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Dogliotti I, Levis M, Martin A, Bartoncini S, Felicetti F, Cavallin C, Maffini E, Cerrano M, Bruno B, Ricardi U, Giaccone L. Maintain Efficacy and Spare Toxicity: Traditional and New Radiation-Based Conditioning Regimens in Hematopoietic Stem Cell Transplantation. Cancers (Basel) 2024; 16:865. [PMID: 38473227 DOI: 10.3390/cancers16050865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Novelty in total body irradiation (TBI) as part of pre-transplant conditioning regimens lacked until recently, despite the developments in the field of allogeneic stem cell transplants. Long-term toxicities have been one of the major concerns associated with TBI in this setting, although the impact of TBI is not so easy to discriminate from that of chemotherapy, especially in the adult population. More recently, lower-intensity TBI and different approaches to irradiation (namely, total marrow irradiation, TMI, and total marrow and lymphoid irradiation, TMLI) were implemented to keep the benefits of irradiation and limit potential harm. TMI/TMLI is an alternative to TBI that delivers more selective irradiation, with healthy tissues being better spared and the control of the radiation dose delivery. In this review, we discussed the potential radiation-associated long-term toxicities and their management, summarized the evidence regarding the current indications of traditional TBI, and focused on the technological advances in radiotherapy that have resulted in the development of TMLI. Finally, considering the most recent published trials, we postulate how the role of radiotherapy in the setting of allografting might change in the future.
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Affiliation(s)
- Irene Dogliotti
- Allogeneic Transplant and Cellular Therapy Unit, Division of Hematology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", University of Torino, 10126 Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
| | - Mario Levis
- Department of Oncology, University of Turin, 10126 Torino, Italy
| | - Aurora Martin
- Allogeneic Transplant and Cellular Therapy Unit, Division of Hematology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", University of Torino, 10126 Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
| | - Sara Bartoncini
- Department of Oncology, University of Turin, 10126 Torino, Italy
| | - Francesco Felicetti
- Division of Oncological Endocrinology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", 10126 Torino, Italy
| | - Chiara Cavallin
- Department of Oncology, University of Turin, 10126 Torino, Italy
| | - Enrico Maffini
- Hematology Institute "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marco Cerrano
- Division of Hematology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", 10126 Torino, Italy
| | - Benedetto Bruno
- Allogeneic Transplant and Cellular Therapy Unit, Division of Hematology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", University of Torino, 10126 Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
| | - Umberto Ricardi
- Department of Oncology, University of Turin, 10126 Torino, Italy
| | - Luisa Giaccone
- Allogeneic Transplant and Cellular Therapy Unit, Division of Hematology, Department of Oncology, University Hospital A.O.U. "Città della Salute e della Scienza di Torino", University of Torino, 10126 Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
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D'Agostino M, Bertuglia G, Rota-Scalabrini D, Belotti A, Morè S, Corradini P, Oliva S, Ledda A, Grasso M, Pavone V, Ronconi S, Vincelli ID, Ballanti S, Velluti C, Cellini C, Gozzetti A, Palmas AD, Gamberi B, Mancuso K, Paris L, Zambello R, Petrucci MT, Bruno B, Musto P, Gay F. Predictors of unsustained measurable residual disease negativity in patients with multiple myeloma. Blood 2024; 143:592-596. [PMID: 38048557 DOI: 10.1182/blood.2023022080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023] Open
Abstract
ABSTRACT The prognostic impact of achieving and in particular maintaining measurable residual disease (MRD) negativity in multiple myeloma is now established; therefore, identifying among MRD-negative patients the ones at higher risk of losing MRD negativity is of importance. We analyzed predictors of unsustained MRD negativity in patients enrolled in the FORTE trial (NCT02203643). MRD was performed by multiparameter flow cytometry (sensitivity of 10-5) at premaintenance and every 6 months thereafter. The cumulative incidence (CI) of MRD resurgence and/or progression was analyzed in MRD-negative patients. A total of 306 of 474 (65%) MRD-negative patients were analyzed. After a median follow-up of 50.4 months from MRD negativity, 185 of 306 (60%) patients were still MRD negative and progression free, 118 (39%) lost their MRD-negative status, and 3 patients (1%) died without progression. Amp1q vs normal (4-year CI, 63% vs 34), ≥2 concomitant high-risk cytogenetic abnormalities vs 0 (4-year CI, 59% vs 33%), circulating tumor cells at baseline (high vs low at 4-year CI, 62% vs 32%), and time-to-reach MRD negativity postconsolidation vs preconsolidation (4-year CI, 46% vs 35%) were associated with a higher risk of unsustained MRD negativity in a multivariate Fine-Gray model. During the first 2 years of maintenance, patients receiving carfilzomib-lenalidomide vs lenalidomide alone had a lower risk of unsustained MRD negativity (4-year CI, 20% vs 33%).
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Affiliation(s)
- Mattia D'Agostino
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy
- Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - Giuseppe Bertuglia
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy
- Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - Delia Rota-Scalabrini
- Medical Oncology Department Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia-Istituto di Ricovero e Cura a Carattere Scientifico, Turin, Italy
| | - Angelo Belotti
- Department of Hematology, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
| | - Sonia Morè
- Clinica di Ematologia Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Paolo Corradini
- University of Milan, Milan, Italy; and Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Stefania Oliva
- Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - Antonio Ledda
- Ematologia/Centro Trapianti Midollo Osseo, Ospedale A. Businco, Cagliari, Italy
| | | | - Vincenzo Pavone
- Hematology and Bone Marrow Transplant, Hospital Cardinale G. Panico, Tricase, Italy
| | - Sonia Ronconi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Iolanda Donatella Vincelli
- Divisione di Ematologia, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Stelvio Ballanti
- Sezione di Ematologia e Immunologia Clinica, Ospedale Santa Maria della Misericordia, località Sant'Andrea delle Fratte, Perugia, Italy
| | - Cristina Velluti
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy
| | - Claudia Cellini
- U.O.C. Ematologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Alessandro Gozzetti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico S. Maria alle Scotte, Siena, Italy
| | - Angelo D Palmas
- Struttura Complessa Ematologia, Ospedale San Francesco, Azienda Sanitaria Locale Nuoro, Nuoro, Italy
| | | | - Katia Mancuso
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia Seràgnoli, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Laura Paris
- Division of Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Renato Zambello
- Hematology Section, Department of Medicine, Padua University School of Medicine, Padua, Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Benedetto Bruno
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy
- Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - Pellegrino Musto
- Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University School of Medicine, Bari, Italy
- Hematology and Stem Cell Transplantation Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy
| | - Francesca Gay
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy
- Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
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3
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Aharonian F, Benkhali FA, Aschersleben J, Ashkar H, Backes M, Martins VB, Batzofin R, Becherini Y, Berge D, Bernlöhr K, Bi B, Böttcher M, Boisson C, Bolmont J, de Lavergne MDB, Borowska J, Bouyahiaoui M, Breuhaus M, Brose R, Brown AM, Brun F, Bruno B, Bulik T, Burger-Scheidlin C, Caroff S, Casanova S, Cecil R, Celic J, Cerruti M, Chand T, Chandra S, Chen A, Chibueze J, Chibueze O, Cotter G, Dai S, Mbarubucyeye JD, Djannati-Ataï A, Dmytriiev A, Doroshenko V, Egberts K, Einecke S, Ernenwein JP, Filipovic M, Fontaine G, Füßling M, Funk S, Gabici S, Ghafourizadeh S, Giavitto G, Glawion D, Glicenstein JF, Grolleron G, Haerer L, Hinton JA, Hofmann W, Holch TL, Holler M, Horns D, Jamrozy M, Jankowsky F, Jardin-Blicq A, Joshi V, Jung-Richardt I, Kasai E, Katarzyński K, Khatoon R, Khélifi B, Klepser S, Kluźniak W, Komin N, Kosack K, Kostunin D, Kundu A, Lang RG, Le Stum S, Leitl F, Lemière A, Lenain JP, Leuschner F, Lohse T, Luashvili A, Lypova I, Mackey J, Malyshev D, Malyshev D, Marandon V, Marchegiani P, Marcowith A, Martí-Devesa G, Marx R, Mehta A, Mitchell A, Moderski R, Mohrmann L, Montanari A, Moulin E, Murach T, Nakashima K, de Naurois M, Niemiec J, Noel AP, Ohm S, Olivera-Nieto L, de Ona Wilhelmi E, Ostrowski M, Panny S, Panter M, Parsons RD, Peron G, Prokhorov DA, Pühlhofer G, Punch M, Quirrenbach A, Reichherzer P, Reimer A, Reimer O, Ren H, Renaud M, Reville B, Rieger F, Rowell G, Rudak B, Ricarte HR, Ruiz-Velasco E, Sahakian V, Salzmann H, Santangelo A, Sasaki M, Schäfer J, Schüssler F, Schwanke U, Shapopi JNS, Sol H, Specovius A, Spencer S, Stawarz L, Steenkamp R, Steinmassl S, Steppa C, Streil K, Sushch I, Suzuki H, Takahashi T, Tanaka T, Taylor AM, Terrier R, Tsirou M, Tsuji N, Unbehaun T, van Eldik C, Vecchi M, Veh J, Venter C, Vink J, Wach T, Wagner SJ, Werner F, White R, Wierzcholska A, Wong YW, Zacharias M, Zargaryan D, Zdziarski AA, Zech A, Zouari S, Żywucka N. Acceleration and transport of relativistic electrons in the jets of the microquasar SS 433. Science 2024; 383:402-406. [PMID: 38271522 DOI: 10.1126/science.adi2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024]
Abstract
SS 433 is a microquasar, a stellar binary system that launches collimated relativistic jets. We observed SS 433 in gamma rays using the High Energy Stereoscopic System (H.E.S.S.) and found an energy-dependent shift in the apparent position of the gamma-ray emission from the parsec-scale jets. These observations trace the energetic electron population and indicate that inverse Compton scattering is the emission mechanism of the gamma rays. Our modeling of the energy-dependent gamma-ray morphology constrains the location of particle acceleration and requires an abrupt deceleration of the jet flow. We infer the presence of shocks on either side of the binary system, at distances of 25 to 30 parsecs, and that self-collimation of the precessing jets forms the shocks, which then efficiently accelerate electrons.
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Affiliation(s)
- F Aharonian
- Dublin Institute for Advanced Studies, Dublin D02 XF86, Ireland
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - F Ait Benkhali
- Landessternwarte, Universität Heidelberg, Heidelberg D-69117, Germany
| | - J Aschersleben
- Kapteyn Astronomical Institute, University of Groningen, Groningen 9747 AD, Netherlands
| | - H Ashkar
- Laboratoire Leprince-Ringuet, École Polytechnique, Centre national de la recherche scientifique, Institut Polytechnique de Paris, Palaiseau F-91128, France
| | - M Backes
- Department of Physics, University of Namibia, Windhoek 10005, Namibia
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | | | - R Batzofin
- Institut für Physik und Astronomie, Universität Potsdam, Potsdam 14476, Germany
| | - Y Becherini
- Laboratoire Astroparticule et Cosmologie, Université de Paris, Centre national de la recherche scientifique, Paris F-75013, France
- Department of Physics and Electrical Engineering, Linnaeus University, Växjö 351 95, Sweden
| | - D Berge
- Deutsches Elektronen-Synchrotron, Zeuthen D-15738, Germany
- Institut für Physik, Humboldt-Universität zu Berlin, Berlin D-12489, Germany
| | - K Bernlöhr
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - B Bi
- Institut für Astronomie und Astrophysik, Universität Tübingen, Tübingen D-72076, Germany
| | - M Böttcher
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - C Boisson
- Laboratoire Univers et Théories, Observatoire de Paris, Université Paris Sciences et Lettres, CNRS, Université de Paris, Meudon 92190, France
| | - J Bolmont
- Laboratoire de Physique Nucléaire et de Hautes Energies, Sorbonne Université, Université Paris Diderot, Université Paris Cité, Institut national de physique nucléaire et de physique des particules, Centre national de la recherche scientifique, Paris F-75252, France
| | - M de Bony de Lavergne
- Laboratoire d'Annecy de Physique des Particules, Centre national de la recherche scientifique, Institut national de physique nucléaire et de physique des particules, Université Savoie Mont Blanc, Annecy 74000, France
| | - J Borowska
- Institut für Physik, Humboldt-Universität zu Berlin, Berlin D-12489, Germany
| | - M Bouyahiaoui
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - M Breuhaus
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - R Brose
- Dublin Institute for Advanced Studies, Dublin D02 XF86, Ireland
| | - A M Brown
- Department of Physics, University of Oxford, Oxford OX1 3RH, UK
| | - F Brun
- Institute for Research on the Fundamental Laws of the Universe, Commissariat à l'énergie atomique et aux énergies alternatives, Université Paris-Saclay, Gif-sur-Yvette F-91191, France
| | - B Bruno
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - T Bulik
- Astronomical Observatory, The University of Warsaw, Warsaw 00-478, Poland
| | | | - S Caroff
- Laboratoire d'Annecy de Physique des Particules, Centre national de la recherche scientifique, Institut national de physique nucléaire et de physique des particules, Université Savoie Mont Blanc, Annecy 74000, France
| | - S Casanova
- Instytut Fizyki J[Formula: see text]drowej, Polska Akademia Nauk, Kraków 31-342, Poland
| | - R Cecil
- Institut für Experimentalphysik, Universität Hamburg, Hamburg D-22761, Germany
| | - J Celic
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - M Cerruti
- Laboratoire Astroparticule et Cosmologie, Université de Paris, Centre national de la recherche scientifique, Paris F-75013, France
| | - T Chand
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - S Chandra
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - A Chen
- School of Physics, University of the Witwatersrand, Johannesburg 2050, South Africa
| | - J Chibueze
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - O Chibueze
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - G Cotter
- Department of Physics, University of Oxford, Oxford OX1 3RH, UK
| | - S Dai
- School of Science, Western Sydney University, Penrith NSW 2751, Australia
| | | | - A Djannati-Ataï
- Laboratoire Astroparticule et Cosmologie, Université de Paris, Centre national de la recherche scientifique, Paris F-75013, France
| | - A Dmytriiev
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - V Doroshenko
- Institut für Astronomie und Astrophysik, Universität Tübingen, Tübingen D-72076, Germany
| | - K Egberts
- Institut für Physik und Astronomie, Universität Potsdam, Potsdam 14476, Germany
| | - S Einecke
- School of Physical Sciences, University of Adelaide, Adelaide 5005, Australia
| | - J-P Ernenwein
- Centre de Physique des Particules de Marseille, Aix Marseille Université, Centre national de la recherche scientifique, Institut national de physique nucléaire et de physique des particules, Marseille 13288, France
| | - M Filipovic
- School of Science, Western Sydney University, Penrith NSW 2751, Australia
| | - G Fontaine
- Laboratoire Leprince-Ringuet, École Polytechnique, Centre national de la recherche scientifique, Institut Polytechnique de Paris, Palaiseau F-91128, France
| | - M Füßling
- Deutsches Elektronen-Synchrotron, Zeuthen D-15738, Germany
| | - S Funk
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - S Gabici
- Laboratoire Astroparticule et Cosmologie, Université de Paris, Centre national de la recherche scientifique, Paris F-75013, France
| | - S Ghafourizadeh
- Landessternwarte, Universität Heidelberg, Heidelberg D-69117, Germany
| | - G Giavitto
- Deutsches Elektronen-Synchrotron, Zeuthen D-15738, Germany
| | - D Glawion
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - J-F Glicenstein
- Institute for Research on the Fundamental Laws of the Universe, Commissariat à l'énergie atomique et aux énergies alternatives, Université Paris-Saclay, Gif-sur-Yvette F-91191, France
| | - G Grolleron
- Laboratoire de Physique Nucléaire et de Hautes Energies, Sorbonne Université, Université Paris Diderot, Université Paris Cité, Institut national de physique nucléaire et de physique des particules, Centre national de la recherche scientifique, Paris F-75252, France
| | - L Haerer
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - J A Hinton
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - W Hofmann
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - T L Holch
- Deutsches Elektronen-Synchrotron, Zeuthen D-15738, Germany
| | - M Holler
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, Innsbruck A-6020, Austria
| | - D Horns
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - M Jamrozy
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, Kraków 30-244, Poland
| | - F Jankowsky
- Landessternwarte, Universität Heidelberg, Heidelberg D-69117, Germany
| | - A Jardin-Blicq
- Laboratoir de de Physique des deux Infinis, Université Bordeaux, CNRS, Gradignan F-33170, France
| | - V Joshi
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - I Jung-Richardt
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - E Kasai
- Department of Physics, University of Namibia, Windhoek 10005, Namibia
| | - K Katarzyński
- Institute of Astronomy, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, Torun 87-100, Poland
| | - R Khatoon
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - B Khélifi
- Laboratoire Astroparticule et Cosmologie, Université de Paris, Centre national de la recherche scientifique, Paris F-75013, France
| | - S Klepser
- Deutsches Elektronen-Synchrotron, Zeuthen D-15738, Germany
| | - W Kluźniak
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, Warsaw 00-716, Poland
| | - Nu Komin
- School of Physics, University of the Witwatersrand, Johannesburg 2050, South Africa
| | - K Kosack
- Institute for Research on the Fundamental Laws of the Universe, Commissariat à l'énergie atomique et aux énergies alternatives, Université Paris-Saclay, Gif-sur-Yvette F-91191, France
| | - D Kostunin
- Deutsches Elektronen-Synchrotron, Zeuthen D-15738, Germany
| | - A Kundu
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - R G Lang
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - S Le Stum
- Centre de Physique des Particules de Marseille, Aix Marseille Université, Centre national de la recherche scientifique, Institut national de physique nucléaire et de physique des particules, Marseille 13288, France
| | - F Leitl
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - A Lemière
- Laboratoire Astroparticule et Cosmologie, Université de Paris, Centre national de la recherche scientifique, Paris F-75013, France
| | - J-P Lenain
- Laboratoire de Physique Nucléaire et de Hautes Energies, Sorbonne Université, Université Paris Diderot, Université Paris Cité, Institut national de physique nucléaire et de physique des particules, Centre national de la recherche scientifique, Paris F-75252, France
| | - F Leuschner
- Institut für Astronomie und Astrophysik, Universität Tübingen, Tübingen D-72076, Germany
| | - T Lohse
- Institut für Physik, Humboldt-Universität zu Berlin, Berlin D-12489, Germany
| | - A Luashvili
- Laboratoire Univers et Théories, Observatoire de Paris, Université Paris Sciences et Lettres, CNRS, Université de Paris, Meudon 92190, France
| | - I Lypova
- Landessternwarte, Universität Heidelberg, Heidelberg D-69117, Germany
| | - J Mackey
- Dublin Institute for Advanced Studies, Dublin D02 XF86, Ireland
| | - D Malyshev
- Institut für Astronomie und Astrophysik, Universität Tübingen, Tübingen D-72076, Germany
| | - D Malyshev
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - V Marandon
