1
|
Mulas O, Abruzzese E, Luciano L, Iurlo A, Attolico I, Castagnetti F, Galimberti S, Bonifacio M, Annunziata M, Gozzini A, Orlandi EM, Stagno F, Binotto G, Pregno P, Fozza C, Loi M, Trawinska MM, De Gregorio F, Cattaneo D, Albano F, Iezza M, Baratè C, Scaffidi L, Elena C, Giai V, Scalzulli E, Breccia M, La Nasa G, Caocci G. The new Systematic Coronary Risk Evaluation (SCORE2 and SCORE2-OP) estimates the risk of arterial occlusive events in chronic myeloid leukemia patients treated with nilotinib or ponatinib. Ann Hematol 2024; 103:427-436. [PMID: 38012435 PMCID: PMC10798925 DOI: 10.1007/s00277-023-05556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023]
Abstract
Patients with chronic myeloid leukemia (CML) treated with nilotinib or ponatinib may experience arterial occlusive events (AOEs). It is currently recommended to thoroughly assess cardiovascular risk factors before treating CML. We identified 455 consecutive CML adult patients, 335 treated with nilotinib and 120 with ponatinib; 380 patients without previous cardiovascular diseases or diabetes were stratified according to the Systematic Coronary Risk Evaluation (SCORE2) and SCORE2-Older Persons (SCORE2-OP). This updated algorithm from the European Society of Cardiology (ESC) estimates a 10-year risk of fatal and non-fatal cardiovascular diseases. It is based on sex, age, smoking habits, systolic blood pressure, non-high-density lipoprotein cholesterol, and European geographical region of cardiovascular risk. The SCORE2/SCORE2-OP algorithm translated more patients (50.2%) to the high-very high cardiovascular risk category than the previous SCORE (25.3%). Patients with a high to very high SCORE2/SCORE2-OP risk showed a significantly higher incidence rate of AOEs (69.2% vs. 46.5%, p < 0.001). The older SCORE was less specific in estimating AOEs in patients classified as low-intermediate risk (69.8 vs. 54.2%). In multivariate analysis, no associations were found between AOEs and gender, age, and type or dose of tyrosine kinase inhibitor. Only the SCORE2/SCORE2-OP risk was confirmed as a significant predictive factor (p = 0.028; hazard ratio = 2.2; 95% confidence interval = 1.1-4.5). Patients with AOEs required, in most cases, imaging diagnostic tests, additional drugs, and sometimes invasive procedures, increasing access to visits and hospital management. This real-life study suggested that the SCORE2 and SCORE2-OP charts could help identify cardiovascular fragility in CML patients providing them with more attention and a proper TKI selection.
Collapse
MESH Headings
- Adult
- Humans
- Aged
- Aged, 80 and over
- Cardiovascular Diseases/chemically induced
- Cardiovascular Diseases/epidemiology
- Cardiovascular Diseases/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/chemically induced
- Imidazoles/adverse effects
- Pyrimidines/therapeutic use
- Protein Kinase Inhibitors/adverse effects
- Pyridazines
Collapse
Affiliation(s)
- Olga Mulas
- Department of Medical Sciences and Public Health, Hematology Unit, Businco Hospital, University of Cagliari, Cagliari, Italy
| | | | - Luigiana Luciano
- Hematology Unit "Federico II", University of Naples, Naples, Italy
| | - Alessandra Iurlo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Immacolata Attolico
- Hematology and Stem Cell Transplantation Unit, Azienda Ospedaliero-Universitaria-Consorziale (AOUC) - Policlinico, Bari, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | | | | | - Antonella Gozzini
- Hematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Ester Maria Orlandi
- Division of Hematology, Fondazione IRCCS Policlinico S. Matteo", Pavia, Italy
| | - Fabio Stagno
- Hematology Unit, AOU Policlinico - V. Emanuele, Rodolico Hospital, Catania, Italy
| | | | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Turin, Italy
| | - Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maurizio Loi
- Department of Medical Sciences and Public Health, Hematology Unit, Businco Hospital, University of Cagliari, Cagliari, Italy
| | | | | | - Daniele Cattaneo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Albano
- Hematology and Stem Cell Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Miriam Iezza
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Chiara Elena
- Division of Hematology, Fondazione IRCCS Policlinico S. Matteo", Pavia, Italy
| | - Valentina Giai
- Hematology Unit, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Turin, Italy
| | - Emilia Scalzulli
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Giorgio La Nasa
- Department of Medical Sciences and Public Health, Hematology Unit, Businco Hospital, University of Cagliari, Cagliari, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, Hematology Unit, Businco Hospital, University of Cagliari, Cagliari, Italy.
- SC Ematologia E CTMO, Ospedale Businco, Dipartimento di Scienze Mediche e Sanità Pubblica, Università Di Cagliari, Via Jenner, Sn, 09124, Cagliari, Italy.
| |
Collapse
|
2
|
Autore F, Innocenti I, Reda G, Visentin A, Vitale C, Piciocchi A, Fresa A, Leone MMA, Farina L, Quaresmini G, Baratè C, Giordano A, Ferrari A, Angeletti I, De Paolis MR, Malerba L, Chiurazzi F, Loseto G, Catania G, Sportoletti P, Scortechini I, Moia R, Gentile M, Rigolin GM, Mattiello V, Gattei V, Coscia M, Trentin L, Foà R, Cuneo A, Laurenti L. Lymphadenopathy as a predictor of progression during venetoclax treatment in chronic lymphocytic leukemia. A campus chronic lymphocytic leukemia study. Hematol Oncol 2023; 41:877-883. [PMID: 37392141 DOI: 10.1002/hon.3199] [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: 04/07/2023] [Revised: 05/30/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023]
Abstract
Clinical or biological parameters useful to predict progression during treatment in real-life setting with ibrutinib, idelalisib and venetoclax in relapsed/refractory chronic lymphocytic leukemia (CLL) are still debated. We conducted a multi-center retrospective study on CLL patients treated with ibrutinib and/or idelalisib who were switched to venetoclax for progression or due to adverse events to identify any clinical and/or biological parameters useful to predict progression during treatment with venetoclax. Of all the 128 evaluable patients, 81 had received ibrutinib prior to switching to venetoclax, 35 had received idelalisib and 12 both. When comparing the three subgroups, we did not notice any statistical difference in terms of clinical or biological features. No variable at baseline and at different time points during the follow-up (at 6, 12, 18 and 24 months) was found to predict progression nor to have significance for Progression Free Survival (PFS) in the ibrutinib group and in the idelalisib group and in subgroups according to the line of treatment. Analyzing the data of the venetoclax treatment, after a median follow up of 14.3 months, median PFS was not reached and estimated 3-year PFS was 54%. Of the 128 patients treated with venetoclax, 28 (22%) experienced progressive disease. At multivariate analysis for predictive factors for progression, lymph node diameter >56.5 mm before starting treatment emerged as an independent risk factor for progression. The lymph node predictive role for progression during venetoclax treatment could be a new parameter that deserves to be investigate in future studies.
Collapse
Affiliation(s)
- Francesco Autore
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Idanna Innocenti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Gianluigi Reda
- Fondazione IRCCS Ca' Granda Ospedale Maggiore, Milano, Italy
| | | | - Candida Vitale
- A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Alberto Fresa
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Lucia Farina
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | - Angela Ferrari
- Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | | | | | - Lara Malerba
- A.O. Ospedali San Salvatore di Pesaro, Pesaro, Italy
| | | | | | | | - Paolo Sportoletti
- Centro di Ricerca Emato-Oncologica (CREO), Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | | | - Riccardo Moia
- Università del Piemonte Orientale, A.O.U. Maggiore della Carità, Novara, Italy
| | - Massimo Gentile
- AO di Cosenza, Presidio Ospedaliero Annunziata, Cosenza, Italy
| | | | | | - Valter Gattei
- Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Italy
| | - Marta Coscia
- A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Robin Foà
- Policlinico Umberto I, Università Sapienza, Roma, Italy
| | - Antonio Cuneo
- A.O.U. Arcispedale S. Anna, Università di Ferrara, Ferrara, Italy
| | - Luca Laurenti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| |
Collapse
|
3
|
Baratè C, Sanna A, Benedetti E, Bocchia M, Capochiani E, Danesi R, Moretti S, Occhini U, Santini S, Galimberti S, Gozzetti A. Real-life diagnostic and therapeutic approach to CLL: a 2022 update from an expert panel in Tuscany. Clin Exp Med 2023; 23:4251-4264. [PMID: 37979127 DOI: 10.1007/s10238-023-01244-5] [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: 02/24/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
A panel of chronic lymphocytic leukemia (CLL) experts from Tuscany propose a real-life diagnostic and therapeutic approach CLL that considers the role of genomic and somatic prognostic factors in risk stratification and treatment decisions. Safety and efficacy of new agents has been demonstrated now not only in clinical trials but also in many real-world series. The BTK inhibitors, ibrutinib and acalabrutinib, and BH3 mimetic venetoclax are now indicated as first-line therapy and chemoimmunotherapy can be spared to the majority of CLL patients, thus preventing unnecessary hematological and non-hematological toxicity and second primary tumors. For treatment, FISH for 17 p and P53 mutational status are essential. IGHV mutation can be done at diagnosis or before treatment. Echography is the gold standard radiological investigation in CLL, at both diagnosis and response evaluation. Chemotherapy is virtually abandoned. Age, genetic risk, and patient comorbidities have to be carefully evaluated for treatment decision. With the availability of different drugs, there is a need for a uniform and shared approach in daily therapeutic choice. The proposed approach is based on current evidence and guidelines as well as results from clinical trials and daily clinical experience.
Collapse
Affiliation(s)
- Claudia Baratè
- Department of Clinical and Experimental Medicine, UO Hematology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
| | - Alessandro Sanna
- Hematology Unit, Department of Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Edoardo Benedetti
- Department of Clinical and Experimental Medicine, UO Hematology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
- Italian School of Basic and Emergency Ultrasound (SIUMB), Pisa, Italy
| | - Monica Bocchia
- Hematology Unit, Azienda USL, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Enrico Capochiani
- Hematology Unit, Department of Internal Medicine, Toscana Nord Ovest, Leghorn, Italy
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | | | | | | | - Sara Galimberti
- Department of Clinical and Experimental Medicine, UO Hematology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alessandro Gozzetti
- Hematology Unit, Azienda USL, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| |
Collapse
|
4
|
Baratè C, Caruso T, Mavilia F, Sammuri P, Pratesi F, Motta G, Guerri V, Galimberti S, Migliorini P. Induction of neutralizing antibodies in CLL patients after SARS-CoV-2 mRNA vaccination: a monocentric experience. Clin Exp Med 2023; 23:1197-1203. [PMID: 36074205 PMCID: PMC9453722 DOI: 10.1007/s10238-022-00877-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/14/2022] [Indexed: 11/03/2022]
Abstract
Vaccination represents the best strategy to fight COVID-19 pandemics, especially in immune compromised subjects. In chronic lymphatic leukemia patients, a marked impairment of the immune response to mRNA SARS-CoV-2 vaccine was observed. In this report, we analyzed anti-RBD and neutralizing antibodies in CLL patients after two doses of mRNA SARS CoV 2 vaccine and evaluated the impact of Bruton kinase inhibitory agents. Twenty-seven CLL patients vaccinated with mRNA vaccines against SARS CoV-2 were recruited. Serum IgG, IgM and IgA anti-RBD antibodies and neutralizing antibodies were detected, and antibody avidity was measured. Peripheral blood leukocytes subsets were evaluated by flow cytometry. After two vaccine doses anti-RBD IgG were produced in 11/27 (40.5%) of patients and levels of IgG and IgA anti RBD in CLL patients were sensibly lower than in controls. Neutralizing antibodies were detectable in 12/27 (44.5%) of the patients and their level was lower than that observed in controls. Disease burden and treatment with Bruton kinases inhibitors markedly impaired vaccine induced antibody response. However, in responder patients, antibody avidity was comparable to normal subjects, indicating that the process of clonal selection and affinity maturation takes place as expected. Taken together, these data confirm the impact of disease burden and therapy on production of anti-RBD and neutralizing antibodies and support the current policy of vaccinating CLL patients.
Collapse
Affiliation(s)
- Claudia Baratè
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Teresita Caruso
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Fabrizio Mavilia
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paola Sammuri
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federico Pratesi
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
- General Pathology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giuseppe Motta
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Valentina Guerri
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Galimberti
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paola Migliorini
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
| |
Collapse
|
5
|
Castellani F, Visentin A, Schirinzi E, Salvalaggio A, Cacciavillani M, Candiotto C, Baratè C, Cellini A, Bertorelle R, Siciliano G, Trentin L, Briani C. Mutational Profile in 75 Patients With Anti-Myelin-Associated Glycoprotein Neuropathy: Clinical and Hematologic Therapy Response and Hints on New Therapeutic Targets. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/4/e200122. [PMID: 37137530 PMCID: PMC10155778 DOI: 10.1212/nxi.0000000000200122] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/13/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Neuropathy with antibodies to myelin-associated glycoprotein (MAG) is the most common paraproteinemic IgM neuropathy. Recently, the mutational profile of the MYD88 and CXCR4 genes has been included in the diagnostic workup of IgM monoclonal gammopathies. The objective of our study was to assess the prevalence of MYD88 L265P and CXCR4 S338X gene variants in patients with anti-MAG antibody neuropathy. Secondary aims were to evaluate possible correlations between the mutational profile and neuropathy severity, antibody titers, and treatment response. METHODS Seventy-five patients (47 men, mean age at molecular analysis 70.8 ± 10.2 years; mean disease duration 5.1 ± 4.9 years) with anti-MAG antibody neuropathy were recruited. Among them, 38 (50.7%) had IgM monoclonal gammopathy of undetermined significance, 29 (38.7%) Waldenstrom macroglobulinemia (WM), and 8 (10.6%) chronic lymphocytic leukemia/marginal zone lymphoma/hairy cell leukemia variant. Molecular analysis was performed on DNA from the bone marrow mononuclear cells in 55 of 75 patients and from peripheral mononuclear cells in 18 of 75 patients. Forty-five patients were treated with rituximab, 6 with ibrutinib, 2 with obinutuzumab-chlorambucil, and 3 with venetoclax-based therapy. All the patients were assessed with the Inflammatory Neuropathy Cause and Treatment (INCAT) Disability Scale, INCAT Sensory Sum Score, and MRC Sum Score at baseline and follow-up. We considered as responders, patients who improved by at least 1 point in 2 clinical scales. RESULTS Fifty patients (66.7%) carried the MYD88L265P variant, with a higher frequency in WM and naive patients (77.2% vs 33.3%, p = 0.0012). No patients harbored the CXCR4S338X variant. There were no significant differences in hematologic data (IgM levels, M protein, and anti-MAG antibody titers), neuropathy severity, or response to rituximab in MYD88-altered and MYD88 wild-type patients. Nine of 11 (81.8%) patients treated with novel targeted drug, according to the MYD88 status, responded to treatments. DISCUSSION MYD88L265P variant has a high prevalence (66.7%) in anti-MAG antibody neuropathy representing a potential effective mutational target for Bruton tyrosine kinase inhibitors. MYD88L265P variant, however, does not seem to be a prognostic factor of neuropathy severity or response to rituximab. In patients not responding or becoming refractory to rituximab, a tailored therapy with new effective target therapies should be considered.
