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Raiola AM, Di Grazia C, Dominietto A, Bregante S, Giammarco S, Varaldo R, Sorà F, Metafuni E, Limongiello MA, Laudisi A, Passannante M, Galli E, Gambella M, Sica S, Bacigalupo A, Angelucci E, Chiusolo P. Haploidentical bone marrow transplantation for AML in remission after TBF conditioning: a long-term follow-up. Blood Adv 2024; 8:1964-1967. [PMID: 38324723 PMCID: PMC11017277 DOI: 10.1182/bloodadvances.2023011759] [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: 09/22/2023] [Revised: 01/02/2024] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
- Anna M. Raiola
- Divisione Ematologia e Terapia Cellulare, IRCCS Policlinico San Martino IST, Genova, Italy
| | - Carmen Di Grazia
- Divisione Ematologia e Terapia Cellulare, IRCCS Policlinico San Martino IST, Genova, Italy
| | - Alida Dominietto
- Divisione Ematologia e Terapia Cellulare, IRCCS Policlinico San Martino IST, Genova, Italy
| | - Stefania Bregante
- Divisione Ematologia e Terapia Cellulare, IRCCS Policlinico San Martino IST, Genova, Italy
| | - Sabrina Giammarco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Varaldo
- Divisione Ematologia e Terapia Cellulare, IRCCS Policlinico San Martino IST, Genova, Italy
| | - Federica Sorà
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria A. Limongiello
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Laudisi
- Divisione Ematologia e Terapia Cellulare, IRCCS Policlinico San Martino IST, Genova, Italy
| | - Monica Passannante
- Divisione Ematologia e Terapia Cellulare, IRCCS Policlinico San Martino IST, Genova, Italy
| | - Eugenio Galli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimiliano Gambella
- Divisione Ematologia e Terapia Cellulare, IRCCS Policlinico San Martino IST, Genova, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Bacigalupo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Angelucci
- Divisione Ematologia e Terapia Cellulare, IRCCS Policlinico San Martino IST, Genova, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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Mikulska M, Melchio M, Signori A, Ullah N, Miletich F, Sepulcri C, Limongelli A, Giacobbe DR, Balletto E, Russo C, Magnasco L, Vena A, Di Grazia C, Raiola AM, Portunato F, Dentone C, Battaglini D, Ball L, Robba C, Angelucci E, Brunetti I, Bassetti M. Lower blood levels of isavuconazole in critically ill patients compared with other populations: possible need for therapeutic drug monitoring. J Antimicrob Chemother 2024; 79:835-845. [PMID: 38366368 DOI: 10.1093/jac/dkae037] [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: 11/12/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Isavuconazole is first-line treatment of invasive aspergillosis. Therapeutic drug monitoring (TDM) is deemed not necessary, since most patients reached therapeutic levels (>1 mg/L) in large studies. Low levels were reported in some critically ill patients admitted to the ICU. The aim was to compare isavuconazole levels between critically ill and non-critically ill patients. MATERIALS AND METHODS Retrospective analysis of data from all patients treated with standard-dose isavuconazole between 1 January 2019 and 26 October 2022 was performed. The following data were collected: TDM results from the first 30 days of therapy; ward of admission; demographic and clinical characteristics; continuous renal replacement therapy; extracorporeal membrane oxygenation; and co-administered drugs. RESULTS Seventy-two patients (median age 65 years) and 188 TDM measurements (mean number of samples per patient 2.6 ± 1.7) were included; 33 (45.8%) were ICU patients (3 also had haematological disorders); 39 (54.2%) were non-ICU patients, of whom 31 had haematological disorders. In all patients, the mean isavuconazole blood level was 3.33 ± 2.26 mg/L. Significantly lower levels were observed in the ICU versus the non-ICU population: mean 2.02 ± 1.22 versus 4.15 ± 2.31 mg/L (P < 0.001). Significantly higher rates of subtherapeutic levels were observed in ICU patients compared with the non-ICU population: all determinations <2 mg/L in 33.3% versus 7.7%, and all determinations <1 mg/L in 12.1% versus 0%, respectively. Predictors of lower isavuconazole levels were admission to the ICU, BMI > 25 kg/m2, bilirubin > 1.2 mg/dL and the absence of haematological disorder. CONCLUSIONS ICU patients had significantly lower isavuconazole blood levels compared to non-ICU population. The TDM of isavuconazole for efficacy should be performed in ICU.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genova, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Monica Melchio
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genova, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genova, Italy
| | - Nadir Ullah