- Institute for Research on the Fundamental Laws of the Universe, Commissariat à l'énergie atomique et aux énergies alternatives, Université Paris-Saclay, Gif-sur-Yvette F-91191, France
| | - P Marchegiani
- School of Physics, University of the Witwatersrand, Johannesburg 2050, South Africa
| | - A Marcowith
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, Centre national de la recherche scientifique, Institut national de physique nucléaire et de physique des particules, Montpellier F-34095, France
| | - G Martí-Devesa
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, Innsbruck A-6020, Austria
| | - R Marx
- Landessternwarte, Universität Heidelberg, Heidelberg D-69117, Germany
| | - A Mehta
- Deutsches Elektronen-Synchrotron, Zeuthen D-15738, Germany
| | - A Mitchell
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - R Moderski
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, Warsaw 00-716, Poland
| | - L Mohrmann
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - A Montanari
- Landessternwarte, Universität Heidelberg, Heidelberg D-69117, Germany
| | - E Moulin
- Institute for Research on the Fundamental Laws of the Universe, Commissariat à l'énergie atomique et aux énergies alternatives, Université Paris-Saclay, Gif-sur-Yvette F-91191, France
| | - T Murach
- Deutsches Elektronen-Synchrotron, Zeuthen D-15738, Germany
| | - K Nakashima
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - M de Naurois
- Laboratoire Leprince-Ringuet, École Polytechnique, Centre national de la recherche scientifique, Institut Polytechnique de Paris, Palaiseau F-91128, France
| | - J Niemiec
- Instytut Fizyki J[Formula: see text]drowej, Polska Akademia Nauk, Kraków 31-342, Poland
| | - A Priyana Noel
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, Kraków 30-244, Poland
| | - S Ohm
- Deutsches Elektronen-Synchrotron, Zeuthen D-15738, Germany
| | - L Olivera-Nieto
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | | | - M Ostrowski
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, Kraków 30-244, Poland
| | - S Panny
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, Innsbruck A-6020, Austria
| | - M Panter
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - R D Parsons
- Institut für Physik, Humboldt-Universität zu Berlin, Berlin D-12489, Germany
| | - G Peron
- Laboratoire Astroparticule et Cosmologie, Université de Paris, Centre national de la recherche scientifique, Paris F-75013, France
| | - D A Prokhorov
- Gravitation and Astroparticle Physics Amsterdam, Anton Pannekoek Institute for Astronomy, University of Amsterdam, Amsterdam 1098 XH, Netherlands
| | - G Pühlhofer
- Institut für Astronomie und Astrophysik, Universität Tübingen, Tübingen D-72076, Germany
| | - M Punch
- Laboratoire Astroparticule et Cosmologie, Université de Paris, Centre national de la recherche scientifique, Paris F-75013, France
| | - A Quirrenbach
- Landessternwarte, Universität Heidelberg, Heidelberg D-69117, Germany
| | - P Reichherzer
- Institute for Research on the Fundamental Laws of the Universe, Commissariat à l'énergie atomique et aux énergies alternatives, Université Paris-Saclay, Gif-sur-Yvette F-91191, France
| | - A Reimer
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, Innsbruck A-6020, Austria
| | - O Reimer
- Institut für Astro- und Teilchenphysik, Leopold-Franzens-Universität Innsbruck, Innsbruck A-6020, Austria
| | - H Ren
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - M Renaud
- Laboratoire Univers et Particules de Montpellier, Université Montpellier, Centre national de la recherche scientifique, Institut national de physique nucléaire et de physique des particules, Montpellier F-34095, France
| | - B Reville
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - F Rieger
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - G Rowell
- School of Physical Sciences, University of Adelaide, Adelaide 5005, Australia
| | - B Rudak
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, Warsaw 00-716, Poland
| | - H Rueda Ricarte
- Institute for Research on the Fundamental Laws of the Universe, Commissariat à l'énergie atomique et aux énergies alternatives, Université Paris-Saclay, Gif-sur-Yvette F-91191, France
| | - E Ruiz-Velasco
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - V Sahakian
- Yerevan Physics Institute, Yerevan 375036, Armenia
| | - H Salzmann
- Institut für Astronomie und Astrophysik, Universität Tübingen, Tübingen D-72076, Germany
| | - A Santangelo
- Institut für Astronomie und Astrophysik, Universität Tübingen, Tübingen D-72076, Germany
| | - M Sasaki
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - J Schäfer
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - F Schüssler
- Institute for Research on the Fundamental Laws of the Universe, Commissariat à l'énergie atomique et aux énergies alternatives, Université Paris-Saclay, Gif-sur-Yvette F-91191, France
| | - U Schwanke
- Institut für Physik, Humboldt-Universität zu Berlin, Berlin D-12489, Germany
| | - J N S Shapopi
- Department of Physics, University of Namibia, Windhoek 10005, Namibia
| | - H Sol
- Laboratoire Univers et Théories, Observatoire de Paris, Université Paris Sciences et Lettres, CNRS, Université de Paris, Meudon 92190, France
| | - A Specovius
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - S Spencer
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - L Stawarz
- Obserwatorium Astronomiczne, Uniwersytet Jagielloński, Kraków 30-244, Poland
| | - R Steenkamp
- Department of Physics, University of Namibia, Windhoek 10005, Namibia
| | - S Steinmassl
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - C Steppa
- Institut für Physik und Astronomie, Universität Potsdam, Potsdam 14476, Germany
| | - K Streil
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - I Sushch
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - H Suzuki
- Department of Physics, Konan University, Higashinada-ku Kobe 658-8501, Japan, Japan
| | - T Takahashi
- Kavli Institute for the Physics and Mathematics of the Universe, The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa Chiba 277-8583, Japan
| | - T Tanaka
- Department of Physics, Konan University, Higashinada-ku Kobe 658-8501, Japan, Japan
| | - A M Taylor
- Deutsches Elektronen-Synchrotron, Zeuthen D-15738, Germany
| | - R Terrier
- Laboratoire Astroparticule et Cosmologie, Université de Paris, Centre national de la recherche scientifique, Paris F-75013, France
| | - M Tsirou
- Deutsches Elektronen-Synchrotron, Zeuthen D-15738, Germany
| | - N Tsuji
- The Institute of Physical and Chemical Research (RIKEN), Wako Saitama 351-0198, Japan
| | - T Unbehaun
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - C van Eldik
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - M Vecchi
- Kapteyn Astronomical Institute, University of Groningen, Groningen 9747 AD, Netherlands
| | - J Veh
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - C Venter
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - J Vink
- Gravitation and Astroparticle Physics Amsterdam, Anton Pannekoek Institute for Astronomy, University of Amsterdam, Amsterdam 1098 XH, Netherlands
| | - T Wach
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - S J Wagner
- Landessternwarte, Universität Heidelberg, Heidelberg D-69117, Germany
| | - F Werner
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - R White
- Max-Planck-Institut für Kernphysik, Heidelberg D-69117, Germany
| | - A Wierzcholska
- Instytut Fizyki J[Formula: see text]drowej, Polska Akademia Nauk, Kraków 31-342, Poland
| | - Yu Wun Wong
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen D-91058, Germany
| | - M Zacharias
- Landessternwarte, Universität Heidelberg, Heidelberg D-69117, Germany
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
| | - D Zargaryan
- Dublin Institute for Advanced Studies, Dublin D02 XF86, Ireland
| | - A A Zdziarski
- Nicolaus Copernicus Astronomical Center, Polish Academy of Sciences, Warsaw 00-716, Poland
| | - A Zech
- Dublin Institute for Advanced Studies, Dublin D02 XF86, Ireland
- Kapteyn Astronomical Institute, University of Groningen, Groningen 9747 AD, Netherlands
| | - S Zouari
- Laboratoire Astroparticule et Cosmologie, Université de Paris, Centre national de la recherche scientifique, Paris F-75013, France
| | - N Żywucka
- Centre for Space Research, North-West University, Potchefstroom 2520, South Africa
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Benevolo G, Bertuglia G, Bringhen S, Maletta F, Bruno B. An atypical presentation of visceral leishmaniasis mimicking multiple myeloma relapse. Am J Hematol 2024; 99:137-141. [PMID: 37986135 DOI: 10.1002/ajh.27147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/07/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Giulia Benevolo
- Division of Hematology U, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Department of Oncology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Giuseppe Bertuglia
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Department of Oncology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Division of Hematology U, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Sara Bringhen
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Department of Oncology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Maletta
- Division of Pathology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Benedetto Bruno
- Division of Hematology U, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Division of Hematology U, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
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5
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Urbino I, Secreto C, Apolito V, Olivi M, Arrigo G, Boscaro E, Catania FM, D'Ardia S, Frairia C, Giai V, Freilone R, Bruno B, Lanzarone G, Giaccone L, Busca A, Dellacasa CM, Ferrero D, Audisio E, Cerrano M. Sorafenib in combination with intensive chemotherapy for relapsed or refractory FLT3-ITD positive acute myeloid leukemia: A two centers experience. Leuk Res 2024; 136:107421. [PMID: 38042648 DOI: 10.1016/j.leukres.2023.107421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Irene Urbino
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Carolina Secreto
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Vincenzo Apolito
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy; Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children's Hospital, Turin, Italy
| | - Matteo Olivi
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy
| | - Giulia Arrigo
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy
| | - Eleonora Boscaro
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy
| | - Federica Maria Catania
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy
| | - Stefano D'Ardia
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Chiara Frairia
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Valentina Giai
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Roberto Freilone
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy; Division of Hematology, Allogeneic Transplant and Cell Therapy Unit, AOU "Città della Salute e della Scienza di Torino" University of Turin, Italy
| | - Giuseppe Lanzarone
- Division of Hematology, Allogeneic Transplant and Cell Therapy Unit, AOU "Città della Salute e della Scienza di Torino" University of Turin, Italy
| | - Luisa Giaccone
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy; Division of Hematology, Allogeneic Transplant and Cell Therapy Unit, AOU "Città della Salute e della Scienza di Torino" University of Turin, Italy
| | - Alessandro Busca
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Chiara Maria Dellacasa
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Dario Ferrero
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy; Division of Hematology, Allogeneic Transplant and Cell Therapy Unit, AOU "Città della Salute e della Scienza di Torino" University of Turin, Italy
| | - Ernesta Audisio
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Marco Cerrano
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy.
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Benevolo Savelli C, Clerico M, Botto B, Secreto C, Cavallo F, Dellacasa C, Busca A, Bruno B, Freilone R, Cerrano M, Novo M. Chimeric Antigen Receptor-T Cell Therapy for Lymphoma: New Settings and Future Directions. Cancers (Basel) 2023; 16:46. [PMID: 38201473 PMCID: PMC10778255 DOI: 10.3390/cancers16010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
In the last decade, anti-CD19 CAR-T cell therapy has led to a treatment paradigm shift for B-cell non-Hodgkin lymphomas, first with the approval for relapsed/refractory (R/R) large B-cell lymphomas and subsequently for R/R mantle cell and follicular lymphoma. Many efforts are continuously being made to extend the therapeutic setting in the lymphoma field. Several reports are supporting the safety and efficacy of CAR-T cells in patients with central nervous system disease involvement. Anti-CD30 CAR-T cells for the treatment of Hodgkin lymphoma are in development and early studies looking for the optimal target for T-cell malignancies are ongoing. Anti-CD19/CD20 and CD19/CD22 dual targeting CAR-T cells are under investigation in order to increase anti-lymphoma activity and overcome tumor immune escape. Allogeneic CAR product engineering is on the way, representing a rapidly accessible 'off-the-shelf' and potentially more fit product. In the present manuscript, we will focus on recent advances in CAR-T cell therapy for lymphomas, including new settings and future perspectives in the field, reviewing data reported in literature in the last decade up to October 2023.
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Affiliation(s)
- Corrado Benevolo Savelli
- Hematology Division, A.O.U. Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, Italy; (B.B.); (R.F.); (M.C.)
| | - Michele Clerico
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, Italy; (M.C.); (F.C.); (B.B.)
| | - Barbara Botto
- Hematology Division, A.O.U. Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, Italy; (B.B.); (R.F.); (M.C.)
| | - Carolina Secreto
- Stem Cell Transplant Center, AOU Città della Salute e della Scienza di Torino, C.so Bramente 88, 10126 Turin, Italy; (C.S.); (C.D.); (A.B.)
| | - Federica Cavallo
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, Italy; (M.C.); (F.C.); (B.B.)
| | - Chiara Dellacasa
- Stem Cell Transplant Center, AOU Città della Salute e della Scienza di Torino, C.so Bramente 88, 10126 Turin, Italy; (C.S.); (C.D.); (A.B.)
| | - Alessandro Busca
- Stem Cell Transplant Center, AOU Città della Salute e della Scienza di Torino, C.so Bramente 88, 10126 Turin, Italy; (C.S.); (C.D.); (A.B.)
| | - Benedetto Bruno
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, Italy; (M.C.); (F.C.); (B.B.)
| | - Roberto Freilone
- Hematology Division, A.O.U. Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, Italy; (B.B.); (R.F.); (M.C.)
| | - Marco Cerrano
- Hematology Division, A.O.U. Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, Italy; (B.B.); (R.F.); (M.C.)
| | - Mattia Novo
- Hematology Division, A.O.U. Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Turin, Italy; (B.B.); (R.F.); (M.C.)
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7
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Ziccheddu B, Giannotta C, D'Agostino M, Bertuglia G, Saraci E, Oliva S, Genuardi E, Papadimitriou M, Diamond B, Corradini P, Coffey D, Landgren O, Bolli N, Bruno B, Boccadoro M, Massaia M, Maura F, Larocca A. Genomic and immune determinants of resistance to anti-CD38 monoclonal antibody-based therapy in relapsed refractory multiple myeloma. medRxiv 2023:2023.12.04.23299287. [PMID: 38106151 PMCID: PMC10723485 DOI: 10.1101/2023.12.04.23299287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Anti-CD38 antibody therapies have transformed multiple myeloma (MM) treatment. However, a large fraction of patients inevitably relapses. To understand this, we investigated 32 relapsed MM patients treated with daratumumab, lenalidomide, and dexamethasone (Dara-Rd; NCT03848676 ). Whole genome sequencing (WGS) before and after treatment pinpointed genomic drivers associated with early progression, including RPL5 loss and APOBEC mutagenesis. Flow cytometry on 202 blood samples, collected every three months until progression for 31 patients, revealed distinct immune changes significantly impacting clinical outcomes. Progressing patients exhibited significant depletion of CD38+ NK cells, persistence of T cell exhaustion, and reduced depletion of T-reg cells over time. These findings underscore the influence of immune composition and daratumumab-induced immune changes in promoting MM resistance. Integrating genomics and flow cytometry unveiled associations between adverse genomic features and immune patterns. Overall, this study sheds light on the intricate interplay between genomic complexity and the immune microenvironment driving resistance to Dara-Rd.
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8
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Benevolo G, Marchetti M, Melchio R, Beggiato E, Sartori C, Biolé CA, Rapezzi D, Bruno B, Milan A. Diagnosis and Management of Cardiovascular Risk in Patients with Polycythemia Vera. Vasc Health Risk Manag 2023; 19:765-778. [PMID: 38025519 PMCID: PMC10676644 DOI: 10.2147/vhrm.s429995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by aberrant myeloid lineage hematopoiesis with excessive red blood cell and pro-inflammatory cytokine production. Patients with PV present with a range of thrombotic and hemorrhagic symptoms that affect quality of life and reduce overall survival expectancy. Thrombotic events, transformation into acute myeloid leukemia, and myelofibrosis are largely responsible for the observed mortality. Treatment of PV is thus primarily focused on symptom control and survival extension through the prevention of thrombosis and leukemic transformation. Patients with PV frequently experience thrombotic events and have elevated cardiovascular risk, including hypertension, dyslipidemias, obesity, and smoking, all of which negatively affect survival. To reduce the risk of thrombotic complications, PV therapy should aim to normalize hemoglobin, hematocrit, and leukocytosis and, in addition, identify and modify cardiovascular risk factors. Herein, we review what is currently known about the associated cardiovascular risk and propose strategies for diagnosing and managing patients with PV.
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Affiliation(s)
- Giulia Benevolo
- University Hematology Division, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Monia Marchetti
- Hematology and Transplant Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Remo Melchio
- Division of Internal Medicine, A.O. S. Croce E Carle, Cuneo, Italy
| | - Eloise Beggiato
- University Hematology Division, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Chiara Sartori
- Cardiology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | - Benedetto Bruno
- University Hematology Division, Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Molecular Biotechnolgies and Medical Sciences, University of Turin, Turin, Italy
| | - Alberto Milan
- Department of Medical Sciences, University of Turin, Città della Salute e della Scienza di Torino, Turin, Italy
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9
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Mina R, Petrucci MT, Bonello F, Bongarzoni V, Saccardi R, Bertuglia G, Mengarelli A, Spadaro A, Lisi C, Curci P, Lemoli RM, Ballanti S, Floris R, Cupelli L, Tosi P, Olivieri A, Rota-Scalabrini D, Cangialosi C, Nozzoli C, Anaclerico B, Fazio F, Bruno B, Mancuso K, Corradini P, Milone G, Boccadoro M. A prospective, multicenter study on hematopoietic stem-cell mobilization with cyclophosphamide plus granulocyte colony-stimulating factor and 'on-demand' plerixafor in multiple myeloma patients treated with novel agents. Haematologica 2023. [PMID: 37981892 DOI: 10.3324/haematol.2023.284023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Indexed: 11/21/2023] Open
Abstract
High-dose melphalan plus autologous stem-cell transplantation (ASCT) is a standard of care for transplant-eligible patients with newly diagnosed multiple myeloma (NDMM), and adequate hematopoietic stem-cell (HSC) collection is crucial to ensure hematologic recovery after ASCT. In this prospective, observational study we evaluated HSC mobilization with granulocyte colony-stimulating factor (G-CSF), cyclophosphamide, and 'on-demand' plerixafor (in patients with.
