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Gambella M, Carlomagno S, Mangerini R, Colombo N, Parodi A, Ghiggi C, Giannoni L, Coviello E, Setti C, Luchetti S, Serio A, Laudisi A, Passannante M, Bo A, Tedone E, Sivori S, Angelucci E, Raiola AM. Early CAR - CD4 + T-lymphocytes recovery following CAR-T cell infusion: A worse outcome in diffuse large B cell lymphoma. EJHaem 2024; 5:360-368. [PMID: 38633118 PMCID: PMC11020131 DOI: 10.1002/jha2.871] [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] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Abstract
CAR- CD4+ T cell lymphopenia is an emerging issue following CAR-T cell therapy. We analyzed the determinants of CD4+ T cell recovery and a possible association with survival in 31 consecutive patients treated with commercial CAR-T for diffuse large B-cell (DLBCL) or mantle cell lymphoma. Circulating immune subpopulations were characterized through multiparametric-flow cytometry. Six-month cumulative incidence of CAR- CD4+ T cell recovery (≥200 cells/μL) was 0.43 (95% confidence interval [CI]: 0.28-0.65). Among possible determinants of CD4+ T cell recovery, we recognized infusion of a 4-1BB product (tisagenlecleucel, TSA) in comparison with a CD28 (axicabtagene/brexucabtagene, AXI/BRX) (hazard ratio [HR] [95% CI]: 5.79 [1.16-24.12] p = 0.016). Higher CD4+ T cell counts resulted with TSA at month-1, -2 and -3. Moderate-to-severe infections were registered with prolonged CD4+ T cell lymphopenia. Early, month-1 CD4+ T cell recovery was associated with a worse outcome in the DLBCL cohort, upheld in a multivariate regression model for overall survival (HR: 4.46 [95% CI: 1.12-17.71], p = 0.03). We conclude that a faster CAR- CD4+ T cell recovery is associated with TSA as compared to AXI/BRX. Month-1 CAR- CD4+ T cell subset recovery could represent a "red flag" for CAR-T cell therapy failure in DLBCL patients.
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Affiliation(s)
- Massimiliano Gambella
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
- Department of Experimental Medicine (DIMES)University of GenoaGenovaItaly
| | | | - Rosa Mangerini
- Anatomia Patologica OspedalieraIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Nicoletta Colombo
- Anatomia Patologica OspedalieraIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Alessia Parodi
- Anatomia Patologica OspedalieraIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Chiara Ghiggi
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Livia Giannoni
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Elisa Coviello
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Chiara Setti
- Department of Experimental Medicine (DIMES)University of GenoaGenovaItaly
| | - Silvia Luchetti
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Alberto Serio
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Antonella Laudisi
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Monica Passannante
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Alessandra Bo
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Elisabetta Tedone
- Anatomia Patologica OspedalieraIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Simona Sivori
- Department of Experimental Medicine (DIMES)University of GenoaGenovaItaly
- IRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Emanuele Angelucci
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Anna Maria Raiola
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
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Conconi A, Chiappella A, Ferreri AJM, Stathis A, Botto B, Sassone M, Gaidano G, Balzarotti M, Merli F, Tucci A, Vanazzi A, Tani M, Bruna R, Orsucci L, Cabras MG, Celli M, Annibali O, Liberati AM, Zanni M, Ghiggi C, Pisani F, Pinotti G, Dore F, Esposito F, Pirosa MC, Cesaretti M, Bonomini L, Vitolo U, Zucca E. IELSG30 phase 2 trial: intravenous and intrathecal CNS prophylaxis in primary testicular diffuse large B-cell lymphoma. Blood Adv 2024; 8:1541-1549. [PMID: 38181782 DOI: 10.1182/bloodadvances.2023011251] [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: 07/18/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/07/2024] Open
Abstract
ABSTRACT Primary testicular diffuse large B-cell lymphoma (PTL) is characterized by high risk of contralateral testis and central nervous system (CNS) relapse. Chemoimmunotherapy with intrathecal (IT) CNS prophylaxis and contralateral testis irradiation eliminates contralateral recurrences and reduces CNS relapses. The IELSG30 phase 2 study investigated feasibility and activity of an intensified IT and IV CNS prophylaxis. Patients with stage I/II PTL who had not received treatment received 2 cycles of IV high-dose methotrexate (MTX) (1.5 g/m2) after 6 cycles of the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, every 21 days). IT liposomal cytarabine was administered on day 0 of cycles 2 to 5 of 21-day R-CHOP regimen. Contralateral testis radiotherapy (25-30 Gy) was recommended. Fifty-four patients (median age: 66 years) with stage I (n = 32) or II (n = 22) disease were treated with R-CHOP, 53 received at least 3 doses of IT cytarabine, 48 received at least 1 dose of IV MTX, and 50 received prophylactic radiotherapy. No unexpected toxicity occurred. At a median follow-up of 6 years, there was no CNS relapse; 7 patients progressed, and 8 died, with 5-year progression-free and overall survival rates of 91% (95% confidence interval [CI], 79-96) and 92% (95% CI, 81-97), respectively. Extranodal recurrence was documented in 6 patients (in 2 without nodal involvement). In 4 cases, the relapse occurred >6 years after treatment. Causes of death were lymphoma (n = 4), second primary malignancy (n = 1), cerebral vasculopathy (n = 1), unknown (n = 2). Intensive prophylaxis was feasible and effective in preventing CNS relapses. Late relapses, mainly at extranodal sites, represented the most relevant pattern of failure. This trial was registered at www.clinicaltrials.gov as #NCT00945724.
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Affiliation(s)
| | - Annalisa Chiappella
- Haematology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Barbara Botto
- SC Ematologia, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marianna Sassone
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianluca Gaidano
- SCDU Ematologia, Department of Translational Medicine, University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Monica Balzarotti
- UO Ematologia, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Merli
- Hematology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Tucci
- Division of Hematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Anna Vanazzi
- Division of Clinical Haemato-Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Monica Tani
- UO Ematologia, Dipartimento Oncologia ed Ematologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Riccardo Bruna
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Lorella Orsucci
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Melania Celli
- Ospedale degli Infermi, Hematology Unit, Rimini, Italy
| | - Ombretta Annibali
- Area Ematologia Medicina Trasfusionale e Terapia cellulare Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Anna Marina Liberati
- SC Oncoematologia, Azienda Ospedaliera Santa Maria, Università degli studi di Perugia, Terni, Italy
| | - Manuela Zanni
- Antonio e Biagio e Cesare Arrigo Hospital, Hematology Unit, Alessandria, Italy
| | - Chiara Ghiggi
- IRCCS Ospedale Policlinico San Martino UO Ematologia e Terapie Cellulari, Genoa, Italy
| | - Francesco Pisani
- Hematology and Stem Cell Transplantation Unit, IRCCS Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | | | | | - Fabiana Esposito
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Maria Cristina Pirosa
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Institute of Oncology Research, Bellinzona, Switzerland
| | | | | | - Umberto Vitolo
- Medical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia-IRCCS, Candiolo, Turin, Italy
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Institute of Oncology Research, Bellinzona, Switzerland
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3
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Ladetto M, Tavarozzi R, Zanni M, Evangelista A, Ferrero S, Tucci A, Botto B, Bolis S, Volpetti S, Zilioli VR, Puccini B, Arcari A, Pavone V, Gaidano G, Corradini P, Tani M, Cavallo F, Milone G, Ghiggi C, Pinto A, Pastore D, Ferreri AJM, Latte G, Patti C, Re F, Benedetti F, Luminari S, Pennese E, Bossi E, Boccomini C, Anastasia A, Bottelli C, Ciccone G, Vitolo U. Radioimmunotherapy versus autologous hematopoietic stem cell transplantation in relapsed/refractory follicular lymphoma: a Fondazione Italiana Linfomi multicenter, randomized, phase III trial. Ann Oncol 2024; 35:118-129. [PMID: 37922989 DOI: 10.1016/j.annonc.2023.10.095] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Optimal consolidation for young patilents with relapsed/refractory (R/R) follicular lymphoma (FL) remains uncertain in the rituximab era, with an unclear benefit of autologous stem cell transplantation (ASCT). The multicenter, randomized, phase III FLAZ12 (NCT01827605) trial compared anti-CD20 radioimmunotherapy (RIT) with ASCT as consolidation after chemoimmunotherapy, both followed by rituximab maintenance. PATIENTS AND METHODS Patients (age 18-65 years) with R/R FL and without significant comorbidities were enrolled and treated with three courses of conventional, investigator-chosen chemoimmunotherapies. Those experiencing at least a partial response were randomized 1 : 1 to ASCT or RIT before CD34+ collection, and all received postconsolidation rituximab maintenance. Progression-free survival (PFS) was the primary endpoint. The target sample size was 210 (105/group). RESULTS Between August 2012 and September 2019, of 164 screened patients, 159 were enrolled [median age 57 (interquartile range 49-62) years, 55% male, 57% stage IV, 20% bulky disease]. The study was closed prematurely because of low accrual. Data were analyzed on 8 June 2023, on an intention-to-treat basis, with a 77-month median follow-up from enrollment. Of the 141 patients (89%), 70 were randomized to ASCT and 71 to RIT. The estimated 3-year PFS in both groups was 62% (hazard ratio 1.11, 95% confidence interval 0.69-1.80, P = 0.6662). The 3-year overall survival also was similar between the two groups. Rates of grade ≥3 hematological toxicity were 94% with ASCT versus 46% with RIT (P < 0.001), and grade ≥3 neutropenia occurred in 94% versus 41%, respectively (P < 0.001). Second cancers occurred in nine patients after ASCT and three after radioimmunotherapy (P = 0.189). CONCLUSIONS Even if prematurely discontinued, our study did not demonstrate the superiority of ASCT versus RIT. ASCT was more toxic and demanding for patients and health services. Both strategies yielded similar, favorable long-term outcomes, suggesting that consolidation programs milder than ASCT require further investigation in R/R FL.