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genova, Italy
| | - Franca Miletich
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genova, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Sepulcri
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genova, Italy
| | - Alessandro Limongelli
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genova, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Daniele Roberto Giacobbe
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genova, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elisa Balletto
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Russo
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genova, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Laura Magnasco
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonio Vena
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genova, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carmen Di Grazia
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federica Portunato
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Dentone
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
| | - Emanuele Angelucci
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Iole Brunetti
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Genova, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Pemmaraju N, Deconinck E, Mehta P, Walker I, Herling M, Garnache-Ottou F, Gabarin N, Campbell CJV, Duell J, Moshe Y, Mughal T, Mohty M, Angelucci E. Recent Advances in the Biology and CD123-Directed Treatment of Blastic Plasmacytoid Dendritic Cell Neoplasm. Clin Lymphoma Myeloma Leuk 2024; 24:e130-e137. [PMID: 38267355 DOI: 10.1016/j.clml.2023.12.010] [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: 10/30/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive myeloid malignancy of the dendritic cell lineage that affects patients of all ages, though the incidence appears to be highest in patients over the age of 60 years. Diagnosis is based on the presence of plasmacytoid dendritic cell precursors expressing CD123, the interleukin-3 (IL-3) receptor alpha, and a distinct histologic appearance. Timely diagnosis remains a challenge, due to lack of disease awareness and overlapping biologic and clinical features with other hematologic malignancies. Prognosis is poor with a median overall survival of 8 to 14 months, irrespective of disease presentation pattern. Historically, the principal treatment was remission induction therapy followed by a stem cell transplant (SCT) in eligible patients. However, bridging to SCT is often not achieved with induction chemotherapy regimens. The discovery that CD123 is universally expressed in BPDCN and is considered to have a pathogenetic role in its development paved the way for the successful introduction of tagraxofusp, a recombinant human IL-3 fused to a truncated diphtheria toxin payload, as an initial treatment for BPDCN. Tagraxofusp was approved in 2018 by the United States Food and Drug Administration for the treatment of patients aged 2 years and older with newly diagnosed and relapsed/refractory BPDCN, and by the European Medicines Agency in 2021 for first-line treatment of adults. The advent of tagraxofusp has opened a new era of precision oncology in the treatment of BPDCN. Herein, we present an overview of BPDCN biology, its diagnosis, and treatment options, illustrated by clinical cases.
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Affiliation(s)
- Naveen Pemmaraju
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Eric Deconinck
- Department of Hematology, CHU Besançon, Besançon Cedex, France; INSERM, UMR1098 RIGHT, Franche-Comté University, Établissement Français du Sang, Besançon, France
| | - Priyanka Mehta
- Department of Haematology, University Hospitals of Bristol and Weston, NHS Foundation Trust, Bristol, United Kingdom
| | - Irwin Walker
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | - Marco Herling
- Department of Hematology, Cellular Therapy, and Hemostaseology, University of Leipzig, Leipzig, Germany
| | - Francine Garnache-Ottou
- University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France; Etablissement Français du Sang Bourgogne Franche-Comté, Laboratoire d'Hématologie et d'Immunologie Régional, Besançon, France
| | - Nadia Gabarin
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Clinton J V Campbell
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Johannes Duell
- Medizinische Klinik und Poliklinik II des Universitätsklinikums, Zentrum Innere Medizin (ZIM), Würzburg, Germany
| | - Yakir Moshe
- Department of Hematology and Bone Marrow Transplantation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tariq Mughal
- Division of Hematology-Oncology, Tufts University School of Medicine, Boston, MA; Consultant to Stemline Therapeutics Inc, New York, NY