Collapse
Affiliation(s)
- Francesca Castellani
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Andrea Visentin
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Erika Schirinzi
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Alessandro Salvalaggio
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Mario Cacciavillani
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Cinzia Candiotto
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Claudia Baratè
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Alessandro Cellini
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Roberta Bertorelle
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Gabriele Siciliano
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Livio Trentin
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy
| | - Chiara Briani
- From the Department of Neurosciences (F.C., A.S., Chiara Briani), Neurology Unit, University of Padova; Hematology and Clinical Immunology Unit (A.V., A.C., L.T.), Department of Medicine, University of Padova; Department of Clinical and Experimental Medicine (E.S., G.S.), Neurological Clinic, University of Pisa; EMG Lab (M.C.), CEMES, Synlab Group, Padova; Immunology and Molecular Oncology (C.C., R.B.), Veneto Institute of Oncology IOV-IRCCS, Padova; and Department of Clinical and Experimental Medicine (Claudia Baratè), Section of Hematology, University of Pisa, Italy.
| |
Collapse
|
6
|
Mavilia F, Ghio F, Cervetti G, Baratè C, Tandredi G, Dardanis D, Mazzantini E, Rossi P, Sammuri P, Guerri V, Bono C, Grassi S, Benedetti E, Galimberti S. CLO23-053: Update From the Dedalo Protocol: An Integrated Approach to MRD in CLL Patients Receiving Venetoclax Plus Rituximab. J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
|
7
|
Benedetti E, Baratè C, Mavilia F, Bramanti E, Morganti R, Guerri V, Cervetti G, Capochiani E, Bertaggia I, Stella SM, Traverso G, Bruno B, Galimberti S. Relapsed/Refractory Chronic Lymphocytic Leukemia Patients Treated with Fixed Duration Venetoclax-Rituximab: Assessment of Response with Ultrasound, and Relationship with Minimal Residual Disease. J Clin Med 2023; 12:jcm12051772. [PMID: 36902559 PMCID: PMC10003523 DOI: 10.3390/jcm12051772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
A fixed duration of venetoclax-rituximab (VenR) resulted in a significant benefit of both PFS and in the attainment of an undetectable minimal residual disease (uMRD) compared with bendamustine-rituximab in relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL) patients. The 2018 International Workshop on CLL guidelines, outside the context of clinical trials, suggested ultrasonography (US) as a possible imaging technique to evaluate visceral involvement, and palpation to evaluate superficial lymph nodes (SupLNs). In this real-life study we prospectively enrolled N = 22 patients. Patients were assessed by US, to determine nodal and splenic response in R/R CLL patients treated with a fixed duration VenR. We found an overall response rate, complete remission, partial remission, and stable disease, of 95.4%, 68%, 27.3%, and 4.5%, respectively. Responses were also correlated with risk categories. The time to response, and the time to clearance of the disease in the spleen, in abdominal LN (AbdLNs), and in SupLNs were discussed. Responses were independent from LN size. The correlation between response rate with MRD were also investigated. US allowed to detect a substantial CR rate correlated with uMRD.
Collapse
Affiliation(s)
- Edoardo Benedetti
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Italian School of Basic and Emergency Ultrasound (SIUMB), 56100 Pisa, Italy
- Correspondence:
| | - Claudia Baratè
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Fabrizio Mavilia
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Emilia Bramanti
- Institute of Chemistry of Organometallic Compounds (ICCOM), Italian National Research Council (CNR), Via G Moruzzi 1, 56124 Pisa, Italy
| | - Riccardo Morganti
- Azienda Ospedaliero Universitaria Pisana, Section of Statistics, 56126 Pisa, Italy
| | - Valentina Guerri
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giulia Cervetti
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Enrico Capochiani
- Hematology Unit, Azienda USL Toscana Nord Ovest, 57124 Livorno, Italy
| | - Ilaria Bertaggia
- Hematology Unit, Azienda USL Toscana Nord Ovest, 57124 Livorno, Italy
| | | | - Ginevra Traverso
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Torino, Italy
| | - Sara Galimberti
- Azienda Ospedaliero Universitaria Pisana, Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| |
Collapse
|
8
|
Palumbo GA, Breccia M, Baratè C, Bonifacio M, Elli EM, Iurlo A, Pugliese N, Rossi E, Guglielmelli P, Palandri F. Management of polycythemia vera: A survey of treatment patterns in Italy. Eur J Haematol 2023; 110:161-167. [PMID: 36319575 PMCID: PMC10100449 DOI: 10.1111/ejh.13889] [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: 09/01/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Polycythemia vera (PV) is an acquired clonal hematopoietic stem cell disorder characterized by the overproduction of red blood cells. It has long been underlined that there are differences in treatment patterns in routine practice. Therapeutic strategies have also expanded, and in recent years the JAK1/JAK2 inhibitor ruxolitinib has emerged as a second-line therapeutic option in patients who are intolerant to or resistant to hydroxyurea. Determining the impact of changes on practice patterns is of interest, especially for aspects that lack detailed guidance for management. METHODS To gain insights into treatment patterns by clinicians treating patients with PV in Italy, we carried out a survey of 60 hematologists and transfusion specialists. The questions covered: treatment of low-risk patients, definition of significant leukocytosis, splenomegaly and excessive phlebotomies, resistance/intolerance to hydroxyurea, use of ruxolitinib, cytoreductive therapy, and vaccines. RESULTS In general, the results of the survey indicate that there is a large heterogeneity in management of patients with PV across these areas. CONCLUSIONS While helping to provide greater understanding of treatment patterns for patients with PV in Italy, our survey highlights the need for additional clinical studies to obtain more precise guidance for the routine care of patients with PV.
Collapse
Affiliation(s)
- Giuseppe Alberto Palumbo
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Massimo Breccia
- Hematology, Department of Precision and Translational Medicine, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Massimiliano Bonifacio
- Department of Medicine, Section of Hematology, University of Verona and AOUI Verona, Verona, Italy
| | - Elena Maria Elli
- Hematology Division and Bone Marrow Transplant Unit, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elena Rossi
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Paola Guglielmelli
- Center of Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
| | - Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| |
Collapse
|
9
|
Frustaci AM, Del Poeta G, Visentin A, Sportoletti P, Fresa A, Vitale C, Murru R, Chiarenza A, Sanna A, Mauro FR, Reda G, Gentile M, Varettoni M, Baratè C, Borella C, Greco A, Deodato M, Zamprogna G, Laureana R, Cipiciani A, Galitzia A, Curto Pelle A, Morelli F, Malvisi L, Coscia M, Laurenti L, Trentin L, Montillo M, Cairoli R, Tedeschi A. Coexisting conditions and concomitant medications do not affect venetoclax management and survival in chronic lymphocytic leukemia. Ther Adv Hematol 2022; 13:20406207221127550. [PMID: 36246422 PMCID: PMC9554118 DOI: 10.1177/20406207221127550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background The question of which parameters may be informative on venetoclax outcome in chronic lymphocytic leukemia (CLL) is still unclear. Furthermore, the choice to treat with venetoclax can be challenging in patients with baseline characteristics or comorbidities that may potentially favor some specific adverse events. Objectives This study was aimed to evaluate whether age, fitness status, patients'/disease characteristics, or concomitant medications may predict outcomes in CLL patients receiving venetoclax. Design Retrospective observational study. Methods Impact of age, presence of Cumulative Illness Rating Scale (CIRS) >6 or severe organ impairment (CIRS3+), Eastern Cooperative Oncology Group-Performance Status (ECOG-PS), renal function, and concomitant medications were retrospectively analyzed on treatment management (definitive discontinuation due to toxicity, discontinuation due to toxicity, Tox-DTD; permanent dose reduction, PDR) and survival [progression free survival (PFS), event free survival (EFS), overall survival (OS)] in unselected patients receiving venetoclax monotherapy in common practice. Results A total of 221 relapsed/refractory patients were included. Tox-DTD and PDR were reported in 5.9% and 21.7%, respectively, and were not influenced by any fitness parameter, age, number or type of concomitant medication, baseline neutropenia, or impaired renal function. None of these factors were associated with tumor lysis syndrome (TLS) development. Age and coexisting conditions had no influence on PFS and EFS. At univariate analysis, OS was significantly shorter only in patients with ECOG-PS >1 (p < 0.0001) and elderly (⩾65 years) with CIRS >6 (p = 0.014) or CIRS3+ (p = 0.031). ECOG-PS >1 retained an independent role only for EFS and OS. While Tox-DTD affected all survival outcomes, no differences in PFS were reported among patients permanently reducing dose or interrupting venetoclax for > 7 days. Conclusion Clinical outcome with venetoclax is not influenced by comorbidities, patients' clinical characteristics, or concomitant medications. Differently from other targeted therapies, this demonstrates that, except ECOG-PS, none of the parameters generally considered for treatment choice, including baseline neutropenia or impaired renal function, should rule the decision process with this agent. Anyway, if clinically needed, a correct drug management does not compromise treatment efficacy and may avoid toxicity-driven discontinuations. Plain Language Summary Chapter 1: Why was this study done? Chapter 2: Which are the main findings of the study? Chapter 3: How these findings may impact on clinical practice? Coexisting conditions and concomitant medications do not affect venetoclax management and survival in chronic lymphocytic leukemia • The question of which parameters may be informative on venetoclax outcome in chronic lymphocytic leukemia is still unclear. Furthermore, the choice to treat with venetoclax can be challenging in patients with baseline characteristics or comorbidities that may potentially favor some specific adverse events (e.g. compromised renal function or baseline neutropenia).• In our large series of patients treated outside of clinical trials, we demonstrated that neither age, fitness, comorbidities nor concomitant medications impact on venetoclax management and survival. Importantly, patients presenting with baseline neutropenia or impaired renal function did not have a higher rate of dose reductions or toxicity-driven discontinuations, thus further underlining that venetoclax may be safely administered even in those categories with no preclusions.• Differently from other targeted agents, our data demonstrate that none of the baseline factors commonly considered in treatment decision process retains a role with venetoclax. Finally, permanent dose reductions and temporary interruptions did not adversely impact PFS suggesting that, if clinically needed, a correct drug management should be adopted with no risk of compromising venetoclax efficacy.
Collapse
Affiliation(s)
| | | | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato-Oncologica (CREO), Department of Medicine and Surgery, Institute of Hematology, University of Perugia, Perugia, Italy
| | - Alberto Fresa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, Università di Torino, Torino, Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A.Businco, ARNAS ‘G. Brotzu’, Cagliari, Italy
| | - Annalisa Chiarenza
- Hematology Division, A.O.U. Policlinico ‘G. Rodolico-S.Marco’, Catania, Italy
| | | | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, ‘Sapienza’ University, Roma, Italy
| | - Gianluigi Reda
- U.O.C. Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | | | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Chiara Borella
- Department of Hematology, Ospedale San Gerardo, Monza, Italy
| | - Antonino Greco
- Department of Hematology, Azienda Ospedaliera Giovanni Panìco, Tricase, Italy
| | - Marina Deodato
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giulia Zamprogna
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Roberta Laureana
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Roma, Italy
| | - Alessandra Cipiciani
- Centro di Ricerca Emato-Oncologica (CREO), Department of Medicine and Surgery, Institute of Hematology, University of Perugia, Perugia, Italy
| | - Andrea Galitzia
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Angelo Curto Pelle
- Hematology Division, A.O.U. Policlinico ‘G. Rodolico-S.Marco’, University of Catania, Catania, Italy
| | | | | | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, Università di Torino, Torino, Italy
| | - Luca Laurenti
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Marco Montillo
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Roberto Cairoli
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Alessandra Tedeschi
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| |
Collapse
|
10
|
Mavilia F, Pratesi F, Baratè C, Benedetti E, Guerri V, Sammuri P, Migliorini P, Galimberti S. CLL-050 Induction of Neutralizing Antibodies in Chronic Lymphocytic Leukemia Patients After SARS-CoV-2 mRNA Vaccination: A Monocentric Experience. Clinical Lymphoma Myeloma and Leukemia 2022. [PMCID: PMC9489250 DOI: 10.1016/s2152-2650(22)01318-0] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: SARS-CoV-2 infection increases the clinical risk and mortality of patients with chronic lymphocytic leukemia (CLL). Covid-19 vaccinations have the potential to protect individuals from severe infection, but little is known about the antibody response profile in these patients after vaccination. We compared the anti-receptor binding domain (RBD) and neutralizing antibody responses of 27 patients with CLL to those of healthy donors after mRNA Covid-19 vaccination. Methods: Of the 27 patients enrolled in the study, 21 received the BNT162b2 mRNA vaccine and 6 received the Spikevax mRNA vaccine. Four patients were in clinical remission after treatment, 10 were treatment-naïve, and 13 were under treatment at the time of vaccination. Blood samples were taken before vaccination and after the second dose, with a median time between of 23 days. The levels of anti-RBD IgG, IgM, and IgA were evaluated by ELISA on recombinant RBD; the neutralizing antibody response was evaluated by spike protein inhibition assay (SPIA). We also performed a fluorescence-activated cell sorting study of peripheral blood mononuclear cell subpopulations, a disease burden assessment using blood indicators (lactate dehydrogenase, beta-2-microglobulin, lymphocytic count) and imaging, and an evaluation of IgG levels at the time of vaccination. Results: A comparison of anti-RBD antibody seroconversion (IgG, IgM, and IgA) and neutralizing antibodies present after vaccination between 27 patients with CLL and healthy control subjects indicated that CLL patients had a considerably lower response rate (50% vs. 100%) and lower antibody levels than the healthy controls. We found an inverse correlation between the spleen dimension and lymphonodal area. By stratifying patients according to the presence of neutralizing antibodies after vaccination, we found a larger prevalence of SPIA positives than SPIA negatives in treatment-naïve patients (60%); however, patients undergoing treatment had a much lower percentage of SPIA positives (23.1%). Conclusions: Only around half of vaccinated CLL patients acquire detectable anti-RBD and neutralizing antibodies, according to our findings. Furthermore, we discovered a substantial difference in the rates of detectable anti-SARS-CoV-2 antibodies between patients who were treatment-naïve/in clinical remission and those on CLL-directed treatment. The persistence and burden of disease represent a surrogate of vaccine failure, probably due to the persistence of immune dysfunction.
Collapse
|
11
|
Fiorino F, Ciabattini A, Sicuranza A, Pastore G, Santoni A, Simoncelli M, Polvere J, Galimberti S, Baratè C, Sammartano V, Montagnani F, Bocchia M, Medaglini D. The third dose of mRNA SARS-CoV-2 vaccines enhances the spike-specific antibody and memory B cell response in myelofibrosis patients. Front Immunol 2022; 13:1017863. [PMID: 36248803 PMCID: PMC9556722 DOI: 10.3389/fimmu.2022.1017863] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Vaccination against SARS-CoV-2 using mRNA-based vaccines has been highly recommended for fragile subjects, including myelofibrosis patients (MF). Available data on the immune responsiveness of MF patients to mRNA SARS-CoV-2 vaccination, and the impact of the therapy with the JAK inhibitor ruxolitinib, are still fragmented. Here, we profile the spike-specific IgG and memory B-cell response in MF patients, treated or not with ruxolitinib, after the second and the third dose of SARS-CoV-2 BNT162b2 (BioNTech) and mRNA-1273 (Moderna) vaccines. Plasma and peripheral blood mononuclear cells samples were collected before vaccination, post the second and the third doses and tested for spike-specific antibodies, ACE2/RBD antibody inhibition binding activity and spike-specific B cells. The third vaccine dose significantly increased the spike-specific IgG titers in both ruxolitinib-treated and untreated patients, and strongly enhanced the percentage of subjects with antibodies capable of in vitro blocking ACE2/RBD interaction, from 50% up to 80%. While a very low frequency of spike-specific B cells was measured in blood 7 days after the second vaccination dose, a strong and significant increase was elicited by the third dose administration, generating a B cell response similar to the one detected in healthy controls. Despite the overall positive impact of the third dose in MF patients, two patients that were under active concomitant immunosuppressive treatment at the time of vaccination, and a patient that received lymphodepleting therapies in the past, remained low responders. The third mRNA vaccine dose strongly increases the SARS-CoV-2 specific humoral and B cell responses in MF patients, promoting a reactivation of the immune response similar to the one observed in healthy controls.
Collapse
Affiliation(s)
- Fabio Fiorino
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Annalisa Ciabattini
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Anna Sicuranza
- Hematology Unit, Department of Medical Science, Surgery and Neuroscience, Azienda Ospedaliero Universitaria Senese, University of Siena, Siena, Italy
| | - Gabiria Pastore
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Adele Santoni
- Hematology Unit, Department of Medical Science, Surgery and Neuroscience, Azienda Ospedaliero Universitaria Senese, University of Siena, Siena, Italy
| | - Martina Simoncelli
- Hematology Unit, Department of Medical Science, Surgery and Neuroscience, Azienda Ospedaliero Universitaria Senese, University of Siena, Siena, Italy
| | - Jacopo Polvere
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudia Baratè
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vincenzo Sammartano
- Hematology Unit, Department of Medical Science, Surgery and Neuroscience, Azienda Ospedaliero Universitaria Senese, University of Siena, Siena, Italy
| | - Francesca Montagnani
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, University Hospital of Siena, Siena, Italy
| | - Monica Bocchia
- Hematology Unit, Department of Medical Science, Surgery and Neuroscience, Azienda Ospedaliero Universitaria Senese, University of Siena, Siena, Italy
- *Correspondence: Donata Medaglini, ; Monica Bocchia,
| | - Donata Medaglini
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- *Correspondence: Donata Medaglini, ; Monica Bocchia,
| |
Collapse
|
12
|
Galimberti S, Baldini C, Baratè C, Fornili M, Balducci S, Ricci F, Ferro F, Elefante E, Di Paolo A, Baglietto L, Donati V, Petrini M. Myeloid neoplasms and autoimmune diseases: markers of association. Clin Exp Rheumatol 2022; 40:49-55. [PMID: 33427624 DOI: 10.55563/clinexprheumatol/ddxmp9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To investigate the prognostic significance of concomitant autoimmune diseases (ADs) in myeloproliferative neoplasms (MPNs). METHODS 435 subjects with a diagnosis of MPNs were included in this observational single institution longitudinal study. Of them, 34 patients presented an overt AD at diagnosis of MPN. Clinical presenting features, progression-free and overall survival were compared between MPN subgroups in relation to co-existence of AD at diagnosis of MPN. RESULTS Compared to cases without ADs, the subjects with ADs were significantly younger, had lower haemoglobin and haematocrit levels and more frequently presented with splenomegaly. The clinical and biological features associated to progression-free and overall survival were: age, presence of splenomegaly, histotype (MF vs. PV vs. ET), anaemia, high platelet count and presence of any AD at diagnosis of MPN. The age-adjusted hazard ratio (HR) of progression for the presence of AD at diagnosis of MPN was 2.76. Overall survival was not significantly associated to AD at diagnosis, but the HR of progression for the presence of AD at diagnosis of MPN was 2.18. CONCLUSIONS A possible common genetic predisposition, the inflammatory bone marrow microenvironment and the activation of theJAK/STAT pathway could be considered as responsible for the observed association between MPNs and ADs.
