2024; 99:463-464. [PMID: 38146593 DOI: 10.1002/ajh.27189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/27/2023]
Abstract
β-thalassemia patient treated with thalidomide: dimensional reduction of EMH foci (MRI evaluation) and reduction of hematological responce at follow-up.
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Affiliation(s)
- Valeria Maria Pinto
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Nicola Romano
- Department of Diagnostic and Interventional Neuroradiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Manuela Balocco
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Paola Carrara
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Martina Lamagna
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Sabrina Quintino
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Antonio Castaldi
- Department of Diagnostic and Interventional Neuroradiology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Gian Luca Forni
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
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2
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Pinto VM, Gianesin B, Sardo S, Mazzi F, Baiardi G, Menotti S, Piras F, Quintino S, Robello G, Mattioli F, Finco G, Forni GL, De Franceschi L. Safety and efficacy of ketorolac continuous infusion for multimodal analgesia of vaso-occlusive crisis in patients with sickle cell disease. Orphanet J Rare Dis 2024; 19:22. [PMID: 38254184 PMCID: PMC10801952 DOI: 10.1186/s13023-023-02998-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Pain is an hallmark of sickle-cell-related acute clinical manifestations as part of acute vaso-occlusive crisis (VOC). In SCD pain has different origins such as vascular or neuropathic pain, which requires multimodal analgesia. This is based on the administration of drugs with different pharmacological mechanisms of action, maximizing analgesia and minimizing their adverse events and the risk of drug-addition in patients experiencing acute-recurrent pain events as in SCD. Ketorolac is a potent non-narcotic analgesic, being relatively safe and effective during pain-management in children and adults. Up to now, there is a lack of safety information on continuous infusion ketorolac as used to control acute pain in patients with SCD, and the benefits/risks ratio needs to be investigated. Here, we report for the first time the safety profile of ketorolac in the special population of patients with SCD. We confirmed that ketorolac in combination with tramadol, an opioid like molecule, is effective in pain control of adult patients with SCD experiencing acute severe VOCs defined by pain visual analog scale. Our study shows that short term (72 h) continuous infusion of ketorolac plus tramadol is not associated with adverse events such as liver or kidney acute disfunction or abnormalities in coagulation parameters during patients' hospitalization and within 30 days after patients discharge. This is extremely important for patients with SCD, who should have access to multimodal therapy to control recurrent acute pain crisis in order to limit central sensitization a fearsome issue of undertreated recurrent acute pain and of chronic pain.
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Affiliation(s)
- Valeria Maria Pinto
- EO Ospedali Galliera, Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Genoa, Italy
| | - Barbara Gianesin
- EO Ospedali Galliera, Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Genoa, Italy
- For Anemia Foundation, Genoa, Italy
| | - Salvatore Sardo
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Filippo Mazzi
- Department of Medicine, University of Verona and AOUI Verona, Verona, Italy
| | - Giammarco Baiardi
- Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genoa, Italy
- Clinical Pharmacology Unit, EO Ospedali Galliera, Genoa, Italy
| | - Sofia Menotti
- Department of Medicine, University of Verona and AOUI Verona, Verona, Italy
| | - Fabio Piras
- Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genoa, Italy
| | - Sabrina Quintino
- EO Ospedali Galliera, Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Genoa, Italy
| | - Giacomo Robello
- EO Ospedali Galliera, Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Genoa, Italy
| | - Francesca Mattioli
- Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, Genoa, Italy
- Clinical Pharmacology Unit, EO Ospedali Galliera, Genoa, Italy
| | - Gabriele Finco
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Gian Luca Forni
- EO Ospedali Galliera, Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Genoa, Italy.
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Pinto VM, Russo R, Quintino S, Rosato BE, Marra R, Del Giudice F, Mogni M, Maffei M, Iolascon A, Forni GL, Andolfo I. Coinheritance of PIEZO1 variants and multi-locus red blood cell defects account for the symptomatic phenotype in beta-thalassemia carriers. Am J Hematol 2023; 98:E130-E133. [PMID: 36882369 DOI: 10.1002/ajh.26901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
Workflow of the study with some examples of the achieved results.
