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Gurnari C, Koster L, Baaij L, Heiblig M, Yakoub-Agha I, Collin M, Passweg J, Bulabois CE, Khan A, Loschi M, Carnevale-Schianca F, Crisà E, Caravelli D, Kuball J, Saraceni F, Olivieri A, Rambaldi A, Kulasekararaj AG, Hayden PJ, Badoglio M, Onida F, Scheid C, Franceschini F, Mekinian A, Savic S, Voso MT, Drozd-Sokolowska J, Snowden JA, Raj K, Alexander T, Robin M, Greco R, McLornan DP. Allogeneic hematopoietic cell transplantation for VEXAS syndrome: results of a multicenter study of the EBMT. Blood Adv 2024; 8:1444-1448. [PMID: 38330178 PMCID: PMC10955646 DOI: 10.1182/bloodadvances.2023012478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Affiliation(s)
- Carmelo Gurnari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | | | | | - Mael Heiblig
- Department of Hematology, Centre Hospitalier Lyon Sud, Lyon, France
| | | | | | | | | | - Anjum Khan
- Yorkshire Blood & Marrow Transplant Program, Leeds, United Kingdom
| | | | | | - Elena Crisà
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | | | - Jürgen Kuball
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
| | | | | | - Alessandro Rambaldi
- Department of Oncology and Hematology, University of Milan and Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Patrick J. Hayden
- Department of Haematology, Trinity College Dublin, St. James’s Hospital, Dublin, Ireland
| | | | - Francesco Onida
- ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | | | - Franco Franceschini
- Rheumatology and Clinical Immunology, ASST Spedali Civili of Brescia and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Arsène Mekinian
- Sorbonne Université, Assistance Publique–Hôpitaux de Paris, Hôpital Saint Antoine, Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department, Paris, France
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals, NHS Trust, Leeds, United Kingdom
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Kavita Raj
- University College London Hospitals NHS Trust, London, United Kingdom
| | - Tobias Alexander
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Rheumatology and Clinical Immunology, Berlin, Germany
| | | | - Raffaella Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Donal P. McLornan
- University College London Hospitals NHS Trust, London, United Kingdom
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Lupia T, Crisà E, Sangiorgio V, Bosio R, Stroffolini G, Staffilano E, Gregorc V, Corcione S, De Rosa FG. Presumptive pulmonary toxocariasis in a patient affected by acute myeloid leukemia and Hodgkin lymphoma: case report and review of the literature in immunocompromised hosts. Infez Med 2024; 32:103-112. [PMID: 38456027 PMCID: PMC10917563 DOI: 10.53854/liim-3201-14] [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] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/26/2024] [Indexed: 03/09/2024]
Abstract
Toxocariasis is a zoonosis transmitted by the nematode Toxocara spp. Immunocompromised hosts are more susceptible than general population to bacterial, viral, fungal and parasitic infections. In this population toxocariasis may present as exacerbation or reactivation and could have severe or atypical manifestations being a diagnostic challenge for healthcare providers. We report a case of a presumptive pulmonary toxocariasis during chemotherapy in a patient affected by acute myeloid leukaemia (AML) and Hodgkin lymphoma and we summarize current evidence of pulmonary involvement in immunocompromised population with Toxocara spp infection in a narrative review. The aim of this work is also to revise the current literature on pulmonary involvement during Toxocara spp infection in immunocompromised hosts to improve knowledge on clinical presentation, treatment and outcome. A 66 years old man who had undergone to a cytarabine and idarubicin chemotherapy induction scheme for AML, complained of febrile neutropenia and dry cought. At the chest computed tomography (CT) there were multiple nodular pulmonary lesions with subpleural consolidations. The lung biopsy revealed inflammatory infiltration with diffuse small granulomas with minor eosinophil component. The laboratory analysis showed high immunoglobulin E (IgE) count with normal peripherical eosinophils, among the extended parasitological analysis, Toxocara immunoblot assay resulted positive. In the most accepted hypothesis of a polmunary toxocariasis infection, the patient was treated with a combination of albendazole plus corticosteroids for four weeks, with a positive outcome. Infection complications during chemotherapy are not uncommon, however, this is the first reported case of pulmonary toxocariasis during cytarabine and idarubicin treatment in AML. The revised literature shows male gender and younger age as possible risk factors, nevertheless the majority of cases of seropositivity for Toxocara was reported in solid organ malignancies. In this case, the suspect was mainly based on laboratory total elevated IgE, confirmed by serological, anatomo-pathological and radiological findings. Hypereosinophilia is often not present in chronic infection. In conclusion, pulmonary toxocariasis should be ruled out in patients with pulmonary involvement and high IgE titre, with or without peripheral eosinophilia, especially in those with known immunocompromised status.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia, Asti, Italy
| | - Elena Crisà
- Unit of Oncology and Haematology, Candiolo Cancer Institute, Candiolo, Italy
| | - Valentina Sangiorgio
- Pathological Anatomy Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Roberta Bosio
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Giacomo Stroffolini
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Elena Staffilano
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Vanesa Gregorc
- Unit of Oncology and Haematology, Candiolo Cancer Institute, Candiolo, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- School of Medicine, Infectious Disease & Geographic Medicine, Tufts University, Boston, MA, USA
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia, Asti, Italy
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
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3
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Gurnari C, Pascale MR, Vitale A, Diral E, Tomelleri A, Galossi E, Falconi G, Bruno A, Crisafulli F, Frassi M, Cattaneo C, Bertoli D, Bernardi M, Condorelli A, Morsia E, Poloni A, Crisà E, Caravelli D, Triggianese P, Brussino L, Battipaglia G, Bindoli S, Sfriso P, Caroni F, Dragani M, Mallegni F, Pilo F, Firinu D, Curti A, Papayannidis C, Olivieri A, Kordasti S, Albano F, Pane F, Musto P, Bocchia M, Lugli E, Breccia M, Frigeni M, Dagna L, Greco R, Franceschini F, Campochiaro C, Cantarini L, Voso MT. Diagnostic capabilities, clinical features, and longitudinal UBA1 clonal dynamics of a nationwide VEXAS cohort. Am J Hematol 2024; 99:254-262. [PMID: 38108611 DOI: 10.1002/ajh.27169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023]
Abstract
VEXAS is a prototypic hemato-inflammatory disease combining rheumatologic and hematologic disorders in a molecularly defined nosological entity. In this nationwide study, we aimed at screenshotting the current diagnostic capabilities and clinical-genomic features of VEXAS, and tracked UBA1 longitudinal clonal dynamics upon different therapeutics, including allogeneic hematopoietic cell transplant. We leveraged a collaboration between the Italian Society of Experimental Hematology and of Rheumatology and disseminated a national survey to collect clinical and molecular patient information. Overall, 13/29 centers performed UBA1 genomic testing locally, including Sanger sequencing (46%), next-generation sequencing (23%), droplet digital polymerase chain reaction (8%), or combination (23%). A total of 41 male patients were identified, majority (51%) with threonine substitutions at Met41 hotspot, followed by valine and leucine (27% and 8%). Median age at VEXAS diagnosis was 67 years. All patients displayed anemia (median hemoglobin 9.1 g/dL), with macrocytosis. Bone marrow vacuoles were observed in most cases (89%). The most common rheumatologic association was polychondritis (49%). A concomitant myelodysplastic neoplasm/syndrome (MDS) was diagnosed in 71% of patients (n = 28), chiefly exhibiting lower Revised International Prognostic Scoring System risk profiles. Karyotype was normal in all patients, except three MDS cases showing -Y, t(12;16)(q13;q24), and +8. The most frequently mutated gene was DNMT3A (n = 10), followed by TET2 (n = 3). At last follow-up, five patients died and two patients progressed to acute leukemia. Longitudinal UBA1 clonal dynamics demonstrated mutational clearance following transplant. We collected a nationwide interdisciplinary VEXAS patient cohort, characterized by heterogeneous rheumatologic manifestations and treatments used. MDS was diagnosed in 71% of cases. Patients exhibited various longitudinal UBA1 clonal dynamics.
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Affiliation(s)
- Carmelo Gurnari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Maria Rosaria Pascale
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Vitale
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Elisa Diral
- Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Elisa Galossi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giulia Falconi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Bruno
- Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Micol Frassi
- ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Chiara Cattaneo
- ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Diego Bertoli
- ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Massimo Bernardi
- Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Erika Morsia
- Hematology Department, University of Ancona, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Antonella Poloni
- Hematology Department, University of Ancona, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Elena Crisà
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | | | - Paola Triggianese
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Luisa Brussino
- Department of Medical Sciences Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - Giorgia Battipaglia
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Sara Bindoli
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Federico Caroni
- Hematology, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Flavia Mallegni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Federica Pilo
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Curti
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Papayannidis
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Attilio Olivieri
- Hematology Department, University of Ancona, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Sharham Kordasti
- Hematology Department, University of Ancona, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
- Haematology, Guy's Hospital & Comprehensive Cancer Centre, King's College, London, UK
| | - Francesco Albano
- Department of Precision and Regenerative Medicine and Ionian Area, "Aldo Moro" University, Bari, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Pellegrino Musto
- Department of Precision and Regenerative Medicine and Ionian Area, "Aldo Moro" University, Bari, Italy
| | - Monica Bocchia
- Hematology, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Elisabetta Lugli
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Breccia
- Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Marco Frigeni
- Azienda SocioSanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Raffaella Greco
- Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Lupia T, Carnevale-Schianca F, Vita D, Busca A, Caravelli D, Crisà E, Gregorc V, Curtoni A, Cerutti A, Shbaklo N, Corcione S, De Rosa FG. Stenotrophomonas maltophilia Infections in Haematological Malignancies and Hematopoietic Stem Cell Transplantation: A Case Series including Cefiderocol-Based Regimens. Medicina (Kaunas) 2024; 60:88. [PMID: 38256349 PMCID: PMC10818980 DOI: 10.3390/medicina60010088] [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] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Stenotrophomonas maltophilia is a ubiquitous, aerobic, Gram-negative bacillus causing increasing concern in patients affected by haematological malignancies. Materials and Methods: We report a case series from two centres in Northern Italy to describe the characteristics, outcome and microbiological response of S. maltophilia infections in patients with haematological malignancies and/or allogenic hematopoietic stem cell transplantation (aHSCT). Results: Ten patients were included. The median age was 67 years, and seven patients (70%) were males. The median Charlson Comorbidity Index was 6 (IQR: 4-8). The most frequent haematological comorbidities were acute myeloid leukaemia (AML; n = 3; 30%) and non-Hodgkin's lymphoma (n = 3; 30%). Three (30%) patients underwent aHSCT before infection, all for AML. All the patients had undergone a recent antibiotics course and had an indwelling central venous catheter before infection. The main clinical presentations were nosocomial pneumonia, with (2; 20%) or without (4; 40%) secondary bloodstream infection and CRBSI (3; 30%). Four patients were treated with cefiderocol in monotherapy or combinations therapy with cotrimoxazole. The rest of the patients were treated with cotrimoxazole or levofloxacin in monotherapy. Conclusions: Despite a high rate of clinical improvement (90%) after starting antimicrobial therapy, we faced high 30-day mortality (30%) and in-hospital mortality (50%) rates in a highly comorbid population.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy;
| | - Fabrizio Carnevale-Schianca
- Unit of Oncology and Haematology, Candiolo Cancer Institute, FPO-IRCCS Strada Provinciale 142, 10060 Candiolo, Italy; (F.C.-S.); (D.C.); (E.C.); (V.G.)
| | - Davide Vita
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (D.V.); (N.S.); (S.C.)
| | - Alessandro Busca
- Department of Oncology, Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, 10100 Turin, Italy;
| | - Daniela Caravelli
- Unit of Oncology and Haematology, Candiolo Cancer Institute, FPO-IRCCS Strada Provinciale 142, 10060 Candiolo, Italy; (F.C.-S.); (D.C.); (E.C.); (V.G.)
| | - Elena Crisà
- Unit of Oncology and Haematology, Candiolo Cancer Institute, FPO-IRCCS Strada Provinciale 142, 10060 Candiolo, Italy; (F.C.-S.); (D.C.); (E.C.); (V.G.)
| | - Vanesa Gregorc
- Unit of Oncology and Haematology, Candiolo Cancer Institute, FPO-IRCCS Strada Provinciale 142, 10060 Candiolo, Italy; (F.C.-S.); (D.C.); (E.C.); (V.G.)
| | - Antonio Curtoni
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10100 Turin, Italy;
| | | | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (D.V.); (N.S.); (S.C.)
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (D.V.); (N.S.); (S.C.)
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy;
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy; (D.V.); (N.S.); (S.C.)
