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Fianchi L, Guolo F, Marchesi F, Cattaneo C, Gottardi M, Restuccia F, Candoni A, Ortu La Barbera E, Fazzi R, Pasciolla C, Finizio O, Fracchiolla N, Delia M, Lessi F, Dargenio M, Bonuomo V, Del Principe MI, Zappasodi P, Picardi M, Basilico C, Piedimonte M, Minetto P, Giordano A, Chiusolo P, Prezioso L, Buquicchio C, Melillo LMA, Zama D, Farina F, Mancini V, Terrenato I, Rondoni M, Urbino I, Tumbarello M, Busca A, Pagano L. Multicenter Observational Retrospective Study on Febrile Events in Patients with Acute Myeloid Leukemia Treated with Cpx-351 in "Real-Life": The SEIFEM Experience. Cancers (Basel) 2023; 15:3457. [PMID: 37444567 DOI: 10.3390/cancers15133457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
In the present study, we aimed to evaluate the absolute risk of infection in the real-life setting of AML patients treated with CPX-351. The study included all patients with AML from 30 Italian hematology centers of the SEIFEM group who received CPX-351 from July 2018 to June 2021. There were 200 patients included. Overall, 336 CPX-351 courses were counted: all 200 patients received the first induction cycle, 18 patients (5%) received a second CPX-351 induction, while 86 patients (26%) proceeded with the first CPX-351 consolidation cycle, and 32 patients (10%) received a second CPX-351 consolidation. A total of 249 febrile events were recorded: 193 during the first or second induction, and 56 after the first or second consolidation. After the diagnostic work-up, 92 events (37%) were classified as febrile neutropenia of unknown origin (FUO), 118 (47%) were classifiable as microbiologically documented infections, and 39 (17%) were classifiable as clinically documented infections. The overall 30-day mortality rate was 14% (28/200). The attributable mortality-infection rate was 6% (15/249). A lack of response to the CPX-351 treatment was the only factor significantly associated with mortality in the multivariate analysis [p-value: 0.004, OR 0.05, 95% CI 0.01-0.39]. Our study confirms the good safety profile of CPX-351 in a real-life setting, with an incidence of infectious complications comparable to that of the pivotal studies; despite prolonged neutropenia, the incidence of fungal infections was low, as was infection-related mortality.
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Affiliation(s)
- Luana Fianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Fabio Guolo
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | | | - Chiara Cattaneo
- SC Ematologia e Dipartimento di Oncologia Clinica, A.O. Spedali Civili, 25123 Brescia, Italy
| | - Michele Gottardi
- Onco Hematology, Department of Oncology, Veneto Institute of Oncology, IOV-IRCCS, 31033 Padua, Italy
| | | | - Anna Candoni
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
| | | | - Rita Fazzi
- Hematology Unit-A.O.U.P. Ospedale Santa Chiara, 56126 Pisa, Italy
| | - Crescenza Pasciolla
- Haematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | | | - Nicola Fracchiolla
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico di Milano, 20122 Milano, Italy
| | - Mario Delia
- Hematology and Transplant Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy
| | - Federica Lessi
- Ematologia e Immunologia, Clinica Azienda Ospedaliera di Padova, 35128 Padova, Italy
| | | | | | - Maria Ilaria Del Principe
- Dipartimento di Biomedicina e Prevenzione, Università degli studi di Roma "Tor Vergata", 00133 Roma, Italy
| | | | | | - Claudia Basilico
- Azienda Socio Sanitaria Territoriale dei Sette Laghi, 21100 Varese, Italy
| | | | - Paola Minetto