Collapse
Affiliation(s)
- Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Chiara Baldini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Marco Fornili
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Serena Balducci
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Federica Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesco Ferro
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Elena Elefante
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Valentina Donati
- Pathological Anatomy Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mario Petrini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| |
Collapse
|
13
|
Tedeschi A, Frustaci AM, Mauro FR, Chiarenza A, Coscia M, Ciolli S, Reda G, Laurenti L, Varettoni M, Murru R, Baratè C, Sportoletti P, Greco A, Borella C, Rossi V, Deodato M, Biagi A, Zamprogna G, Pelle AC, Lapietra G, Vitale C, Morelli F, Cassin R, Fresa A, Cavalloni C, Postorino M, Ielo C, Cairoli R, Di Raimondo F, Montillo M, Del Poeta G. Do age, fitness, and concomitant medications influence management and outcomes of patients with CLL treated with ibrutinib? Blood Adv 2021; 5:5490-5500. [PMID: 34525181 PMCID: PMC8714729 DOI: 10.1182/bloodadvances.2021004824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022] Open
Abstract
Functional reserve of organs and systems is known to be relevant in predicting immunochemotherapy tolerance. Age and comorbidities, assessed by the cumulative illness rating scale (CIRS), have been used to address chemotherapy intensity. In the ibrutinib era, it is still unclear whether age, CIRS, and Eastern Cooperative Oncology Group performance status (ECOG-PS) retain their predictive role on treatment vulnerability. In this series of 712 patients with chronic lymphocytic leukemia (CLL) treated with ibrutinib outside clinical trials, baseline ECOG-PS and neutropenia resulted as the most accurate predictors of treatment feasibility and outcomes. Age did not independently influence survival and ibrutinib tolerance, indicating that not age per se, but age-related conditions, may affect drug management. We confirmed the role of CIRS > 6 as a predictor of a poorer progression- and event-free survival (PFS, EFS). The presence of a severe comorbidity was significantly associated with permanent dose reductions (PDRs), not translating into worse outcomes. As expected, del(17p) and/or TP53mut and previous therapies affected PFS, EFS, and overall survival. No study so far has analyzed the influence of concomitant medications and CYP3A inhibitors with ibrutinib. In our series, these factors had no impact, although CYP3A4 inhibitors use correlated with Cox regression analysis, with an increased risk of PDR. Despite the limitation of its retrospective nature, this large study confirmed the role of ECOG-PS as the most accurate predictor of ibrutinib feasibility and outcomes, and importantly, neutropenia emerged as a relevant tool influencing patients' vulnerability. Although CIRS > 6 retained a significant impact on PFS and EFS, its value should be confirmed by prospective studies.
Collapse
Affiliation(s)
- Alessandra Tedeschi
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Anna Maria Frustaci
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Annalisa Chiarenza
- Division of Hematology, AOU “Policlinico-Vittorio Emanuele,” University of Catania, Catania, Italy
| | - Marta Coscia
- Division of Hematology, AOU Città della Salute e della Scienza di Torino, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Stefania Ciolli
- Department of Hematology, Università degli Studi di Firenze, Firenze, Italy
| | - Gianluigi Reda
- Department of Hematology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Luca Laurenti
- Hematology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Roma, Italy
| | - Marzia Varettoni
- Division of Hematology Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, ARNAS “G. Brotzu,” Cagliari, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Paolo Sportoletti
- Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Antonino Greco
- Department of Hematology, Azienda Ospedaliera Giovanni Panìco, Tricase, Italy
| | - Chiara Borella
- Department of Hematology, Ospedale San Gerardo, Monza, Italy
| | - Valentina Rossi
- Hematology & Transfusion Medicine L. Sacco University Hospital and School of Medicine, Milano, Italy; and
| | - Marina Deodato
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Annalisa Biagi
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Giulia Zamprogna
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Angelo Curto Pelle
- Division of Hematology, AOU “Policlinico-Vittorio Emanuele,” University of Catania, Catania, Italy
| | - Gianfranco Lapietra
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Candida Vitale
- Division of Hematology, AOU Città della Salute e della Scienza di Torino, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Francesca Morelli
- Department of Hematology, Università degli Studi di Firenze, Firenze, Italy
| | - Ramona Cassin
- Department of Hematology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Alberto Fresa
- Hematology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Roma, Italy
| | - Chiara Cavalloni
- Division of Hematology Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Postorino
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Claudia Ielo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Roberto Cairoli
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Francesco Di Raimondo
- Division of Hematology, AOU “Policlinico-Vittorio Emanuele,” University of Catania, Catania, Italy
| | - Marco Montillo
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giovanni Del Poeta
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| |
Collapse
|
14
|
Carpenedo M, Baldacci E, Baratè C, Borchiellini A, Buccisano F, Calvaruso G, Chiurazzi F, Fattizzo B, Giuffrida G, Rossi E, Palandri F, Scalzulli PR, Siragusa SM, Vitucci A, Zaja F. Second-line administration of thrombopoietin receptor agonists in immune thrombocytopenia: Italian Delphi-based consensus recommendations. Ther Adv Hematol 2021; 12:20406207211048361. [PMID: 34646432 PMCID: PMC8504223 DOI: 10.1177/20406207211048361] [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] [Received: 04/16/2021] [Accepted: 09/06/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction: In patients with primary immune thrombocytopenia (ITP), a short course of steroids is routinely given as first-line therapy. However, the response is often transient and additional therapy is usually needed. Thrombopoietin receptor agonists (TPO-RAs) are frequently used as second-line therapy, although there is little clinical guidance on the timing of their administration and on tapering/discontinuation of the drug. To provide clinical recommendations, we used the Delphi technique to obtain consensus for statements regarding administration and on tapering/discontinuation of second-line TPO-RAs among a group of Italian clinicians with expertise in management of ITP. Methods: The Delphi process was used to obtain agreement on five statements regarding initiation and on tapering/discontinuation of second-line TPO-RAs. Agreement was considered when 75% of participants approved the statement. Eleven experts participated in the voting. Results: Full consensus was reached for three of the five statements. The experts held that an early switch from corticosteroids to a TPO-RA has the dual advantage of sparing patients from corticosteroid abuse and improve long-term clinical outcomes. All felt that dose reduction of TPO-RAs can be considered in patients with a stable response and platelet count >100 × 109/L that is maintained for at least 6 months in the absence of concomitant treatments, although there was less agreement in patients with a platelet count >50 × 109/L. Near consensus was reached regarding the statement that early treatment with a TPO-RA is associated with an increase in clinically significant partial or complete response. The experts also agreed that optimization of tapering and discontinuation of TPO-RA therapy in selected patients can improve the quality of life. Conclusion: The present consensus can help to provide guidance on use of TPO-RAs in daily practice in patients with ITP. Plain language summary Second-line administration of thrombopoietin receptor agonists in immune thrombocytopenia
Collapse
Affiliation(s)
- Monica Carpenedo
- Hematology and Transplantation Unit, ASST San Gerardo Hospital, Via G. B. Pergolesi, 33, 20900 Monza MB, Italy
| | - Erminia Baldacci
- Department of Hematology, Policlinico Umberto I University Hospital, Rome, Italy
| | - Claudia Baratè
- Hematology and Bone Marrow Transplant Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandra Borchiellini
- Regional Reference Center of Haemostasis and Thrombosis Haematology Unit, Città della Salute e della Scienza, Turin, Italy
| | - Francesco Buccisano
- Hematology, Department of BioMedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Giuseppina Calvaruso
- Campus of Hematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Federico Chiurazzi
- Department of Clinical Medicine, University "Federico II" of Naples, Naples, Italy
| | - Bruno Fattizzo
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaetano Giuffrida
- Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Elena Rossi
- Department of Radiological and Hematological Sciences, Universita Cattolica del Sacro Cuore and Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Potito Rosario Scalzulli
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | | | - Angelantonio Vitucci
- Haematology with Transplant Unit, Az. Universitario-Ospedaliera Consorziale Policlinico, Bari, Italy
| | - Francesco Zaja
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| |
Collapse
|
15
|
Fiorino F, Sicuranza A, Ciabattini A, Santoni A, Pastore G, Simoncelli M, Polvere J, Galimberti S, Auddino S, Baratè C, Montagnani F, Sammartano V, Bocchia M, Medaglini D. The Slower Antibody Response in Myelofibrosis Patients after Two Doses of mRNA SARS-CoV-2 Vaccine Calls for a Third Dose. Biomedicines 2021; 9:1480. [PMID: 34680595 PMCID: PMC8533286 DOI: 10.3390/biomedicines9101480] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 09/21/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/22/2022] Open
Abstract
Immunization with mRNA SARS-CoV-2 vaccines has been highly recommended and prioritized in fragile subjects, including patients with myelofibrosis (MF). Available data on the vaccine immune response developed by MF patients and the impact of ruxolitinib treatment are still too fragmented to support an informed decision on a third dose for this category of subjects. Here, we show that 76% of MF patients develop spike-specific IgG after the second mRNA SARS-CoV-2 vaccine dose, but the response has a slower kinetics compared to healthy subjects, suggesting a reduced capability of their immune system to promptly react to vaccination. A reduced ACE2/RBD binding inhibition activity of spike-specific antibodies was also observed, especially in ruxolitinib-treated patients. Our results, showing slow kinetics of antibody responses in MF patients following vaccination with mRNA SARS-CoV-2 vaccines, support the need for a third vaccine dose.
Collapse
Affiliation(s)
- Fabio Fiorino
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (F.F.); (A.C.); (G.P.); (J.P.); (S.A.)
| | - Anna Sicuranza
- Hematology Unit, Department of Medical Science, Surgery and Neuroscience, Azienda Ospedaliero Universitaria Senese, University of Siena, 53100 Siena, Italy; (A.S.); (A.S.); (M.S.); (V.S.)
| | - Annalisa Ciabattini
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (F.F.); (A.C.); (G.P.); (J.P.); (S.A.)
| | - Adele Santoni
- Hematology Unit, Department of Medical Science, Surgery and Neuroscience, Azienda Ospedaliero Universitaria Senese, University of Siena, 53100 Siena, Italy; (A.S.); (A.S.); (M.S.); (V.S.)
| | - Gabiria Pastore
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (F.F.); (A.C.); (G.P.); (J.P.); (S.A.)
| | - Martina Simoncelli
- Hematology Unit, Department of Medical Science, Surgery and Neuroscience, Azienda Ospedaliero Universitaria Senese, University of Siena, 53100 Siena, Italy; (A.S.); (A.S.); (M.S.); (V.S.)
| | - Jacopo Polvere
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (F.F.); (A.C.); (G.P.); (J.P.); (S.A.)
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.G.); (C.B.)
| | - Stefano Auddino
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (F.F.); (A.C.); (G.P.); (J.P.); (S.A.)
| | - Claudia Baratè
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (S.G.); (C.B.)
| | - Francesca Montagnani
- Department of Medical Sciences, Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, University of Siena, 53100 Siena, Italy;
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Vincenzo Sammartano
- Hematology Unit, Department of Medical Science, Surgery and Neuroscience, Azienda Ospedaliero Universitaria Senese, University of Siena, 53100 Siena, Italy; (A.S.); (A.S.); (M.S.); (V.S.)
| | - Monica Bocchia
- Hematology Unit, Department of Medical Science, Surgery and Neuroscience, Azienda Ospedaliero Universitaria Senese, University of Siena, 53100 Siena, Italy; (A.S.); (A.S.); (M.S.); (V.S.)
| | - Donata Medaglini
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (F.F.); (A.C.); (G.P.); (J.P.); (S.A.)
| |
Collapse
|
16
|
Cuneo A, Rigolin GM, Coscia M, Quaresmini G, Scarfò L, Mauro FR, Motta M, Quaglia FM, Trentin L, Ferrario A, Laurenti L, Reda G, Ferrari A, Pietrasanta D, Sportoletti P, Re F, De Paoli L, Foglietta M, Giordano A, Marchetti M, Farina L, Del Poeta G, Varettoni M, Chiurazzi F, Marasca R, Malerba L, Ibatici A, Tisi MC, Stefoni V, Leone M, Baratè C, Olivieri J, Murru R, Gentile M, Sanna A, Gozzetti A, Gattei V, Gottardi D, Derenzini E, Levato L, Orsucci L, Penna G, Chiarenza A, Foà R. Management of chronic lymphocytic leukemia in Italy during a one year of the COVID-19 pandemic and at the start of the vaccination program. A Campus CLL report. Hematol Oncol 2021; 39:570-574. [PMID: 34258787 PMCID: PMC8426998 DOI: 10.1002/hon.2899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Antonio Cuneo
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Gian Matteo Rigolin
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marta Coscia
- Division of Hematology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Lydia Scarfò
- Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Marina Motta
- S.C. Ematologia, ASST Spedali Civili, Brescia, Italy
| | | | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Italy
| | - Andrea Ferrario
- UOC Ematologia Azienda Socio Sanitaria Territoriale dei Sette Laghi, Ospedale di Circolo di Varese, Varese, Italy
| | - Luca Laurenti
- Hematology, Fondazione Universitaria Policlinico A. Gemelli, Rome, Italy
| | - Gianluigi Reda
- U.O.C. Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angela Ferrari
- Hematology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniela Pietrasanta
- Division of Hematology, SC di Ematologia, Ospedale Civile SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paolo Sportoletti
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncological Research, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Francesca Re
- Hematology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Myriam Foglietta
- SC Ematologia Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | - Annamaria Giordano
- Hematology-Department of Emergency and Organ Transplantation, Azienda Ospedaliero Universitaria Policlinico, Bari, Italy
| | - Monia Marchetti
- Hematology-Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo Alessandria, Alessandria, Italy
| | - Lucia Farina
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Marzia Varettoni
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Roberto Marasca
- Hematology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Lara Malerba
- UOC Ematologia e Centro trapianti AORMN Pesaro, Pesaro, Italy
| | - Adalberto Ibatici
- Hematology and Bone Marrow Transplant, Policlinico San Martino, Genova, Italy
| | - Maria Chiara Tisi
- Hematology, Azienda ULSS 8 Berica Dipartimento Strutturale Oncologia Clinica Vicenza, Vicenza, Italy
| | - Vittorio Stefoni
- Department of Hematology and Oncology "L. and A. Seràgnoli", Bologna, Italy
| | - Monica Leone
- Hematology, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Claudia Baratè
- Clinical and Experimental Medicine, Hematology Section, University of Pisa, Pisa, Italy
| | - Jacopo Olivieri
- Hematology Unit, Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Roberta Murru
- SC Ematologia e CTMO Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | | | - Alessandro Sanna
- Hemtology Unit, Azienda Ospedaliero Universitaria Careggi Firenze, Firenze, Italy
| | - Alessandro Gozzetti
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese Siena, Siena, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Enrico Derenzini
- Oncohematology Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Luciano Levato
- SOC Ematologia, Dipartimento di Ematologia Oncologia Azienda Ospedaliera Pugliese Ciaccio Catanzaro, Catanzaro, Italy
| | - Lorella Orsucci
- SC Ematologia, AUO Città della Scienza e della Salute di Torino, Torino, Italy
| | - Giuseppa Penna
- UOC Ematologia Policlinico Universitario di Messina, Messina, Italy
| | - Annalisa Chiarenza
- Divisione di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliera Universitaria Policlinico "G.Rodolico-S.Marco", Catania, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| |
Collapse
|
17
|
Latagliata R, Attolico I, Trawinska MM, Capodanno I, Annunziata M, Elena C, Luciano L, Crugnola M, Bergamaschi M, Bonifacio M, Baratè C, Mauro E, Binotto G, Sgherza N, Aguzzi C, Monteleone B, Sorà F, Caocci G, Luzi D, Mariggiò E, Scaffidi L, Cattaneo D, Gozzini A, Di Veroli A, Abruzzese E, Galimberti S, Iurlo A, Specchia G, Breccia M. Bosutinib in the real-life treatment of chronic myeloid leukemia patients aged >65 years resistant/intolerant to previous tyrosine-kinase inhibitors. Hematol Oncol 2021; 39:401-408. [PMID: 33617659 DOI: 10.1002/hon.2851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 01/08/2023]
Abstract
To evaluate the role of bosutinib in elderly patients aged >65 years with chronic myeloid leukemia (CML), a real-life cohort of 101 chronic-phase CML patients followed up in 23 Italian centers and treated with bosutinib in second or a subsequent line was retrospectively evaluated. Starting dose of bosutinib was 500 mg/day in 25 patients (24.8%), 400 mg/day in 7 patients (6.9%), 300 mg/day in 33 patients (32.7%), 200 mg/day in 34 patients (33.6%), and 100 mg/day in 2 patients (2.0%). Grade 3/4 hematological toxicity occurred in 7/101 patients (6.9%) and grade 3/4 extra-hematological toxicity in 19/101 patients (18.8%). Permanent bosutinib discontinuation due to toxicity was needed in 12 patients (11.9%). Among the 96 patients evaluable for response, 74 (77.0%) achieved a complete cytogenetic response (CCyR), while 64 of these 74 patients in CCyR (66.6% of all 96 evaluable patients) also achieved a molecular response (MR) (major MR [MR 3.0] in 21 [21.8%], deep MR [MR 4.0/4.5] in 43 [44.8%]). The 3-year event-free survival and overall survival of the whole patients' cohort from bosutinib start were 60.9% (CI 95% 49.3-72.5) and 86.4% (CI 95% 77.2-95.6), respectively. Our real-life data show that bosutinib is effective, with a favorable safety profile, also in elderly patients with important comorbidities and resistance and/or intolerance to previous tyrosine-kinase inhibitor treatments. As a consequence, it could play a significant role in current clinical practice for frail patients.
