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Modi NB, Shames R, Lickliter JD, Gupta S. Pharmacokinetics, pharmacodynamics, and tolerability of an aqueous formulation of rusfertide (PTG-300), a hepcidin mimetic, in healthy volunteers: A double-blind first-in-human study. Eur J Haematol 2024; 113:340-350. [PMID: 38785334 DOI: 10.1111/ejh.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Rusfertide is a potent peptide mimetic of hepcidin being investigated for the treatment of polycythemia vera. This randomized, placebo-controlled, double-blind study evaluated the safety, pharmacokinetics, and pharmacodynamics of single and repeated subcutaneous doses of an aqueous formulation of rusfertide in healthy adult males. METHODS Subjects received single doses of 1, 3, 10, 20, 40, or 80 mg rusfertide or placebo. A separate cohort of subjects received two doses of 40 mg rusfertide or placebo 1 week apart. Blood samples for pharmacokinetics and pharmacodynamics were collected, and adverse events, clinical laboratory tests, 12-lead electrocardiograms, and vital signs were monitored. RESULTS Rusfertide was well tolerated. There were no serious or severe treatment-emergent adverse events, and no patterns of clinically important adverse events, or laboratory, vital sign, or electrocardiogram abnormalities. Mean maximum rusfertide plasma concentration (Cmax) and area under the concentration-time curve increased with dose, but less than dose proportionally. Median time to Cmax was 2-4.5 h for 40 and 80 mg rusfertide and 8-24 h for lower doses. Apparent clearance and half-life increased with dose. Single doses of rusfertide 1-80 mg were associated with dose-dependent decreases in serum iron and transferrin-iron saturation. CONCLUSIONS Rusfertide was well tolerated and showed dose-dependent pharmacokinetics and pharmacodynamics.
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Affiliation(s)
- Nishit B Modi
- Protagonist Therapeutics, Inc., Newark, California, USA
| | | | | | - Suneel Gupta
- Protagonist Therapeutics, Inc., Newark, California, USA
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Martinez J, Handa S, Skorodinsky A, Kremyanskaya M. The evolving landscape of polycythemia vera therapies. Expert Opin Pharmacother 2024. [PMID: 39106053 DOI: 10.1080/14656566.2024.2387681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION The treatment landscape of polycythemia vera (PV) has seen major advancements within the last decade including approval of ruxolitinib in the second line setting after hydroxyurea, ropegylated interferon-α2b, and advanced clinical development of a novel class of agents called hepcidin mimetics. AREAS COVERED We provide a comprehensive review of the evidence discussing the risk stratification, treatment indications, role and limitations of phlebotomy only approach and pivotal trials covering nuances related to the use of interferon-α (IFN-α), ruxolitinib, hepcidin mimetics and upcoming investigational agents including HDAC and LSD1 inhibitors. EXPERT OPINION The research paradigm in PV is slowly shifting from the sole focus on hematocrit control and moving toward disease modification. The discovery of hepcidin mimetics has come as a breakthrough in restoring iron homeostasis, achieving phlebotomy-independence and may lead to improved thrombosis-free survival with stricter hematocrit control. On the other hand, emerging data with IFN- α and ruxolitinib as well as combination of the two agents suggests the potential for achieving molecular remission in a subset of PV patients and long-term follow-up is awaited to validate the correlation of molecular responses with clinically relevant outcomes of progression-free and thrombosis-free survival.
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Affiliation(s)
- Juana Martinez
- Department of Internal Medicine, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mount Sinai, Queens, NY, USA
| | - Shivani Handa
- Department of Internal Medicine, Division of Hematology & Medical Oncology, Tisch Cancer Institute/Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Marina Kremyanskaya
- Department of Internal Medicine, Division of Hematology & Medical Oncology, Tisch Cancer Institute/Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Shimoda K, Qin A, Komatsu N, Kirito K. Efficacy and safety outcomes in Japanese patients with low-risk polycythemia vera treated with ropeginterferon alfa-2b. Int J Hematol 2024; 120:151-156. [PMID: 38951434 DOI: 10.1007/s12185-024-03804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 07/03/2024]
Abstract
Polycythemia vera (PV) is a Philadelphia chromosome-negative myeloproliferative neoplasm characterized by clonal erythrocytosis. A phase 2 study reported that ropeginterferon alfa-2b is a well-tolerated and effective treatment for PV in Japanese patients. This post hoc analysis of the phase 2 data further evaluated outcomes in patients at low risk of thrombosis (low-risk PV). Among 20 patients with low-risk PV, 60.0% (12/20) and 85.0% (17/20) achieved < 45% hematocrit by weeks 24 and 52, respectively. The proportion of responders with complete hematologic response (CHR) was 60.0% (12/20) at week 52, and the median time to response was 11.9 months. The mean JAK2 V617F allele burden decreased from 75.8% at baseline to 53.7% at week 52. No patient experienced thrombosis or bleeding episodes. All patients experienced treatment-emergent adverse events (TEAEs) related to ropeginterferon alfa-2b, but no grade ≥ 3 TEAEs or deaths related to ropeginterferon alfa-2b occurred, and no new safety concerns arose. This analysis indicated that ropeginterferon alfa-2b may be an effective treatment option for Japanese patients with low-risk PV.
