126
|
Piccaluga PP, Ricci P, Martinelli G, Malagola M, Rondoni M, Visani G. Prompt resolution of nasal aspergillosis with intranasal instillation of liposomal amphotericin-B (amBisome) and granulocyte transfusions. Leuk Lymphoma 2004; 45:637-8. [PMID: 15160933 DOI: 10.1080/1042819031000139756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
127
|
Mele A, Sparaventi G, Guiducci B, Nicolini G, d'Adamo F, Leopardi G, Delfini C, Piccaluga P, Visani G. Gemtuzumab ozogamicin plus cytarabine determines complete remission in acute myeloid leukemia refractory to a double conventional treatment: a case report. Haematologica 2004; 89:ECR18. [PMID: 15194554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
|
128
|
Piccaluga PP, Luatti S, Ascani S, Bianchini M, Malagola M, Rondoni M, Gaitani S, Testoni N, Pileri SA, Baccarani M, Martinelli G, Visani G. Identification of a novel t(1;9)(q11;q34) in acute myelocytic leukemia. ACTA ACUST UNITED AC 2004; 151:85-6. [PMID: 15120916 DOI: 10.1016/j.cancergencyto.2003.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
129
|
Piccaluga PP, Malagola M, Rondoni M, Amabile M, Paolini S, Soverini S, Gaitani S, Visani G, Baccarani M, Martinelli G. Dose increase of imatinib mesylate may overcome acquired resistance in bcr/abl-positive acute lymphoid leukaemia. Eur J Haematol 2004; 72:302-3. [PMID: 15089772 DOI: 10.1111/j.1600-0609.2004.00212.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
130
|
Pulsoni A, Pagano L, Latagliata R, Casini M, Cerri R, Crugnola M, De Paoli L, Di Bona E, Invernizzi R, Marmont F, Petti MC, Rigolin G, Ronco F, Spadano A, Tosti ME, Visani G, Mele A, Mandelli F. Survival of elderly patients with acute myeloid leukemia. Haematologica 2004; 89:296-302. [PMID: 15020267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The prognosis of elderly patients with acute myelogenous leukemia (AML) is usually dismal, while the true survival of older patients not included in clinical trials is not known. We retrospectively evaluated the impact on survival of an aggressive versus a non-aggressive approach in 1005 patients aged >60 years registered in the database of the GIMEMA cooperative group. DESIGN AND METHODS Group A patients (n=621) received aggressive treatment, while group B patients (n=384) underwent non-aggressive therapy. The groups were different for risk factor distribution: the patients in group B had a higher median age, worse performance status (PS) and a higher proportion of previous myelodysplastic disease. RESULTS The overall median survival was 7 and 5 months in groups A and B, respectively (p min of 0.0001). At multivariate analysis the following factors were associated with a significantly shorter survival: age >71 years (RR=1.27; 95% CI=1.07-1.50), PS=2-4 (RR=1.44; 95% CI=1.24-1.68), white cell count > 10,000 mL (RR=1.37; 95% CI=1.06-1.75), and heart dysfunction requiring treatment (RR=1.26; 95% CI=1.05-1.50). No difference in survival was associated with aggressive or non-aggressive treatment (RR=1.1; 95% CI=0.94-1.32). Patients aged min of 70 years, with no heart disease, but a white cell count > 10,000/mL showed a significantly better survival when treated aggressively (median survival 7 vs 3 months, p = 0.011). INTERPRETATION AND CONCLUSIONS Despite an obvious selection of patients with a worse prognosis in group B, the difference in survival between the two groups was marginal. Multivariate analysis failed to demonstrate a significant survival benefit in aggressively treated patients. All these considerations indicate that elderly patients with AML are overall unlikely to benefit from aggressive treatment, so that this should be offered only to selected patients.
Collapse
|
131
|
Nesci S, Buffi O, Iliescu A, Luchetti M, Battarra MR, Amadei M, Visani G, Andreani M. A new HLA-DRB1*11 allele, DRB1*1144, identified by cloning and sequencing. ACTA ACUST UNITED AC 2004; 63:282-3. [PMID: 14989721 DOI: 10.1111/j.1399-0039.2004.00176.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report here the identification of a novel DRB1*11 allele, DRB1*1144, identified during sequence-based HLA-DRB1 typing. Molecular cloning and direct sequencing confirmed that the new allele is identical to DRB1*110401 at exon 2, except for a single nucleotide substitution (GTG-->GCG) changing codon 38 from Valine to Alanine.