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Affiliation(s)
- M Ladetto
- Department of Translational Medicine, University of Eastern Piedmont, Novara; SCDU di Ematologia, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria.
| | - R Tavarozzi
- Department of Translational Medicine, University of Eastern Piedmont, Novara; SCDU di Ematologia, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M Zanni
- SCDU di Ematologia, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | - A Evangelista
- SSD of Clinical Epidemiology, Universitaria Città della Salute e della Scienza di Torino and Centre for Cancer Prevention Piemonte, Torino
| | - S Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Universitaria Città della Salute e della Scienza di Torino and Centre for Cancer Prevention Piemonte, Torino
| | - A Tucci
- Department of Hematology, Spedali Civili, Brescia
| | - B Botto
- Struttura Complessa Ematologia, AOU Città della salute e della scienza di Torino, Turin
| | - S Bolis
- SC Ematologia ASST-Monza, Monza
| | - S Volpetti
- Division of Hematology, Clinica Ematologica, Centro Trapianti e Terapie Cellulari Carlo Melzi, DISM, Azienda Ospedaliero Universitaria S. M. Misericordia, Udine
| | - V R Zilioli
- Division of Haematology, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - B Puccini
- Department of Haematology, University of Florence, Firenze
| | - A Arcari
- Hematology Unit, Ospedale Guglielmo da Saliceto, Piacenza
| | - V Pavone
- A. O. C. Panico-U.O.C Ematologia e Trapianto, Tricase, Lecce
| | - G Gaidano
- SCDU di Ematologia, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria; Division of Hematology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara
| | - P Corradini
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milano
| | - M Tani
- Hematology Unit, Department of Oncology and Hematology, "Santa Maria delle Croci" Hospital, Ravenna
| | - F Cavallo
- Department of Molecular Biotechnologies and Health Sciences, Universitaria Città della Salute e della Scienza di Torino and Centre for Cancer Prevention Piemonte, Torino
| | - G Milone
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania
| | - C Ghiggi
- Hematology Division, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova
| | - A Pinto
- Department of Hematology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico "Fondazione G Pascale", Naples
| | | | - A J M Ferreri
- Onco-Hematology Department, Fondazione Centro San Raffaele, Milano
| | - G Latte
- Unità di Ematologia e Trapianto di Midollo Osseo, San Francesco Hospital, Nuoro
| | - C Patti
- Divisione di Oncoematologia, Azienda Villa Sofia - Cervello, Palermo
| | - F Re
- Department of Hematology, A.O.U. di Parma, Parma
| | - F Benedetti
- Department of Medicine, Section of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona
| | - S Luminari
- Department of Hematology, IRCCS Reggio Emilia, Reggio Emilia
| | - E Pennese
- Lymphoma Unit, Department of Hematology, Ospedale Spirito Santo, Pescara
| | - E Bossi
- SC Ematologia ASST-Monza, Monza
| | - C Boccomini
- Struttura Complessa Ematologia, AOU Città della salute e della scienza di Torino, Turin
| | - A Anastasia
- Department of Hematology, Spedali Civili, Brescia
| | - C Bottelli
- Department of Hematology, Spedali Civili, Brescia
| | - G Ciccone
- SSD of Clinical Epidemiology, Universitaria Città della Salute e della Scienza di Torino and Centre for Cancer Prevention Piemonte, Torino
| | - U Vitolo
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
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Nizzoli ME, Manni M, Ghiggi C, Pulsoni A, Musuraca G, Merli M, Califano C, Bari A, Massaia M, Conconi A, Musto P, Mannina D, Perrone T, Re F, Galimberti S, Gini G, Capponi M, Vitolo U, Usai SV, Stefani PM, Ballerini F, Liberati AM, Pennese E, Pastore D, Skrypets T, Catellani H, Marcheselli L, Federico M, Luminari S. Impact of immunochemotherapy with R-bendamustine or R-CHOP for treatment naïve advanced-stage follicular lymphoma: A subset analysis of the FOLL12 trial by Fondazione Italiana Linfomi. Hematol Oncol 2023; 41:655-662. [PMID: 37246287 DOI: 10.1002/hon.3184] [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: 04/06/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Abstract
We conducted a post hoc analysis of the FOLL12 trial to determine the impact of different initial immunochemotherapy (ICT) regimens on patient outcomes. Patients were selected from the FOLL12 trial, which included adults with stage II-IV follicular lymphoma (FL) grade 1-3a and high tumor burden. Patients were randomized 1:1 to receive either standard ICT followed by rituximab maintenance (RM) or the same ICT followed by a response-adapted approach. ICT consisted of rituximab-bendamustine (RB) or rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP), per physician's decision. A total of 786 patients were included in this analysis, 341 of whom received RB and 445 R-CHOP. RB was more frequently prescribed to older subjects, females, patients without bulky disease, and those with grade 1-2 FL. After a median of 56 months of follow-up, R-CHOP and RB had similar progression-free survival (PFS) (Hazard Ratio for RB 1.11, 95% CI 0.87-1.42, p = 0.392). Standard RM was associated with improved PFS compared to response-adapted management both after R-CHOP and RB. Grade 3-4 hematologic adverse events were more frequent with R-CHOP during induction treatment and more frequent with RB during RM. Grade 3-4 infections were more frequent with RB. RB was also associated with a higher incidence of transformed FL. R-CHOP and RB showed similar activity and efficacy, but with different safety profiles and long-term events, suggesting that the treating physician should carefully select the most appropriate chemotherapy regimen for each patient based on patient's individual characteristics, choices, and risk profile.
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Affiliation(s)
- Maria E Nizzoli
- Hematology Unit, Azienda Unitа Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Martina Manni
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Ghiggi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Pulsoni
- Department of Translational and Precision Medicine, Sapienza University - UOC Ematologia, S.M. Goretti Hospital, Latina, Italy
| | - Gerardo Musuraca
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Michele Merli
- Hematology, University Hospital Ospedale di Circolo e Fondazione Macchi-ASST Sette Laghi, University of Insubria, Varese, Italy
| | | | - Alessia Bari
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università di Modena e Reggio Emilia, Modena, Italy
| | - Massimo Massaia
- SC Ematologia, AO S. Croce e Carle, Cuneo, Italy
- Centro di Biotecnologie Molecolari, University of Torino, Turin, Italy
| | | | - Pellegrino Musto
- Hematology, IRCCS CROB of Rionero in Vulture, Rionero in Vulture, Italy
| | - Donato Mannina
- Azienda Ospedaliera Papardo-UOC di Ematologia, Messina, Italy
| | - Tommasina Perrone
- Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari, Italy
| | - Francesca Re
- Division od Immuno-Haematology, AOU Parma, Parma, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Guido Gini
- Clinic of Hematology AOU delle Marche- Università Politecnica delle Marche, Ancona, Italy
| | - Monia Capponi
- Department of Hematology, University of Perugia, Perugia, Italy
| | - Umberto Vitolo
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Sara V Usai
- Division of Hematology, Ospedale Oncologico Armando Businco, Cagliari, Italy
| | - Piero M Stefani
- Hematology Unit, General Hospital Ca' Foncello, Treviso, Italy
| | - Filippo Ballerini
- Clinica Ematologica, Ospedale Policlinico San Martino, Genova, Italy
| | - Anna M Liberati
- Oncohematology Unit, University of Perugia, Azienda Ospedaliera S.Maria Terni, Messina, Italy
| | - Elsa Pennese
- Lymphoma Unit, Department of Hematology, Ospedale Spirito Santo, Pescara, Italy
| | | | - Tetiana Skrypets
- Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Hillary Catellani
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Massimo Federico
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda Unitа Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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5
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Morbelli S, Gambella M, Raiola AM, Ghiggi C, Bauckneht M, Raimondo TD, Lapucci C, Sambuceti G, Inglese M, Angelucci E. Brain FDG-PET findings in chimeric antigen receptor T-cell therapy neurotoxicity for diffuse large B-cell lymphoma. J Neuroimaging 2023; 33:825-836. [PMID: 37291470 DOI: 10.1111/jon.13135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Chimeric antigen receptor (CAR) T-cell therapy is potentially associated with treatment-related toxicities mainly consisting of cytokine release syndrome (CRS) and immune-effector cell-associated neurotoxicity syndrome (ICANS). We evaluated brain metabolic correlates of CRS with and without ICANS in diffuse large B-cell lymphoma patients treated with CAR-T. METHODS Twenty-one refractory DLCBLs underwent whole-body and brain [18 F]-fluorodeoxyglucose (FDG) PET before and 30 days after treatment with CAR-T. Five patients did not develop inflammatory-related side effects, 11 patients developed CRS, while in 5 patients CRS evolved in ICANS. Baseline and post-CAR-T brain FDG-PET were compared with a local controls dataset to identify hypometabolic patterns both at single-patient and group levels (p < .05 after correction for family-wise error [FWE). Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were computed on baseline FDG-PET and compared between patients' subgroups (t-test). RESULTS ICANS showed an extended and bilateral hypometabolic pattern mainly involving the orbitofrontal cortex, frontal dorsolateral cortex, and anterior cingulate (p < .003 FWE-corrected). CRS without ICANS showed significant hypometabolism in less extended clusters mainly involving bilateral medial and lateral temporal lobes, posterior parietal lobes, anterior cingulate, and cerebellum (p < .002 FWE-corrected). When compared, ICANS showed a more prominent hypometabolism in the orbitofrontal and frontal dorsolateral cortex in both hemispheres than CRS (p < .002 FWE-corrected). Mean baseline MTV and TLG were significantly higher in ICANS than CRS (p < .02). CONCLUSIONS Patients with ICANS are characterized by a frontolateral hypometabolic signature coherently with the hypothesis of ICANS as a predominant frontal syndrome and with the more prominent susceptibility of frontal lobes to cytokine-induced inflammation.