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Affiliation(s)
- Valeria Maria Pinto
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli 'Federico II', Naples, Italy.,CEINGE Biotecnologie Avanzate, Franco Salvatore, Naples, Italy
| | - Sabrina Quintino
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Barbara Eleni Rosato
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli 'Federico II', Naples, Italy.,CEINGE Biotecnologie Avanzate, Franco Salvatore, Naples, Italy
| | - Roberta Marra
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli 'Federico II', Naples, Italy.,CEINGE Biotecnologie Avanzate, Franco Salvatore, Naples, Italy
| | | | - Massimo Mogni
- Laboratorio di Genetica Umana, Istituto Giannina Gaslini, Genoa, Italy
| | - Massimo Maffei
- Laboratorio di Genetica Umana, Istituto Giannina Gaslini, Genoa, Italy
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli 'Federico II', Naples, Italy.,CEINGE Biotecnologie Avanzate, Franco Salvatore, Naples, Italy
| | - Gian Luca Forni
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli 'Federico II', Naples, Italy.,CEINGE Biotecnologie Avanzate, Franco Salvatore, Naples, Italy
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Bordoni V, Casale M, Pinto VM, Carsetti R, Gianesin B, Gamberini MR, Mazdai L, Barella S, Denotti AR, Colavita F, Perrotta S, Maggio A, Pitrolo L, Quintino S, Caminati M, Mazzi F, Ceolan J, De Franceschi L, Forni GL, Locatelli F, Agrati C. Inflammatory and senescence-associated mediators affect the persistence of humoral response to COVID-19 mRNA vaccination in transfusion-dependent beta-thalassemic patients. Am J Hematol 2023; 98:E145-E147. [PMID: 36871203 DOI: 10.1002/ajh.26905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Veronica Bordoni
- Oncoematologia e Officina Farmaceutica, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maddalena Casale
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università, degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Valeria Maria Pinto
- Center for Microcythemia, Congenital Anemia, and Iron Dysmetabolism, Galliera Hospital, Genoa, Italy
| | - Rita Carsetti
- B-Cell Laboratory, Immunology Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Barbara Gianesin
- Center for Microcythemia, Congenital Anemia, and Iron Dysmetabolism, Galliera Hospital, Genoa, Italy.,ForAnemia Foundation, Genoa, Italy
| | - Maria Rita Gamberini
- Day Hospital della Talassemia e delle Emoglobinopatie, Dipartimento di Medicina, Azienda Ospedaliero-Universitaria S. Anna, Cona, Italy
| | - Leila Mazdai
- Day Hospital della Talassemia e delle Emoglobinopatie, Dipartimento di Medicina, Azienda Ospedaliero-Universitaria S. Anna, Cona, Italy
| | - Susanna Barella
- SC Microcitemie e anemie rare, Ospedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
| | - Anna Rita Denotti
- SC Microcitemie e anemie rare, Ospedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
| | | | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università, degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Aurelio Maggio
- Campus of Hematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Lorella Pitrolo
- Campus of Hematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Sabrina Quintino
- Center for Microcythemia, Congenital Anemia, and Iron Dysmetabolism, Galliera Hospital, Genoa, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona & AOUI Verona, Verona, Italy
| | - Filippo Mazzi
- Department of Medicine, University of Verona & AOUI Verona, Verona, Italy
| | - Jacopo Ceolan
- Department of Medicine, University of Verona & AOUI Verona, Verona, Italy
| | | | - Gian Luca Forni
- Center for Microcythemia, Congenital Anemia, and Iron Dysmetabolism, Galliera Hospital, Genoa, Italy
| | - Franco Locatelli
- Oncoematologia e Officina Farmaceutica, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Chiara Agrati
- Oncoematologia e Officina Farmaceutica, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Romano N, Baiardi G, Pinto VM, Quintino S, Gianesin B, Sasso R, Diociasi A, Mattioli F, Marchese R, Abbruzzese G, Castaldi A, Forni GL. Long-Term Neuroradiological and Clinical Evaluation of NBIA Patients Treated with a Deferiprone Based Iron-Chelation Therapy. J Clin Med 2022; 11:jcm11154524. [PMID: 35956138 PMCID: PMC9369383 DOI: 10.3390/jcm11154524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 12/01/2022] Open
Abstract
Neurodegeneration with brain iron accumulation (NBIA) comprises various rare clinical entities with brain iron overload as a common feature. Magnetic resonance imaging (MRI) allows diagnosis of this condition, and genetic molecular testing can confirm the diagnosis to better understand the intracellular damage mechanism involved. NBIA groups disorders include: pantothenate kinase-associated neurodegeneration (PKAN), mutations in the gene encoding pantothenate kinase 2 (PANK2); neuroferritinopathy, mutations in the calcium-independent phospholipase A2 gene (PLA2G6); aceruloplasminemia; and other subtypes with no specific clinical or MRI specific patterns identified. There is no causal therapy, and only symptom treatments are available for this condition. Promising strategies include the use of deferiprone (DFP), an orally administered bidentate iron chelator with the ability to pass through the blood–brain barrier. This is a prospective study analysis with a mean follow-up time of 5.5 ± 2.3 years (min–max: 2.4–9.6 years) to define DFP (15 mg/kg bid)’s efficacy and safety in the continuous treatment of 10 NBIA patients through clinical and neuroradiological evaluation. Our results show the progressive decrease in the cerebral accumulation of iron evaluated by MRI and a substantial stability of the overall clinical neurological picture without a significant correlation between clinical and radiological findings. Complete ferrochelation throughout the day appears to be of fundamental importance considering that oxidative damage is generated, above, all by non-transferrin-bound iron (NTBI); thus, we hypothesize that a (TID) administration regimen of DFP might better apply its chelating properties over 24 h with the aim to also obtain clinical improvement beyond the neuroradiological improvement.
