1
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Ronnacker J, Urbahn MA, Reicherts C, Kolloch L, Berning P, Sandmann S, Eßeling E, Call S, Floeth M, Marx J, Albring J, Mikesch JH, Schliemann C, Lenz G, Stelljes M. Early blast clearance during sequential conditioning prior to allogeneic stem cell transplantation in patients with acute myeloid leukaemia. Br J Haematol 2024. [PMID: 38831752 DOI: 10.1111/bjh.19552] [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: 02/15/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024]
Abstract
For patients with relapsed or refractory AML, sequential conditioning prior to allogeneic stem cell transplantation (alloSCT) is an established and potentially curative treatment option. Early response to treatment during conditioning indicates chemotherapy-responsive disease and may have prognostic value. We retrospectively evaluated blast clearance on day 5 after melphalan, administered 11 days prior to alloSCT as part of a sequential conditioning in 176 patients with active AML. Overall survival (OS) was 52% (95% confidence interval [CI] 45%-60%), and relapse-free survival (RFS) was 47% (95% CI 40%-55%) at 3 years. Patients who achieved early blast clearance did not show a significant improvement in OS and RFS (OS, hazard ratio [HR] HR 0.75, p 0.19; RFS, HR 0.71, p 0.09, respectively), but had a significantly lower non-relapse mortality rate (HR 0.46, p 0.017). HLA-mismatched donor, older age, adverse genetic risk and higher comorbidity scores were associated with inferior survival outcomes. A high initial blast count was only associated with inferior prognosis in patients receiving chemotherapy-only compared to total body irradiation containing conditioning therapy. These results indicate that for patients transplanted with active AML, sensitivity to chemotherapy might be of less importance, compared to other disease- and transplant-related factors.
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Affiliation(s)
- Julian Ronnacker
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Marc-Andre Urbahn
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Christian Reicherts
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Lina Kolloch
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Philipp Berning
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Sarah Sandmann
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Eva Eßeling
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Simon Call
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Matthias Floeth
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Julia Marx
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Jörn Albring
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Jan-Henrik Mikesch
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Georg Lenz
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Matthias Stelljes
- Department of Medicine A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
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2
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Tolosa-Ridao C, Suárez-Lledó M, Jiménez-Vicente C, Cortés-Bullich A, Merchan B, Martínez-Roca A, Guijarro F, Castaño-Díez S, Rosiñol L, Fernández-Avilés F, Martínez C, Díaz-Beya M, Esteve J, Rovira M, Salas MQ. Allogeneic hematopoietic cell transplantation with sequential conditioning regimen in relapsed refractory acute myeloid leukemia. Bone Marrow Transplant 2024:10.1038/s41409-024-02310-6. [PMID: 38778147 DOI: 10.1038/s41409-024-02310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Carles Tolosa-Ridao
- Hematology Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - María Suárez-Lledó
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carlos Jiménez-Vicente
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Albert Cortés-Bullich
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Beatriz Merchan
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alexandra Martínez-Roca
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Francisca Guijarro
- Biomedic Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sandra Castaño-Díez
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marina Díaz-Beya
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jordi Esteve
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Queralt Salas
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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3
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Schulz F, Jäger P, Tischer J, Fraccaroli A, Bug G, Hausmann A, Baermann BN, Tressin P, Hoelscher A, Kasprzak A, Nachtkamp K, Schetelig J, Hilgendorf I, Germing U, Dietrich S, Kobbe G. Smart Conditioning with Venetoclax-Enhanced Sequential FLAMSA + RIC in Patients with High-Risk Myeloid Malignancies. Cancers (Basel) 2024; 16:532. [PMID: 38339283 PMCID: PMC10854830 DOI: 10.3390/cancers16030532] [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: 11/24/2023] [Revised: 01/03/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Up to 50% of patients with high-risk myeloid malignancies die of relapse after allogeneic stem cell transplantation. Current sequential conditioning regimens like the FLAMSA protocol combine intensive induction therapy with TBI or alkylators. Venetoclax has synergistic effects to chemotherapy. In a retrospective survey among German transplant centers, we identified 61 patients with myeloid malignancies that had received FLAMSA-based sequential conditioning with venetoclax between 2018 and 2022 as an individualized treatment approach. Sixty patients (98%) had active disease at transplant and 74% had genetic high-risk features. Patients received allografts from matched unrelated, matched related, or mismatched donors. Tumor lysis syndrome occurred in two patients but no significant non-hematologic toxicity related to venetoclax was observed. On day +30, 55 patients (90%) were in complete remission. Acute GvHD II°-IV° occurred in 17 (28%) and moderate/severe chronic GvHD in 7 patients (12%). Event-free survival and overall survival were 64% and 80% at 1 year as well as 57% and 75% at 2 years, respectively. The off-label combination of sequential FLAMSA-RIC with venetoclax appears to be safe and highly effective. To further validate these insights and enhance the idea of smart conditioning, a controlled prospective clinical trial was initiated in July 2023.