Collapse
|
132
|
Pagano L, Pulsoni A, Tosti ME, Caramatti C, Cerri R, Falcucci P, Fazi P, Fianchi L, Martino B, Mattei D, Offidani M, Pacilli L, Pogliani EM, Rotoli B, Specchia G, Visani G, Vignetti M, Voso MT, Leone G, Mandelli F. Second malignancy after treatment of adult acute myeloid leukemia: cohort study on adult patients enrolled in the GIMEMA trials. Leukemia 2004; 18:651-3. [PMID: 14749702 DOI: 10.1038/sj.leu.2403276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
133
|
Breccia M, Diverio D, Noguera NI, Visani G, Santoro A, Locatelli F, Damiani D, Marmont F, Vignetti M, Petti MC, Lo Coco F. Clinico-biological features and outcome of acute promyelocytic leukemia patients with persistent polymerase chain reaction-detectable disease after the AIDA front-line induction and consolidation therapy. Haematologica 2004; 89:29-33. [PMID: 14754603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Front line treatment of acute promyelocytic leukemia (APL) with all-trans retinoic acid (ATRA) and chemotherapy (CHT) results in molecular remission in approximately 95% of patients tested after consolidation. The small fraction of patients with persistence of molecular disease (i.e. those in whom polymerase chain reaction (PCR) is positive for PML/RARalpha) after such therapy are thought to have a dismal prognosis but has not yet been investigated in detail. DESIGN AND METHODS We analyzed the clinico-biological features at presentation of APL patients who showed PCR-detectable residual disease and compared them to those of patients achieving molecular remission after AIDA induction and consolidation. Furthermore, we report the outcome of patients with molecularly persistent disease treated with salvage therapy. RESULTS Patients attaining molecular remission (n=650) and patients who tested PCR+ve at the end of consolidation (n=23) were not statistically significantly different as regards median age, white cell and platelet counts, morphologic subtype (M3 or M3v), fibrinogen levels or PML/RARalpha transcript type. As to treatment outcome after salvage therapy, 7 patients were treated before morphologic relapse [3 with chemotherapy and autologous stem cell transplantation (SCT) and 4 with allogeneic SCT], and are alive after 64-118 months. Of 16 patients treated at the time of morphologic relapse, only 2 patients are alive, both of whom received an allogeneic SCT. INTERPRETATION AND CONCLUSIONS Our findings indicate that APL patients who are molecularly resistant to the AIDA protocol have no distinguishing features at presentation. Their outcome suggests the need for early therapeutic intervention with aggressive treatment prior to the occurrence of hematologic relapse.
Collapse
|
134
|
Buonamici S, Ottaviani E, Visani G, Bonifazi F, Fiacchini M, Baccarani M, Martinelli G. Patterns of AML1-ETO transcript expression in patients with acute myeloid leukemia and t(8;21) in complete hematologic remission. Haematologica 2004; 89:103-5. [PMID: 14754613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
|
135
|
Piccaluga PP, Martinelli G, Rondoni M, Malagola M, Ronconi S, Visani G, Baccarani M. Low dose gemtuzumab ozogamicin for relapsed acute myeloid leukaemia in elderly. Haematologica 2003; 88:ECR37. [PMID: 14688010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
|
136
|
Martinelli G, Ottaviani E, Buonamici S, Isidori A, Borsaru G, Visani G, Piccaluga PP, Malagola M, Testoni N, Rondoni M, Nucifora G, Tura S, Baccarani M. Association of 3q21q26 syndrome with different RPN1/EVI1 fusion transcripts. Haematologica 2003; 88:1221-8. [PMID: 14607750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with acute myeloblastic leukemia (AML) with features of myelodysplastic syndrome and abnormalities of megakaryocytopoiesis often have cytogenetic aberrations of 3q21 and 3q26 bands involving the paracentric inversion [inv(3) (q21q26)] or a reciprocal translocation [t(3;3) (q21;q26)]. These abnormalities frequently cause inappropriate expression of the EVI1 gene located at 3q26. Other genes that have been implicated at the rearrangement breakpoint are GR6 and RPN1 (both on 3q21). The aim of this study was to investigate the expression of the EVI1 fusion genes in AML patients with 3q21q26 syndrome. DESIGN AND METHODS We used reverse transcription polymerase chain reaction to evaluate the expression of EVI1 and GR6, and particularly of the fusion genes RPN1-EVI1 and GR6-EVI1 in 9 AML patients with either inv(3)(q21q26) (7 cases) or t(3;3)(q21;q26) (2 cases). RESULTS EVI1 and GR6 were always expressed, as was RPN1-EVI1; GR6-EVI1 was absent. In 8/9 patients, the part of EVI1 retained in RPN1-DEVI1 contained blocks B and C of the PR domain commonly found in the MDS1-EVI1 gene. In the remaining patient [with inv(3) (q21q26)], only block C was retained: we named this variant fusion gene RPN1-DEVI1. This patient lacked the micromegakaryocytopoiesis frequently found in 3q21q26 syndrome. INTERPRETATION AND CONCLUSIONS These findings support the hypothesis that EVI1 activation plays a dominant role in the pathogenesis of the 3q21q26 syndrome. EVI1 expression might occur either as a consequence of rearrangements leading to the formation of different fusion transcripts, such as RPN1-EVI1 and RPN1-DEVI1 or following disruption of the PR activation domain of the MDS1-EVI1 gene.