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5
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Oliva EN, Riva M, Niscola P, Santini V, Breccia M, Giai V, Poloni A, Patriarca A, Crisà E, Capodanno I, Salutari P, Reda G, Cascavilla N, Ferrero D, Guarini A, Tripepi G, Iannì G, Russo E, Castelli A, Fattizzo B, Beltrami G, Bocchia M, Molteni A, Fenaux P, Germing U, Ricco A, Palumbo GA, Impera S, Di Renzo N, Rivellini F, Buccisano F, Stamatoullas-Bastard A, Liberati AM, Candoni A, Delfino IM, Arcadi MT, Cufari P, Rizzo L, Bova I, D'Errigo MG, Zini G, Latagliata R. Eltrombopag for Low-Risk Myelodysplastic Syndromes With Thrombocytopenia: Interim Results of a Phase II, Randomized, Placebo-Controlled Clinical Trial (EQOL-MDS). J Clin Oncol 2023; 41:4486-4496. [PMID: 37294914 PMCID: PMC10552995 DOI: 10.1200/jco.22.02699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/16/2023] [Accepted: 05/01/2023] [Indexed: 06/11/2023] Open
Abstract
PURPOSE In myelodysplastic syndromes (MDS), severe thrombocytopenia is associated with poor prognosis. This multicenter trial presents the second-part long-term efficacy and safety results of eltrombopag in patients with low-risk MDS and severe thrombocytopenia. METHODS In this single-blind, randomized, placebo-controlled, phase-II trial of adult patients with International Prognostic Scoring System low- or intermediate-1-risk MDS, patients with a stable platelet (PLT) count (<30 × 103/mm3) received eltrombopag or placebo until disease progression. Primary end points were duration of PLT response (PLT-R; calculated from the time of PLT-R to date of loss of PLT-R, defined as bleeding/PLT count <30 × 103/mm3 or last date in observation) and long-term safety and tolerability. Secondary end points included incidence and severity of bleeding, PLT transfusions, quality of life, leukemia-free survival, progression-free survival, overall survival and pharmacokinetics. RESULTS From 2011 to 2021, of 325 patients screened, 169 patients were randomly assigned oral eltrombopag (N = 112) or placebo (N = 57) at a starting dose of 50 mg once daily to maximum of 300 mg. PLT-R, with 25-week follow-up (IQR, 14-68) occurred in 47/111 (42.3%) eltrombopag patients versus 6/54 (11.1%) in placebo (odds ratio, 5.9; 95% CI, 2.3 to 14.9; P < .001). In eltrombopag patients, 12/47 (25.5%) lost the PLT-R, with cumulative thrombocytopenia relapse-free survival at 60 months of 63.6% (95% CI, 46.0 to 81.2). Clinically significant bleeding (WHO bleeding score ≥ 2) occurred less frequently in the eltrombopag arm than in the placebo group (incidence rate ratio, 0.54; 95% CI, 0.38 to 0.75; P = .0002). Although no difference in the frequency of grade 1-2 adverse events (AEs) was observed, a higher proportion of eltrombopag patients experienced grade 3-4 AEs (χ2 = 9.5, P = .002). AML evolution and/or disease progression occurred in 17% (for both) of eltrombopag and placebo patients with no difference in survival times. CONCLUSION Eltrombopag was effective and relatively safe in low-risk MDS with severe thrombocytopenia. This trial is registered with ClinicalTrials.gov identifier: NCT02912208 and EU Clinical Trials Register: EudraCT No. 2010-022890-33.
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Affiliation(s)
- Esther Natalie Oliva
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Marta Riva
- Dipartimento di Ematologia, Ospedale Niguarda Ca' Granda, Milano, Italy
| | | | - Valeria Santini
- U.O. di Ematologia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Massimo Breccia
- Dipartimento di Ematologia Policlinico Umberto I, Università La Sapienza, Roma, Italy
| | - Valentina Giai
- S.C. a Direzione Universitaria di Ematologia A.O., SS. Antonio e Biagio e Cesare Arrigo Alessandria, Alessandria, Italy
| | - Antonella Poloni
- Clinica di Ematologia Azienda Ospedaliera Universitaria—Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Elena Crisà
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Isabella Capodanno
- U.O. di Ematologia, A.U.S.L.-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Prassede Salutari
- Dipartimento Oncologico-Ematologico, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Gianluigi Reda
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Cascavilla
- U.O. Ematologia Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Dario Ferrero
- Dipartimento Biotecnologie Molecolari, Ematologia Universitaria A.O.U. Citta' della Salute e della Scienza di Torino, Turin, Italy
| | - Attilio Guarini
- U.O. Ematologia I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Giovanni Tripepi
- IFC-CNR Institute of Clinical Physiology, Reggio Calabria, Italy
| | | | - Emilio Russo
- Department of Pharmacology, University of Germaneto Catanzaro, Catanzaro, Italy
| | | | - Bruno Fattizzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
| | - Germana Beltrami
- U.O. Ematologia e terapie cellulari, IRCCS Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Monica Bocchia
- UOC Ematologia, Università di Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Pierre Fenaux
- Groupe Francais desmyélodysplasies (GFM), Paris, France
| | - Ulrich Germing
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Alessandra Ricco
- U.O. Ematologia con Trapianto, Azienda Ospedale Policlinicodi Bari, Bari, Italy
| | - Giuseppe A. Palumbo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Stefana Impera
- U.O. C. Ematologia, A. O.ad Alta Specializzazione Ospedale Garibaldi Nesima, Catania, Italy
| | | | - Flavia Rivellini
- Divisione Ematologia, P.O. A. Tortora di Pagani-ASL Salerno, Pagani, Italy
| | - Francesco Buccisano
- Divisione di Biopatologia e Diagnostica per Immagini, Policlinico Universitario Tor Vergata, Rome, Italy
| | | | - Anna Marina Liberati
- S.C. Oncoematologia, Università degli Studi di Perugia A.O. Santa Maria, Terni, Italy
| | - Anna Candoni
- Divisione Ematologia, P.O. Santa Maria della Misericordia, A.S.U.F.C di Udine, Udine, Italy
| | - Ilaria Maria Delfino
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Maria Teresa Arcadi
- U.O. Farmacia Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Patrizia Cufari
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Lorenzo Rizzo
- Dipartimento di Ematologia, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Irene Bova
- U.O.S. di Genetica Medica Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Maria Grazia D'Errigo
- U.O.S. di Genetica Medica Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Gina Zini
- Fondazione Policlinico, Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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6
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Tiribelli M, Latagliata R, Breccia M, Capodanno I, Miggiano MC, Cavazzini F, Bucelli C, Attolico I, Crescenzi SL, Russo S, Annunziata M, Sorà F, Bonifacio M, Mulas O, Loglisci G, Maggi A, Binotto G, Crisà E, Scortechini AR, Leporace AP, Sancetta R, Murgano P, Abruzzese E, Stagno F, Rapezzi D, Luzi D, Vincelli I, Bocchia M, Fava C, Malato A, Crugnola M, Pizzuti M, Lunghi F, Galimberti S, Dalmazzo M, Fanin R, Scalzulli E, Foà R, Iurlo A, Saglio G, Specchia G. Determinants of frontline tyrosine kinase inhibitor choice for patients with chronic-phase chronic myeloid leukemia: A study from the Registro Italiano LMC and Campus CML. Cancer 2023; 129:2637-2644. [PMID: 37354090 DOI: 10.1002/cncr.34923] [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: 11/24/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Imatinib, dasatinib, and nilotinib are tyrosine kinase inhibitors (TKIs) approved in Italy for frontline treatment of chronic-phase chronic myeloid leukemia (CP-CML). The choice of TKI is based on a combined evaluation of the patient's and the disease characteristics. The aim of this study was to analyze the use of frontline TKI therapy in an unselected cohort of Italian patients with CP-CML to correlate the choice with the patient's features. METHODS A total of 1967 patients with CP-CML diagnosed between 2012 and 2019 at 36 centers throughout Italy were retrospectively evaluated; 1089 patients (55.4%) received imatinib and 878 patients (44.6%) received a second-generation (2G) TKI. RESULTS Second-generation TKIs were chosen for most patients aged <45 years (69.2%), whereas imatinib was used in 76.7% of patients aged >65 years (p < .001). There was a predominant use of imatinib in intermediate/high European long-term survival risk patients (60.0%/66.0% vs. 49.7% in low-risk patients) and a limited use of 2G-TKIs in patients with comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease, previous neoplasms, ischemic heart disease, or stroke and in those with >3 concomitant drugs. We observed a greater use of imatinib (61.1%) in patients diagnosed in 2018-2019 compared to 2012-2017 (53.2%; p = .002). In multivariable analysis, factors correlated with imatinib use were age > 65 years, spleen size, the presence of comorbidities, and ≥3 concomitant medications. CONCLUSIONS This observational study of almost 2000 cases of CML shows that imatinib is the frontline drug of choice in 55% of Italian patients with CP-CML, with 2G-TKIs prevalently used in younger patients and in those with no concomitant clinical conditions. Introduction of the generic formulation in 2018 seems to have fostered imatinib use.
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Affiliation(s)
- Mario Tiribelli
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medical Area, University of Udine, Udine, Italy
| | | | - Massimo Breccia
- Hematology, Department of Precision and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | | | | | - Cristina Bucelli
- Division of Hematology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Immacolata Attolico
- Hematology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Sabina Russo
- Hematology, University of Messina, Messina, Italy
| | | | - Federica Sorà
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and Department of Radiological and Hematological Sciences, Cattolica University, Rome, Italy
| | | | - Olga Mulas
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | - Gianni Binotto
- Hematology and Clinical Immunology, Department of Medicine, University of Padua, Padua, Italy
| | - Elena Crisà
- Hematology, Ospedale Maggiore della Carità di Novara, University of Eastern Piedmont, Novara, Italy
| | | | | | | | - Pamela Murgano
- Division of Hematology, Sant'Elia Hospital, Caltanissetta, Italy
| | | | - Fabio Stagno
- Hematology Section and Bone Marrow Transplant Unit, Rodolico Hospital, Azienda Ospedaliero Universitaria Policlinico "Rodolico-San Marco", Catania, Italy
| | - Davide Rapezzi
- Hematology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | - Debora Luzi
- Onco-Hematology Department, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Iolanda Vincelli
- Hematology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Monica Bocchia
- Hematology, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Monica Crugnola
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliero Universitaria, Parma, Italy
| | | | | | | | - Matteo Dalmazzo
- Division of Hematology and Internal Medicine, "San Luigi Gonzaga" University Hospital, Turin, Italy
| | - Renato Fanin
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medical Area, University of Udine, Udine, Italy
| | - Emilia Scalzulli
- Hematology, Department of Precision and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Precision and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Alessandra Iurlo
- Division of Hematology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giorgina Specchia
- Hematology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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7
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Lupia T, Crisà E, Gaviraghi A, Rizzello B, Di Vincenzo A, Carnevale-Schianca F, Caravelli D, Fizzotti M, Tolomeo F, Vitolo U, De Benedetto I, Shbaklo N, Cerutti A, Fenu P, Gregorc V, Corcione S, Ghisetti V, De Rosa FG. Overlapping Infection by Strongyloides spp. and Cytomegalovirus in the Immunocompromised Host: A Comprehensive Review of the Literature. Trop Med Infect Dis 2023; 8:358. [PMID: 37505654 PMCID: PMC10385408 DOI: 10.3390/tropicalmed8070358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
Strongyloides and cytomegalovirus co-infections are rarely reported, even though they are distinguished by high morbidity and mortality, especially in immunocompromised hosts. We narratively reviewed the literature on reported cases of Strongyloides and CMV co-infections in immunosuppressed patients. Most cases occurred in males with a median age of 47 (IQR, 37-59). Strongyloides/CMV co-infections occurred among immunocompromised hosts, especially in solid organ transplants and hematological or rheumatological diseases. Most of the patients underwent a course of steroid treatment before the diagnosis of co-infections. Other common immunomodulatory agents were tacrolimus and mycophenolate. The first clinical manifestations of co-infections were mainly gastrointestinal, followed by respiratory symptoms. CMV was, in most patients, co-infected with an isolated reactivation, although Strongyloides manifested especially as hyperinfection syndrome. Ganciclovir and ivermectin are the mainstays of CMV and Strongyloides treatment. However, the treatment mortality reported in this narrative review is around 52.4%. Interestingly secondary bacterial infections are common in CMV/Strongyloides-infected patients.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
| | - Elena Crisà
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Alberto Gaviraghi
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Barbara Rizzello
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | | | - Fabrizio Carnevale-Schianca
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Daniela Caravelli
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Marco Fizzotti
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Francesco Tolomeo
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Umberto Vitolo
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | | | - Piero Fenu
- Healthcare Management, IRCCS Candiolo, 10100 Candiolo, Italy
| | - Vanesa Gregorc
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Valeria Ghisetti
- Microbiology Unit, Amedeo di Savoia Hospital, 10100 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
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8
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Lupia T, Crisà E, Gaviraghi A, Rizzello B, Di Vincenzo A, Carnevale-Schianca F, Caravelli D, Fizzotti M, Tolomeo F, Vitolo U, De Benedetto I, Shbaklo N, Cerutti A, Fenu P, Gregorc V, Corcione S, Ghisetti V, De Rosa FG. Strongyloides spp. and Cytomegalovirus Co-Infection in Patient Affected by Non-Hodgkin Lymphoma. Trop Med Infect Dis 2023; 8:331. [PMID: 37368749 DOI: 10.3390/tropicalmed8060331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
