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Volzone F, Becchimanzi C, Crisci S, De Chiara A, Porto A, Caronna A, Cuccaro A, Sarno S, Mallardo D, Cagini L, De Filippi R, Pinto A. Long-term complete remission in a patient with high-risk primary mediastinal B-cell lymphoma and iatrogenic symptomatic bradycardia after only two courses of DA-EPOCH-R followed by chemo-free treatment. Ann Hematol 2024:10.1007/s00277-024-05994-4. [PMID: 39264432 DOI: 10.1007/s00277-024-05994-4] [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: 08/13/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024]
Abstract
Most patients with Primary Mediastinal B-Cell Lymphoma (PMBCL) are cured by rituximab and doxorubicin-based immunochemotherapy, with or without radiotherapy. In cases with relapsed and refractory (RR) disease the prognosis was historically poor. Recently, immune checkpoint-based strategies have been shown to be highly effective in patients with RR-PMBCL. We report the case of a 23-year-old woman who, due to recurring episodes of symptomatic chemotherapy-induced sinus bradycardia, was unable to receive the planned six courses of immunochemotherapy, mediastinal radiotherapy, and autologous transplantation, leading to the early initiation of a chemo-free strategy. The patient maintains a continuous complete remission at a four-year follow-up after only two cycles of immunochemotherapy followed by nivolumab plus brentuximab vedotin (BV) and pembrolizumab consolidation. Beyond describing an underreported complication of anticancer treatments, the favorable clinical outcome suggests that in PMBCL, a minimal load of chemotherapy, integrated by early PD-1 blockade, with or without BV, may be sufficient to achieve long-term disease control and cure at least in some patients.
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Affiliation(s)
- Francesco Volzone
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Via Mariano Semmola 49, Naples, I- 80131, Italy
| | - Cristina Becchimanzi
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Via Mariano Semmola 49, Naples, I- 80131, Italy
| | - Stefania Crisci
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Via Mariano Semmola 49, Naples, I- 80131, Italy
| | - Annarosaria De Chiara
- Pathology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Naples, 80131, Italy
| | - Annamaria Porto
- Radiology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Naples, 80131, Italy
| | - Antonietta Caronna
- Cardiology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Naples, 80131, Italy
| | - Annarosa Cuccaro
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Via Mariano Semmola 49, Naples, I- 80131, Italy
| | - Sabrina Sarno
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Via Mariano Semmola 49, Naples, I- 80131, Italy
| | - Domenico Mallardo
- Melanoma, Cancer Immunotherapy, and Developmental Therapeutics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Naples, 80131, Italy
| | - Lucio Cagini
- Thoracic Surgery Unit, Ospedale del Mare, ALS Napoli1 Centro, Thoracic Surgery, University of Perugia, Naples, Italy
| | - Rosaria De Filippi
- Department of Clinical Medicine and Surgery, niversità degli Studi Federico II, Naples, Italy
| | - Antonio Pinto
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Via Mariano Semmola 49, Naples, I- 80131, Italy.
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2
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Benedetti E, Traverso G, Pucci G, Morganti R, Bramanti E, Cavallo F, Capochiani E, De Maria M, Ricchiuto V, Stella MS, Galimberti S. Prospective study on the impact of BEAM versus FEAM conditioning on occurrence of neutropenic enterocolitis and on transplant outcome in lymphoma patients. Front Oncol 2024; 14:1369601. [PMID: 38803538 PMCID: PMC11128601 DOI: 10.3389/fonc.2024.1369601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Carmustine (BCNU), etoposide, cytarabine, and melphalan (BEAM) are a widely used high-dose chemotherapy regimen for autologous stem cell transplantation transplant (ASCT) in lymphoid malignancies. During BCNU shortages, some centers switched to fotemustine-substituted BEAM (FEAM). Neutropenic enterocolitis (NEC) is a life-threatening complication occurring after intestinal mucosa damage related to intensive chemotherapy. NEC mortality may be up to 30%-50%. In our study, we compared NEC incidence, symptoms, mortality, and transplant outcome in terms of overall survival (OS) and progression-free survival (PFS) in the BEAM vs. FEAM groups. Furthermore, we compared the cost of hospitalization of patients who did vs. patients who did not experience a NEC episode (NECe). Methods A total of 191 patients were enrolled in this study (N = 129 and N = 62 were conditioned with BEAM and FEAM, respectively). All patients received bed-side high-resolution ultrasound (US) for NEC diagnosis. Results and discussion NEC incidence and NEC-related mortality were similar in the BEAM and FEAM groups (31% and 40.3%, p = 0.653, and 5% and 8%, p = 0.627, respectively). At a median follow-up of 116 months, no difference was noted between BEAM vs. FEAM groups in terms of OS and PFS (p = 0.181 and p = 0.978, respectively). BEAM appeared equivalent to FEAM in terms of NEC incidence and efficacy. The high incidence of NEC and the low mortality is related to a timely US diagnosis and prompt treatment. US knowledge in NEC diagnosis allows to have comparable days of hospitalization of patients NECpos vs. patients NECneg. The cost analysis of NECpos vs. NECneg has been also performed.
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Affiliation(s)
- Edoardo Benedetti
- Operational Unit Hematology, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Viale delle Milizie 9 00195 Roma, Italian School of Basic and Emergency Ultrasound Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Pisa, Italy
| | - Ginevra Traverso
- Operational Unit Hematology, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giulia Pucci
- Operational Unit Hematology, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Riccardo Morganti
- Section of Statistics, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Emilia Bramanti
- Institute of Chemistry of Organo Metallic Compounds (ICCOM), Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy
| | - Federica Cavallo
- Division of Hematology U, University Hospital Azienda Ospedaliero Universitaria (AOU) “Città della Salute e della Scienza”, Turin, Italy
- Division of Hematology U, Department of Molecular Biotechnologies and Health Sciences, University of Turin, Torino, Italy
| | - Enrico Capochiani
- Hematology Unit, Azienda Unità Sanitaria Locale (USL) Toscana Nord Ovest, Livorno, Italy
| | - Maurizio De Maria
- Hematology Unit, Azienda Unità Sanitaria Locale (USL) Toscana Nord Ovest, Livorno, Italy
| | - Vittorio Ricchiuto
- Dipartimento di Tecnologie Sanitarie Ente di Supporto Tecnico Amministrativo Regionale (ESTAR), Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Massimo Salvatore Stella
- Viale delle Milizie 9 00195 Roma, Italian School of Basic and Emergency Ultrasound Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Pisa, Italy
| | - Sara Galimberti
- Hematology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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3
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Sarmiento M, Rojas P, Gutierrez C, Quezada J, Jara V, Campbell J, Maria G, Vergara M, Triantafilo N, Ocqueteau M. Autologous Stem Cell Transplant in Lymphoma Using a Noncryopreserved Platform: An Adapted Sequential Conditioning Maintaining Dose Intensity Does not Affect Transplantation Outcomes. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023:S2152-2650(23)00126-X. [PMID: 37127472 DOI: 10.1016/j.clml.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Hematopoietic autologous stem cell transplantation (ASCT) is a validated therapeutic strategy for lymphoma treatment and precise well-tolerated conditioning. Several conditioning methods are available, but the most commonly used are CVB, BEAM, and ICE, which are conventionally administered in 6 to 7 days. Since 2015, our program has moved toward noncryopreserved platforms that require concise times; therefore, we have modified the conditioning by reducing it to 4 to 5 days. In this study, we show our experience. METHODS We compared ASCT performed in our program before and after 2015 in lymphoma patients. Between 2000 and 2014 and from 2015 to 2022, we performed 46 and 61 ASCT procedures, respectively. RESULTS Since 2015, we observed a greater number of infused stem cells, fewer episodes of febrile neutropenia (60% vs. 37% P = .008), shorter hospitalizations (30 vs. 18 days P = .001), faster engraftment (20 vs. 14 days P = .001) and better progression-free survival (72 vs. 44 months P = .002). Additionally, a prolonged overall survival was observed at these results, and this prolonged survival is difficult to interpret due to the short follow-up. CONCLUSION In conclusion, conditioning adjusted for a noncryopreserved strategy offers at least similar or even better results than the cryopreserved strategy. Prospective studies are warranted.
