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Srisuwananukorn A, Krull JE, Ma Q, Zhang P, Pearson AT, Hoffman R. Applications of artificial intelligence to myeloproliferative neoplasms: a narrative review. Expert Rev Hematol 2024; 17:669-677. [PMID: 39114884 DOI: 10.1080/17474086.2024.2389997] [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: 04/23/2024] [Accepted: 08/05/2024] [Indexed: 09/21/2024]
Abstract
INTRODUCTION Artificial intelligence (AI) is a rapidly growing field of computational research with the potential to extract nuanced biomarkers for the prediction of outcomes of interest. AI implementations for the prediction for clinical outcomes for myeloproliferative neoplasms (MPNs) are currently under investigation. AREAS COVERED In this narrative review, we discuss AI investigations for the improvement of MPN clinical care utilizing either clinically available data or experimental laboratory findings. Abstracts and manuscripts were identified upon querying PubMed and the American Society of Hematology conference between 2000 and 2023. Overall, multidisciplinary researchers have developed AI methods in MPNs attempting to improve diagnostic accuracy, risk prediction, therapy selection, or pre-clinical investigations to identify candidate molecules as novel therapeutic agents. EXPERT OPINION It is our expert opinion that AI methods in MPN care and hematology will continue to grow with increasing clinical utility. We believe that AI models will assist healthcare workers as clinical decision support tools if appropriately developed with AI-specific regulatory guidelines. Though the reported findings in this review are early investigations for AI in MPNs, the collective work developed by the research community provides a promising framework for improving decision-making in the future of MPN clinical care.
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Affiliation(s)
- Andrew Srisuwananukorn
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan E Krull
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Qin Ma
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Ping Zhang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Computer Science and Engineering, College of Engineering, The Ohio State University, Columbus, OH, USA
- Translational Data Analytics Institute, The Ohio State University, Columbus, OH, USA
| | - Alexander T Pearson
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Ronald Hoffman
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Duminuco A, Au Yeung J, Vaghela R, Virdee S, Woodley C, Asirvatham S, Curto‐Garcia N, Sriskandarajah P, O'Sullivan J, de Lavallade H, Radia D, Kordasti S, Palumbo G, Harrison C, Harrington P. Development of a natural language processing pipeline for assessment of cardiovascular risk in myeloproliferative neoplasms. Hemasphere 2024; 8:e143. [PMID: 39131900 PMCID: PMC11310405 DOI: 10.1002/hem3.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/18/2024] [Accepted: 07/16/2024] [Indexed: 08/13/2024] Open
Affiliation(s)
- Andrea Duminuco
- Department of HaematologyGuy's and St Thomas' NHS Foundation TrustLondonUK
- Haematology Unit with BMTA.O.U. Policlinico “G. Rodolico‐San Marco”CataniaItaly
| | | | - Raj Vaghela
- Department of HaematologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Sukhraj Virdee
- Department of HaematologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Claire Woodley
- Department of HaematologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Susan Asirvatham
- Department of HaematologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | | | | | | | | | - Deepti Radia
- Department of HaematologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Shahram Kordasti
- Department of HaematologyGuy's and St Thomas' NHS Foundation TrustLondonUK
- School of Cancer and Pharmaceutical Science, King's College LondonLondonUK
| | - Giuseppe Palumbo
- Haematology Unit with BMTA.O.U. Policlinico “G. Rodolico‐San Marco”CataniaItaly
| | - Claire Harrison
- Department of HaematologyGuy's and St Thomas' NHS Foundation TrustLondonUK
- School of Cancer and Pharmaceutical Science, King's College LondonLondonUK
| | - Patrick Harrington
- Department of HaematologyGuy's and St Thomas' NHS Foundation TrustLondonUK
- School of Cancer and Pharmaceutical Science, King's College LondonLondonUK
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Gozzo L, Leotta S, Romano GL, Vetro C, Duminuco A, Milone G, Cupri A, Palumbo FE, Brancati S, Ruscica R, Longo L, Vitale DC, Fiorenza G, Lombardo GE, Lazzara A, Di Raimondo F, Palumbo GA, Drago F. Early Access for Medicines in ITALY: The Case of Ruxolitinib for Patients with Graft-Versus-Host Disease. J Clin Med 2024; 13:4273. [PMID: 39064314 PMCID: PMC11278132 DOI: 10.3390/jcm13144273] [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: 06/22/2024] [Revised: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
After European Medicines Agency (EMA) approval, national pricing and reimbursement procedures are necessary to guarantee access to drugs, based on the willingness to pay and the recognition of therapeutic value. These can result in delays in drug availability for patients, even for those with important unfmet needs for whom it may be necessary and ethical to ensure access. The objective of this study was to evaluate the use of ruxolitinib for patients with graft-versus-host disease (GvHD) after EMA approval at the University Hospital of Catania. We analysed data about the use of ruxolitinib in patients with GvHD, describing their basic characteristics, their outcomes and the cost of the treatment. In the reference period, 24 ruxolitinib treatments were started according to the Summary of Product Characteristic. The average treatment duration was 10 months. Twenty patients showed a response, maintained over time, with no adverse reactions. The total expenditure amounts to EUR 963,424. The use of ruxolitinib in a real population confirms its role in an important therapeutic need. The quantification of costs requires a reflection on the sustainability of early access to medicines authorised by the EMA for serious diseases and in the absence of therapeutic alternatives.
