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Vitale C, Griggio V, Todaro M, Riganti C, Jones R, Boccellato E, Perutelli F, Arruga F, Vaisitti T, Efremov DG, Deaglio S, Landesman Y, Bruno B, Coscia M. Anti-tumor activity of selinexor in combination with antineoplastic agents in chronic lymphocytic leukemia. Sci Rep 2023; 13:16950. [PMID: 37805613 PMCID: PMC10560255 DOI: 10.1038/s41598-023-44039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023] Open
Abstract
Despite recent relevant therapeutic progresses, chronic lymphocytic leukemia (CLL) remains an incurable disease. Selinexor, an oral inhibitor of the nuclear export protein XPO1, is active as single agent in different hematologic malignancies, including CLL. The purpose of this study was to evaluate the anti-tumor effects of selinexor, used in combination with chemotherapy drugs (i.e. fludarabine and bendamustine) or with the PI3Kδ inhibitor idelalisib in CLL. Our results showed a significant decrease in CLL cell viability after treatment with selinexor-containing drug combinations compared to each single compound, with demonstration of synergistic cytotoxic effects. Interestingly, this drug synergism was exerted also in the presence of the protective effect of stromal cells. From the molecular standpoint, the synergistic cytotoxic activity of selinexor plus idelalisib was associated with increased regulatory effects of this drug combination on the tumor suppressors FOXO3A and IkBα compared to each single compound. Finally, selinexor was also effective in potentiating the in vivo anti-tumor effects of the PI3Kδ inhibitor in mice treated with the drug combination compared to single agents. Our data provide preclinical evidence of the synergism and potential efficacy of a combination treatment targeting XPO1 and PI3Kδ in CLL.
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Affiliation(s)
- Candida Vitale
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Valentina Griggio
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Maria Todaro
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Chiara Riganti
- Department of Oncology, University of Torino, 10126, Turin, Italy
| | - Rebecca Jones
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Elia Boccellato
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Francesca Perutelli
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Francesca Arruga
- Department of Medical Sciences, University of Torino, 10126, Turin, Italy
| | - Tiziana Vaisitti
- Department of Medical Sciences, University of Torino, 10126, Turin, Italy
| | - Dimitar G Efremov
- Molecular Hematology, International Centre for Genetic Engineering and Biotechnology, 34149, Trieste, Italy
| | - Silvia Deaglio
- Department of Medical Sciences, University of Torino, 10126, Turin, Italy
| | | | - Benedetto Bruno
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy
| | - Marta Coscia
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126, Turin, Italy.
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126, Turin, Italy.
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Perutelli F, Montalbano MC, Boccellato E, Coscia M, Vitale C. Beyond ibrutinib: novel BTK inhibitors for the treatment of chronic lymphocytic leukemia. Curr Opin Oncol 2022; 34:757-767. [PMID: 35993294 DOI: 10.1097/cco.0000000000000897] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF THE REVIEW Ibrutinib was the first Bruton tyrosine kinase inhibitor (BTKi) approved for clinical use, contributing to a dramatic change in the treatment landscape of chronic lymphocytic leukemia (CLL). This review provides an overview of next-generation BTKi that have been recently approved or are being investigated for the treatment of CLL, specifically highlighting differences and similarities compared to ibrutinib. RECENT FINDINGS Acalabrutinib presented comparable response rates to ibrutinib with lower rates of adverse events and is currently approved for the treatment of CLL. Zanubrutinib displayed excellent response rates with a lower incidence of BTKi-related adverse events, but major rates of neutropenia, and its approval is awaited. With the aim of overcoming drug resistance, noncovalent BTKi have been developed. Of all the explored agents to date, pirtobrutinib has shown promising results with manageable toxicities. SUMMARY For the treatment of CLL, several effective therapeutic strategies to target BTK are or will soon be available: these drugs present different safety profiles, thus making it possible to tailor the treatment choice according to patient's characteristics. Importantly, noncovalent BTKi will provide a therapeutic chance also for those relapsed/refractory CLL patients who are BTKi-resistant and are considered an unmet clinical need.
