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Sica A, Casale B, Sagnelli C, Di Dato MT, Rispoli M, Santagata M, Buonavolontà P, Fiorelli A, Vitiello P, Caccavale S, Creta M, Salzano AM, Sagnelli E, Saracco E, Gazzerro G, Famiglietti V, Tammaro D, Papa A. Chronic Chest Pain Control after Trans-Thoracic Biopsy in Mediastinal Lymphomas. Healthcare (Basel) 2021; 9:589. [PMID: 34069774 PMCID: PMC8157245 DOI: 10.3390/healthcare9050589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/01/2021] [Accepted: 05/10/2021] [Indexed: 12/14/2022] Open
Abstract
Chest pain following a trans-thoracic biopsy often has multiple etiologies, especially in patients with lymphomas. Pathological neuronal mechanisms integrate with an overproduction of IL-6, TNF-α, IL1-β by macrophages and monocytes, which amplifies inflammation and pain. In consideration of this complex pathogenesis, international guidelines recommend diversified analgesia protocols: thoracic epidural, paravertebral block, and systemic administration of opioids. This study reports an attempt to reduce chest pain and prevent chronic pain in 51 patients undergoing trans-thoracic biopsy for mediastinal lymphoma. The entity of pain, measured 72nd hour after biopsy by the Numerical Rating Scale (NRS), was compared with that seen at a 6th month checkpoint in 46 patients. The pain decreased in all cases. At the 6th month checkpoint, among 31 opioid-treated patients, none of the 16 patients with NRS < 6 within the 72nd hour post biopsy had developed chronic chest pain, while 8 of the 15 with higher values did (p < 0.01). Of 10 patients undergoing thoracotomy and treated with opioids, eight had a NRS of no more than 2, of which six had no chronic pain. Of the twenty-one patients who underwent VATS biopsy and were treated with opioids, fifteen had NRS no greater than 2, of which ten had no chronic pain. Subgroups of patients biopsied under mediastinotomy or video-assisted thoracoscopic surgery (VATS) and treated with thoracic epidural analgesia (TEA) or PVB were too small for such analysis.
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Affiliation(s)
- Antonello Sica
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Beniamino Casale
- Department of Pneumology and Tisiology, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy;
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.S.); (E.S.)
| | - Maria Teresa Di Dato
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Marco Rispoli
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Mario Santagata
- Multidisciplinary Department of Medical Surgery and Dental Specialties, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Pietro Buonavolontà
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Paola Vitiello
- Dermatology Unit, University of Campania, 80131 Naples, Italy; (P.V.); (S.C.)
| | - Stefano Caccavale
- Dermatology Unit, University of Campania, 80131 Naples, Italy; (P.V.); (S.C.)
| | - Massimiliano Creta
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Anna Maria Salzano
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (C.S.); (E.S.)
| | - Elisabetta Saracco
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Giuseppe Gazzerro
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Vincenzo Famiglietti
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Dario Tammaro
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
| | - Alfonso Papa
- Pain Department, AORN Dei Colli-V. Monaldi, 80131 Naples, Italy; (M.T.D.D.); (M.R.); (P.B.); (A.M.S.); (E.S.); (G.G.); (D.T.); (A.P.)