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Affiliation(s)
- Lucia Gozzo
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, 95125 Catania, Italy; (S.B.); (R.R.); (L.L.); (D.C.V.); (F.D.)
| | - Salvatore Leotta
- Haematology and BMT Unit, University Hospital of Catania, 95125 Catania, Italy; (S.L.); (C.V.); (A.D.); (G.M.); (A.C.); (F.E.P.); (F.D.R.); (G.A.P.)
| | - Giovanni Luca Romano
- Faculty of Medicine and Surgery, University of Enna “Kore”, Piazza dell’Università, 94100 Enna, Italy;
| | - Calogero Vetro
- Haematology and BMT Unit, University Hospital of Catania, 95125 Catania, Italy; (S.L.); (C.V.); (A.D.); (G.M.); (A.C.); (F.E.P.); (F.D.R.); (G.A.P.)
| | - Andrea Duminuco
- Haematology and BMT Unit, University Hospital of Catania, 95125 Catania, Italy; (S.L.); (C.V.); (A.D.); (G.M.); (A.C.); (F.E.P.); (F.D.R.); (G.A.P.)
| | - Giuseppe Milone
- Haematology and BMT Unit, University Hospital of Catania, 95125 Catania, Italy; (S.L.); (C.V.); (A.D.); (G.M.); (A.C.); (F.E.P.); (F.D.R.); (G.A.P.)
| | - Alessandra Cupri
- Haematology and BMT Unit, University Hospital of Catania, 95125 Catania, Italy; (S.L.); (C.V.); (A.D.); (G.M.); (A.C.); (F.E.P.); (F.D.R.); (G.A.P.)
| | - Fanny Erika Palumbo
- Haematology and BMT Unit, University Hospital of Catania, 95125 Catania, Italy; (S.L.); (C.V.); (A.D.); (G.M.); (A.C.); (F.E.P.); (F.D.R.); (G.A.P.)
| | - Serena Brancati
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, 95125 Catania, Italy; (S.B.); (R.R.); (L.L.); (D.C.V.); (F.D.)
| | - Rosy Ruscica
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, 95125 Catania, Italy; (S.B.); (R.R.); (L.L.); (D.C.V.); (F.D.)
| | - Laura Longo
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, 95125 Catania, Italy; (S.B.); (R.R.); (L.L.); (D.C.V.); (F.D.)
| | - Daniela Cristina Vitale
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, 95125 Catania, Italy; (S.B.); (R.R.); (L.L.); (D.C.V.); (F.D.)
| | - Giorgia Fiorenza
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy;
| | - Giovanni Enrico Lombardo
- Faculty of Medicine and Surgery, University of Enna “Kore”, Piazza dell’Università, 94100 Enna, Italy;
| | - Antonio Lazzara
- Health Department, University Hospital of Catania, 95125 Catania, Italy;
| | - Francesco Di Raimondo
- Haematology and BMT Unit, University Hospital of Catania, 95125 Catania, Italy; (S.L.); (C.V.); (A.D.); (G.M.); (A.C.); (F.E.P.); (F.D.R.); (G.A.P.)
| | - Giuseppe Alberto Palumbo
- Haematology and BMT Unit, University Hospital of Catania, 95125 Catania, Italy; (S.L.); (C.V.); (A.D.); (G.M.); (A.C.); (F.E.P.); (F.D.R.); (G.A.P.)
| | - Filippo Drago
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, 95125 Catania, Italy; (S.B.); (R.R.); (L.L.); (D.C.V.); (F.D.)