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Affiliation(s)
- Roberto Mina
- Division of Hematology, AOU Citta della Salute e della Scienza di Torino, University of Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino.
| | - Maria Teresa Petrucci
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome
| | - Francesca Bonello
- Medical Oncology Department, Candiolo Cancer Institute, FPO-IRCCS, Candiolo
| | - Velia Bongarzoni
- U.O.C. Ematologia, Azienda Ospedaliera "San Giovanni/Addolorata", Roma
| | - Riccardo Saccardi
- Cellular Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence
| | - Giuseppe Bertuglia
- Division of Hematology, AOU Citta della Salute e della Scienza di Torino, University of Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino
| | - Andrea Mengarelli
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome
| | - Andrea Spadaro
- Division of Hematology, AOU Policlinico, University of Catania
| | - Chiara Lisi
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome
| | - Paola Curci
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari
| | - Roberto Massimo Lemoli
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genova, Italy; IRCCS Policlinico San Martino, Genova
| | - Stelvio Ballanti
- Sezione di Ematologia e Immunologia Clinica, Ospedale Santa Maria della Misericordia, localita Sant'Andrea delle Fratte, Perugia
| | - Rita Floris
- S.C. Ematologia e CTMO, Ospedale Oncologico "A. Businco", Cagliari
| | - Luca Cupelli
- Department of Hematology, S. Eugenio Hospital, Rome
| | | | - Attilio Olivieri
- Clinica di Ematologia, Azienda Ospedaliero Universitaria delle Marche, Ancona
| | | | | | - Chiara Nozzoli
- Cellular Therapy and Transfusion Medicine Unit, Careggi University Hospital, Florence
| | | | - Francesca Fazio
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome
| | - Benedetto Bruno
- Division of Hematology, AOU Citta della Salute e della Scienza di Torino, University of Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino
| | - Katia Mancuso
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seragnoli", Bologna, Italy; Dipartimento di Scienze Mediche e Chirurgiche, Universita di Bologna, Bologna
| | - Paolo Corradini
- Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Universita di Milano, Milano
| | - Giuseppe Milone
- Division of Hematology, AOU Policlinico, University of Catania
| | - Mario Boccadoro
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino
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10
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Apolito V, Arrigo G, Vasseur L, Olivi M, Perrone S, Giai V, Secreto C, Di Biase F, De Simone MC, Copia C, Gravetti A, Freilone R, Bruno B, Lanzarone G, Beggiato E, Frairia C, Audisio E, D'Ardia S, Ferrero D, Cerrano M, Ferrara F. Validation of SIE/SIES/GITMO consensus criteria for unfitness to predict early mortality and survival in acute myeloid leukaemia patients treated with hypomethylating agents and venetoclax. Br J Haematol 2023; 203:e98-e101. [PMID: 37533098 DOI: 10.1111/bjh.19022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Vincenzo Apolito
- Division of Haematology, University of Turin, Turin, Italy
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children's Hospital, Turin, Italy
| | - Giulia Arrigo
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Loic Vasseur
- Hôpital Saint-Louis, Assistance, Publique-Hôpitaux de Paris, Paris, France
| | - Matteo Olivi
- Division of Haematology, University of Turin, Turin, Italy
| | - Silvia Perrone
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Valentina Giai
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Carolina Secreto
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Roberto Freilone
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | - Chiara Frairia
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ernesta Audisio
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano D'Ardia
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Dario Ferrero
- Division of Haematology, University of Turin, Turin, Italy
| | - Marco Cerrano
- Division of Haematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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11
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Benedetti E, Traverso G, Pucci G, Morganti R, Bramanti E, Lippolis P, Susini MC, Mazzantini E, Giubbolini R, Mavilia F, Capochiani E, Neri E, Arena C, Cerri F, De Simone L, Valentini K, Stella SM, Ricchiuto V, Bruno B, Galimberti S. Impact of different chemotherapy regimens on intestinal mucosal injury assessed with bedside ultrasound: a study in 213 AML patients. Front Oncol 2023; 13:1272072. [PMID: 38023169 PMCID: PMC10646482 DOI: 10.3389/fonc.2023.1272072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Neutropenic enterocolitis (NEC) is a life-threatening complication reported in patients with acute myeloid leukemia (AML) following chemotherapy (CHT). Intensive induction and consolidation CHT may damage intestinal mucosa leading to a NEC episode (NECe). NEC reported mortality may be up to 30-60%. Early US-guided bed-side diagnosis and prompt treatment may substantially improve the survival. An emerging worldwide concern is the intestinal colonization by multi-drug-resistant bacteria especially when patients are exposed to chemotherapy regimens potentially correlated to mucosal damage. Methods In our study we prospectively enrolled all AML patients admitted in our leukemia unit to receive intensive induction and consolidation chemotherapy and experiencing chemotherapy-induced-neutropenia (CHTN). Results and discussion Overall, we enrolled N=213 patients from 2007 to March 2023. We recorded N=465 CHTN, and N=42 NECe (9.0% incidence). The aim of our study was to assess which chemotherapy regimens are more associated with NEC. We found that ALM1310, followed by 7 + 3 (daunorubicin), 7 + 3 (idarubicin), 5 + 3 + 3 (cytarabine, etoposide, idarubicin), and AML1310 (consolidation) were associated with a statistically higher incidence of NEC. We did not detect NEC episodes in patients treated with CPX-351, 5 + 2 (cytarabine, idarubicine), and high-dose cytarabine. Thus, we found that cytarabine could determine mucosal damage when associated with an anthracycline but not if delivered either alone or as dual-drug liposomal encapsulation of daunorubicin/cytarabine. We also describe NEC mortality, symptoms at diagnosis, intestinal sites involvement, and prognostic significance of bowel wall thickening.
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Affiliation(s)
- Edoardo Benedetti
- Hematology Operative Unit (UO), Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Ginevra Traverso
- Hematology Operative Unit (UO), Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giulia Pucci
- Hematology Operative Unit (UO), 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
| | - Piero Lippolis
- General and Peritoneal Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Maria Chiara Susini
- Hematology Operative Unit (UO), Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Elisa Mazzantini
- Hematology Operative Unit (UO), Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Fabrizio Mavilia
- Hematology Operative Unit (UO), Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Emanuele Neri
- Radiology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Chiara Arena
- Radiology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesca Cerri
- Radiology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Luigi De Simone
- Anesthesia and Maternal-Infantile Resuscitation Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Katia Valentini
- Anesthesia and Maternal-Infantile Resuscitation Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Vittorio Ricchiuto
- Dipartimento di Tecnologie Sanitarie ESTAR, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, 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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12
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Vitale C, Griggio V, Todaro M, Riganti C, Jones R, Boccellato E, Perutelli F, Arruga F, Vaisitti T, Efremov DG, Deaglio S, Landesman Y, Bruno B, Coscia M. Anti-tumor activity of selinexor in combination with antineoplastic agents in chronic lymphocytic leukemia. Sci Rep 2023; 13:16950. [PMID: 37805613 PMCID: PMC10560255 DOI: 10.1038/s41598-023-44039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023] Open
Abstract
Despite recent relevant therapeutic progresses, chronic lymphocytic leukemia (CLL) remains an incurable disease. Selinexor, an oral inhibitor of the nuclear export protein XPO1, is active as single agent in different hematologic malignancies, including CLL. The purpose of this study was to evaluate the anti-tumor effects of selinexor, used in combination with chemotherapy drugs (i.e. fludarabine and bendamustine) or with the PI3Kδ inhibitor idelalisib in CLL. Our results showed a significant decrease in CLL cell viability after treatment with selinexor-containing drug combinations compared to each single compound, with demonstration of synergistic cytotoxic effects. Interestingly, this drug synergism was exerted also in the presence of the protective effect of stromal cells. From the molecular standpoint, the synergistic cytotoxic activity of selinexor plus idelalisib was associated with increased regulatory effects of this drug combination on the tumor suppressors FOXO3A and IkBα compared to each single compound. Finally, selinexor was also effective in potentiating the in vivo anti-tumor effects of the PI3Kδ inhibitor in mice treated with the drug combination compared to single agents. Our data provide preclinical evidence of the synergism and potential efficacy of a combination treatment targeting XPO1 and PI3Kδ in CLL.
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Affiliation(s)
- Candida Vitale
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Valentina Griggio
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Maria Todaro
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Chiara Riganti
- Department of Oncology, University of Torino, 10126, Turin, Italy
| | - Rebecca Jones
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Elia Boccellato
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Francesca Perutelli
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Francesca Arruga
- Department of Medical Sciences, University of Torino, 10126, Turin, Italy
| | - Tiziana Vaisitti
- Department of Medical Sciences, University of Torino, 10126, Turin, Italy
| | - Dimitar G Efremov
- Molecular Hematology, International Centre for Genetic Engineering and Biotechnology, 34149, Trieste, Italy
| | - Silvia Deaglio
- Department of Medical Sciences, University of Torino, 10126, Turin, Italy
| | | | - Benedetto Bruno
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Marta Coscia
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy.
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy.
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13
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Boyle EM, Blaney P, Stoeckle JH, Wang Y, Ghamlouch H, Gagler D, Braunstein M, Williams L, Tenenbaum A, Siegel A, Chen X, Varma G, Avigan J, Li A, Jinsi M, Kaminetzsky D, Arbini A, Montes L, Corre J, Rustad EH, Landgren O, Maura F, Walker BA, Bauer M, Bruno B, Tsirigos A, Davies FE, Morgan GJ. Multiomic Mapping of Acquired Chromosome 1 Copy-Number and Structural Variants to Identify Therapeutic Vulnerabilities in Multiple Myeloma. Clin Cancer Res 2023; 29:3901-3913. [PMID: 37449980 DOI: 10.1158/1078-0432.ccr-22-3209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/27/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Chromosome 1 (chr1) copy-number abnormalities (CNA) and structural variants (SV) are frequent in newly diagnosed multiple myeloma (NDMM) and are associated with a heterogeneous impact on outcomes, the drivers of which are largely unknown. EXPERIMENTAL DESIGN A multiomic approach comprising CRISPR, gene mapping of CNAs and SVs, methylation, expression, and mutational analysis was used to document the extent of chr1 molecular variants and their impact on pathway utilization. RESULTS We identified two distinct groups of gain(1q): focal gains associated with limited gene-expression changes and a neutral prognosis, and whole-arm gains, which are associated with substantial gene-expression changes, complex genetics, and an adverse prognosis. CRISPR identified a number of dependencies on chr1 but only limited variants associated with acquired CNAs. We identified seven regions of deletion, nine of gain, three of chromothripsis (CT), and two of templated insertion (TI), which contain a number of potential drivers. An additional mechanism involving hypomethylation of genes at 1q may contribute to the aberrant gene expression of a number of genes. Expression changes associated with whole-arm gains were substantial and gene set enrichment analysis identified metabolic processes, apoptotic resistance, signaling via the MAPK pathway, and upregulation of transcription factors as being key drivers of the adverse prognosis associated with these variants. CONCLUSIONS Multiple layers of genetic complexity impact the phenotype associated with CNAs on chr1 to generate its associated clinical phenotype. Whole-arm gains of 1q are the critically important prognostic group that deregulate multiple pathways, which may offer therapeutic vulnerabilities.
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Affiliation(s)
- Eileen M Boyle
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Patrick Blaney
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
- Applied Bioinformatics Laboratories, NYU Langone Medical Center, New York, New York
| | - James H Stoeckle
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Yubao Wang
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Hussein Ghamlouch
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Dylan Gagler
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
- Applied Bioinformatics Laboratories, NYU Langone Medical Center, New York, New York
| | - Marc Braunstein
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Louis Williams
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
- Myeloma Group, Cleveland Clinic Foundation, Taussig Cancer Center, Cleveland, Ohio
| | - Avital Tenenbaum
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Ariel Siegel
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Xiaoyi Chen
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Gaurav Varma
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Jason Avigan
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Alexander Li
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Monica Jinsi
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - David Kaminetzsky
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Arnaldo Arbini
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | | | - Jill Corre
- Unit for Genomics in Myeloma, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, Toulouse; Centre de Recherche en Cancérologie de Toulouse, Institut National de la Santé et de la Recherche Médicale U1037, Toulouse, France
| | - Even H Rustad
- Institute for Cancer Research, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - Ola Landgren
- Myeloma Service, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Francesco Maura
- Myeloma Service, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Brian A Walker
- Melvin and Bren Simon Comprehensive Cancer Center, Department of Hematology Oncology, Indiana University, Indianapolis, Indiana
| | - Michael Bauer
- Department of Biomedical Informatics (DBMI), UAMS, Little-Rock, Arkansas
| | - Benedetto Bruno
- Department of Hematology, Azienda Ospedaliera Citta della Salute e della Scienza di Torino, Piemonte, Italy
| | - Aristotelis Tsirigos
- Applied Bioinformatics Laboratories, NYU Langone Medical Center, New York, New York
| | - Faith E Davies
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Gareth J Morgan
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
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14
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Rejeski K, Subklewe M, Aljurf M, Bachy E, Balduzzi A, Barba P, Bruno B, Benjamin R, Carrabba MG, Chabannon C, Ciceri F, Corradini P, Delgado J, Di Blasi R, Greco R, Houot R, Iacoboni G, Jäger U, Kersten MJ, Mielke S, Nagler A, Onida F, Peric Z, Roddie C, Ruggeri A, Sánchez-Guijo F, Sánchez-Ortega I, Schneidawind D, Schubert ML, Snowden JA, Thieblemont C, Topp M, Zinzani PL, Gribben JG, Bonini C, Sureda A, Yakoub-Agha I. Immune effector cell-associated hematotoxicity: EHA/EBMT consensus grading and best practice recommendations. Blood 2023; 142:865-877. [PMID: 37300386 DOI: 10.1182/blood.2023020578] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Hematological toxicity is the most common adverse event after chimeric antigen receptor (CAR) T-cell therapy. Cytopenias can be profound and long-lasting and can predispose for severe infectious complications. In a recent worldwide survey, we demonstrated that there remains considerable heterogeneity in regard to current practice patterns. Here, we sought to build consensus on the grading and management of immune effector cell-associated hematotoxicity (ICAHT) after CAR T-cell therapy. For this purpose, a joint effort between the European Society for Blood and Marrow Transplantation (EBMT) and the European Hematology Association (EHA) involved an international panel of 36 CAR T-cell experts who met in a series of virtual conferences, culminating in a 2-day meeting in Lille, France. On the basis of these deliberations, best practice recommendations were developed. For the grading of ICAHT, a classification system based on depth and duration of neutropenia was developed for early (day 0-30) and late (after day +30) cytopenia. Detailed recommendations on risk factors, available preinfusion scoring systems (eg, CAR-HEMATOTOX score), and diagnostic workup are provided. A further section focuses on identifying hemophagocytosis in the context of severe hematotoxicity. Finally, we review current evidence and provide consensus recommendations for the management of ICAHT, including growth factor support, anti-infectious prophylaxis, transfusions, autologous hematopoietic stem cell boost, and allogeneic hematopoietic cell transplantation. In conclusion, we propose ICAHT as a novel toxicity category after immune effector cell therapy, provide a framework for its grading, review literature on risk factors, and outline expert recommendations for the diagnostic workup and short- and long-term management.
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Affiliation(s)
- Kai Rejeski
- Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, Lyon, France
| | - Adriana Balduzzi
- Pediatric Transplantation Unit, Department of Medicine and Surgery, University of Milan-Bicocca-Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Pere Barba
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Benedetto Bruno
- Division of Hematology and Cell Therapy Unit, Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Reuben Benjamin
- School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Matteo G Carrabba
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Milan, Italy
| | - Christian Chabannon
- Institut Paoli-Calmettes Comprehensive Cancer Centre and Module Biothérapies du Centre d'Investigations Cliniques de Marseille, INSERM-Aix-Marseille Université-AP-HM-IPC, CBT-1409, Marseille, France
| | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Corradini
- Division of Hematology and Stem Cell Transplantation, Fondazione IRCCS Instituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - Julio Delgado
- Oncoimmunotherapy Unit, Department of Hematology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Roberta Di Blasi
- Université de Paris, Assistance Publique-Hopitaux de Paris, Service d'hémato-oncologie, Paris, France
| | - Raffaella Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Milan, Italy
| | - Roch Houot
- Department of Hematology, CHU Rennes, University of Rennes, INSERM U1236, Rennes, France
| | - Gloria Iacoboni
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ulrich Jäger
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Stephan Mielke
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Department of Laboratory Medicine and Medicine Huddinge, Karolinska University Hospital and Institute, Stockholm, Sweden
| | - Arnon Nagler
- Division of Hematology, Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | - Francesco Onida
- Hematology and Bone Marrow Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Zinaida Peric
- Department of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Claire Roddie
- Department of Hematology, University College London Hospital, London, United Kingdom
| | - Annalisa Ruggeri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Milan, Italy
| | - Fermín Sánchez-Guijo
- University of Salamanca, IBSAL-University Hospital of Salamanca, Salamanca, Spain
| | - Isabel Sánchez-Ortega
- Executive Office, European Society for Blood and Marrow Transplantation, Barcelona, Spain
| | - Dominik Schneidawind
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | | | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Catherine Thieblemont
- Université de Paris, Assistance Publique-Hopitaux de Paris, Service d'hémato-oncologie, Paris, France
| | - Max Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - John G Gribben
- Barts Cancer Institute, Queen Mary, University of London, London, United Kingdom
| | - Chiara Bonini
- Division of Immunology, Transplantation and Infectious Disease, Experimental Hematology Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-L'Hospitalet, Barcelona, Spain
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Dainese C, Valeri F, Bruno B, Borchiellini A. Anti-ADAMTS13 Autoantibodies: From Pathophysiology to Prognostic Impact-A Review for Clinicians. J Clin Med 2023; 12:5630. [PMID: 37685697 PMCID: PMC10488355 DOI: 10.3390/jcm12175630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 09/10/2023] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) is a fatal disease in which platelet-rich microthrombi cause end-organ ischemia and damage. TTP is caused by markedly reduced ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity. ADAMTS13 autoantibodies (autoAbs) are the major cause of immune TTP (iTTP), determining ADAMTS13 deficiency. The pathophysiology of such autoAbs as well as their prognostic role are continuous objects of scientific studies in iTTP fields. This review aims to provide clinicians with the basic information and updates on autoAbs' structure and function, how they are typically detected in the laboratory and their prognostic implications. This information could be useful in clinical practice and contribute to future research implementations on this specific topic.
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Affiliation(s)
- Cristina Dainese
- Regional Centre for Hemorrhagic and Thrombotic Diseases, AOU Città Della Salute e Della Scienza, 10126 Turin, Italy; (F.V.); (A.B.)
- Division of Hematology, AOU Città Della Salute e Della Scienza and University of Turin, 10124 Turin, Italy;
| | - Federica Valeri
- Regional Centre for Hemorrhagic and Thrombotic Diseases, AOU Città Della Salute e Della Scienza, 10126 Turin, Italy; (F.V.); (A.B.)