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Affiliation(s)
- Kazuya Shimoda
- Division of Hematology, Diabetes and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake‑cho, Miyazaki‑city, Miyazaki, 889‑1692, Japan.
| | - Albert Qin
- Medical Research & Clinical Operations, PharmaEssentia Corporation, 13F, No. 3, Park Street, Nangang District, Taipei, 115, Taiwan
| | - Norio Komatsu
- PharmaEssentia Japan KK, Akasaka Center Building 12F, 1‑3‑13 Moto‑akasaka, Minato‑ku, Tokyo, 107‑0051, Japan
- Department of Hematology, Juntendo University Graduate School of Medicine, 2‑1‑1 Hongo, Bunkyo‑ku, Tokyo, 113‑8421, Japan
- Department of Advanced Hematology, Juntendo University Graduate School of Medicine, 2‑1‑1 Hongo, Bunkyo‑ku, Tokyo, 113‑8421, Japan
| | - Keita Kirito
- Department of Hematology and Oncology, University of Yamanashi, 1110 Shimokato, Chuo‑shi, Yamanashi, 409‑3898, Japan
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Andreescu M, Andreescu B. A Review About the Assessment of the Bleeding and Thrombosis Risk for Patients With Myeloproliferative Neoplasms Scheduled for Surgery. Cureus 2024; 16:e56008. [PMID: 38606222 PMCID: PMC11007487 DOI: 10.7759/cureus.56008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Myeloproliferative neoplasms (MPNs) present a unique challenge in surgical management due to their inherent predisposition to both bleeding and thrombosis. MPNs are a heterogenous group of acquired clonal conditions. The three classic MPNs are essential thrombocythemia (ET), myelofibrosis (PMF), and polycythemia vera (PV). All subtypes of MPN are associated with both thrombotic and bleeding complications. There are four risk categories for thrombosis in MPN patients: age, thrombosis history, and JAK-2 mutation. They are further classified as very low, low, intermediate, and high risk. The genetic landscape of MPN is fascinating and complex like all myeloid disorders. Bleeding risk can be assessed through leukocytosis, thrombocytosis, acquired von Willebrand syndrome (AVWS), and a previous history of bleeding in a patient. Risk assessment and perioperative management are important aspects of improving the quality of life and preventing complications in surgeries. Preoperative management includes a risk assessment of venous thromboembolism, use of appropriate pharmacological treatment, platelet count control, and correction and cardiovascular risk factors. This review summarizes the assessment of bleeding and thrombosis risk for patients with MPNs scheduled for surgery. Furthermore, this review discusses various tools that can be used to identify MPN patients at risk of thrombosis prior to surgery.