To our knowledge, we have described the first case of Strongyloides/Cytomegalovirus (CMV) concomitant infection that occurred in a European country. The patient was a 76-year-old woman affected by relapsed non-Hodgkin lymphoma who presented interstitial pneumonia with a rapidly progressive worsening of respiratory insufficiency, leading to cardiac dysfunction and consequent death. CMV reactivation is a common complication in immunocompromised patients, while hyperinfection/disseminated strongyloidiasis (HS/DS) is rare in low endemic regions, but has been widely described in Southeast Asia and American countries. HS and DS are two consequences of the failure of infection control by the immune system: HS is the uncontrolled replication of the parasite within the host and DS the spreading of the L3 larvae in organs other than the usual replication sites. Only a few cases of HS/CMV infection have been reported in the literature, and only in one patient with lymphoma as an underlying disease. The clinical manifestations of these two infections overlap, usually leading to a delayed diagnosis and a consequent poor outcome.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
| | - Elena Crisà
- Unit of Oncology and Haematology, Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Alberto Gaviraghi
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Barbara Rizzello
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | | | | | - Daniela Caravelli
- Unit of Oncology and Haematology, Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Marco Fizzotti
- Unit of Oncology and Haematology, Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Francesco Tolomeo
- Unit of Oncology and Haematology, Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Umberto Vitolo
- Unit of Oncology and Haematology, Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | | | - Piero Fenu
- Healthcare Management, IRCCS Candiolo, 10100 Candiolo, Italy
| | - Vanesa Gregorc
- Unit of Oncology and Haematology, Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Valeria Ghisetti
- Microbiology Unit, Amedeo di Savoia Hospital, 10100 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
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9
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Lanino L, Restuccia F, Perego A, Ubezio M, Fattizzo B, Riva M, Consagra A, Musto P, Cilloni D, Oliva EN, Palmieri R, Poloni A, Califano C, Capodanno I, Itri F, Elena C, Fozza C, Pane F, Pelizzari AM, Breccia M, Di Bassiano F, Crisà E, Ferrero D, Giai V, Barraco D, Vaccarino A, Griguolo D, Minetto P, Quintini M, Paolini S, Sanpaolo G, Sessa M, Bocchia M, Di Renzo N, Diral E, Leuzzi L, Genua A, Guarini A, Molteni A, Nicolino B, Occhini U, Rivoli G, Bono R, Calvisi A, Castelli A, Di Bona E, Di Veroli A, Ferrara F, Fianchi L, Galimberti S, Grimaldi D, Marchetti M, Norata M, Frigeni M, Sancetta R, Selleri C, Tanasi I, Tosi P, Turrini M, Giordano L, Finelli C, Pasini P, Naldi I, Santini V, Della Porta MG. Real-world efficacy and safety of luspatercept and predictive factors of response in patients with lower risk myelodysplastic syndromes with ring sideroblasts. Am J Hematol 2023. [PMID: 37222267 DOI: 10.1002/ajh.26960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/25/2023]
Affiliation(s)
- Luca Lanino
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | - Marta Ubezio
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Bruno Fattizzo
- SC Ematologia, IRCCS Ca' Granda Ospedale Maggiore Policlinico & Dipartimento di Oncologia ed Emato-oncologia, University of Milan, Milan, Italy
| | - Marta Riva
- S.C. Ematologia, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angela Consagra
- MDS Unit, Dipartimento Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Pellegrino Musto
- Dipartimento di Medicina di Precisione e Rigenerativa e Area Ionica, Università degli Studi "Aldo Moro", AOU Consorziale Policlinico, Bari, Italy
| | - Daniela Cilloni
- AO Ordine Mauriziano, Università degli Studi di Torino, Turin, Italy
| | - Esther Natalie Oliva
- UOC Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | | | - Antonella Poloni
- Università Politecnica Marche, UOC Ematologia, AOU Marche, Ancona, Italy
| | | | - Isabella Capodanno
- Azienda Unità Sanitaria Locale- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federico Itri
- AOU San Luigi Gonzaga, SCDU Medicina Interna ad Indirizzo Ematologico, Università degli Studi di Torino, Torino, Italy
| | - Chiara Elena
- UOC Ematologia1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Fozza
- Dipartimento di Medicina, Chirurgia e Farmacia, Università di Sassari, Sassari, Italy
| | - Fabrizio Pane
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | | | | | | | - Elena Crisà
- AOU Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy
| | - Dario Ferrero
- SC Ematologia, AOU Città della Salute e della Scienza, Torino, Italy
| | - Valentina Giai
- SC Ematologia, AOU Città della Salute e della Scienza, Torino, Italy
| | - Daniela Barraco
- SC Ematologia, Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
| | | | - Davide Griguolo
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale Maggiore, Trieste, Italy
| | - Paola Minetto
- Clinica Ematologica, IRCCS-Policlinico San Martino, Genoa, Italy
| | - Martina Quintini
- Azienda Ospedaliera di Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Stefania Paolini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Grazia Sanpaolo
- UOC Ematologia e Trapianto di Cellule Staminali Emopoietiche - Ospedale Casa Sollievo della Sofferenza, IRCCS San Giovanni Rotondo, San Giovanni Rotondo, Italy
| | - Mariarosaria Sessa
- Hematology Section, Department of Medical Sciences, Azienda Ospedaliero-Universitaria, Arcispedale S.Anna, University of Ferrara, Ferrara, Italy
| | - Monica Bocchia
- UOC Ematologia, Azienda Ospedaliero Universitaria Senese, Università di Siena, Siena, Italy
| | - Nicola Di Renzo
- UOC Ematologia e Trapianto di Cellule Staminali P.O. "Vito Fazzi" -ASL Lecce, Lecce, Italy
| | - Elisa Diral
- Unità di Ematologia e Trapianto di Midollo Osseo, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Livia Leuzzi
- SC Oncologia, SS Oncoematologia, PO Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | | | | | - Barbara Nicolino
- SSD Ematologia, ASLTO4 Presidio Ospedaliero di Ivrea, Ivrea, Italy
| | | | - Giulia Rivoli
- IRCCS Ospedale Policlinico San Martino, U.O Ematologia e terapie Cellulari, Genoa, Italy
| | - Roberto Bono
- A.O.O.R Villa Sofia - Cervello, U.O.S.D. Unità Trapianti di Midollo Osseo, Palermo, Italy
| | - Anna Calvisi
- U.O.C. Ematologia - CTMO Ospedale San Francesco, Nuoro, Italy
| | | | - Eros Di Bona
- Oncoematologia, AULSS 7 Pedemontana, Bassano del Grappa, Italy
| | | | | | - Luana Fianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Sara Galimberti
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | | | - Monia Marchetti
- Hematology Unit, AO Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marianna Norata
- Hematology Unit, IRCCS - Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Marco Frigeni
- Dipartimento di Oncologia ed Ematologia, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Carmine Selleri
- UOC Ematologia, AOU San Giovanni Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy
| | - Ilaria Tanasi
- U.O.C. di Ematologia Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Patrizia Tosi
- UO Ematologia Ospedale Infermi Rimini, Rimini, Italy
| | - Mauro Turrini
- Division of Hematology, Valduce Hospital, Como, Italy
| | - Laura Giordano
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Carlo Finelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Paolo Pasini
- AIPASIM (Associazione Italiana Pazienti con Sindrome Mielodisplastica), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ilaria Naldi
- MDS Unit, Dipartimento Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Valeria Santini
- MDS Unit, Dipartimento Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Matteo Giovanni Della Porta
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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10
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Inzoli E, Crisà E, Pugliese N, Civettini I, Lanzarone G, Castelli A, Martinelli V, Montelisciani L, Antolini L, Gambacorti-Passerini C, Elli EM. Biosimilar erythropoiesis-stimulating agents are an effective and safe option for the management of myelofibrosis-related anemia. Eur J Haematol 2023; 110:354-361. [PMID: 36480004 DOI: 10.1111/ejh.13910] [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: 10/03/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Erythropoiesis-stimulating agents (ESA) have an established role in treating anemia in hematological malignancies. However, their role, particularly biosimilar ESA (B-ESA), in myelofibrosis (MF) is not well established. METHODS This study retrospectively collected data on 96 MF patients treated with B-ESA (alpha/zeta) for the management of anemia to assess safety, efficacy (anemia response [AR]), and survival. RESULTS Seventy-seven patients (80%) obtained AR. The median time to AR was 2.5 months. In multivariate analysis, significant predictive factors of AR were transfusion independency (p = .006) and ferritin levels <200 ng/ml (p = .009) at baseline. After a median follow-up of 43.8 months from diagnosis, 38 patients (39%) died, 11 (28.9%) from leukemic evolution. Only two patients (2.5%) stopped B-ESA for toxicity. The 24-month survival was significantly affected by response to B-ESA (70.8% in AR vs. 55.3% in non-responder patients, p = .016). In multivariate analysis, age ≤ 70 years (p = .029) and Hb > 8.5 g/dl (p = .047) at baseline were significantly associated with improved survival, with a trend for longer survival in AR patients (p = .06). CONCLUSIONS B-ESA seems to be an effective and well-tolerated option for anemia treatment in the MF setting. This strategy deserves further clinical investigation.
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Affiliation(s)
- Elena Inzoli
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.,Hematology Division and Bone Marrow Unit, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Elena Crisà
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ivan Civettini
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.,Hematology Division and Bone Marrow Unit, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Lanzarone
- SC Hematology Unit, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Castelli
- Division of Hematology, Ospedale degli Infermi, Biella, Italy
| | - Vincenzo Martinelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Laura Montelisciani
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), University of Milano-Bicocca, Monza, Italy
| | - Laura Antolini
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), University of Milano-Bicocca, Monza, Italy
| | - Carlo Gambacorti-Passerini
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.,Hematology Division and Bone Marrow Unit, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Elena Maria Elli
- Hematology Division and Bone Marrow Unit, ASST Monza, San Gerardo Hospital, Monza, Italy
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11
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Battipaglia G, Vincenzi A, Falconi G, Fiore A, D'Agostino F, Iannotta R, Grimaldi F, Gurnari C, Galossi E, Crisà E, Bonello F, Scalia G, Izzo B, Voso MT, Pane F. New scenarios in Vacuoles, E1 enzyme, X linked, Autoinflammatory, Somatic (VEXAS) syndrome: Evolution from myelodysplastic syndrome to acute myeloid leukemia. Curr Res Transl Med 2023; 71:103386. [PMID: 36905702 DOI: 10.1016/j.retram.2023.103386] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Affiliation(s)
- Giorgia Battipaglia
- Hematology and Bone Marrow Transplantation Unit, Federico II University of Naples, Hematology Department, Naples, Italy; Department of Clinical Medicine and Surgery, Hematology Unit, University Federico II, Naples, Italy.
| | - Annamaria Vincenzi
- Hematology and Bone Marrow Transplantation Unit, Federico II University of Naples, Hematology Department, Naples, Italy
| | - Giulia Falconi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Alessia Fiore
- Hematology and Bone Marrow Transplantation Unit, Federico II University of Naples, Hematology Department, Naples, Italy
| | - Francesco D'Agostino
- Hematology and Bone Marrow Transplantation Unit, Federico II University of Naples, Hematology Department, Naples, Italy
| | - Raffaella Iannotta
- Hematology and Bone Marrow Transplantation Unit, Federico II University of Naples, Hematology Department, Naples, Italy
| | - Francesco Grimaldi
- Hematology and Bone Marrow Transplantation Unit, Federico II University of Naples, Hematology Department, Naples, Italy; Department of Clinical Medicine and Surgery, Hematology Unit, University Federico II, Naples, Italy
| | - Carmelo Gurnari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elisa Galossi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Elena Crisà
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (Torino), Italy
| | - Francesca Bonello
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (Torino), Italy
| | - Giulia Scalia
- Centre for Advanced Biotechnology (CEINGE), Naples, Italy
| | - Barbara Izzo
- Centre for Advanced Biotechnology (CEINGE), Naples, Italy; Department of Molecular Medicine and Medical Biotechnologies, University Federico II and Centre for Advanced Biotechnology (CEINGE), Naples, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Fabrizio Pane
- Hematology and Bone Marrow Transplantation Unit, Federico II University of Naples, Hematology Department, Naples, Italy; Department of Clinical Medicine and Surgery, Hematology Unit, University Federico II, Naples, Italy
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12
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Gallazzi M, Ucciero MAM, Faraci DG, Mahmoud AM, Al Essa W, Gaidano G, Mouhssine S, Crisà E. New Frontiers in Monoclonal Antibodies for the Targeted Therapy of Acute Myeloid Leukemia and Myelodysplastic Syndromes. Int J Mol Sci 2022; 23:ijms23147542. [PMID: 35886899 PMCID: PMC9320300 DOI: 10.3390/ijms23147542] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 12/13/2022] Open
Abstract
Acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) represent an unmet clinical need whose prognosis is still dismal. Alterations of immune response play a prominent role in AML/MDS pathogenesis, revealing novel options for immunotherapy. Among immune system regulators, CD47, immune checkpoints, and toll-like receptor 2 (TLR2) are major targets. Magrolimab antagonizes CD47, which is overexpressed by AML and MDS cells, thus inducing macrophage phagocytosis with clinical activity in AML/MDS. Sabatolimab, an inhibitor of T-cell immunoglobulin and mucin domain-containing protein 3 (TIM3), which disrupts its binding to galectin-9, has shown promising results in AML/MDS, enhancing the effector functions of lymphocytes and triggering tumor cell death. Several other surface molecules, namely CD33, CD123, CD45, and CD70, can be targeted with monoclonal antibodies (mAbs) that exert different mechanisms of action and include naked and conjugated antibodies, bispecific T-cell engagers, trispecific killer engagers, and fusion proteins linked to toxins. These novel mAbs are currently under investigation for use as monotherapy or in combination with hypomethylating agents, BCL2 inhibitors, and chemotherapy in various clinical trials at different phases of development. Here, we review the main molecular targets and modes of action of novel mAb-based immunotherapies, which can represent the future of AML and higher risk MDS treatment.