| | - Mohamad Mohty
- Department of Hematology and Cellular Therapy, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Emanuele Angelucci
- Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Balletto E, Ponzano M, Raiola AM, Gambella M, Grazia CD, Dominietto A, Giannoni L, Ghiso A, Nicolini LA, Sepulcri C, Ullah N, Bruzzone B, Signori A, Angelucci E, Bassetti M, Mikulska M. Adenovirus infection in adult patients undergoing allogeneic hematopoietic stem cell transplant: Incidence, clinical management, and outcome. Transpl Infect Dis 2024; 26:e14215. [PMID: 38192010 DOI: 10.1111/tid.14215] [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: 10/06/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Adenovirus infection (ADVi) is an emergent complication in adult patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is associated with poor outcome. Available data on risk factors and optimal management of ADVi in adult allo-HSCT recipients are limited, and recommendations on monitoring and pre-emptive therapy are mainly based on pediatric data. METHODS In this single-center, retrospective study, we reported all cases of positive ADV-DNA from adult patients undergoing allo-HSCT in the period 2014-2019. The study aimed to describe the incidence of ADVi at day +180 post-transplant. Secondly to describe timing, clinical presentation, risk factors, and outcome of ADVi and to analyze the application of a screening strategy in our cohort. RESULTS In 445 allo-HSCT recipients, the day +180 incidence was: 9% (39/445) for ADVi, 5% (24/445) for ADV viremia (ADVv), and 3% (15/445) for localized ADVi. The median time to ADVi was 65 (IQR 19; 94) days after HSCT. ADVv-related mortality was 13% (3/24), all cases occurring with blood max-ADV-DNA > 10^3 cp/mL. Independent risk factors for ADVi were diagnosis of lymphoproliferative disease (p = .011) and acute graft-versus-host-disease (p = .021). CONCLUSIONS In our cohort, ADVi and ADVv were more frequent than previously reported. ADVv with max-ADV-DNA > 10^3 cp/mL was associated with ADV-related mortality, thus careful monitoring and early initiation of treatment are advisable.
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Affiliation(s)
- Elisa Balletto
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Ponzano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Anna Maria Raiola
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Massimiliano Gambella
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Carmen Di Grazia
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Alida Dominietto
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Livia Giannoni
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Anna Ghiso
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Laura Ambra Nicolini
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Sepulcri
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Nadir Ullah
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Emanuele Angelucci
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Gambella M, Carlomagno S, Mangerini R, Colombo N, Parodi A, Ghiggi C, Giannoni L, Coviello E, Setti C, Luchetti S, Serio A, Laudisi A, Passannante M, Bo A, Tedone E, Sivori S, Angelucci E, Raiola AM. Early CAR - CD4 + T-lymphocytes recovery following CAR-T cell infusion: A worse outcome in diffuse large B cell lymphoma. EJHaem 2024; 5:360-368. [PMID: 38633118 PMCID: PMC11020131 DOI: 10.1002/jha2.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Abstract
CAR- CD4+ T cell lymphopenia is an emerging issue following CAR-T cell therapy. We analyzed the determinants of CD4+ T cell recovery and a possible association with survival in 31 consecutive patients treated with commercial CAR-T for diffuse large B-cell (DLBCL) or mantle cell lymphoma. Circulating immune subpopulations were characterized through multiparametric-flow cytometry. Six-month cumulative incidence of CAR- CD4+ T cell recovery (≥200 cells/μL) was 0.43 (95% confidence interval [CI]: 0.28-0.65). Among possible determinants of CD4+ T cell recovery, we recognized infusion of a 4-1BB product (tisagenlecleucel, TSA) in comparison with a CD28 (axicabtagene/brexucabtagene, AXI/BRX) (hazard ratio [HR] [95% CI]: 5.79 [1.16-24.12] p = 0.016). Higher CD4+ T cell counts resulted with TSA at month-1, -2 and -3. Moderate-to-severe infections were registered with prolonged CD4+ T cell lymphopenia. Early, month-1 CD4+ T cell recovery was associated with a worse outcome in the DLBCL cohort, upheld in a multivariate regression model for overall survival (HR: 4.46 [95% CI: 1.12-17.71], p = 0.03). We conclude that a faster CAR- CD4+ T cell recovery is associated with TSA as compared to AXI/BRX. Month-1 CAR- CD4+ T cell subset recovery could represent a "red flag" for CAR-T cell therapy failure in DLBCL patients.