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Affiliation(s)
- Francesca Perutelli
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Maria Chiara Montalbano
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Elia Boccellato
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Marta Coscia
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Candida Vitale
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
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Vitale C, Griggio V, Riganti C, Todaro M, Kopecka J, Jones R, Salvetti C, Boccellato E, Perutelli F, Voena C, Godio L, Boccadoro M, Coscia M. Targeting HIF-1α Regulatory Pathways as a Strategy to Hamper Tumor-Microenvironment Interactions in CLL. Cancers (Basel) 2021; 13:cancers13122883. [PMID: 34207596 PMCID: PMC8229189 DOI: 10.3390/cancers13122883] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 12/25/2022] Open
Abstract
The hypoxia-inducible factor 1 (HIF-1) and the CXCL12/CXCR4 axis regulate the interaction of chronic lymphocytic leukemia cells and the tumor microenvironment. However, the interconnections occurring between HIF-1 and the CXCL12/CXCR4 axis are not fully elucidated. Here, we demonstrate that the CXCL12/CXCR4 axis plays a pivotal role in the positive regulation of the α subunit of HIF-1 (HIF-1α) that occurs in CLL cells co-cultured with stromal cells (SC). Inhibitors acting at different levels on CXCR4 downstream signalling counteract the SC-induced HIF-1α upregulation in CLL cells, also hindering the SC-mediated pro-survival effect. HIF-1α inhibition also exerts off-tumor effects on the SC component, inducing the downregulation of target genes, including CXCL12. Consistently, our data show that pretreatment of leukemic cells and/or SC with idelalisib effectively abrogates the SC-mediated survival support. A combined on-tumor and off-tumor inhibition of HIF-1α was also observed in idelalisib-treated patients, who showed, along with a downregulation of HIF-1α target genes in leukemic cells, a significant decrease in CXCL12 serum concentration and changes in the bone marrow microenvironment. Our data demonstrate that the targeting of HIF-1α or its regulatory pathways acts at the tumor- and SC-level, and may be an appealing strategy to overcome the microenvironment-mediated protection of CLL cells.
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Affiliation(s)
- Candida Vitale
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, via Genova 3, 10126 Torino, Italy; (C.V.); (V.G.); (M.T.); (R.J.); (C.S.); (E.B.); (F.P.); (M.B.)
- Department of Molecular Biotechnology and Health Sciences, University of Torino, via Nizza 52, 10126 Torino, Italy;
| | - Valentina Griggio
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, via Genova 3, 10126 Torino, Italy; (C.V.); (V.G.); (M.T.); (R.J.); (C.S.); (E.B.); (F.P.); (M.B.)
- Department of Molecular Biotechnology and Health Sciences, University of Torino, via Nizza 52, 10126 Torino, Italy;
| | - Chiara Riganti
- Department of Oncology, University of Torino, via Santena 5, 10126 Torino, Italy; (C.R.); (J.K.)
| | - Maria Todaro
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, via Genova 3, 10126 Torino, Italy; (C.V.); (V.G.); (M.T.); (R.J.); (C.S.); (E.B.); (F.P.); (M.B.)
- Department of Molecular Biotechnology and Health Sciences, University of Torino, via Nizza 52, 10126 Torino, Italy;
| | - Joanna Kopecka
- Department of Oncology, University of Torino, via Santena 5, 10126 Torino, Italy; (C.R.); (J.K.)
| | - Rebecca Jones
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, via Genova 3, 10126 Torino, Italy; (C.V.); (V.G.); (M.T.); (R.J.); (C.S.); (E.B.); (F.P.); (M.B.)