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Affiliation(s)
- Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Massimiliano Gambella
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Anna Maria Raiola
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Ghiggi
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Bauckneht
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Tania Di Raimondo
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Caterina Lapucci
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
| | - Gianmario Sambuceti
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
| | - Emanuele Angelucci
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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6
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Bachy E, Savage KJ, Huang H, Kwong YL, Gritti G, Zhang Q, Liberati AM, Cao J, Yang H, Hao S, Hu J, Zhou K, Petrini M, Russo F, Zhang H, Sang W, Ji J, Ferreri AJM, Damaj GL, Liu H, Zhang W, Ke X, Ghiggi C, Huang S, Li X, Yao H, Paik J, Novotny W, Zhou W, Zhu H, Zinzani PL. Treating relapsed/refractory mature T- and NK-cell neoplasms with tislelizumab: a multicenter open-label phase 2 study. Blood Adv 2023; 7:4435-4447. [PMID: 37276067 PMCID: PMC10440460 DOI: 10.1182/bloodadvances.2022009575] [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: 12/19/2022] [Revised: 03/27/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023] Open
Abstract
Patients with relapsed/refractory (R/R) mature T- and natural killer (NK)-cell neoplasms lack effective treatments after failure of standard therapies. This phase 2 study evaluated the efficacy and safety of the programmed cell death protein 1 inhibitor tislelizumab in these patients. Seventy-seven patients were treated with 200 mg tislelizumab every 3 weeks. Twenty-two patients with extranodal NK-/T-cell lymphomas were enrolled in cohort 1; 44 patients with peripheral T-cell lymphoma (PTCL) were enrolled in cohort 2 (21 patients had PTCL not otherwise specified, 11 patients had angioimmunoblastic T-cell lymphoma, and 12 patients had anaplastic large-cell lymphoma). Cohort 3 comprised 11 patients with cutaneous T-cell lymphoma, of which 8 patients had mycosis fungoides (MF) and 3 had Sézary syndrome. Of the 77 patients, 76.6% had advanced-stage disease, 51.9% had refractory disease, and 49.4% received ≥3 prior systemic regimens. Promising efficacy was observed in cohort 3 (median follow-up [FU], 16.6 months; overall response rate [ORR], 45.5%; complete response [CR], 9.1%; median duration of response [DOR], 11.3 months; median progression-free survival, 16.8 months; median overall survival, not reached). Modest efficacy was observed in cohort 1 (median FU, 8.4 months; ORR, 31.8%; CR, 18.2%; median DOR, not reached) and cohort 2 (median FU, 9.3 months; ORR, 20.5%; CR, 9.1%; median DOR, 8.2 months). Most treatment-related adverse events were grade 1 or 2, and the safety profile was consistent with the known safety profile of tislelizumab. In conclusion, tislelizumab was well tolerated, achieving modest efficacy in R/R mature T- and NK-cell neoplasms, with some long-lasting remissions. This trial was registered at www.clinicaltrials.gov as #NCT03493451.
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Affiliation(s)
- Emmanuel Bachy
- Hematology Department, Lyon Sud Hospital and Claude Bernard Lyon 1 University, Lyon, France
| | - Kerry J. Savage
- Division of Medical Oncology, University of British Columbia, BC Cancer, Vancouver, Canada
| | | | | | | | - Qingyuan Zhang
- Harbin Medical University Cancer Hospital, Harbin, China
| | | | - Junning Cao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Haiyan Yang
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Siguo Hao
- Xin Hua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianda Hu
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Keshu Zhou
- Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Mario Petrini
- Azienda Ospedaliero Universitaria Pisana, Stabilimento di Santa Chiara, Pisa, Italy
| | - Filomena Russo
- Ospedale Maggiore, Ematologia e Centro Trapianti Midollo Osseo (CTMO), AOU Parma, Parma, Italy
| | - Huilai Zhang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Wei Sang
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jie Ji
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | - Hui Liu
- Beijing Hospital, Beijing, China
| | - Wei Zhang
- Peking Union Medical College Hospital, Beijing, China
| | - Xiaoyan Ke
- Peking University Third Hospital, Beijing, China
| | | | - Sha Huang
- BeiGene (Shanghai) Co Ltd, Shanghai, China
| | | | - Hui Yao
- BeiGene (Shanghai) Co Ltd, Shanghai, China
| | | | | | | | | | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
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7
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Tisi MC, Moia R, Patti C, Evangelista A, Ferrero S, Spina M, Tani M, Botto B, Celli M, Puccini B, Cencini E, Di Rocco A, Chini C, Ghiggi C, Zambello R, Zanni M, Sciarra R, Bruna R, Ferrante M, Pileri SA, Quaglia FM, Stelitano C, Re A, Volpetti S, Zilioli VR, Arcari A, Merli F, Visco C. Long-term follow-up of rituximab plus bendamustine and cytarabine in older patients with newly diagnosed MCL. Blood Adv 2023; 7:3916-3924. [PMID: 37171620 PMCID: PMC10405197 DOI: 10.1182/bloodadvances.2023009744] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
The combination of rituximab, bendamustine, and low-dose cytarabine (R-BAC) has been studied in a phase 2 prospective multicenter study from Fondazione Italiana Linfomi (RBAC500). In 57 previously untreated elderly patients with mantle cell lymphoma (MCL), R-BAC was associated with a complete remission rate of 91% and 2-year progression-free survival (PFS) of 81% (95% confidence interval [CI], 68-89). Here, we report the long-term survival outcomes, late toxicities, and results of minimal residual disease (MRD) evaluation. After a median follow-up of 86 months (range, 57-107 months), the median overall survival (OS) and PFS were not reached. The 7-year PFS and OS rates were 55% (95% CI, 41-67), and 63% (95% CI, 49-74), respectively. Patients who responded (n = 53) had a 7-year PFS of 59% (95% CI, 44-71), with no relapse or progression registered after the sixth year. In the multivariate analysis, blastoid/pleomorphic morphology was the strongest adverse predictive factor for PFS (P = .04). Patients with an end of treatment negative MRD had better, but not significant, outcomes for both PFS and OS than patients with MRD-positive (P = 0.148 and P = 0.162, respectively). There was no signal of late toxicity or an increase in secondary malignancies during the prolonged follow-up. In conclusion, R-BAC, which was not followed by maintenance therapy, showed sustained efficacy over time in older patients with MCL. Survival outcomes compare favorably with those of other immunochemotherapy regimens (with or without maintenance), including combinations of BTK inhibitors upfront. This study was registered with EudraCT as 2011-005739-23 and at www.clinicaltrials.gov as #NCT01662050.
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Affiliation(s)
- Maria Chiara Tisi
- Hematology Unit, San Bortolo Hospital, AULSS 8 Berica, Vicenza, Italy
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and AOU Maggiore della Carità, Novara, Italy
| | - Caterina Patti
- Oncohematology Azienda Ospedali Riuniti Villa Sofia-V. Cervello Palermo, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza and CPO Piemonte, Turin, Italy
| | - Simone Ferrero
- Hematology 1 U, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy/AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Michele Spina
- Division of Medical Oncology and Immune-related Tumors, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - Monica Tani
- Hematology, Ospedale di Ravenna, Ravenna, Italy
| | - Barbara Botto
- Hematology, Città' della Salute e della Scienza University Hospital, Torino, Italy
| | | | - Benedetta Puccini
- Department of Hematology, Careggi Hospital and University of Florence, Florence, Italy
| | - Emanuele Cencini
- UOC Ematologia, Azienda Ospedaliera Universitaria Senese & University of Siena, Siena, Italy
| | - Alice Di Rocco
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Chiara Ghiggi
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Manuela Zanni
- Hematology, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Roberta Sciarra
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Bruna
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and AOU Maggiore della Carità, Novara, Italy
| | - Martina Ferrante
- Hematology 1 U, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | | | - Francesca Maria Quaglia
- Section of Hematology, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
| | - Caterina Stelitano
- Grande Ospedale Metropolitano, Bianchi Melacrino Morelli, Ematologia Reggio Calabria, Reggio Calabria, Italy
| | | | - Stefano Volpetti
- Hematology Department, Santa Maria della Misericordia Hospital - ASUFC, Udine, Italy
| | | | - Annalisa Arcari
- Hematology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Carlo Visco
- Section of Hematology, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
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8
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Mikulska M, Sepulcri C, Dentone C, Magne F, Balletto E, Baldi F, Labate L, Russo C, Mirabella M, Magnasco L, Di Grazia C, Ghiggi C, Raiola AM, Giacobbe DR, Vena A, Beltramini S, Bruzzone B, Lemoli RM, Angelucci E, Bassetti M. Triple Combination Therapy With 2 Antivirals and Monoclonal Antibodies for Persistent or Relapsed Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Immunocompromised Patients. Clin Infect Dis 2023; 77:280-286. [PMID: 36976301 DOI: 10.1093/cid/ciad181] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Severely immunocompromised patients are at risk for prolonged or relapsed Coronavirus Disease 2019 (COVID-19), leading to increased morbidity and mortality. We aimed to evaluate efficacy and safety of combination treatment in immunocompromised COVID-19 patients. METHODS We included all immunocompromised patients with prolonged/relapsed COVID-19 treated with combination therapy with 2 antivirals (remdesivir plus nirmatrelvir/ritonavir, or molnupiravir in case of renal failure) plus, if available, anti-spike monoclonal antibodies (mAbs), between February and October 2022. The main outcomes were virological response at day 14 (negative Severe Acute Respiratory Syndrome Coronavirus 2 [SARS-CoV-2] swab) and virological and clinical response (alive, asymptomatic, with negative SARS-CoV-2 swab) at day 30 and the last follow-up. RESULTS Overall, 22 patients (Omicron variant in 17/18) were included: 18 received full combination of 2 antivirals and mAbs and 4 received 2 antivirals only; in 20 of 22 (91%) patients, 2 antivirals were nirmatrelvir/ritonavir plus remdesivir. Nineteen (86%) patients had hematological malignancy, and 15 (68%) had received anti-CD20 therapy. All were symptomatic; 8 (36%) required oxygen. Four patients received a second course of combination treatment. The response rate at day 14, day 30, and last follow-up was 75% (15/20 evaluable), 73% (16/22), and 82% (18/22), respectively. Day 14 and 30 response rates were significantly higher when combination therapy included mAbs. Higher number of vaccine doses was associated with better final outcome. Two patients (9%) developed severe side effects (bradycardia leading to remdesivir discontinuation and myocardial infarction). CONCLUSIONS Combination therapy including 2 antivirals (mainly remdesivir and nirmatrelvir/ritonavir) and mAbs was associated with high rate of virological and clinical response in immunocompromised patients with prolonged/relapsed COVID-19.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Sepulcri