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Affiliation(s)
| | - Patricio Rojas
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Veronica Jara
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - James Campbell
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Garcia Maria
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Max Vergara
- Pontificia Universidad Católica de Chile, Santiago, Chile
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4
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Lin M, Wu X, Zhang L, Li L, Wang X, Fu X, Sun Z, Zhang X, Zhu L, Yu H, Chang Y, Nan F, Yan J, Zhou Z, Shi C, Zhang M, Li X. Fotemustine, etoposide, cytarabine, and cyclophosphamide (FEAC) conditioning regimen for autologous stem cell transplantation in lymphoma. Leuk Lymphoma 2023; 64:605-612. [PMID: 36657436 DOI: 10.1080/10428194.2023.2167492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To investigate the efficacy and safety of the FEAC (fotemustine, etoposide, cytarabine, and cyclophosphamide) conditioning regimen for the treatment of lymphoma, we retrospectively analyzed the records of 76 Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) patients who underwent autologous stem cell transplantation (ASCT) after the FEAC conditioning regimen. Their survival, as well as the clinical efficacy, hematopoietic engraftment time, and toxicity, were analyzed. One patient died of severe pulmonary infection, and the transplant-related mortality (TRM) was 1.3% (1/76). Hematopoietic engraftment was achieved successfully in the remaining 75 patients. The median times of neutrophil and platelet engraftment were 11 d (6-21 d) and 13 d (8-24 d), respectively. The 2-year progression-free survival (PFS) rate was 69.1%, and the 2-year overall survival (OS) rate was 84.2%. FEAC conditioning regimen has acceptable toxicity, and the prognosis of patients is good, making it a feasible alternative to the BEAM regimen for ASCT.
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Affiliation(s)
- Meng Lin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xiaolong Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Linan Zhu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Hui Yu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Yu Chang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Feifei Nan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Jiaqin Yan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Zhiyuan Zhou
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Cunzhen Shi
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P.R. China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, P.R. China
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5
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Autore F, Stirparo L, Innocenti I, Papa E, Marchesi F, Togni C, Mariani S, Torrieri L, Salvatori M, Fazio F, Metafuni E, Giammarco S, Sora F, Falcucci P, Ferrari A, Trisolini SM, Capria S, Tafuri A, Chiusolo P, Sica S, Laurenti L. Immunogenicity of SARS-CoV-2 vaccination in patients undergoing autologous stem cell transplantation. A multicentric experience. Front Oncol 2022; 12:897937. [PMID: 36531008 PMCID: PMC9755510 DOI: 10.3389/fonc.2022.897937] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/14/2022] [Indexed: 11/10/2023] Open
Abstract
COVID-19 disease has a strong impact on hematological patients; those receiving autologous hematopoietic stem cell transplantation (aHSCT) represent a particularly vulnerable group, in which the effectiveness of vaccination is very variable. Chiarucci et al. showed that patients affected by non-Hodgkin lymphoma (NHL) and treated with rituximab experienced a lower rate of immunization against SARS-CoV-2 (54%), as well as significantly lower IgG antibody titers. In our multicenter retrospective observational study, we included 82 patients who underwent aHSCT, divided into two groups: 58 patients vaccinated after aHSCT (group A) and 24 vaccinated before getting transplantation (group B). In group A, 39 (67%) patients had positive serology, and the rate of positivity increased with time after aHSCT. In the subgroup of patients with NHL, the administration of rituximab predicted negative serology, particularly when administered in the 6 months before vaccination (13% response rate). Patients affected by plasma cells had a higher rate of positivity (83% overall), independently of the time to aHSCT. In group B, no patient who initially showed positive serology became negative after transplantation, so the aHSCT did not affect the response to the vaccination. Our study confirmed the role of rituximab as a negative predictor of response to SARS-CoV-2 vaccination, whereas the conditioning and transplantation procedure itself seemed to be less important.
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Affiliation(s)
- Francesco Autore
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia Fondazione Policlinico, Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Luca Stirparo
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Idanna Innocenti
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia Fondazione Policlinico, Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Elena Papa
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Chiara Togni
- Hematology Unit, Azienda Ospedaliera Universitaria Sant’Andrea, Sapienza University, Rome, Italy
| | - Sabrina Mariani
- Hematology Unit, Azienda Ospedaliera Universitaria Sant’Andrea, Sapienza University, Rome, Italy
| | - Lorenzo Torrieri
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Martina Salvatori
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Francesca Fazio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia Fondazione Policlinico, Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Sabrina Giammarco
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia Fondazione Policlinico, Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Federica Sora
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia Fondazione Policlinico, Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Falcucci
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Antonella Ferrari
- Hematology Unit, Azienda Ospedaliera Universitaria Sant’Andrea, Sapienza University, Rome, Italy
| | - Silvia Maria Trisolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Saveria Capria
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Agostino Tafuri
- Hematology Unit, Azienda Ospedaliera Universitaria Sant’Andrea, Sapienza University, Rome, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia Fondazione Policlinico, Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia Fondazione Policlinico, Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Laurenti
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia Fondazione Policlinico, Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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6
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Besutti G, Massaro F, Bonelli E, Braglia L, Casali M, Versari A, Ligabue G, Pattacini P, Cavuto S, Merlo DF, Luminari S, Merli F, Vaccaro S, Pellegrini M. Prognostic Impact of Muscle Quantity and Quality and Fat Distribution in Diffuse Large B-Cell Lymphoma Patients. Front Nutr 2021; 8:620696. [PMID: 34026803 PMCID: PMC8138563 DOI: 10.3389/fnut.2021.620696] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/07/2021] [Indexed: 12/25/2022] Open
Abstract
Baseline CT scans of 116 patients (48% female, median 64 years) with diffuse large B-cell lymphoma (DLBCL) were retrospectively reviewed to investigate the prognostic role of sarcopenia and fat compartment distributions on overall survival (OS), progression-free survival (PFS), and early therapy termination. Skeletal muscle index (SMI), skeletal muscle density (SMD), and intermuscular adipose tissue (IMAT) were quantified at the level of the third lumbar vertebra (L3) and proximal thigh (PT). Low L3-SMD, but not low L3-SMI, was associated with early therapy termination (p = 0.028), shorter OS (HR = 6.29; 95% CI = 2.17-18.26; p < 0.001), and shorter PFS (HR = 2.42; 95% CI = 1.26-4.65; p = 0.008). After correction for sex, International Prognostic Index (IPI), BMI, and R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), low L3-SMD remained associated with poor OS (HR = 3.54; 95% CI = 1.10-11.40; p = 0.034) but not with PFS. Increased PT-IMAT was prognostic for poor OS and PFS after correction for sex, IPI, BMI, and R-CHOP therapy (HR = 1.35; CI = 1.03-1.7; p = 0.03, and HR = 1.30; CI = 1.04-1.64; p = 0.024, respectively). Reduced muscle quality (SMD) and increased intermuscular fat (IMAT), rather than low muscle quantity (SMI), are associated with poor prognosis in DLBCL, when measured at the L3 level, and particularly at the level of the proximal thigh. The proximal thigh represents a novel radiological landmark to study body composition.