Collapse
MESH Headings
- Adult
- Amino Acid Sequence
- Anemia, Refractory, with Excess of Blasts/genetics
- Bone Marrow/pathology
- Chromosome Inversion
- Chromosomes, Human, Pair 3/genetics
- Chromosomes, Human, Pair 3/ultrastructure
- Disease Progression
- Female
- Gene Expression Regulation, Leukemic
- Humans
- Karyotyping
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Male
- Middle Aged
- Molecular Sequence Data
- Oncogene Proteins, Fusion/genetics
- Protein Structure, Tertiary
- RNA, Messenger/genetics
- RNA, Neoplasm/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Sequence Alignment
- Syndrome
- Thrombocytopenia/etiology
- Thrombocytopenia/genetics
- Translocation, Genetic
Collapse
|
137
|
Lemoli RM, de Vivo A, Damiani D, Isidori A, Tani M, Bonini A, Cellini C, Curti A, Gugliotta L, Visani G, Fanin R, Baccarani M. Autologous transplantation of granulocyte colony-stimulating factor-primed bone marrow is effective in supporting myeloablative chemotherapy in patients with hematologic malignancies and poor peripheral blood stem cell mobilization. Blood 2003; 102:1595-600. [PMID: 12714501 DOI: 10.1182/blood-2003-02-0440] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We assessed the hematopoietic recovery and transplantation-related mortality (TRM) of patients who had failed peripheral blood stem cell mobilization and subsequently received high-dose chemotherapy supported by granulocyte colony-stimulating factor (G-CSF)-primed bone marrow (BM). Studied were 86 heavily pretreated consecutive patients with acute leukemia (n = 21), refractory/relapsed non-Hodgkin lymphoma (n = 41) and Hodgkin disease (n = 17), and multiple myeloma (n = 7). There were 78 patients who showed insufficient mobilization of CD34+ cells (< 10 cells/microL), whereas 8 patients collected less than 1 x 106 CD34+ cells/kg. BM was primed in vivo for 3 days with 15 to 16 microg/kg of subcutaneous G-CSF. Median numbers of nucleated cells, colony-forming unit cells (CFU-Cs), and CD34+ cells per kilogram harvested were 3.5 x 10(8), 3.72 x 10(4), and 0.82 x 10(6), respectively. Following myeloablative chemotherapy, median times to achieve a granulocyte count higher than 0.5 x 10(9)/L and an unsupported platelet count higher than 20 and 50 x 10(9)/L were 13 (range, 8-24), 15 (range, 12-75), and 22 (range, 12-180) days, respectively, for lymphoma/myeloma patients and 23 (range, 13-53), 52 (range, 40-120), and 90 (range, 46-207) days, respectively, for leukemia patients. Median times to hospital discharge after transplantation were 17 (range, 12-40) and 27 (range, 14-39) days for lymphoma/myeloma and acute leukemia patients, respectively. TRM was 4.6%, whereas 15 patients died of disease. G-CSF-primed BM induces effective multilineage hematopoietic recovery after high-dose chemotherapy and can be safely used in patients with poor stem cell mobilization.