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Dentone
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federica Magne
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elisa Balletto
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federico Baldi
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Laura Labate
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Russo
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Michele Mirabella
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Laura Magnasco
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carmen Di Grazia
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Ghiggi
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Daniele Roberto Giacobbe
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonio Vena
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Bianca Bruzzone
- Department of Health Sciences, Hygiene Unit, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
| | - Roberto M Lemoli
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, Clinic of Hematology, University of Genoa, Genova, Italy
| | - Emanuele Angelucci
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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9
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Marini C, Cossu V, Lanfranchi F, Carta S, Vitale F, D'Amico F, Bauckneht M, Morbelli S, Donegani MI, Chiola S, Raffa S, Sofia L, Di Raimondo T, Ballerini F, Ghiggi C, Durando P, Ravera S, Riondato M, Orengo AM, Bruno S, Chiesa S, Sambuceti G. Divergent Oxidative Stress in Normal Tissues and Inflammatory Cells in Hodgkin and Non-Hodgkin Lymphoma. Cancers (Basel) 2023; 15:3533. [PMID: 37444643 DOI: 10.3390/cancers15133533] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Previous studies reported mitochondrial and endoplasmic reticulum redox stress in peripheral blood mononucleated cells (PBMCs) of treatment-naïve Hodgkin lymphoma (HL) patients. Here, we assessed whether this response also applies to non-HL (NHL) patients, and whether the oxidative damage is a selective feature of PBMCs or, rather, also affects tissues not directly involved in the inflammatory response. METHODS Isolated PBMCs of 28 HL, 9 diffuse large B cell lymphoma, 8 less aggressive-NHL, and 45 controls underwent flow cytometry to evaluate redox stress and uptake of the glucose analogue 2-NBDG. This analysis was complemented with the assay of malondialdehyde (MDA) levels and enzymatic activity of glucose-6P-dehydrogenase and hexose-6P-dehydrogenase (H6PD). In all lymphoma patients, 18F-fluoro-deoxyglucose uptake was estimated in the myocardium and skeletal muscles. RESULTS Mitochondrial reactive oxygen species generation and MDA levels were increased only in HL patients as well as H6PD activity and 2-NBDG uptake. Similarly, myocardial FDG retention was higher in HL than in other groups as opposed to a similar tracer uptake in the skeletal muscle. CONCLUSIONS Redox stress of PBMCs is more pronounced in HL with respect to both NHL groups. This phenomenon is coherent with an increased activity of H6PD that also extends to the myocardium.
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Affiliation(s)
- Cecilia Marini
- Institute of Molecular Bioimaging and Physiology (IBFM), National Research Council (CNR), 20054 Milan, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Vanessa Cossu
- Human Anatomy Section, Department of Experimental Medicine, University of Genoa, 16132 Genova, Italy
| | | | - Sonia Carta
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | | | - Francesca D'Amico
- Department of Health Sciences, University of Genoa, 16132 Genova, Italy
| | - Matteo Bauckneht
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Health Sciences, University of Genoa, 16132 Genova, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Health Sciences, University of Genoa, 16132 Genova, Italy
| | | | - Silvia Chiola
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Stefano Raffa
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Luca Sofia
- Department of Health Sciences, University of Genoa, 16132 Genova, Italy
| | - Tania Di Raimondo
- Department of Health Sciences, University of Genoa, 16132 Genova, Italy
| | - Filippo Ballerini
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
| | - Chiara Ghiggi
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, 16132 Genova, Italy
| | - Silvia Ravera
- Human Anatomy Section, Department of Experimental Medicine, University of Genoa, 16132 Genova, Italy
| | | | | | - Silvia Bruno
- Human Anatomy Section, Department of Experimental Medicine, University of Genoa, 16132 Genova, Italy
| | - Sabrina Chiesa
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Gianmario Sambuceti
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Health Sciences, University of Genoa, 16132 Genova, Italy
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10
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Mikulska M, Testi D, Russo C, Balletto E, Sepulcri C, Bussini L, Dentone C, Magne F, Policarpo S, Campoli C, Miselli F, Cilli A, Ghiggi C, Aquino S, Di Grazia C, Giannella M, Giacobbe DR, Vena A, Raiola AM, Bonifazi F, Zinzani P, Cavo M, Lemoli R, Angelucci E, Viale P, Bassetti M, Bartoletti M. Outcome of early treatment of SARS-CoV-2 infection in patients with haematological disorders. Br J Haematol 2023; 201:628-639. [PMID: 36806152 DOI: 10.1111/bjh.18690] [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: 12/02/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
Outcome of early treatment of COVID-19 with antivirals or anti-spike monoclonal antibodies (MABs) in patients with haematological malignancies (HM) is unknown. A retrospective study of HM patients treated for mild/moderate COVID-19 between March 2021 and July 2022 was performed. The main composite end-point was treatment failure (severe COVID-19 or COVID-19-related death). We included 328 consecutive patients who received MABs (n = 120, 37%; sotrovimab, n = 73) or antivirals (n = 208, 63%; nirmatrelvir/ritonavir, n = 116) over a median of two days after symptoms started; 111 (33.8%) had non-Hodgkin lymphoma (NHL); 89 (27%) were transplant/CAR-T (chimaeric antigen receptor T-cell therapy) recipients. Most infections (n = 309, 94%) occurred during the Omicron period. Failure developed in 31 patients (9.5%). Its independent predictors were older age, fewer vaccine doses, and treatment with MABs. Rate of failure was lower in the Omicron versus the pre-Omicron period (7.8% versus 36.8%, p < 0.001). During the Omicron period, predictors of failure were age, fewer vaccine doses and diagnosis of acute myeloid leukaemia/myelodysplastic syndrome (AML/MDS). Independent predictors of longer viral shedding were age, comorbidities, hospital admission at diagnosis, NHL/CLL, treatment with MABs. COVID-19-associated mortality was 3.4% (n = 11). The mortality in those who developed severe COVID-19 after early treatment was 26% in the Omicron period. Patients with HM had a significant risk of failure of early treatment, even during the Omicron period, with high mortality rate.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Diletta Testi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Chiara Russo
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Balletto
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Sepulcri
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Linda Bussini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Sílvia Policarpo
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Caterina Campoli
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Filippo Miselli
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandro Cilli
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Chiara Ghiggi
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Aquino
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carmen Di Grazia
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Daniele Roberto Giacobbe
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Bonifazi
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Institute of Hematology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - Pierluigi Zinzani
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Institute of Hematology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - Michele Cavo
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Institute of Hematology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - Roberto Lemoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Internal Medicine (DiMI), Clinic of Hematology, University of Genoa, Genoa, Italy
| | - Emanuele Angelucci
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Bartoletti
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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11
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Ferrero S, Grimaldi D, Genuardi E, Drandi D, Zaccaria GM, Alessandria B, Ghislieri M, Ferrante M, Evangelista A, Mantoan B, De Luca G, Stefani PM, Benedetti F, Casaroli I, Zanni M, Castellino C, Pavone V, Petrini M, Re F, Hohaus S, Musuraca G, Cascavilla N, Ghiggi C, Liberati AM, Cortelazzo S, Ladetto M. Punctual and kinetic MRD analysis from the Fondazione Italiana Linfomi MCL0208 phase 3 trial in mantle cell lymphoma. Blood 2022; 140:1378-1389. [PMID: 35737911 PMCID: PMC9507010 DOI: 10.1182/blood.2021014270] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/27/2022] [Indexed: 11/20/2022] Open
Abstract
Minimal residual disease (MRD) analysis is a known predictive tool in mantle cell lymphoma (MCL). We describe MRD results from the Fondazione Italiana Linfomi phase 3 MCL0208 prospective clinical trial assessing lenalidomide (LEN) maintenance vs observation after autologous stem cell transplantation (ASCT) in the first prospective comprehensive analysis of different techniques, molecular markers, and tissues (peripheral blood [PB] and bone marrow [BM]), taken at well-defined time points. Among the 300 patients enrolled, a molecular marker was identified in 250 (83%), allowing us to analyze 234 patients and 4351 analytical findings from 10 time points. ASCT induced high rates of molecular remission (91% in PB and 83% in BM, by quantitative real-time polymerase chain reaction [RQ-PCR]). Nevertheless, the number of patients with persistent clinical and molecular remission decreased over time in both arms (up to 30% after 36 months). MRD predicted early progression and long-term outcome, particularly from 6 months after ASCT (6-month time to progression [TTP] hazard ratio [HR], 3.83; P < .001). In single-timepoint analysis, BM outperformed PB, and RQ-PCR was more reliable, while nested PCR appeared applicable to a larger number of patients (234 vs 176). To improve MRD performance, we developed a time-varying kinetic model based on regularly updated MRD results and the MIPI (Mantle Cell Lymphoma International Prognostic Index), showing an area under the ROC (Receiver Operating Characteristic) curve (AUROC) of up to 0.87 using BM. Most notably, PB reached an AUROC of up to 0.81; with kinetic analysis, it was comparable to BM in performance. MRD is a powerful predictor over the entire natural history of MCL and is suitable for models with a continuous adaptation of patient risk. The study can be found in EudraCT N. 2009-012807-25 (https://eudract.ema.europa.eu/).