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Affiliation(s)
- Massimiliano Gambella
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
- Department of Experimental Medicine (DIMES)University of GenoaGenovaItaly
| | | | - Rosa Mangerini
- Anatomia Patologica OspedalieraIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Nicoletta Colombo
- Anatomia Patologica OspedalieraIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Alessia Parodi
- Anatomia Patologica OspedalieraIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Chiara Ghiggi
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Livia Giannoni
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Elisa Coviello
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Chiara Setti
- Department of Experimental Medicine (DIMES)University of GenoaGenovaItaly
| | - Silvia Luchetti
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Alberto Serio
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Antonella Laudisi
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Monica Passannante
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Alessandra Bo
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Elisabetta Tedone
- Anatomia Patologica OspedalieraIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Simona Sivori
- Department of Experimental Medicine (DIMES)University of GenoaGenovaItaly
- IRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Emanuele Angelucci
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Anna Maria Raiola
- Ematologia e Terapie CellulariIRCCS Ospedale Policlinico San MartinoGenovaItaly
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Sbragia E, Boffa G, Varaldo R, Raiola AM, Ghiso A, Gambella M, Benedetti L, Angelucci E, Inglese M. An aggressive form of MOGAD treated with aHSCT: A case report. Mult Scler 2024; 30:612-616. [PMID: 38116593 DOI: 10.1177/13524585231213792] [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] [Indexed: 12/21/2023]
Abstract
BACKGROUND Although myelin-oligodendrocyte-glycoprotein (MOG)-antibody-associated disease (MOGAD) has been considered a more favorable demyelinating central nervous system disorder, recent data evidence that some patients might experience severe relapses and high disability. Actual treatment-options are acquired mostly from anti-aquaporin-4-antibody-positive neuromyelitis optica spectrum disorder and rely on clinical experience. Therefore, treatment of aggressive forms of MOGAD can be challenging. OBJECTIVES AND METHODS To describe a patient with an aggressive MOGAD treated with autologous hematopoietic stem cell transplantation (aHSCT). RESULTS A 56-year-old man was diagnosed with MOGAD in 2017 because of right optic-neuritis and anti-MOG-antibody positivity. In the following 2 years, he experienced two optic neuritis with good recovery after high-dose steroid. At the end of 2019, he presented sensory and motor impairment at lower limbs with evidence of several spinal, longitudinally extended, tumefactive inflammatory lesions. Despite sequential treatment with rituximab and tocilizumab alongside high-dose steroid, intravenous immunoglobulins and plasma-exchange, he experienced several clinical relapses and exhibited persistent magnetic resonance activity. He was finally addressed to intense immunosuppression with myeloablative conditioning regimen followed by autologous hematopoietic stem cell transplantation (aHSCT). After 2 years follow-up, he is free from disease-activity. CONCLUSIONS In a patient affected by aggressive, treatment-refractory MOGAD, aHSCT resulted as safe and was able to suppress disease-activity for over 2 years.
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Affiliation(s)
- Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
- Department of Neurology, Galliera Hospital, Genoa, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Riccardo Varaldo
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Maria Raiola
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Ghiso
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Massimiliano Gambella
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luana Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emanuele Angelucci
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
- Neurology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Angelucci E, Artoni A, Fianchi L, Dovizio M, Iacolare B, Saragoni S, Esposti LD. Real-World Data Analysis of Patients Affected by Immune-Mediated Thrombotic Thrombocytopenic Purpura in Italy. J Clin Med 2024; 13:1342. [PMID: 38592185 PMCID: PMC10931660 DOI: 10.3390/jcm13051342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The therapeutic management of immune-mediated thrombotic thrombocytopenic purpura (iTTP) has recently benefited from the introduction of caplacizumab, an agent directed at the inhibition of platelet aggregation. This real-world analysis investigated the epidemiology and the demographic and clinical characteristics of iTTP patients in Italy before and after caplacizumab introduction in 2020. Methods: Hospitalized adults with iTTP were included using the administrative databases of healthcare entities covering 17 million residents. Epidemiological estimates of iTTP considered the 3-year period before and after caplacizumab introduction. After stratification by treatment with or without caplacizumab, iTTP patients were characterized for their baseline features. Results: The annual incidence before and after 2020 was estimated in the range of 4.3-5.8 cases/million and 3.6-4.6 cases/million, respectively. From 2018 to 2022, 393 patients with iTTP were included, and 42 of them were treated with caplacizumab. Caplacizumab-treated patients showed better clinical outcomes, with tendentially shorter hospital stays and lower mortality rates (no treated patients died at either 1 month or 3 months after caplacizumab treatment initiation, compared to 10.5% and 11.1% mortality rates at 1 and 3 months, respectively, of the untreated ones). Conclusions: These findings may suggest that caplacizumab advent provided clinical and survival benefits for patients with iTTP.