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95125 Catania, Italy;
- Centre for Research and Consultancy in HTA and Drug Regulatory Affairs (CERD), University of Catania, 95125 Catania, Italy
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Mangione R, Giallongo C, Duminuco A, La Spina E, Longhitano L, Giallongo S, Tibullo D, Lazzarino G, Saab MW, Sbriglione A, Palumbo GA, Graziani A, Alanazi AM, Di Pietro V, Tavazzi B, Amorini AM, Lazzarino G. Targeted Metabolomics Highlights Dramatic Antioxidant Depletion, Increased Oxidative/Nitrosative Stress and Altered Purine and Pyrimidine Concentrations in Serum of Primary Myelofibrosis Patients. Antioxidants (Basel) 2024; 13:490. [PMID: 38671937 PMCID: PMC11047794 DOI: 10.3390/antiox13040490] [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: 03/03/2024] [Revised: 04/13/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
To date, little is known concerning the circulating levels of biochemically relevant metabolites (antioxidants, oxidative/nitrosative stress biomarkers, purines, and pyrimidines) in patients with primary myelofibrosis (PMF), a rare form of myeloproliferative tumor causing a dramatic decrease in erythropoiesis and angiogenesis. In this study, using a targeted metabolomic approach, serum samples of 22 PMF patients and of 22 control healthy donors were analyzed to quantify the circulating concentrations of hypoxanthine, xanthine, uric acid (as representative purines), uracil, β-pseudouridine, uridine (as representative pyrimidines), reduced glutathione (GSH), ascorbic acid (as two of the main water-soluble antioxidants), malondialdehyde, nitrite, nitrate (as oxidative/nitrosative stress biomarkers) and creatinine, using well-established HPLC method for their determination. Results showed that PMF patients have dramatic depletions of both ascorbic acid and GSH (37.3- and 3.81-times lower circulating concentrations, respectively, than those recorded in healthy controls, p < 0.0001), accompanied by significant increases in malondialdehyde (MDA) and nitrite + nitrate (4.73- and 1.66-times higher circulating concentrations, respectively, than those recorded in healthy controls, p < 0.0001). Additionally, PMF patients have remarkable alterations of circulating purines, pyrimidines, and creatinine, suggesting potential mitochondrial dysfunctions causing energy metabolism imbalance and consequent increases in these cell energy-related compounds. Overall, these results, besides evidencing previously unknown serum metabolic alterations in PMF patients, suggest that the determination of serum levels of the aforementioned compounds may be useful to evaluate PMF patients on hospital admission for adjunctive therapies aimed at recovering their correct antioxidant status, as well as to monitor patients' status and potential pharmacological treatments.
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Affiliation(s)
- Renata Mangione
- Department of Basic Biotechnological Sciences, Intensive and Perioperative Clinics, Catholic University of the Sacred Heart of Rome, Largo F. Vito 1, 00168 Rome, Italy;
- Departmental Faculty of Medicine, UniCamillus—Saint Camillus International University of Health and Medical Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy; (A.G.); (G.L.)
| | - Cesarina Giallongo
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Division of Hematology, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (C.G.); (S.G.); (G.A.P.)
| | - Andrea Duminuco
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, Via S. Sofia 78, 95123 Catania, Italy;
| | - Enrico La Spina
- Department of Biomedical and Biotechnological Sciences, Division of Medical Biochemistry, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (E.L.S.); (L.L.); (D.T.); (G.L.); (M.W.S.); (A.S.)
| | - Lucia Longhitano
- Department of Biomedical and Biotechnological Sciences, Division of Medical Biochemistry, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (E.L.S.); (L.L.); (D.T.); (G.L.); (M.W.S.); (A.S.)
| | - Sebastiano Giallongo
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Division of Hematology, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (C.G.); (S.G.); (G.A.P.)
| | - Daniele Tibullo
- Department of Biomedical and Biotechnological Sciences, Division of Medical Biochemistry, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (E.L.S.); (L.L.); (D.T.); (G.L.); (M.W.S.); (A.S.)
| | - Giuseppe Lazzarino
- Department of Biomedical and Biotechnological Sciences, Division of Medical Biochemistry, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (E.L.S.); (L.L.); (D.T.); (G.L.); (M.W.S.); (A.S.)
| | - Miriam Wissam Saab
- Department of Biomedical and Biotechnological Sciences, Division of Medical Biochemistry, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (E.L.S.); (L.L.); (D.T.); (G.L.); (M.W.S.); (A.S.)
| | - Arianna Sbriglione
- Department of Biomedical and Biotechnological Sciences, Division of Medical Biochemistry, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (E.L.S.); (L.L.); (D.T.); (G.L.); (M.W.S.); (A.S.)
| | - Giuseppe A. Palumbo
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Division of Hematology, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; (C.G.); (S.G.); (G.A.P.)
| | - Andrea Graziani
- Departmental Faculty of Medicine, UniCamillus—Saint Camillus International University of Health and Medical Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy; (A.G.); (G.L.)
| | - Amer M. Alanazi
- Pharmaceutical Biotechnology Laboratory, Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Valentina Di Pietro
- Neurotrauma and Ophthalmology Research Group, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK
| | - Barbara Tavazzi
- Departmental Faculty of Medicine, UniCamillus—Saint Camillus International University of Health and Medical Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy; (A.G.); (G.L.)
| | - Angela Maria Amorini
- Department of Biomedical and Biotechnological Sciences, Division of Medical Biochemistry, University of Catania, Via S. Sofia 97, 95123 Catania, Italy; (E.L.S.); (L.L.); (D.T.); (G.L.); (M.W.S.); (A.S.)
| | - Giacomo Lazzarino
- Departmental Faculty of Medicine, UniCamillus—Saint Camillus International University of Health and Medical Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy; (A.G.); (G.L.)