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13
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Elli EM, Di Veroli A, Bartoletti D, Iurlo A, Carmosino I, Benevolo G, Abruzzese E, Bonifacio M, Bergamaschi M, Polverelli N, Caramella M, Cilloni D, Tiribelli M, Pugliese N, Caocci G, Crisà E, Porrini R, Markovic U, Renso R, Auteri G, Cattaneo D, Trawinska MM, Scaffidi L, Biale L, Bucelli C, Breccia M, Gambacorti-Passerini C, Palumbo GA, Latagliata R, Palandri F. Deferasirox in the management of iron overload in patients with myelofibrosis treated with ruxolitinib: The multicentre retrospective RUX-IOL study. Br J Haematol 2022; 197:190-200. [PMID: 35137397 DOI: 10.1111/bjh.18057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
Deferasirox (DFX) is used for the management of iron overload (IOL) in many haematological malignancies including myelofibrosis (MF). The 'RUX-IOL' study retrospectively collected 69 MF patients treated with ruxolitinib (RUX) and DFX for IOL to assess: safety, efficacy in term of iron chelation response (ICR) and erythroid response (ER), and impact on overall survival of the combination therapy. The RUX-DFX therapy was administered for a median time of 12.4 months (interquartile range 3.1-71.2). During treatment, 36 (52.2%) and 34 (49.3%) patients required RUX and DFX dose reductions, while eight (11.6%) and nine (13.1%) patients discontinued due to RUX- or DFX-related adverse events; no unexpected toxicity was reported. ICR and ER were achieved by 33 (47.8%) and 32 patients (46.4%) respectively. Thirteen (18.9%) patients became transfusion-independent. Median time to ICR and ER was 6.2 and 2 months respectively. Patients achieving an ER were more likely to obtain an ICR also (p = 0.04). In multivariable analysis, the absence of leukocytosis at baseline (p = 0.02) and achievement of an ICR at any time (p = 0.02) predicted improved survival. In many MF patients, the RUX-DFX combination provided ICR and ER responses that correlated with improved outcome in the absence of unexpected toxicities. This strategy deserves further clinical investigation.
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Affiliation(s)
- Elena Maria Elli
- Hematology Division and Bone Marrow Unit, Ospedale San Gerardo, Monza, Italy
| | | | - Daniela Bartoletti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia 'Seràgnoli', Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Giulia Benevolo
- Division of Haematology, Città della Salute e della Scienza Hospital, Turin, Italy
| | | | | | - Micaela Bergamaschi
- Medicina Interna PO ponente, Ospedale Santa Corona Pietra Ligure, Savona, Italy
| | - Nicola Polverelli
- Unit of Blood Diseases and Stem Cell Transplantation, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marianna Caramella
- Division of Haematology, ASST Grande Ospedale Metropolitano, Niguarda, Milan, Italy
| | - Daniela Cilloni
- Haematology Division, Department of Clinical and Biological Sciences, Ospedale San Luigi di Orbassano, University of Turin, Orbassano, Italy
| | - Mario Tiribelli
- Division of Haematology and BMT, Department of Medical Area and Azienda Ospedaliero-Universitaria Friuli Centrale, Udine, Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery, Haematology Section, University of Naples 'Federico II', Naples, Italy
| | - Giovanni Caocci
- Ematologia, Ospedale Businco, Università degli studi di Cagliari, Cagliari, Italy
| | - Elena Crisà
- Division of Haematology, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | | | - Uros Markovic
- Hematology Division, AOU Policlinico 'G. Rodolico' - San Marco, Catania, Italy
| | - Rossella Renso
- Hematology Division and Bone Marrow Unit, Ospedale San Gerardo, Monza, Italy
| | - Giuseppe Auteri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia 'Seràgnoli', Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Luigi Scaffidi
- Department of Medicine, Section of Haematology, University of Verona, Verona, Italy
| | - Lucia Biale
- Banca del Sangue, Servizio di Immunoematologia, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, Rome, Italy
| | | | - Giuseppe Alberto Palumbo
- Department of Scienze Mediche, Chirurgiche e Tecnologie Avanzate 'G.F. Ingrassia', University of Catania, Catania, Italy
| | | | - Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia 'Seràgnoli', Bologna, Italy
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14
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Breccia M, Abruzzese E, Accurso V, Attolico I, Barulli S, Bergamaschi M, Binotto G, Bocchia M, Bonifacio M, Caocci G, Capodanno I, Castagnetti F, Cavazzini F, Crisà E, Crugnola M, Stella De Candia M, Elena C, Fava C, Galimberti S, Gozzini A, Gugliotta G, Intermesoli T, Iurlo A, La Barba G, Latagliata R, Leonetti Crescenzi S, Levato L, Loglisci G, Lucchesi A, Luciano L, Lunghi F, Luzi D, Malato A, Cristina Miggiano M, Pizzuti M, Pregno P, Rapezzi D, Rege-Cambrin G, Rosti G, Russo S, Sancetta R, Rita Scortechini A, Sorà F, Sportoletti P, Stagno F, Tafuri A, Tiribelli M, Foà R, Saglio G. COVID-19 infection in chronic myeloid leukaemia after one year of the pandemic in Italy. A Campus CML report. Br J Haematol 2021; 196:559-565. [PMID: 34636033 PMCID: PMC8652631 DOI: 10.1111/bjh.17890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
Limited information is available on the impact of the COVID-19 pandemic on the management of chronic myeloid leukaemia (CML). The Campus CML network collected retrospective information on 8 665 CML patients followed at 46 centres throughout Italy during the pandemic between February 2020 and January 2021. Within this cohort, we recorded 217 SARS-CoV-2-positive patients (2·5%). Most patients (57%) were diagnosed as having SARS-CoV-2 infection during the second peak of the pandemic (September 2020 to January 2021). The majority (35%) was aged between 50 and 65 years with a male prevalence (73%). Fifty-six percent of patients presented concomitant comorbidities. The median time from CML diagnosis to SARS-CoV-2 infection was six years (three months to 18 years). Twenty-one patients (9·6%) required hospitalization without the need of respiratory assistance, 18 (8·2%) were hospitalized for respiratory assistance, 8 (3·6%) were admitted to an intensive care unit, while 170 (78%) were only quarantined. Twenty-three percent of patients discontinued tyrosine kinase inhibitor (TKI) therapy during the infection. Twelve patients died due to COVID-19 with a mortality rate of 5·5% in the positive cohort and of 0·13% in the whole cohort. We could also document sequelae caused by the SARS-CoV-2 infection and an impact of the pandemic on the overall management of CML patients.
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Affiliation(s)
- Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University, Roma, Italy
| | | | - Vincenzo Accurso
- UO di Ematologia con Trapianto, AU Policlinico Paolo Giaccone, Palermo, Italy
| | - Immacolata Attolico
- UO Ematologia con Trapianto, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Sara Barulli
- Divisione di Ematologia di Muraglia, CTMO Ospedale San Salvatore, Pesaro, Italy
| | | | - Gianni Binotto
- Ematologia ed Immunologia Clinica, Università degli Studi di Padova, Padova, Italy
| | - Monica Bocchia
- U.O.C. Ematologia e Trapianti, A.O. Senese - Policlinico 'Le Scotte', Siena, Italy
| | - Massimiliano Bonifacio
- Divisione di Ematologia, Istituti Ospitalieri di Verona, Policlinico G.B. Rossi, Verona, Italy
| | | | | | - Fausto Castagnetti
- Istituto di Ematologia 'Lorenzo e A. Seragnoli', Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | - Elena Crisà
- S.C.D.U. Ematologia - DIMECS e Dipartimento Oncologico, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | | | | | - Chiara Elena
- Ematologia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Carmen Fava
- A.S.O. Ordine Mauriziano, P.O. Umberto I, Struttura Complessa a Direzione Universitaria-Ematologia e Terapie Cellulari, Torino, Italy
| | - Sara Galimberti
- Ematologia, Università di Pisa - Azienda Ospedaliera Pisana, Pisa, Italy
| | - Antonella Gozzini
- Unità di Ricerca e di Malattie del Sangue, Ematologia San Luca Vecchio, Firenze, Italy
| | - Gabriele Gugliotta
- Istituto di Ematologia 'Lorenzo e A. Seragnoli', Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | - Alessandra Iurlo
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | | | | | - Alessandro Lucchesi
- Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - Luigiana Luciano
- Ematologia, Azienda Ospedaliera Universitaria - Università degli Studi di Napoli 'Federico II', Napoli, Italy
| | | | - Debora Luzi
- Ematologia, A.O. Santa Maria - Terni S.C Oncoematologia, Terni, Italy
| | | | | | | | - Patrizia Pregno
- Dipartimento di Oncologia ed Ematologia S.C. Ematologia 2, A.O. Città della Salute e della Scienza di Torino S. G. Battista, Torino, Italy
| | | | - Giovanna Rege-Cambrin
- Dipartimento di Scienze Cliniche e Biologiche, Ospedale S. Luigi Gonzaga-Medicina Interna 2, Orbassano, Italy
| | - Gianantonio Rosti
- Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - Sabina Russo
- Dipartimento di Medicina Interna, Azienda Ospedaliera Universitaria - Policlinico G. Martino, Messina, Italy
| | | | | | - Federica Sorà
- Ematologia, Policlinico Gemelli - Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Fabio Stagno
- Hematology Section and BMT Unit, AOU Policlinico 'Rodolico-San Marco', Catania, Italy
| | | | - Mario Tiribelli
- Clinica Ematologica-Centro Trapianti e Terapie cellulari, Azienda Ospedaliero-Universitaria, Udine, Italy
| | - Robin Foà
- Department of Translational and Precision Medicine, Sapienza University, Roma, Italy
| | - Giuseppe Saglio
- A.S.O. Ordine Mauriziano, Struttura Complessa a Direzione Universitaria-Ematologia e Terapie Cellulari-, P.O. Umberto I, Torino, Italy
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15
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Crisà E, Zallio F, Zacchi G, Cerrano M, Rivolta G, Ferrero D, Deambrogi C, Essa W, Awikeh B, Nicolosi M, Santini V, Gaidano G, Bruno B, Patriarca A. Topic: AS08-Treatment/AS08h-Allogeneic hematopoietic cell transplantation - Bridging to transplantation. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106680.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Clavio M, Crisà E, Miglino M, Guolo F, Ceccarelli M, Salvi F, Allione B, Ferrero D, Balleari E, Finelli C, Poloni A, Selleri C, Danise P, Cilloni D, Di Tucci AA, Cametti G, Freilone R, Fanin R, Bigazzi C, Zambello R, Crugnola M, Oliva EN, Centurioni R, Alesiani F, Catarini M, Castelli A, Abbadessa A, Capalbo SF, Musto P, Angelucci E, Santini V. Overall survival of myelodysplastic syndrome patients after azacitidine discontinuation and applicability of the North American MDS Consortium scoring system in clinical practice. Cancer 2021; 127:2015-2024. [PMID: 33739457 DOI: 10.1002/cncr.33472] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Azacitidine (AZA) is the standard treatment for myelodysplastic syndromes (MDS); however, many patients prematurely stop therapy and have a dismal outcome. METHODS The authors analyzed outcomes after AZA treatment for 402 MDS patients consecutively enrolled in the Italian MDS Registry of the Fondazione Italiana Sindromi Mielodisplastiche, and they evaluated the North American MDS Consortium scoring system in a clinical practice setting. RESULTS At treatment discontinuation, 20.3% of the patients were still responding to AZA, 35.4% of the cases had primary resistance, and 44.3% developed adaptive resistance. Overall survival (OS) was better for patients who discontinued treatment while in response because of planned allogeneic hematopoietic stem cell transplantation (HSCT; median OS, not reached) in comparison with patients with primary resistance (median OS, 4 months) or adaptive resistance (median OS, 5 months) or patients responsive but noncompliant/intolerant to AZA (median OS, 4 months; P = .004). After AZA discontinuation, 309 patients (77%) received best supportive care (BSC), 60 (15%) received active treatments, and 33 (8%) received HSCT. HSCT was associated with a significant survival advantage, regardless of the response to AZA. The North American MDS Consortium scoring system was evaluable in 278 of the 402 cases: patients at high risk had worse OS than patients at low risk (3 and 7 months, respectively; P < .001). The score was predictive of survival both in patients receiving BSC (median OS, 2 months for high-risk patients vs 5 months for low-risk patients) and in patients being actively treated (median OS, 8 months for high-risk patients vs 16 months for low-risk patients; P < .001), including transplant patients. CONCLUSIONS Real-life data confirm that this prognostic scoring system for MDS patients failing a hypomethylating agent seems to be a useful tool for optimal prognostic stratification and for choosing a second-line treatment after AZA discontinuation.