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Affiliation(s)
- Mihaela Andreescu
- Faculty of Medicine, Titu Maiorescu University, Bucharest, ROU
- Hematology, Colentina Clinical Hospital, Bucharest, ROU
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Fahrurriza H, Gofir A, Setyawan TR, Hutajulu SH, Nugroho DB, Rochmah MA. Concomitant Cerebral Venous Thrombosis and Intracranial Hemorrhages in Presentation of a Patient with Secondary Polycythemia: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e941507. [PMID: 37838828 PMCID: PMC10584197 DOI: 10.12659/ajcr.941507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/30/2023] [Accepted: 08/23/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Cerebral ischemia and hemorrhages were reported to be the main complications of polycythemia vera (PV). The relationship between PV and increased risk of the cerebrovascular events has been established. Some patients with secondary polycythemia have thromboembolic events comparable to those of PV. However, secondary polycythemia that leads to cerebrovascular events is uncommon. CASE REPORT A 35-year-old man without any prior medical history presented with mild clinical acute ischemic stroke and polycythemia. The patient then showed worsening neurological deficits that were later attributed to the concurrent cerebral venous thrombosis, which led to malignant cerebral infarction with hemorrhagic transformation, and subarachnoid hemorrhage. His polycythemia appeared to be secondary to bacterial infection. The treatments for the secondary polycythemia were first phlebotomy and intravenous hydration, followed by intravenous broad-spectrum antibiotics. PV was excluded because the JAK2 V617F mutation was absent, the patient's peripheral blood smear suggested secondary polycythemia due to bacterial infection, and there were improvements in hemoglobin, erythrocyte count, and hematocrit after intravenous antibiotics. At the 1-month follow-up, he was moderately dependent, and hemoglobin, erythrocyte count, and hematocrit were within normal limits, without receiving any further phlebotomy or cytoreductive agents. CONCLUSIONS This case highlights the plausible causation of secondary polycythemia that could lead to concomitant cerebral thrombosis and hemorrhagic events. The diagnosis of cerebral venous thrombosis should be considered in a patient who presents with headache, focal neurological deficits, polycythemia, and normal head computed tomography scan.
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Affiliation(s)
- Hiztien Fahrurriza
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Abdul Gofir
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tommy Rachmat Setyawan
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susanna Hilda Hutajulu
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dhite Bayu Nugroho
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mawaddah Ar Rochmah
- Department of Neurology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Barbui T, Vannucchi AM, De Stefano V, Carobbio A, Ghirardi A, Carioli G, Masciulli A, Rossi E, Ciceri F, Bonifacio M, Iurlo A, Palandri F, Benevolo G, Pane F, Ricco A, Carli G, Caramella M, Rapezzi D, Musolino C, Siragusa S, Rumi E, Patriarca A, Cascavilla N, Mora B, Cacciola E, Mannarelli C, Loscocco GG, Guglielmelli P, Gesullo F, Betti S, Lunghi F, Scaffidi L, Bucelli C, Vianelli N, Bellini M, Finazzi MC, Tognoni G, Rambaldi A. Ropeginterferon versus Standard Therapy for Low-Risk Patients with Polycythemia Vera. NEJM EVIDENCE 2023; 2:EVIDoa2200335. [PMID: 38320126 DOI: 10.1056/evidoa2200335] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND: Whether phlebotomy alone can adequately maintain target hematocrit in patients with low-risk polycythemia vera (PV) remains elusive. METHODS: In a phase 2 open-label randomized trial, we compared ropeginterferon alfa-2b (ropeg; 100 μg every 2 weeks) with phlebotomy only regarding maintenance of a median hematocrit level (≤45%) over 12 months in the absence of progressive disease (primary end point). In follow-up, crossover to the alternative treatment group was allowed if the primary end point was not met. RESULTS: In total, 127 patients were enrolled (ropeg: n=64; standard group: n=63). The primary end point was met in 81% and 51% in the ropeg and standard groups, respectively. Responders continued the assigned treatment until month 24 and maintained response in 83% and 59%, respectively (P=0.02). Ropeg responders less frequently experienced moderate/severe symptoms (33% vs. 67% in the standard group) and palpable splenomegaly (14% vs. 37%) and showed normalization of ferritin levels and blood counts. Nonresponders at 12 months crossed over to the standard (n=9) or ropeg (n=23) group; in patients switched to ropeg only, 7 of 23 met the response criteria in 12 months, and phlebotomy need was high (4.7 per patient per year). Discontinuation because of adverse events occurred in seven patients treated with ropeg. CONCLUSIONS: In this 24-month trial, ropeg was superior to phlebotomy alone in maintaining hematocrit on target. No dose-limiting side effects or toxicities were noted; 9.2% of patients on ropeg and no patients on standard treatment developed neutropenia. (Funded by AOP Health and others; ClinicalTrials.gov number, NCT03003325.)
