5
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Li Z, Ju X, Lee K, Clarke C, Hsu JL, Abadir E, Bryant CE, Pears S, Sunderland N, Heffernan S, Hennessy A, Lo TH, Pietersz GA, Kupresanin F, Fromm PD, Silveira PA, Tsonis C, Cooper WA, Cunningham I, Brown C, Clark GJ, Hart DNJ. CD83 is a new potential biomarker and therapeutic target for Hodgkin lymphoma. Haematologica 2018; 103:655-665. [PMID: 29351987 PMCID: PMC5865416 DOI: 10.3324/haematol.2017.178384] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/10/2018] [Indexed: 11/30/2022] Open
Abstract
Chemotherapy and hematopoietic stem cell transplantation are effective treatments for most Hodgkin lymphoma patients, however there remains a need for better tumor-specific target therapy in Hodgkin lymphoma patients with refractory or relapsed disease. Herein, we demonstrate that membrane CD83 is a diagnostic and therapeutic target, highly expressed in Hodgkin lymphoma cell lines and Hodgkin and Reed-Sternberg cells in 29/35 (82.9%) Hodgkin lymphoma patient lymph node biopsies. CD83 from Hodgkin lymphoma tumor cells was able to trogocytose to surrounding T cells and, interestingly, the trogocytosing CD83+T cells expressed significantly more programmed death-1 compared to CD83-T cells. Hodgkin lymphoma tumor cells secreted soluble CD83 that inhibited T-cell proliferation, and anti-CD83 antibody partially reversed the inhibitory effect. High levels of soluble CD83 were detected in Hodgkin lymphoma patient sera, which returned to normal in patients who had good clinical responses to chemotherapy confirmed by positron emission tomography scans. We generated a human anti-human CD83 antibody, 3C12C, and its toxin monomethyl auristatin E conjugate, that killed CD83 positive Hodgkin lymphoma cells but not CD83 negative cells. The 3C12C antibody was tested in dose escalation studies in non-human primates. No toxicity was observed, but there was evidence of CD83 positive target cell depletion. These data establish CD83 as a potential biomarker and therapeutic target in Hodgkin lymphoma.
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Affiliation(s)
- Ziduo Li
- Dendritic Cell Research, ANZAC Research Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Xinsheng Ju
- Dendritic Cell Research, ANZAC Research Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Kenneth Lee
- Sydney Medical School, University of Sydney, Australia
- Department of Anatomical Pathology, Concord Repatriation General Hospital, Sydney, Australia
| | - Candice Clarke
- Department of Anatomical Pathology, Concord Repatriation General Hospital, Sydney, Australia
| | - Jennifer L Hsu
- Dendritic Cell Research, ANZAC Research Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Edward Abadir
- Dendritic Cell Research, ANZAC Research Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Christian E Bryant
- Dendritic Cell Research, ANZAC Research Institute, Sydney, Australia
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Suzanne Pears
- Animal Facility, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Scott Heffernan
- Animal Facility, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Tsun-Ho Lo
- Dendritic Cell Research, ANZAC Research Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Geoffrey A Pietersz
- Burnet Institute, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Fiona Kupresanin
- Dendritic Cell Research, ANZAC Research Institute, Sydney, Australia
| | - Phillip D Fromm
- Dendritic Cell Research, ANZAC Research Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Pablo A Silveira
- Dendritic Cell Research, ANZAC Research Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Con Tsonis
- Dendritic Cell Research, ANZAC Research Institute, Sydney, Australia
| | - Wendy A Cooper
- Sydney Medical School, University of Sydney, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
- School of Medicine, University of Western Sydney, Australia
| | - Ilona Cunningham
- Department of Haematology, Concord Repatriation General Hospital, Sydney, Australia
| | - Christina Brown
- Sydney Medical School, University of Sydney, Australia
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Georgina J Clark
- Dendritic Cell Research, ANZAC Research Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
| | - Derek N J Hart
- Dendritic Cell Research, ANZAC Research Institute, Sydney, Australia
- Sydney Medical School, University of Sydney, Australia
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9
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Castagna L, Sarina B, Crocchiolo R, Bramanti S, Furst S, Devillier R, Coso D, Bouabdallah R, Mokart D, Morabito L, Harbi S, Giordano L, Rimondo A, Jean Weiller P, Carlo-Stella C, Santoro A, Chabannon C, Blaise D. Outcomes of Hodgkin lymphoma patients who relapse after allogeneic stem cell transplantation. Bone Marrow Transplant 2016; 51:1644-1646. [PMID: 27748737 DOI: 10.1038/bmt.2016.257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- L Castagna
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - B Sarina
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - R Crocchiolo
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - S Bramanti
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - S Furst
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - R Devillier
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - D Coso
- Hematology Department, Lymphoma Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - R Bouabdallah
- Hematology Department, Lymphoma Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - D Mokart
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - L Morabito