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Impact of DAA-Based Regimens on HCV-Related Extra-Hepatic Damage: A Narrative Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1323:115-147. [PMID: 33326112 DOI: 10.1007/5584_2020_604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Two-third of patients with chronic hepatitis C show extrahepatic manifestations due to HCV infection of B lymphocytes, such as mixed cryoglobulinemia and non-Hodgkin B-cell lymphoma, or develop a chronic inflammatory status that may favor the development of adverse cardiovascular events, kidney diseases or metabolic abnormalities.DAAs treatments induce HCV eradication in 95% of treated patients, which also improves the clinical course of extrahepatic manifestations, but with some limitations. After HCV eradication a good compensation of T2DM has been observed, but doubts persist about the possibility of obtaining a stable reduction in fasting glucose and HbA1c levels.Chronic HCV infection is associated with low total and LDL cholesterol serum levels, which however increase significantly after HCV elimination, possibly due to the disruption of HCV/lipid metabolism interaction. Despite this adverse effect, HCV eradication exerts a favorable action on cardiovascular system, possibly by eliminating numerous other harmful effects exerted by HCV on this system.DAA treatment is also indicated for the treatment of patients with mixed cryoglobulinemia syndrome, since HCV eradication results in symptom reduction and, in particular, is effective in cryoglobulinemic vasculitis. Furthermore, HCV eradication exerts a favorable action on HCV-related lymphoproliferative disorders, with frequent remission or reduction of clinical manifestations.There is also evidence that HCV clearance may improve impaired renal functions, but same conflicting data persist on the effect of some DAAs on eGFR.
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Ronchi A, Sica A, Vitiello P, Franco R. Dermatological Considerations in the Diagnosis and Treatment of Marginal Zone Lymphomas. Clin Cosmet Investig Dermatol 2021; 14:231-239. [PMID: 33727844 PMCID: PMC7954031 DOI: 10.2147/ccid.s277667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/23/2021] [Indexed: 12/16/2022]
Abstract
Primary cutaneous marginal zone lymphoma (PC-MZL) is a B-cell lymphoma arising in the skin. Although it is a rare disease, PC-MZL accounts for 20–40% of all primary cutaneous B-cell lymphoma in Western Countries. The aetiology and the pathogenesis of PC-MZL are poorly understood, as it generally lacks the chromosomal translocations most typically present in marginal zone lymphomas of other sites. The diagnosis of PC-MZL may be challenging, due to the rarity of the disease, and needs the competence of different professional figures, including the dermatologist and the pathologist. Furthermore, the management of the patient after the diagnosis is complex and involves the dermatologist, the haematologist, the surgeon, the radiotherapist and the radiologist. The aim of this review is to describe the clinical and histological findings for the diagnosis of PC-MZL, and the state of art for the management of the patient.
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Affiliation(s)
- Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Antonello Sica
- Oncology and Haematology Unit, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, 80131, Italy
| | - Paola Vitiello
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, 80131, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, 80138, Italy
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Sica A, Santagata M, Sagnelli C, Rambaldi P, Franco R, Creta M, Vitiello P, Caccavale S, Tammaro V, Sagnelli E, Ronchi A. Primary Extra-Nodal DLBCL of Glands: Our Experiences outside Guidelines of Treatment. Healthcare (Basel) 2021; 9:healthcare9030286. [PMID: 33807793 PMCID: PMC8002204 DOI: 10.3390/healthcare9030286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023] Open
Abstract
Lymphomas usually involve lymph nodes and other lymphoid tissues, but sometimes occur in non-lymphoid organs, called extra-nodal sites. Primary diffuse extra-lymph node large B-cell lymphoma (DLBCL) of the thyroid and parotid gland have been observed rarely. According to the most accredited guidelines, primary extra-nodal DLBCL of the parotid and thyroid glands should be treated with three cycles of R-CHOP followed by radiotherapy of the involved site (ISRT). Surgery alone is not enough to treat DLBCL. We describe two unusual cases of primary extra-nodal DLBCL in elderly patients treated exclusively with surgical resection, given the inability to apply chemotherapy. Both patients achieved clinical recovery, which was maintained after a follow-up of more than 18 months, despite not having performed the indicated chemotherapy protocol. The two cases presented here, and a few others reported in the literature, should be considered exceptions to the rule, and do not allow the conclusion that surgery alone might be sufficient for complete remission.
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Affiliation(s)
- Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.S.); (P.R.)
| | - Mario Santagata
- Multidisciplinary Department of Medical Surgery and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
- Correspondence: ; Tel.: +39-3332253315 or +39-08119573375
| | - Piero Rambaldi
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.S.); (P.R.)
| | - Renato Franco
- Division of Pathology, Department of Mental Health and Preventive, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.F.); (A.R.)