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Affiliation(s)
- Nicola Romano
- Department of Diagnostic and Interventional Neuroradiology, EO Ospedali Galliera, 16128 Genoa, Italy; (N.R.); (R.S.); (A.C.)
| | - Giammarco Baiardi
- Clinical Pharmacology Unit, EO Ospedali Galliera, 16128 Genoa, Italy; (G.B.); (F.M.)
- Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, 16132 Genoa, Italy
| | - Valeria Maria Pinto
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, EO Ospedali Galliera, 16128 Genoa, Italy; (V.M.P.); (S.Q.); (B.G.)
| | - Sabrina Quintino
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, EO Ospedali Galliera, 16128 Genoa, Italy; (V.M.P.); (S.Q.); (B.G.)
| | - Barbara Gianesin
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, EO Ospedali Galliera, 16128 Genoa, Italy; (V.M.P.); (S.Q.); (B.G.)
| | - Riccardo Sasso
- Department of Diagnostic and Interventional Neuroradiology, EO Ospedali Galliera, 16128 Genoa, Italy; (N.R.); (R.S.); (A.C.)
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, 16132 Genoa, Italy;
| | - Andrea Diociasi
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, 16132 Genoa, Italy;
| | - Francesca Mattioli
- Clinical Pharmacology Unit, EO Ospedali Galliera, 16128 Genoa, Italy; (G.B.); (F.M.)
- Department of Internal Medicine, Pharmacology & Toxicology Unit, University of Genoa, 16132 Genoa, Italy
| | | | - Giovanni Abbruzzese
- Clinical Neurophysiology, Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, 16132 Genoa, Italy;
| | - Antonio Castaldi
- Department of Diagnostic and Interventional Neuroradiology, EO Ospedali Galliera, 16128 Genoa, Italy; (N.R.); (R.S.); (A.C.)
| | - Gian Luca Forni
- Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, EO Ospedali Galliera, 16128 Genoa, Italy; (V.M.P.); (S.Q.); (B.G.)
- Correspondence: ; Tel.: +39-010-563-4557; Fax: +39-010-563-4556
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Longo F, Gianesin B, Voi V, Motta I, Pinto VM, Piolatto A, Spasiano A, Ruffo GB, Gamberini MR, Barella S, Mariani R, Fidone C, Rosso R, Casale M, Roberti D, Dal Zotto C, Vitucci A, Bonetti F, Pitrolo L, Quaresima M, Ribersani M, Quota A, Arcioni F, Campisi S, Massa A, De Michele E, Lisi R, Miano M, Bagnato S, Gentile M, Carrai V, Putti MC, Serra M, Gaglioti C, Migone De Amicis M, Graziadei G, De Giovanni A, Ricchi P, Balocco M, Quintino S, Borsellino Z, Fortini M, Denotti AR, Tartaglione I, Beccaria A, Marziali M, Maggio A, Perrotta S, Piperno A, Filosa A, Cappellini MD, De Franceschi L, Piga A, Forni GL. Italian patients with hemoglobinopathies exhibit a 5-fold increase in age-standardized lethality due to SARS-CoV-2 infection. Am J Hematol 2022; 97:E75-E78. [PMID: 34861054 PMCID: PMC9011434 DOI: 10.1002/ajh.26429] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 12/04/2022]
Affiliation(s)
| | | | | | - Irene Motta
- Dipartimento di Scienze Cliniche e di Comunità Università degli Studi di Milano Milan Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Valeria Maria Pinto
- E.O. Ospedali Galliera Centro della Microcitemia e delle Anemie Congenite Genoa Italy
| | | | | | | | | | - Susanna Barella
- SSS Talassemia Ospedale Pediatrico Microcitemico A. Cao Cagliari Italy
| | - Raffaella Mariani
- University of Milano Bicocca, ASST‐Monza, S. Gerardo Hospital Monza Italy
| | | | | | - Maddalena Casale
- AOU Università degli Studi della Campania Luigi Vanvitelli Naples Italy
| | - Domenico Roberti
- AOU Università degli Studi della Campania Luigi Vanvitelli Naples Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Roberto Lisi
- Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi Catania Italy
| | | | | | | | | | | | | | | | | | | | - Anna De Giovanni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | | | - Manuela Balocco
- E.O. Ospedali Galliera Centro della Microcitemia e delle Anemie Congenite Genoa Italy
| | - Sabrina Quintino
- E.O. Ospedali Galliera Centro della Microcitemia e delle Anemie Congenite Genoa Italy
| | | | - Monica Fortini
- Azienda Ospedaliero‐Universitaria S.Anna di Ferrara Ferrara Italy
| | - Anna Rita Denotti
- SSS Talassemia Ospedale Pediatrico Microcitemico A. Cao Cagliari Italy