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Affiliation(s)
- Marino Clavio
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- UO Clinic of Hematology, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Elena Crisà
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Ospedale Maggiore della Carità, Novara, Italy
| | - Maurizio Miglino
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- UO Clinic of Hematology, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Fabio Guolo
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- UO Clinic of Hematology, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Manuela Ceccarelli
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- SCDU Epidemiologia dei Tumori, CPO Piemonte, Turin, Italy
| | - Flavia Salvi
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- UO Hematology, SS Antonio e Biagio Hospital, Alessandria, Italy
| | - Bernardino Allione
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Division of Hematology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Dario Ferrero
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Division of Hematology, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
| | - Enrico Balleari
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- UO Internal Medicine, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Carlo Finelli
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- UO Hematology, AOU Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Antonella Poloni
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Hematology, Università Politecnica Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Carmine Selleri
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Hematology and Transplant Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Paolo Danise
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Hematology Laboratory, Umberto I Hospital, Nocera Inferiore, Italy
| | - Daniela Cilloni
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Turin, Italy
| | - Anna Angela Di Tucci
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Divisione di Ematologia, Ospedale Businco, Cagliari, Italy
| | - Gianni Cametti
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Division of Internal Medicine, ASLTO5, Turin, Italy
| | - Roberto Freilone
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Servizio di Oncologia ed Ematologia, Ciriè, Italy
| | - Renato Fanin
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Clinica Ematologia e Trapianto Midollo Osseo, AOU Santa Maria della Misericordia, Udine, Italy
| | - Catia Bigazzi
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- UOC di Ematologia, Ospedale Gen. le Prov. le C. G. Mazzoni, Ascoli Piceno, Italy
| | - Renato Zambello
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Hematology and Clinical Immunology Branch, Department of Medicine, University of Padua, Padua, Italy
| | - Monica Crugnola
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Hematology Unit and BMT Center, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Esther N Oliva
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Hematology Unit, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Riccardo Centurioni
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- UOS di Ematologia, Ospedale di Civitanova Marche, Costamartina, Italy
| | - Francesco Alesiani
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Unità Operativa Semplice di Ematologia, Ospedale di San Severino, San Severino Marche, Italy
| | - Massimo Catarini
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Divisione di Medicina Interna, Ospedale Civile di Macerata, Macerata, Italy
| | - Andrea Castelli
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Division of Hematology, Ospedale degli Infermi, Biella, Italy
| | - Antonio Abbadessa
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Onco-Hematology, AORN S. Anna e S. Sebastiano National Hospital, Caserta, Italy
| | - Silvana F Capalbo
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Hematology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Foggia, Italy
| | - Pellegrino Musto
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Regional Department of Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | - Emanuele Angelucci
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valeria Santini
- Fondazione Italiana Sindromi Mielodisplastiche-ETS, Bologna, Italy
- MDS Unit, AOU Careggi, Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
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17
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Crisà E, Boggione P, Nicolosi M, Mahmoud AM, Al Essa W, Awikeh B, Aspesi A, Andorno A, Boldorini R, Dianzani I, Gaidano G, Patriarca A. Genetic Predisposition to Myelodysplastic Syndromes: A Challenge for Adult Hematologists. Int J Mol Sci 2021; 22:ijms22052525. [PMID: 33802366 PMCID: PMC7959319 DOI: 10.3390/ijms22052525] [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] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/17/2022] Open
Abstract
Myelodysplastic syndromes (MDS) arising in the context of inherited bone marrow failure syndromes (IBMFS) differ in terms of prognosis and treatment strategy compared to MDS occurring in the adult population without an inherited genetic predisposition. The main molecular pathways affected in IBMFS involve telomere maintenance, DNA repair, biogenesis of ribosomes, control of proliferation and others. The increased knowledge on the genes involved in MDS pathogenesis and the wider availability of molecular diagnostic assessment have led to an improvement in the detection of IBMFS genetic predisposition in MDS patients. A punctual recognition of these disorders implies a strict surveillance of the patient in order to detect early signs of progression and promptly offer allogeneic hematopoietic stem cell transplantation, which is the only curative treatment. Moreover, identifying an inherited mutation allows the screening and counseling of family members and directs the choice of donors in case of need for transplantation. Here we provide an overview of the most recent data on MDS with genetic predisposition highlighting the main steps of the diagnostic and therapeutic management. In order to highlight the pitfalls of detecting IBMFS in adults, we report the case of a 27-year-old man affected by MDS with an underlying telomeropathy.
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Affiliation(s)
- Elena Crisà
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (P.B.); (M.N.); (A.M.M.); (W.A.E.); (B.A.); (A.P.)
- Correspondence: (E.C.); (G.G.); Tel.: +39-0321-660-655 (E.C. & G.G.); Fax: +39-0321-373-3095 (E.C.)
| | - Paola Boggione
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (P.B.); (M.N.); (A.M.M.); (W.A.E.); (B.A.); (A.P.)
| | - Maura Nicolosi
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (P.B.); (M.N.); (A.M.M.); (W.A.E.); (B.A.); (A.P.)
| | - Abdurraouf Mokhtar Mahmoud
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (P.B.); (M.N.); (A.M.M.); (W.A.E.); (B.A.); (A.P.)
| | - Wael Al Essa
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (P.B.); (M.N.); (A.M.M.); (W.A.E.); (B.A.); (A.P.)
| | - Bassel Awikeh
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (P.B.); (M.N.); (A.M.M.); (W.A.E.); (B.A.); (A.P.)
| | - Anna Aspesi
- Laboratory of Genetic Pathology, Division of Pathology, Department of Health Sciences, University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (A.A.); (I.D.)
| | - Annalisa Andorno
- Division of Pathology, Department of Health Sciences, University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (A.A.); (R.B.)
| | - Renzo Boldorini
- Division of Pathology, Department of Health Sciences, University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (A.A.); (R.B.)
| | - Irma Dianzani
- Laboratory of Genetic Pathology, Division of Pathology, Department of Health Sciences, University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (A.A.); (I.D.)
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (P.B.); (M.N.); (A.M.M.); (W.A.E.); (B.A.); (A.P.)
- Correspondence: (E.C.); (G.G.); Tel.: +39-0321-660-655 (E.C. & G.G.); Fax: +39-0321-373-3095 (E.C.)
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy; (P.B.); (M.N.); (A.M.M.); (W.A.E.); (B.A.); (A.P.)
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18
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Crisà E, Kulasekararaj AG, Adema V, Such E, Schanz J, Haase D, Shirneshan K, Best S, Mian SA, Kizilors A, Cervera J, Lea N, Ferrero D, Germing U, Hildebrandt B, Martínez ABV, Santini V, Sanz GF, Solé F, Mufti GJ. Impact of somatic mutations in myelodysplastic patients with isolated partial or total loss of chromosome 7. Leukemia 2020; 34:2441-2450. [PMID: 32066866 DOI: 10.1038/s41375-020-0728-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/19/2019] [Accepted: 01/28/2020] [Indexed: 11/09/2022]
Abstract
Monosomy 7 [-7] and/or partial loss of chromosome 7 [del(7q)] are associated with poor and intermediate prognosis, respectively, in myelodysplastic syndromes (MDS), but somatic mutations may also play a key complementary role. We analyzed the impact on the outcomes of deep targeted mutational screening in 280 MDS patients with -7/del(7q) as isolated cytogenetic abnormality (86 with del(7q) and 194 with -7). Patients with del(7q) or -7 had similar demographic and disease-related characteristics. Somatic mutations were detected in 79% (93/117) of patients (82% in -7 and 73% in del(7q) group). Median number of mutations per patient was 2 (range 0-8). There was no difference in mutation frequency between the two groups. Patients harbouring ≥2 mutations had a worse outcome than patients with <2 or no mutations (leukaemic transformation at 24 months, 38% and 20%, respectively, p = 0.044). Untreated patients with del(7q) had better overall survival (OS) compared with -7 (median OS, 34 vs 17 months, p = 0.034). In multivariable analysis, blast count, TP53 mutations and number of mutations were independent predictors of OS, whereas the cytogenetic subgroups did not retain prognostic relevance. This study highlights the importance of mutational analysis in terms of prognosis in MDS patients with isolated -7 or del(7q).
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Affiliation(s)
- Elena Crisà
- Department of Haematological Medicine, King's College Hospital, NHS Foundation Trust, London, UK. .,Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy. .,Fondazione Italiana Sindromi Mielodisplastiche (FISiM), Bologna, Italy.
| | - Austin G Kulasekararaj
- Department of Haematological Medicine, King's College Hospital, NHS Foundation Trust, London, UK
| | - Vera Adema
- Institut de Recerca Contra la Leucèmia Josep Carreras, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Esperanza Such
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Julie Schanz
- Department of Hematology and Medical Oncology, University Medical Center of Göttingen, Göttingen, Germany
| | - Detlef Haase
- Department of Hematology and Medical Oncology, University Medical Center of Göttingen, Göttingen, Germany
| | - Katayoon Shirneshan
- Department of Hematology and Medical Oncology, University Medical Center of Göttingen, Göttingen, Germany
| | - Steven Best
- Laboratory for Molecular Haemato-Oncology, King's College Hospital, NHS Foundation Trust, London, UK
| | - Syed A Mian
- Department of Haematological Medicine, King's College Hospital, NHS Foundation Trust, London, UK.,Haematopoietic Stem Cell Laboratory, The Francis Crick Institute, London, UK
| | - Aytug Kizilors
- Laboratory for Molecular Haemato-Oncology, King's College Hospital, NHS Foundation Trust, London, UK
| | - José Cervera
- Genetics Unit, Hospital Universitario La Fe, Valencia, Spain
| | - Nicholas Lea
- Laboratory for Molecular Haemato-Oncology, King's College Hospital, NHS Foundation Trust, London, UK
| | - Dario Ferrero
- Fondazione Italiana Sindromi Mielodisplastiche (FISiM), Bologna, Italy.,Division of Hematology, University of Torino, AOU Città della Salute e della Scienza, Torino, Italy
| | - Ulrich Germing
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Barbara Hildebrandt
- Institute of Human Genetics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Valeria Santini
- Fondazione Italiana Sindromi Mielodisplastiche (FISiM), Bologna, Italy.,MDS UNIT, AOU Careggi, University of Florence, Firenze, Italy
| | - Guillermo F Sanz
- Department of Hematology, Hospital Universitario La Fe, Valencia, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Francesc Solé
- Institut de Recerca Contra la Leucèmia Josep Carreras, ICO-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ghulam J Mufti
- Department of Haematological Medicine, King's College Hospital, NHS Foundation Trust, London, UK
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19
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Moia R, Boggio E, Gigliotti L, Crisà E, De Paoli L, Margiotta Casaluci G, Rolla R, Patriarca A, Gaidano G, Dianzani U, Bruna R. Anti-rasburicase antibodies induce clinical refractoriness by inhibiting the enzyme catalytic activity. Hematol Oncol 2020; 38:204-206. [PMID: 31985842 DOI: 10.1002/hon.2700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Riccardo Moia
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Ospedale Maggiore della Carità, Novara, Italy
| | - Elena Boggio
- Department of Health Sciences and Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Università del Piemonte Orientale and Ospedale Maggiore della Carità, Novara, Italy
| | - Luca Gigliotti
- Department of Health Sciences and Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Università del Piemonte Orientale and Ospedale Maggiore della Carità, Novara, Italy
| | - Elena Crisà
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Ospedale Maggiore della Carità, Novara, Italy
| | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Ospedale Maggiore della Carità, Novara, Italy
| | - Gloria Margiotta Casaluci
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Ospedale Maggiore della Carità, Novara, Italy
| | - Roberta Rolla
- Department of Health Sciences and Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Università del Piemonte Orientale and Ospedale Maggiore della Carità, Novara, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Ospedale Maggiore della Carità, Novara, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Ospedale Maggiore della Carità, Novara, Italy
| | - Umberto Dianzani
- Department of Health Sciences and Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Università del Piemonte Orientale and Ospedale Maggiore della Carità, Novara, Italy
| | - Riccardo Bruna
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Ospedale Maggiore della Carità, Novara, Italy
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20
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Balleari E, Filiberti RA, Salvetti C, Allione B, Angelucci E, Bruzzone M, Calzamiglia T, Cavaliere M, Cavalleri M, Cilloni D, Clavio M, Crisà E, Da Col A, Danise P, Pilo F, Ferrero D, Finelli C, Gioia D, Lemoli RM, Masiera E, Messa E, Miglino M, Musto P, Natalie Oliva E, Poloni A, Salvi F, Sanna A, Scudeletti M, Tassara R, Santini V. Effects of different doses of erythropoietin in patients with myelodysplastic syndromes: A propensity score-matched analysis. Cancer Med 2019; 8:7567-7576. [PMID: 31657156 PMCID: PMC6912022 DOI: 10.1002/cam4.2638] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/15/2019] [Accepted: 10/05/2019] [Indexed: 11/29/2022] Open
Abstract
Background Erythropoiesis‐stimulating agents effectively improve the hemoglobin levels in a fraction of anemic patients with myelodysplastic syndromes (MDS). Higher doses (HD) of recombinant human erythropoietin (rhEPO) have been proposed to overcome suboptimal response rates observed in MDS patients treated with lower “standard doses” (SD) of rhEPO. However, a direct comparison between the different doses of rhEPO is lacking. Methods A cohort of 104 MDS patients treated with HD was retrospectively compared to 208 patients treated with SD in a propensity score‐matched analysis to evaluate hematological improvement‐erythroid (HI‐E) rate induced by the different doses of rhEPO. The impact of rhEPO doses on survival and progression to leukemia was also investigated. Results Overall HI‐E rate was 52.6%. No difference was observed between different rhEPO doses (P = .28) in matched cohorts; in a subgroup analysis, transfusion‐dependent patients and patients with higher IPSS‐R score obtained a higher HI‐E rate with HD, although without significant impact on overall survival (OS). Achievement of HI‐E resulted in superior OS. At univariate analysis, a higher HI‐E rate was observed in transfusion‐independent patients (P < .001), with a lower IPSS‐R score (P < .001) and lower serum EPO levels (P = .027). Multivariate analysis confirmed that rhEPO doses were not significantly related to HI‐E (P = .26). There was no significant difference in OS or progression to leukemia in patients treated with HD vs SD. Conclusion SD are substantially equally effective to HD to improve anemia and influencing survival in MDS patients stratified according to similar propensity to be exposed to rhEPO treatment.