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Paola Vitiello
- Dermatology Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.V.); (S.C.)
| | - Stefano Caccavale
- Dermatology Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.V.); (S.C.)
| | - Vincenzo Tammaro
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Andrea Ronchi
- Division of Pathology, Department of Mental Health and Preventive, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.F.); (A.R.)
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Sica A, Sagnelli C, Casale B, Svanera G, Creta M, Calogero A, Franco R, Sagnelli E, Ronchi A. How Fear of COVID-19 Can Affect Treatment Choices for Anaplastic Large Cell Lymphomas ALK+ Therapy: A Case Report. Healthcare (Basel) 2021; 9:healthcare9020135. [PMID: 33572634 PMCID: PMC7912420 DOI: 10.3390/healthcare9020135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/11/2021] [Accepted: 01/25/2021] [Indexed: 12/16/2022] Open
Abstract
Background: The t (2; 5) chromosomal rearrangement of the ALK gene with nucleophosmin 1 gene (NPM1), resulting in an NPM1–ALK fusion, was first demonstrated in 1994 in anaplastic large cell lymphoma, (ALCL), a T-cell lymphoma responsive to cyclophosphamide, abriblastine, vincristine and prednisone in approximately 80% of cases; refractory cases usually respond favorably to brentuximab vedotin. These treatments are regarded as a bridge to allogeneic hematopoietic stem cell transplantation (allo-SCT). Nowadays, transplant procedures and the monitoring of chemotherapy patients proceed very slowly because the SARS-CoV-2 pandemic has heavily clogged the hospitals in all countries. Results: A 40-year-old Caucasian woman was first seen at our clinical center in June 2020. She had ALCL ALK+, a history of failure to two previous therapeutic lines and was in complete remission after 12 courses of brentuximab, still pending allo-SCT after two failed donor selections. Facing a new therapeutic failure, we requested and obtained authorization from the Italian drug regulatory agency to administer 250 mg of crizotinib twice a day, a drug incomprehensibly not registered for ALCL ALK +. Conclusions: The response to crizotinib was optimal since no adverse event occurred, and CT-PET scans persisted negative; this drug has proved to be a valid bridge to allo-SCT.
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Affiliation(s)
- Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-3332253315 or +39-08119573375
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.S.); (E.S.)
| | - Beniamino Casale
- Pain Department, AORN Dei Colli—V. Monaldi, 80131 Naples, Italy;
| | - Gino Svanera
- Department of Medical Area ASLNA2 NORTH, 80014 Giugliano, Italy;
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.F.); (A.R.)
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.S.); (E.S.)
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.F.); (A.R.)
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Sica A, Casale D, Rossi G, Casale B, Ciccozzi M, Fasano M, Ciotti M, Sagnelli E, Papa A, Sagnelli C. The impact of the SARS-CoV-2 infection, with special reference to the hematological setting. J Med Virol 2021; 93:223-233. [PMID: 32558961 PMCID: PMC7323149 DOI: 10.1002/jmv.26197] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a disease known from a few months, caused by a recently arisen virus and, consequently, it is little known. The disease has a benign course in most infected subjects (children and young adults), is often symptomatic in adults over the age of 50 and often serious and life threatening in people with comorbidities and the elderly. The few data published on coronavirus disease-2019 (COVID-19) in the blood-oncology field report a serious clinical presentation, a serious course of the disease, and a high mortality rate, as has also been reported for other cancer contexts. The current strategy for treating patients with SARS-CoV-2 includes antivirals that are effective against other viral infections and drugs that can moderate the cytokine storm. There is no specific vaccine and consequently all possible precautions must be taken to prevent SARS-CoV-2 infection in the areas of oncology, oncohematology, and bone marrow transplantation. In this reviewer's article, we report the information currently available on SARS-CoV-2 infection to help young doctors and hematologists to successfully manage patients with COVID-19.