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Affiliation(s)
- Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
- AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniele Grimaldi
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
- Hematology Division, AO S.Croce e Carle, Cuneo, Italy
| | - Elisa Genuardi
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Daniela Drandi
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Gian Maria Zaccaria
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Beatrice Alessandria
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Marco Ghislieri
- PoliToBIOMed Lab, Politecnico di Torino, Torino, Italy
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Martina Ferrante
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Andrea Evangelista
- Unit of Cancer Epidemiology, CPO, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Barbara Mantoan
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Gabriele De Luca
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | | | - Fabio Benedetti
- Department of Medicine, Section of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy
| | | | - Manuela Zanni
- Division of Hematology, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | | | | | - Francesca Re
- Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Stefan Hohaus
- Hematology Unit, Università Cattolica S.Cuore; Roma, Italy
| | - Gerardo Musuraca
- Department of Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS
| | - Nicola Cascavilla
- Hematology, Casa Sollievo della Sofferenza IRCCS Hospital, San Giovanni Rotondo, Italy
| | - Chiara Ghiggi
- Department of Hematology, San Martino Hospital and University, Genova, Italy
| | - Anna Marina Liberati
- Department of Hematology, A.O. Santa Maria Terni, University of Perugia, Perugia, Italy; and
| | | | - Marco Ladetto
- Division of Hematology, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
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12
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Gambella M, Carlomagno S, Raiola AM, Giannoni L, Ghiggi C, Setti C, Giordano C, Luchetti S, Serio A, Bo A, Falco M, Della Chiesa M, Angelucci E, Sivori S. CD19-Targeted Immunotherapies for Diffuse Large B-Cell Lymphoma. Front Immunol 2022; 13:837457. [PMID: 35280988 PMCID: PMC8911710 DOI: 10.3389/fimmu.2022.837457] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 12/15/2022] Open
Abstract
Surgical resection, chemotherapy and radiotherapy were, for many years, the only available cancer treatments. Recently, the use of immune checkpoint inhibitors and adoptive cell therapies has emerged as promising alternative. These cancer immunotherapies are aimed to support or harness the patient's immune system to recognize and destroy cancer cells. Preclinical and clinical studies, based on the use of T cells and more recently NK cells genetically modified with chimeric antigen receptors retargeting the adoptive cell therapy towards tumor cells, have already shown remarkable results. In this review, we outline the latest highlights and progress in immunotherapies for the treatment of Diffuse Large B-cell Lymphoma (DLBCL) patients, focusing on CD19-targeted immunotherapies. We also discuss current clinical trials and opportunities of using immunotherapies to treat DLBCL patients.
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Affiliation(s)
- Massimiliano Gambella
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Simona Carlomagno
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Livia Giannoni
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Ghiggi
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Setti
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Chiara Giordano
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Silvia Luchetti
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Serio
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Bo
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michela Falco
- Laboratory of Clinical and Experimental Immunology, Integrated Department of Services and Laboratories, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Emanuele Angelucci
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simona Sivori
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
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13
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Casaccia M, Mora M, Santori G, Ghiggi C, Angelucci E. Laparoscopic lymph node biopsy for lymphoma with a novel use of indocyanine green fluorescence in a 66-year-old male patient. Int J Surg Case Rep 2022; 90:106692. [PMID: 34952317 PMCID: PMC8715068 DOI: 10.1016/j.ijscr.2021.106692] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Indocyanine green (ICG) near-infrared fluorescence is primarily employed in detecting Intraoperative sentinel lymph node (SLN) mapping or to evaluate the extent of radical lymphadenectomy mainly in colo-rectal and gastric cancer. To date there are no reports indicating the use of this dye to detect pathologic lymphatic tissue when a lymph node biopsy for suspected lymphoproliferative disease is performed. Presentation of case A 66-year-old male patient was admitted to the hospital for severe pain of left renal colic type. A computed tomography (CT) scan and a positron emission tomography (PET) showed a left hydroureteronephrosis due to ureter compression by paraortic solid tissue of lymphomatous aspect with a standardized uptake value (SUV) of 15. Multiple lymphadenopathies on paracaval, para-aortic and common iliac sites were present as well. Discussion A laparoscopic lymph node biopsy (LLB) was planned for diagnostic purposes. After induction of anesthesia a ICG solution was injected Intradermally at both inguinal regions. At laparoscopy a complete visualization of the pathologic lymphnodes was achieved, enabling incisional biopsies of the lymphomatous mass. Histopathological examination showed an extranodal localization of an aggressive B-cell non-Hodgkin lymphoma. Conclusion ICG-fluorescence seems to offer a simple and safe method for pathologic lymph node detection. LLB in the suspicion of intra abdominal lymphoma can largely take advantage by this novel opportunity not yet tested to date. More studies with large case series are needed to confirm the efficacy of ICG-fluorescence for detecting pathologic lymph nodes. First report in literature concerning the use of indocyanine green (ICG) for laparoscopic lymph node biopsy Periaortic and iliac lymph nodes visualized at PET as pathological, at laparoscopy turned out to be stained up by ICG. Deep lymph nodes staining with ICG is possible by means of a preoperative injection of an ICG solution into the inguinal regions. ICG-fluorescence seems to offer a useful, expeditious, and easy reproductible method for pathologic lymph node [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]] laparoscopic lymph node biopsy (LLB).
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14
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Tilch MK, Robak T, Ghiggi C, Wuff E, Herold S, Theobald M, Hess G. Safety of the Anti-CD19 antibody Tafasitamab in Long Term Responders from A Phase II Trial for Relapsed Lymphoma. Clin Lymphoma Myeloma Leuk 2021; 22:270-275. [PMID: 34776401 DOI: 10.1016/j.clml.2021.10.005] [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] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/22/2021] [Accepted: 10/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Information about the long-term tolerability of tafasitamab is still limited. METHODS 5 of 92 patients treated within a phase IIa study of single-agent tafasitamab in relapsed or refractory B NHL were followed for up to five years or longer for long-term tolerability. RESULTS Treatment was very well tolerated in an outpatient setting with no hospitalizations needed and mild and tolerable adverse events that occurred mostly within the first two years of treatment. CONCLUSIONS Given the excellent tolerability and efficacy of tafasitamab this agent can be used to induce remission in relapsed or refractory lymphoma either alone or in combination with chemotherapy.
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Affiliation(s)
- Marie-Kristin Tilch
- Department of Hematology, Oncology and Pneumology & University Cancer Center, University Medical Center of the Johannes Gutenberg-University, Mainz, Rhineland-Palatinate, Germany
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Chiara Ghiggi
- Division of Hematology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elke Wuff
- Department of Hematology, Oncology and Pneumology & University Cancer Center, University Medical Center of the Johannes Gutenberg-University, Mainz, Rhineland-Palatinate, Germany
| | - Stephanie Herold
- Department of Hematology, Oncology and Pneumology & University Cancer Center, University Medical Center of the Johannes Gutenberg-University, Mainz, Rhineland-Palatinate, Germany
| | - Matthias Theobald
- Department of Hematology, Oncology and Pneumology & University Cancer Center, University Medical Center of the Johannes Gutenberg-University, Mainz, Rhineland-Palatinate, Germany
| | - Georg Hess
- Department of Hematology, Oncology and Pneumology & University Cancer Center, University Medical Center of the Johannes Gutenberg-University, Mainz, Rhineland-Palatinate, Germany.
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15
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Kostakoglu L, Mattiello F, Martelli M, Sehn LH, Belada D, Ghiggi C, Chua N, González-Barca E, Hong X, Pinto A, Shi Y, Tatsumi Y, Bolen C, Knapp A, Sellam G, Nielsen T, Sahin D, Vitolo U, Trněný M. Total metabolic tumor volume as a survival predictor for patients with diffuse large B-cell lymphoma in the GOYA study. Haematologica 2021; 107:1633-1642. [PMID: 34407602 PMCID: PMC9244811 DOI: 10.3324/haematol.2021.278663] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 03/01/2021] [Indexed: 11/14/2022] Open
Abstract
This retrospective analysis of the phase III GOYA study investigated the prognostic value of baseline metabolic tumor volume parameters and maximum standardized uptake values for overall and progression-free survival (PFS) in treatment-naïve diffuse large B-cell lymphoma. Baseline total metabolic tumor volume (determined for tumors >1 mL using a threshold of 1.5 times the mean liver standardized uptake value +2 standard deviations), total lesion glycolysis, and maximum standardized uptake value positron emission tomography data were dichotomized based on receiver operating characteristic analysis and divided into quartiles by baseline population distribution. Of 1,418 enrolled patients, 1,305 had a baseline positron emission tomography scan with detectable lesions. Optimal cut-offs were 366 cm3 for total metabolic tumor volume and 3,004 g for total lesion glycolysis. High total metabolic tumor volume and total lesion glycolysis predicted poorer PFS, with associations retained after adjustment for baseline and disease characteristics (high total metabolic tumor volume hazard ratio: 1.71, 95% confidence interval [CI]: 1.35– 2.18; total lesion glycolysis hazard ratio: 1.46; 95% CI: 1.15–1.86). Total metabolic tumor volume was prognostic for PFS in subgroups with International Prognostic Index scores 0–2 and 3–5, and those with different cell-of-origin subtypes. Maximum standardized uptake value had no prognostic value in this setting. High total metabolic tumor volume associated with high International Prognostic Index or non-germinal center B-cell classification identified the highest-risk cohort for unfavorable prognosis. In conclusion, baseline total metabolic tumor volume and total lesion glycolysis are independent predictors of PFS in patients with diffuse large B-cell lymphoma after first-line immunochemotherapy.