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Affiliation(s)
- Felicitas Schulz
- Department for Hematology, Immunology and Clinical Oncology, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (P.J.); (A.H.); (G.K.)
| | - Paul Jäger
- Department for Hematology, Immunology and Clinical Oncology, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (P.J.); (A.H.); (G.K.)
| | - Johanna Tischer
- Department of Medicine III, LMU University Hospital, Ludwig-Maximilians-University, 80539 Munich, Germany (A.F.)
| | - Alessia Fraccaroli
- Department of Medicine III, LMU University Hospital, Ludwig-Maximilians-University, 80539 Munich, Germany (A.F.)
| | - Gesine Bug
- Department of Medicine 2, University Hospital, Goethe University Frankfurt, 60590 Frankfurt, Germany;
- Frankfurt Cancer Institute, Goethe University, 60590 Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Andreas Hausmann
- Department of Hematology, Oncology, Immunology, Palliative Care, Munich Clinic Schwabing, 80804 Munich, Germany;
| | - Ben-Niklas Baermann
- Department for Hematology, Immunology and Clinical Oncology, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (P.J.); (A.H.); (G.K.)
| | - Patrick Tressin
- Department for Hematology, Immunology and Clinical Oncology, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (P.J.); (A.H.); (G.K.)
| | - Alexander Hoelscher
- Department for Hematology, Immunology and Clinical Oncology, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (P.J.); (A.H.); (G.K.)
| | - Annika Kasprzak
- Department for Hematology, Immunology and Clinical Oncology, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (P.J.); (A.H.); (G.K.)
| | - Kathrin Nachtkamp
- Department for Hematology, Immunology and Clinical Oncology, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (P.J.); (A.H.); (G.K.)
| | - Johannes Schetelig
- Medical Clinic I, Department of Hematology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01062 Dresden, Germany
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Onkologie, Universitätsklinikum Jena, 07747 Jena, Germany
| | - Ulrich Germing
- Department for Hematology, Immunology and Clinical Oncology, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (P.J.); (A.H.); (G.K.)
| | - Sascha Dietrich
- Department for Hematology, Immunology and Clinical Oncology, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (P.J.); (A.H.); (G.K.)
| | - Guido Kobbe
- Department for Hematology, Immunology and Clinical Oncology, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (P.J.); (A.H.); (G.K.)