Collapse
Affiliation(s)
- Roberto Latagliata
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, Rome, Italy.,Hematology, Belcolle Hospital, Viterbo, Italy
| | - Immacolata Attolico
- Hematology Section, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | | | - Isabella Capodanno
- Hematology Department, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Chiara Elena
- Department of Molecular Medicine & Hematology Oncology, University of Pavia, Pavia, Italy
| | - Luigiana Luciano
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Monica Crugnola
- Hematology and BMT Center, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | | | - Claudia Baratè
- Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Endri Mauro
- UOC Hematology, Ca'Foncello Hospital, Treviso, Italy
| | - Gianni Binotto
- Department of Medicine, Hematology and Clinical Immunology, Padua School of Medicine, Padua, Italy
| | - Nicola Sgherza
- UOC Hematology and Marrow Transplantation, "A Perrino" Hospital, Brindisi, Italy
| | | | | | - Federica Sorà
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Caocci
- Hematology-Centro Trapianti Midollo Osseo, Ospedale Businco, Università di Cagliari, Cagliari, Italy
| | - Debora Luzi
- Hematology, Azienda Ospedaliera - S, Maria Terni, Terni, Italy
| | - Elena Mariggiò
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Luigi Scaffidi
- Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | - Sara Galimberti
- Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgina Specchia
- Hematology Section, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, Rome, Italy
| |
Collapse
|
18
|
Caocci G, Mulas O, Capodanno I, Bonifacio M, Annunziata M, Galimberti S, Luciano L, Tiribelli M, Martino B, Castagnetti F, Binotto G, Pregno P, Stagno F, Abruzzese E, Bocchia M, Gozzini A, Albano F, Fozza C, Luzi D, Efficace F, Simula MP, Scaffidi L, Baratè C, De Gregorio F, Stella R, Gugliotta G, Pirillo F, Trawinska MM, Sicuranza A, Cattaneo D, Attolico I, Scalzulli E, Iurlo A, Foà R, Breccia M, La Nasa G. Low-density lipoprotein (LDL) levels and risk of arterial occlusive events in chronic myeloid leukemia patients treated with nilotinib. Ann Hematol 2021; 100:2005-2014. [PMID: 33388860 DOI: 10.1007/s00277-020-04392-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022]
Abstract
Recommendations for dyslipidemia management aimed at reducing arterial occlusive events (AOEs) have been recently published. So far, no data have been reported on the management of dyslipidemia in chronic myeloid leukemia (CML) patients treated with nilotinib. We investigated 369 CML adult patients, stratified according to the new Systematic Coronary Risk Evaluation (SCORE) scoring system. Plasma levels of cholesterol, HDL, LDL, and triglycerides were measured prior to the start of nilotinib and after 3, 6, and 12 months. The 5-year cumulative incidence of AOEs was 15.9%. Patients with cholesterol levels > 200 mg/dL and LDL > 70 mg/dL 3 months after treatment showed a significantly higher incidence of AOEs (21.9 ± 4.6% vs 6.2 ± 2.5, P = 0.003). Patients belonging to the high and very high SCORE risk group showed a significant increase of AOEs (34.4 ± 6% vs 10 ± 2.1%, P < 0.001). In multivariate analysis, both high cholesterol and LDL levels and a high and very high SCORE risk remained significantly associated with the risk of AOEs (P = 0.008; HR = 3.5; 95% CI = 1.4-8.7 and P < 0.001; HR = 4.4; 95% CI = 2-9.8, respectively). Overall, 78 patients (21.1%) presented dyslipidemia at the time of CML diagnosis and 88 (23.3%) after starting nilotinib, but only 26 of them (29.5%) were treated with statins.Low LDL and cholesterol plasma levels are associated with a significant lower risk of AOEs in CML patients treated with nilotinib in the real life.
Collapse
Affiliation(s)
- Giovanni Caocci
- Hematology Unit, Businco Hospital, ARNAS Brotzu, Cagliari, Italy. .,Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy.
| | - Olga Mulas
- Hematology Unit, Businco Hospital, ARNAS Brotzu, Cagliari, Italy.,Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale -IRCCS, Reggio Emilia, Italy
| | | | | | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Luigiana Luciano
- Hematology Unit, "Federico II" University of Naples, Naples, Italy
| | - Mario Tiribelli
- Division of Hematology and BMT, University of Udine, Udine, Italy
| | - Bruno Martino
- Hematology Unit, Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Fabio Stagno
- Hematology Unit, AOU Policlinico -V. Emanuele, Rodolico Hospital, Catania, Italy
| | | | - Monica Bocchia
- Haematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Antonella Gozzini
- Hematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Francesco Albano
- Department of Emergency and Organ Transplantation - Hematology Section, University of Bari, Bari, Italy
| | - Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Debora Luzi
- Division of Hematology, Hematology Unit, Santa Maria Hospital, Terni, Italy
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | | | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | | | - Rossella Stella
- Division of Hematology and BMT, University of Udine, Udine, Italy
| | - Gabriele Gugliotta
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesca Pirillo
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | | | - Anna Sicuranza
- Haematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Daniele Cattaneo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Immacolata Attolico
- Department of Emergency and Organ Transplantation - Hematology Section, University of Bari, Bari, Italy
| | - Emilia Scalzulli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto 1, Rome, Italy
| | - Alessandra Iurlo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto 1, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto 1, Rome, Italy
| | - Giorgio La Nasa
- Hematology Unit, Businco Hospital, ARNAS Brotzu, Cagliari, Italy.,Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| |
Collapse
|
19
|
Benedetti E, Baratè C, Bruno B, Bramanti E, Ghia P, Scarfò L, Morganti R, Ricchiuto V, Galimberti S. Response assessment to venetoclax in relapsed/refractory chronic lymphocytic leukemia by ultrasonography. Leuk Res 2020; 100:106488. [PMID: 33316660 DOI: 10.1016/j.leukres.2020.106488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/21/2020] [Accepted: 11/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Edoardo Benedetti
- Azienda Ospedaliero-Universitaria Pisana, Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, Italy.
| | - Claudia Baratè
- Azienda Ospedaliero-Universitaria Pisana, Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, Italy.
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Italy.
| | - Emilia Bramanti
- Institute of Chemistry of Organometallic Compounds (ICCOM), CNR, Via G Moruzzi 1, 567124, Pisa, Italy.
| | - Paolo Ghia
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy.
| | - Lydia Scarfò
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy.
| | - Riccardo Morganti
- Section of Statistics, Azienda Ospedaliero-Universitaria Pisana, Italy.
| | - Vittorio Ricchiuto
- Dipartimento di Tecnologie Sanitarie ESTAR, Azienda Ospedaliero-Universitaria Pisana, Italy.
| | - Sara Galimberti
- Azienda Ospedaliero-Universitaria Pisana, Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, Italy.
| |
Collapse
|
20
|
Galimberti S, Petrini M, Baratè C, Ricci F, Balducci S, Grassi S, Guerrini F, Ciabatti E, Mechelli S, Di Paolo A, Baldini C, Baglietto L, Macera L, Spezia PG, Maggi F. Tyrosine Kinase Inhibitors Play an Antiviral Action in Patients Affected by Chronic Myeloid Leukemia: A Possible Model Supporting Their Use in the Fight Against SARS-CoV-2. Front Oncol 2020; 10:1428. [PMID: 33014780 PMCID: PMC7493657 DOI: 10.3389/fonc.2020.01428] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022] Open
Abstract
SARS-CoV-2 is the viral agent responsible for the pandemic that in the first months of 2020 caused about 400,000 deaths. Among compounds proposed to fight the SARS-CoV-2-related disease (COVID-19), tyrosine kinase inhibitors (TKIs), already effective in Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL) and chronic myeloid leukemia (CML), have been proposed on the basis of their antiviral action already demonstrated against SARS-CoV-1. Very few cases of COVID-19 have been reported in Ph+ ALL and in CML Italian cohorts; authors suggested that this low rate of infections might depend on the use of TKIs, but the biological causes of this phenomenon remain unknown. In this study, the CML model was used to test if TKIs would sustain or not the viral replication and if they could damage patient immunity. Firstly, the infection and replication rate of torquetenovirus (TTV), whose load is inversely proportional to the host immunological control, have been measured in CML patients receiving nilotinib. A very low percentage of subjects were infected at baseline, and TTV did not replicate or at least showed a low replication rate during the follow-up, with a mean load comparable to the measured one in healthy subjects. Then, after gene expression profiling experiments, we found that several “antiviral” genes, such as CD28 and IFN gamma, were upregulated, while genes with “proviral” action, such as ARG-1, CEACAM1, and FUT4, were less expressed during treatment with imatinib, thus demonstrating that TKIs are not detrimental from the immunological point of view. To sum up, our data could offer some biological explanations to the low COVID-19 occurrence in Ph+ ALL and CML patients and sustain the use of TKIs in COVID-19, as already proposed by several international ongoing studies.
Collapse
Affiliation(s)
- Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Petrini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Federica Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Serena Balducci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Susanna Grassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Guerrini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Ciabatti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Baldini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lisa Macera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Pietro Giorgio Spezia
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Fabrizio Maggi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| |
Collapse
|
21
|
Cesini L, Frieri C, Baratè C, Sorà F, Bonifacio M, Cerrano M, Cagnetta A, Elena C, Aprile L, Sgherza N, Trawinska M, Gozzini A, Capodanno I, Crugnola M, Carmosino I, Scalzulli E, Ricci F, Bocchia M, Bergamaschi M, Aguzzi C, Sica S, Galimberti S, Breccia M, Luciano L, Latagliata R. Erythropoietin treatment in chronic phase chronic myeloid leukemia patients treated with frontline imatinib who developed late anemia. Eur J Haematol 2020; 105:286-291. [PMID: 32365249 DOI: 10.1111/ejh.13436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Role of erythropoietin (EPO) in the treatment of late anemia in patients with Chronic Myeloid Leukemia (CML) is still undefined. METHODS Fifty CML patients treated at 14 institutions with frontline imatinib for at least 12 months and in stable complete cytogenetic response who developed a late chronic anemia treated with EPO were retrospectively evaluated. RESULTS Median time from imatinib start to EPO treatment was 42.2 months [interquartile range (IQR) 20.8-91.9]. Median Hb value at EPO starting time was 9.9 g/dL (IQR 8.9-10.3): Eleven patients (22.0%) were transfusion dependent. Alpha-EPO (40 000 UI weekly) was employed in 37 patients, beta-EPO (30 000 UI weekly) in 9 patients, zeta-EPO (40 000 UI weekly) in 2 patients, and darbepoetin (150 mcg/weekly) in the remaining 2 patients. On the whole, 41 patients (82.0%) achieved an erythroid response, defined as a stable (>3 months) improvement >1.5 g/dL of Hb level, and 9 patients (18.0%) indeed resulted resistant. Among responding patients, 10 relapsed after a median time from EPO start of 20.7 months (IQR 10.8-63.7). No EPO-related toxicity was observed. CONCLUSIONS Results of EPO treatment for late chronic anemia during long-lasting imatinib therapy are encouraging, with a high rate of response.