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Affiliation(s)
- Lale Kostakoglu
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA.
| | | | - Maurizio Martelli
- Department of translational and precision medicine, Sapienza University, Rome
| | - Laurie H Sehn
- BC Cancer Centre for Lymphoid Cancer and the University of British Columbia, Vancouver, BC
| | - David Belada
- 4th Department of Internal Medicine-Hematology, Charles University, Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | | | - Neil Chua
- Cross Cancer Institute, University of Alberta, Edmonton, AB
| | - Eva González-Barca
- Institut Català d'Oncologia, Institut d'Investigació Biomédica de Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona
| | - Xiaonan Hong
- Fudan University Shanghai Cancer Center, Shanghai
| | - Antonio Pinto
- Hematology-Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples
| | - Yuankai Shi
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Yoichi Tatsumi
- Department of Patient Safety and Management, Kindai University Hospital and Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Osaka
| | | | | | | | | | | | - Umberto Vitolo
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin
| | - Marek Trněný
- First Department of Medicine, Charles University General Hospital, Prague, Czech Republic
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16
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Santoro A, Mazza R, Spina M, Califano C, Specchia G, Carella M, Consoli U, Palombi F, Musso M, Pulsoni A, Kovalchuk S, Bonfichi M, Ricci F, Fabbri A, Liberati AM, Rodari M, Giordano L, Chimienti E, Balzarotti M, Sorasio R, Gallamini A, Ghiggi C, Ciammella P, Ricardi U, Chauvie S, Carlo-Stella C, Merli F. Dose-dense ABVD as first-line therapy in early-stage unfavorable Hodgkin lymphoma: results of a prospective, multicenter double-step phase II study by Fondazione Italiana Linfomi. Ann Hematol 2021; 100:2547-2556. [PMID: 34327561 DOI: 10.1007/s00277-021-04604-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] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/04/2021] [Indexed: 11/28/2022]
Abstract
We investigated the feasibility and activity of an intensified dose-dense ABVD (dd-ABVD) regimen in patients with early-stage unfavorable Hodgkin lymphoma (HL). This prospective, multicenter, phase II study enrolled 96 patients with newly diagnosed, unfavorable stage I or II classical HL. The patients received four cycles of dd-ABVD followed by radiotherapy. Interim PET (PET-2) was mandatory after two courses. Primary endpoints were the evaluation of dd-ABVD feasibility and activity (incidence of PET-2 negativity). The feasibility endpoint was achieved with 48/52 (92.3%) patients receiving > 85% of the programmed dose. The mean dose intensity in the overall patient population (n = 96) was 93.7%, and the median duration of dd-ABVD was 85 days (range, 14-115) versus an expected duration of 84 days. PET-2 was available for 92/96 (95.8%) patients, of whom 79 were PET-2 negative (85.9%). In total, 90 (93.8%) patients showed complete response at the end of treatment. With a follow-up of 80.9 months (3.3-103.2), the median progression-free survival (PFS) and overall survival (OS) were not reached. At 84 months, PFS and OS rates were 88.4% and 95.7%, respectively. No evidence for a difference in PFS or OS was observed for PET-2-negative and PET-2-positive patients. Infections were documented in 8.3% and febrile neutropenia in 6.2% of cases. Four patients died: one had alveolitis at cycle 3, one death was unrelated to treatment, and two died from a secondary cancer. dd-ABVD is feasible and demonstrates activity in early-stage unfavorable HL. The predictive role of PET-2 positivity in early-stage unfavorable HL remains controversial. The study was registered in the EudraCT (reference number, 2011-003,191-36) and the ClinicalTrials.gov (reference number, NCT02247869) databases.
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Affiliation(s)
- Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy. .,IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Rita Mazza
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Michele Spina
- Medical Oncology Division, Centro Riferimento Oncologico, Aviano, Italy
| | - Catello Califano
- Onco-Hematology Department, A. Tortora Hospital, Pagani, Salerno, Italy
| | - Giorgina Specchia
- Emergency and Transplantation Department, Hematology Section, University of Bari Medical School, Bari, Italy
| | - Michele Carella
- Hematology and Bone Marrow Transplantation Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Clinica La Madonnina, Milan, Italy.,Clinica Villa Pia, Rome, Italy
| | - Ugo Consoli
- Hematology Department, Garibaldi Nesima Hospital, Catania, Italy
| | | | - Maurizio Musso
- Onco-Hematology Unit, Casa Di Cura "La Maddalena", Palermo, Italy
| | - Alessandro Pulsoni
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Francesca Ricci
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | | | - Anna Marina Liberati
- Onco-Hematology Division, S. Maria Hospital, Università Degli Studi Di Perugia, Terni, Italy
| | - Marcello Rodari
- IRCCS Humanitas Clinical and Research Hospital, Department of Diagnostic Imaging, Via Manzoni 56, Milano, Rozzano, Italy
| | - Laura Giordano
- Biostatistic Unit, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy
| | | | - Monica Balzarotti
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Roberto Sorasio
- Division of Hematology, S. Croce E Carle Hospital, Cuneo, Italy
| | - Andrea Gallamini
- Division of Hematology, S. Croce E Carle Hospital, Cuneo, Italy.,Research and Clinical Innovation Department, Centre Antoine-Lacassagne, Nice, France
| | - Chiara Ghiggi
- Hematology and Bone Marrow Transplantation Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda Unità Sanitaria Locale IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Umberto Ricardi
- Oncology Department, Radiation Oncology, University of Torino, Torino, Italy
| | - Stephane Chauvie
- Medical Physics Department, S. Croce E Carle Hospital, Cuneo, Italy
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Francesco Merli
- Hematology Department, Azienda Unità Sanitaria Locale IRCCS Di Reggio Emilia, Reggio Emilia, Italy
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17
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Chiappella A, Carniti C, Re A, Castellino C, Evangelista A, Ciancia R, Orsucci L, Pinto A, Usai SV, Arcari A, Ilariucci F, Rossi FG, Benedetti F, Flenghi L, Ghiggi C, Molinari AL, Stefoni V, Volpetti S, Zilioli VR, Ballerini F, Bruna R, Cavallo F, Musuraca G, Patti C, Re F, Tani M, Varettoni M, Zanni M, Dodero A, Pileri SA, Ciccone G, Corradini P. ROMIDEPSIN‐CHOEP PLUS UP‐FRONT STEM‐CELL TRANSPLANTATION IN PERIPHERAL T‐CELL LYMPHOMA (PTCL): FIRST ANALYSIS OF THE PHASE II FIL‐PTCL13 STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.130_2880] [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] [Indexed: 11/06/2022]
Affiliation(s)
- A. Chiappella
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Hematology and Stem Cell Transplantation Milano Italy
| | - C. Carniti
- Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano Laboratory of Hematology Division of Hematology and Stem Cell Transplantation Milano Italy
| | - A. Re
- ASST Spedali Civili di Brescia Hematology Division Brescia Italy
| | - C. Castellino
- Azienda Ospedaliera S. Croce e Carle Division of Hematology Cuneo Italy
| | - A. Evangelista
- Azienda Ospedaliera e Universitaria Città della Salute e della Scienza and CPO Piemonte Unit of Clinical Epidemiology Torino Italy
| | - R. Ciancia
- Centro di Riferimento Oncologico (CRO) IRCCS Onco‐hematology and Stem Cell Transplantation and Cellular Therapies Aviano Italy
| | - L. Orsucci
- Azienda Ospedaliera e Universitaria Città della Salute e della Scienza Division of Hematology Torino Italy
| | - A. Pinto
- Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS Hematology‐Oncology & Stem Cell Transplantation Unit Napoli Italy
| | - S. V. Usai
- Ospedale Oncologico Armando Businco Hematology Cagliari Italy
| | - A. Arcari
- Ospedale Guglielmo da Saliceto Hematology Unit Piacenza Italy
| | - F. Ilariucci
- Azienda USL‐IRCCS, Hematology Reggio Emilia Italy
| | - F. G. Rossi
- Fondazione IRCCS Cà Granda OM Policlinico Division of Hematology Milano Italy
| | - F. Benedetti
- Azienda Ospedaliera Universitaria di Verona Hematology and Stem Cell Transplantation Verona Italy
| | - L. Flenghi
- Azienda Ospedaliera di Perugia Hematology Perugia Italy
| | - C. Ghiggi
- IRCCS Ospedale Policlinico San Martino Hematology Genova Italy
| | | | - V. Stefoni
- University of Bologna Institute of Hematology "Seràgnoli" Bologna Italy
| | - S. Volpetti
- Presidio Ospedaliero Universitario "Santa Maria della Misericordia” di Udine ASUFC Clinic of Hematology Udine Italy
| | - V. R. Zilioli
- ASST Grande Ospedale Metropolitano Niguarda Division of Hematology Milano Italy
| | - F. Ballerini
- IRCCS Ospedale Policlinico San Martino Clinic of Hematology Genova Italy
| | - R. Bruna
- Ospedale Maggiore Della Carità Division of Hematology Novara Italy
| | - F. Cavallo
- University of Torino Azienda Ospedaliera e Universitaria Città della Salute e della Scienza Division of Hematology Department of Molecular Biotechnologies and Health Sciences Torino Italy
| | - G. Musuraca
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" Division of Hematology Meldola Italy
| | - C. Patti
- Azienda Villa Sofia Cervello Division of Onco‐Hematology Palermo Italy
| | - F. Re
- Azienda Ospedaliera‐Universitaria di Parma Hematology and CTMO Parma Italy
| | - M. Tani
- Ospedale Santa Maria delle Croci Hematology Unit Ravenna Italy
| | - M. Varettoni
- Fondazione IRCCS Policlinico San Matteo Division of Hematology Pavia Italy
| | - M. Zanni
- Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo Division of Hematology Alessandria Italy
| | - A. Dodero
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Hematology and Stem Cell Transplantation Milano Italy
| | - S. A. Pileri
- European Institute of Oncology IRCCS Division of Haematopathology Milano Italy
| | - G. Ciccone
- Azienda Ospedaliera e Universitaria Città della Salute e della Scienza and CPO Piemonte Unit of Clinical Epidemiology Torino Italy
| | - P. Corradini
- Chair of Hematology University of Milano Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Division of Hematology and Stem Cell Transplantation Milano Italy
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Luminari S, Guerra L, Durmo R, Chauvie S, Peano S, Franceschetto A, Fallanca F, Tarantino V, Pinto A, Ghiggi C, Pulsoni A, Merli M, Farina L, Tani M, Botto B, Musuraca G, Falini B, Ballerini F, Stefani PM, Bolis S, Pietrantuono G, Manni M, Marcheselli L, Federico M, Versari A. EARLY METABOLIC RESPONSE IN FOLLICULAR LYMPHOMA: A SUBSET ANALYSIS OF THE FOLL12 TRIAL BY THE FONDAZIONE ITALIANA LINFOMI (FIL). Hematol Oncol 2021. [DOI: 10.1002/hon.33_2880] [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] [Indexed: 11/09/2022]