- Department of Molecular Biotechnology and Health Sciences, University of Torino, via Nizza 52, 10126 Torino, Italy;
| | - Chiara Salvetti
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, via Genova 3, 10126 Torino, Italy; (C.V.); (V.G.); (M.T.); (R.J.); (C.S.); (E.B.); (F.P.); (M.B.)
- Department of Molecular Biotechnology and Health Sciences, University of Torino, via Nizza 52, 10126 Torino, Italy;
| | - Elia Boccellato
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, via Genova 3, 10126 Torino, Italy; (C.V.); (V.G.); (M.T.); (R.J.); (C.S.); (E.B.); (F.P.); (M.B.)
- Department of Molecular Biotechnology and Health Sciences, University of Torino, via Nizza 52, 10126 Torino, Italy;
| | - Francesca Perutelli
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, via Genova 3, 10126 Torino, Italy; (C.V.); (V.G.); (M.T.); (R.J.); (C.S.); (E.B.); (F.P.); (M.B.)
- Department of Molecular Biotechnology and Health Sciences, University of Torino, via Nizza 52, 10126 Torino, Italy;
| | - Claudia Voena
- Department of Molecular Biotechnology and Health Sciences, University of Torino, via Nizza 52, 10126 Torino, Italy;
| | - Laura Godio
- Division of Pathology, A.O.U. Città della Salute e della Scienza di Torino, via Santena 5, 10126 Torino, Italy;
| | - Mario Boccadoro
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, via Genova 3, 10126 Torino, Italy; (C.V.); (V.G.); (M.T.); (R.J.); (C.S.); (E.B.); (F.P.); (M.B.)
- Department of Molecular Biotechnology and Health Sciences, University of Torino, via Nizza 52, 10126 Torino, Italy;
| | - Marta Coscia
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, via Genova 3, 10126 Torino, Italy; (C.V.); (V.G.); (M.T.); (R.J.); (C.S.); (E.B.); (F.P.); (M.B.)
- Department of Molecular Biotechnology and Health Sciences, University of Torino, via Nizza 52, 10126 Torino, Italy;
- Correspondence: ; Tel.: +39-0116336728; Fax: +39-0116963737
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Dogliotti I, Ragaini S, Vassallo F, Boccellato E, De Luca G, Perutelli F, Boccomini C, Clerico M, Botto B, Grimaldi D, Orsucci L, Ferrero S, Vitale C, Ferrero D, Coscia M, Cavallo F. Real Life Use of Bendamustine in Elderly Patients with Lymphoid Neoplasia. J Pers Med 2021; 11:jpm11040249. [PMID: 33808164 PMCID: PMC8066290 DOI: 10.3390/jpm11040249] [Citation(s) in RCA: 3] [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: 02/19/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Bendamustine is a cytotoxic alkylating drug with a broad range of indications as a single agent or in combination therapy in lymphoid neoplasia patients. However, its tolerability in elderly patients is still debated. METHODS An observational, retrospective study was carried out; patients with chronic lymphocytic leukemia (CLL) or lymphoma, aged ≥ 65 years old, treated with bendamustine-based regimens in first or subsequent lines between 2010 and 2020 were considered eligible. RESULTS Overall, 179 patients aged ≥ 65 years were enrolled, 53% between 71 and 79 years old. Cumulative Illness Rating Scale (CIRS) comorbidity score was ≥6 in 54% patients. Overall survival (OS) at 12 months was 95% (95% confidence interval [CI]: 90-97%); after a median follow up of 50 months, median OS was 84 months. The overall response rate was 87%, with 56% complete responses; the median time to progression (TTP) was 61 months. The baseline factors affecting OS by multivariable analysis were sex, histological diagnosis, renal function, and planned bendamustine dose, while only type of lymphoma and bendamustine dose impacted on TTP. Main adverse events were neutropenia (grade ≥ 3: 43%) and infections (any grade: 36%), with 17% of patients requiring hospital admission. CONCLUSIONS The responses to bendamustine, as well as survival, are relevant even in advanced age patients, with a manageable incidence of acute toxicity.