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Duminuco A, Chifotides HT, Giallongo S, Giallongo C, Tibullo D, Palumbo GA. ACVR1: A Novel Therapeutic Target to Treat Anemia in Myelofibrosis. Cancers (Basel) 2023; 16:154. [PMID: 38201581 PMCID: PMC10778144 DOI: 10.3390/cancers16010154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Activin receptor type I (ACVR1) is a transmembrane kinase receptor belonging to bone morphogenic protein receptors (BMPs). ACVR1 plays an important role in hematopoiesis and anemia via the BMP6/ACVR1/SMAD pathway, which regulates expression of hepcidin, the master regulator of iron homeostasis. Elevated hepcidin levels are inversely associated with plasma iron levels, and chronic hepcidin expression leads to iron-restricted anemia. Anemia is one of the hallmarks of myelofibrosis (MF), a bone marrow (BM) malignancy characterized by BM scarring resulting in impaired hematopoiesis, splenomegaly, and systemic symptoms. Anemia and red blood cell transfusions negatively impact MF prognosis. Among the approved JAK inhibitors (ruxolitinib, fedratinib, momelotinib, and pacritinib) for MF, momelotinib and pacritinib are preferably used in cytopenic patients; both agents are potent ACVR1 inhibitors that suppress hepcidin expression via the BMP6/ACVR1/SMAD pathway and restore iron homeostasis/erythropoiesis. In September 2023, momelotinib was approved as a treatment for patients with MF and anemia. Zilurgisertib (ACVR1 inhibitor) and DISC-0974 (anti-hemojuvelin monoclonal antibody) are evaluated in early phase clinical trials in patients with MF and anemia. Luspatercept (ACVR2B ligand trap) is assessed in transfusion-dependent MF patients in a registrational phase 3 trial. Approved ACVR1 inhibitors and novel agents in development are poised to improve the outcomes of anemic MF patients.
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Affiliation(s)
- Andrea Duminuco
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy;
| | - Helen T. Chifotides
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd., Houston, TX 77030, USA;
| | - Sebastiano Giallongo
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (S.G.); (C.G.)
| | - Cesarina Giallongo
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (S.G.); (C.G.)
| | - Daniele Tibullo
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy;
| | - Giuseppe A. Palumbo
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy;
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy; (S.G.); (C.G.)
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Duminuco A, Harrington P, Harrison C, Curto-Garcia N. Polycythemia Vera: Barriers to and Strategies for Optimal Management. Blood Lymphat Cancer 2023; 13:77-90. [PMID: 38146420 PMCID: PMC10749566 DOI: 10.2147/blctt.s409443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/16/2023] [Indexed: 12/27/2023]
Abstract
Polycythemia vera (PV) is a subtype of myeloproliferative neoplasms characterized by impaired quality of life and severe complications. Despite the increasingly in-depth knowledge of this condition, it necessitates a multifaceted management approach to mitigate symptoms and prevent thrombotic and hemorrhagic events, ensuring prolonged survival. The therapeutic landscape has been revolutionized in recent years, where venesection and hydroxycarbamide associated with antiplatelet therapy have a central role and are now accompanied by other drugs, such as interferon and Janus kinase inhibitors. Ongoing research and advancements in targeted therapies hold promise for further enhancing the therapeutic choice for PV management.
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Affiliation(s)
- Andrea Duminuco
- Department of Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Haematology with BMT Unit, A.O.U. Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Patrick Harrington
- Department of Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Claire Harrison
- Department of Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Natalia Curto-Garcia
- Department of Haematology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Palumbo GA, Duminuco A. Myelofibrosis: In Search for BETter Targeted Therapies. J Clin Oncol 2023; 41:5044-5048. [PMID: 37751563 DOI: 10.1200/jco.23.00833] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/22/2023] [Accepted: 07/31/2023] [Indexed: 09/28/2023] Open
Affiliation(s)
- Giuseppe A Palumbo
- Department of Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia," University of Catania, Catania, Italy
| | - Andrea Duminuco
- Postgraduate School of Hematology, University of Catania, Catania, Italy
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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