Affiliation(s)
- S. Luminari
- Azienda Unità Sanitaria Locale IRCCS Arcispedale Santa Maria Nuova IRCCS, Hematology Unit and University of Modena and Reggio Emilia Surgical, Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine Reggio Emilia Italy
| | - L. Guerra
- S. Gerardo Hospital University of Milano‐Bicocca, Nuclear Medicine and , University of Milano Bicocca School of Medicine and Surgery Monza Italy
| | - R. Durmo
- Azienda USL‐IRCCS di Reggio Emilia Nuclear Medicine Reggio Emilia Italy
| | - S. Chauvie
- Santa Croce e Carle Hospital Department of Medical Physics Cuneo Italy
| | - S. Peano
- ASO S. Croce e Carle S.C. Medicina Nucleare Cuneo Italy
| | - A. Franceschetto
- Modena Cancer Center University of Modena and Reggio Emilia Department of Oncology and Hematology Unit of Nuclear Medicine Modena Italy
| | - F. Fallanca
- IRCCS San Raffaele Scientific Institute Nuclear Medicine Unit Milano Italy
| | - V. Tarantino
- University of Modena and Reggio Emilia PhD program in Clinical and Experimental Medicine (CEM) Modena Italy
| | - A. Pinto
- National Cancer Institute Fondazione "G. Pascale" IRCCS Hematology‐Oncology and Stem Cell Transplantation Unit Napoli Italy
| | - C. Ghiggi
- IRCCS San Martino Hospital Hematology and Transplant Center Division Genoa Italy
| | - A. Pulsoni
- Sapienza Università di Roma Dipartimento di Biotecnologie Cellulari ed Ematologia Roma Italy
| | - M. Merli
- University Hospital Ospedale di Circolo e Fondazione Macchi ASST Settelaghi Varese Italy
| | - L. Farina
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Division of Hematology Milano Italy
| | - M. Tani
- Ospedale Civile S Maria delle Croci Azienda Unità Sanitaria Locale (AUSL) Ravenna Italy
| | - B. Botto
- A.O.U. Città della Salute e della Scienza di Torino SC Ematologia Torino Italy
| | - G. Musuraca
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" Department of Hematology Meldola Italy
| | - B. Falini
- University of Perugia, Institute of Hematology and CREO (Center for Hemato‐Oncological Research) Ospedale S. Maria della Misericordia Perugia Italy
| | - F. Ballerini
- IRCCS Ospedale Policlinico San Martino University of Genoa Clinica Ematologica Genova Italy
| | - P. M. Stefani
- General Hospital Ca' Foncello Hematology Treviso Italy
| | - S. Bolis
- ASST MONZA, SC di Ematologia Monza Italy
| | - G. Pietrantuono
- IRCCS Centro di Riferimento Oncologico della Basilicata Hematology and Stem Cell Transplantation Unit Rionero in Vulture Italy
| | - M. Manni
- University of Modena and Reggio Emilia Surgical, Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine Modena Italy
| | | | - M. Federico
- University of Modena and Reggio Emilia Surgical, Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine Modena Italy
| | - A. Versari
- Azienda USL‐IRCCS di Reggio Emilia Nuclear Medicine Reggio Emilia Italy
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Casaccia M, Fornaro R, Papadia FS, Testa T, Mascherini M, Ibatici A, Ghiggi C, Bregante S, De Cian F. Single-Port vs. Conventional Multi-Port Laparoscopic Lymph Node Biopsy. JSLS 2021; 24:JSLS.2020.00045. [PMID: 33100817 PMCID: PMC7546779 DOI: 10.4293/jsls.2020.00045] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background and Objectives The purpose of the investigation was to compare clinical results and diagnostic accuracy for conventional multiport laparoscopic lymph node biopsy (MPLB) and single-port laparoscopic lymph node biopsy (SPLB) operations at a single institution. Methods A set of 20 SPLB patients operated on from October 2016 to May 2019 were compared to an historical series of 35 MPLB patients. Primary endpoints were the time of surgery, estimated blood loss, surgical conversion, length of stay and morbidity. The secondary endpoint was the diagnostic accuracy of the technique. Results SPLB was completed laparoscopically in all cases. Two MPLB patients (5.7%) experienced a surgical conversion due to intraoperative difficulties. Duration of surgery was similar in SPLB and MPLB groups respectively (84 ± 31.7 min vs. 81.1 ± 22.2; P = .455). A shorter duration of hospital stay was shown for patients operated on by SPLB compared to the MPLB group (1.7 ± 0.9 days vs. 2.1 ± 1.2 days; P = .133). The postoperative course was uneventful in both groups. In 95% of the SPLB and 97.1% of the MPLB cases respectively, LLB achieved the necessary information for the diagnosis. Conclusion SPLB has shown good procedural and postoperative outcomes as well as a high diagnostic yield, comparable to traditional MPLB. Therefore, our results show that this approach is safe and effective and can be an equally valid option to MPLB to obtain a diagnosis or to follow the progression of a lymphoproliferative disease. Further studies are necessary to support these results before its widespread adoption.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Rosario Fornaro
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Francesco Saverio Papadia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Tommaso Testa
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Matteo Mascherini
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Adalberto Ibatici
- Hematology and Transplant Center Division, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Ghiggi
- Hematology and Transplant Center Division, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefania Bregante
- Hematology and Transplant Center Division, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Franco De Cian
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
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20
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Casaccia M, Lemoli RM, Angelucci E, Bregante S, Ballerini F, Ibatici A, Ghiggi C, De Cian F. Feasibility of Single-Port Laparoscopic Lymph Node Biopsy for Intra-Abdominal Lymphoma: A Case Series. J Laparoendosc Adv Surg Tech A 2020; 31:458-461. [PMID: 33216698 DOI: 10.1089/lap.2020.0695] [Citation(s) in RCA: 2] [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] [Indexed: 01/18/2023] Open
Abstract
Background: Laparoscopic lymph node biopsy through a multi-port access (MPLB) is a well-established technique for intra-abdominal lymphoma diagnosis. The aim of the current study is to assess the feasibility and the diagnostic accuracy of the single-port laparoscopic lymph node biopsy (SPLB) in intra-abdominal lymphoma. Materials and Methods: Between October 2016 and February 2019, 15 patients underwent SPLB to rule out or to follow the progression of a lymphoma. The clinical outcome and the pathology reports were analyzed retrospectively. Results: SPLB was completed laparoscopically in all cases. The total number of biopsies performed for each procedure was sometimes multiple (median: 2; range: 1-3). Duration of surgery was 85 ± 32 minutes (range: 75-105 minutes). Length of hospitalization was 1.8 ± 0.7 days (range: 1-3 days). No major postoperative complications occurred. A cutaneous infection managed conservatively was observed in a patient. In 10 patients, SPLB was used to establish a diagnosis whereas in 5 patients it was performed to follow a progression of a lymphoproliferative disease. In 93.3% of the cases, SPLB achieved the correct diagnosis and subsequent therapeutic decisions. Conclusion: SPLB has shown good procedure and postoperative outcomes as well as a high diagnostic yield, comparable to literature data on traditional MPLB. Therefore, our results show that this approach is safe and effective and can be an equally valid option to MPLB to obtain a diagnosis or to follow the progression of a lymphoproliferative disease. Further studies are necessary to support these results before its widespread adoption.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Roberto Massimo Lemoli
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Emanuele Angelucci
- Hematology and Transplant Center Division, IRCCS San Martino Hospital, Genoa, Italy
| | - Stefania Bregante
- Hematology and Transplant Center Division, IRCCS San Martino Hospital, Genoa, Italy
| | - Filippo Ballerini
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Adalberto Ibatici
- Hematology and Transplant Center Division, IRCCS San Martino Hospital, Genoa, Italy
| | - Chiara Ghiggi
- Hematology and Transplant Center Division, IRCCS San Martino Hospital, Genoa, Italy
| | - Franco De Cian
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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21
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Furfaro E, Signori A, Di Grazia C, Dominietto A, Raiola AM, Aquino S, Ghiggi C, Ghiso A, Ungaro R, Angelucci E, Viscoli C, Mikulska M. Serial monitoring of isavuconazole blood levels during prolonged antifungal therapy. J Antimicrob Chemother 2020; 74:2341-2346. [PMID: 31119272 DOI: 10.1093/jac/dkz188] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/28/2019] [Accepted: 04/05/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Isavuconazole is the newest triazole antifungal approved for the treatment of invasive aspergillosis (IA) and invasive mucormycosis in adult patients. OBJECTIVES To characterize the assessment of the blood levels of isavuconazole and their association with efficacy and toxicity. METHODS From January 2017 to May 2018, blood samples obtained from patients receiving isavuconazole were analysed for therapeutic drug monitoring. Factors influencing the blood concentrations of isavuconazole, such as weight, length of treatment, route of administration and results of selected liver function tests, were analysed in univariate and multivariate models. The receiver operating characteristic (ROC) curve was analysed to detect the best cut-off for isavuconazole toxicity. RESULTS A total of 264 isavuconazole blood concentrations in 19 patients were analysed. The median value of isavuconazole concentration in all patients during the first 30 days of therapy was 3.69 mg/L (range 0.64-8.13 mg/L). A linear increase of 0.032 mg/L (range 0.023-0.041 mg/L) for each day of treatment (P = 0.002) was observed. In multivariate analysis the association between the length of treatment and higher levels of isavuconazole (P < 0.001) and higher serum GGT and lower isavuconazole levels (P = 0.001) was confirmed. Adverse events, mainly gastrointestinal, were reported in six patients (31.6%). Based on time-dependent and fixed-time ROC curve analysis, 4.87 mg/L and 5.13 mg/L, respectively, were the identified thresholds for toxicity. CONCLUSIONS Isavuconazole was efficacious and well tolerated. Side effects, mainly gastrointestinal, were associated with prolonged administration and high serum levels.