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4
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El-Cheikh J, Bidaoui G, Saleh M, Moukalled N, Abou Dalle I, Bazarbachi A. Venetoclax: A New Partner in the Novel Treatment Era for Acute Myeloid Leukemia and Myelodysplastic Syndrome. Clin Hematol Int 2023:10.1007/s44228-023-00041-x. [PMID: 37071328 DOI: 10.1007/s44228-023-00041-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/09/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS) are two closely related blood cancers that are more frequent in older adults. AML is the most common type of adult acute leukemia, and MDS is characterized by ineffective blood cell production and abnormalities in the bone marrow and blood. Both can be resistant to treatment, often due to dysfunction in the process of apoptosis, the body's natural mechanism for cell death. Venetoclax, an orally-administered medication that selectively targets the BCL-2 protein, has shown promise in enhancing treatment sensitivity in some hematological malignancies by reducing the apoptotic threshold. This review aims to evaluate the effectiveness of venetoclax in treating AML and MDS, as well as potential mechanisms of resistance to the medication. METHODS A literature search was conducted utilizing PUBMED to capture all relevant research articles on the use of venetoclax as a therapy for both diseases. The MeSH terms "acute myeloid leukemia", "myelodysplastic syndrome" and "venetoclax" were searched. Furthermore, Clinicaltrials.gov was accessed to ensure the inclusion of all ongoing clinical trials. RESULTS Although Venetoclax showed modest results as a single-agent therapy in AML, venetoclax-based combination therapies? mainly with hypomethylating agents or low-dose cytarabine? yielded significantly positive results. Preliminary results oN the use of venetoclax-based combination therapy with HMA, mainly azacitidine, in unfit high-risk MDS also yielded optimistic results. Identification of mutations for which various drugs have been approved has spurred active investigation of venetoclax in combination trials. CONCLUSION Venetoclax-based combination therapies have been shown to induce rapid responses and increase overall survival in AML patients unfit for intensive chemotherapy. These therapies are also yielding positive preliminary results in high-risk MDS patients in phase I trials. Resistance to venetoclax and drug-related toxicity are two main obstacles that need to be overcome to reap the full benefits of this therapy.
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Affiliation(s)
- Jean El-Cheikh
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
- Department of Internal Medicine, Medical Center, Bone Marrow Transplantation Program, American University of Beirut, P.O. Box 113-6044, Beirut, Lebanon.
| | - Ghassan Bidaoui
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mustafa Saleh
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Nour Moukalled
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Iman Abou Dalle
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Bazarbachi
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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5
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Bonifazi F, Pavoni C, Peccatori J, Giglio F, Arpinati M, Busca A, Bernasconi P, Grassi A, Iori AP, Patriarca F, Brunello L, Di Grazia C, Carella AM, Cilloni D, Picardi A, Proia A, Santarone S, Sorasio R, Carluccio P, Chiusolo P, Cupri A, Luppi M, Nozzoli C, Baronciani D, Casini M, Grillo G, Musso M, Onida F, Palazzo G, Parma M, Tringali S, Vacca A, Vallisa D, Sacchi N, Oldani E, Masciulli A, Gheorghiu A, Girmenia C, Martino M, Bruno B, Rambaldi A, Ciceri F. Myeloablative conditioning with thiotepa-busulfan-fludarabine does not improve the outcome of patients transplanted with active leukemia: final results of the GITMO prospective trial GANDALF-01. Bone Marrow Transplant 2022; 57:949-958. [PMID: 35413985 PMCID: PMC9200637 DOI: 10.1038/s41409-022-01626-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/09/2022]
Abstract
The outcome of refractory/relapsed (R/R) acute leukemias is still dismal and their treatment represents an unmet clinical need. However, allogeneic transplantation (allo-HSCT) remains the only potentially curative approach in this setting. A prospective study (GANDALF-01, NCT01814488; EUDRACT:2012-004008-37) on transplantation with alternative donors had been run by GITMO using a homogeneous myeloablative conditioning regimen with busulfan, thiotepa and fludarabine while GVHD prophylaxis was stratified by donor type. The study enrolled 101 patients; 90 found an alternative donor and 87 ultimately underwent allo-HSCT. Two-year overall survival of the entire and of the transplant population (primary endpoint) were 19% and 22%, without significant differences according to disease, donor type and disease history (relapsed vs refractory patients). Two-year progression-free survival was 19% and 17% respectively. The cumulative incidences of relapse and non-relapse mortality were 49% and 33% at two years. Acute grade II-IV and chronic GVHD occurred in 23 and 10 patients. Dose intensification with a myeloablative two-alkylating regimen as sole strategy for transplanting R/R acute leukemia does seem neither to improve the outcome nor to control disease relapse. A pre-planned relapse prevention should be included in the transplant strategy in this patient population.