- Division of Hematology, AOU Città Della Salute e Della Scienza and University of Turin, 10124 Turin, Italy;
| | - Benedetto Bruno
- Division of Hematology, AOU Città Della Salute e Della Scienza and University of Turin, 10124 Turin, Italy;
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10124 Turin, Italy
| | - Alessandra Borchiellini
- Regional Centre for Hemorrhagic and Thrombotic Diseases, AOU Città Della Salute e Della Scienza, 10126 Turin, Italy; (F.V.); (A.B.)
- Division of Hematology, AOU Città Della Salute e Della Scienza and University of Turin, 10124 Turin, Italy;
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Levis M, Ferrero S, Chiappella A, Bruno B, Ricardi U. Editorial: Implementation of novel drugs and modern radiotherapy in the treatment of lymphoma patients. Front Oncol 2023; 13:1273598. [PMID: 37664055 PMCID: PMC10470469 DOI: 10.3389/fonc.2023.1273598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Mario Levis
- Department of Oncology, University of Torino, Torino, Italy
| | - Simone Ferrero
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, Torino, Italy
| | - Annalisa Chiappella
- Division of Hematology and Stem Cell Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, Torino, Italy
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Al-Homsi AS, Cirrone F, Wo S, Cole K, Suarez-Londono JA, Gardner SL, Hsu J, Stocker K, Bruno B, Goldberg JD, Levinson BA, Abdul-Hay M. PTCy, abatacept, and a short course of tacrolimus for GVHD prevention after haploidentical transplantation. Blood Adv 2023; 7:3604-3611. [PMID: 37163349 PMCID: PMC10368845 DOI: 10.1182/bloodadvances.2023010545] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023] Open
Abstract
Reducing the incidence of graft-versus-host disease (GVHD) after haploidentical hematopoietic stem cell transplantation (HSCT) is warranted. Posttransplant cyclophosphamide (PTCy) is the main agent used for GVHD prevention in this setting. It remains unknown whether costimulation blockade can be safely combined with PTCy and enhance its efficacy. We performed a phase 1b-2 clinical trial to examine the combination of PTCy, abatacept, and a short course of tacrolimus (CAST) after peripheral blood haploidentical HSCT. The primary end point was the incidence of grades 2-4 acute GVHD by day +120. The study enrolled 46 patients with a median age of 60 years (range, 18-74 years). The cumulative incidences of grades 2-4 and 3 or 4 acute GVHD were 17.4% (95% confidence interval [CI], 9.2-32.9) and 4.4% (95% CI, 1.1-17.1), respectively. With a median follow-up of 15.3 months, the cumulative incidence of 1-year treatment-related mortality was 4.4% (95% CI, 1.1-17.1). The estimated 1-year moderate-to-severe chronic GVHD rate, relapse rate, progression-free survival, overall survival, and GVHD- and relapse-free survival were 15.9% (95% CI, 8-31.7), 11.7% (95% CI, 5-27.2), 84.1% (95% CI, 73.8-95.7), 85.9% (95% CI, 75.9-97.2), and 66.1% (95% CI, 53.4-81.8), respectively. Toxicities were similar to those expected in patients receiving haploidentical HSCT. This clinical trial showed that the CAST regimen is safe and effective in reducing the rate of grades 2-4 acute GVHD after haploidentical peripheral blood HSCT. This trial was registered at www.clinicaltrials.gov as #NCT04503616.
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Affiliation(s)
- A. Samer Al-Homsi
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - Frank Cirrone
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - Stephanie Wo
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - Kelli Cole
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - J. Andres Suarez-Londono
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - Sharon L. Gardner
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - Jingmei Hsu
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | - Kelsey Stocker
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
| | | | - Judith D. Goldberg
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Benjamin A. Levinson
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Maher Abdul-Hay
- Blood and Marrow Transplantation and Cellular Therapy, New York University Langone Health, New York, NY
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Sella C, Bardetta M, Valeri F, Dainese C, Valpreda A, Massaia M, Grimaldi D, Porreca A, Bruno B, Borchiellini A. Surgery and Prophylaxis with Susoctocog-Alfa in Acquired Hemophilia: Case Series and Literature Review. J Clin Med 2023; 12:4590. [PMID: 37510704 PMCID: PMC10380857 DOI: 10.3390/jcm12144590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Acquired hemophilia A (AHA) is a rare bleeding disease due to autoantibodies directed against clotting factor VIII (FVIII). Treatment of AHA consists of inhibitor eradication with immunosuppressive therapy (IST) and prompt control of bleeding obtained with bypassing agents or recombinant porcine FVIII (rpFVIII). The latter has recently been licensed for management of acute bleeding in AHA. Unlike treatment with bypassing agents, rpFVIII can be monitored to provide a successful hemostatic effect and avoid overtreatment. Correlation between rpFVIII inhibitor titers and efficacy of rpFVIII treatment remains a matter of debate. METHODS We report three cases of AHA in which rpFVIII was successfully used with an unconventional schedule despite the presence of medium-high titers of the rpFVIII. The modified Nijmegen-Bethesda inhibitor assay (NBA) was used to dose porcine FVIII inhibitors. RESULT The presence of rpFVIII inhibitors prior to the exposition to susoctocog-alfa, that may suggest a cross-reactivity with human FVIII inhibitors, did not affect hemostasis. CONCLUSION In our experience, rpFVIII demonstrates safety and efficacy in the presence of rpFVIII inhibitors and using an unconventional schedule in both the perioperative and outpatient settings. Laboratory measurement of inhibitors against rpFVIII during treatment is described for the first time.
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Affiliation(s)
- Carola Sella
- Regional Centre for Hemorrhagic and Thrombotic Diseases, AOU Città della Salute e della Scienza, 10126 Turin, Italy
- Division of Hematology, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10124 Turin, Italy
| | - Marco Bardetta
- Regional Centre for Hemorrhagic and Thrombotic Diseases, AOU Città della Salute e della Scienza, 10126 Turin, Italy
- Division of Hematology, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10124 Turin, Italy
| | - Federica Valeri
- Regional Centre for Hemorrhagic and Thrombotic Diseases, AOU Città della Salute e della Scienza, 10126 Turin, Italy
- Division of Hematology, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy
| | - Cristina Dainese
- Regional Centre for Hemorrhagic and Thrombotic Diseases, AOU Città della Salute e della Scienza, 10126 Turin, Italy
- Division of Hematology, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy
| | - Alessandra Valpreda
- Central Laboratory Baldi and Riberi, AOU Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy
| | - Massimo Massaia
- Hematology Unit, Santa Croce e Carle Hospital, 12100 Cuneo, Italy
| | - Daniele Grimaldi
- Hematology Unit, Santa Croce e Carle Hospital, 12100 Cuneo, Italy
| | - Annamaria Porreca
- Department of Medical, Oral and Biotechnologies Science, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Benedetto Bruno
- Division of Hematology, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10124 Turin, Italy
| | - Alessandra Borchiellini
- Regional Centre for Hemorrhagic and Thrombotic Diseases, AOU Città della Salute e della Scienza, 10126 Turin, Italy
- Division of Hematology, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy
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Oliva S, Genuardi E, Paris L, D'Agostino M, Rogers J, Rota-Scalabrini D, Jacob AP, Patriarca F, Luppi M, Bertazzoni P, Velluti C, Capra A, Saraci E, Rossi M, Allegra A, Mina R, Gentile M, Kirsch IR, Belotti A, Cavo M, Bruno B, Musto P, Boccadoro M, Zamagni E, Gay F. Prospective evaluation of minimal residual disease in the phase II FORTE trial: a head-to-head comparison between multiparameter flow cytometry and next-generation sequencing. EClinicalMedicine 2023; 60:102016. [PMID: 37396800 PMCID: PMC10314153 DOI: 10.1016/j.eclinm.2023.102016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 07/04/2023] Open
Abstract
Background Limited data are available on the concordance between multiparameter flow cytometry (MFC) and next-generation sequencing (NGS) for minimal residual disease (MRD) detection in a large trial for multiple myeloma (MM) patients. Methods MRD was explored in the FORTE trial for transplant-eligible MM patients randomised to three carfilzomib-based induction-intensification-consolidation treatments and carfilzomib-lenalidomide (KR) vs R maintenance. MRD was assessed by 8-colour 2nd-generation flow cytometry in patients with ≥very good partial response before maintenance. NGS was performed in case of suspected complete response (CR) in a correlative subanalysis. Biological/prognostic concordance between MFC and NGS, conversion to MRD negativity during maintenance, and 1-year/2-year sustained MRD negativity were explored. Findings Between September 28, 2015 and December 22, 2021, 2020 samples were available for MFC and 728 for the simultaneous MFC/NGS correlation in the "suspected CR population". Median follow-up was 62 months. Biological agreement was 87% at the 10-5 and 83% at the 10-6 cut-offs. A remarkable prognostic concordance was observed: hazard ratios in MFC-MRD and NGS-MRD-negative vs -positive patients were 0.29 and 0.27 for progression-free survival (PFS) and 0.35 and 0.31 for overall survival, respectively (p < 0.05). During maintenance, 4-year PFS was 91% and 97% in 1-year sustained MFC-MRD-negative and NGS-MRD-negative patients (10-5), respectively, and 99% and 97% in 2-year sustained MFC-MRD-negative and NGS-MRD-negative patients, regardless of treatment received. The conversion rate from pre-maintenance MRD positivity to negativity during maintenance was significantly higher with KR vs R both by MFC (46% vs 30%, p = 0.046) and NGS (56% vs 30%, p = 0.046). Interpretation The significant biological/clinical concordance between MFC and NGS at the same sensitivity suggests their possible use in the evaluation of one of the currently strongest predictors of outcome. Funding Amgen, Celgene/Bristol Myers Squibb, Multiple Myeloma Research Foundation.
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Affiliation(s)
- Stefania Oliva
- Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Elisa Genuardi
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Laura Paris
- Division of Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mattia D'Agostino
- Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Jennifer Rogers
- Multiple Myeloma Research Foundation (MMRF), Norwalk, CT, USA
| | - Delia Rota-Scalabrini
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO - IRCCS, Torino, Italy
| | | | - Francesca Patriarca
- Hematologic Clinic and Transplant Center, University Hospital of Central Friuli, DAME, University of Udine, Udine, Italy
| | - Mario Luppi
- Dipartimento di Scienze Mediche e Chirurgiche Materno Infantili e dell'Adulto, UNIMORE, UOC Ematologia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | - Cristina Velluti
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Andrea Capra
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Elona Saraci
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Marco Rossi
- SOC Ematologia, Department of Oncology/Hematology, Azienda Ospedaliera Pugliese-Ciaccio and Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Roberto Mina
- Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | | | | | - Angelo Belotti
- Department of Hematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Benedetto Bruno
- Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Pellegrino Musto
- Department of Precision and Regenerative Medicine and Ionian Area, “Aldo Moro” University School of Medicine, Bari, Italy
- Hematology and Stem Cell Transplantation Unit, AOU Consorziale Policlinico, Bari, Italy
| | - Mario Boccadoro
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Elena Zamagni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Francesca Gay
- Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
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Larocca A, Cani L, Bertuglia G, Bruno B, Bringhen S. New Strategies for the Treatment of Older Myeloma Patients. Cancers (Basel) 2023; 15:2693. [PMID: 37345030 DOI: 10.3390/cancers15102693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 06/23/2023] Open
Abstract
Multiple myeloma (MM) mostly affects older patients, who represent a highly heterogeneous population. In the last few years, the introduction of novel agents led to a significant improvement in the outcome of MM patients. Nonetheless, this positive trend is less likely to occur in all older patients due to comorbidities/disabilities and major susceptibility to toxic events. Furthermore, older patients with major comorbidities are usually excluded or underrepresented in most registrational clinical trials. In this context, physicians have called for greater caution in the management of the disease. Several scores allow for the identification of frail and unfit patients and establish the possibility of tailoring therapy, reducing toxicity. This review explores the available tools for the assessment of frailty and what has been done to improve the discriminative power of the available scores. Thereafter, it describes the main therapeutic strategies for the management of transplant-ineligible (NTE) newly diagnosed (ND) MM patients and relapsed/refractory (RR) MM patients, in order to better guide physicians in choosing treatment options and to suggest possible strategies for more frail patients.
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Affiliation(s)
- Alessandra Larocca
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Department of Oncology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Lorenzo Cani
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Department of Oncology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Giuseppe Bertuglia
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Department of Oncology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Benedetto Bruno
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy
- Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Sara Bringhen
- SSD Clinical Trial in Oncoematologia e Mieloma Multiplo, Department of Oncology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
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Olivi M, Di Biase F, Lanzarone G, Arrigo G, Martella F, Apolito V, Secreto C, Freilone R, Bruno B, Audisio E, Ferrero D, Beggiato E, Cerrano M. Thrombosis in Acute Myeloid Leukemia: Pathogenesis, Risk Factors and Therapeutic Challenges. Curr Treat Options Oncol 2023; 24:693-710. [PMID: 37099265 DOI: 10.1007/s11864-023-01089-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/27/2023]
Abstract
OPINION STATEMENT Prophylaxis and treatment of thrombosis in leukemic patients still represent a major challenge with several clinical questions yet to be solved. Indeed, the paucity of evidence makes the management of venous thromboembolic events difficult and not uniform. Due to thrombocytopenia, patients with acute myeloid leukemia (AML) are underrepresented in trials investigating prophylaxis and treatment of thrombosis in cancer, and prospective data are lacking. Likewise, the therapeutic approach with anti-coagulants in leukemic patients is inferred from guidelines originally developed in the solid cancer setting and clear recommendations in the thrombocytopenic population are limited. Importantly, the discrimination of patients at high risk of bleeding from those with a predominant risk of thrombosis remains extremely difficult with no predictive score validated so far. Thus, the management of thrombosis often relies on clinician experience, and it is tailored to the individual patient, constantly balancing thrombotic and hemorrhagic risks. Who would benefit from primary prophylaxis and how a thrombotic event should be appropriately treated are some of the unanswered questions that the future guidelines and trials should address. Moreover, a greater effort should be made to identify robust predictive factors able to guide clinicians in the management of this potential serious complication for AML patients.
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Affiliation(s)
- Matteo Olivi
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Federica Di Biase
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Giuseppe Lanzarone
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Giulia Arrigo
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy
| | - Federica Martella
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
- Department of Hematology and Bone Marrow Transplant, Hospital Card. G. Panico, Tricase, LE, Italy
| | - Vincenzo Apolito
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
- Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children's Hospital, Turin, Italy
| | - Carolina Secreto
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy
| | - Roberto Freilone
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Ernesta Audisio
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy
| | - Dario Ferrero
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Eloise Beggiato
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Marco Cerrano
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Corso Bramante 88/90, 10126, Turin, Italy.
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Collignon C, Domenech C, Ducassou S, Pluchart C, Bruno B, Pasquet M, Simon P, Petit A, Rialland-Battisti F, Brethon B. Temporary contraindication to chemotherapy due to toxicity: blinatumomab's effectiveness in paediatric patients with B‐acute lymphoblastic leukaemia. Br J Haematol 2023; 201:e42-e45. [PMID: 36971071 DOI: 10.1111/bjh.18759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023]
Affiliation(s)
- C Collignon
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - C Domenech
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - S Ducassou
- Pediatrics Oncology Department, Children's Hospital of Bordeaux University Hospital, Bordeaux, France
| | - C Pluchart
- Pediatric Hematology-Oncology Unit, CHU Reims, Reims, France
| | - B Bruno
- Pediatric Hematology Unit, CHU Lille, Lille, France
| | - M Pasquet
- Pediatric Hematology-Oncology Unit, CHU Toulouse, Toulouse, France
| | - P Simon
- Pediatric Hematology-Oncology Unit, CHU Besançon, Besançon, France
| | - A Petit
- Sorbonne Université, Hôpital Armand Trousseau, AP-HP, Paris, France
| | | | - B Brethon
- Hematology and Immunology Pediatric Unit, Robert Debré Hospital, Paris, France
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Felicetti F, Gatti F, Faraci D, Rosso D, Zavattaro M, Fortunati N, Marinelli L, Leone S, Gill J, Dionisi-Vici M, Dellacasa C, Busca A, Giaccone L, Arvat E, Bruno B, Brignardello E. Impact of allogeneic stem cell transplantation on thyroid function. J Endocrinol Invest 2023:10.1007/s40618-023-02039-x. [PMID: 36884196 DOI: 10.1007/s40618-023-02039-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/09/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Primary hypothyroidism is a main endocrine complication after allogeneic stem cells transplantation (allo-SCT) in children, but in adults data on post-SCT hypothyroidism are limited. The aims of this observational, cross-sectional study were to assess the prevalence of hypothyroidism in adult allo-SCT recipients according to time from transplantation, and to identify risk factors. METHODS One hundred and eighty-six patients (M 104; F 82; median age 53.4 years) who underwent allo-SCT between January 2010 and December 2017 were enrolled and divided into three groups, according to time from allo-SCT (1-3 years; 3-5 years; > 5 years). Pre-transplant TSH and fT4 levels were available for all patients. After transplantation, TSH, fT4 and anti-thyroperoxidase antibodies (TPO-Ab) were evaluated. RESULTS After a follow-up of 3.7 years, 34 (18.3%) patients developed hypothyroidism, with higher prevalence in females (p < 0.001) and in patients who received matched unrelated donor grafts (p < 0.05). No difference in prevalence was found at different time points. Patients who developed hypothyroidism showed higher rate of TPO-Ab positivity (p < 0.05) and higher pre-transplant TSH levels (median 2.34 µU/ml) compared to those with preserved thyroid function (median 1.53 µU/ml; p < 0.001). Multivariable analysis identified higher pre-transplant TSH levels as a positive predictor of hypothyroidism (p < 0.005). The ROC curve analysis identified a pre-SCT TSH cutoff of 1.84 µU/ml, which can predict hypothyroidism with sensitivity 74.1% and specificity 67.2%. CONCLUSIONS About one out of four patients developed hypothyroidism after allo-SCT, with a greater incidence in females. Pre-transplant TSH levels seem to predict the onset of post-SCT hypothyroidism.
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Affiliation(s)
- F Felicetti
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy.