Collapse
|
138
|
Visani G, Mele A, Malagola M, Isidori A, Finelli C, Piccaluga PP. Sequential combination of thalidomide and erythropoietin determines transfusion independence and disease control in idiopathic myelofibrosis previously insensitive to both drugs used as single agents. Leukemia 2003; 17:1669-70. [PMID: 12886259 DOI: 10.1038/sj.leu.2403017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
139
|
Piccaluga PP, Martinelli G, Malagola M, Rondoni M, Bianchini M, Visani G, Baccarani M. Complete remission in acute myeloid leukemia with granulocyte-colony stimulating factor without chemotherapy. Report of cytogenetic remission of a t(9;11)(p22q23) positive AML patient and review of literature. Haematologica 2003; 88:ECR28. [PMID: 12935987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
|
140
|
Delfini C, Centis F, Tabellini L, Nicolini G, Visani G. Interferon-alpha modulates the immune response enhancing B7-1 and B7-2 costimulatory molecules and T8 lymphocytes in chronic myeloid leukemia. Leukemia 2003; 17:983-4; author reply 985. [PMID: 12750716 DOI: 10.1038/sj.leu.2402903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
MESH Headings
- Antigen Presentation
- Antigens, CD/analysis
- Antigens, CD/metabolism
- B7-1 Antigen/metabolism
- B7-2 Antigen
- CD8-Positive T-Lymphocytes/metabolism
- Dendritic Cells/drug effects
- Gene Expression Regulation, Leukemic/drug effects
- Humans
- Immunity, Cellular
- Interferon alpha-2
- Interferon-alpha/pharmacology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Membrane Glycoproteins/metabolism
- Recombinant Proteins
Collapse
|
141
|
Piccaluga PP, Visani G, Isidori A, Malagola M, Ascani S, Pileri SA. Microdose alpha-interferon shows clinical and antiangiogenic effect in extramedullary myeloid tumor: a case report. Leukemia 2003; 17:986-7. [PMID: 12750719 DOI: 10.1038/sj.leu.2402904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
142
|
Visani G, Piccaluga PP, Martinelli G, Rossi M, Malagola M, Baccarani M. Sustained molecular remission in advanced acute promyelocytic leukemia with combined pulsed retinoic acid and arsenic trioxide. Clinical evidence of synergistic effect and real-time quantification of minimal residual disease. Haematologica 2003; 88:ELT15. [PMID: 12681992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
|
143
|
Martinelli G, Buonamici S, Visani G, Malagola M, Piccaluga PP, Isidori A, Bosi C, Bonifazi F, Soverini S, Terragna C, Amabile M, Giannini B, Baccarani M. Molecular monitoring of acute myeloid leukemia associated with inv(16): threshold of CBFbeta/MYH11 transcript copy number above which relapse occurs and below which continuous Complete Remission is likely. Leukemia 2003; 17:650-1; author reply 651-2. [PMID: 12646962 DOI: 10.1038/sj.leu.2402822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
144
|
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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
|
145
|
Barosi G, Giovanni B, Elliott M, Michelle E, Canepa L, Letizia C, Ballerini F, Filippo B, Piccaluga PP, Pier Paolo P, Visani G, Giuseppe V, Marchetti M, Monia M, Pozzato G, Gabriele P, Zorat F, Francesca Z, Tefferi A, Ayalew T. Thalidomide in myelofibrosis with myeloid metaplasia: a pooled-analysis of individual patient data from five studies. Leuk Lymphoma 2002; 43:2301-7. [PMID: 12613516 DOI: 10.1080/1042819021000040008] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Trials to determine the effect of thalidomide in patients with Myelofibrosis with Myeloid Metaplasia (MMM) have produced inconclusive results due to different criteria for response and heterogeneous study participants. We undertook a pooled-analysis to assess the effects of such treatment on a larger series of cases and with a uniform assessment of response. We used updated data on 62 individual patients from 5 phase II trials that evaluated thalidomide therapy in MMM patients. Responsewas judged on individual disease parameters, on the improvement of the Dupriez risk categories and on the improvement of a 6 point "severity score" based on myeloproliferative and myelodepletive indexes of the disease. Overall, using standard dose of thalidomide, i.e. starting with no less than 100 mg/day, 49 patients (79%) had more than 4 weeks of therapy. Twenty-nine percent of patients with moderate to severe anemia showed an increase in hemoglobin or reduction/abolishment of blood transfusion requirements, 38% with moderate to severe thrombocytopenia had an increase in platelet counts, and 41% with high grade splenomegaly demonstrated a measurable reduction in splenic size. These effects led to an absolute decrease in the "severity" score in 44.9% of the patients. Major disease severity and high degrees of splenomegaly before therapy predicted response with a probability of 61.9%. However, worsening of the "severity" score was observed in 20.4% of the patients, 18% having a "myeloproliferative reaction" with leukocytosis and/or thrombocytosis. Sixty-six percent of the patients discontinued the drug before 6 months of treatment due to intolerance. In conclusion, there is a small but clear improvement of disease severity with thalidomide therapy in MMM. The potential for myeloproliferative reactions and the unfavorable dose-related toxicity profile argue for future studies using lower doses of this drug.