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - S Harbi
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - L Giordano
- Biostatistical Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - A Rimondo
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - P Jean Weiller
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - C Carlo-Stella
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milano, Milano, Italy
| | - A Santoro
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy.,Humanitas University, Rozzano, Italy
| | - C Chabannon
- Cell Therapy Unit, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille Université, Marseille, France.,Centre de Recherche en Cancérologie de Marseille, Inserm, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - D Blaise
- Hematology Department, Transplantation Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy.,Hematology Department, Lymphoma Program, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy.,Aix-Marseille Université, Marseille, France.,Centre de Recherche en Cancérologie de Marseille, Inserm, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
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10
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Santoro A, Mazza R, Pulsoni A, Re A, Bonfichi M, Zilioli VR, Salvi F, Merli F, Anastasia A, Luminari S, Annechini G, Gotti M, Peli A, Liberati AM, Di Renzo N, Castagna L, Giordano L, Carlo-Stella C. Bendamustine in Combination With Gemcitabine and Vinorelbine Is an Effective Regimen As Induction Chemotherapy Before Autologous Stem-Cell Transplantation for Relapsed or Refractory Hodgkin Lymphoma: Final Results of a Multicenter Phase II Study. J Clin Oncol 2016; 34:3293-9. [PMID: 27382096 DOI: 10.1200/jco.2016.66.4466] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This multicenter, open-label, phase II study evaluated the combination of bendamustine, gemcitabine, and vinorelbine (BeGEV) as induction therapy before autologous stem-cell transplantation (ASCT) in patients with relapsed or refractory Hodgkin lymphoma (HL). PATIENTS AND METHODS Patients with HL who were refractory to or had relapsed after one previous chemotherapy line were eligible. The primary end point was complete response (CR) rate after four cycles of therapy. Secondary end points were: overall response rate, stem-cell mobilization activity, and toxicity. Progression-free and overall survival were also evaluated. RESULTS In total, 59 patients were enrolled. After four cycles of therapy, 43 patients (73%) achieved CR, and six (10%) achieved partial response, for an overall response rate of 83%. The most common grade 3 to 4 nonhematologic toxicities included febrile neutropenia (n = 7) and infection (n = 4). Regarding hematologic toxicities, grade 3 to 4 thrombocytopenia and neutropenia were each experienced by eight patients (13.5%). CD34+ cells were successfully harvested in 55 of 57 evaluable patients, and 43 of 49 responding patients underwent ASCT. With a median follow-up of 29 months, the 2-year progression-free and overall survival rates for the total population were 62.2% and 77.6%, respectively. The same figures for patients undergoing autograft were 80.8% and 89.3%, respectively. CONCLUSION This phase II study demonstrates that BeGEV is an effective salvage regimen able to induce CR in a high proportion of patients with relapsed or refractory HL before ASCT. These data provide a strong rationale for further development of the BeGEV regimen.
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Affiliation(s)
- Armando Santoro
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy.
| | - Rita Mazza
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Alessandro Pulsoni
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Alessandro Re
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Maurizio Bonfichi
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Vittorio Ruggero Zilioli
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Flavia Salvi
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Francesco Merli
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Antonella Anastasia
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Stefano Luminari
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Giorgia Annechini
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Manuel Gotti
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Annalisa Peli
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Anna Marina Liberati
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Nicola Di Renzo
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Luca Castagna
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Laura Giordano
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
| | - Carmelo Carlo-Stella
- Armando Santoro, Rita Mazza, Luca Castagna, Laura Giordano, and Carmelo Carlo-Stella, Humanitas Cancer Center; Armando Santoro, Humanitas University, Rozzano; Alessandro Pulsoni and Giorgia Annechini, Sapienza University, Rome; Alessandro Re, Antonella Anastasia, and Annalisa Peli, Spedali Civili, Brescia; Maurizio Bonfichi and Manuel Gotti, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia; Vittorio Ruggero Zilioli, Niguarda Ca' Granda Hospital; Carmelo Carlo-Stella, University of Milano, Milan; Flavia Salvi, SS Antonio e Biagio Hospital, Alessandria; Francesco Merli, Arcispedale S. Maria Nuova/IRCCS, Reggio Emilia; Stefano Luminari, University of Modena and Reggio Emilia, Modena; Anna Marina Liberati, A.O. Santa Maria, Terni; and Nicola Di Renzo, Vito Fazzi Hospital, Lecce, Italy
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