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Affiliation(s)
- E Furfaro
- Division of Infectious Diseases, Department of Health Science DISSAL, University of Genoa, Genoa, Italy
| | - A Signori
- Section of Biostatistics, Department of Health Science DISSAL, University of Genoa, Genoa, Italy
| | - C Di Grazia
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Dominietto
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A M Raiola
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Aquino
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - C Ghiggi
- Division of Hematology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Ghiso
- Division of Hematology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - R Ungaro
- Division of Infectious Diseases, Department of Health Science DISSAL, University of Genoa, Genoa, Italy.,Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - E Angelucci
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - C Viscoli
- Division of Infectious Diseases, Department of Health Science DISSAL, University of Genoa, Genoa, Italy.,Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Mikulska
- Division of Infectious Diseases, Department of Health Science DISSAL, University of Genoa, Genoa, Italy.,Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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22
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Guolo F, Minetto P, Clavio M, Miglino M, Galaverna F, Raiola AM, Di Grazia C, Colombo N, Pozzi S, Ibatici A, Bagnasco S, Guardo D, Kunkl A, Ballerini F, Ghiggi C, Lemoli RM, Gobbi M, Bacigalupo A. Combining flow cytometry and WT1 assessment improves the prognostic value of pre-transplant minimal residual disease in acute myeloid leukemia. Haematologica 2017; 102:e348-e351. [PMID: 28495917 DOI: 10.3324/haematol.2017.167254] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Fabio Guolo
- Clinic of Hematology, Department of internal medicine (DIMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Paola Minetto
- Clinic of Hematology, Department of internal medicine (DIMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Marino Clavio
- Clinic of Hematology, Department of internal medicine (DIMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Maurizio Miglino
- Clinic of Hematology, Department of internal medicine (DIMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Federica Galaverna
- Division of Hematology and Bone Marrow Transplantation, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Anna Maria Raiola
- Division of Hematology and Bone Marrow Transplantation, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Carmen Di Grazia
- Division of Hematology and Bone Marrow Transplantation, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Nicoletta Colombo
- Division of Hematology and Bone Marrow Transplantation, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Sarah Pozzi
- Division of Hematology and Bone Marrow Transplantation, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Adalberto Ibatici
- Division of Hematology and Bone Marrow Transplantation, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Samuele Bagnasco
- Clinic of Hematology, Department of internal medicine (DIMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Daniela Guardo
- Clinic of Hematology, Department of internal medicine (DIMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Annalisa Kunkl
- Clinical Flow Cytometry Unit, Department of Pathology, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Filippo Ballerini
- Clinic of Hematology, Department of internal medicine (DIMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Chiara Ghiggi
- Division of Hematology and Bone Marrow Transplantation, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Roberto M Lemoli
- Clinic of Hematology, Department of internal medicine (DIMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Marco Gobbi
- Clinic of Hematology, Department of internal medicine (DIMI), University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Andrea Bacigalupo
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A Gemelli, Rome, Italy
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Galaverna F, Ghiggi C, Guolo F, Beltrami G, Dellepiane C, Giannoni L, Carella A, Carella A. Management of Early Stage Chronic Myeloid Leukemia: State-of-the-art Approach and Future Perspectives. Curr Cancer Drug Targets 2013; 13:749-54. [DOI: 10.2174/15680096113139990087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 05/23/2013] [Accepted: 06/21/2013] [Indexed: 11/22/2022]
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Miglino M, Colombo N, Grasso R, Marani C, Clavio M, Pica GM, Ballerini F, Ghiggi C, Minetto P, Guolo F, Carella AM, Gobbi M. Nucleophosmin gene-based monitoring inde novocytogenetically normal acute myeloid leukemia with nucleophosmin gene mutations: comparison with cytofluorimetric analysis and study of Wilms tumor gene 1 expression. Leuk Lymphoma 2012; 53:2214-7. [DOI: 10.3109/10428194.2012.681658] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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25
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Miglino M, Colombo N, Pica G, Grasso R, Clavio M, Bergamaschi M, Ballerini F, Ghiso A, Ghiggi C, Mitscheunig L, Beltrami G, Cagnetta A, Vignolo L, Lucchetti MV, Aquino S, Pierri I, Sessarego M, Carella AM, Gobbi M. WT1 overexpression at diagnosis may predict favorable outcome in patients with de novo non-M3 acute myeloid leukemia. Leuk Lymphoma 2012; 52:1961-9. [PMID: 21942328 DOI: 10.3109/10428194.2011.585673] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We reviewed the frequency and prognostic significance of FLT3 (fms-like tyrosine kinase receptor-3) and NPM (nucleophosmin) gene mutations and WT1 (Wilms' tumor) and BAALC (brain and acute leukemia, cytoplasmic) gene expression in 100 consecutive patients with intermediate and poor cytogenetic risk de novo acute myeloid leukemia (AML) receiving conventional anthracycline-AraC based therapy. We observed a strict relationship between unfavorable karyotype and BAALC >1000 (p = 0.0001). Multivariate analysis of 81 patients with intermediate karyotype revealed that younger age (p = 0.00009), NPM gene mutation (p = 0.002), and WT1 >75th percentile (>2365) (p = 0.003) were independent, positive factors for complete remission (CR). WT1 expression above 2365 was correlated also to longer event-free survival (EFS) and overall survival (OS) in the same subset of patients (p = 0.003 and p = 0.02, respectively); the same finding occurred in younger patients with AML with intermediate karyotype (p = 0.008 and p = 0.01, respectively). In patients with intermediate karyotype, FLT3 internal tandem duplication (ITD) negatively affected EFS (EFS at 30 months: 30% vs. 6% in FLT3-ITD negative and FLT3 positive patients, respectively; p = 0.01) and OS (OS at 30 months: 38% vs. 20%, p = 0.03). The positive prognostic value of high WT1 expression does not have a clear explanation; it may be implicated either with WT1 anti-oncogenic function, or with the stimulating effect of WT1 oncogene on the leukemic cellular cycle, possibly associated with an enhanced response to chemotherapy.
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Affiliation(s)
- Maurizio Miglino
- Department of Hematology and Oncology, Azienda Ospedaliera Universitaria San Martino, Genova, Italy.
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Collins AM, Zabkiewicz J, Ghiggi C, Hauser JC, Burnett AK, Mann S. Tris(8-hydroxyquinolinato)gallium(III)-loaded copolymer micelles as cytotoxic nanoconstructs for cosolvent-free organometallic drug delivery. Small 2011; 7:1635-1640. [PMID: 21574252 DOI: 10.1002/smll.201100405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 03/25/2011] [Indexed: 05/30/2023]
Affiliation(s)
- Andrew M Collins
- Centre for Organized Matter Chemistry, School of Chemistry, University of Bristol, BS8 1TS, UK
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27
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Clavio M, Ghiso A, Ghiggi C, Spriano M, Colombo N, Grasso R, Varaldo R, Miglino M, Pierri I, Olcese F, Aquino S, Biasco S, Balleari E, Carella AM, Sessarego M, Gobbi M. Seventeen years of experience with ATRA-based therapy for acute promyelocytic leukaemia: long-term follow-up of patients treated at S. Martino Hospital, Genoa. Oncol Rep 2009; 21:1045-52. [PMID: 19288007 DOI: 10.3892/or_00000322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We conducted a long-term follow-up retrospective study on 91 consecutive newly diagnosed acute promyelocytic leukaemia (APL) patients. Induction and consolidation therapy were well-tolerated by most patients. Of the 79 patients who were initially treated with the all-trans retinoic acid (ATRA)-containing regimens, there were 3 haemorrhagic deaths during the first period of therapy (4%) and one in consolidation which was due to infection. Following consolidation, molecular assessment of response was performed on 67 patients, and 66 were found to have achieved cytogenetic and molecular remission (98%). After a median follow-up of 100 months (12-192), 10 of the 75 patients who achieved complete remission (13%) relapsed. Seventy-eight percent of the patients were expected to be alive at 14 years from diagnosis, i.e., 90 and 48% of patients of intermediate-low risk and high risk at presentation, respectively (p=0.0009). Sixty-nine patients were in molecular remission after first-line and/or salvage therapy (74%). To date, 4 patients out of the 91 have undergone salvage allogeneic transplant (4%).
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Affiliation(s)
- Marino Clavio
- Department of Haematology, University of Genoa, 16132 Genoa, Italy.
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Pierri I, Balleari E, Olcese F, Passalia C, Calvia A, Clavio M, Varaldo R, Miglino M, Ballerini F, Canepa L, Ghiggi C, Vignolo L, Ghiso A, Ghio R, Gobbi M. PO023 High dose of r-EPO (40,000 IU) once a week is highly effective in a selected cohort of MDS patients with basal EPO level <250mu/ml, IPSS score ≤1.5 and low transfusional need. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70253-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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