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy.
| | - F Gatti
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - D Faraci
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - D Rosso
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - M Zavattaro
- Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy
- Division of Endocrinology, University Hospital "Maggiore della Carità", Novara, Italy
| | - N Fortunati
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - L Marinelli
- Division of Endocrinology, Diabetology, and Metabolism, Città della Salute e della Scienza Hospital, Turin, Italy
| | - S Leone
- Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - J Gill
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - M Dionisi-Vici
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy
| | - C Dellacasa
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
| | - A Busca
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
| | - L Giaccone
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - E Arvat
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - B Bruno
- Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - E Brignardello
- Transition Unit for Childhood Cancer Survivors, Città della Salute e della Scienza Hospital, Corso Bramante 88, 10126, Turin, Italy
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24
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Benedetti E, Baratè C, Mavilia F, Bramanti E, Morganti R, Guerri V, Cervetti G, Capochiani E, Bertaggia I, Stella SM, Traverso G, Bruno B, Galimberti S. Relapsed/Refractory Chronic Lymphocytic Leukemia Patients Treated with Fixed Duration Venetoclax-Rituximab: Assessment of Response with Ultrasound, and Relationship with Minimal Residual Disease. J Clin Med 2023; 12:jcm12051772. [PMID: 36902559 PMCID: PMC10003523 DOI: 10.3390/jcm12051772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
A fixed duration of venetoclax-rituximab (VenR) resulted in a significant benefit of both PFS and in the attainment of an undetectable minimal residual disease (uMRD) compared with bendamustine-rituximab in relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL) patients. The 2018 International Workshop on CLL guidelines, outside the context of clinical trials, suggested ultrasonography (US) as a possible imaging technique to evaluate visceral involvement, and palpation to evaluate superficial lymph nodes (SupLNs). In this real-life study we prospectively enrolled N = 22 patients. Patients were assessed by US, to determine nodal and splenic response in R/R CLL patients treated with a fixed duration VenR. We found an overall response rate, complete remission, partial remission, and stable disease, of 95.4%, 68%, 27.3%, and 4.5%, respectively. Responses were also correlated with risk categories. The time to response, and the time to clearance of the disease in the spleen, in abdominal LN (AbdLNs), and in SupLNs were discussed. Responses were independent from LN size. The correlation between response rate with MRD were also investigated. US allowed to detect a substantial CR rate correlated with uMRD.
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Affiliation(s)
- Edoardo Benedetti
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Italian School of Basic and Emergency Ultrasound (SIUMB), 56100 Pisa, Italy
- Correspondence:
| | - Claudia Baratè
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Fabrizio Mavilia
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Emilia Bramanti
- Institute of Chemistry of Organometallic Compounds (ICCOM), Italian National Research Council (CNR), Via G Moruzzi 1, 56124 Pisa, Italy
| | - Riccardo Morganti
- Azienda Ospedaliero Universitaria Pisana, Section of Statistics, 56126 Pisa, Italy
| | - Valentina Guerri
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giulia Cervetti
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Enrico Capochiani
- Hematology Unit, Azienda USL Toscana Nord Ovest, 57124 Livorno, Italy
| | - Ilaria Bertaggia
- Hematology Unit, Azienda USL Toscana Nord Ovest, 57124 Livorno, Italy
| | | | - Ginevra Traverso
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
| | - Sara Galimberti
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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25
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Miklos DB, Abu Zaid M, Cooney JP, Albring JC, Flowers M, Skarbnik AP, Yakoub-Agha I, Ko BS, Bruno B, Waller EK, Yared J, Sohn SK, Bulabois CE, Teshima T, Jacobsohn D, Greinix H, Mokatrin A, Lee Y, Wahlstrom JT, Styles L, Socie G. Ibrutinib for First-Line Treatment of Chronic Graft-Versus-Host Disease: Results From the Randomized Phase III iNTEGRATE Study. J Clin Oncol 2023; 41:1876-1887. [PMID: 36608310 PMCID: PMC10082299 DOI: 10.1200/jco.22.00509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To present primary and final analyses from the randomized, double-blind, placebo-controlled, phase III iNTEGRATE study, which evaluated the safety and efficacy of ibrutinib with prednisone in previously untreated patients with chronic graft-versus-host disease (cGVHD). METHODS Patients (age ≥ 12 years) with newly diagnosed moderate or severe cGVHD, requiring systemic corticosteroid therapy, and with no prior systemic treatment for cGVHD were randomly assigned 1:1 to receive ibrutinib 420 mg once daily plus prednisone, starting at 1 mg/kg once daily or placebo plus prednisone. The primary end point was response rate at 48 weeks according to 2014 National Institutes of Health Consensus Development Project Criteria. Other end points included event-free survival, duration of response, time to withdrawal of immunosuppressants, improvement in Lee cGVHD Symptom Scale score, overall survival (OS), and safety. RESULTS Ninety-five and 98 patients enrolled in the ibrutinib-prednisone and placebo-prednisone arms, respectively. At 48 weeks, response rates were 41% (ibrutinib-prednisone) and 37% (placebo-prednisone; P = .54). At 33 months of follow-up, median duration of response was 19 months (ibrutinib-prednisone) and 10 months (placebo-prednisone; P = .10). Median event-free survival was 15 months (ibrutinib-prednisone) and 8 months (placebo-prednisone; hazard ratio, 0.76; 95% CI, 0.54 to 1.1; P = .11). Improvement in overall Lee cGVHD Symptom Scale was 43% (ibrutinib-prednisone) and 31% (placebo-ibrutinib; P = .07). Median OS was not reached in either arm. The 24-month Kaplan-Meier OS estimates were 80% for both arms (hazard ratio, 1.06; 95% CI, 0.59 to 1.90). Grade ≥ 3 serious adverse events occurred in 49% (ibrutinib-prednisone) and 47% (placebo-prednisone) of patients. CONCLUSION There was no statistical difference observed in the primary and secondary end points with ibrutinib-prednisone treatment. No new safety signals were observed with ibrutinib treatment in previously untreated patients with cGVHD. The primary end point of iNTEGRATE was not met.
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Affiliation(s)
| | - Mohammad Abu Zaid
- Melvin and Bren Simon Cancer Center (IUSCC), Indiana University, Indianapolis, IN
| | - Julian P Cooney
- Fiona Stanley Hospital, Murdoch, Australia.,University of Western Australia, Crawley, Australia
| | | | - Mary Flowers
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Alan P Skarbnik
- John Theurer Cancer Center, Hackensack, NJ.,Novant Health Cancer Institute, Charlotte, NC
| | | | - Bor-Sheng Ko
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | | | - Jean Yared
- University of Maryland School of Medicine, Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Sang Kyun Sohn
- Kyungpook National University Hospital, Daegu, South Korea
| | | | | | | | | | - Ahmad Mokatrin
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | - Yihua Lee
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | | | - Lori Styles
- Pharmacyclics LLC, an AbbVie Company, South San Francisco, CA
| | - Gerard Socie
- AP-HP, Hopital St Louis and University of Paris, Paris, France
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26
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Marchionni L, Lobo FP, Kostadinov R, Serra A, Besso FG, Deaglio S, Stratta P, Berrino M, Zanettini C, Imada EL, Omar MN, Gaidano G, Bruno B, Saglio G, Amoroso A. Donor-derived acute myeloid leukemia in solid organ transplantation. Am J Transplant 2022; 22:3111-3119. [PMID: 35979657 PMCID: PMC9897593 DOI: 10.1111/ajt.17174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 02/05/2023]
Abstract
We report the transmission of acute myeloid leukemia (AML) undetected at donation from a deceased organ donor to two kidneys and one liver recipients. We reviewed the medical records, and performed molecular analyses and whole exome sequencing (WES) to ascertain AML donor origin and its molecular evolution. The liver recipient was diagnosed 11 months after transplantation and died from complications 2 months later. The two kidney recipients (R1 and R2) were diagnosed 19 and 20 months after transplantation and both received treatment for leukemia. R1 died of complications 11 months after diagnosis, while R2 went into complete remission for 44 months, before relapsing. R2 died 10 months later of complications from allogenic bone marrow transplantation. Microsatellite analysis demonstrated donor chimerism in circulating cells from both kidney recipients. Targeted molecular analyses and medical records revealed NPM1 mutation present in the donor and recipients, while FLT3 was mutated only in R1. These findings were confirmed by WES, which revealed additional founder and clonal mutations, and HLA genomic loss in R2. In conclusion, we report the first in-depth genomic analysis of AML transmission following solid organ transplantation, revealing distinct clonal evolution, and providing a potential molecular explanation for tumor escape.
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Affiliation(s)
- Luigi Marchionni
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Francisco Pereira Lobo
- Department of Genetics, Ecology and Evolution, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rumen Kostadinov
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna Serra
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Federico Genzano Besso
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Silvia Deaglio
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
- Department of Medical Sciences, University of Turin, Torino, Italy
| | - Piero Stratta
- Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara, Italy
| | - Monica Berrino
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Claudio Zanettini
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Eddie Luidy Imada
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mohamed N. Omar
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Gianluca Gaidano
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Antonio Amoroso
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
- Department of Medical Sciences, University of Turin, Torino, Italy
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27
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Dainese C, Valeri F, Bardetta M, Sella C, Porreca A, Valpreda A, Pittaluga F, Mengozzi G, Bruno B, Borchiellini A. Impact of COVID-19 Infection, Vaccination, and Serological Response in Immune Thrombocytopenic Purpura Patients: A Single-Center Global Analysis. Biomedicines 2022; 10:2674. [PMID: 36359194 PMCID: PMC9687178 DOI: 10.3390/biomedicines10112674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2023] Open
Abstract
Both SARS-CoV-2 infection and vaccination have raised concern in immune-mediated diseases, including immune thrombocytopenic purpura (ITP) considering risk of de novo ITP development and ITP recurrence. Here, we report on data from a single-center retrospective-prospective collection aiming to evaluate platelet (plt) dynamics in patients (pts) with chronic ITP after COVID-19 infection (before and after vaccination) and after the first, second and third vaccine doses. Furthermore, we analyzed the serological response after the first two doses of COVID-19 vaccination. A total of 64 pts currently followed for chronic ITP who experienced COVD-19 infection and/or vaccination with an available plt count before and after such events were included in the analysis. A low incidence of ITP exacerbation following vaccine sessions (6-16%) was observed in comparison with a high frequency of exacerbation and rescue treatment necessity after COVID-19 infection in unvaccinated pts (83%). Moreover, the lower ITP exacerbation rate observed in infected pts previously vaccinated (18%) suggests further protective effects in this population. Finally, a high seroconversion rate was observed, confirming data reported in previously published studies on immune cytopenia and rheumatological diseases, but more evidence is awaited to establish the clinical impact of serological response.
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Affiliation(s)
- Cristina Dainese
- Regional Reference Center for Thrombotic and Haemorrhagic Disorders of the Adult, Department of Hematology and Oncology, Hematology Divison, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Federica Valeri
- Regional Reference Center for Thrombotic and Haemorrhagic Disorders of the Adult, Department of Hematology and Oncology, Hematology Divison, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Marco Bardetta
- Regional Reference Center for Thrombotic and Haemorrhagic Disorders of the Adult, Department of Hematology and Oncology, Hematology Divison, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Carola Sella
- Regional Reference Center for Thrombotic and Haemorrhagic Disorders of the Adult, Department of Hematology and Oncology, Hematology Divison, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Annamaria Porreca
- Department of Medical, Oral and Biotechnologies Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Alessandra Valpreda
- Clinical Biochemistry Laboratory, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Fabrizia Pittaluga
- Laboratory of Microbiology and Virology, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Giulio Mengozzi
- Clinical Biochemistry Laboratory, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
| | - Benedetto Bruno
- Hematology Division, Department of Hematology and Oncology, Azienda Ospedaliera Città della Salute e della Scienza di Torino-Molinette, 10126 Turin, Italy
| | - Alessandra Borchiellini
- Regional Reference Center for Thrombotic and Haemorrhagic Disorders of the Adult, Department of Hematology and Oncology, Hematology Divison, University Hospital City of Science and Health Molinette, 10126 Turin, Italy
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28
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Mariotti J, Raiola AM, Evangelista A, Harbi S, Patriarca F, Carella MA, Martino M, Risitano A, Busca A, Giaccone L, Brunello L, Merla E, Savino L, Loteta B, Console G, Fanin R, Sperotto A, Marano L, Marotta S, Frieri C, Sica S, Chiusolo P, Chabannon C, Furst S, Santoro A, Bacigalupo A, Bruno B, Blaise D, Mavilio D, Bramanti S, Devillier R, Angelucci E, Castagna L. Impact of second-degree related donor on the outcomes of T cell-replete haploidentical transplantation with post-transplant cyclophosphamide. Bone Marrow Transplant 2022; 57:1758-1764. [PMID: 36057732 DOI: 10.1038/s41409-022-01565-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 11/09/2022]
Abstract
Donor selection may contribute to improve clinical outcomes of T cell-replete haploidentical stem cell transplantation (Haplo-SCT) with post-transplant cyclophosphamide (PT-Cy). Impact of second-degree related donor (SRD) was not fully elucidated in this platform. We retrospectively compared the outcome of patients receiving Haplo-SCT either from a SRD (n = 31) or a first-degree related donor (FRD, n = 957). Median time to neutrophil and platelet recovery did not differ between a SRD and a FRD transplant (p = 0.599 and 0.587). Cumulative incidence of grade II-IV acute graft-versus host disease (GVHD) and moderate-severe chronic GVHD was 13% and 19% after SRD vs 24% (p = 0.126) and 13% (p = 0.395) after FRD transplant. One-year cumulative incidence of non-relapse mortality (NRM) was 19% for SRD and 20% for FRD (p = 0.435) cohort. The 3-year probability of overall survival (OS) and progression-free survival (PFS) was 42% vs 55% (p = 0.273) and 49% vs 35% (p = 0.280) after SRD and FRD transplant, respectively. After propensity score adjustment or matched pair analysis, the outcome of patients receiving Haplo-SCT from a SRD or a FRD did not differ in terms of NRM, OS, PFS, acute and chronic GVHD. Our results suggest that a SRD is a viable option for Haplo-SCT with PT-Cy when a FRD is not available.
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Affiliation(s)
- Jacopo Mariotti
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Anna Maria Raiola
- Hematology and Bone Marrow Transplant Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Samia Harbi
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Francesca Patriarca
- Hematology and Transplant Center Unit, Udine University Hospital, DAME, University of Udine, 33100, Udine, Italy
| | - Michele Angelo Carella
- Department of Oncology and Hematology Bone Marrow Transplant Unit Fondazione Casa Sollievo della Sofferenza San Giovanni Rotondo, Torino, Italy
| | - Massimo Martino
- Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Antonio Risitano
- Department of Clinical Medicine and Surgery, Bone Marrow Transplant Center, Federico II University of Naples, Naples, Italy
| | - Alessandro Busca
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Luisa Giaccone
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Lucia Brunello
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Emanuela Merla
- Department of Oncology and Hematology Bone Marrow Transplant Unit Fondazione Casa Sollievo della Sofferenza San Giovanni Rotondo, Torino, Italy
| | - Lucia Savino
- Department of Oncology and Hematology Bone Marrow Transplant Unit Fondazione Casa Sollievo della Sofferenza San Giovanni Rotondo, Torino, Italy
| | - Barbara Loteta
- Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Giuseppe Console
- Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Renato Fanin
- Hematology and Transplant Center Unit, Udine University Hospital, DAME, University of Udine, 33100, Udine, Italy
| | - Alessandra Sperotto
- Hematology and Transplant Center Unit, Udine University Hospital, DAME, University of Udine, 33100, Udine, Italy
| | - Luana Marano
- Department of Clinical Medicine and Surgery, Bone Marrow Transplant Center, Federico II University of Naples, Naples, Italy
| | - Serena Marotta
- Department of Clinical Medicine and Surgery, Bone Marrow Transplant Center, Federico II University of Naples, Naples, Italy
| | - Camilla Frieri
- Department of Clinical Medicine and Surgery, Bone Marrow Transplant Center, Federico II University of Naples, Naples, Italy
| | - Simona Sica
- Istituto di Ematologia, Fondazione Policlinico Universitario A.Gemelli, Universita' Cattolica, Roma, Italy
| | - Patrizia Chiusolo
- Istituto di Ematologia, Fondazione Policlinico Universitario A.Gemelli, Universita' Cattolica, Roma, Italy
| | - Christian Chabannon
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Sabine Furst
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Armando Santoro
- Department of Oncology/Hematology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Andrea Bacigalupo
- Istituto di Ematologia, Fondazione Policlinico Universitario A.Gemelli, Universita' Cattolica, Roma, Italy
| | - Benedetto Bruno
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Didier Blaise
- Department of Hematology, Transplantation Program, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano-Milan, Italy.,Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Stefania Bramanti
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Raynier Devillier
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Emanuele Angelucci
- Hematology and Bone Marrow Transplant Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Castagna
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, via Manzoni 56, 20089, Rozzano, Milan, Italy
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Nagler A, Labopin M, Dholaria B, Ciceri F, Fraccaroli A, Blaise D, Fanin R, Bruno B, Forcade E, Vydra J, Chevallier P, Bulabois CE, Jindra P, Bornhäuser M, Canaani J, Sanz J, Savani BN, Spyridonidis A, Giebel S, Brissot E, Bazarbachi A, Esteve J, Mohty M. Impact of Cytogenetic Risk on Outcomes of Non-T-Cell–Depleted Haploidentical Hematopoietic Cell Transplantation in Patients with Relapsed or Refractory Acute Myeloid Leukemia. Transplant Cell Ther 2022; 28:773.e1-773.e8. [DOI: 10.1016/j.jtct.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Leone SG, Rohatgi S, Cirrone F, Londono JAS, Hay MA, Bruno B, Cole K, Al-Homsi AS. An Evaluation of Hyperhydration for the Prevention of Cyclophosphamide-Induced Hemorrhagic Cystitis in Allogeneic Bone Marrow Transplantation. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Al-Homsi AS, Cirrone F, Cole K, Stocker K, Bruno B, Londono JAS, Goldberg J, Hay MA. Post-Transplant Cyclophosphamide, Abatacept, and Short Course of Tacrolimus (CAST) for Graft-Versus-Host Disease Prevention Following Haploidentical Peripheral Blood Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00552-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lia G, Di Vito C, Bruno S, Tapparo M, Brunello L, Mariotti J, Bramanti S, Zaghi E, Calvi M, Comba L, Fasci M, Giaccone L, Camussi G, Castagna L, Evangelista A, Mavilio D, Bruno B. Antigen Expression Profile and Micrornas Cargo in Extracellular Vesicles As Plasmatic Biomarkers of Acute Graft-Versus-Host Disease after Haplo-Identical Allografting. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00551-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Caro J, Braunstein M, Williams L, Bruno B, Kaminetzky D, Siegel A, Razzo B, Alfandari S, Morgan GJ, Davies FE, Boyle EM. Inflammation and infection in plasma cell disorders: how pathogens shape the fate of patients. Leukemia 2022; 36:613-624. [PMID: 35110727 PMCID: PMC8809233 DOI: 10.1038/s41375-021-01506-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 12/26/2022]
Abstract
The role of infection and chronic inflammation in plasma cell disorders (PCD) has been well-described. Despite not being a diagnostic criterion, infection is a common complication of most PCD and represents a significant cause of morbidity and mortality in this population. As immune-based therapeutic agents are being increasingly used in multiple myeloma, it is important to recognize their impact on the epidemiology of infections and to identify preventive measures to improve outcomes. This review outlines the multiple factors attributed to the high infectious risk in PCD (e.g. the underlying disease status, patient age and comorbidities, and myeloma-directed treatment), with the aim of highlighting future prophylactic and preventive strategies that could be implemented in the clinic. Beyond this, infection and pathogens as an entity are believed to also influence disease biology from initiation to response to treatment and progression through a complex interplay involving pathogen exposure, chronic inflammation, and immune response. This review will outline both the direct and indirect role played by oncogenic pathogens in PCD, highlight the requirement for large-scale studies to decipher the precise implication of the microbiome and direct pathogens in the natural history of myeloma and its precursor disease states, and understand how, in turn, pathogens shape plasma cell biology.