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Affiliation(s)
- Antonello Sica
- Department of Precision MedicineUniversity of Campania Luigi VanvitelliNaplesItaly
| | - Danilo Casale
- Anesthesiology DivisionBuon Consiglio Fatebenefratelli HospitalNaplesItaly
| | - Giovanni Rossi
- Radiology DivisionAORN Dei Colli ‐ V. MonaldiNaplesItaly
| | | | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular EpidemiologCampus Bio‐Medico UniversityRomeItaly
| | - Morena Fasano
- Department of Precision MedicineUniversity of Campania Luigi VanvitelliNaplesItaly
| | - Marco Ciotti
- Division of Virology, Laboratory of Clinical Microbiology and VirologyPolyclinic Tor Vergata FoundationRomeItaly
| | - Evangelista Sagnelli
- Department of Mental Health and Public MedicineUniversity of Campania Luigi VanvitelliNaplesItaly
| | - Alfonso Papa
- Department of PainAORN Dei Colli ‐ V. MonaldiNaplesItaly
| | - Caterina Sagnelli
- Department of Mental Health and Public MedicineUniversity of Campania Luigi VanvitelliNaplesItaly
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Sica A, Casale B, Sagnelli C, Di Dato MT, Buonavolontà P, Salzano AM, Sagnelli E, Famiglietti V, Saracco E, Tammaro D, Papa A. All-in-One Spinal Cord Stimulation in Lymphoproliferative Diseases. Front Neurol 2020; 11:550554. [PMID: 33281699 PMCID: PMC7691594 DOI: 10.3389/fneur.2020.550554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/02/2020] [Indexed: 12/20/2022] Open
Abstract
Even patients with lymphoproliferative diseases may develop a persistent chronic pain not responsive to usual treatments due to changes in antibody production and to some treatments like radiotherapy, chemotherapy, and the administration of monoclonal antibodies, which further impair the immune defense and induce chronic inflammatory phenomena acting as a substrate for a persistent chronic pain. Five patients with indolent lymphoproliferative diseases were treated for severe pain nonresponsive to other pain reliever treatments with SCS applied with an All-in-One Shot (OS) procedure. For all patients, the estimated survival time was of 5 years or more. All patients showed a significant reduction of the intensity of pain: the mean Numerical Rating Scale was 7.4 before treatment and 2.2 after. No patient developed adverse events. Supported by the data of this study, we believe that the habit to deprive patients with an indolent form of lymphoproliferative diseases of the possibility to reduce the intensity of chronic pain by SCS treatment is extremely reductive and frustrating.
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Affiliation(s)
- Antonello Sica
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Beniamino Casale
- Department of Pain Therapy Monaldi Hospital-Azienda Ospedaliera di Rilievo Nazionale Ospedali dei Colli, Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Maria Teresa Di Dato
- Department of Pain Therapy Monaldi Hospital-Azienda Ospedaliera di Rilievo Nazionale Ospedali dei Colli, Naples, Italy
| | - Pietro Buonavolontà
- Department of Pain Therapy Monaldi Hospital-Azienda Ospedaliera di Rilievo Nazionale Ospedali dei Colli, Naples, Italy
| | - Anna Maria Salzano
- Department of Pain Therapy Monaldi Hospital-Azienda Ospedaliera di Rilievo Nazionale Ospedali dei Colli, Naples, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Famiglietti
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Elisabetta Saracco
- Department of Pain Therapy Monaldi Hospital-Azienda Ospedaliera di Rilievo Nazionale Ospedali dei Colli, Naples, Italy
| | - Dario Tammaro
- Department of Pain Therapy Monaldi Hospital-Azienda Ospedaliera di Rilievo Nazionale Ospedali dei Colli, Naples, Italy
| | - Alfonso Papa
- Department of Pain Therapy Monaldi Hospital-Azienda Ospedaliera di Rilievo Nazionale Ospedali dei Colli, Naples, Italy
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