- Ematologia e Trapianto, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Antonio Giordano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | | | | | | | - Daniele Zama
- Policlinico Sant'Orsola Malpighi, 40138 Bologna, Italy
| | - Francesca Farina
- U.O. Ematologia e Trapianto Midollo, Dipartimento di Oncologia, Istituto Scientifico San Raffaele, 20132 Milano, Italy
| | - Valentina Mancini
- Divisione di Ematologia, Ospedale Niguarda Milano, 20162 Milano, Italy
| | - Irene Terrenato
- UOSD Clinical Trial Center e Biostatistica e Bioinformatica, IRCCS Istituto Nazionale Tumori Regina Elena, 00128 Roma, Italy
| | - Michela Rondoni
- U.O.C. di Ematologia, Azienda Unità Sanitaria Locale della Romagna, 48124 Ravenna, Italy
| | - Irene Urbino
- SC Ematologia, Ospedale AOU Città Della Salute e della Scienza, 10126 Torino, Italy
| | - Mario Tumbarello
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Alessandro Busca
- SC Ematologia, Ospedale AOU Città Della Salute e della Scienza, 10126 Torino, Italy
| | - Livio Pagano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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Bernal T, Moreno AF, de LaIglesia A, Benavente C, García‐Noblejas A, Belmonte DG, Riaza R, Salamero O, Foncillas MA, Roldán A, Concepción VN, González LL, Bergua Burgués JM, Lorente de Uña S, Rodríguez‐Macías G, de la Fuente Burguera A, García Pérez MJ, López‐Lorenzo JL, Martínez P, Aláez C, Callejas M, Martínez‐Chamorro C, Roca JR, Barciela LA, Mena Durán AV, Gómez Correcha K, Lavilla Rubira E, Amigo ML, Vall‐llovera F, Garrido A, García‐Fortes M, de Miguel Llorente D, Leonardo AA, Cervero C, Jordá RC, Pérez‐Encinas MM, Zarzuela MP, Figuera A, Rad G, Martínez‐Cuadrón D, Montesinos P. Clinical outcomes after CPX-351 in patients with high-risk acute myeloid leukemia: A comparison with a matched cohort from the Spanish PETHEMA registry. Cancer Med 2023; 12:14892-14901. [PMID: 37212507 PMCID: PMC10417130 DOI: 10.1002/cam4.6120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/28/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND CPX-351 is approved for the treatment of therapy related acute myeloid leukemia (t-AML) and AML with myelodysplastic related changes (MRC-AML). The benefits of this treatment over standard chemotherapy has not been addressed in well matched cohorts of real-life patients. METHODS Retrospective analysis of AML patients treated with CPX-351 as per routine practice. A propensity score matching (PSM) was used to compare their main outcomes with those observed in a matched cohort among 765 historical patients receiving intensive chemotherapy (IC), all of them reported to the PETHEMA epidemiologic registry. RESULTS Median age of 79 patients treated with CPX-351 was 67 years old (interquartile range 62-71), 53 were MRC-AML. The complete remission (CR) rate or CR without recovery (CRi) after 1 or 2 cycles of CPX-351 was 52%, 60-days mortality 18%, measurable residual disease <0.1% in 54% (12 out of 22) of them. Stem cell transplant (SCT) was performed in 27 patients (34%), median OS was 10.3 months, and 3-year relapse incidence was 50%. Using PSM, we obtained two comparable cohorts treated with CPX-351 (n = 52) or IC (n = 99), without significant differences in CR/CRi (60% vs. 54%) and median OS (10.3 months vs. 9.1 months), although more patients were bridged to SCT in the CPX-351 group (35% vs. 12%). The results were confirmed when only 3 + 7 patients were included in the historical cohort. In multivariable analyses, SCT was associated with better OS (HR 0.33 95% CI: 0.18-0.59), p < 0.001. CONCLUSION Larger post-authorization studies may provide evidence of the clinical benefits of CPX-351 for AML in the real-life setting.