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Affiliation(s)
- Enrico Balleari
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | | | - Chiara Salvetti
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, University of Turin, Torino, Italy
| | - Bernardino Allione
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Molinette Hospital, Torino, Italy
| | - Emanuele Angelucci
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Marco Bruzzone
- UO Clinical Epidemiology, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Tullio Calzamiglia
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 1, Sanremo (IM), Italy
| | - Marina Cavaliere
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 2, Savona, Italy
| | - Maurizio Cavalleri
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 4, Sestri Levante (GE), Italy
| | - Daniela Cilloni
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Marino Clavio
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Clinic of Hematology, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Elena Crisà
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, University of Turin, Torino, Italy
| | - Anna Da Col
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Paolo Danise
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Nocera Hospital, Nocera Inferiore, Italy
| | - Federica Pilo
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology-P.O. Oncologico Businco AOG. Brotzu, Cagliari, Italy
| | - Dario Ferrero
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, University of Turin, Torino, Italy
| | - Carlo Finelli
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, AOU Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Daniela Gioia
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy
| | - Roberto Massimo Lemoli
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Clinic of Hematology, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Elisa Masiera
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy
| | - Emanuela Messa
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine, ASLTo4, Carmagnola, Italy
| | - Maurizio Miglino
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Clinic of Hematology, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino-IRCCS, Genova, Italy
| | - Pellegrino Musto
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,Regional Department of Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy
| | - Esther Natalie Oliva
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Grande Ospedale Metropolitano "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - Antonella Poloni
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, Università Politecnica delle Marche, Ancona, Italy
| | - Flavia Salvi
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Hematology, SS. Antonio e Biagio Hospital, Alessandria, Italy
| | - Alessandro Sanna
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,Ematologia, Ospedale di Livorno, Livorno, Italy
| | - Marco Scudeletti
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 4, Sestri Levante (GE), Italy
| | - Rodolfo Tassara
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,UO Internal Medicine-ASL 2, Savona, Italy
| | - Valeria Santini
- Fondazione Italiana Sindromi Mielodisplastiche (FISM), Bologna, Italy.,MDS Unit, AOU Careggi, University of Florence, Firenze, Italy
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21
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Kizilors A, Crisà E, Lea N, Passera R, Mian S, Anwar J, Best S, Nicolini FE, Ireland R, Aldouri M, Pocock C, Corbett T, Gale R, Bart-Smith E, Weston-Smith S, Wykes C, Kulasekararaj A, Jackson S, Harrington P, McLornan D, Raj K, Pagliuca A, Mufti GJ, de Lavallade H. Effect of low-level BCR-ABL1 kinase domain mutations identified by next-generation sequencing in patients with chronic myeloid leukaemia: a population-based study. Lancet Haematol 2019; 6:e276-e284. [PMID: 31036317 DOI: 10.1016/s2352-3026(19)30027-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Kinase domain mutations in BCR-ABL1 are associated with resistance to tyrosine kinase inhibitors in patients with chronic myeloid leukaemia. Next-generation sequencing (NGS) allows detection of low-level kinase domain mutations, but its relevance in clinical practice remains debated. We aimed to examine the clinical effects of low-level kinase domain mutations identified using NGS in patients with chronic myeloid leukaemia. METHODS In this population-based study, we included consecutive patients newly diagnosed with chronic myeloid leukaemia treated with first-line tyrosine kinase inhibitors, and patients identified at the time of resistance to first-line treatment with imatinib at six institutions (teaching hospitals and district hospitals) in southeast England. We screened patients for BCR-ABL1 kinase domain mutations using NGS, irrespective of patient response to tyrosine kinase inhibitor therapy. When we detected a mutation with NGS, we retrospectively analysed all previous samples to establish the date of first occurrence and subsequent kinetics of the mutant subclone (or subclones). The primary endpoints of this study were progression-free and event-free survival at 5 years. FINDINGS Between Feb 1, 2007, and Dec 31, 2014, we screened 121 patients with chronic myeloid leukaemia for BCR-ABL1 kinase domain mutation. 99 consecutive patients were newly diagnosed, with available sequential RNA stored. The remaining 22 patients were diagnosed between June 1, 1999, and June 30, 2006, and were screened at the time of resistance to first-line treatment with imatinib. Imatinib was the first-line treatment for 111 patients, nilotinib for seven patients, and dasatinib for three patients. We detected a kinase domain mutation in 25 (21%) of 121 patients. Low-level kinase domain mutations were first identified in 17 (68%) of 25 patients with mutation. For patients with a complete cytogenetic response, 13 (14%) of 93 patients screened had a mutation. Five (71%) of the seven patients with a clinically relevant mutation lost complete cytogenetic response compared with 15 (17%) of 86 patients without a clinically relevant mutation (80 patients without mutation and six patients with a tyrosine kinase inhibitor-sensitive mutation, p=0·0031). Patients harbouring a mutant clone had poorer 5-year progression-free survival (65·3% [95% CI 40·5-81·8] vs 86·9% [75·8-93·2]; p=0·0161) and poorer 5-year event-free survival (22·2% [CI 5·6-45·9] vs 62·0% [50·4-71·6]; p<0·0001) than did patients without a mutation. We identified a kinase domain mutation in four (10%) of 41 patients with samples available at 3 months after starting first-line tyrosine kinase inhibitor treatment; all four subsequently progressed to accelerated phase disease compared with only three (8%) of 37 without a mutation (p<0·0001). INTERPRETATION NGS reliably and consistently detected early appearance of kinase domain mutations that would not otherwise be detected by Sanger sequencing. For the first time, to our knowledge, we report the presence of kinase domain mutations after only 3 months of therapy, which could have substantial clinical implications. NGS will allow early clinical intervention and our findings will contribute to the establishment of new recommendations on the frequency of kinase domain mutation analysis to improve patient clinical care. FUNDING None.
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Affiliation(s)
- Aytug Kizilors
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Haematological Medicine, King's College London School of Medicine, London, UK
| | - Elena Crisà
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Haematological Medicine, King's College London School of Medicine, London, UK; Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Nicholas Lea
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Haematological Medicine, King's College London School of Medicine, London, UK
| | - Roberto Passera
- Nuclear Medicine Division, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Syed Mian
- Department of Haematological Medicine, King's College London School of Medicine, London, UK
| | - Jamal Anwar
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Steve Best
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Robin Ireland
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Haematological Medicine, King's College London School of Medicine, London, UK
| | - Maadh Aldouri
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Haematology, Medway Maritime Hospital, Gillingham, UK
| | | | - Tim Corbett
- Department of Haematology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Richard Gale
- Department of Haematology, Maidstone and Tunbridge Wells Hospitals, Maidstone, UK
| | - Emily Bart-Smith
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Simon Weston-Smith
- Department of Haematology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Clare Wykes
- Department of Haematology, Maidstone and Tunbridge Wells Hospitals, Maidstone, UK
| | - Austin Kulasekararaj
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Haematological Medicine, King's College London School of Medicine, London, UK
| | - Sophie Jackson
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Patrick Harrington
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Haematological Medicine, King's College London School of Medicine, London, UK
| | - Donal McLornan
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Haematological Medicine, King's College London School of Medicine, London, UK
| | - Kavita Raj
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Haematological Medicine, King's College London School of Medicine, London, UK
| | - Antonio Pagliuca
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Haematological Medicine, King's College London School of Medicine, London, UK
| | - Ghulam J Mufti
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Haematological Medicine, King's College London School of Medicine, London, UK
| | - Hugues de Lavallade
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; Department of Haematological Medicine, King's College London School of Medicine, London, UK.
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22
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Cerrano M, Candoni A, Crisà E, Dubbini MV, D'Ardia S, Zannier ME, Boccadoro M, Audisio E, Bruno B, Ferrero D. FLAI induction regimen in elderly patients with acute myeloid leukemia. Leuk Lymphoma 2019; 60:3339-3340. [PMID: 31159609 DOI: 10.1080/10428194.2019.1620943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Marco Cerrano
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy.,Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Anna Candoni
- Division of Hematology and SCT, University of Udine, Udine, Italy
| | - Elena Crisà
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy.,Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Stefano D'Ardia
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Mario Boccadoro
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy.,Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ernesta Audisio
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy.,Department of Oncology, SSD Trapianto Allogenico, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Dario Ferrero
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy.,Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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23
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Pugliese N, Giordano C, Nappi D, Luciano L, Cerchione C, Annunziata M, Casale B, Crisà E, Villa MR, Pezzullo L, Iovine M, Picardi M, Grimaldi F, Pane F, Martinelli V. Adding hydroxyurea in combination with ruxolitinib improves clinical responses in hyperproliferative forms of myelofibrosis. Cancer Med 2019; 8:2802-2809. [PMID: 30997748 PMCID: PMC6558489 DOI: 10.1002/cam4.2147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 09/12/2018] [Revised: 02/11/2019] [Accepted: 03/20/2019] [Indexed: 12/21/2022] Open
Abstract
Ruxolitinib, an orally bioavailable and selective inhibitor of Janus kinase 1 (JAK1) and JAK2, significantly reduces splenomegaly and disease‐related symptoms in patients with myelofibrosis (MF). However, no clear survival benefit has been demonstrated, which may in part reflect suboptimal drug exposure related to lower dosages needed to minimize hematological toxicity, specifically cytopenias. Furthermore, the optimal management of specific conditions such as leukocytosis or thrombocytosis in patients under ruxolitinib therapy is still undefined. In these cases, combining ruxolitinib with a cytoreductive agent like hydroxyurea might improve hematological response. This observational multi‐center study enrolled 20 adult patients with intermediate‐ or high‐risk primary MF, post‐ polycythemia vera MF, or postessential thrombocythemia MF with hyperproliferative manifestations of the disease and WBC and/or platelet counts not controlled by ruxolitinib therapy. The patients received treatment with a combination of ruxolitinib and hydroxyurea. A clinical response of any type was obtained in 8 patients (40%) during ruxolitinib monotherapy and in 17 patients (85%) during ruxolitinib‐hydroxyurea combination (P = 0.003). After a median duration of 12.4 months of combination therapy, 16/20 patients had a hematological response; 14/17 patients who had started combination therapy to control WBC count and 2/3 who started in order to reduce platelets count. The number of patients requiring ruxolitinib dosage reduction or discontinuations was lower during combination therapy and, at the end of follow‐up the median ruxolitinib dose was increased in 50% of patients. In conclusion, the combination of hydroxyurea with ruxolitinib yielded a high clinical response rate and increased ruxolitinib exposure in patients with hyperproliferative forms of MF.
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Affiliation(s)
- Novella Pugliese
- Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Claudia Giordano
- Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Davide Nappi
- Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Luigiana Luciano
- Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Claudio Cerchione
- Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy.,Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Mario Annunziata
- Hematology Unit, A.O.R.N. Antonio Cardarelli Hospital, Naples, Italy
| | - Beniamino Casale
- Hematology Unit, AO Ospedali dei Colli Napoli, PO Monaldi, Naples, Italy
| | - Elena Crisà
- Hematology Division, Università degli Studi di Torino, Turin, Italy
| | | | - Luca Pezzullo
- Hematology and Hematopoietic Stem Cell Transplant Center, A.U.O. San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Maria Iovine
- Hematology Unit, AORN Sant'Anna e San Sebastiano Caserta, Caserta, Italy
| | - Marco Picardi
- Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Francesco Grimaldi
- Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Fabrizio Pane
- Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Vincenzo Martinelli
- Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
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24
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Crisà E, Cilloni D, Elli EM, Martinelli V, Palumbo GA, Pugliese N, Beggiato E, Frairia C, Cerrano M, Lanzarone G, Marchetti M, Mezzabotta M, Boccadoro M, Ferrero D. The use of erythropoiesis-stimulating agents is safe and effective in the management of anaemia in myelofibrosis patients treated with ruxolitinib. Br J Haematol 2018; 182:701-704. [DOI: 10.1111/bjh.15450] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Elena Crisà
- Haematology Division; A.O.U. Città della Salute e della Scienza di Torino; University of Turin; Torino Italy
| | - Daniela Cilloni
- Haematology Division; Department of Clinical and Biological Sciences; Ospedale San Luigi di Orbassano; University of Turin; Orbassano Italy
| | - Elena M. Elli
- Haematology Division; Ospedale San Gerardo; ASST Monza; Monza Italy
| | | | - Giuseppe A. Palumbo
- Haematology Division; A.O.U. Policlinico-V.Emanuele; University of Catania; Catania Italy
| | | | - Eloise Beggiato
- Haematology Division; A.O.U. Città della Salute e della Scienza di Torino; University of Turin; Torino Italy
| | - Chiara Frairia
- Haematology Division; Department of Translational Medicine; Azienda Ospedaliero-Universitaria Maggiore della Carita; Novara Italy
| | - Marco Cerrano
- Haematology Division; A.O.U. Città della Salute e della Scienza di Torino; University of Turin; Torino Italy
| | - Giuseppe Lanzarone
- Haematology Division; A.O.U. Città della Salute e della Scienza di Torino; University of Turin; Torino Italy
| | | | - Mauro Mezzabotta
- Haematology Division; Ordine Mauriziano - Ospedale Umberto I; Torino Italy
| | - Mario Boccadoro
- Haematology Division; A.O.U. Città della Salute e della Scienza di Torino; University of Turin; Torino Italy
| | - Dario Ferrero
- Haematology Division; A.O.U. Città della Salute e della Scienza di Torino; University of Turin; Torino Italy
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25
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Brunello L, Passera R, Dellacasa CM, Giaccone L, Audisio E, Ferrero D, D'Ardia S, Allione B, Aydin S, Festuccia M, Lia G, Crisà E, Maffini E, Butera S, Busca A, Bruno B. Haplo-identical allografting with post-transplant cyclophosphamide in high-risk patients. Ann Hematol 2018; 97:2205-2215. [PMID: 29987350 DOI: 10.1007/s00277-018-3433-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 07/03/2018] [Indexed: 12/19/2022]
Abstract
Haplo-identical transplants (Haplo-Tx) are an important alternative for patients with hematological malignancies who lack a HLA-identical donor. Seventy-one T-replete Haplo-Tx were performed in 70 high-risk patients at our center; 22/70 (31%) patients with refractory/relapsed leukemia received sequential salvage therapy (SeqTh) with high-dose chemotherapy followed by Haplo-Tx during the chemotherapy-induced neutropenia. Graft-versus-host disease (GVHD) prophylaxis consisted of post-transplant cyclophosphamide (days + 3 and + 4) with tacrolimus and mycophenolic acid. After a median follow-up of 29.2 months, 3-year overall survival (OS) and event-free survival (EFS) were 43.8 and 40.2%, while 3-year cumulative incidences (CIs) of non-relapse mortality (NRM) and relapse (RI) were 27 and 33%. Day 100 and day 400 CI of grade III-IV acute and moderate-severe chronic GVHD were 11 and 15%. Three-year RI was significantly lower in patients in complete remission (CR) versus those not in CR at the time of transplant (21.5 vs. 48%, p = 0.009) and in patients who received PBSC as compared to BM (22 vs. 45%, p = 0.009). In patients treated with SeqTh, 3-year OS was 19%, while 3-year RI and NRM were 52 and 28% at a median follow-up of 50 months. Overall, Haplo-Tx was feasible in heavily pretreated high-risk patients without a suitable HLA-identical donor.