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Affiliation(s)
- Giulia Besutti
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Fulvio Massaro
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Hematology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Efrem Bonelli
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Braglia
- Research and Biostatistics Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimiliano Casali
- Nuclear Medicine Unit, Oncology Department, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Oncology Department, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Guido Ligabue
- Radiology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Pierpaolo Pattacini
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Research and Biostatistics Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Domenico F Merlo
- Research and Biostatistics Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Merli
- Hematology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Salvatore Vaccaro
- Clinical Nutrition Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Pellegrini
- Clinical Nutrition Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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7
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Ferrero D, Bonello F, Oliva S, Gay F, Boccadoro M. Can the dismal prognosis of patients with central nervous system plasma cell neoplasms be improved? Leuk Res 2021; 107:106592. [PMID: 33933932 DOI: 10.1016/j.leukres.2021.106592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/19/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Dario Ferrero
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
| | - Francesca Bonello
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stefania Oliva
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Gay
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mario Boccadoro
- Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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8
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Marchesi F, Capria S, Pedata M, Terrenato I, Ballotta L, Riccardi C, Papa E, Riemma C, Trisolini S, Celentano M, Regazzo G, Ferrara F, Mengarelli A, Picardi A. BEAM conditioning regimen ensures better progression-free survival compared with TEAM but not with FEAM in lymphoma patients undergoing autologous stem cell transplant. Leuk Lymphoma 2020; 61:2238-2241. [PMID: 32419550 DOI: 10.1080/10428194.2020.1765238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Saveria Capria
- Division of Hematology, Department of Translational and Precision Medicine, University of Rome 'Sapienza', Rome, Italy
| | | | - Irene Terrenato
- Biostatistics and Bioinformatic Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Ballotta
- Division of Hematology, Department of Translational and Precision Medicine, University of Rome 'Sapienza', Rome, Italy
| | - Cira Riccardi
- Stem Cell Transplant Program of AORN Cardarelli, Naples, Italy
| | - Elena Papa
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Costantino Riemma
- Division of Hematology, Department of Translational and Precision Medicine, University of Rome 'Sapienza', Rome, Italy
| | - Silvia Trisolini
- Division of Hematology, Department of Translational and Precision Medicine, University of Rome 'Sapienza', Rome, Italy
| | - Maria Celentano
- Stem Cell Transplant Program of AORN Cardarelli, Naples, Italy
| | - Giulia Regazzo
- Genomic and Epigenetic Unit, Translational Research Area, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Andrea Mengarelli
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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9
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Mascolo A, Scavone C, Bertini M, Brusco S, Punzo F, Pota E, Di Martino M, Di Pinto D, Rossi F. Safety of Anticancer Agents Used in Children: A Focus on Their Off-Label Use Through Data From the Spontaneous Reporting System. Front Pharmacol 2020; 11:621. [PMID: 32457620 PMCID: PMC7221123 DOI: 10.3389/fphar.2020.00621] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/20/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Among factors influencing the higher risk of developing unknown or rare adverse drug reactions (ADRs) among children and adolescents, there is the frequent off-label use of drugs that seems to be very common in pediatric oncological patients. Our study aim to collect and evaluate data on the safety profile of antineoplastic drugs and their off-label use in the pediatrics population using real life data. METHODS We retrieved Individual Case Safety Reports (ICSRs) with an anticancer agent as suspected drug among those reported through the Campania spontaneous reporting system from 1 January 2013 to 30 September 2019. We classified ICSRs into four off-label categories: "age," "route of administration," "weight," and "therapeutic indication." We defined an ICSR as an off-label case if it met at least one of the aforementioned categories for at least one of the reported suspected antineoplastic drugs. RESULTS A total of 18 ICSRs (7.6%) out of 236 were classified as off-label cases. The median age of patients was 13 years (interquartile range, IQR: 6-16), with 94.4% of cases occurring in male patients. In the classification of the off-label category, 16 ICSRs were categorized according to the "therapeutic indication" and two for the "age." No case was categorized for the off-label categories "route of administration" and "weight." The two off-label cases categorized as "age" were both related to the use of brentuximab vedotin for Hodgkin's lymphoma in patients aged 16 years. Twenty-nine ADRs (1.6 suspected adverse drug reactions per ICSR) were identified among off-label cases. Among ADRs, those reported more than one were diarrhea (N = 3), neutropenia (N = 3), nausea (N = 2), pyrexia (N = 2), and vomit (N = 2). CONCLUSIONS Our findings showed a low number of ICSRs classified as off-label. The majority of off-label ICSRs were categorized for the "therapeutic indication." This low number of off-label ICSRs might be largely due to the underreporting phenomenon, which is a major limit in pharmacovigilance. Therefore, we believe that spreading pharmacovigilance knowledge and awareness might improve this aspect.
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Affiliation(s)
- Annamaria Mascolo
- Department of Experimental Medicine–Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Cristina Scavone
- Department of Experimental Medicine–Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Michele Bertini
- Department of Experimental Medicine–Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Simona Brusco
- Department of Experimental Medicine–Section of Pharmacology “L. Donatelli”, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesca Punzo
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Elvira Pota
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Martina Di Martino
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Daniela Di Pinto
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesca Rossi
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
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10