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Affiliation(s)
- Teresa Bernal
- Hospital Universitario Central AsturiasOviedoSpain
- Instituto de Oncología del Principado de Asturias (IUOPA), Instituto de Investigación del Principado de Asturias (ISPA)Spain
| | - Ainhoa Fernández Moreno
- Hospital Universitario Central AsturiasOviedoSpain
- Instituto de Oncología del Principado de Asturias (IUOPA), Instituto de Investigación del Principado de Asturias (ISPA)Spain
| | | | | | | | | | | | | | | | - Alicia Roldán
- Departamento de MedicinaHospital Infanta Sofía San Sebastián de los Reyes, Universidad EuropeaMadridSpain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Garrido
- Hospital de la Santa Creu i Sant PauBarcelonaSpain
| | | | | | | | | | - Rosa Coll Jordá
- ICO Girona, Hospital Universitario Dr. Josep TruetaGironaSpain
| | | | | | | | - Guillermo Rad
- Instituto de Oncología del Principado de Asturias (IUOPA), Instituto de Investigación del Principado de Asturias (ISPA)Spain
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Diagnosis and Treatment of Therapy-related Acute Myeloid Leukemia. Crit Rev Oncol Hematol 2022; 171:103607. [DOI: 10.1016/j.critrevonc.2022.103607] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/01/2021] [Accepted: 01/26/2022] [Indexed: 11/21/2022] Open
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Evolving Therapeutic Approaches for Older Patients with Acute Myeloid Leukemia in 2021. Cancers (Basel) 2021; 13:cancers13205075. [PMID: 34680226 PMCID: PMC8534216 DOI: 10.3390/cancers13205075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The better understanding of disease biology, the availability of new effective drugs and the increased awareness of patients’ heterogeneity in terms of fitness and personal expectations has made the current treatment paradigm of AML in the elderly very challenging. Here, we discuss the evolving criteria used to define eligibility for induction chemotherapy and transplantation, the introduction of new agents in the treatment of patients with very different clinical conditions, the implications of precision medicine and the importance of quality of life and supportive care, proposing a simplified algorithm that we follow in 2021. Abstract Acute myeloid leukemia (AML) in older patients is characterized by unfavorable prognosis due to adverse disease features and a high rate of treatment-related complications. Classical therapeutic options range from intensive chemotherapy in fit patients, potentially followed by allogeneic hematopoietic cell transplantation (allo-HCT), to hypomethylating agents or palliative care alone for unfit/frail ones. In the era of precision medicine, the treatment paradigm of AML is rapidly changing. On the one hand, a plethora of new targeted drugs with good tolerability profiles are becoming available, offering the possibility to achieve a prolonged remission to many patients not otherwise eligible for more intensive therapies. On the other hand, better tools to assess patients’ fitness and improvements in the selection and management of those undergoing allo-HCT will hopefully reduce treatment-related mortality and complications. Importantly, a detailed genetic characterization of AML has become of paramount importance to choose the best therapeutic option in both intensively treated and unfit patients. Finally, improving supportive care and quality of life is of major importance in this age group, especially for the minority of patients that are still candidates for palliative care because of very poor clinical conditions or unwillingness to receive active treatments. In the present review, we discuss the evolving approaches in the treatment of older AML patients, which is becoming increasingly challenging following the advent of new effective drugs for a very heterogeneous and complex population.
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Jacoby MA, Finn L, Emadi A, Saba NS, Powell BL, Seiter K, Garcia R, Faderl S, Male HJ. Frequency of infusion-related reactions with CPX-351 treatment in an observational study in adults with newly diagnosed therapy-related AML or AML with myelodysplasia-related changes (AML-MRC). Leuk Lymphoma 2021; 62:2539-2542. [PMID: 33974493 PMCID: PMC9102836 DOI: 10.1080/10428194.2021.1919668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Meagan A Jacoby
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Ashkan Emadi
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Nakhle S Saba
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Bayard L Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | | | | | - Heather J Male
- University of Kansas Medical Center, Kansas City, KS, USA