| | | | | | | | | | - Silverio Perrotta
- AOU Università degli Studi della Campania Luigi Vanvitelli Naples Italy
| | - Alberto Piperno
- University of Milano Bicocca, ASST‐Monza, S. Gerardo Hospital Monza Italy
| | | | | | | | - Antonio Piga
- Department of Clinical and Biological Sciences University of Torino Turin Italy
| | - Gian Luca Forni
- E.O. Ospedali Galliera Centro della Microcitemia e delle Anemie Congenite Genoa Italy
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Gianesin B, Pinto VM, Casale M, Corti P, Fidone C, Quintino S, Voi V, Forni GL. Manual erythroexchange in sickle cell disease: multicenter validation of a protocol predictive of volume to exchange and hemoglobin values. Ann Hematol 2020; 99:2047-2055. [PMID: 32691114 DOI: 10.1007/s00277-020-04188-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/16/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Abstract
Manual erythroexchange (MEEX) was proven to be effective and safe in the management of sickle cell disease (SCD). The goal is to quickly reduce the percentage of hemoglobin S (HbS%). A national survey of the Italian Society for Thalassemia and Hemoglobinopathies (SITE) observed a great variability among MEEX protocols none of which were found to be predictive of the values of HbS% and hemoglobin (Hb) after the exchange. Two equations to estimate the HbS% and Hb values to be obtained after MEEX were developed based on the results of the MEEX procedures in place in the centers participating in the present study. A standard protocol was subsequently defined to evaluate the volumes to exchange to obtain the target values of HbS% and Hb. The protocol was tested in 261 MEEX performed in SCD patients followed in the 5 participating centers that belong to the Italian Hemoglobinopathy Comprehensive Care Network, with the support of the SITE. The results showed a correlation between the estimated and measured values of HbS% and Hb (Rp 0.95 and 0.65 respectively, p < 0.001). A negligible bias was found for the prediction of HbS% and a bias of 1 g/dl for Hb. From consecutive MEEX, a rate of increase of HbS% between two exchanges of around 0.4% per day (p < 0.001) was measured. This protocol was shown to be effective and safe, as all patients reached the target value of HbS%. All the MEEX procedures were carried out with single venous access. No adverse events or reactions such as hypotension or electrolyte imbalance were reported nor were any complaints concerning the procedures received from patients.
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Affiliation(s)
- Barbara Gianesin
- Hemoglobinopathies and Congenital Anemia Center, Ospedale Galliera, Genoa, Italy
| | - Valeria Maria Pinto
- Hemoglobinopathies and Congenital Anemia Center, Ospedale Galliera, Genoa, Italy
| | - Maddalena Casale
- Department of Woman Child and General Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Corti
- Pediatrics Unit, Monza e Brianza per il Bambino e la sua Mamma Foundation (FMBBM), Monza, Italy
| | | | - Sabrina Quintino
- Hemoglobinopathies and Congenital Anemia Center, Ospedale Galliera, Genoa, Italy
| | - Vincenzo Voi
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Gian Luca Forni
- Hemoglobinopathies and Congenital Anemia Center, Ospedale Galliera, Genoa, Italy.
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Abstract
Sickle cell disease (SCD) is the most important hemoglobinopathy worldwide in terms of frequency and social impact, recently recognized as a global public health problem by the World Health Organization. It is a monogenic but multisystem disorder with high morbidity and mortality. Vaso-occlusion, hemolytic anemia and vasculopathy are the hallmarks of SCD pathophysiology. This review focuses both on "time-dependent" acute clinical manifestations of SCD and chronic complications commonly described in adults with SCD. The review covers a broad spectrum of topics concerning current management of SCD targeted at the internists and emergency specialists who are increasingly involved in the care of acute and chronic complications of SCD patients.