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Affiliation(s)
- Jessica Caro
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Marc Braunstein
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Louis Williams
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Benedetto Bruno
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - David Kaminetzky
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Ariel Siegel
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Beatrice Razzo
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Serge Alfandari
- Service de Réanimation et Maladies Infectieuses, CH Gustave Dron, Tourcoing, France
| | - Gareth J Morgan
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Faith E Davies
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Eileen M Boyle
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA.
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Reinoso-Segura M, Caballero-Velázquez T, Herrera P, Patriarca F, Fanin R, Bruno B, Einsele H, Nahi H, Granell M, López-Corral L, Reguera JL, García-Cadenas I, Gahrton G, Pérez-Simón JA. Phase II trial of allogeneic transplantation plus novel drugs in multiple myeloma: effect of intensifying reduced intensity conditioning with bortezomib and adding maintenance treatment. Transplant Cell Ther 2022; 28:258.e1-258.e8. [DOI: 10.1016/j.jtct.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/05/2022] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
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Lia G, Di Vito C, Bruno S, Tapparo M, Brunello L, Santoro A, Mariotti J, Bramanti S, Zaghi E, Calvi M, Comba L, Fascì M, Giaccone L, Camussi G, Boyle EM, Castagna L, Evangelista A, Mavilio D, Bruno B. Extracellular Vesicles as Biomarkers of Acute Graft-vs.-Host Disease After Haploidentical Stem Cell Transplantation and Post-Transplant Cyclophosphamide. Front Immunol 2022; 12:816231. [PMID: 35145514 PMCID: PMC8821147 DOI: 10.3389/fimmu.2021.816231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
Even with high-dose post-transplant cyclophosphamide (PT-Cy) which was initially introduced for graft-versus-host disease (GvHD) prevention in the setting of HLA-haploidentical transplantation, both acute and chronic GvHDs remain a major clinical challenge. Despite improvements in the understanding of the pathogenesis of both acute and chronic GvHDs, reliable biomarkers that predict their onset have yet to be identified. We recently studied the potential correlation between extracellular vesicles (EVs) and the onset of acute (a)GvHD in transplant recipients from related and unrelated donors. In the present study, we further investigated the role of the expression profile of membrane proteins and their microRNA (miRNA) cargo (miRNA100, miRNA155, and miRNA194) in predicting the onset of aGvHD in haploidentical transplant recipients with PT-Cy. Thirty-two consecutive patients were included. We evaluated the expression profile of EVs, by flow cytometry, and their miRNA cargo, by real-time PCR, at baseline, prior, and at different time points following transplant. Using logistic regression and Cox proportional hazard models, a significant association between expression profiles of antigens such as CD146, CD31, CD140a, CD120a, CD26, CD144, and CD30 on EVs, and their miRNA cargo with the onset of aGvHD was observed. Moreover, we also investigated a potential correlation between EV expression profile and cargo with plasma biomarkers (e.g., ST2, sTNFR1, and REG3a) that had been associated with aGVHD previously. This analysis showed that the combination of CD146, sTNFR1, and miR100 or miR194 strongly correlated with the onset of aGvHD (AUROC >0.975). A large prospective multicenter study is currently in progress to validate our findings.
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Affiliation(s)
- Giuseppe Lia
- Division of Hematology, Department of Oncology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Clara Di Vito
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Milan, Italy
| | - Stefania Bruno
- Department of Medical Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Marta Tapparo
- Department of Medical Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Lucia Brunello
- Division of Hematology, Department of Oncology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Armando Santoro
- Bone Marrow Transplant Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Jacopo Mariotti
- Bone Marrow Transplant Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Stefania Bramanti
- Bone Marrow Transplant Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Elisa Zaghi
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Michela Calvi
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Milan, Italy
| | - Lorenzo Comba
- Division of Hematology, Department of Oncology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Martina Fascì
- Division of Hematology, Department of Oncology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Luisa Giaccone
- Division of Hematology, Department of Oncology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Giovanni Camussi
- Department of Medical Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Eileen M. Boyle
- Division of Hematology and Medical Oncology, New York University Grossman School of Medicine, Perlmutter Cancer Center, New York University (NYU) Langone Health, New York, NY, United States
| | - Luca Castagna
- Bone Marrow Transplant Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Andrea Evangelista
- Clinical Epidemiology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Milan, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
- Division of Hematology and Medical Oncology, New York University Grossman School of Medicine, Perlmutter Cancer Center, New York University (NYU) Langone Health, New York, NY, United States
- *Correspondence: Benedetto Bruno,
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Schetelig J, Baldauf H, Koster L, Kuxhausen M, Heidenreich F, de Wreede LC, Spellman S, van Gelder M, Bruno B, Onida F, Lange V, Massalski C, Potter V, Ljungman P, Schaap N, Hayden P, Lee SJ, Kröger N, Hsu K, Schmidt AH, Yakoub-Agha I, Robin M. Corrigendum: Haplotype Motif-Based Models for KIR-Genotype Informed Selection of Hematopoietic Cell Donors Fail to Predict Outcome of Patients With Myelodysplastic Syndromes or Secondary Acute Myeloid Leukemia. Front Immunol 2022; 12:813838. [PMID: 34992613 PMCID: PMC8724253 DOI: 10.3389/fimmu.2021.813838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Johannes Schetelig
- Medizinische Klinik und Poliklinik I, University Hospital Dresden, Dresden, Germany.,DKMS Clinical Trials Unit, Dresden, Germany
| | | | | | - Michelle Kuxhausen
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN, United States
| | - Falk Heidenreich
- Medizinische Klinik und Poliklinik I, University Hospital Dresden, Dresden, Germany.,DKMS Clinical Trials Unit, Dresden, Germany
| | - Liesbeth C de Wreede
- DKMS Clinical Trials Unit, Dresden, Germany.,Leiden University Medical Center, Department of Biomedical Data Sciences, Leiden, Netherlands
| | - Stephen Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN, United States
| | - Michel van Gelder
- Maastricht University Medical Center, Department of Internal Medicine, Maastricht, Netherlands
| | - Benedetto Bruno
- A.O.U. Citta della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Onida
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | | | - Per Ljungman
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | - Stephanie J Lee
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | | | - Kathy Hsu
- Memorial Sloan Kettering Cancer Center, New York & Scientific Director, CIBMTR Immunobiology Working Committee, New York City, NY, United States
| | - Alexander H Schmidt
- DKMS Clinical Trials Unit, Dresden, Germany.,DKMS Life Science Lab, Dresden, Germany
| | | | - Marie Robin
- Hopital Saint-Louis, APHP, Universite´ de Paris, Paris, France
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Dainese C, Valeri F, Pizzo E, Valpreda A, Sivera P, Montaruli B, Porreca A, Massaia M, Bruno B, Borchiellini A. ADAMTS13 Autoantibodies and Burden of Care in Immune Thrombotic Thrombocytopenic purpura: New Evidence and Future Implications. Clin Appl Thromb Hemost 2022; 28:10760296221125785. [PMID: 36124377 PMCID: PMC9490478 DOI: 10.1177/10760296221125785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The introduction Caplacizumab in the management of Immune thrombotic thrombocytopenic purpura (iTTP) has raised different questions, considering its cost-efficacy and the optimal immunosuppressive treatment (IST) to associate. A retrospective multicenter collection of 42 first iTTP cases was conducted to identify variables associated with a higher burden of care and necessity of an implemented IST with early Rituximab (RTX) rescue. A significant correlation resulted between ADAMTS13 inhibitors (ADAMTS13inh) at diagnosis with total plasma exchange (PEXtot) and PEX needed to achieve clinical response (PEXtoCR, r = 0.46; r = 0.48), along with age (r = - 0.31; r = -0.35), platelet count (r = -0.30; r = -0.30), LDH (r = 0.44; r = 0.41) and total bilirubin (r = 0.54; r = 0.35). ADAMTS13inh also correlated with number of days of hospitalization (DoH, r = 0.44). A significant difference was observed in terms of median ADAMTS13inh titer at diagnosis in patient treated with RTX rescue and those responding to only steroid treatment. Thus, ADAMTS13inh titer resulted a marker of iTTP burden of care, associated with higher number of PEXtot, PEXtoCR, DoH and higher probability of needing RTX rescue to achieve clinical response and could be a useful tool for management of new iTTP cases and an interesting variable to optimize iTTP cases stratification in future Caplacizumab cost-efficacy analysis.
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Affiliation(s)
- Cristina Dainese
- Regional Reference Center for Thrombotic and Haemorrhagic disorders of the adult, Department of Hematology and Oncology, 18691Azienda Ospedaliera Città della Salute e della Scienza di Torino - Molinette, 10126, Turin, Italy
| | - Federica Valeri
- Regional Reference Center for Thrombotic and Haemorrhagic disorders of the adult, Department of Hematology and Oncology, 18691Azienda Ospedaliera Città della Salute e della Scienza di Torino - Molinette, 10126, Turin, Italy
| | - Eleonora Pizzo
- School of Medicine, Study University of Turin, 10126 Turin, Italy
| | | | - Piera Sivera
- Hematology Unit, Ordine Mauriziano Hospital, Turin, 10128, Italy
| | - Barbara Montaruli
- Laboratory Analysis, Ordine Mauriziano Hospital, 10128, Turin, Italy
| | - Annamaria Porreca
- Department of Medical, Oral and Biotechnologies Sciences, University of Chieti-Pescara, 66100, Chieti, Italy
| | - Massimo Massaia
- Division of Hematology, "Santa Croce e Carle di Cuneo" Hospital, 12100, Cuneo, Italy
| | - Benedetto Bruno
- Hematology Unit, Department of Hematology and Oncology, Azienda Ospedaliera Città della Salute e della Scienza di Torino - Molinette, 10126, Turin, Italy
| | - Alessandra Borchiellini
- Regional Reference Center for Thrombotic and Haemorrhagic disorders of the adult, Department of Hematology and Oncology, 18691Azienda Ospedaliera Città della Salute e della Scienza di Torino - Molinette, 10126, Turin, Italy
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Mariotti J, Legrand F, Furst S, Giordano L, Magri F, Richiardi L, Granata A, De Philippis C, Maisano V, Faraci D, Sarina B, Giaccone L, Harbi S, Mannina D, Valli V, Tordato F, Mineri R, Bramanti S, Santoro A, Bruno B, Devillier R, Blaise D, Castagna L. Risk Factors for early CMV reactivation and Impact of early CMV reactivation on Clinical Outcomes after T Cell-replete Haploidentical Transplantation with Post-transplant Cyclophosphamide. Transplant Cell Ther 2021; 28:169.e1-169.e9. [PMID: 34954296 DOI: 10.1016/j.jtct.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Risk factors for cytomegalovirus (CMV) reactivation and the impact of CMV reactivation on patients' outcomes have been extensively investigated after matched related or unrelated donor transplants, but little is known in the setting of haploidentical stem cell transplant (Haplo-SCT) with post-transplant cyclophosphamide (PT-Cy), where recipients are supposed to be more severely immune-compromised. METHODS We retrospectively analyzed a cohort of 554 consecutive patients undergoing Haplo-SCT with PT-Cy at 3 different centers. RESULTS Early CMV reactivation, taking place within the first 120 days after transplant, occurred in 242 patients for an estimated cumulative incidence of 44%. Out of those patients, 74 (30%) had recurrent CMV and 20 (8%) CMV disease. By multivariable analysis, positive recipient CMV serostatus (Hazard ratio [HR] > 2.5, p<0.001), disease histology (lymphoid vs myeloid: HR 0.66, p=0.003) and increasing recipient age (HR 1.01, p=0.015) were independent predictors of CMV reactivation. At four months landmark analysis, CMV reactivation was associated with higher 1-year and 5-year cumulative incidence of non-relapse mortality (NRM) relative to patients without reactivation: 13% vs 5% and 22% vs 9%, respectively (p<0.001). By multivariable analysis, CMV reactivation was an independent negative predictor of non-relapse mortality (NRM) (HR 2.69, p<0.001) and was close to statistical significance for overall survival (OS) (HR: 1.38, p=0.062). CONCLUSIONS Our results suggest that CMV reactivation plays an important role at determining NRM. Because patient CMV serostatus is the main predictor of CMV reactivation, it should be considered when evaluating strategies for preventing CMV reactivation.
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Affiliation(s)
- Jacopo Mariotti
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy.
| | - Faezeh Legrand
- Department of Hematology, Transplantation Program, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Sabine Furst
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Laura Giordano
- Biostatistic Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Filippo Magri
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - Angela Granata
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Chiara De Philippis
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Valerio Maisano
- Department of Hematology, Transplantation Program, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Danilo Faraci
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Barbara Sarina
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Luisa Giaccone
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy; Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Samia Harbi
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Daniele Mannina
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Viviana Valli
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Federica Tordato
- Infectious Disease Unit, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano 20089, Italy
| | - Rossana Mineri
- Molecular Biology Section, Clinical Investigation Laboratory, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano 20089, Italy
| | - Stefania Bramanti
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Armando Santoro
- Department of Oncology/Hematology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Benedetto Bruno
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy; Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Raynier Devillier
- Department of Hematology, Transplantation Program, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Didier Blaise
- Department of Hematology, Transplantation Program, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Luca Castagna
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
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Ghamlouch H, Boyle EM, Blaney P, Wang Y, Choi J, Williams L, Bauer M, Auclair D, Bruno B, Walker BA, Davies FE, Morgan GJ. Insights into high-risk multiple myeloma from an analysis of the role of PHF19 in cancer. J Exp Clin Cancer Res 2021; 40:380. [PMID: 34857028 PMCID: PMC8638425 DOI: 10.1186/s13046-021-02185-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/13/2021] [Indexed: 02/07/2023] Open
Abstract
Despite improvements in outcome, 15-25% of newly diagnosed multiple myeloma (MM) patients have treatment resistant high-risk (HR) disease with a poor survival. The lack of a genetic basis for HR has focused attention on the role played by epigenetic changes. Aberrant expression and somatic mutations affecting genes involved in the regulation of tri-methylation of the lysine (K) 27 on histone 3 H3 (H3K27me3) are common in cancer. H3K27me3 is catalyzed by EZH2, the catalytic subunit of the Polycomb Repressive Complex 2 (PRC2). The deregulation of H3K27me3 has been shown to be involved in oncogenic transformation and tumor progression in a variety of hematological malignancies including MM. Recently we have shown that aberrant overexpression of the PRC2 subunit PHD Finger Protein 19 (PHF19) is the most significant overall contributor to HR status further focusing attention on the role played by epigenetic change in MM. By modulating both the PRC2/EZH2 catalytic activity and recruitment, PHF19 regulates the expression of key genes involved in cell growth and differentiation. Here we review the expression, regulation and function of PHF19 both in normal and the pathological contexts of solid cancers and MM. We present evidence that strongly implicates PHF19 in the regulation of genes important in cell cycle and the genetic stability of MM cells making it highly relevant to HR MM behavior. A detailed understanding of the normal and pathological functions of PHF19 will allow us to design therapeutic strategies able to target aggressive subsets of MM.
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Affiliation(s)
- Hussein Ghamlouch
- Myeloma Research Program, NYU Langone Medical Center, Perlmutter Cancer Center, 522 1st Avenue, Manhattan, New York City, NY, 10016, USA.
| | - Eileen M Boyle
- Myeloma Research Program, NYU Langone Medical Center, Perlmutter Cancer Center, 522 1st Avenue, Manhattan, New York City, NY, 10016, USA
| | - Patrick Blaney
- Myeloma Research Program, NYU Langone Medical Center, Perlmutter Cancer Center, 522 1st Avenue, Manhattan, New York City, NY, 10016, USA
- Applied Bioinformatics Laboratories (ABL), NYU Langone Medical Center, New York, NY, USA
| | - Yubao Wang
- Myeloma Research Program, NYU Langone Medical Center, Perlmutter Cancer Center, 522 1st Avenue, Manhattan, New York City, NY, 10016, USA
| | - Jinyoung Choi
- Myeloma Research Program, NYU Langone Medical Center, Perlmutter Cancer Center, 522 1st Avenue, Manhattan, New York City, NY, 10016, USA
| | - Louis Williams
- Myeloma Research Program, NYU Langone Medical Center, Perlmutter Cancer Center, 522 1st Avenue, Manhattan, New York City, NY, 10016, USA
| | - Michael Bauer
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Daniel Auclair
- The Multiple Myeloma Research Foundation (MMRF), Norwalk, CT, USA
| | - Benedetto Bruno
- Myeloma Research Program, NYU Langone Medical Center, Perlmutter Cancer Center, 522 1st Avenue, Manhattan, New York City, NY, 10016, USA
| | - Brian A Walker
- Division of Hematology Oncology, Indiana University, Indianapolis, IN, USA
| | - Faith E Davies
- Myeloma Research Program, NYU Langone Medical Center, Perlmutter Cancer Center, 522 1st Avenue, Manhattan, New York City, NY, 10016, USA
| | - Gareth J Morgan
- Myeloma Research Program, NYU Langone Medical Center, Perlmutter Cancer Center, 522 1st Avenue, Manhattan, New York City, NY, 10016, USA.