Collapse
Affiliation(s)
- Laura Cesini
- Department of Translational and Precision Medicine, University "La Sapienza" of Rome, Rome, Italy
| | - Camilla Frieri
- Hematology, University "Federico II" of Neaples, Naples, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine - Hematology, University of Pisa, Pisa, Italy
| | - Federica Sorà
- Hematology, Catholic University of Sacred Heart of Rome, Rome, Italy
| | | | - Marco Cerrano
- Department of Oncology and Hematology, University of Turin, Turin, Italy
| | | | | | - Lara Aprile
- Division of Hematology, University of Siena, Siena, Italy
| | - Nicola Sgherza
- Hematology, IRCCS, "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | | | | | | | | | - Ida Carmosino
- Department of Translational and Precision Medicine, University "La Sapienza" of Rome, Rome, Italy
| | - Emilia Scalzulli
- Department of Translational and Precision Medicine, University "La Sapienza" of Rome, Rome, Italy
| | - Federica Ricci
- Department of Clinical and Experimental Medicine - Hematology, University of Pisa, Pisa, Italy
| | - Monica Bocchia
- Division of Hematology, University of Siena, Siena, Italy
| | | | - Chiara Aguzzi
- Department of Oncology and Hematology, University of Turin, Turin, Italy
| | - Simona Sica
- Hematology, Catholic University of Sacred Heart of Rome, Rome, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine - Hematology, University of Pisa, Pisa, Italy
| | - Massimo Breccia
- Department of Translational and Precision Medicine, University "La Sapienza" of Rome, Rome, Italy
| | | | - Roberto Latagliata
- Department of Translational and Precision Medicine, University "La Sapienza" of Rome, Rome, Italy
| |
Collapse
|
22
|
Ricci F, Balducci S, Guerrini F, Grassi S, Ciabatti E, Baratè C, Ferreri MI, Giuliani C, Valetto A, Petrini M, Galimberti S. Sorafenib Induced Complete Cytogenetic and Molecular Response in a Chronic Eosinophilic Leukemia Case with t(12;13) Translocation. Clin Hematol Int 2020; 2:129-131. [PMID: 34595453 PMCID: PMC8432331 DOI: 10.2991/chi.k.200714.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/05/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Federica Ricci
- Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, Pisa, Italy
| | - Serena Balducci
- Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, Pisa, Italy
| | - Francesca Guerrini
- Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, Pisa, Italy
| | - Susanna Grassi
- Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, Pisa, Italy
| | - Elena Ciabatti
- Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, Pisa, Italy
| | - Claudia Baratè
- UO Hematology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Cecilia Giuliani
- UO Cytogenetics, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Angelo Valetto
- UO Cytogenetics, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mario Petrini
- Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, Pisa, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, UO Hematology, University of Pisa, Pisa, Italy
| |
Collapse
|
23
|
Mulas O, Caocci G, Annunziata M, Martino B, Luciano L, Castagnetti F, Pregno P, Galimberti S, Albano F, Orlandi EM, Sgherza N, Iurlo A, Bonifacio M, Binotto G, Gozzini A, Bocchia M, Abruzzese E, Fozza C, Simula MP, De Gregorio F, Gugliotta G, Pirillo F, Baratè C, Attolico I, Elena C, Cattaneo D, Scaffidi L, Sicuranza A, Trawinska MM, Scalzulli E, Foà R, Breccia M, La Nasa G. Favorable outcome of chronic myeloid leukemia co-expressing e13a2 and e14a2 transcripts, treated with nilotinib. Hematol Oncol 2020; 38:607-610. [PMID: 32602167 DOI: 10.1002/hon.2765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/04/2020] [Accepted: 06/18/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Olga Mulas
- Department of Medical Sciences and Public Health, University of Cagliari, Businco Hospital, Cagliari, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, Businco Hospital, Cagliari, Italy
| | | | - Bruno Martino
- Haematology Unit, Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Luigiana Luciano
- Haematology Unit "Federico II", University of Naples, Naples, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Patrizia Pregno
- Haematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Francesco Albano
- Haematology and Transplants Unit, University of Bari, Bari,, Italy
| | - Ester M Orlandi
- Haematology Unit, "Fondazione IRCCS Policlinico S. Matteo" University Hospital, Pavia, Italy
| | - Nicola Sgherza
- Haematology and Transplant Center, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Alessandra Iurlo
- Haematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Antonella Gozzini
- Haematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Monica Bocchia
- Haematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Claudio Fozza
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Maria P Simula
- Department of Medical Sciences and Public Health, University of Cagliari, Businco Hospital, Cagliari, Italy
| | | | - Gabriele Gugliotta
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesca Pirillo
- Haematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Imma Attolico
- Haematology and Transplants Unit, University of Bari, Bari,, Italy
| | - Chiara Elena
- Haematology Unit, "Fondazione IRCCS Policlinico S. Matteo" University Hospital, Pavia, Italy
| | - Daniele Cattaneo
- Haematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Anna Sicuranza
- Haematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Emilia Scalzulli
- Division of Haematology, Department of Precision and Translational Medicine, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Robin Foà
- Division of Haematology, Department of Precision and Translational Medicine, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Massimo Breccia
- Division of Haematology, Department of Precision and Translational Medicine, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Giorgio La Nasa
- Department of Medical Sciences and Public Health, University of Cagliari, Businco Hospital, Cagliari, Italy
| |
Collapse
|
24
|
Ferro F, Baratè C, Elefante E, Ricci F, Balducci S, Governato G, Fulvio G, Mosca M, Petrini M, Galimberti S, Baldini C. THU0264 MYELOID MALIGNANCIES, SYSTEMIC AUTOIMMUNE DISEASES AND CARDIOVASCULAR RISK: AN UNDER-REPORTED ASSOCIATION? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4752] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The association between systemic autoimmune diseases (ADs) and lymphoproliferative malignancies is well established; nonetheless, few studies have investigated the prevalence and prognostic impact of myeloid malignancies on systemic autoimmune conditions.Objectives:To investigate the frequency of myeloid malignancies (i.e myelodysplastic syndrome (MDS) and chronic, either Philadelphia-positive or Philadelphia-negative, myeloproliferative disorders (MPNs)) in patients with ADs and their influence on the ADs clinical course and vice-versa.Methods:A retrospective systematic search through the electronic health records of the patients admitted at our Rheumatology University Hospital from 2009 and 2019 was performed to select those presenting with ADs and MDS or MPNs. To refine the search the ICD-9-CM diagnosis codes for MDS/MPNs were utilized. Medical charts of eligible patients were retrieved and data were collected with regard to demographics, type of AD, AD duration, prior treatments, serum laboratory indices, bone marrow aspiration and biopsy data. Categorical variables were compared using chi square test and Fisher’s test; continuous variables were compared using Student’s t-test. A 2-tailed value of p <0.05 was taken to indicate statistical significance.Results:Out of the medical records of 5040 patients, we identified 51 patients (31 F: 20 M, mean age: 61 years (15)) with AD and myeloid malignancies: 17/51 with AD and MDS and 34/51 with AD and MPNs. No demographic differences were observed in the two subgroups. Regarding MDS, anaemia was the most common haematologic presenting finding (15/17, 88%), while the most common diagnosis was refractory anemia with excess of blasts (RAEB I/II) (5/17, 29%) followed by sideroblastic anemia (2/17, 12%). In the MPNs subgroup, 12/34 patients (35%) had a diagnosis of chronic myeloid leukemia (CML), 9/34 (26%) had a myelofibrosis (MF), 7/34 (21%) had an essential thrombocythemia (ET) and 6/34 (18%) had a polycythemia vera (PV). The JAK2 V617F mutation was detected in 100%, 57%, and 66% of PV, ET, and MF patients. Regarding the temporal appearance of myeloid malignancy, MDS occurred concurrently (9/17) or followed (7/17) the diagnosis of ADs in the vast majority of the cases whereas MPNs generally preceded the diagnosis of ADs (19/34). In MDS the most commonly diagnosed ADs were seronegative arthritis (5/17, 29 %), large and small vessel vasculitis (4/17, 23%) and Systemic Lupus Erythematosus (3/17, 17%). In patients with MPNs the diagnosis of rheumatoid arthritis (2/9, 22%), and antiphospholipid syndrome (3/9, 33%) were often associated with MF, whereas anti-Ro52 (TRIM21) positive systemic connective tissue disorders (4/7, 57%) were more frequently detected in ET. Cardiovascular events were observed in 14/51 (27%): 4/17 (23%) in MDS, 3/12 (25%) in CML and 7/22 (32%) in Philadelphia-negative MPNs. The latter seven cardiovascular events were all observed in patients presenting JAK2 V617F mutation (p=0.05).Conclusion:Our study is limited by its retrospective design. However, our results documented that the frequency of MDS and MPNs in ADs is not negligible and might be considered in the assessment of cardiovascular risk in systemic autoimmunity. Moreover, it has been reported that, under viral infection, TRIM21 is up-regulated by activation of the IFN/JAK/STAT pathway; interestingly, anti-Ro52 (TRIM21) were over-represented in MPN, where the JAK/STAT signal is hyper activated. This could explain also our observation that frequently the onset of ADs follows the diagnosis of MPN.Disclosure of Interests:Francesco Ferro: None declared, Claudia Baratè Speakers bureau: paid as a speaker by Jansen, Abbvie, Novartis, Amgen, Elena Elefante: None declared, Federica Ricci: None declared, Serena Balducci: None declared, Gianmaria Governato: None declared, Giovanni Fulvio: None declared, Marta Mosca: None declared, Mario Petrini Speakers bureau: paid as a speaker by Jansen, Abbvie, Novartis, Amgen, Sara galimberti Speakers bureau: paid as a speaker by Jansen, Abbvie, Novartis, Amgen, Chiara Baldini: None declared
Collapse
|
25
|
Ferro F, Elefante E, Puxeddu I, Baldini C, Bartoloni E, Baratè C, Galimberti S, Talarico R, Mosca M, Bombardieri S. COVID-19: the new challenge for rheumatologists. First update. Clin Exp Rheumatol 2020. [DOI: 10.55563/clinexprheumatol/yvn0nh] [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: 02/16/2023]
Affiliation(s)
- Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Ilaria Puxeddu
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Claudia Baratè
- Haematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Sara Galimberti
- Haematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | |
Collapse
|
26
|
Galimberti S, Baldini C, Baratè C, Ricci F, Balducci S, Grassi S, Ferro F, Buda G, Benedetti E, Fazzi R, Baglietto L, Lucenteforte E, Di Paolo A, Petrini M. The CoV-2 outbreak: how hematologists could help to fight Covid-19. Pharmacol Res 2020; 157:104866. [PMID: 32387301 PMCID: PMC7202852 DOI: 10.1016/j.phrs.2020.104866] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 02/08/2023]
Abstract
COVID-19 is a medical emergency, with 20 % of patients presenting with severe clinical manifestations. From the pathogenetic point of view, COVID-19 mimics two other well-known diseases characterized by cytokine storm and hyper-activation of the immune response, with consequent organ damage: acute graft-versus-host disease (aGVHD) and macrophage activation syndrome (MAS). Hematologists are confident with these situations requiring a prompt therapeutic approach for switching off the uncontrolled cytokine release; here, we discuss pros and cons of drugs that are already employed in hematology in the light of their possible application in COVID-19. The most promising drugs might be: Ruxolitinib, a JAK1/2 inhibitor, with a rapid and powerful anti-cytokine effect, tyrosine kinase inhibitors (TKIs), with their good anti-inflammatory properties, and perhaps the anti-Cd26 antibody Begelomab. We also present immunological data from gene expression experiments where TKIs resulted effective anti-inflammatory and pro-immune drugs. A possible combined treatment algorithm for COVID-19 is here proposed.
Collapse
Affiliation(s)
- Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Chiara Baldini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Federica Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Serena Balducci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Susanna Grassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Ferro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Buda
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Petrini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
27
|
Ferro F, Elefante E, Puxeddu I, Baldini C, Bartoloni E, Baratè C, Galimberti S, Talarico R, Mosca M, Bombardieri S. COVID-19: the new challenge for rheumatologists. First update. Clin Exp Rheumatol 2020; 38:373-382. [PMID: 32452355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 02/14/2023]
Affiliation(s)
- Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Ilaria Puxeddu
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Claudia Baratè
- Haematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Sara Galimberti
- Haematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | |
Collapse
|
28
|
Zaja F, Carpenedo M, Baratè C, Borchiellini A, Chiurazzi F, Finazzi G, Lucchesi A, Palandri F, Ricco A, Santoro C, Scalzulli P. Tapering and discontinuation of thrombopoietin receptor agonists in immune thrombocytopenia: Real-world recommendations. Blood Rev 2020; 41:100647. [DOI: 10.1016/j.blre.2019.100647] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 01/23/2023]
|
29
|
Rumi E, Baratè C, Benevolo G, Maffioli M, Ricco A, Sant'Antonio E. Cover Image. Hematol Oncol 2020. [DOI: 10.1002/hon.2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
30
|
Caocci G, Mulas O, Annunziata M, Luciano L, Abruzzese E, Bonifacio M, Orlandi EM, Albano F, Galimberti S, Iurlo A, Pregno P, Sgherza N, Martino B, Binotto G, Castagnetti F, Gozzini A, Bocchia M, Fozza C, Stagno F, Simula MP, De Gregorio F, Trawinska MM, Scaffidi L, Elena C, Attolico I, Baratè C, Cattaneo D, Pirillo F, Gugliotta G, Sicuranza A, Molica M, La Nasa G, Foà R, Breccia M. Long-term mortality rate for cardiovascular disease in 656 chronic myeloid leukaemia patients treated with second- and third-generation tyrosine kinase inhibitors. Int J Cardiol 2020; 301:163-166. [DOI: 10.1016/j.ijcard.2019.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/30/2019] [Accepted: 10/21/2019] [Indexed: 11/28/2022]
|
31
|
Breccia M, Baratè C, Benevolo G, Bonifacio M, Elli EM, Guglielmelli P, Maffioli M, Malato A, Mendicino F, Palumbo GA, Pugliese N, Rossi E, Rumi E, Sant'Antonio E, Ricco A, Tiribelli M, Palandri F. Tracing the decision-making process for myelofibrosis: diagnosis, stratification, and management of ruxolitinib therapy in real-word practice. Ann Hematol 2020; 99:65-72. [PMID: 31832751 PMCID: PMC6944647 DOI: 10.1007/s00277-019-03847-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022]
Abstract
The management of patients with myelofibrosis (MF) has dramatically changed since the introduction of ruxolitinib as a tailored treatment strategy. However, the perceptions about the use of this drug in clinical practice remain, at times, a matter of discussion. We conducted a survey about the diagnostic evaluation, prognostic assessment, and management of ruxolitinib in real-life clinical practice in 18 Italian hematology centers. At diagnosis, most hematologists do not use genetically or molecularly inspired score systems to assess prognosis, mainly due to scarce availability of next-generation sequencing (NGS) methodology, with NGS conversely reserved only for a subset of lower-risk MF patients with the aim of possibly improving the treatment strategy. Some common points in the management of ruxolitinib were 1) clinical triggers for ruxolitinib therapy, regardless of risk category; 2) evaluation of infectious risk before the starting of the drug; and 3) schedule of monitoring during the first 12 weeks with the need, in some instances, of supportive treatment. Further development of international recommendations and insights will allow the achievement of common criteria for the management of ruxolitinib in MF, before and after treatment, and for the definition of response and failure.
Collapse
Affiliation(s)
- Massimo Breccia
- Hematology, Department of Precision and Translational Medicine, Policlinico Umberto 1, Sapienza University, Rome, Italy.
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Giulia Benevolo
- Hematology, Città della Salute e della Scienza, Turin, Italy
| | | | - Elena Maria Elli
- Hematology Division and Bone Marrow Transplant Unit, ASST Monza, Ospedale San Gerardo, Monza, Italy
| | - Paola Guglielmelli
- Center of Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
| | | | - Alessandra Malato
- Division of Hematology and Bone Marrow Transplant, Villa Sofia-Cervello Hospital, 90146, Palermo, Italy
| | - Francesco Mendicino
- Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata, Via San Martino, snc -, 87100, Cosenza, Italy
| | - Giuseppe Alberto Palumbo
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elena Rossi
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Elisa Rumi
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Emanuela Sant'Antonio
- Department of Oncology, Division of Hematology, Azienda USL Toscana Nord Ovest, Lucca, Italy
- Medical Genetics, University of Siena, Siena, Italy
| | - Alessandra Ricco
- Department of Emergency and Organ Transplantation (DETO), Hematology Section, University of Bari, Bari, Italy
| | - Mario Tiribelli
- Division of Hematology and Bone Marrow Transplantation, Department of Medical Area, University of Udine, Udine, Italy
| | - Francesca Palandri
- Institute of Hematology "L. and A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| |
Collapse
|
32
|
Rumi E, Baratè C, Benevolo G, Maffioli M, Ricco A, Sant'Antonio E. Myeloproliferative and lymphoproliferative disorders: State of the art. Hematol Oncol 2019; 38:121-128. [PMID: 31833567 DOI: 10.1002/hon.2701] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/06/2019] [Indexed: 12/28/2022]
Abstract
Myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are clonal disorders complicated mainly by vascular events and transformation to myelofibrosis (for PV and ET) or leukemia. Although secondary malignancies, in particular, lymphoproliferative disorders (LPNs), are rare, they occur at a higher frequency than found in the general population, and there has been recent scientific discussion regarding a hypothetical relationship between treatment with JAK inhibitors in MPN and the risk of development of LPN. This has prompted increased interest regarding the coexistence of MPN and LPN. This review focuses on the role of JAK2 and the JAK/STAT pathway in MPN and LPN, whether there is a role for the genetic background in the occurrence of both MPN and LPN and whether there is a role for cytoreductive drugs in the occurrence of both MPN and LPN. Furthermore, whether an increased risk of lymphoma development is limited to patients who receive the JAK inhibitor ruxolitinib, is a more general phenomenon that occurs following JAK1/2 inhibition or is associated with preferential JAK1 or JAK2 targeting is discussed.
Collapse
Affiliation(s)
- Elisa Rumi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Giulia Benevolo
- Hematology, Città della Salute e della Scienza, Turin, Italy
| | | | - Alessandra Ricco
- Department of Emergency and Organ Transplantation (D.E.T.O), Hematology Section, University of Bari, Bari, Italy
| | - Emanuela Sant'Antonio
- UOC Ematologia Aziendale, Azienda Usl Toscana Nord Ovest, Pisa, Italy.,Medical Genetics, University of Siena, Siena, Italy
| |
Collapse
|
33
|
Elli EM, Baratè C, Mendicino F, Palandri F, Palumbo GA. Mechanisms Underlying the Anti-inflammatory and Immunosuppressive Activity of Ruxolitinib. Front Oncol 2019; 9:1186. [PMID: 31788449 PMCID: PMC6854013 DOI: 10.3389/fonc.2019.01186] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/21/2019] [Indexed: 12/20/2022] Open
Abstract
The JAK-STAT signaling pathway plays a central role in signal transduction in hematopoietic cells, as well as in cells of the immune system. The occurrence in most patients affected by myeloproliferative neoplasms (MPNs) of driver mutations resulting in the constitutive activation of JAK2-dependent signaling identified the deregulated JAK-STAT signal transduction pathway as the major pathogenic mechanism of MPNs. It also prompted the development of targeted drugs for MPNs. Ruxolitinib is a potent and selective oral inhibitor of both JAK2 and JAK1 protein kinases. Its use in patients with myelofibrosis is associated with a substantial reduction in spleen volume, attenuation of symptoms and decreased mortality. With growing clinical experience, concerns about infectious complications, and increased risk of B-cell lymphoma, presumably caused by the effects of JAK1/2 inhibition on immune response and immunosurveillance, have been raised. Evidence shows that ruxolitinib exerts potent anti-inflammatory and immunosuppressive effects. Cellular targets of ruxolitinib include various components of both the innate and adaptive immune system, such as natural killer cells, dendritic cells, T helper, and regulatory T cells. On the other hand, immunomodulatory properties have proven beneficial in some instances, as highlighted by the successful use of ruxolitinib in corticosteroid-resistant graft vs. host disease. The objective of this article is to provide an overview of published evidence addressing the key question of the mechanisms underlying ruxolitinib-induced immunosuppression.