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Affiliation(s)
- Valeria Maria Pinto
- Centro della Microcitemia E Delle Anemie Congenite Ente Ospedaliero Ospedali Galliera, Via Volta 6, 16128, Genoa, Italy
| | - Manuela Balocco
- Centro della Microcitemia E Delle Anemie Congenite Ente Ospedaliero Ospedali Galliera, Via Volta 6, 16128, Genoa, Italy
| | - Sabrina Quintino
- Centro della Microcitemia E Delle Anemie Congenite Ente Ospedaliero Ospedali Galliera, Via Volta 6, 16128, Genoa, Italy
| | - Gian Luca Forni
- Centro della Microcitemia E Delle Anemie Congenite Ente Ospedaliero Ospedali Galliera, Via Volta 6, 16128, Genoa, Italy.
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Pinto VM, Balocco M, Quintino S, Bacigalupo L, Gianesin B, Rizzi M, Malagò R, De Franceschi L, Forni GL. Daily alternating deferasirox and deferiprone therapy successfully controls iron accumulation in untreatable transfusion-dependent thalassemia patients. Am J Hematol 2018; 93:E338-E340. [PMID: 30033633 DOI: 10.1002/ajh.25222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Valeria Maria Pinto
- Centro della Microcitemia e delle Anemie Congenite; Ente Ospedaliero Ospedali Galliera; Genoa Italy
| | - Manuela Balocco
- Centro della Microcitemia e delle Anemie Congenite; Ente Ospedaliero Ospedali Galliera; Genoa Italy
| | - Sabrina Quintino
- Centro della Microcitemia e delle Anemie Congenite; Ente Ospedaliero Ospedali Galliera; Genoa Italy
| | | | - Barbara Gianesin
- Centro della Microcitemia e delle Anemie Congenite; Ente Ospedaliero Ospedali Galliera; Genoa Italy
| | - Monica Rizzi
- Department of Medicine; Policlinico GB Rossi, University of Verona and AOUI-Verona; Verona Italy
| | - Roberto Malagò
- Radiology Unit; University of Verona and AOUI Verona; Verona Italy
| | - Lucia De Franceschi
- Department of Medicine; Policlinico GB Rossi, University of Verona and AOUI-Verona; Verona Italy
| | - Gian Luca Forni
- Centro della Microcitemia e delle Anemie Congenite; Ente Ospedaliero Ospedali Galliera; Genoa Italy
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Gianesin B, Zefiro D, Paparo F, Caminata A, Balocco M, Carrara P, Quintino S, Pinto V, Bacigalupo L, Rollandi GA, Marinelli M, Forni GL. Characterization of ferromagnetic or conductive properties of metallic foreign objects embedded within the human body with magnetic iron detector (MID): Screening patients for MRI. Magn Reson Med 2015; 73:2030-7. [DOI: 10.1002/mrm.25604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Barbara Gianesin
- Department of Physics; University of Genoa; Italy
- S.C. Fisica Sanitaria, E.O. Ospedali Galliera; Genoa Italy
- National Institute of Nuclear Physics; Genoa Italy
| | - Daniele Zefiro
- S.C. Fisica Sanitaria, E.O. Ospedali Galliera; Genoa Italy
| | | | - Alessio Caminata
- Department of Physics; University of Genoa; Italy
- National Institute of Nuclear Physics; Genoa Italy
| | - Manuela Balocco
- S.S.D. Ematologia - Centro della microcitemia ed anemie congenite, E.O. Ospedali Galliera; Genoa Italy
| | - Paola Carrara
- S.S.D. Ematologia - Centro della microcitemia ed anemie congenite, E.O. Ospedali Galliera; Genoa Italy
| | - Sabrina Quintino
- S.S.D. Ematologia - Centro della microcitemia ed anemie congenite, E.O. Ospedali Galliera; Genoa Italy
| | - Valeria Pinto
- S.S.D. Ematologia - Centro della microcitemia ed anemie congenite, E.O. Ospedali Galliera; Genoa Italy
| | | | | | - Mauro Marinelli
- Department of Physics; University of Genoa; Italy
- National Institute of Nuclear Physics; Genoa Italy
| | - Gian Luca Forni
- S.S.D. Ematologia - Centro della microcitemia ed anemie congenite, E.O. Ospedali Galliera; Genoa Italy
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11
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Delgado R, do Carmo Figueira M, Quintino S. Redox method for the determination of stability constants of some trivalent metal complexes. Talanta 2012; 45:451-62. [PMID: 18967026 DOI: 10.1016/s0039-9140(97)00157-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/1997] [Revised: 05/13/1997] [Accepted: 05/16/1997] [Indexed: 12/01/2022]
Abstract
Stability constants determination of very stable metal complexes using the redox method, based on the equilibrium of Fe (3+)Fe (2+) followed by a couple of platinum/reference electrodes, was undertaken and tested to complexes of some trivalent metal ions with well known polyaminopolycarboxymethylated linear ligands (edta, nta, cdta, dtpa and ttha) and also to some new macrocyclic ligands. SUPERQUAD program was used for the calculations, after adaptation of the experimental data. The method proved to be very useful for Fe(3+) and In(3+) complexes, if no polynuclear complexes are formed or/and if the kinetics of the complexation reaction is not very slow. However, for the Ga(3+) complexes the applicability of this method is very limited and the competition with OH(-) using the displacement reaction which occurs at pH higher than 6 with formation of Ga(OH)(4)(-) seems to give more accurate results. A complete data of stability constants for the case of the complexes of ttha with In(3+) is given.