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Redondo AM, Valcárcel D, González‐Rodríguez AP, Suárez‐Lledó M, Bello JL, Canales M, Gayoso J, Colorado M, Jarque I, Campo R, Arranz R, Terol MJ, Rifón JJ, Rodríguez MJ, Ramírez MJ, Castro N, Sánchez A, López‐Jiménez J, Montes‐Moreno S, Briones J, López A, Palomera L, López‐Guillermo A, Caballero D, Martín A. Bendamustine as part of conditioning of autologous stem cell transplantation in patients with aggressive lymphoma: a phase 2 study from the GELTAMO group. Br J Haematol 2018; 184:797-807. [DOI: 10.1111/bjh.15713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 11/05/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Alba M. Redondo
- Department of Haematology Hospital Universitario de Salamanca ‐ IBSAL CIBERONC Salamanca Spain
| | - David Valcárcel
- Department of Haematology Hospital Vall d'Hebron University Autònoma of Barcelona (UAB) Barcelona Spain
- Experimental Haematology Unit Vall d’ Hebron Institute of Oncology (VHIO) Barcelona Spain
| | | | | | - José L. Bello
- Department of Haematology Complejo Hospitalario Universitario de Santiago (CHUS) Santiago de Compostela Spain
| | | | - Jorge Gayoso
- Department of Haematology Hospital Gregorio Marañón Madrid Spain
| | - Mercedes Colorado
- Department of Haematology Hospital Marqués de Valdecilla Santander Spain
| | - Isidro Jarque
- Department of Haematology Hospital Universitario La Fe CIBERONC Valencia Spain
| | - Raquel Campo
- Department of Haematology Hospital Son Llítzer Palma de Mallorca Spain
| | - Reyes Arranz
- Department of Haematology Hospital de La Princesa Madrid Spain
| | - María J. Terol
- Department of Haematology Hospital Clínico de Valencia Valencia Spain
| | - José J. Rifón
- Department of Haematology Clínica Universitaria de Navarra Pamplona Spain
| | - María J. Rodríguez
- Department of Haematology Hospital Universitario de Canarias Las Palmas de Gran Canaria Spain
| | - María J Ramírez
- Department of Haematology Hospital de Jerez Jerez de la Frontera Spain
| | - Nerea Castro
- Department of Haematology Hospital 12 de Octubre Madrid Spain
| | - Andrés Sánchez
- Department of Haematology Hospital Virgen de la Arrixaca Murcia Spain
| | | | - Santiago Montes‐Moreno
- Department of Pathology Hospital Universitario Marqués de Valdecilla IFIMAV Santander Spain
| | - Javier Briones
- Department of Haematology Hospital Santa Creu i Sant Pau Barcelona Spain
| | - Aurelio López
- Department of Haematology Hospital Arnau de Villanova Valencia Spain
| | - Luis Palomera
- Department of Haematology Hospital Clínico de Zaragoza Zaragoza Spain
| | | | - Dolores Caballero
- Department of Haematology Hospital Universitario de Salamanca ‐ IBSAL CIBERONC Salamanca Spain
| | - Alejandro Martín
- Department of Haematology Hospital Universitario de Salamanca ‐ IBSAL CIBERONC Salamanca Spain
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11
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Norman JE, Schouten HC, Dreger P, Robinson SP. The role of stem cell transplantation in the management of relapsed follicular lymphoma in the era of targeted therapies. Bone Marrow Transplant 2018; 54:787-797. [DOI: 10.1038/s41409-018-0372-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023]
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12
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Olivieri J, Mosna F, Pelosini M, Fama A, Rattotti S, Giannoccaro M, Carli G, Tisi MC, Ferrero S, Sgherza N, Mazzone AM, Marino D, Calimeri T, Loseto G, Saraceni F, Tomei G, Sica S, Perali G, Codeluppi K, Billio A, Olivieri A, Orciuolo E, Matera R, Stefani PM, Borghero C, Ghione P, Cascavilla N, Lanza F, Chiusolo P, Finotto S, Federici I, Gherlinzoni F, Centurioni R, Fanin R, Zaja F. A Comparison of the Conditioning Regimens BEAM and FEAM for Autologous Hematopoietic Stem Cell Transplantation in Lymphoma: An Observational Study on 1038 Patients From Fondazione Italiana Linfomi. Biol Blood Marrow Transplant 2018; 24:1814-1822. [DOI: 10.1016/j.bbmt.2018.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/14/2018] [Indexed: 01/17/2023]
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13
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Genomic Integration of HHV-6 Mimicking Viral Reactivation after Autologous Stem Cell Transplantation. Mediterr J Hematol Infect Dis 2018. [PMID: 29531650 PMCID: PMC5841938 DOI: 10.4084/mjhid.2018.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The monitoring of Human Herpesvirus 6 (HHV-6) after allogeneic stem cell transplantation has proven to be useful in preventing life-threatening complications; however, the pathogenic role of HHV-6 after autologous transplantation is not well-characterized, although viral reactivation might be responsible for significant complications even after this type of transplant. Here we report, for the first time to our knowledge, the case of a patient with chromosomally integrated HHV-6 (ciHHV-6), presenting with high titers of HHV-6 DNA copies after autologous transplantation, mimicking HHV-6 reactivation. The presence of viral DNA in the follicle bulb confirmed the ciHHV-6 and allowed for the discontinuation of the antiviral treatment. Due to the increasing awareness of HHV-6 potential pathogenicity and the fact that ciHHV-6 is expected in 1–2% of the population, such a case might be helpful in recognizing ci HHV-6, thus avoiding unnecessary and potentially toxic antiviral therapy once the viral genomic integration is confirmed.
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14
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BEAM vs FEAM high-dose chemotherapy: retrospective study in lymphoma patients undergoing autologous stem cell transplant. Bone Marrow Transplant 2018; 53:1051-1054. [PMID: 29440737 DOI: 10.1038/s41409-018-0120-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/07/2018] [Accepted: 01/22/2018] [Indexed: 11/08/2022]
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15
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Modified BEAM as conditioning regimen for lymphoma patients undergoing autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 2017; 53:91-93. [PMID: 28967898 DOI: 10.1038/bmt.2017.206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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16
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Piccin A, Rebulla P, Pupella S, Tagnin M, Marano G, Di Pierro AM, Santodirocco M, Di Mauro L, Beqiri L, Kob M, Primerano M, Casini M, Billio A, Eisendle K, Fontanella F. Impressive tissue regeneration of severe oral mucositis post stem cell transplantation using cord blood platelet gel. Transfusion 2017; 57:2220-2224. [PMID: 28656652 DOI: 10.1111/trf.14205] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Platelet gel from cord blood (CBPG) is a recently developed blood component for topical use. We report a case of life-threatening mucositis after high-dose chemotherapy with fotemustine and cytarabine that was successfully treated with CBPG. CASE REPORT A patient with non-Hodgkin lymphoma who was undergoing autologous hematopoietic stem cell transplantation developed severe oral and esophageal mucositis with severe bacterial sepsis and cytomegalovirus infection, causing prolonged neutropenia. CBPG was topically administered daily to the oral cavity. The CBPG was partially reabsorbed and partially swallowed. RESULTS After 8 consecutive days of administration, the patient's oral mucosa markedly improved, showing restitutio ad integrum, and the patient's clinical status progressively improved. No side effects were seen after CBPG application. CONCLUSION This case supports the need to conduct controlled studies comparing the efficacy of autologous and allogeneic platelet gel from adult and umbilical cord blood for the topical treatment of severe oral mucositis occurring after high-dose chemotherapy.