Collapse
|
146
|
Alessandrino EP, Amadori S, Barosi G, Cazzola M, Grossi A, Liberato LN, Locatelli F, Marchetti M, Morra E, Rebulla P, Visani G, Tura S. Evidence- and consensus-based practice guidelines for the therapy of primary myelodysplastic syndromes. A statement from the Italian Society of Hematology. Haematologica 2002; 87:1286-306. [PMID: 12495903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Novel therapeutic agents and strategies have been introduced into the management of myelodysplastic syndromes (MDS) in the last years. This has led to more treatment options and a better chance of long-term survival for MDS patients, but also to uncertainty regarding the optimal use and possible side effects of these treatments. The Italian Society of Hematology commissioned a project to develop guidelines for the therapy of MDS using evidence-based knowledge and consensus-formation techniques. DESIGN AND METHODS An Advisory Council (AC) shaped the project around a series of key clinical questions, performed a systematic search for evidence and graded the available evidence according to the Scottish Intercollegiate Guidelines Network (SIGN). A list of clinical questions was mailed to each of 10 senior hematologists composing the Expert Panel (EP): the panelists were asked to rank the most relevant questions, and to formulate answers to the questions according to the tables of evidence. A scenario phase followed, so as to reach a consensus on the three top ranked questions. The EP was asked to score patient profiles as appropriate or not appropriate for the therapeutic strategy under scrutiny, according to the RAND technique. Finally, from September 2001 to January 2002, four Consensus Conferences conducted according to the Nominal Group Technique were held in Milan, Italy. The overall goal of the conferences was to take a final decision upon the appropriateness of the uncertain scenarios and of the uncertain responses to the clinical questions. RESULTS Evidence was judged sufficient for providing recommendations on the use of allogeneic stem cell transplantation, leukemia-like chemotherapy, autologous stem cell transplantation, low-dose chemotherapy, danazol, immunosuppressive therapy, hypomethylating agents and hematopoietic growth factors. Specific recommendations for supportive therapy, including iron chelation, were issued. Allogeneic stem cell transplantation was unanimously considered as the only curative treatment for MDS patients, and recommendations on its use were agreed based on patient's age, risk, clinical features and donor availability. AML-like chemotherapy was also considered a valuable therapeutic option for subsets of MDS patients. Autologous stem cell transplantation was recommended for patients who lack an HLA identical donor and have achieved complete remission with AML-like chemotherapy. Decitabine, recombinant human erythropoietin and immunosuppressive therapy were judged valuable therapeutic options for subsets of MDS patients whereas low-dose cytarabine was not. Specific therapeutic strategies for those subjects younger than 18 years or older than 75 years and the strategy of watchful waiting were decided by patient-oriented questions. INTERPRETATION AND CONCLUSIONS Using evidence and consensus, recommendations for the treatment of MDS were issued. Statements were graded according to the strength of the supporting evidence and uncertainty was explicitly declared.