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Affiliation(s)
- R Delgado
- Instituto de Tecnologia Quimica e Biológica, Rua da Quinta Grande, 6, Apartado 127, 2780 Oeiras, Portugal; Instituto Superior Técnico, 1096 Lisboa codex, Portugal
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12
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Fugazza G, Miglino M, Bruzzone R, Quintino S, Gatti AM, Grasso R, Gobbi M, Frassoni F, Sessarego M. Cytogenetic and fluorescence in situ hybridization monitoring in Ph+ Chronic Myeloid Leukemia patients treated with imatinib mesylate. J Exp Clin Cancer Res 2004; 23:295-9. [PMID: 15354415] [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
Imatinib mesylate determines a favorable clinical course in most Ph positive Chronic Myeloid Leukemia (CML) patients in the chronic phase. Cytogenetic response is usually evaluated by analyzing 20-25 bone marrow metaphases using standard banding techniques. Since this methodology has very low sensitivity, we compared the results obtained by standard banding techniques to the ones obtained by fluorescent in situ hybridization (FISH). This was also done to identify any possible discrepancies between the two techniques. We analyzed 40 Ph+ CML patients in the chronic phase who had previously been treated with interferon alpha (IFNalpha) and who were receiving imatinib. The studies were performed by utilizing the same BM cell samples fixed in acetic acid/methanol, before imatinib therapy and then quarterly. Comparison of cytogenetic results to FISH results at 3 and 6 months of imatinib treatment showed that some patients who had achieved major cytogenetic response (i.e.<35% of examined metaphases showing Ph), showed retention of a higher number of persisting Ph+ cells when examined by FISH, and they did not achieve major FISH response (i.e. <35% of examined interphase cells show the BCR-ABL fusion signal). The discrepancy we found between the results that were obtained by analyzing metaphases and interphase cells disappeared in the subsequent examinations. Moreover, we found that 4 patients (10%) were still Ph+ in all the metaphases we examined even though they achieved excellent clinical response. On the basis of this small series of patients, we suggest that cytogenetic evaluation of patients on imatinib therapy should be performed by utilizing the classic banding technique (metaphase examination), but also by using the FISH technique (interphase examination), since the two methodologies may provide different results.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Benzamides
- Bone Marrow/metabolism
- Bone Marrow/pathology
- Chromosome Banding
- Cytogenetic Analysis
- Drug Resistance, Neoplasm
- Humans
- Imatinib Mesylate
- In Situ Hybridization, Fluorescence
- Interferon-alpha/adverse effects
- Interphase
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Metaphase
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Neoplasm, Residual/diagnosis
- Piperazines/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Pyrimidines/therapeutic use
- Salvage Therapy
- Survival Rate
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Affiliation(s)
- G Fugazza
- Dipartimento di Medicina Interna and Dipartimento di Ematologia e Oncologia, Università degli Studi di Genova, Genova
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13
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Clavio M, Gatto S, Beltrami G, Quintino S, Canepa L, Pierri I, Galbusera V, Carrara P, Miglino M, Varaldo R, Ballerini F, Venturino C, Cerri R, Risso M, Balleari E, Carella AM, Sessarego M, Ghio R, Bacigalupo A, Gobbi M. Fludarabine, ARA-C, idarubicin and G-CSF (FLAG-Ida), high dose ARA-C and early stem cell transplant. A feasable and effective therapeutic strategy for de novo AML patients. J Exp Clin Cancer Res 2002; 21:481-7. [PMID: 12636093] [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: 03/01/2023]
Abstract
Forty-three consecutive patients with de novo and untreated non M3 AML aged 60 or less entered the study. The mean age of patients was 50 (range 15-60). The induction regimen (FLAG-Ida) included fludarabine (30 mg/sqm), Ara-C (2 g/sqm) on days 1-5, and idarubicin (10 mg/sqm) on days 1, 3, 5. G-CSF (300 mcg/day) was administered s.c. 12 hours before starting fludarabine and was continued for five days. HDT with stem cell rescue was planned for all patients in first CR after one course of high dose Ara-C (HDAC) consolidation and in good clinical conditions. Forty-two (98%) patients were evaluable for response. One patient died during induction (2%). CR was achieved in 35 patients (82%). Twenty-three patients, 66% of those achieving CR, underwent autologous (N = 17) or allogeneic (N = 6) transplantation. With a median follow up of 24 months, the average median duration of CR is 17 months (range 3-66) and the median survival is 20 months (range 1-83). Overall the 5 year projected disease free survival (DFS) and overall survival (OS) were 37% and 43%, respectively. Among patients who underwent stem cell transplantation DFS and OS were 53% and 69%, respectively. The median time to PMN recovery (> 0.5 x 10(9)/l) was 17 days (range 10-28) and 50 x 10(9)/l platelets were reached at a median of 17 days (12-38). In conclusion FLAG-Ida regimen is effective, low toxic and improves feasibility of stem cell transplant.