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Affiliation(s)
- Andrea Piccin
- Hematology Department, San Maurizio Regional Hospital, South Tyrol, Italy.,Claudiana College of Healthcare Professions, Bolzano, South Tyrol, Italy.,Internal Medicine V, University of Innsbruck, Innsbruck, Austria.,IMREST, Interdisciplinary Medical Research Center of South Tyrol, Bolzano South Tyrol, Italy
| | - Paolo Rebulla
- Blood Transfusion Center, Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simonetta Pupella
- Istituto Superiore di Sanità, Italian National Blood Center, Rome, Italy
| | - Mario Tagnin
- Odontostomatology Department, San Maurizio Regional Hospital, South Tyrol, Italy
| | - Giuseppe Marano
- Istituto Superiore di Sanità, Italian National Blood Center, Rome, Italy
| | - Angela Maria Di Pierro
- Hematology Department, San Maurizio Regional Hospital, South Tyrol, Italy.,IMREST, Interdisciplinary Medical Research Center of South Tyrol, Bolzano South Tyrol, Italy
| | - Michele Santodirocco
- Puglia Cord Blood Bank, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Lazzaro Di Mauro
- Puglia Cord Blood Bank, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Lisa Beqiri
- Odontostomatology Department, San Maurizio Regional Hospital, South Tyrol, Italy
| | - Michael Kob
- Claudiana College of Healthcare Professions, Bolzano, South Tyrol, Italy.,IMREST, Interdisciplinary Medical Research Center of South Tyrol, Bolzano South Tyrol, Italy
| | - Marco Primerano
- IMREST, Interdisciplinary Medical Research Center of South Tyrol, Bolzano South Tyrol, Italy.,Hospital Pharmacy, San Maurizio Regional Hospital
| | - Marco Casini
- Hematology Department, San Maurizio Regional Hospital, South Tyrol, Italy
| | - Atto Billio
- Hematology Department, San Maurizio Regional Hospital, South Tyrol, Italy
| | - Klaus Eisendle
- Claudiana College of Healthcare Professions, Bolzano, South Tyrol, Italy.,IMREST, Interdisciplinary Medical Research Center of South Tyrol, Bolzano South Tyrol, Italy.,Department of Dermatology, Venerology, and Allergology, San Maurizio Regional Hospital, South Tyrol, Italy
| | - Fabrizio Fontanella
- IMREST, Interdisciplinary Medical Research Center of South Tyrol, Bolzano South Tyrol, Italy.,Odontostomatology Department, San Maurizio Regional Hospital, South Tyrol, Italy
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17
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Shi Y, Liu P, Zhou S, Yang J, Han X, He X, Zhang C, Gui L, Qin Y, Yang S, Zhao L, Yao J, Jia B, Zhang S, Sun Y, Shi Y. Comparison of CBV, BEAM and BEAC high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation in non-Hodgkin lymphoma: Efficacy and toxicity. Asia Pac J Clin Oncol 2017; 13:e423-e429. [PMID: 28101911 DOI: 10.1111/ajco.12610] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Youwu Shi
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Peng Liu
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Shengyu Zhou
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Jianliang Yang
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Xiaohong Han
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Xiaohui He
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Changgong Zhang
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Lin Gui
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Yan Qin
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Sheng Yang
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Liya Zhao
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Jiarui Yao
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Bo Jia
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Shuxiang Zhang
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Yan Sun
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
| | - Yuankai Shi
- Department of Medical Oncology; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; National Cancer Center / Cancer Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Beijing China
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18
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Isidori A, Christofides A, Visani G. Novel regimens prior to autologous stem cell transplantation for the management of adults with relapsed/refractory non-Hodgkin lymphoma and Hodgkin lymphoma: alternatives to BEAM conditioning. Leuk Lymphoma 2016; 57:2499-509. [DOI: 10.1080/10428194.2016.1185785] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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A retrospective comparison of toxicity and initial efficacy of two autologous stem cell transplant conditioning regimens for relapsed lymphoma: LEAM and BEAM. Bone Marrow Transplant 2016; 51:1397-1399. [DOI: 10.1038/bmt.2016.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Musso M, Messina G, Di Renzo N, Di Carlo P, Vitolo U, Scalone R, Marcacci G, Scalzulli PR, Moscato T, Matera R, Crescimanno A, Santarone S, Orciuolo E, Merenda A, Pavone V, Pastore D, Donnarumma D, Carella AM, Ciochetto C, Cascavilla N, Mele A, Lanza F, Di Nicola M, Bonizzoni E, Pinto A. Improved outcome of patients with relapsed/refractory Hodgkin lymphoma with a new fotemustine-based high-dose chemotherapy regimen. Br J Haematol 2016; 172:111-21. [PMID: 26458240 PMCID: PMC5053328 DOI: 10.1111/bjh.13803] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 08/03/2015] [Indexed: 01/04/2023]
Abstract
High-dose chemotherapy (HDT) with autologous stem cell transplantation is the standard of care for relapsed/refractory (RR) Hodgkin lymphoma (HL). Given that HDT may cure a sizeable proportion of patients refractory to first salvage, development of newer conditioning regimens remains a priority. We present the results of a novel HDT regimen in which carmustine was substituted by a third-generation chloroethylnitrosourea, fotemustine, with improved pharmacokinetics and safety (FEAM; fotemustine, etoposide, cytarabine, melphalan) in 122 patients with RR-HL accrued into a prospective registry-based study. Application of FEAM resulted in a 2-year progression-free survival (PFS) of 73·8% [95% confidence interval (CI), 0·64-0·81] with median PFS, overall survival and time to progression yet to be reached. The 2-year risk of progression adjusted for the competitive risk of death was 19·4% (95% CI, 0·12-0·27) for the entire patient population. Most previously established independent risk factors, except for fluorodeoxyglucose ((18) (F) FDG)-uptake, were unable to predict for disease progression and survival after FEAM. Although 32% of patients had (18) (F) FDG-positrin emission tomography-positive lesions before HDT, the 2-year risk of progression adjusted for competitive risk of death was 19·4% (95% CI; 0·12-0·27). No unusual acute toxicities or early/late pulmonary adverse events were registered. FEAM emerges as an ideal HDT regimen for RR-HL patients typically pre-exposed to lung-damaging treatments.
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Affiliation(s)
- Maurizio Musso
- Dipartimento Oncologico “La Maddalena”UOC di Oncoematologia e TMOPalermoItaly
| | - Giuseppe Messina
- Azienda Ospedaliera ‘Bianchi Melacrino Morelli’C.T.M.O. Centro Unico Regionale Trapianti di Cellule Staminali e Terapie CellulariReggio CalabriaItaly
| | - Nicola Di Renzo
- UOC di Ematologia e Trapianto di Cellule StaminaliP.O. “Vito Fazzi”LecceItaly
| | - Paolo Di Carlo
- Unità Terapia Intensiva Ematologica per il Trapianto EmopoieticoOspedale CivilePescaraItaly
| | - Umberto Vitolo
- Dipartimento di Oncologia ed EmatologiaA.O. U.Città della Salute e della Scienza di Torino San Giovanni BattistaS.C. EmatologiaTorinoItaly
| | - Renato Scalone
- Dipartimento Oncologico “La Maddalena”UOC di Oncoematologia e TMOPalermoItaly
| | - Gianpaolo Marcacci
- Dipartimento di EmatologiaIstituto Nazionale TumoriFondazione ‘G. Pascale’IRCCSUOC di Ematologia Oncologica e Trapianto di Cellule StaminaliNapoliItaly
| | - Potito R. Scalzulli
- Divisione di EmatologiaIRCSS Casa Sollievo della SofferenzaSan Giovanni RotondoItaly
| | - Tiziana Moscato
- Azienda Ospedaliera ‘Bianchi Melacrino Morelli’C.T.M.O. Centro Unico Regionale Trapianti di Cellule Staminali e Terapie CellulariReggio CalabriaItaly
| | - Rossella Matera
- UOC di Ematologia e Trapianto di Cellule StaminaliP.O. “Vito Fazzi”LecceItaly
| | | | - Stella Santarone
- Unità Terapia Intensiva Ematologica per il Trapianto EmopoieticoOspedale CivilePescaraItaly
| | - Enrico Orciuolo
- Dipartimento di Oncologia, Trapianti e Tecnologie AvanzateAzienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Anxur Merenda
- ARNAS Ospedale Civico BenfratelliU.O. di EmatologiaPalermoItaly
| | - Vincenzo Pavone
- Ospedale Generale Provinciale “Cardinale G. Panico”S.C. di Ematologia e Trapianto di Cellule StaminaliTricase, LecceItaly
| | | | - Daniela Donnarumma
- Dipartimento di EmatologiaIstituto Nazionale TumoriFondazione ‘G. Pascale’IRCCSUOC di Ematologia Oncologica e Trapianto di Cellule StaminaliNapoliItaly
| | - Angelo M. Carella
- U.O. Complessa di EmatologiaIRCCS Azienda Ospedaliera Universitaria San Martino‐ISTGenovaItaly
| | - Chiara Ciochetto
- Dipartimento di Oncologia ed EmatologiaA.O. U.Città della Salute e della Scienza di Torino San Giovanni BattistaS.C. EmatologiaTorinoItaly
| | - Nicola Cascavilla
- Divisione di EmatologiaIRCSS Casa Sollievo della SofferenzaSan Giovanni RotondoItaly
| | - Anna Mele
- Ospedale Generale Provinciale “Cardinale G. Panico”S.C. di Ematologia e Trapianto di Cellule StaminaliTricase, LecceItaly
| | - Francesco Lanza
- Unità Operativa di EmatologiaIstituti Ospitalieri di CremonaCremonaItaly
| | - Massimo Di Nicola
- Dipartimento di Oncologia MedicaFondazione IRCCS Istituto Nazionale TumoriMilanoItaly
| | - Erminio Bonizzoni
- Sezione di Statistica Medica e Biometria ‘GA Maccaro’Dipartimento di Scienze Cliniche e di ComunitàUniversità di MilanoMilanoItaly
| | - Antonello Pinto
- Dipartimento di EmatologiaIstituto Nazionale TumoriFondazione ‘G. Pascale’IRCCSUOC di Ematologia Oncologica e Trapianto di Cellule StaminaliNapoliItaly
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Clinical Options in Relapsed or Refractory Hodgkin Lymphoma: An Updated Review. J Immunol Res 2015; 2015:968212. [PMID: 26788526 PMCID: PMC4695673 DOI: 10.1155/2015/968212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022] Open
Abstract
Hodgkin lymphoma (HL) is a potentially curable lymphoma, and modern therapy is expected to successfully cure more than 80% of the patients. Second-line salvage high-dose chemotherapy and autologous stem cell transplantation (auto-SCT) have an established role in the management of refractory and relapsed HL, leading to long-lasting responses in approximately 50% of relapsed patients and a minority of refractory patients. Patients progressing after intensive treatments, such as auto-SCT, have a very poor outcome. Allogeneic SCT represents the only strategy with a curative potential for these patients; however, its role is controversial. Based on recent knowledge of HL pathology, biology, and immunology, antibody-drug conjugates targeting CD30, small molecule inhibitors of cell signaling, and antibodies that inhibit immune checkpoints are currently explored. This review will discuss the clinical results regarding auto-SCT and allo-SCT as well as the current role of emerging new treatment strategies.