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Guolo F, Fianchi L, Minetto P, Clavio M, Gottardi M, Galimberti S, Rizzuto G, Rondoni M, Bertani G, Dargenio M, Bilio A, Scappini B, Zappasodi P, Scattolin AM, Grimaldi F, Pietrantuono G, Musto P, Cerrano M, D'Ardia S, Audisio E, Cignetti A, Pasciolla C, Pavesi F, Candoni A, Gurreri C, Morselli M, Alati C, Fracchiolla N, Rossi G, Caizzi M, Carnevale-Schianca F, Tafuri A, Rossi G, Ferrara F, Pagano L, Lemoli RM. CPX-351 treatment in secondary acute myeloblastic leukemia is effective and improves the feasibility of allogeneic stem cell transplantation: results of the Italian compassionate use program. Blood Cancer J 2020; 10:96. [PMID: 33024084 PMCID: PMC7538937 DOI: 10.1038/s41408-020-00361-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023] Open
Abstract
Secondary acute myeloid leukemia (sAML) poorly responds to conventional treatments and allogeneic stem cell transplantation (HSCT). We evaluated toxicity and efficacy of CPX-351 in 71 elderly patients (median age 66 years) with sAML enrolled in the Italian Named (Compassionate) Use Program. Sixty days treatment-related mortality was 7% (5/71). The response rate at the end of treatment was: CR/CRi in 50/71 patients (70.4%), PR in 6/71 (8.5%), and NR in 10/71 (19.7%). After a median follow-up of 11 months relapse was observed in 10/50 patients (20%) and 12 months cumulative incidence of relapse (CIR) was 23.6%. Median duration of response was not reached. In competing risk analysis, CIR was reduced when HSCT was performed in first CR (12 months CIR of 5% and 37.4%, respectively, for patients receiving (=20) or not (=30) HSCT, p = 0.012). Twelve-months OS was 68.6% (median not reached). In landmark analysis, HSCT in CR1 was the only significant predictor of longer survival (12 months OS of 100 and 70.5%, for patients undergoing or not HSCT in CR1, respectively, p = 0.011). In conclusion, we extend to a real-life setting, the notion that CPX is an effective regimen for high risk AML patients and may improve the results of HSCT.
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Affiliation(s)
- Fabio Guolo
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy. .,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy.
| | - Luana Fianchi
- Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Paola Minetto
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Marino Clavio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Sara Galimberti
- UO Ematologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | - Giuliana Rizzuto
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Rondoni
- U.O.C. di Ematologia, Azienda Unità Sanitaria Locale della Romagna, Ravenna, Italy
| | - Giambattista Bertani
- S.C. Ematologia, ASST Grande Ospedale Metropolitano, Niguarda Ca' Granda Milano, Milan, Italy
| | | | | | - Barbara Scappini
- Dipartimento di Oncologia-SODc Ematologia, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy
| | - Patrizia Zappasodi
- Clinica Ematologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Francesco Grimaldi
- Dipartimento di Medicina Clinica e Chirurgia, AOU Federico II di Napoli, Naples, Italy
| | | | - Pellegrino Musto
- IRCCS Centro Oncologico della Basilicata, Rionero in Vulture, Potenza, Italy.,Unit of Hematology and Stem Cell Transplantation, AOU Policlinico Consorziale, "Aldo Moro" University, Bari, Italy
| | - Marco Cerrano
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Stefano D'Ardia
- Institute for Cancer Research and Treatment, University of Turin-School of Medicine, Turin, Italy
| | - Ernesta Audisio
- S.C. Ematologia2, Dipartimento di Ematologia e Oncologia, AO Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandro Cignetti
- Divisione Universitaria di Ematologia e Terapie Cellulari, A.O. Ordine Mauriziano, Turin, Italy
| | | | - Francesca Pavesi
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Anna Candoni
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Carmela Gurreri
- U.O. Ematologia ed Immunologia Clinica, Azienda Ospedaliera di Padova, Padova, Italy
| | - Monica Morselli
- Department of Medical and Surgical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | | | - Nicola Fracchiolla
- Oncoematologia, IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Giovanni Rossi
- U.O. Ematologia, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Manuela Caizzi
- S.C. Ematologia Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale Maggiore, Trieste, Italy
| | - Fabrizio Carnevale-Schianca
- Medical Oncology, Hematopoietic Stem Cells Unit, Turin Metropolitan Transplant Center, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Agostino Tafuri
- Department of Clinical and Molecular Medicine & Hematology, Sant'Andrea - University Hospital - Sapienza - University of Rome, Rome, Italy
| | - Giuseppe Rossi
- SC Ematologia e Dipartimento di Oncologia Clinica, A.O. Spedali Civili, Brescia, Italy
| | | | - Livio Pagano
- Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Roberto Massimo Lemoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
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