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Affiliation(s)
- M Clavio
- Dept. of Hematology and Oncology (DEMO), Azienda Ospedale San Martino e Cliniche Universitarie Convenzionate, Genova, Italy
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14
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Abstract
Myelofibrosis with myeloid metaplasia (MMM) is a clonal disorder involving disregulation of angiogenesis and immunomodulatory mechanisms. Thalidomide (Thal) retains antiangiogenic, immunomodulatory and cytokine regulatory properties and recently it has been used successfully in multiple myeloma. Here, we report our experience in 10 MMM patients treated with Thal. Patients with agnogenic MMM treated in an early phase of the disease obtained significant benefits from the therapy and remain transfusion-free. In contrast, all secondary MMM failed to respond. These preliminary findings confirm that Thal plays a role in MMM therapy, although the efficacy in the different phases of the disease must be further evaluated.
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Affiliation(s)
- L Canepa
- Department of Internal Medicine, University of Genova, Genova, Italy
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15
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Clavio M, Quintino S, Venturino C, Ballerini F, Varaldo R, Gatto S, Galbusera V, Garrone A, Grasso R, Canepa L, Miglino M, Pierri I, Gobbi M. Lymphoplasmacytic lymphoma/immunocytoma: towards a disease-targeted treatment? J Exp Clin Cancer Res 2001; 20:351-8. [PMID: 11718214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Lymphoplasmacytic-lymphoplasmacytoid lymphoma (LPL)/Waldenstrom's macroglobulinemia (WM) or immunocytoma (IMC) consists of diffuse proliferation of small mature B lymphocytes, plasmacytoid lymphocytes, and plasma-cells. The nosographic definition includes the lack of histological, immunophenotypic, cytogenetic, and molecular markers considered specific of other types of lymphoma. The cells show surface Ig (usually IgM), B-cell-associated antigens and display the CD5-, CD23- and CD10- phenotype, which allows for differential diagnosis from B-CLL and mantle cell lymphoma. t(9;14)(p13;q32) chromosomal translocation has been found in 50% of all LPL cases. The cytogenetic rearrangement juxtaposes the PAX-5 gene, which encodes for an essential transcription factor for B-cell proliferation and differention, to the Ig heavy chain gene. The combination of chlorambucil and prednisone holds as the standard treatment and seems to guarantee good control of the disease in most patients. Similar therapeutic results have been described with the combination of cyclophosphamide, vincristine, prednisone with (CHOP) or without doxorubicin (CVP), or with a combination of other alkylating agents and prednisone. Nucleoside analogues, alone or in combination with alkylating agents and anthracyclines, provide good salvage therapy for IMC and being increasingly employed as first line therapy. In a multicentric European trial Foran et al. administered the chimeric anti-CD20-monoclonal antibody (Rituximab) to 28 patients with previously treated IMC. Seven out of 25 evaluable patients (28%) achieved a partial response. Byrd et al. examined the outcome of 7 previously treated WM patients who received weekly infusions of rituximab (375 mg/m2). Therapy was well tolerated by all patients, and there was no decrease in cellular immune function, or significant infectious morbidity. Partial responses were noted in three of these patients, including two with fludarabine-refractory disease. These data suggest that rituximab exerts clinical activity on heavily pre-treated patients with WM. Furthermore, Weide et al. first reported that WM-associated polyneuropathy can be treated effectively with a combination of chemotherapy and the anti-CD20 monoclonal antibody rituximab. Most published trials exploring the efficacy of high dose treatment as salvage therapy for relapsed or refractory low grade non Hodgkin's lymphoma have included prevalently follicular or lymphocytic lymphomas. In selected high risk patients radioimmunotherapy with autologous stem-cell rescue, and myeloablative therapy followed either by autologous stem cell transplantation (SCT) or allogeneic SCT might represent an alternative strategy.