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Affiliation(s)
- Irene Dogliotti
- Stem Cell Transplant Unit, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Simone Ragaini
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Francesco Vassallo
- Division of Hematology, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (F.V.); (C.B.); (B.B.); (L.O.)
| | - Elia Boccellato
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Gabriele De Luca
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Francesca Perutelli
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Carola Boccomini
- Division of Hematology, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (F.V.); (C.B.); (B.B.); (L.O.)
| | - Michele Clerico
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Barbara Botto
- Division of Hematology, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (F.V.); (C.B.); (B.B.); (L.O.)
| | - Daniele Grimaldi
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Lorella Orsucci
- Division of Hematology, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (F.V.); (C.B.); (B.B.); (L.O.)
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Candida Vitale
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Dario Ferrero
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Marta Coscia
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
| | - Federica Cavallo
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, A.O.U., Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (S.R.); (E.B.); (G.D.L.); (F.P.); (M.C.); (D.G.); (S.F.); (C.V.); (D.F.); (M.C.)
- Correspondence: ; Tel.: +39-01-1633-4556; Fax: +39-01-1633-6507
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Griggio V, Perutelli F, Salvetti C, Boccellato E, Boccadoro M, Vitale C, Coscia M. Immune Dysfunctions and Immune-Based Therapeutic Interventions in Chronic Lymphocytic Leukemia. Front Immunol 2020; 11:594556. [PMID: 33312177 PMCID: PMC7708380 DOI: 10.3389/fimmu.2020.594556] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 08/13/2020] [Accepted: 10/14/2020] [Indexed: 01/01/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a B-cell malignancy characterized by a wide range of tumor-induced alterations, which affect both the innate and adaptive arms of the immune response, and accumulate during disease progression. In recent years, the development of targeted therapies, such as the B-cell receptor signaling inhibitors and the Bcl-2 protein inhibitor venetoclax, has dramatically changed the treatment landscape of CLL. Despite their remarkable anti-tumor activity, targeted agents have some limitations, which include the development of drug resistance mechanisms and the inferior efficacy observed in high-risk patients. Therefore, additional treatments are necessary to obtain deeper responses and overcome drug resistance. Allogeneic hematopoietic stem cell transplantation (HSCT), which exploits immune-mediated graft-versus-leukemia effect to eradicate tumor cells, currently represents the only potentially curative therapeutic option for CLL patients. However, due to its potential toxicities, HSCT can be offered only to a restricted number of younger and fit patients. The growing understanding of the complex interplay between tumor cells and the immune system, which is responsible for immune escape mechanisms and tumor progression, has paved the way for the development of novel immune-based strategies. Despite promising preclinical observations, results from pilot clinical studies exploring the safety and efficacy of novel immune-based therapies have been sometimes suboptimal in terms of long-term tumor control. Therefore, further advances to improve their efficacy are needed. In this context, possible approaches include an earlier timing of immunotherapy within the treatment sequencing, as well as the possibility to improve the efficacy of immunotherapeutic agents by administering them in combination with other anti-tumor drugs. In this review, we will provide a comprehensive overview of main immune defects affecting patients with CLL, also describing the complex networks leading to immune evasion and tumor progression. From the therapeutic standpoint, we will go through the evolution of immune-based therapeutic approaches over time, including i) agents with broad immunomodulatory effects, such as immunomodulatory drugs, ii) currently approved and next-generation monoclonal antibodies, and iii) immunotherapeutic strategies aiming at activating or administering immune effector cells specifically targeting leukemic cells (e.g. bi-or tri-specific antibodies, tumor vaccines, chimeric antigen receptor T cells, and checkpoint inhibitors).
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Affiliation(s)
- Valentina Griggio
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Francesca Perutelli
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Chiara Salvetti
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Elia Boccellato
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Mario Boccadoro
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Candida Vitale
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Marta Coscia
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
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