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Affiliation(s)
- Tiziano Barbui
- Fondazione per la Ricerca Ospedale di Bergamo (FROM) Ente del Terzo Settore (ETS), Bergamo, Italy
| | - Alessandro Maria Vannucchi
- Centro di Ricerca ed Innovazione per le Malattie Mieloproliferative (CRIMM), Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Valerio De Stefano
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore - Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
| | - Alessandra Carobbio
- Fondazione per la Ricerca Ospedale di Bergamo (FROM) Ente del Terzo Settore (ETS), Bergamo, Italy
| | - Arianna Ghirardi
- Fondazione per la Ricerca Ospedale di Bergamo (FROM) Ente del Terzo Settore (ETS), Bergamo, Italy
| | - Greta Carioli
- Fondazione per la Ricerca Ospedale di Bergamo (FROM) Ente del Terzo Settore (ETS), Bergamo, Italy
| | - Arianna Masciulli
- Fondazione per la Ricerca Ospedale di Bergamo (FROM) Ente del Terzo Settore (ETS), Bergamo, Italy
| | - Elena Rossi
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore - Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
| | - Fabio Ciceri
- Unità Operativa di Ematologia e Trapianto Midollo Osseo, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan
| | - Massimiliano Bonifacio
- Department of Medicine, Section of Hematology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandra Iurlo
- Unità Operativa Complessa di Ematologia, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda - Ospedale Maggiore Policlinico, Milan
| | - Francesca Palandri
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero Universitaria di Bologna, Istituto di Ematologia "L. & A. Seragnoli", Bologna, Italy
| | - Giulia Benevolo
- Struttura Complessa di Ematologia Universitaria, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabrizio Pane
- Unità Operativa Complessa di Ematologia e Trapianti di Midollo, Azienda Ospedaliera Universitaria Federico II di Napoli, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Alessandra Ricco
- Unità Operativa di Ematologia con Trapianto, Azienda Ospedaliera Universitaria "Consorziale Policlinico" di Bari, Bari, Italy
| | - Giuseppe Carli
- Unità Operativa Complessa di Ematologia, Azienda Unità Sanitaria Locale Socio Sanitaria (ULSS) 8 Berica, Ospedale San Bortolo di Vicenza, Vicenza, Italy
| | - Marianna Caramella
- Divisione di Ematologia, Azienda Socio Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan
| | - Davide Rapezzi
- Divisione di Ematologia, Azienda Ospedaliera S. Croce e Carle di Cuneo, Cuneo, Italy
| | - Caterina Musolino
- Unità Operativa Complessa di Ematologia, Azienda Ospedaliera Universitaria Policlinico "G. Martino", Messina, Italy
| | - Sergio Siragusa
- Divisione di Ematologia, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Palermo, Italy
| | - Elisa Rumi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Divisione di Ematologia, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo di Pavia, Pavia, Italy
| | - Andrea Patriarca
- Struttura Complessa a Direzione Universitaria (SCDU) di Ematologia, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Nicola Cascavilla
- Unità Operativa di Ematologia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Barbara Mora
- Unità Operativa di Ematologia, Azienda Socio Sanitaria Territoriale (ASST) Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Emma Cacciola
- Unità Operativa di Emostasi Centro Federato Federazione Centri per la Diagnosi della Trombosi e la Sorveglianza delle terapie Antitrombotiche (FCSA), Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G. F. Ingrassia", Azienda Ospedaliera Universitaria Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Carmela Mannarelli
- Centro di Ricerca ed Innovazione per le Malattie Mieloproliferative (CRIMM), Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Giuseppe Gaetano Loscocco
- Centro di Ricerca ed Innovazione per le Malattie Mieloproliferative (CRIMM), Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Paola Guglielmelli
- Centro di Ricerca ed Innovazione per le Malattie Mieloproliferative (CRIMM), Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Francesca Gesullo
- Centro di Ricerca ed Innovazione per le Malattie Mieloproliferative (CRIMM), Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Silvia Betti
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore - Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome
| | - Francesca Lunghi
- Unità Operativa di Ematologia e Trapianto Midollo Osseo, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cristina Bucelli
- Unità Operativa Complessa di Ematologia, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda - Ospedale Maggiore Policlinico, Milan
| | - Nicola Vianelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero Universitaria di Bologna, Istituto di Ematologia "L. & A. Seragnoli", Bologna, Italy
| | - Marta Bellini
- Struttura Complessa di Ematologia, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Chiara Finazzi
- Struttura Complessa di Ematologia, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan
| | - Gianni Tognoni
- Centro di Coordinamento Nazionale dei Comitati Etici, Agenzia Italiana del Farmaco (AIFA), Rome
| | - Alessandro Rambaldi
- Struttura Complessa di Ematologia, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan
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