Collapse
Affiliation(s)
- Elena Maria Elli
- Hematology Division and Bone Marrow Transplant Unit, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Francesco Mendicino
- Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata, Cosenza, Italy
| | - Francesca Palandri
- Institute of Hematology "L. and A. Seràgnoli", Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giuseppe Alberto Palumbo
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| |
Collapse
|
34
|
Izzo B, Gottardi EM, Errichiello S, Daraio F, Baratè C, Galimberti S. Monitoring Chronic Myeloid Leukemia: How Molecular Tools May Drive Therapeutic Approaches. Front Oncol 2019; 9:833. [PMID: 31555590 PMCID: PMC6742705 DOI: 10.3389/fonc.2019.00833] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/13/2019] [Indexed: 12/25/2022] Open
Abstract
More than 15 years ago, imatinib entered into the clinical practice as a "magic bullet"; from that point on, the prognosis of patients affected by chronic myeloid leukemia (CML) became comparable to that of aged-matched healthy subjects. The aims of treatment with tyrosine kinase inhibitors (TKIs) are for complete hematological response after 3 months of treatment, complete cytogenetic response after 6 months, and a reduction of the molecular disease of at least 3 logs after 12 months. Patients who do not reach their goal can switch to another TKI. Thus, the molecular monitoring of response is the main consideration of management of CML patients. Moreover, cases in deep and persistent molecular response can tempt the physician to interrupt treatment, and this "dream" is possible due to the quantitative PCR. After great international effort, today the BCR-ABL1 expression obtained in each laboratory is standardized and expressed as "international scale." This aim has been reached after the establishment of the EUTOS program (in Europe) and the LabNet network (in Italy), the platforms where biologists meet clinicians. In the field of quantitative PCR, the digital PCR is now a new and promising, sensitive and accurate tool. Some authors reported that digital PCR is able to better classify patients in precise "molecular classes," which could lead to a better identification of those cases that will benefit from the interruption of therapy. In addition, digital PCR can be used to identify a point mutation in the ABL1 domain, mutations that are often responsible for the TKI resistance. In the field of resistance, a prominent role is played by the NGS that enables identification of any mutation in ABL1 domain, even at sub-clonal levels. This manuscript reviews how the molecular tools can lead the management of CML patients, focusing on the more recent technical advances.
Collapse
Affiliation(s)
- Barbara Izzo
- Department of Clinical Medicine and Surgery, Molecular Biology, University Federico II, Naples, Italy
| | | | - Santa Errichiello
- Department of Clinical Medicine and Surgery, Molecular Biology, University Federico II, Naples, Italy
| | - Filomena Daraio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Claudia Baratè
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
35
|
Grassi S, Palumbo S, Mariotti V, Liberati D, Guerrini F, Ciabatti E, Salehzadeh S, Baratè C, Balducci S, Ricci F, Buda G, Iovino L, Mazziotta F, Ghio F, Ercolano G, Di Paolo A, Cecchettini A, Baldini C, Mattii L, Pellegrini S, Petrini M, Galimberti S. The WNT Pathway Is Relevant for the BCR-ABL1-Independent Resistance in Chronic Myeloid Leukemia. Front Oncol 2019; 9:532. [PMID: 31293972 PMCID: PMC6601352 DOI: 10.3389/fonc.2019.00532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/31/2019] [Indexed: 01/08/2023] Open
Abstract
Notwithstanding the introduction of Tyrosine Kinase Inhibitors (TKIs) revolutionized the outcome of Chronic Myeloid Leukemia (CML), one third of patients still suspends treatment for failure response. Recent research demonstrated that several BCR/ABL1-independent mechanisms can sustain resistance, but the relationship between these mechanisms and the outcome has not yet been fully understood. This study was designed to evaluate in a “real-life” setting if a change of expression of several genes involved in the WNT/BETA-CATENIN, JAK-STAT, and POLYCOMB pathways might condition the outcome of CML patients receiving TKIs. Thus, the expression of 255 genes, related to the aforementioned pathways, was measured by quantitative PCR after 6 months of therapy and compared with levels observed at diagnosis in 11 CML patients, in order to find possible correlations with quality of response to treatment and event-free-survival (EFS). These results were then re-analyzed by the principal component method (PCA) for tempting to better cluster resistant cases. After 12 months of therapy, 6 patients achieved an optimal response and 5 were “resistant;” after application of both statistical methods, it was evident that in all pathways a significant overall up-regulation occurred, and that WNT was the pathway mostly responsible for the TKIs resistance. Indeed, 100% of patients with a “low” up-regulation of this pathway achieved an optimal response vs. 33% of those who showed a “high” gene over-expression (p = 0.016). Analogously, the 24-months EFS resulted significantly influenced by the degree of up-regulation of the WNT signaling: all patients with a “low” up-regulation were event-free vs. 33% of those who presented a “high” gene expression (p = 0.05). In particular, the PCA analysis confirmed the role of WNT pathway and showed that the most significantly up-regulated genes with negative prognostic value were DKK, WNT6, WISP1, and FZD8. In conclusion, our results sustain the need of a wide and multitasking approach in order to understand the resistance mechanisms in CML.
Collapse
Affiliation(s)
- Susanna Grassi
- Hematology Division, University of Pisa, Pisa, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Sara Palumbo
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Veronica Mariotti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | | | | | | | | | | | - Gabriele Buda
- Hematology Division, University of Pisa, Pisa, Italy
| | | | - Francesco Mazziotta
- Hematology Division, University of Pisa, Pisa, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | | | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, Pharmacology Division, University of Pisa, Pisa, Italy
| | | | - Chiara Baldini
- Department of Clinical and Experimental Medicine, Rheumatology Division, University of Pisa, Pisa, Italy
| | - Letizia Mattii
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Pellegrini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Petrini
- Hematology Division, University of Pisa, Pisa, Italy
| | | |
Collapse
|
36
|
Caocci G, Mulas O, Abruzzese E, Luciano L, Iurlo A, Attolico I, Castagnetti F, Galimberti S, Sgherza N, Bonifacio M, Annunziata M, Gozzini A, Orlandi EM, Stagno F, Binotto G, Pregno P, Fozza C, Trawinska MM, De Gregorio F, Cattaneo D, Albano F, Gugliotta G, Baratè C, Scaffidi L, Elena C, Pirillo F, Scalzulli E, La Nasa G, Foà R, Breccia M. Arterial occlusive events in chronic myeloid leukemia patients treated with ponatinib in the real-life practice are predicted by the Systematic Coronary Risk Evaluation (SCORE) chart. Hematol Oncol 2019; 37:296-302. [PMID: 30892724 PMCID: PMC6766852 DOI: 10.1002/hon.2606] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/14/2019] [Indexed: 01/13/2023]
Abstract
Arterial occlusive events (AOEs) represent emerging complications in chronic myeloid leukemia (CML) patients treated with ponatinib. We identified 85 consecutive CML adult patients who were treated with ponatinib in 17 Italian centers. Patients were stratified according to the Systematic Coronary Risk Evaluation (SCORE) assessment, based on sex, age, smoking habits, systolic blood pressure, and total cholesterol levels. The 60‐month cumulative incidence rate of AOEs excluding hypertension was 25.7%. Hypertension was reported in 14.1% of patients. The median time of exposure to ponatinib was 28 months (range, 3‐69 months). Patients with a high to very high SCORE risk showed a significantly higher incidence rate of AOEs (74.3% vs 15.2%, P < 0.001). Patients aged ≥60 years showed a significantly higher incidence rate of AOEs (51.5% vs 16.9%, P = 0.008). In multivariate analysis, no association was found between AOEs and positive history of CV disease, age, dose of ponatinib, previous exposure to nilotinib, and comorbidities. Only the SCORE risk was confirmed as a significant predictive factor (P = 0.01; HR = 10.9; 95% C.I. = 1.7‐67.8). Patients aged ≥60 years who were treated with aspirin had a lower incidence rate of AOEs (33.3% vs 61.8%). Among the 14 reported AOEs, 78.6% of them showed grade 3 to 4 toxicity. This real‐life study confirmed the increased incidence of AOEs in CML patients treated with ponatinib, with high to very high SCORE risk. We suggest that patients aged ≥60 years who were treated with ponatinib should undergo prophylaxis with 100 mg/day of aspirin. Our findings emphasize personalized prevention strategies based on CV risk factors.
Collapse
Affiliation(s)
- Giovanni Caocci
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Olga Mulas
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Luigiana Luciano
- Hematology Unit "Federico II" University of Naples, Naples, Italy
| | - Alessandra Iurlo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Immacolata Attolico
- Department of Emergency and Organ Transplantation-Hematology Section, University of Bari, Bari, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Nicola Sgherza
- Hematology and Transplant Center, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Antonella Gozzini
- Hematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Ester Maria Orlandi
- Division of Hematology, "Fondazione IRCCS Policlinico S. Matteo", Pavia, Italy
| | - Fabio Stagno
- Hematology Unit, AOU Policlinico-V. Emanuele, Rodolico Hospital, Catania, Italy
| | | | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | | | - Daniele Cattaneo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Albano
- Department of Emergency and Organ Transplantation-Hematology Section, University of Bari, Bari, Italy
| | - Gabriele Gugliotta
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Chiara Elena
- Division of Hematology, "Fondazione IRCCS Policlinico S. Matteo", Pavia, Italy
| | - Francesca Pirillo
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Emilia Scalzulli
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Giorgio La Nasa
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| |
Collapse
|
37
|
Caocci G, Mulas O, Bonifacio M, Abruzzese E, Galimberti S, Orlandi EM, Iurlo A, Annunziata M, Luciano L, Castagnetti F, Gozzini A, Stagno F, Binotto G, Pregno P, Albano F, Martino B, Fozza C, Scaffidi L, Trawinska MM, Baratè C, Elena C, Cattaneo D, Scalzulli E, La Nasa G, Foà R, Breccia M. Recurrent arterial occlusive events in patients with chronic myeloid leukemia treated with second- and third-generation tyrosine kinase inhibitors and role of secondary prevention. Int J Cardiol 2019; 288:124-127. [PMID: 31029498 DOI: 10.1016/j.ijcard.2019.04.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/03/2019] [Accepted: 04/16/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Risk of death is particularly high in patients with a previous history of arterial occlusive events (AOEs) and the probability for a recurrent event is around 20%. Little is known about recurrent AOE and the role of secondary prevention in patients with Chronic Myeloid Leukemia (CML) with previous AOE, treated with second- and third-generation tyrosine kinase inhibitors (2ndG/3rdG TKIs), nilotinib, dasatinib, bosutinib and ponatinib. METHODS We identified a real-life cohort of 57 consecutive adult CML patients treated with 2ndG/3rdG TKI. All patients had a previous history of AOE. Ongoing use of secondary prevention of AOE (including antiplatelet agents, anticoagulant therapy, and statins) before starting a 2ndG/3rdG TKI was recorded, as well as CV risk factors. RESULTS The 60-month cumulative incidence rate of recurrent AOEs was 47.8 ± 10.9%. Despite a history of AOE, 10 patients (16%) were not receiving secondary preventative measures. Patients treated with nilotinib and ponatinib showed a higher incidence of recurrent AOEs (76.7 ± 14.3% and 64 ± 20.1%, respectively) than those treated with dasatinib and bosutinib (44 ± 24.2% and 30.5 ± 15.5%, respectively) (p = 0.01). Only treatment with a 2ndG/3rdG TKI given as second or subsequent line therapy showed a significant association with an increased incidence of recurrent AOE (p = 0.039). Overall, 17 recurrent AOEs were observed; 3 CV-related deaths were reported. CONCLUSION CML patients with a previous history of AOE treated with 2ndG/3rdG TKI represent a particular patient population with a higher probability of experiencing a recurrent AOE; individualized treatment is needed to optimize secondary prevention.
Collapse
Affiliation(s)
- Giovanni Caocci
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Olga Mulas
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Ester Maria Orlandi
- Division of Hematology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Alessandra Iurlo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Luigiana Luciano
- Hematology Unit "Federico II" University of Naples, Naples, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonella Gozzini
- Hematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Fabio Stagno
- Hematology Unit, AOU Policlinico -V. Emanuele, Rodolico Hospital, Catania, Italy
| | | | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Francesco Albano
- Department of Emergency and Organ Transplantation - Hematology Section, University of Bari, Bari, Italy
| | - Bruno Martino
- Hematology Unit, Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Claudio Fozza
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | | | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Chiara Elena
- Division of Hematology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Daniele Cattaneo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Emilia Scalzulli
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Giorgio La Nasa
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| |
Collapse
|
38
|
Borghi L, Galimberti S, Baratè C, Bonifacio M, Capochiani E, Cuneo A, Falzetti F, Iurlo A, Lunghi F, Minotto C, Orlandi EM, Rege-Cambrin G, Sica S, Supekar S, Haenig J, Vegni E. Chronic Myeloid Leukemia Patient's Voice About the Experience of Treatment-Free Remission Failure: Results From the Italian Sub-Study of ENESTPath Exploring the Emotional Experience of Patients During Different Phases of a Clinical Trial. Front Psychol 2019; 10:329. [PMID: 30842749 PMCID: PMC6391340 DOI: 10.3389/fpsyg.2019.00329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/03/2019] [Indexed: 12/15/2022] Open
Abstract
Background: The main objective of this study is to gain further insights on how chronic myeloid leukemia (CML) patients involved in an interventional clinical trial with the purpose of reaching treatment free remission (TFR) phase, perceived and experienced TFR failure. TFR failure was defined for the individual patient as either not being eligible for drug discontinuation or as having relapse in the TFR phase with reintroduction of nilotinib treatment. Methods: Using a qualitative approach, out of 25 patients with CML who experienced TFR failure 14 were interviewed. Patients' views and experiences were explored using in-depth interviews, analyzed using the Interpretative Phenomenological Analysis (IPA). Results: The analysis of the interviews revealed that the experience of the diagnosis seems to have been lived as a traumatic break that has created a dichotomy, like an ambivalence in the ways in which CML patients perceived and experienced the whole disease journey, with contradictory feelings of both positive and negative emotions (e.g., a diagnosis of cancer, that is something distressing and of being afraid of, but also with a treatment and a life expectancies of which being grateful). This ambivalence of feelings was found to give meaning to the way in which patients cognitively and emotionally experienced the different steps of their disease history. Thus, four main issues, corresponding to different steps of the patients' journey, were identified: (1) the moment of the diagnosis, (2) the experience of the illness journey: disease and treatment, (3) the moment of "TFR failure," and (4) the impact of disease, treatment and relapse on the patient's life. Conclusion: This qualitative analysis helps in understanding patients' perspective, both in terms of getting access to the inner subjective experience of having CML and its strict relationship with the involvement in a trial or its cessation. Clinicians should consider that the way in which CML patients feel engaged in a clinical trial, create expectancies about TFR or experience the TFR failure is linked to the process of coping with the diagnosis, which is characterized by ambivalence.