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41
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Giaccone L, Brunello L, Londono JS, Scaldaferri M, Cerrano M, Redoglia V, Omedè P, Lia G, Massaia M, Ferrero D, Cavallo F, Bringhen S, Leone S, Cattel F, Francisci T, Tassi V, Evangelista A, Boccadoro M, Bruno B. Cost efficiency and effectiveness of biosimilar filgrastim in autologous transplant. Bone Marrow Transplant 2021; 57:312-314. [PMID: 34848834 DOI: 10.1038/s41409-021-01541-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Luisa Giaccone
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy. .,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.
| | - Lucia Brunello
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Jaime Suarez Londono
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Matilde Scaldaferri
- Pharmacy, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Cerrano
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Valter Redoglia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Paola Omedè
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Giuseppe Lia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Massimo Massaia
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Dario Ferrero
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Federica Cavallo
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Sara Bringhen
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Sarah Leone
- Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Francesco Cattel
- Pharmacy, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Tiziana Francisci
- Blood bank and immunohematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Valter Tassi
- Blood bank and immunohematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Evangelista
- Unit of clinical epidemiology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Mario Boccadoro
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Benedetto Bruno
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Division of Hematology and Medical Oncology, Perlmutter Cancer Center, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
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42
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Malagola M, Polverelli N, Rubini V, Martino M, Patriarca F, Bruno B, Giaccone L, Grillo G, Bramanti S, Bernasconi P, De Gobbi M, Natale A, Terruzzi E, Olivieri A, Chiusolo P, Carella AM, Casini M, Nozzoli C, Mazza P, Bassi S, Onida F, Vacca A, Falcioni S, Luppi M, Iori AP, Pavone V, Skert C, Carluccio P, Borghero C, Proia A, Selleri C, Sacchi N, Mammoliti S, Oldani E, Ciceri F, Russo D, Bonifazi F. GITMO Registry Study on Allogeneic Transplantation in Patients Aged ≥60 Years from 2000 to 2017: Improvements and Criticisms. Transplant Cell Ther 2021; 28:96.e1-96.e11. [PMID: 34818581 DOI: 10.1016/j.jtct.2021.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/13/2021] [Accepted: 11/15/2021] [Indexed: 12/18/2022]
Abstract
Today, allogeneic stem cell transplantation (allo-SCT) can be offered to patients up to age 70 to 72 years and represents one of the most effective curative treatments for many hematologic malignancies. The primary objective of the study was to collect data from the allo-SCTs performed in Italy between 2000 and 2017 in patients aged ≥60 years to evaluate the changes in safety and efficacy outcomes, as well as their distribution and characteristics over time. The Italian Group for Bone Marrow Transplantation, Hematopoietic Stem Cells and Cell Therapy (GITMO) AlloEld study (ClinicalTrials.gov identifier NCT04469985) is a retrospective analysis of allo-SCTs performed at 30 Italian transplantation centers in older patients (age ≥60 years) between 2000 and 2017 (n = 1996). For the purpose of this analysis, patients were grouped into 3 time periods: time A, 2000 to 2005 (n = 256; 12%); time B, 2006 to 2011 (n = 584; 29%); and time C, 2012 to 2017 (n = 1156; 59%). After a median follow-up of 5.6 years, the 5-year nonrelapse mortality (NRM) remained stable (time A, 32.8%; time B, 36.2%; and time C, 35.0%; P = .5), overall survival improved (time A, 28.4%; time B, 31.8%; and time C, 37.3%; P = .012), and the cumulative incidence of relapse was reduced (time A, 45.3%; time B, 38.2%; time C, 30.0%; P < .0001). The 2-year incidence of extensive chronic graft-versus-host disease was reduced significantly (time A, 17.2%; time B, 15.8%; time C, 12.2%; P = .004). Considering times A and B together (2000 to 2011), the 2-year NRM was positively correlated with the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) score; NRM was 25.2% in patients with an HCT-CI score of 0, 33.9% in those with a score of 1 or 2, and 36.1% in those with a score of 3 (P < .001). However, after 2012, the HCT-CI score was not significantly predictive of NRM. This study shows that the transplantation procedure in elderly patients became more effective over time. Relapse incidence remains the major problem, and strategies to prevent it are currently under investigation (eg, post-transplantation maintenance). The selection of patients aged ≥60 could be improved by combining HCT-CI and frailty assessment to better predict NRM.
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Affiliation(s)
- Michele Malagola
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit, "ASST-Spedali Civili" Hospital of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Nicola Polverelli
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit, "ASST-Spedali Civili" Hospital of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Vicky Rubini
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit, "ASST-Spedali Civili" Hospital of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Massimo Martino
- Stem Cell Transplant and Cellular Therapies Unit, "BMM" Hospital, Reggio Calabria, Italy
| | - Francesca Patriarca
- Hematologic Clinic and Transplant Center, University Hospital of Central Friuli, DAME, University of Udine, Udine, Italy
| | - Benedetto Bruno
- Department of Oncology, SSD Allogeneic Stem Cell Transplantation, "Città della Salute e della Scienza", Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Turin, Italy
| | - Luisa Giaccone
- Department of Oncology, SSD Allogeneic Stem Cell Transplantation, "Città della Salute e della Scienza", Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Turin, Italy
| | - Giovanni Grillo
- Division of Hematology and Marrow Transplant, Niguarda Hospital, Milan, Italy
| | | | - Paolo Bernasconi
- Transplant Center, Unit of Hematology, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco De Gobbi
- Department of Clinical and Biological Sciences, University of Turin, Internal Medicine and Hematology Division, San Luigi University Hospital - Orbassano (Turin), Italy
| | - Annalisa Natale
- Hematologic Intensive Care, Pescara Hospital, Pescara, Italy
| | | | - Attilio Olivieri
- Haematology Clinic, "Ospedali Riuniti," University Hospital of Ancona, Ancona, Italy
| | - Patrizia Chiusolo
- Department of Medical Imaging, Radiotherapy, Oncology, and Hematology, "A. Gemelli IRCCS" University Teaching Hospital Foundation, Hematology Division, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Michele Carella
- SSD Hematologic Intensive Care and Cell Therapy Unit; Department of Medical Sciences, "Casa Sollievo della Sofferenza" Foundation, San Giovanni Rotondo, Italy
| | - Marco Casini
- Hematology and Bone Marrow Transplantation, Bolzano Hospital, Bolzano, Italy
| | - Chiara Nozzoli
- Cell Therapy and Ttransfusion Medicine, "Careggi" University Hospital, Florence, Italy
| | - Patrizio Mazza
- PO San Giuseppe Moscati, Department of Hematology with Transplant Division, ASL Taranto, Italy
| | - Simona Bassi
- Hematology Unit, "G. da Saliceto" Hospital, Piacenza, Italy
| | - Francesco Onida
- IRCCS Foundation "Ospedale Maggiore Ca' Granda Policlinico," University of Milan, Milan, Italy
| | - Adriana Vacca
- Hematology Unit, CTMO PO, "A. Businco", ARNAS Brotzu, Cagliari, Italy
| | - Sadia Falcioni
- Unit of Hematology and Cellular Therapy, "C. e G. Mazzoni" Hospital, Ascoli Piceno, Italy
| | - Mario Luppi
- Department of Medical and Surgical Sciences, UNIMORE, Division of Hematology, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Anna Paola Iori
- Department of Hematology, Oncology, and Dermatology, "Umberto I" University Hospital, Roma Sapienza University, Rome, Italy
| | - Vincenzo Pavone
- Department of Hematology and Bone Marrow Transplantation, "Card. G. Panico" Hospital, Tricase, Italy
| | - Cristina Skert
- Unit of Hematology/Bone Marrow Transplantation, Unit "Ospedale dell'Angelo" Venice, Mestre, Italy
| | - Paola Carluccio
- Hematology and Stem Cell Transplantation Unit, Department of Emergency and Organ Transplantation, "Aldo Moro" University of Bari, Bari, Italy
| | - Carlo Borghero
- Hematology Department, "San Bortolo" Hospital, Vicenza, Italy
| | - Anna Proia
- Unit of Hematology and Stem Cell Transplant Center, "San Camillo" Hospital, Rome, Italy
| | - Carmine Selleri
- "San Giovanni di Dio e Ruggi d'Aragona" University Hospital, Salerno, Italy
| | - Nicoletta Sacchi
- Italian Bone Marrow Donor Registry, E. O. Galliera Hospitals, Genoa, Italy
| | | | - Elena Oldani
- Hematology Unit, "ASST Papa Giovanni XXIII," Bergamo, Italy
| | - Fabio Ciceri
- Department of Onco-Hematology, Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Domenico Russo
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit, "ASST-Spedali Civili" Hospital of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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43
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Martino M, Pitino A, Gori M, Bruno B, Crescimanno A, Federico V, Picardi A, Tringali S, Ingrosso C, Carluccio P, Pastore D, Musuraca G, Paviglianiti A, Vacca A, Serio B, Storti G, Mordini N, Leotta S, Cimminiello M, Prezioso L, Loteta B, Ferreri A, Colasante F, Merla E, Giaccone L, Busca A, Musso M, Scalone R, Di Renzo N, Marotta S, Mazza P, Musto P, Attolico I, Selleri C, Canale FA, Pugliese M, Tripepi G, Porto G, Martinelli G, Carella AM, Cerchione C. Letermovir Prophylaxis for Cytomegalovirus Infection in Allogeneic Stem Cell Transplantation: A Real-World Experience. Front Oncol 2021; 11:740079. [PMID: 34616684 PMCID: PMC8489185 DOI: 10.3389/fonc.2021.740079] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/13/2021] [Indexed: 12/15/2022] Open
Abstract
Despite effective treatments, cytomegalovirus (CMV) continues to have a significant impact on morbidity and mortality in allogeneic stem cell transplant (allo-SCT) recipients. This multicenter, retrospective, cohort study aimed to evaluate the reproducibility of the safety and efficacy of commercially available letermovir for CMV prophylaxis in a real-world setting. Endpoints were rates of clinically significant CMV infection (CSCI), defined as CMV disease or CMV viremia reactivation within day +100-+168. 204 adult CMV-seropositive allo-SCT recipients from 17 Italian centres (median age 52 years) were treated with LET 240 mg/day between day 0 and day +28. Overall, 28.9% of patients underwent a haploidentical, 32.4% a matched related, and 27.5% a matched unrelated donor (MUD) transplant. 65.7% were considered at high risk of CSCI and 65.2% had a CMV seropositive donor. Low to mild severe adverse events were observed in 40.7% of patients during treatment [gastrointestinal toxicity (36.3%) and skin rash (10.3%)]. Cumulative incidence of CSCI at day +100 and day +168 was 5.4% and 18.1%, respectively, whereas the Kaplan-Meier event rate was 5.8% (95% CI: 2.4-9.1) and 23.3% (95% CI: 16.3-29.7), respectively. Overall mortality was 6.4% at day +100 and 7.3% at day +168. This real-world experience confirms the efficacy and safety of CMV.
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Affiliation(s)
- Massimo Martino
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Annalisa Pitino
- Istituto di Fisiologia Clinica del Consiglio Nazionale delle Ricerche (CNR), Roma, Italy
| | - Mercedes Gori
- Istituto di Fisiologia Clinica del Consiglio Nazionale delle Ricerche (CNR), Roma, Italy
| | - Benedetto Bruno
- Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, AOU Città della Salute e della Scienza di Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Divisione di Ematologia, Università di Torino, Torino, Italy
| | | | - Vincenzo Federico
- Ematologia e Trapianto di Cellule Staminali, Polo Ospedaliero "Vito Fazzi", Lecce, Italy
| | - Alessandra Picardi
- UOC Ematologia con Trapianto CSE, AORN "Antonio Cardarelli", Napoli, Italy.,Dipartimento di Biomedicina e Prevenzione, Università di Roma Tor Vergata, Roma, Italy
| | | | - Claudia Ingrosso
- Ematologia e Trapianto di Midollo Osseo, Ospedale "San Giuseppe Moscati", Taranto, Italy
| | - Paola Carluccio
- UOC di Ematologia con Trapianto, Dipartimento di Emergenza e Trapianti d'Organo, Università degli Studi "Aldo Moro" e AOUC Policlinico di Bari, Bari, Italy
| | - Domenico Pastore
- Divisione di Ematologia, Ospedale "Antonio Perrino", Brindisi, Italy
| | - Gerardo Musuraca
- Unità di Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Annalisa Paviglianiti
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Adriana Vacca
- UO Ematologia - CTMO, Polo Ospedaliero "Armando Businco", Cagliari, Italy
| | - Bianca Serio
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Salerno, Salerno, Italy
| | - Gabriella Storti
- Unità di Ematologia, Azienda Ospedaliera "San Giuseppe Moscati", Avellino, Italy
| | - Nicola Mordini
- SC Ematologia, Azienda Ospedaliera "S. Croce e Carle", Cuneo, Italy
| | - Salvatore Leotta
- Programma di Trapianto Emopoietico, Azienda Policlinico "Vittorio Emanuele", Catania, Italy
| | | | - Lucia Prezioso
- Ematologia e Centro Trapianti Midollo Osseo (CTMO), Dipartimento ad Attività Integrata Medicina Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Barbara Loteta
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Anna Ferreri
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Fabrizia Colasante
- Ospedale I.R.C.C.S. Casa Sollievo della Sofferenza - Centro Trapianti di Cellule Staminali, San Giovanni Rotondo, Italy
| | - Emanuela Merla
- Ospedale I.R.C.C.S. Casa Sollievo della Sofferenza - Centro Trapianti di Cellule Staminali, San Giovanni Rotondo, Italy
| | - Luisa Giaccone
- Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, AOU Città della Salute e della Scienza di Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Divisione di Ematologia, Università di Torino, Torino, Italy
| | - Alessandro Busca
- Dipartimento di Oncologia, SSD Trapianto Allogenico di Cellule Staminali, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maurizio Musso
- Unità Operativa di Oncoematologia e TMO, Istituto "La Maddalena", Palermo, Italy
| | - Renato Scalone
- Unità Operativa di Oncoematologia e TMO, Istituto "La Maddalena", Palermo, Italy
| | - Nicola Di Renzo
- Ematologia e Trapianto di Cellule Staminali, Polo Ospedaliero "Vito Fazzi", Lecce, Italy
| | - Serena Marotta
- UOC Ematologia con Trapianto CSE, AORN "Antonio Cardarelli", Napoli, Italy
| | - Patrizio Mazza
- Ematologia e Trapianto di Midollo Osseo, Ospedale "San Giuseppe Moscati", Taranto, Italy
| | - Pellegrino Musto
- UOC di Ematologia con Trapianto, Dipartimento di Emergenza e Trapianti d'Organo, Università degli Studi "Aldo Moro" e AOUC Policlinico di Bari, Bari, Italy
| | - Immacolata Attolico
- UOC di Ematologia con Trapianto, Dipartimento di Emergenza e Trapianti d'Organo, Università degli Studi "Aldo Moro" e AOUC Policlinico di Bari, Bari, Italy
| | - Carmine Selleri
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Salerno, Salerno, Italy
| | - Filippo Antonio Canale
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Marta Pugliese
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Giovanni Tripepi
- Istituto di Fisiologia Clinica del Consiglio Nazionale delle Ricerche (CNR), Reggio Calabria, Italy
| | - Gaetana Porto
- Centro Unico Regionale Trapianti Cellule Staminali e Terapie Cellulari (CTMO), Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Giovanni Martinelli
- Unità di Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Angelo Michele Carella
- Ospedale I.R.C.C.S. Casa Sollievo della Sofferenza - Centro Trapianti di Cellule Staminali, San Giovanni Rotondo, Italy
| | - Claudio Cerchione
- Unità di Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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Decanter C, Delepine J, Behal H, Manier S, Bruno B, Barbatti M, Robin C, Labreuche J, Morschhauser F, Pigny P. Longitudinal study of AMH variations in 122 Adolescents and Young Adults (AYA) and non-AYA lymphoma patients to evaluate the chemo-induced ovarian toxicity to further personalise fertility preservation counselling. Hum Reprod 2021; 36:2743-2752. [PMID: 34417822 DOI: 10.1093/humrep/deab189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/02/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the influence of age and chemotherapy regimen on the longitudinal blood anti-Müllerian hormone (AMH) variations in a large series of adolescents and young adult (AYA) (15-24 years old) and non-AYA (25-35 years old) lymphoma patients? SUMMARY ANSWER In case of alkylating regimen treatment, there was a deep and sustained follicular depletion in AYA as well as non-AYA patients; however in both groups, the ovarian toxicity was extremely low in cases of non-alkylating treatments. WHAT IS KNOWN ALREADY AMH is now well-recognised to be a real-time indicator of ovarian follicular depletion and recovery in women treated by chemotherapy. Its longitudinal variations may discriminate between highly and minimally toxic protocols regarding ovarian function. It has been shown, in different cancer types, that age, type of chemotherapy regimen and pre-treatment AMH levels are the main predictors of ovarian recovery. Large studies on longitudinal AMH variations under chemotherapy in lymphoma patients are few but can provide the opportunity to assess the degree of follicle loss at a young age. STUDY DESIGN, SIZE, DURATION This prospective cohort study was conducted in the Fertility Observatory of the Lille University Hospital. Data were collected between 2007 and 2016. Non-Hodgkin or Hodgkin lymphoma patients (n = 122) between 15 and 35 years old were prospectively recruited before commencing chemotherapy. Patients were treated either by a non-alkylating protocol (ABVD group; n = 67) or by an alkylating regimen (alkylating group; n = 55). PARTICIPANTS/MATERIALS, SETTING, METHODS Serial AMH measurements were performed at baseline (AMH0), 15 days after the start of chemotherapy (AMH1), 15 days before the last chemotherapy cycle (AMH2), and at time 3, 6, 9, 12, 18 and 24 months from the end of chemotherapy. The whole study population was divided into two groups according to age: AYA (15-24; n = 65) and non-AYA (25-35; n = 57). All patients received a once monthly GnRH agonist injection during the whole treatment period. A linear mixed model was used to account for the repeated measures of single patients. MAIN RESULTS AND THE ROLE OF CHANCE At baseline, non-AYA patients had higher BMI and lower AMH levels than AYA patients. All AYA and non-AYA patients having received ABVD protocols had regular cycles at 12 months of follow-up. In case of alkylating regimens, amenorrhoea was more frequent in non-AYA patients than in AYA patients at 12 months (37% vs 4%, P = 0.011) and at 24 months (24% vs 4%, P = 0.045). We distinguished a similar depletion phase from AMH0 to AMH2 between ABVD and alkylating groups but significantly different recovery phases from AMH2 to AMH + 24 months. AMH recovery was fast and complete in case of ABVD protocols whatever the age: AMH reached pre-treatment values as soon as the 6th month of follow-up in the AYA group (mean (95% CI) in log AMH M0 vs M6: 3.07 (2.86 to 3.27) vs 3.05 (2.78 to 3.31), P = 1.00) and in the non-AYA group (mean (95% CI) in log AMH M0 vs M6: 2.73 (2.40 to 3.05) vs 2.47 (2.21 to 2.74), P = 1.00). In contrast, no patients from the alkylating group returned to pre-treatment AMH values whatever the age of patients (AYA or non-AYA). Moreover, none of the AMH values post-chemotherapy in the non-AYA group were significantly different from AMH2. Conversely in the AYA group, AMH levels from 6 months (mean (95% CI) in log AMH: 1.79 (1.47 to 2.11), P < 0.001) to 24 months (mean (95% CI) in log AMH: 2.16 (1.80 to 2.52), P ≤ 0.001) were significantly higher than AMH2 (mean (95% CI) in log AMH: 1.13 (0.89 to 1.38)). Considering the whole study population (AYA and non-AYA), pre-treatment AMH levels influenced the pattern of the AMH variation both in alkylating and ABVD protocols (interaction P-value = 0.005 and 0.043, respectively). Likewise, age was significantly associated with the pattern of the recovery phase but only in the alkylating group (interaction P-value =0.001). BMI had no influence on the AMH recovery phase whatever the protocol (interaction P-value = 0.98 in alkylating group, 0.72 in ABVD group). LIMITATIONS, REASONS FOR CAUTION There was a large disparity in subtypes of protocols in the alkylating group. The average duration of chemotherapy for patients treated with alkylating protocols was longer than that for patients treated with ABVD. WIDER IMPLICATIONS OF THE FINDINGS These results make it possible to develop strategies for fertility preservation according to age and type of protocol in a large series of young lymphoma patients. In addition, it was confirmed that young age does not protect against ovarian damage caused by alkylating agents. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by Agence Régionale de Santé Hauts de France and Agence Onco Hauts-de-France who provided finances for AMH dosages (n° DOS/SDES/AR/FIR/2019/282). There are no competing interests. TRIAL REGISTRATION NUMBER DC-2008-642 and CNIL DEC2015-112.