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Isidori A, Clissa C, Loscocco F, Guiducci B, Barulli S, Malerba L, Gabucci E, Visani G. Advancement in high dose therapy and autologous stem cell rescue in lymphoma. World J Stem Cells 2015; 7:1039-1046. [PMID: 26328019 PMCID: PMC4550627 DOI: 10.4252/wjsc.v7.i7.1039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/27/2015] [Accepted: 07/17/2015] [Indexed: 02/06/2023] Open
Abstract
Although advanced stage aggressive non-Hodgkin’s lymphomas and Hodgkin’s disease are thought to be chemotherapy-responsive cancers, a considerable number of patients either relapse or never attain a remission. High-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) is often the only possibility of cure for most of these patients. However, many controversial issues still remain with respect to HDT/ASCT for lymphomas, including its role for, the optimal timing of transplantation, the best conditioning regimen and the potential use of localized radiotherapy or immunologic methods to decrease post-transplant recurrence. Recently, mainly due to the unavailability of carmustine, several novel conditioning protocols have been clinically developed, with the aim of improving the overall outcome by enhancing the anti-lymphoma effect and, at the same time, by reducing short and long-term toxicity. Furthermore, the better safety profiles of novel approaches would definitively allow patients aged more than 65-70 years to benefit from this therapeutic option. In this review, we will briefly discuss the most relevant and recent data available regarding HDT/ASCT in lymphomas.
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Sakellari I, Mallouri D, Batsis I, Apostolou C, Konstantinou V, Abela EM, Douka V, Marvaki A, Karypidis K, Iskas M, Baliakas P, Kaloyannidis P, Yannaki E, Sotiropoulos D, Kouvatseas G, Smias C, Anagnostopoulos A. Carmustine, etoposide, cytarabine and melphalan versus a newly designed intravenous busulfan-based Busulfex, etoposide and melphalan conditioning regimen for autologous hematopoietic cell transplant: a retrospective matched-pair analysis in advanced Hodgkin and non-Hodgkin lymphomas. Leuk Lymphoma 2015; 56:3071-81. [DOI: 10.3109/10428194.2015.1028054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Current role of autologous and allogeneic stem cell transplantation for relapsed and refractory hodgkin lymphoma. Mediterr J Hematol Infect Dis 2015; 7:e2015015. [PMID: 25745542 PMCID: PMC4344175 DOI: 10.4084/mjhid.2015.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/19/2015] [Indexed: 11/25/2022] Open
Abstract
Classical Hodgkin lymphoma (cHL) is a relatively rare disease, with approximately 9,200 estimated new cases and 1,200 estimated deaths per year in the United States. First-line chemo-radiotherapy leads to cure rates approaching 80% in patients with advanced-stage disease. However, 25 to 30% of these patients are not cured with chemotherapy alone (i.e., the ABVD regimen) and show either primary refractoriness to chemotherapy, early disease relapse or late disease relapse. Second-line salvage high-dose chemotherapy (HDC) and autologous stem cell transplantation (SCT) have an established role in the management of refractory/relapsed cHL, leading to durable responses in approximately 50% of relapsed patients and a minority of refractory patients. However, due to the poor responses to second-line salvage chemotherapy and dismal long-term disease control of primary refractory and early relapsed patients, their treatment represents an unmet medical need. Allogeneic SCT represents, by far, the only strategy with a curative potential for these patients; however, as discussed in this review, it’s role in cHL remains controversial. Despite a general consensus that early relapsed and primary refractory patients represent a clinical challenge requiring effective treatments to achieve long-term disease control, there has been no consensus on the optimal therapy that should be offered to these patients. This review will briefly discuss the clinical results and the main issues regarding autologous SCT as well as the current role of allogeneic SCT.
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Safety and efficacy of granulocyte colony-stimulating factor biosimilars in engraftment after autologous stem cell transplantation for haematological malignancies: a 4-year, single institute experience with different conditioning regimens. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:478-83. [PMID: 25761321 DOI: 10.2450/2015.0198-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/03/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Filgrastim biosimilars have recently been introduced into clinical practice. To date biosimilars have demonstrated comparable efficacy and safety as the originator in chemotherapy-induced neutropenia. Published experience in engraftment after autologous stem cell transplantation (ASCT) is limited and concerns relatively few patients. MATERIALS AND METHODS With the aim of assessing the efficacy and the safety of filgrastim biosimilars in post-ASCT bone marrow recovery, we conducted a single institution, retrospective study in 56 lymphoma and myeloma patients who received filgrastim biosimilars (Tevagrastim(®) and Zarzio(®)) at standard doses from day 5. We compared our results with recently published data on the originator. A cost analysis of each biosimilar was performed. RESULTS Neutrophil counts recovered in 55 patients. The median number of filgrastim biosimilar vials injected was seven per patient. The median time to neutrophil and platelet recovery was 10 and 12 days, respectively. Twenty-six patients had febrile neutropenia, in half of whom the agent involved was identified. In the cost analysis, the use of Tevagrastim(®) and Zarzio(®) was associated with cost reductions of 56% and of 86%, respectively. DISCUSSION Despite differences in CD34+ cell counts and time of starting filgrastim, our results in terms of time to engraftment and median number of vials injected are similar to published data. Comparing our results by single conditioning regimen to recent literature data, the time to engraftment and duration of hospitalisation were equivalent. Significant differences were observed in the incidence of febrile neutropenia, perhaps due to different preventive and prophylactic protocols for infections. Although prospective studies should be performed to confirm our results, filgrastim biosimilars were found to be effective and safe in engraftment after ASCT.