Collapse
Affiliation(s)
- Lidia Borghi
- Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | | | | | - Antonio Cuneo
- Institute of Hematology, University of Ferrara, Ferrara, Italy
| | - Franca Falzetti
- Institute of Hematology, Centro di Ricerca Emato-Oncologico (CREO), University of Perugia, Perugia, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Claudia Minotto
- UOS Hematology, UOC Oncologiaed Ematologia Oncologica AULSS3, Mestre, Italy
| | | | - Giovanna Rege-Cambrin
- Division of Hematology and Internal Medicine, "San Luigi Gonzaga" University Hospital, Orbassano, University of Turin, Turin, Italy
| | - Simona Sica
- Fondazione Policlinico Universitario Agostino Gemelli - IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sharon Supekar
- Oncology Region Europe, Novartis Farma SpA, Origgio, Italy
| | - Jens Haenig
- Oncology Region Europe, Novartis Farma SpA, Origgio, Italy
| | - Elena Vegni
- Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| |
Collapse
|
39
|
Raspadori D, Pacelli P, Sicuranza A, Abruzzese E, Iurlo A, Cattaneo D, Gozzini A, Galimberti S, Baratè C, Pregno P, Nicolosi M, Sorà F, Annunziata M, Luciano L, Caocci G, Moretti S, Sgherza N, Fozza C, Russo S, Usala E, Liberati MA, Ciofini S, Trawinska MM, Gozzetti A, Bocchia M. Flow Cytometry Assessment of CD26 + Leukemic Stem Cells in Peripheral Blood: A Simple and Rapid New Diagnostic Tool for Chronic Myeloid Leukemia. Cytometry B Clin Cytom 2019; 96:294-299. [PMID: 30714299 PMCID: PMC6767040 DOI: 10.1002/cyto.b.21764] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 11/05/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 11/17/2022]
Abstract
Background Recent investigations in chronic myeloid leukemia (CML) have focused on the identification and characterization of leukemic stem cells (LSCs). These cells reside within the CD34+/CD38─/Lin─ fraction and score positive for CD26 (dipeptidylpeptidase IV) a marker, expressed in both bone marrow (BM) and peripheral blood (PB) samples, that discriminates CML cells from normal hematopoietic stem cells (HSCs) or from LSCs of other myeloid neoplasms. CD26 evaluation could be a useful tool to improve the identification of CML LCSs by using flow‐cytometry assay. Methods CD26+ LSCs have been isolated from EDTA PB and BM samples of patients with leucocytosis suspected for CML. Analysis of LSCs CML has been performed by using custom‐made lyophilized pre‐titrated antibody mixture test and control tube and a CD45+/CD34+/CD38−/CD26+ panel as a strict flow cytometric gating strategy. Results The expression of CD26 on CD34+/CD38− population was detectable in 211/211 PB and 84/84 BM samples of subsequently confirmed BCR‐ABL+ CP‐CML patients. None of the 32 samples suspicious for CML but scoring negative for circulating CD26+ LSCs were diagnosed as CML after conventional cytogenetic and molecular testing. To validate our results, we checked for PB CD26+ LSCs in patients affected by other hematological disorders and they all scored negative for CD26 expression. Conclusions We propose flow cytometry evaluation of CD26 expression on PB CD34+/CD38− population as a new rapid, reproducible, and powerful diagnostic tool for the diagnosis of CML. © 2019 The Authors. Cytometry Part B: Clinical Cytometry published by Wiley Periodicals, Inc. on behalf of International Clinical Cytometry Society.
Collapse
Affiliation(s)
- Donatella Raspadori
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.,Hematology Unit, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Paola Pacelli
- Hematology Unit, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Anna Sicuranza
- Hematology Unit, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Antonella Gozzini
- Hematology Unit, Careggi University Hospital (AOUC) Firenze, Florence, Italy
| | - Sara Galimberti
- Department of Hematology, Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudia Baratè
- Department of Hematology, Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Patrizia Pregno
- Hematology Division, Azienda Ospedaliera Città della Salute e della Scienza, Torino, Turin, Italy
| | - Maura Nicolosi
- Hematology Division, Azienda Ospedaliera Città della Salute e della Scienza, Torino, Turin, Italy
| | - Federica Sorà
- Università Cattolica del Sacro Cuore Sede di Roma, Rome, Italy
| | | | | | - Giovanni Caocci
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Sabrina Moretti
- Azienda USL Toscana Centro, Ospedale San Giovanni di Dio, Florence, Italy
| | - Nicola Sgherza
- Division of Hematology, Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy
| | - Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Emilio Usala
- Hematology Unit, Ospedale Oncologico A. Businco, Cagliari, Italy
| | - Marina A Liberati
- Azienda Ospedaliera S. Maria, Division of Onco-Hematology, Terni, Italy
| | - Sara Ciofini
- Hematology Unit, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Alessandro Gozzetti
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.,Hematology Unit, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Monica Bocchia
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.,Hematology Unit, University of Siena and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| |
Collapse
|
40
|
Galimberti S, Grassi S, Baratè C, Guerrini F, Ciabatti E, Perutelli F, Ricci F, Del Genio G, Montali M, Barachini S, Giuliani C, Ferreri MI, Valetto A, Abruzzese E, Ippolito C, Iurlo A, Bocchia M, Sicuranza A, Martino B, Iovino L, Buda G, Salehzadeh S, Petrini M, Di Paolo A, Mattii L. The Polycomb BMI1 Protein Is Co-expressed With CD26+ in Leukemic Stem Cells of Chronic Myeloid Leukemia. Front Oncol 2018; 8:555. [PMID: 30574454 PMCID: PMC6291509 DOI: 10.3389/fonc.2018.00555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/08/2018] [Indexed: 11/24/2022] Open
Abstract
The Polycomb gene BMI1 expression exerts a negative predictive impact on several hematological malignancies, such as acute and chronic myeloid leukemia (CML), myelofibrosis, and follicular lymphoma. As already demonstrated in CML, BMI1 is responsible for the resistance to the tyrosine kinase inhibitors (TKIs) in a BCR-ABL1-independent way. Even if, it is unknown where BMI1 in CML is expressed (in progenitors or more mature cells). We decided, therefore, to evaluate if and where the BMI1 protein is located, focusing mainly on the CD34+/CD38-/CD26+ CML progenitors. To begin we measured, by flow cytometry, the proportion of CD34+/CD26+ cells in 31 bone marrow samples from 20 CML patients, at diagnosis and during treatment with imatinib. After that the bone marrow blood smears were stained with antibodies anti-CD26, BCR-ABL1, and BMI1. These smears were observed by a confocal laser microscope and a 3D reconstruction was then performed. At diagnosis, CD34+/CD26+ cells median value/μL was 0.48; this number increased from diagnosis to the third month of therapy and then reduced during treatment with imatinib. The number and behavior of the CD26+ progenitors were independent from the BCR-ABL1 expression, but they summed up what previously observed about the BMI1 expression modulation. In this work we demonstrate for the first time that in CML the BMI1 protein is co-expressed with BCR-ABL1 only in the cytoplasm of the CD26+ precursors; on the contrary, in other hematological malignancies where BMI1 is commonly expressed (follicular lymphoma, essential thrombocytemia, acute myeloid leukemia), it was not co-localized with CD26 or, obviously, with BCR-ABL1. Once translated into the clinical context, if BMI1 is a marker of stemness, our results would suggest the combination of the BMI1 inhibitors with TKIs as an interesting object of research, and, probably, as a promising way to overcome resistance in CML patients.
Collapse
Affiliation(s)
- Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Susanna Grassi
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,GeNOMEC School of Doctorate, University of Siena, Siena, Italy
| | - Claudia Baratè
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Guerrini
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Ciabatti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Perutelli
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federica Ricci
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giada Del Genio
- Unità Operativa Cytogenetics, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marina Montali
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Serena Barachini
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cecilia Giuliani
- Unità Operativa Cytogenetics, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Angelo Valetto
- Unità Operativa Cytogenetics, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Chiara Ippolito
- Section of Histology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Bocchia
- Unità Operativa Ematologia, Università di Siena, Siena, Italy
| | - Anna Sicuranza
- Unità Operativa Ematologia, Università di Siena, Siena, Italy
| | - Bruno Martino
- Unità Operativa Ematologia, Ospedale Binco, Melacrino, Morelli, Reggio Calabria, Italy
| | - Lorenzo Iovino
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Buda
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Serena Salehzadeh
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Petrini
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonello Di Paolo
- Section of Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Letizia Mattii
- Section of Histology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
41
|
Caocci G, Mulas O, Annunziata M, Luciano L, Bonifacio M, Orlandi EM, Pregno P, Galimberti S, Russo Rossi A, Abruzzese E, Iurlo A, Martino B, Sgherza N, Binotto G, Castagnetti F, Gozzini A, Fozza C, Bocchia M, Sicuranza A, Stagno F, Efficace F, Usala E, De Gregorio F, Scaffidi L, Elena C, Pirillo F, Baratè C, Trawinska MM, Cattaneo D, Labate C, Gugliotta G, Molica M, Specchia G, La Nasa G, Foà R, Breccia M. Cardiovascular toxicity in patients with chronic myeloid leukemia treated with second-generation tyrosine kinase inhibitors in the real-life practice: Identification of risk factors and the role of prophylaxis. Am J Hematol 2018; 93:E159-E161. [PMID: 29633312 DOI: 10.1002/ajh.25102] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/27/2018] [Accepted: 03/29/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Giovanni Caocci
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari
| | - Olga Mulas
- Businco Hospital; Hematology and Transplant Center; Cagliari
| | | | | | | | - Ester Maria Orlandi
- Hematology Unit, “Fondazione IRCCS Policlinico S. Matteo” University Hospital; Pavia
| | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza; Torino
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine; Section of Hematology, University of Pisa; Pisa
| | | | | | - Alessandra Iurlo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milano
| | - Bruno Martino
- Hematology Unit, Azienda Ospedaliera “Bianchi-Melacrino-Morelli”; Reggio Calabria
| | - Nicola Sgherza
- Casa Sollievo della Sofferenza Hospital; Hematology and Transplant Center; San Giovanni Rotondo
| | | | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine; S. Orsola-Malpighi Hospital, University of Bologna; Bologna
| | | | - Claudio Fozza
- Department of Clinical and Experimental Medicine; University of Sassari; Sassari
| | - Monica Bocchia
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena; Siena
| | - Anna Sicuranza
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena; Siena
| | | | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA); Data Center and Health Outcomes Research Unit; Rome
| | - Emilio Usala
- Businco Hospital; Hematology and Transplant Center; Cagliari
| | | | - Luigi Scaffidi
- Department of Medicine; Section of Hematology, University of Verona; Verona
| | - Chiara Elena
- Hematology Unit, “Fondazione IRCCS Policlinico S. Matteo” University Hospital; Pavia
| | - Francesca Pirillo
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza; Torino
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine; Section of Hematology, University of Pisa; Pisa
| | | | - Daniele Cattaneo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milano
| | - Claudia Labate
- Hematology Unit, Azienda Ospedaliera “Bianchi-Melacrino-Morelli”; Reggio Calabria
| | - Gabriele Gugliotta
- Department of Experimental, Diagnostic and Specialty Medicine; S. Orsola-Malpighi Hospital, University of Bologna; Bologna
| | - Matteo Molica
- Division of Hematology, Department of Cellular Biotechnologies and Hematology; Policlinico Umberto I, Sapienza University; Rome Italy
| | | | - Giorgio La Nasa
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari
| | - Robin Foà
- Division of Hematology, Department of Cellular Biotechnologies and Hematology; Policlinico Umberto I, Sapienza University; Rome Italy
| | - Massimo Breccia
- Division of Hematology, Department of Cellular Biotechnologies and Hematology; Policlinico Umberto I, Sapienza University; Rome Italy
| |
Collapse
|
42
|
Bocchia M, Sicuranza A, Abruzzese E, Iurlo A, Sirianni S, Gozzini A, Galimberti S, Aprile L, Martino B, Pregno P, Sorà F, Alunni G, Fava C, Castagnetti F, Puccetti L, Breccia M, Cattaneo D, Defina M, Mulas O, Baratè C, Caocci G, Sica S, Gozzetti A, Luciano L, Crugnola M, Annunziata M, Tiribelli M, Pacelli P, Ferrigno I, Usala E, Sgherza N, Rosti G, Bosi A, Raspadori D. Residual Peripheral Blood CD26 + Leukemic Stem Cells in Chronic Myeloid Leukemia Patients During TKI Therapy and During Treatment-Free Remission. Front Oncol 2018; 8:194. [PMID: 29900128 PMCID: PMC5988870 DOI: 10.3389/fonc.2018.00194] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022] Open
Abstract
Chronic myeloid leukemia (CML) patients in sustained "deep molecular response" may stop TKI treatment without disease recurrence; however, half of them lose molecular response shortly after TKI withdrawing. Well-defined eligibility criteria to predict a safe discontinuation up-front are still missing. Relapse is probably due to residual quiescent TKI-resistant leukemic stem cells (LSCs) supposedly transcriptionally low/silent and not easily detectable by BCR-ABL1 qRT-PCR. Bone marrow Ph+ CML CD34+/CD38- LSCs were found to specifically co-express CD26 (dipeptidylpeptidase-IV). We explored feasibility of detecting and quantifying CD26+ LSCs by flow cytometry in peripheral blood (PB). Over 400 CML patients (at diagnosis and during/after therapy) entered this cross-sectional study in which CD26 expression was evaluated by a standardized multiparametric flow cytometry analysis on PB CD45+/CD34+/CD38- stem cell population. All 120 CP-CML patients at diagnosis showed measurable PB CD26+ LSCs (median 19.20/μL, range 0.27-698.6). PB CD26+ LSCs were also detectable in 169/236 (71.6%) CP-CML patients in first-line TKI treatment (median 0.014 cells/μL; range 0.0012-0.66) and in 74/112 (66%), additional patients studied on treatment-free remission (TFR) (median 0.015/μL; range 0.006-0.76). Notably, no correlation between BCR-ABL/ABLIS ratio and number of residual LSCs was found both in patients on or off TKIs. This is the first evidence that "circulating" CML LSCs persist in the majority of CML patients in molecular response while on TKI treatment and even after TKI discontinuation. Prospective studies evaluating the dynamics of PB CD26+ LSCs during TKI treatment and the role of a "stem cell response" threshold to achieve and maintain TFR are ongoing.
Collapse
Affiliation(s)
- Monica Bocchia
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Anna Sicuranza
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Alessandra Iurlo
- IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Santina Sirianni
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Sara Galimberti
- Department of Hematology, Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lara Aprile
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Bruno Martino
- Hematology Unit Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy
| | - Patrizia Pregno
- Hematology Division, Azienda Ospedaliera Città della Salute e della Scienza, Torino, Italy
| | - Federica Sorà
- Fondazione Policlinico Universitario A Gemelli IRCSS Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Carmen Fava
- Hematology Division, Ospedale Mauriziano, Torino, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology and Medical Oncology "L. & A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Luca Puccetti
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Massimo Breccia
- Hematology, Biotecnologie Cellulari ed Ematologia, University "La Sapienza", Rome, Italy
| | - Daniele Cattaneo
- IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Marzia Defina
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Olga Mulas
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Claudia Baratè
- Department of Hematology, Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Caocci
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Simona Sica
- Fondazione Policlinico Universitario A Gemelli IRCSS Università Cattolica Sacro Cuore, Rome, Italy
| | - Alessandro Gozzetti
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Monica Crugnola
- Hematology Unit, Maggiore Hospital University of Parma, Parma, Italy
| | | | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medical and Morphological Researches, University of Udine, Udine, Italy
| | - Paola Pacelli
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Ilaria Ferrigno
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Emilio Usala
- Hematology Unit, Ospedale Oncologico A. Businco, Cagliari, Italy
| | - Nicola Sgherza
- Hematology Unit, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Gianantonio Rosti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology and Medical Oncology "L. & A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Alberto Bosi
- Department of Hematology, University of Firenze, Florence, Italy
| | - Donatella Raspadori
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| |
Collapse
|
43
|
Arrigoni E, Del Re M, Galimberti S, Restante G, Rofi E, Crucitta S, Baratè C, Petrini M, Danesi R, Di Paolo A. Concise Review: Chronic Myeloid Leukemia: Stem Cell Niche and Response to Pharmacologic Treatment. Stem Cells Transl Med 2018; 7:305-314. [PMID: 29418079 PMCID: PMC5827745 DOI: 10.1002/sctm.17-0175] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/09/2018] [Indexed: 12/27/2022] Open
Abstract
Nowadays, more than 90% of patients affected by chronic myeloid leukemia (CML) survive with a good quality of life, thanks to the clinical efficacy of tyrosine kinase inhibitors (TKIs). Nevertheless, point mutations of the ABL1 pocket occurring during treatment may reduce binding of TKIs, being responsible of about 20% of cases of resistance among CML patients. In addition, the presence of leukemic stem cells (LSCs) represents the most important event in leukemia progression related to TKI resistance. LSCs express stem cell markers, including active efflux pumps and genetic and epigenetic alterations together with deregulated cell signaling pathways involved in self-renewal, such as Wnt/β-catenin, Notch, and Hedgehog. Moreover, the interaction with the bone marrow microenvironment, also known as hematopoietic niche, may influence the phenotype of surrounding cells, which evade mechanisms controlling cell proliferation and are less sensitive or frankly resistant to TKIs. This Review focuses on the role of LSCs and stem cell niche in relation to response to pharmacological treatments. A literature search from PubMed database was performed until April 30, 2017, and it has been analyzed according to keywords such as chronic myeloid leukemia, stem cell, leukemic stem cells, hematopoietic niche, tyrosine kinase inhibitors, and drug resistance. Stem Cells Translational Medicine 2018;7:305-314.