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Affiliation(s)
- C Decanter
- Academic ART and Fertility Preservation Centre, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France.,EA 4308 Gamétogénèse et qualité du gamète, Lille University Hospital, Lille, France
| | - J Delepine
- Academic ART and Fertility Preservation Centre, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France.,EA 4308 Gamétogénèse et qualité du gamète, Lille University Hospital, Lille, France
| | - H Behal
- Department of Biostatistics of the Lille University Hospital, ULR 2694-METRICS: Health Technologies Evaluation and Medical Practices, Lille, France
| | - S Manier
- Department of Hematology, Lille University Hospital, Lille, France
| | - B Bruno
- Department of Pediatric Hematology-Oncology Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - M Barbatti
- Department of Pediatric Hematology-Oncology Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - C Robin
- Academic ART and Fertility Preservation Centre, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - J Labreuche
- Department of Biostatistics of the Lille University Hospital, ULR 2694-METRICS: Health Technologies Evaluation and Medical Practices, Lille, France
| | - F Morschhauser
- Department of Hematology, Lille University Hospital, Lille, France
| | - P Pigny
- Department of Biochemistry and Hormonology, Metabolism, Nutrition and Oncology, Lille University Hospital, Lille, France
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Martino M, Macheda S, Aguglia U, Arcudi L, Pucci G, Martino B, Altomonte M, Rossetti AM, Cusumano G, Russo L, Imbalzano L, Stelitano C, Alati C, Germano' J, Labate D, Amalfi V, Florenzano MT, Morabito A, Borzumati V, Dattola V, Gattuso C, Moschella A, Quattrone D, Curmaci F, Franzutti C, Scappatura G, Rao CM, Loddo V, Pontari A, Pellicano' M, Surace R, Sanguedolce C, Naso V, Ferreri A, Irrera G, Console G, Moscato T, Loteta B, Canale FA, Trimarchi A, Monteleone R, Al Sayyad S, Cirrone F, Bruno B. Identifying and managing CAR T-cell-mediated toxicities: on behalf of an Italian CAR-T multidisciplinary team. Expert Opin Biol Ther 2021; 22:407-421. [PMID: 34463175 DOI: 10.1080/14712598.2021.1974394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Chimeric antigen receptor (CAR)-T-cell therapy is a new treatment for patients with hematologic malignancies in which other therapies have failed. AREAS COVERED The review provides an overview for recognizing and managing the most acute toxicities related to CAR-T cells. EXPERT OPINION The development of immune-mediated toxicities is a common challenge of CAR-T therapy. The mechanism that determines this toxicity is still unclear, although an unfavorable tumor microenvironment and a pro-inflammatory state put patients at risk. The monitoring, diagnosis, and treatment of post-CAR-T toxicities must be determined and based on international guidelines and internal clinical practice. It is urgent to identify biomarkers that can identify patients at greater risk of developing complications. The adoption of consistent grading criteria is necessary to improve toxicity management strategies continually. The first-line therapy consists of supportive care and treatment with tocilizumab or corticosteroids. An early start of cytokine blockade therapies could mitigate toxicity. The plan will include cytokine release prophylaxis, a risk-adapted treatment, prevention of on-target/off-tumor effect, and a switch on/off CAR-T approach.
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Affiliation(s)
- Massimo Martino
- Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy.,Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Sebastiano Macheda
- Intensive Care Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Umberto Aguglia
- Department of Medicine, Surgery and Health Sciences, Magna Græcia University, Catanzaro, Italy, Regional Epilepsy Centre, Great Metropolitan Hospital "Bianchi-melacrino-morelli," Reggio Calabria, Italy.,Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Luciano Arcudi
- Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Giulia Pucci
- Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy.,Stem Cell Processing Laboratory Unit, Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Bruno Martino
- Hematology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Maria Altomonte
- Pharmacy Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Antonio Maria Rossetti
- Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy.,Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Giuseppa Cusumano
- Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy.,Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Letteria Russo
- Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy.,Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Lucrezia Imbalzano
- Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy.,Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Caterina Stelitano
- Hematology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Caterina Alati
- Hematology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Jessyca Germano'
- Hematology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Demetrio Labate
- Intensive Care Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Vincenzo Amalfi
- Intensive Care Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Maria Teresa Florenzano
- Pharmacy Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Antonella Morabito
- Pharmacy Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Vittoria Borzumati
- Pharmacy Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Vincenzo Dattola
- Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Caterina Gattuso
- Neurology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Antonio Moschella
- Pain Center Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Domenico Quattrone
- Pain Center Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Francesco Curmaci
- Pain Center Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Claudio Franzutti
- Radiology Department, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Giuseppe Scappatura
- Radiology Department, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Carmelo Massimiliano Rao
- Cardiology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Viviana Loddo
- Catholic University of the Sacred Heart, Rome, Italy
| | - Antonella Pontari
- Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy.,Stem Cell Processing Laboratory Unit, Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Maria Pellicano'
- Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy.,Intensive Care Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Rosangela Surace
- Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy.,Intensive Care Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Cristina Sanguedolce
- Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy.,Intensive Care Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Virginia Naso
- Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy.,Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Anna Ferreri
- Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy.,Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Giuseppe Irrera
- Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy.,Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Giuseppe Console
- Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy.,Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Tiziana Moscato
- Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy.,Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Barbara Loteta
- Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy.,Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Filippo Antonio Canale
- Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy.,Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Alfonso Trimarchi
- Immunotransfusion Service Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli,", Reggio, Calabria, Italy
| | - Renza Monteleone
- Stem Cell Transplant Program CIC 587, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio, Calabria, Italy
| | - Said Al Sayyad
- Onco-hematology and Radiotherapy Department, Great Metropolitan Hospital "Bianchi-melacrino-morelli", Reggio, Calabria, Italy
| | - Frank Cirrone
- Department of Pharmacy, Nyu Langone Health, New York, NY
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Torino and Department of Oncology, Division of Hematology, A.o.u. Città Della Salute E Della Scienza Di Torino, Presidio Molinette, Torino, Italy.,Division Of Hematology And Medical Oncology, Perlmutter Cancer Center, Grossman School Of Medicine, NYU Langone Health, New York, Ny
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Crisà E, Zallio F, Zacchi G, Cerrano M, Rivolta G, Ferrero D, Deambrogi C, Essa W, Awikeh B, Nicolosi M, Santini V, Gaidano G, Bruno B, Patriarca A. Topic: AS08-Treatment/AS08h-Allogeneic hematopoietic cell transplantation - Bridging to transplantation. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106680.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bruno B, Wäsch R, Engelhardt M, Gay F, Giaccone L, D'Agostino M, Rodríguez-Lobato LG, Danhof S, Gagelmann N, Kröger N, Popat R, Van de Donk NWCJ, Terpos E, Dimopoulos MA, Sonneveld P, Einsele H, Boccadoro M. European Myeloma Network perspective on CAR T-Cell therapies for multiple myeloma. Haematologica 2021; 106:2054-2065. [PMID: 33792221 PMCID: PMC8327729 DOI: 10.3324/haematol.2020.276402] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
Chimeric antigen receptor (CAR) T cells (CAR-T) have dramatically changed the treatment landscape of B-cell malignancies, providing a potential cure for relapsed/refractory patients. Long-term responses in patients with acute lymphoblastic leukemia and non Hodgkin lymphomas have encouraged further development in myeloma. In particular, B-cell maturation antigen (BCMA)-targeted CAR-T have established very promising results in heavily pre-treated patients. Moreover, CAR-T targeting other antigens (i.e., SLAMF7 and CD44v6) are currently under investigation. However, none of these current autologous therapies have been approved, and despite high overall response rates across studies, main issues such as long-term outcome, toxicities, treatment resistance, and management of complications limit as yet their widespread use. Here, we critically review the most important pre-clinical and clinical findings, recent advances in CAR-T against myeloma, as well as discoveries in the biology of a still incurable disease, that, all together, will further improve safety and efficacy in relapsed/refractory patients, urgently in need of novel treatment options.
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Affiliation(s)
- Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Torino and Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy; Division of Hematology and Medical Oncology, Perlmutter Cancer Center, Grossman School of Medicine, NYU Langone Health, New York, NY.
| | - Ralph Wäsch
- Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Monika Engelhardt
- Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Francesca Gay
- Department of Molecular Biotechnology and Health Sciences, University of Torino and Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino
| | - Luisa Giaccone
- Department of Molecular Biotechnology and Health Sciences, University of Torino and Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino
| | - Mattia D'Agostino
- Department of Molecular Biotechnology and Health Sciences, University of Torino and Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino
| | - Luis-Gerardo Rodríguez-Lobato
- Unit of Amyloidosis and Multiple Myeloma, Department of Hematology, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Division of Medicine II, University Hospital Würzburg, Würzburg
| | - Sophia Danhof
- Division of Medicine II, University Hospital Würzburg, Würzburg
| | - Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Rakesh Popat
- Department of Hematology, University College London Hospitals, London
| | - Niels W C J Van de Donk
- Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Location VUmc, Amsterdam
| | - Evangelos Terpos
- Stem Cell Transplantation Unit, Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens
| | - Meletios A Dimopoulos
- Stem Cell Transplantation Unit, Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens
| | | | - Hermann Einsele
- Division of Medicine II, University Hospital Würzburg, Würzburg
| | - Mario Boccadoro
- Department of Molecular Biotechnology and Health Sciences, University of Torino and Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino
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Boyle EM, Williams L, Blaney P, Ashby C, Bauer M, Walker BA, Ghamlouch H, Choi J, Perrial E, Wang Y, Caro J, Stoeckle JH, Arbini A, Kaminetzky D, Braunstein M, Bruno B, Razzo B, Diamond B, Maclachlan K, Maura F, Landgren O, Litke R, Fegan CD, Keats J, Auclair D, Davies FE, Morgan GJ. Improving prognostic assignment in older adults with multiple myeloma using acquired genetic features, clonal hemopoiesis and telomere length. Leukemia 2021; 36:221-224. [PMID: 34148053 DOI: 10.1038/s41375-021-01320-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Eileen M Boyle
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - Louis Williams
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - Patrick Blaney
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - Cody Ashby
- Department of Biomedical Informatics, UAMS, Little Rock, AR, USA
| | - Michael Bauer
- Department of Biomedical Informatics, UAMS, Little Rock, AR, USA
| | - Brian A Walker
- Division of Hematology Oncology, Indiana University, Indianapolis, IN, USA
| | - Hussein Ghamlouch
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - Jinyoung Choi
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - Emeline Perrial
- INSERM 1052/CNRS 5286 Cancer Research Center of Lyon, Lyon, France
| | - Yubao Wang
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - Jessica Caro
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - James H Stoeckle
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - Arnaldo Arbini
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - David Kaminetzky
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - Marc Braunstein
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - Benedetto Bruno
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - Beatrice Razzo
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - Benjamin Diamond
- Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kylee Maclachlan
- Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francesco Maura
- Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ola Landgren
- Myeloma Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Rachel Litke
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Johnathan Keats
- Multiple Myeloma Research Laboratory, TGen, Phoenix, AZ, USA
| | | | - Faith E Davies
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA
| | - Gareth J Morgan
- Myeloma Research Program, Perlmutter Cancer Center, NYU Langone Medical Center, New-York, NY, USA.
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Cooper JP, Storer BE, Granot N, Gyurkocza B, Sorror ML, Chauncey TR, Shizuru J, Franke GN, Maris MB, Boyer M, Bruno B, Sahebi F, Langston AA, Hari P, Agura ED, Lykke Petersen S, Maziarz RT, Bethge W, Asch J, Gutman JA, Olesen G, Yeager AM, Hübel K, Hogan WJ, Maloney DG, Mielcarek M, Martin PJ, Flowers MED, Georges GE, Woolfrey AE, Deeg JH, Scott BL, McDonald GB, Storb R, Sandmaier BM. Allogeneic hematopoietic cell transplantation with non-myeloablative conditioning for patients with hematologic malignancies: Improved outcomes over two decades. Haematologica 2021; 106:1599-1607. [PMID: 32499241 PMCID: PMC8168504 DOI: 10.3324/haematol.2020.248187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Indexed: 12/18/2022] Open
Abstract
We have used a non-myeloablative conditioning regimen for allogeneic hematopoietic cell transplantation for the past 20 years. During that period, changes in clinical practice have been aimed at reducing morbidity and mortality from infections, organ toxicity, and graft-versus-host disease. We hypothesized that improvements in clinical practice led to better transplantation outcomes over time. From 1997–2017, 1,720 patients with hematologic malignancies received low-dose total body irradiation ± fludarabine or clofarabine before transplantation from HLAmatched sibling or unrelated donors, followed by mycophenolate mofetil and a calcineurin inhibitor ± sirolimus. We compared outcomes in three cohorts by year of transplantation: 1997–2003 (n=562), 2004–2009 (n =594), and 2010–2017 (n=564). The proportion of patients ≥60 years old increased from 27% in 1997–2003 to 56% in 2010–2017, and with scores from the Hematopoietic Cell Transplantation Comorbidity Index of ≥3 increased from 25% in 1997–2003 to 45% in 2010–2017. Use of unrelated donors increased from 34% in 1997–2003 to 65% in 2010–2017. When outcomes from 2004–2009 and 2010–2017 were compared to 1997–2003, improvements were noted in overall survival (P=0.0001 for 2004–2009 and P≤0.0001 for 2010–2017), progression-free survival (P=0.002 for 2004–2009 and P<0.0001 for 2010–2017), non-relapse mortality (P<0.0001 for 2004– 2009 and P<0.0001 for 2010–2017), and in rates of grades 2–4 acute and chronic graft-versus-host disease. For patients with hematologic malignancies who underwent transplantation with non-myeloablative conditioning, outcomes have improved during the past two decades. Trials reported are registered under clinicaltrials gov. Identifiers: NCT00003145, NCT00003196, 005803, NCT00006251, NCT00014235, NCT00027820, NCT00031655, NCT00036738, NCT00045435, NCT00052546, NCT00060424, NCT00075478, NCT00078858, NCT00089011, NCT00104858, NCT00105001, NCT00110058, NCT00397813, NCT00793572, NCT01231412, NCT01252667, NCT01527045.
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Affiliation(s)
- Jason P Cooper
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Barry E Storer
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Noa Granot
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Boglark Gyurkocza
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Mohamed L Sorror
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Thomas R Chauncey
- Fred Hucthinson Cancer Research Center, Univ of Washington, VA Puget Sound Health Care, Seattle, USA
| | | | | | - Michael B Maris
- Colorado Blood Cancer Institute at HealthONE Presbyterian/St. Luke Medical Center, Denver, USA
| | | | - Benedetto Bruno
- Azienda Ospedaliera S Giovanni Battista, University of Turin, Turin, Italy
| | - Firoozeh Sahebi
- City of Hope/Kaiser Permanente Medical Group, Duarte, CA, USA
| | | | | | | | | | | | | | | | | | | | | | - Kai Hübel
- University Hospital of Cologne, Cologne, Germany
| | | | - David G Maloney
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Marco Mielcarek
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Paul J Martin
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Mary E D Flowers
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - George E Georges
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Ann E Woolfrey
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Joachim H Deeg
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Bart L Scott
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - George B McDonald
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Rainer Storb
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
| | - Brenda M Sandmaier
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA
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Lia G, Giaccone L, Leone S, Bruno B. Biomarkers for Early Complications of Endothelial Origin After Allogeneic Hematopoietic Stem Cell Transplantation: Do They Have a Potential Clinical Role? Front Immunol 2021; 12:641427. [PMID: 34093530 PMCID: PMC8170404 DOI: 10.3389/fimmu.2021.641427] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/04/2021] [Indexed: 12/17/2022] Open
Abstract
Endothelial cell (EC) dysfunction causes a number of early and life-threatening post hematopoietic stem cell transplant (HCT) complications that result in a rapid clinical decline. The main early complications are graft-vs.-host disease (GVHD), transplant associated thrombotic microangiopathy (TA-TMA), and sinusoidal obstruction syndrome (SOS). Post-HCT endothelial dysfunction occurs as a result of chemotherapy, infections, and allogeneic reactivity. Despite major advances in transplant immunology and improvements in supportive care medicine, these complications represent a major obstacle for successful HCT. In recent years, different biomarkers have been investigated for early detection of post-transplant endothelial cell dysfunction, but few have been validated. In this review we will define GVHD, TA-TMA and SOS, summarize the current data available in HCT biomarker research and identify promising biomarkers for detection and diagnosis of early HCT complications.
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Affiliation(s)
- Giuseppe Lia
- Stem Cell Transplant Program, Department of Oncology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Luisa Giaccone
- Stem Cell Transplant Program, Department of Oncology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Sarah Leone
- Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
- Division of Hematology and Medical Oncology, New York University Grossman School of Medicine, Perlmutter Cancer Center, New York University Langone Health, New York, NY, United States
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