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Affiliation(s)
- Lucia Brunello
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Roberto Passera
- Division of Nuclear Medicine, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Maria Dellacasa
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
| | - Luisa Giaccone
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Ernesta Audisio
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Dario Ferrero
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
- Department of Oncology, Division of Hematology Univ., Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stefano D'Ardia
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Bernardino Allione
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Semra Aydin
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Moreno Festuccia
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Giuseppe Lia
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Elena Crisà
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
- Department of Oncology, Division of Hematology Univ., Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Enrico Maffini
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Sara Butera
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Alessandro Busca
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
| | - Benedetto Bruno
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy.
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.
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26
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Buckstein R, Balleari E, Wells R, Santini V, Sanna A, Salvetti C, Crisà E, Allione B, Danise P, Finelli C, Clavio M, Poloni A, Salvi F, Cilloni D, Oliva EN, Musto P, Houston B, Zhu N, Geddes M, Leitch H, Leber B, Sabloff M, Nevill TJ, Yee KW, Storring JM, Francis J, Maurillo L, Latagliata R, Spiriti MAA, Andriani A, Piccioni AL, Fianchi L, Fenu S, Gumenyuk S, Buccisano F. ITACA: A new validated international erythropoietic stimulating agent-response score that further refines the predictive power of previous scoring systems. Am J Hematol 2017; 92:1037-1046. [PMID: 28675513 DOI: 10.1002/ajh.24842] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND In 'real-life', the Nordic score guides Erythropoietic stimulating agent (ESA) use in lower-risk myelodysplastic syndrome (MDS) with predicted response rates of 25% or 74%. As new treatments emerge, a more discriminating score is needed. OBJECTIVES To validate existing ESA predictive scores and develop a new score that identifies non-responders. METHODS ESA-treated patients were identified in 3 MDS registries in Italy and Canada (FISM 555, GROM 233, and MDS-CAN 208). Clinical and disease-related variables were captured. Nordic, MDS-CAN, and IPSS-R-based ESA scores were calculated and documented ESA responses compared. RESULTS 996 ESA-treated patients were identified. Overall response rate (ORR) was 59%. The database was randomly divided into balanced derivation (n = 463) and validation (n = 462) cohorts. By multivariate analysis, transfusion independence, erythropoietin (EPO) level <100 IU/L, and IPSS low-risk were independently predictive of response. Assigning a score of 1 to each resulted in a scoring system of 0-3 with response rates of 23%, 43%, 67%, and 85%. ORR was concordant in the validation cohort. The 'ITACA' score had the highest discriminating power of response. CONCLUSION ITACA is an internally-validated predictive SS of ESA response in real-life 'good risk' MDS patients derived from a large international dataset that surpasses others. The incorporation of biologic markers to better identify non-responders is still needed.
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Affiliation(s)
- Rena Buckstein
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Enrico Balleari
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Richard Wells
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Valeria Santini
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Alessandro Sanna
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Chiara Salvetti
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Elena Crisà
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Bernardino Allione
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Paolo Danise
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Carlo Finelli
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Marino Clavio
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Antonella Poloni
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Flavia Salvi
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Daniela Cilloni
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Esther Natalie Oliva
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Pellegrino Musto
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Brett Houston
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Nancy Zhu
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Michelle Geddes
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Heather Leitch
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Brian Leber
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Mitchell Sabloff
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Thomas J. Nevill
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Karen W. Yee
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - John M. Storring
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Janika Francis
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Luca Maurillo
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Roberto Latagliata
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | | | - Alessandro Andriani
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Anna Lina Piccioni
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Luana Fianchi
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Susanna Fenu
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
| | - Svitlana Gumenyuk
- Hematology and Stem Cell Unit Regina Elena National Cancer Institute; Rome Italy
| | - Francesco Buccisano
- Odette Cancer Centre, Sunnybrook Health Sciences, 2075 Bayview Ave; Toronto Ontario 4N3M5 Canada
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27
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Crisà E, Cerrano M, Beggiato E, Benevolo G, Lanzarone G, Manzini PM, Borchiellini A, Riera L, Boccadoro M, Ferrero D. Can pegylated interferon improve the outcome of polycythemia vera patients? J Hematol Oncol 2017; 10:15. [PMID: 28086927 PMCID: PMC5237341 DOI: 10.1186/s13045-017-0395-1] [Citation(s) in RCA: 12] [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: 10/22/2016] [Accepted: 01/06/2017] [Indexed: 11/10/2022] Open
Abstract
Pegylated interferon (peg-IFN) was proven by phase II trials to be effective in polycythemia vera (PV); however, it is not clear whether it could improve patient outcome compared to hydroxyurea (HU). Here, we present an observational study on 65 PV patients aged 65 years or younger, who received either peg-IFN (30) or HU (35) according to the physician choice. Median follow-up was 75 months. The two cohorts were comparable for patient and disease characteristics. Eighty-seven percent of the patients treated with peg-INF responded, with a CR rate of 70% as compared to 100 and 49% with HU, respectively. Discontinuation rate was similar in the two groups (20% in peg-IFN vs 17% in HU). JAK2 allele burden was monitored in peg-INF arm only, and a reduction was observed in 88% of the patients. No thrombotic events were observed during peg-IFN treatment compared to three on HU. Disease progression to myelofibrosis or acute myeloid leukemia occurred to a patient only in peg-INF, compared to three in HU. Overall, three second malignancies were observed during the study, two in patients who received HU only, and one in a patient largely treated HU who received also peg-IFN for 3 months. Overall survival was significantly better for peg-IFN patients compared to HU, p = 0.027. Our study, albeit limited by small patient and event number and lack of randomization, confirms the efficacy of peg-INF in PV and shows a significant survival advantage for peg-INF-treated patients. Waiting for confirming data from the ongoing phase III trials, our study can support peg-INF as a first-line treatment option for PV, at least for younger patients.
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Affiliation(s)
- Elena Crisà
- Hematology Division, Università degli Studi di Torino, Via Genova 3, 10126, Turin, Italy
| | - Marco Cerrano
- Hematology Division, Università degli Studi di Torino, Via Genova 3, 10126, Turin, Italy.
| | - Eloise Beggiato
- Hematology Division, Università degli Studi di Torino, Via Genova 3, 10126, Turin, Italy
| | - Giulia Benevolo
- S.C. Hematology, A.O. Città della Salute e della Scienza, Turin, Italy
| | - Giuseppe Lanzarone
- Hematology Division, Università degli Studi di Torino, Via Genova 3, 10126, Turin, Italy
| | - Paola Maria Manzini
- Transfusion Medicine Unit, A.O. Città della Salute e della Scienza, Turin, Italy
| | | | - Ludovica Riera
- Section of Pathology, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin, Italy
| | - Mario Boccadoro
- Hematology Division, Università degli Studi di Torino, Via Genova 3, 10126, Turin, Italy
| | - Dario Ferrero
- Hematology Division, Università degli Studi di Torino, Via Genova 3, 10126, Turin, Italy
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28
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Cerrano M, Crisà E, Gottardi E, Aguzzi C, Boccadoro M, Ferrero D. Long-term therapy-free remission in a patient with platelet-derived growth factor receptor beta-rearranged myeloproliferative neoplasm. Am J Hematol 2016; 91:E353. [PMID: 27194679 DOI: 10.1002/ajh.24422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Marco Cerrano
- Hematology Division, Università Degli Studi Di Torino, Turin, Italy
| | - Elena Crisà
- Hematology Division, Università Degli Studi Di Torino, Turin, Italy
| | - Enrico Gottardi
- AOU San Luigi Gonzaga, SCDU Internal Medicine II, Orbassano, Italy
| | - Chiara Aguzzi
- Hematology Division, Università Degli Studi Di Torino, Turin, Italy
| | - Mario Boccadoro
- Hematology Division, Università Degli Studi Di Torino, Turin, Italy
| | - Dario Ferrero
- Hematology Division, Università Degli Studi Di Torino, Turin, Italy
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Ferrero D, Cerrano M, Crisà E, Aguzzi C, Giai V, Boccadoro M. How many patients can proceed from chronic myeloid leukaemia diagnosis to deep molecular response and long-lasting imatinib discontinuation? A real life experience. Br J Haematol 2016; 176:669-671. [PMID: 26914729 DOI: 10.1111/bjh.13983] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Dario Ferrero
- Haematology Division, Università degli Studi di Torino, Turin, Italy
| | - Marco Cerrano
- Haematology Division, Università degli Studi di Torino, Turin, Italy
| | - Elena Crisà
- Haematology Division, Università degli Studi di Torino, Turin, Italy
| | - Chiara Aguzzi
- Haematology Division, Università degli Studi di Torino, Turin, Italy
| | - Valentina Giai
- Haematology Division, Università degli Studi di Torino, Turin, Italy
| | - Mario Boccadoro
- Haematology Division, Università degli Studi di Torino, Turin, Italy
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30
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Giaccone L, Audisio E, Bruno B, Maffini E, D'Ardia S, Caracciolo D, Ferrando F, Butera S, Brunello L, Frairia C, Aydin S, Nicolino B, Festuccia M, Crisà E, Bruna R, Passera R, Boccadoro M, Vitolo U, Busca A, Falda M, Marmont F. Role of Chemotherapy and Allografting in the Treatment of Acute Lymphoblastic Leukemia. Clin Lymphoma Myeloma Leuk 2015; 16:96-103. [PMID: 26711180 DOI: 10.1016/j.clml.2015.11.002] [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] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/26/2015] [Accepted: 11/11/2015] [Indexed: 11/29/2022]
Abstract
We report the clinical outcomes of 83 patients with acute lymphoblastic leukemia (median age, 46 years; range, 18-75 years) treated at our institution between 1999 and 2011. Treatment refers to clinical trials open for accrual at the time of diagnosis or to institutional guidelines. Upfront allografting was considered for younger high-risk patients. Seventy-eight of 83 (94%) patients achieved complete remission after induction, although 53% of them eventually relapsed. Forty of 70 patients younger than 61 years underwent allografting. The median follow-up was 7.4 years (range, 0.2-15.0 years). Overall, the 5-year overall survival (OS) and event-free survival (EFS) were 40% and 39%, respectively. In patients undergoing transplantation, OS and EFS at 5 years were both 53%, whereas in a nontransplantation setting, both OS and EFS were 35% at 5 years (P = .044 for both OS and EFS). By multivariate analysis, the independent predictors of OS and EFS were age and leukocytosis in the overall population and allografting in young patients.