Collapse
Affiliation(s)
- Elena Arrigoni
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Sara Galimberti
- Unit of Hematology, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Giuliana Restante
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Eleonora Rofi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Stefania Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Claudia Baratè
- Unit of Hematology, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Mario Petrini
- Unit of Hematology, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Antonello Di Paolo
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| |
Collapse
|
44
|
Bocchia M, Galimberti S, Aprile L, Sicuranza A, Gozzini A, Santilli F, Abruzzese E, Baratè C, Scappini B, Fontanelli G, Trawinska MM, Defina M, Gozzetti A, Bosi A, Petrini M, Puccetti L. Genetic predisposition and induced pro-inflammatory/pro-oxidative status may play a role in increased atherothrombotic events in nilotinib treated chronic myeloid leukemia patients. Oncotarget 2018; 7:72311-72321. [PMID: 27527867 PMCID: PMC5342164 DOI: 10.18632/oncotarget.11100] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/1969] [Accepted: 07/18/2016] [Indexed: 12/18/2022] Open
Abstract
Several reports described an increased risk of cardiovascular (CV) events, mainly atherothrombotic, in Chronic Myeloid Leukemia (CML) patients receiving nilotinib. However, the underlying mechanism remains elusive. The objective of the current cross-sectional retrospective study is to address a potential correlation between Tyrosine Kinase Inhibitors (TKIs) treatment and CV events. One hundred and 10 chronic phase CML patients in complete cytogenetic response during nilotinib or imatinib, were screened for CV events and evaluated for: traditional CV risk factors, pro/anti-inflammatory biochemical parameters and detrimental ORL1 gene polymorphisms (encoding for altered oxidized LDL receptor-1). Multivariate analysis of the whole cohort showed that the cluster of co-existing nilotinib treatment, dyslipidaemia and G allele of LOX-1 polymorphism was the only significant finding associated with CV events. Furthermore, multivariate analysis according to TKI treatment confirmed IVS4-14 G/G LOX-1 polymorphism as the strongest predictive factor for a higher incidence of CV events in nilotinib patients. Biochemical assessment showed an unbalanced pro-inflammatory cytokines network in nilotinib vs imatinib patients. Surprisingly, pre-existing traditional CV risk factors were not always predictive of CV events. We believe that in nilotinib patients an induced “inflammatory/oxidative status”, together with a genetic pro-atherothrombotic predisposition, may favour the increased incidence of CV events. Prospective studies focused on this issue are ongoing.
Collapse
Affiliation(s)
- Monica Bocchia
- Department of Hematology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, U.O. Hematology, University of Pisa, Pisa, Italy
| | - Lara Aprile
- Department of Hematology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Anna Sicuranza
- Department of Hematology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Antonella Gozzini
- Functional Unit of Hematology, University of Florence, Florence, Italy
| | | | | | - Claudia Baratè
- Department of Clinical and Experimental Medicine, U.O. Hematology, University of Pisa, Pisa, Italy
| | - Barbara Scappini
- Functional Unit of Hematology, University of Florence, Florence, Italy
| | - Giulia Fontanelli
- Department of Clinical and Experimental Medicine, U.O. Hematology, University of Pisa, Pisa, Italy
| | | | - Marzia Defina
- Department of Hematology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandro Gozzetti
- Department of Hematology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alberto Bosi
- Functional Unit of Hematology, University of Florence, Florence, Italy
| | - Mario Petrini
- Department of Clinical and Experimental Medicine, U.O. Hematology, University of Pisa, Pisa, Italy
| | - Luca Puccetti
- Department of Hematology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| |
Collapse
|
45
|
Galimberti S, Bucelli C, Arrigoni E, Baratè C, Grassi S, Ricci F, Guerrini F, Ciabatti E, Fava C, D'Avolio A, Fontanelli G, Cambrin GR, Isidori A, Loscocco F, Caocci G, Greco M, Bocchia M, Aprile L, Gozzini A, Scappini B, Cattaneo D, Scortechini AR, La Nasa G, Bosi A, Leoni P, Danesi R, Saglio G, Visani G, Cortelezzi A, Petrini M, Iurlo A, Di Paolo A. The hOCT1 and ABCB1 polymorphisms do not influence the pharmacodynamics of nilotinib in chronic myeloid leukemia. Oncotarget 2017; 8:88021-88033. [PMID: 29152138 PMCID: PMC5675690 DOI: 10.18632/oncotarget.21406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/29/2017] [Indexed: 11/25/2022] Open
Abstract
First-line nilotinib in chronic myeloid leukemia is more effective than imatinib to achieve early and deep molecular responses, despite poor tolerability or failure observed in one-third of patients. The toxicity and efficacy of tyrosine kinase inhibitors might depend on the activity of transmembrane transporters. However, the impact of transporters genes polymorphisms in nilotinib setting is still debated. We investigated the possible correlation between single nucleotide polymorphisms of hOCT1 (rs683369 [c.480C>G]) and ABCB1 (rs1128503 [c.1236C>T], rs2032582 [c.2677G>T/A], rs1045642 [c.3435C>T]) and nilotinib efficacy and toxicity in a cohort of 78 patients affected by chronic myeloid leukemia in the context of current clinical practice. The early molecular response was achieved by 81% of patients while 64% of them attained deep molecular response (median time, 26 months). The 36-month event-free survival was 86%, whereas 58% of patients experienced toxicities. Interestingly, hOCT1 and ABCB1 polymorphisms alone or in combination did not influence event-free survival or the adverse events rate. Therefore, in contrast to data obtained in patients treated with imatinib, hOCT1 and ABCB1 polymorphisms do not impact on nilotinib efficacy or toxicity. This could be relevant in the choice of the first-line therapy: patients with polymorphisms that negatively condition imatinib efficacy might thus receive nilotinib as first-line therapy.
Collapse
Affiliation(s)
- Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Cristina Bucelli
- Oncohematology Division, IRCCS Ca' Granda, Maggiore Policlinico Hospital Foundation, University of Milan, Milano, Italy
| | - Elena Arrigoni
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Pisa, Pisa, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Susanna Grassi
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy.,GeNOMEC, University of Siena, Siena, Italy
| | - Federica Ricci
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Francesca Guerrini
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Elena Ciabatti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Carmen Fava
- Hematology Division, Ospedale Mauriziano, Torino, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Giulia Fontanelli
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Giovanna Rege Cambrin
- Department of Clinical and Biological Sciences, University of Torino, AOU San Luigi Gonzaga, Torino, Italy
| | - Alessandro Isidori
- Hematology and Stem Cell Transplant Center, San Salvatore Hospital, Pesaro, Italy
| | - Federica Loscocco
- Hematology and Stem Cell Transplant Center, San Salvatore Hospital, Pesaro, Italy
| | - Giovanni Caocci
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Marianna Greco
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Monica Bocchia
- Division of Hematology, Ospedale Le Scotte, University of Siena, Siena, Italy
| | - Lara Aprile
- Division of Hematology, Ospedale Le Scotte, University of Siena, Siena, Italy
| | - Antonella Gozzini
- Division of Hematology, AOU Careggi, University of Florence, Firenze, Italy
| | - Barbara Scappini
- Division of Hematology, AOU Careggi, University of Florence, Firenze, Italy
| | - Daniele Cattaneo
- Oncohematology Division, IRCCS Ca' Granda, Maggiore Policlinico Hospital Foundation, University of Milan, Milano, Italy
| | | | - Giorgio La Nasa
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Alberto Bosi
- Division of Hematology, AOU Careggi, University of Florence, Firenze, Italy
| | - Pietro Leoni
- Division of Hematology, Marche Polytechnic University, Ancona, Italy
| | - Romano Danesi
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Pisa, Pisa, Italy
| | | | - Giuseppe Visani
- Hematology and Stem Cell Transplant Center, San Salvatore Hospital, Pesaro, Italy
| | - Agostino Cortelezzi
- Oncohematology Division, IRCCS Ca' Granda, Maggiore Policlinico Hospital Foundation, University of Milan, Milano, Italy
| | - Mario Petrini
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Alessandra Iurlo
- Oncohematology Division, IRCCS Ca' Granda, Maggiore Policlinico Hospital Foundation, University of Milan, Milano, Italy
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Pisa, Pisa, Italy
| |
Collapse
|
46
|
Galimberti S, Fontanelli G, Barsotti S, Ricci F, Guerrini F, Baratè C. Increased values of the circulating PDGFβ sustains the “withdrawal syndrome” after tyrosine kinase inhibitor discontinuation in patients affected by chronic myeloid leukemia. Blood Cells Mol Dis 2015; 55:211-2. [DOI: 10.1016/j.bcmd.2015.06.010] [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: 04/23/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
|
47
|
Polillo M, Galimberti S, Baratè C, Petrini M, Danesi R, Di Paolo A. Pharmacogenetics of BCR/ABL Inhibitors in Chronic Myeloid Leukemia. Int J Mol Sci 2015; 16:22811-29. [PMID: 26402671 PMCID: PMC4613337 DOI: 10.3390/ijms160922811] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 01/29/2023] Open
Abstract
Chronic myeloid leukemia was the first haematological neoplasia that benefited from a targeted therapy with imatinib nearly 15 years ago. Since then, several studies have investigated the role of genes, their variants (i.e., polymorphisms) and their encoded proteins in the pharmacokinetics and pharmacodynamics of BCR-ABL1 tyrosine kinase activity inhibitors (TKIs). Transmembrane transporters seem to influence in a significant manner the disposition of TKIs, especially that of imatinib at both cellular and systemic levels. In particular, members of the ATP-binding cassette (ABC) family (namely ABCB1 and ABCG2) together with solute carrier (SLC) transporters (i.e., SLC22A1) are responsible for the differences in drug pharmacokinetics. In the case of the newer TKIs, such as nilotinib and dasatinib, the substrate affinity of these drugs for transporters is variable but lower than that measured for imatinib. In this scenario, the investigation of genetic variants as possible predictive markers has led to some discordant results. With the partial exception of imatinib, these discrepancies seem to limit the application of discovered biomarkers in the clinical settings. In order to overcome these issues, larger prospective confirmative trials are needed.
Collapse
MESH Headings
- ATP-Binding Cassette Transporters/genetics
- ATP-Binding Cassette Transporters/metabolism
- Animals
- Biological Transport
- Drug Resistance, Neoplasm
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Organic Cation Transport Proteins/genetics
- Organic Cation Transport Proteins/metabolism
- Pharmacogenetics
- Protein Kinase Inhibitors/pharmacokinetics
- Protein Kinase Inhibitors/pharmacology
Collapse
Affiliation(s)
- Marialuisa Polillo
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Via Roma 57, 56126 Pisa, Italy.
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Via Roma 57, 56126 Pisa, Italy.
| | - Mario Petrini
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Via Roma 57, 56126 Pisa, Italy.
| | - Romano Danesi
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, Section of Pharmacology, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
| |
Collapse
|
48
|
Crea F, Di Paolo A, Liu HH, Polillo M, Clermont PL, Guerrini F, Ciabatti E, Ricci F, Baratè C, Fontanelli G, Barsotti S, Morganti R, Danesi R, Wang Y, Petrini M, Galimberti S, Helgason CD. Polycomb genes are associated with response to imatinib in chronic myeloid leukemia. Epigenomics 2015; 7:757-65. [PMID: 26343356 DOI: 10.2217/epi.15.35] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 12/19/2022] Open
Abstract
AIM Imatinib is a tyrosine kinase inhibitor that has revolutionized the treatment of chronic myeloid leukemia (CML). Despite its efficacy, about a third of patients discontinue the treatment due to therapy failure or intolerance. The rational identification of patients less likely to respond to imatinib would be of paramount clinical relevance. We have shown that transmembrane transporter hOCT1 genotyping predicts imatinib activity. In parallel, Polycomb group genes (PcGs) are epigenetic repressors implicated in CML progression and in therapy resistance. PATIENTS & METHODS We measured the expression of eight PcGs in paired pre- and post-imatinib bone marrow samples from 30 CML patients. RESULTS BMI1, PHC3, CBX6 and CBX7 expression was significantly increased during imatinib treatment. Post-treatment levels of CBX6 and CBX7 predicted 3-month response rate. Measurement of post-treatment BMI1 levels improved the predictive power of hOCT1 genotyping. CONCLUSION These results suggest that the expression levels of PcGs might be useful for a more accurate risk stratification of CML patients.
Collapse
Affiliation(s)
- Francesco Crea
- Experimental Therapeutics, BCCA Research Centre, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Vancouver Prostate Centre, Vancouver General Hospital, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada.,Department of Life Health & Chemical Sciences, The Open University, UK
| | - Antonello Di Paolo
- Department of Clinical & Experimental Medicine, Section of Pharmacology, University of Pisa, Pisa, Italy
| | - Hui Hsuan Liu
- Experimental Therapeutics, BCCA Research Centre, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Marialuisa Polillo
- Department of Clinical & Experimental Medicine, Section of Pharmacology, University of Pisa, Pisa, Italy
| | - Pier-Luc Clermont
- Experimental Therapeutics, BCCA Research Centre, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Francesca Guerrini
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Elena Ciabatti
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Federica Ricci
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Claudia Baratè
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Giulia Fontanelli
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Sara Barsotti
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical & Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Romano Danesi
- Department of Clinical & Experimental Medicine, Section of Pharmacology, University of Pisa, Pisa, Italy
| | - Yuzhuo Wang
- Experimental Therapeutics, BCCA Research Centre, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Vancouver Prostate Centre, Vancouver General Hospital, 2660 Oak Street, Vancouver, BC, V6H 3Z6, Canada
| | - Mario Petrini
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Sara Galimberti
- Department of Clinical & Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Cheryl D Helgason
- Experimental Therapeutics, BCCA Research Centre, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| |
Collapse
|
49
|
Fontanelli G, Baratè C, Ciabatti E, Guerrini F, Grassi S, Del Re M, Morganti R, Petrini I, Arici R, Barsotti S, Metelli MR, Danesi R, Galimberti S. Real-Time PCR and Droplet Digital PCR: two techniques for detection of the JAK2(V617F) mutation in Philadelphia-negative chronic myeloproliferative neoplasms. Int J Lab Hematol 2015; 37:766-73. [PMID: 26189968 DOI: 10.1111/ijlh.12404] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 04/19/2015] [Accepted: 06/19/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Philadelphia-negative chronic myeloproliferative neoplasms (MPNs) are clonal disorders that present JAK2(V617F) mutation in 50-95% of cases. The main objective of this study was the comparison of two PCR methods, real-time (qPCR) and droplet digital PCR (DD-PCR) for detection of the JAK2(V617F) mutation, to assess analytic sensitivity, specificity, and feasibility of the two methods. METHODS Ninety-nine patients with MPN of 225 presenting the JAK2(V617F) mutation by qPCR have been evaluated by DD-PCR also. RESULTS We demonstrated an absolute concordance in terms of specificity between the two methods, DD-PCR showing a higher sensitivity (half a log higher than qPCR). As expected, a progressive increase of mutant allele burden was observed from essential thrombocythemia (ET) to polycythemia vera (PV) and primary myelofibrosis (PMF) to secondary myelofibrosis (SMF). CONCLUSION In conclusion, our study showed that DD-PCR could represent a new and promising technological evolution for detection of JAK2 mutation in MPNs.
Collapse
Affiliation(s)
- G Fontanelli
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Baratè
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Ciabatti
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,GenOMEC, University of Siena, Siena, Italy
| | - F Guerrini
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Grassi
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Del Re
- U.O. Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Morganti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - I Petrini
- Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - R Arici
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Barsotti
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M R Metelli
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Danesi
- U.O. Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Galimberti
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
50
|
Tedeschi A, Picardi P, Ferrero S, Benevolo G, Margiotta Casaluci G, Varettoni M, Baratè C, Motta M, Gini G, Goldaniga MC, Visco C, Zaja F, Belsito Petrizi V, Ravelli E, Gentile M, Urbano MA, Franceschetti S, Ghione P, Orsucci L, Frustaci AM, Gaidano G, Vitolo U, Morra E. Bendamustine and rituximab combination is safe and effective as salvage regimen in Waldenström macroglobulinemia. Leuk Lymphoma 2015; 56:2637-42. [DOI: 10.3109/10428194.2015.1012714] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|