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Affiliation(s)
| | - Chiara Pavoni
- Department of Oncology and Hematology Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Jacopo Peccatori
- Department of Onco-Hematology - Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Fabio Giglio
- Department of Onco-Hematology - Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Mario Arpinati
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Busca
- SSD Trapianto Cellule Staminali, AOU Città della salute e della Scienza, Torino, Italy
| | - Paolo Bernasconi
- Centro trapianti di cellule staminali ematopoietiche, UOC Ematologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Grassi
- Department of Oncology and Hematology Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Paola Iori
- Ematologia, AOU Policlinico Umberto 1, Sapienza Università di Roma, Roma, Italy
| | - Francesca Patriarca
- Clinica Ematologica e Centro Trapianti, ASUFC, Udine; DAME, Università di Udine, Udine, Italy
| | - Lucia Brunello
- di Ematologia, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Carmen Di Grazia
- Ematologia e Centro Trapianti. IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Angelo Michele Carella
- SSD UTIE e Terapie Cellulari, Dipartimento Scienze Mediche, Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alessandra Picardi
- Rome Transplant Network, Department of Biotecnology and Prevention, Tor Vergata University, Rome, Italy.,Stem Cell Transplant Program of AORN Cardarelli, Naples, Italy
| | - Anna Proia
- Ematologia e Trapianto CSE, AO San Camillo-Forlanini, Roma, Italy
| | | | | | - Paola Carluccio
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari, Bari, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandra Cupri
- Unità di Trapianto di Midollo, Divisione di Ematologia, Azienda Ospedaliera Policlinico di Catania, Catania, Italy
| | - Mario Luppi
- Department of Medical and Surgical Sciences Unimore Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Chiara Nozzoli
- Department of Cellular Therapies and Transfusion Medicine, Careggi Hospital, Florence, Italy
| | | | | | | | - Maurizio Musso
- UOC di Oncoematologia e TMO Dipartimento Oncologico "La Maddalena" Palermo, Palermo, Italy
| | - Francesco Onida
- IRCCS Ca' Granda Ospedale Maggiore Policlinico Centro Trapianti Midollo Osseo - UOC Ematologia - Università degli Studi di Milano Dipartimento di Oncologia e Emato-Oncologia, Milano, Italy
| | | | - Matteo Parma
- Divisione di Ematologia e Centro Trapianti di Midollo, Ospedale San Gerardo, Monza, Italy
| | - Stefania Tringali
- AOR Villa Sofia Cervello, Dipartimento Oncologia, UOSD Unità Trapianti di Midollo Osseo, Palermo, Italy
| | - Adriana Vacca
- UO Centro Trapianti di Midollo Osseo Presidio Ospedaliero R. Binaghi, Cagliari, Italy
| | | | | | - Elena Oldani
- Department of Oncology and Hematology Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Angela Gheorghiu
- Trials Office GITMO Gruppo Italiano per il Trapianto di Midollo Osseo, cellule staminali emopoietiche e terapia Cellulare, Genova, Italy
| | - Corrado Girmenia
- Ematologia, AOU Policlinico Umberto 1, Sapienza Università di Roma, Roma, Italy
| | - Massimo Martino
- Stem Cell Transplant and Cellular Therapies Unit, Grande Ospedale Metropolitano "BMM", Reggio Calabria, Italy
| | - Benedetto Bruno
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute - Università di Torino, Torino, Italy
| | - Alessandro Rambaldi
- Department of Oncology and Hematology Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.,University of Milan, Milan, Italy
| | - Fabio Ciceri
- Department of Onco-Hematology - Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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