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Affiliation(s)
- M Clavio
- Dept. of Internal Medicine, University of Genoa, Genova, Italy
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16
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Clavio M, Quintino S, Masoudi B, Carrara S, Cerri R, Pierri I, Canepa L, Miglino M, Muner P, Damasio E, Gobbi M. Cost of de novo acute myeloid leukemia induction therapy in adults: analysis of EORTC-GIMEMA AML10 and FLANG regimens. J Exp Clin Cancer Res 2001; 20:165-73. [PMID: 11484970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Since the social and financial impact of AML therapy is becoming more and more relevant we analyzed the cost of induction therapy of two different regimens. The first one is part of the widely employed EORTC-GIMEMA AML-10 and consists often days of therapy. The second (FLANG) is a short (three day), Fludarabine, Ara-C, mitoxantrone and G-CSF containing regimen. We first retrospectively analyzed the outcome of 77 consecutive AML patients with comparable clinical and haematological features receiving FLANG (25) or AML-10 (52), between June 1993 and October 1999, and observed equivalent CR rate, as well as DFS and overall survival duration. We then selected 9 non pretreated patients per group who reached CR after one course of therapy. Patients treated with FLANG had a statistically significant earlier platelet recovery compared to those treated with AML-10, fewer days of intravenous antibiotic therapy (14/22, respectively, p < 0.05), and a shorter hospitalization period (22/33 days, p < 0.01). FLANG was significantly more expensive than AML 10 as far as the cost of antiblastic drugs (p < 0.01) and G-CSF support (p < 0.05) are concerned. On the contrary, the expense for antiemetic drugs (p < 0.01) and the cost of personnel and other services ($5,906/$3,970, p < 0.05) were higher for AML-10 than for FLANG. Overall, the average costs of FLANG and AML10 were $9,269 and $12,424 respectively (p < 0.05; difference = -25%). Our study seems to indicate that, compared to AML-10, FLANG induction is as effective, less expensive and it allows for a decrease in the length of hospitalization and thus for better exploitation of the financial resources of Hematology-Oncology departments.
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Affiliation(s)
- M Clavio
- Dept. of Haematology, Azienda Ospedale S Martino e Cliniche Universitarie Convenzionate, Genova, Italy
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17
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Pierri I, Clavio M, Beltrami G, Cavaliere M, Lanza L, Miglino M, Canepa L, Pietrasanta D, Ballerini F, Quintino S, Gatto S, Celesti L, Carrara P, Varese P, Gobbi M. GM-CSF, ARA-C, VP-16 and idarubicin (GM-IVA), a short, and effective induction treatment for de novo AML, suitable for the elderly. J Exp Clin Cancer Res 1999; 18:55-60. [PMID: 10374678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
GM-IVA is a short and effective induction therapy of non M3 de novo AML including GM-CSF (300 mcg 12 hrs before starting therapy), Ara-C (250 mg/sqm c.i. x 3 days), VP16 (100 mg/sqm x 3 days) and idarubicin (12 mg/sqm x 3 days); it was followed by a fludarabine containing salvage protocol (FLANG). Patients <60 years of age achieving CR received 2 courses of FLANG and autologous or allogeneic BMT when possible. Patients >60 years of age in CR received a second course of GM-IVA. Twenty-one consecutive patients (mean age 64, range 29-85) entered the study. Three patients (14%) died during induction therapy. After one course of GM-IVA, CR was achieved in 12 patients (57%). Two further patients were salvaged with FLANG therapy so that the final CR rate was 14/21 (67%). In elderly patients the final CR rate (62%) is noteworthy, considering that 6 patients were >70 years of age and 3 were >80. All three patients >80 achieved CR (lasting 5 to 7 months). The median time of granulocyte and platelet recovery was 15 days. Our scheme was well tolerated. In the group of elderly patients 3 out of 14 died during induction (21%) and 4 life-threatening infections were observed (28%). The short duration of cytotoxic therapy and perhaps the use of G-CSF contributed to a reduction of the hospitalization period (median of 22 days), thus providing major savings on induction costs and allowing for better utilization of beds as well as significantly improving patients' quality of life.
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Affiliation(s)
- I Pierri
- Dept. of Haematology, University of Genoa, Italy
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