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Affiliation(s)
- Luisa Giaccone
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy; Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, Scuola di Medicina, Torino, Italy.
| | - Ernesta Audisio
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Benedetto Bruno
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy; Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, Scuola di Medicina, Torino, Italy
| | - Enrico Maffini
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stefano D'Ardia
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniele Caracciolo
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Federica Ferrando
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Sara Butera
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lucia Brunello
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Frairia
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Semra Aydin
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Barbara Nicolino
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Moreno Festuccia
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Elena Crisà
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Riccardo Bruna
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, Scuola di Medicina, Torino, Italy
| | - Roberto Passera
- Divisione di Medicina Nucleare 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mario Boccadoro
- Ematologia 1, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Umberto Vitolo
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandro Busca
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Michele Falda
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Filippo Marmont
- Ematologia 2, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
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Breccia M, Luciano L, Latagliata R, Castagnetti F, Ferrero D, Cavazzini F, Trawinska MM, Annunziata M, Stagno F, Tiribelli M, Binotto G, Crisà E, Musto P, Gozzini A, Cavalli L, Montefusco E, Iurlo A, Russo S, Cedrone M, Rossi AR, Pregno P, Endri M, Spadea A, Molica M, Giglio G, Celesti F, Sorà F, Storti S, D'Addosio A, Cambrin GR, Isidori A, Sica S, Abruzzese E, Speccha G, Rosti G, Alimena G. Age influences initial dose and compliance to imatinib in chronic myeloid leukemia elderly patients but concomitant comorbidities appear to influence overall and event-free survival. Leuk Res 2014; 38:1173-6. [PMID: 25047978 DOI: 10.1016/j.leukres.2014.06.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 04/12/2014] [Revised: 06/15/2014] [Accepted: 06/28/2014] [Indexed: 11/28/2022]
Abstract
We applied Charlson comorbidity index (CCI) stratification on a large cohort of chronic myeloid leukemia (CML) very elderly patients (>75 years) treated with imatinib, in order to observe the impact of concomitant diseases on both compliance and outcome. One hundred and eighty-one patients were recruited by 21 Italian centers. There were 95 males and 86 females, median age 78.6 years (range 75-93.6). According to Sokal score, 106 patients were classified as intermediate risk and 55 as high risk (not available in 20 patients). According to CCI stratification, 71 patients had score 0 and 110 a score ≥ 1. Imatinib standard dose was reduced at start of therapy (200-300 mg/day) in 68 patients independently from the evaluation of baseline comorbidities, but based only on physician judgement: 43.6% of these patients had score 0 compared to 34% of patients who had score ≥ 1. Significant differences were found in terms of subsequent dose reduction (39% of patients with score 0 compared to 53% of patients with score ≥ 1) and in terms of drug discontinuation due to toxicity (35% of patients with score 0 vs 65% of patients with score ≥ 1). We did not find significant differences as regards occurrence of hematologic side effects, probably as a consequence of the initial dose reduction: 39% of patients with score 0 experienced grade 3/4 hematologic toxicity (most commonly anemia) compared to 42% of patients with score ≥ 1. Independently from the initial dose, comorbidities again did not have an impact on development of grade 3/4 non-hematologic side effects (most commonly skin rash, muscle cramps and fluid retention): 62% of patients with score 0 compared to 52.5% of patients with score ≥ 1. Notwithstanding the reduced dose and the weight of comorbidities we did not find significant differences but only a trend in terms of efficacy: 66% of patients with score 0 achieved a CCyR compared to 54% of patients with score ≥ 1. Comorbidities appeared to have an impact on median OS (40.8 months for patients with score 0 vs 20.16 months for patients with score ≥ 1) on EFS and on non-CML death rate. Our results suggest that treatment of very elderly CML patients might be influenced by personal physician perception: evaluation at baseline of comorbidities according to CCI should improve initial decision-making in this subset of patients.
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Affiliation(s)
- Massimo Breccia
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Via Benevento 6, Roma 00161, Italy.
| | | | - Roberto Latagliata
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Via Benevento 6, Roma 00161, Italy
| | | | | | | | | | | | | | | | | | - Elena Crisà
- Ematologia, Università di Torino, Torino, Italy
| | - Pellegrino Musto
- Dipartimento Onco-Ematologico, IRCCS-CROB, Rionero in Vulture, Italy
| | | | | | | | - Alessandra Iurlo
- UOC Oncoematologia, Fondazione IRCSS Cà Granda Policlinico Milano, Milan, Italy
| | - Sabina Russo
- Ematologia, Università di Messina, Messina, Italy
| | | | | | | | - Mauro Endri
- Ematologia, Centro Trapianti Cremona, Cremona, Italy
| | | | - Matteo Molica
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Via Benevento 6, Roma 00161, Italy
| | | | | | - Federica Sorà
- Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sergio Storti
- Onco-Ematologia, Università Cattolica Giovanni Paolo II, Campobasso, Italy
| | | | | | | | - Simona Sica
- Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | | | - Giuliana Alimena
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Via Benevento 6, Roma 00161, Italy
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Ferrero D, Crisà E, Marmont F, Audisio E, Frairia C, Giai V, Gatti T, Festuccia M, Bruno B, Riera L, Passera R, Boccadoro M. Survival improvement of poor-prognosis AML/MDS patients by maintenance treatment with low-dose chemotherapy and differentiating agents. Ann Hematol 2014; 93:1391-400. [PMID: 24705888 DOI: 10.1007/s00277-014-2047-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/27/2014] [Indexed: 12/22/2022]
Abstract
We evaluated a maintenance, post-remission treatment with low-dose chemotherapy plus differentiating agents on poor-prognosis acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) patients ineligible to allografting. Patients had either age over 60 and/or secondary AML, therapy-related AML, previous relapse, high-risk MDS. Forty-five patients received the maintenance therapy based on two alternated schedules: (a) 6-thioguanine + 13-cis retinoic acid + dihydroxylated vitamin D3 and (b) low-dose cytarabine + 6-mercaptopurine + all-trans retinoic acid + dihydroxylated vitamin D3. We compared their outcome, at a median follow-up of 52 months, to that of a matched population of 49 patients who stopped treatments after consolidation. Maintenance group had a lower relapse incidence (70.3 vs. 86.4 % at 5 years p = 0.007) and a longer disease-free survival (median 21.2 vs. 8.7 months, p = 0.017). The relapse reduction improved overall survival: median 40.4 months (35.9 % at 5 years) for maintenance group vs. 15.8 (14.2 % at 5 years) for controls (p = 0.005). At multivariate Cox analysis, both cytogenetic and maintenance therapies resulted independent outcome predictors for overall survival. Maintenance treatment also reduced minimal residual disease (detected by WT1 and CBFβ-MYH11) in five of eight evaluable patients. The present results suggest that our strategy of maintenance therapy might improve the outcome of poor-risk AML/MDS patients.
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Affiliation(s)
- Dario Ferrero
- Section of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Turin, via Genova, 3, 10126, Turin, Italy,
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33
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Cerrano M, Crisà E, Pregno P, Aguzzi C, Riccomagno P, Boccadoro M, Ferrero D. Excellent therapeutic results achieved in chronic myeloid leukemia patients with front-line imatinib and early treatment modifications in suboptimal responders: a retrospective study on 91 unselected patients. Am J Hematol 2013; 88:838-42. [PMID: 23757199 DOI: 10.1002/ajh.23501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 05/27/2013] [Accepted: 05/28/2013] [Indexed: 12/15/2022]
Abstract
Second generation tyrosine kinase-inhibitors (TKI) have been claimed to represent now the first-choice therapy for chronic myeloid leukemia (CML). Indeed, they generally induce faster and deeper molecular responses compared to imatinib that, however, is equally effective in at least 50% of patients. Moreover, some recent reports have questioned the long term safety of dasatinib and nilotinib. Therefore, upfront imatinib with early shift to second generation TKI for patients with slow/incomplete response might be as effective as front-line second generation TKI, with a possibly better safety profile. We retrospectively evaluated 91 chronic phase CML patients (median follow-up 57 months, median age 61 years), treated front-line with standard-dose imatinib and early therapy modifications (at 3-12 months) in case of unsatisfactory response or intolerance. Thirty-three patients (24 with unsatisfactory response, 9 intolerant) changed therapy, either by increasing imatinib dose (11/91) or by switching to second generation TKI (22 directly, 4 after high-dose imatinib). Globally, our strategy led to complete cytogenetic response (CCyR) in 98% of the patients, major molecular response (MMR) in 88% and molecular response 4 logs (MR(4.0) ) in 62%. Three patients in CCyR (3%), 2 of them in MMR too, suddenly progressed to blastic phase. At the last follow-up nine patients had died, seven of CML-unrelated causes and two only of CML progression. These results suggest that our strategy could be as effective as front line second generation TKI, with most of patients still receiving imatinib, a drug of better known long-term side effects and lower cost.
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Affiliation(s)
- Marco Cerrano
- Hematology Division; Università degli Studi di Torino; Turin Italy
| | - Elena Crisà
- Hematology Division; Università degli Studi di Torino; Turin Italy
| | - Patrizia Pregno
- Hematology Division; Azienda Ospedaliera Città della Salute e della Scienza; Turin Italy
| | - Chiara Aguzzi
- Hematology Division; Università degli Studi di Torino; Turin Italy
| | - Paola Riccomagno
- Hematology Division; Azienda Ospedaliera Città della Salute e della Scienza; Turin Italy
| | - Mario Boccadoro
- Hematology Division; Università degli Studi di Torino; Turin Italy
| | - Dario Ferrero
- Hematology Division; Università degli Studi di Torino; Turin Italy
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34
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Messa E, Gioia D, Masiera E, Allione B, Balleari E, Bonferroni M, Cametti G, Crisà E, Cilloni D, Danise P, Del Corso L, Ferrero D, Freilone R, Gaidano G, Lunghi M, Musto P, Pappano S, Pellizzari A, Poloni A, Santini V, Salvi F, Tassara R, Saglio G, Levis A. O-020 Erythropoietin alpha therapy in 1110 lower-risk MDS patients: A real life survey from the network of regional Italian MDS Registries. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lobetti-Bodoni C, Ferrero D, Genuardi E, Passera R, Bernocco E, Sia D, Grignani G, Crisà E, Monitillo L, Rocci A, Drandi D, Giai V, Zanni M, Boi M, Isaia G, Barbero D, Lunghi M, Abruzzese E, Radaelli F, Pini M, Pregno P, Carlo-Stella C, Gaidano G, Boccadoro M, Ladetto M. Telomere loss in Philadelphia-negative hematopoiesis after successful treatment of chronic myeloid leukemia: evidence for premature aging of the myeloid compartment. Mech Ageing Dev 2012; 133:479-88. [PMID: 22687638 DOI: 10.1016/j.mad.2012.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/11/2012] [Accepted: 05/29/2012] [Indexed: 01/08/2023]
Abstract
Telomere shortening, a well-known marker of aging and cellular stress, occurs under several conditions in the hematopoietic compartment, including aplastic anemia and following iatrogenic noxae. We decided to verify whether pathological telomere erosion also arises in restored Philadelphia-negative (Ph-negative) hematopoiesis following successful treatment of chronic myeloid leukemia (CML). Eighty-one CML patients in complete cytogenetic remission were compared to 76 age-matched healthy subjects. Myeloid cells of CML patients had shorter telomeres than controls (6521 bp vs 7233 bp, p<0.001). This difference was specific for the myeloid compartment, since it was not observed in lymphoid cells (6774 bp vs 6909 bp, p=0.620). Acquired Ph-negative cytogenetic abnormalities (p=0.010), lack of complete molecular remission (p=0.016) and age (p=0.013) were independent predictors of telomere shortening. Telomere dynamics were assessed over a median follow-up period of 22 months. We documented accelerated non-physiological ongoing telomere shortening in 17/59 CML patients (28%). Patients experiencing grade 2-4 hematological toxicity, during CML remission possessed significantly shorter telomeres compared to those lacking toxicity (p=0.005 for any toxicity, p=0.007 for anemia). CML patients suffer from significant and often ongoing telomere stress resulting in premature and selective aging of the myeloid compartment which might have long-term consequences on function and integrity of Ph-negative hematopoiesis.
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Affiliation(s)
- Chiara Lobetti-Bodoni
- Division of Hematology, University of Turin, A.O.U. San Giovanni Battista, Turin, Italy
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36
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Crisà E, Foli C, Passera R, Darbesio A, Garvey KB, Boccadoro M, Ferrero D. Long-term follow-up of myelodysplastic syndrome patients with moderate/severe anaemia receiving human recombinant erythropoietin + 13-cis-retinoic acid and dihydroxylated vitamin D3: independent positive impact of erythroid response on survival. Br J Haematol 2012; 158:99-107. [DOI: 10.1111/j.1365-2141.2012.09125.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 03/06/2012] [Indexed: 12/14/2022]
Affiliation(s)
- Elena Crisà
- Haematology Division; S. Giovanni Battista Hospital; University of Turin; Turin
| | | | - Roberto Passera
- Nuclear Medicine Service; S. Giovanni Battista Hospital; Turin
| | | | - Kimberly B. Garvey
- Haematology Division; S. Giovanni Battista Hospital; University of Turin; Turin
| | - Mario Boccadoro
- Haematology Division; S. Giovanni Battista Hospital; University of Turin; Turin
| | - Dario Ferrero
- Haematology Division; S. Giovanni Battista Hospital; University of Turin; Turin
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37
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Crisà E, Venturino E, Passera R, Prina M, Schinco P, Borchiellini A, Giai V, Ciocca Vasino MA, Bazzan M, Vaccarino A, Boccadoro M, Ferrero D. A retrospective study on 226 polycythemia vera patients: impact of median hematocrit value on clinical outcomes and survival improvement with anti-thrombotic prophylaxis and non-alkylating drugs. Ann Hematol 2010; 89:691-9. [DOI: 10.1007/s00277-009-0899-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 12/28/2009] [Indexed: 02/02/2023]
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