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Pinto A, Corradini P, Mussetti A, Zinzani PL. Recurrent Hodgkin lymphoma: toward a new definition of candidates for autologous stem cell transplant in the era of positron emission tomography scan and novel agents. Leuk Lymphoma 2014; 56:1969-74. [DOI: 10.3109/10428194.2014.981174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Musso M, Porretto F, Scalone R, Crescimanno A, Polizzi V, Bonanno V. Novel conditioning regimens for Hodgkin’s and non-Hodgkin’s lymphoma. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.13.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Autologous stem cell transplantation (ASCT), in chemosensitive relapsed patients with Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL), is associated with superior event-free survival (EFS) compared with salvage chemotherapy alone. BEAM is one of the most commonly used regimens in both HL and NHL because of its acceptable toxicity and high effectiveness. The nonrelapsed mortality (NRM) ranges from 7 to 10% in historical studies. More recent investigations have demonstrated a lower NRM, probably due to various factors such as the use of peripheral blood precursor cells and better support therapy. Recently, in order to reduce the toxicity of carmustine and increase antilymphoma activity, several groups have introduced conditioning regimens similar to BEAM. The incorporation of newer drugs (anti-CD20 monoclonal antibodies ± radiolabeled) to ‘classic’ BEAM, or the substitution of carmustine with other drugs (thiotepa, bendamustine and fotemustine) may be a valuable strategy in this patient setting. In this review, we will discuss the data available on HDC followed by ASCT in lymphoma using new conditioning regimens, namely second-generation BEAM.
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Affiliation(s)
- Maurizio Musso
- UO Oncoematologia e trapianto di midollo osseo, Dipartimento Oncologico, La Maddalena, Via S. lorenzo Colli no. 312 D, 90146 Palermo, Italy
| | - Ferdinando Porretto
- UO Oncoematologia e trapianto di midollo osseo, Dipartimento Oncologico, La Maddalena, Via S. lorenzo Colli no. 312 D, 90146 Palermo, Italy
| | - Renato Scalone
- UO Oncoematologia e trapianto di midollo osseo, Dipartimento Oncologico, La Maddalena, Via S. lorenzo Colli no. 312 D, 90146 Palermo, Italy
| | - Alessandra Crescimanno
- UO Oncoematologia e trapianto di midollo osseo, Dipartimento Oncologico, La Maddalena, Via S. lorenzo Colli no. 312 D, 90146 Palermo, Italy
| | - Vita Polizzi
- UO Oncoematologia e trapianto di midollo osseo, Dipartimento Oncologico, La Maddalena, Via S. lorenzo Colli no. 312 D, 90146 Palermo, Italy
| | - Vincenza Bonanno
- UO Oncoematologia e trapianto di midollo osseo, Dipartimento Oncologico, La Maddalena, Via S. lorenzo Colli no. 312 D, 90146 Palermo, Italy
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Moscato T, Fedele R, Messina G, Irrera G, Console G, Martino M. Hematopoietic progenitor cells transplantation for recurrent or refractory Hodgkin's lymphoma. Expert Opin Biol Ther 2013; 13:1013-27. [PMID: 23586758 DOI: 10.1517/14712598.2013.779250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Advanced-stage Hodgkin's lymphoma (HL) has become a curable disease in the majority of patients. Despite this, about 20% of these patients relapsed or are primary refractory to the first-line treatment and high-dose chemotherapy (HDC) and autologous (Auto) hematopoietic progenitor cells transplantation (HPCT) are considered a therapeutic option. AREAS COVERED The authors reviewed HDC and HPCT treatment strategies in recurrent or refractory HL patients, with the goal of providing an overview of this approach. EXPERT OPINION Patients younger than 60-65 years with relapsed disease or refractory to first-line therapy should receive a second-line chemotherapy, followed by HDC and Auto-HPCT. Progression-free and overall survival results are significantly better when a second remission or a minimal disease status is achieved before Auto-HPCT, and demonstrate that this strategy is able to cure more than half of the advanced HL patients. Myeloablative allogeneic HPCT (Allo-HPCT) has been employed in advanced phases of the disease, but there have been significant concerns due to treatment-related mortality (TRM). The safety of allogeneic transplantation has improved with the use of reduced-intensity allogeneic (RIC-Allo) HPCT strategies. Despite early favorable results, mature results of RIC-Allo available in the literature are consistent in demonstrating a lack of long-term disease control.
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Affiliation(s)
- Tiziana Moscato
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera BMM, Via Melacrino n.1, 89100 Reggio Calabria, Italy.
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Carulli G, Rocco M, Panichi A, Chios CF, Ciurli E, Mannucci C, Sordi E, Caracciolo F, Papineschi F, Benedetti E, Petrini M. Treatment of oral mucositis in hematologic patients undergoing autologous or allogeneic transplantation of peripheral blood stem cells: a prospective, randomized study with a mouthwash containing camelia sinensis leaf extract. Hematol Rep 2013; 5:21-5. [PMID: 23888242 PMCID: PMC3719109 DOI: 10.4081/hr.2013.e6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/14/2013] [Accepted: 02/18/2013] [Indexed: 11/22/2022] Open
Abstract
Oral mucositis is an important side effect of hematopoietic stem cell transplantation (HCST), mainly due to toxicity of conditioning regimens. It produces significant pain and morbidity. The present study reports a prospective, randomized, non-blinded study testing the efficacy of a new mouthwash, called Baxidil Onco(®) (Sanitas Farmaceutici Srl, Tortona, Italy) in 60 hematologic patients undergoing HCST (28 autologous, 32 allogeneic). Baxidil Onco(®), used three times a day from Day -1 to Day +30, in addition to standard prophylactic schedules, was administered to 14 patients undergoing autologous and 14 patients undergoing allogeneic HCST. The remaining 32 patients (14 autologous and 18 HCST) were treated only with standard prophylactic schedules and served as control. In our study, the overall incidence of oral mucositis, measured according to the World Health Organization 0-4 scale, was 50% in the Baxidl Onco(®) group versus 82% in the control group (P=0.022). In addition, a significant reduction in scale 2-4 oral mucositis was observed in the Baxidil Onco(®) group (25% vs 56.2%; P=0.0029). The results obtained indicate that incidence, severity and duration of oral mucositis induced by conditioning regimens for HCST can be significantly reduced by oral rinsing with Baxidil Onco(®), in addition to the standard prophylaxis scheme. Since Camelia Sinensin extract, which is used to produce green tea, is the main agent in this mouthwash, we hypothesize that the anti-oxidative properties of polyphenolic compounds of tea might exert protective effects on oral mucosa.