Collapse
|
147
|
Visani G, Isidori A, Malagola M, Alberti D, Capdeville R, Martinelli G, Piccaluga PP, Amabile M, Guiducci B, Tura S, Baccarani M. Efficacy of imatinib mesylate (STI571) in conjunction with alpha-interferon: long-term quantitative molecular remission in relapsed P-190(BCR-ABL)-positive acute lymphoblastic leukemia. Leukemia 2002; 16:2159-60. [PMID: 12357372 DOI: 10.1038/sj.leu.2402729] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2002] [Accepted: 07/05/2002] [Indexed: 11/09/2022]
|
148
|
Pulsoni A, Pagano L, Lo Coco F, Avvisati G, Mele L, Di Bona E, Invernizzi R, Leoni F, Marmont F, Mele A, Melillo L, Nosari AM, Pogliani EM, Vignetti M, Visani G, Zagonel V, Leone G, Mandelli F. Clinicobiological features and outcome of acute promyelocytic leukemia occurring as a second tumor: the GIMEMA experience. Blood 2002; 100:1972-6. [PMID: 12200354 DOI: 10.1182/blood-2001-12-0312] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We analyzed the clinicobiological features and treatment outcome of a series of acute promyelocytic leukemias (APLs) occurring as a second tumor (APL-st's, n = 51) and compared these with a large group of de novo APL cases (n = 641), both observed by the Italian cooperative group GIMEMA. In the APL-st group, 37 patients had received radiotherapy and/or chemotherapy for their primary malignancy (PM), while 14 had been treated by surgery alone. Compared with de novo APL patients, APL-st patients were characterized by a predominance of females (P <.003), higher median age (P <.05), and worse performance status (P <.005). The median time elapsed between PM and APL-st was 36 months, with a longer latency for patients treated with surgery alone. No significant differences were found with regard to karyotypic lesions or type of promyelocytic leukemia/retinoic acid receptor alpha (PML/RARalpha) fusion in the 2 cohorts. A high prevalence of PMs of the reproductive system was observed among the female APL-st population (24 [71%] of 34 patients in this group had suffered from breast, uterine, or ovarian cancer). Thirty-one APL-st and 641 de novo APL patients received homogeneous APL therapy according to the all-trans retinoic acid (ATRA) and idarubicin regimen (the AIDA regimen). The complete remission (CR), 4-year event-free survival (EFS), and 4-year overall survival (OS) rates were 97% and 93%, 65% and 68%, and 85% and 78% in the APL-st and de novo APL groups, respectively. In spite of important clinical differences (older age and poorer performance status), the APL-st group responded as well as the de novo APL group to upfront ATRA plus chemotherapy, probably reflecting genetic similarity.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Child
- Child, Preschool
- Female
- Humans
- Idarubicin/therapeutic use
- Incidence
- Infant
- Leukemia, Promyelocytic, Acute/epidemiology
- Leukemia, Promyelocytic, Acute/mortality
- Leukemia, Promyelocytic, Acute/therapy
- Male
- Middle Aged
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/mortality
- Retrospective Studies
- Risk Factors
- Survival Analysis
- Treatment Outcome
- Tretinoin/therapeutic use
Collapse
|
149
|
Piccaluga PP, Visani G, Pileri SA, Ascani S, Grafone T, Isidori A, Malagola M, Finelli C, Martinelli G, Ricci P, Baccarani M, Tura S. Clinical efficacy and antiangiogenic activity of thalidomide in myelofibrosis with myeloid metaplasia. A pilot study. Leukemia 2002; 16:1609-14. [PMID: 12200671 DOI: 10.1038/sj.leu.2402596] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2001] [Accepted: 03/25/2002] [Indexed: 11/09/2022]
Abstract
Increased neoangiogenesis has been reported in myelofibrosis with myeloid metaplasia (MMM). Thus we studied the effects of thalidomide, an antiangiogenic drug, in 12 MMM patients. Before treatment, all the cases showed a significantly increased micro-vessel density (MVD); in all eight tested cases bFGF and VEGF plasma levels were higher than controls. All patients presented disease progression in the last 3 months with standard therapy, regarding splenomegaly, anemia and/or thrombocytopenia and/or hyperleukocytosis. Thalidomide was administered at daily doses increasing from 100 to 600 mg. Eleven out of 12 patients were evaluable. No progression of disease was seen during the treatment in any case. In particular, spleen size decreased in 7/11 patients, anemia improved in 3/4 (two are now transfusion independent), thrombocytopenia in 2/2 and hyperleukocytosis in 2/5 patients. Side-effects were frequent, although not severe. After treatment, VEGF and bFGF plasma levels varied widely and in selected cases decreased. In particular, VEGF and/or bFGF decreased in 4/5 responders and in 1/3 non-responders. Moreover, MVD significantly decreased in all the responders evaluated after treatment. We conclude that thalidomide is a feasible therapy in MMM patients and looks promising at least to control the growth progression of disease.
Collapse
|
150
|
Piccaluga PP, Visani G, Martinelli G, Isidori A, Malagola M, Rondoni M, Baccarani M, Tura S. Liposomal daunorubicin (DaunoXome) for treatment of relapsed meningeal acute myeloid leukemia. Leukemia 2002; 16:1880-1. [PMID: 12200714 DOI: 10.1038/sj.leu.2402617] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2002] [Accepted: 03/22/2002] [Indexed: 11/08/2022]
|