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Affiliation(s)
- Giovanni Carulli
- Division of Hematology, Department of Clinical and Experimental Medicine, Santa Chiara Hospital , Pisa
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Mangiacavalli S, Pochintesta L, Pascutto C, Cocito F, Cazzola M, Corso A, Corso A. Good clinical activity and favorable toxicity profile of once weekly bortezomib, fotemustine, and dexamethasone (B-MuD) for the treatment of relapsed multiple myeloma. Am J Hematol 2013; 88:102-6. [PMID: 23224960 PMCID: PMC3563219 DOI: 10.1002/ajh.23358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 10/24/2012] [Indexed: 11/11/2022]
Abstract
Since multiple myeloma (MM) is still not-curable, the management of relapse remains challenging. Given the known efficacy of alkylating agents in MM, we conducted a phase I/II study to test a new three drug combination in which Fotemustine (Muphoran), an alkylating agent of nitrosurea family, was added to bortezomib + dexamethasone backbone (B-MuD) for the treatment of MM relapsed patients. Fotemustine was administered at two dose levels (80–100 mg/m2 i.v.) on day 1. The original 21-day schedule was early amended for extra-hematological toxicity and a 35-day schedule was adopted (Bortezomib 1.3 mg/m2 i.v. on days 1, 8, 15, and 22, Dexamethasone 20 mg i.v. on days 1, 8, 15, and 22) for a total of six courses. Twenty-four patients were enrolled. The maximum tolerated dose of Fotemustine was 100 mg/m2. The overall response rate was of 62% (CR 8%, VGPR 33%, and PR 21%). The median OS was 28.5 months, the median progression-free survival (PFS) was 19.1 months. B-MuD resulted effective in patients previous exposed to bortezomib without difference of response (P = 0.25) and PFS (P = 0.87) when compared to bortezomib-naive patients. Thrombocytopenia was the most common AE overall. In conclusion, B-MuD is an effective and well tolerated combination in relapsed MM patients even in advanced disease phase. © Am. J. Hematol., 88:102–106, 2013. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Silvia Mangiacavalli
- Division of HematologyFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Lara Pochintesta
- Division of HematologyFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Cristiana Pascutto
- Division of HematologyFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Federica Cocito
- Division of HematologyFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Mario Cazzola
- Division of HematologyFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Alessandro Corso
- Division of HematologyFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
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Bayraktar UD, Bashir Q, Qazilbash M, Champlin RE, Ciurea SO. Fifty years of melphalan use in hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2012; 19:344-56. [PMID: 22922522 DOI: 10.1016/j.bbmt.2012.08.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/17/2012] [Indexed: 12/22/2022]
Abstract
Melphalan remains the most widely used agent in preparative regimens for hematopoietic stem cell transplantation (SCT). From its initial discovery more than 50 years ago, it has been gradually incorporated in the conditioning regimens for both autologous and allogeneic transplantations because of its myeloablative properties and broad antitumor effects as a DNA alkylating agent. Melphalan remains the mainstay conditioning for multiple myeloma and lymphomas, and it has been used successfully in preparative regimens of a variety of other hematological and nonhematological malignancies. The addition of newer agents to conditioning, such as bortezomib or lenalidomide for myeloma or clofarabine for myeloid malignancies, may improve antitumor effects for transplantation, whereas melphalan in combination with alemtuzumab may represent a backbone for future cellular therapy because of reliable engraftment and low toxicity profile. This review summarizes the development and the current use of this remarkable drug in hematopoietic SCT.
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Affiliation(s)
- Ulas D Bayraktar
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Ramzi M, Mohamadian M, Vojdani R, Dehghani M, Nourani H, Zakerinia M, Haghighinejad H. Autologous noncryopreserved hematopoietic stem cell transplant with CEAM as a modified conditioning regimen in patients with Hodgkin lymphoma: a single-center experience with a new protocol. EXP CLIN TRANSPLANT 2012; 10:163-7. [PMID: 22432762 DOI: 10.6002/ect.2011.0092] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES A BEAM regimen including carmustine (BiCNU: bis-chloroethyl nitrosourea), etoposide, cytarabine (cytosine arabinoside), and melphalan is a widely used conditioning regimen for autologous stem cell transplant in patients with Hodgkin lymphoma. We report the results of noncryopreserved autologous stem cell transplant of 45 patients with Hodgkin lymphoma given an alternative regimen, modified BEAM-like regimen (CEAM regimen: lomustine, etoposide, cytarabine, and melphalan), in which carmustine (BiCNU IV) was substituted by oral lomustine (CCNU: 2 chloroethyl cyclohexyl nitrosourea). PATIENTS AND METHODS Forty-five eligible patients with relapsed/refractory Hodgkin lymphoma were consecutively enrolled and underwent conditioning regimen with BEAM-like regimen protocol as follows: Lomustine 200 mg/m(2) on day -3; etoposide 1000 mg/m(2) on day -3 and -2; cytarabine 1000 mg/m(2) on days -3, -2; and Melphalan 140 mg/m(2) on day -1. RESULTS All 45 patients showed engraftment of infused stem cell, and there was no graft failure in the study group. The median mononuclear cell dose was 3.4 × 10(8). The median time to absolute neutrophil count > 0.5 × 10(9)/L was 11 days, and the median time to platelet count > 20 × 10(9) was 14 days. Grade 2 and grade 3 mucositis was seen in 64.5% our patients. Transplant-related mortality at 100 days occurred in 1 patient (2.2%). With a median follow-up of 27 months, median disease-free survival was 20 months, mean overall survival was 27 months, and median overall survival has not yet been reached. CONCLUSIONS These data demonstrate the safety and feasibility of BEAM-like regimen as a new and modified regimen; longer follow-up is required to evaluate fully efficacy and long-term safety of our method.
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Affiliation(s)
- Mani Ramzi
- Department of Hematology, Oncology and Stem Cell Transplantation, and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Attolico I, Pavone V, Ostuni A, Rossini B, Musso M, Crescimanno A, Martino M, Iacopino P, Milone G, Tedeschi P, Coluzzi S, Nuccorini R, Pascale S, Di Nardo E, Olivieri A. Plerixafor Added to Chemotherapy Plus G-CSF Is Safe and Allows Adequate PBSC Collection in Predicted Poor Mobilizer Patients with Multiple Myeloma or Lymphoma. Biol Blood Marrow Transplant 2012; 18:241-9. [DOI: 10.1016/j.bbmt.2011.07.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 07/20/2011] [Indexed: 01/09/2023]
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Corazzelli G, Frigeri F, Arcamone M, Aloj L, Capobianco G, Becchimanzi C, Morelli E, Volzone F, Marcacci G, Russo F, De Filippi R, Lastoria S, Pinto A. Efficacy and safety of the third-generation chloroethylnitrosourea fotemustine for the treatment of chemorefractory T-cell lymphomas. Eur J Haematol 2011; 87:547-53. [PMID: 21752099 PMCID: PMC3263425 DOI: 10.1111/j.1600-0609.2011.01683.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients with recurring T-cell non-Hodgkin lymphoma (T-NHL) are incurable and candidate for investigational agents. Here, we report on five patients with T-NHL refractory to multiple chemotherapy lines, including in all cases alkylators and gemcitabine, who received the third-generation chloroethylnitrosourea fotemustine at a dose of 120 mg/m(2) every 21 d, up to eight courses. Median actual dose intensity was 79%; toxicity was manageable and mainly hematological. One complete remission, one partial remission, two protracted disease stabilization, and one transient, minor response were achieved. Time to progression ranged from 48 to 240+ d. This is the first evidence ever reporting the activity of fotemustine in end-stage T-NHL. Formal studies with this agent are warranted in T-cell malignancies.
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Affiliation(s)
- Gaetano Corazzelli
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G.Pascale', IRCCS, Naples
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Pennese E, Vergine C, Matera R, Dargenio M, Forese P, Di Renzo N. Complete response induced by fotemustine given as single agent in a patient with primary central nervous system non-Hodgkin aggressive lymphoma relapsed after high-dose chemotherapy and autologous stem cell support. Leuk Lymphoma 2011; 52:2188-9. [PMID: 21718140 PMCID: PMC3211192 DOI: 10.3109/10428194.2011.585672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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