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Affiliation(s)
- Emanuele Angelucci
- U.O. Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Andrea Artoni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milano, Italy;
| | - Luana Fianchi
- Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy;
| | - Melania Dovizio
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy; (M.D.); (B.I.); (S.S.)
| | - Biagio Iacolare
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy; (M.D.); (B.I.); (S.S.)
| | - Stefania Saragoni
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy; (M.D.); (B.I.); (S.S.)
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy; (M.D.); (B.I.); (S.S.)
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8
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Mussetti A, Rius-Sansalvador B, Moreno V, Peczynski C, Polge E, Galimard JE, Kröger N, Blaise D, Peffault de Latour R, Kulagin A, Mousavi A, Stelljes M, Hamladji RM, Middeke JM, Salmenniemi U, Sengeloev H, Forcade E, Platzbecker U, Reményi P, Angelucci E, Chevallier P, Yakoub-Agha I, Craddock C, Ciceri F, Schroeder T, Aljurf M, Ch K, Moiseev I, Penack O, Schoemans H, Mohty M, Glass B, Sureda A, Basak G, Peric Z. Artificial intelligence methods to estimate overall mortality and non-relapse mortality following allogeneic HCT in the modern era: an EBMT-TCWP study. Bone Marrow Transplant 2024; 59:232-238. [PMID: 38007531 DOI: 10.1038/s41409-023-02147-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/04/2023] [Accepted: 11/03/2023] [Indexed: 11/27/2023]
Abstract
Allogeneic haematopoietic cell transplantation (alloHCT) has curative potential counterbalanced by its toxicity. Prognostic scores fail to include current era patients and alternative donors. We examined adult patients from the EBMT registry who underwent alloHCT between 2010 and 2019 for oncohaematological disease. Our primary objective was to develop a new prognostic score for overall mortality (OM), with a secondary objective of predicting non-relapse mortality (NRM) using the OM score. AI techniques were employed. The model for OM was trained, optimized, and validated using 70%, 15%, and 15% of the data set, respectively. The top models, "gradient boosting" for OM (AUC = 0.64) and "elasticnet" for NRM (AUC = 0.62), were selected. The analysis included 33,927 patients. In the final prognostic model, patients with the lowest score had a 2-year OM and NRM of 18 and 13%, respectively, while those with the highest score had a 2-year OM and NRM of 82 and 93%, respectively. The results were consistent in the subset of the haploidentical cohort (n = 4386). Our score effectively stratifies the risk of OM and NRM in the current era but do not significantly improve mortality prediction. Future prognostic scores can benefit from identifying biological or dynamic markers post alloHCT.
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Affiliation(s)
- A Mussetti
- Department of Haematology, Institut Català d'Oncologia - Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain.
| | - B Rius-Sansalvador
- Biomarkers and Susceptibility Unit (UBS), Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology (ICO), L'Hospitalet del Llobregat, Barcelona, Spain
- ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - V Moreno
- Biomarkers and Susceptibility Unit (UBS), Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology (ICO), L'Hospitalet del Llobregat, Barcelona, Spain
- ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Peczynski
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM Unité Mixte de Recherche (UMR)-S 938, Sorbonne University, Paris, France
| | - E Polge
- EBMT Global Committee (Shanghai and Paris Offices) and Acute Leukaemia Working Party, Hospital Saint-Antoine APHP and Sorbonne University, Paris, France
| | | | - N Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - R Peffault de Latour
- Service d'Hématologie-Greffe, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Université Paris Diderot, Institut Universitaire d'Hématologie, Sorbonne Paris Cité, Paris, France
| | - A Kulagin
- Raisa Memorial (RM) Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - A Mousavi
- Shariati Hospital, Haematology-Oncology and BMT Research, Tehran, Islamic Republic of Iran
| | - M Stelljes
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | - R M Hamladji
- Centre Pierre et Marie Curie, Service Hématologie Greffe de Moëlle, Alger, Algeria
| | - J M Middeke
- Med. Klinik I, University Hospital, TU Dresden, Germany
| | - U Salmenniemi
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - H Sengeloev
- Bone Marrow Transplant Unit Copenhagen, Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - E Forcade
- CHU Bordeaux, Service d'hématologie Clinique et Thérapie Cellulaire, 33000, Pessac, France
| | | | - P Reményi
- Department of Haematology and Stem Cell Transplant, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - E Angelucci
- Haematology and Cellular Therapy Unit. IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - I Yakoub-Agha
- CHU de Lille LIRIC, INSERM U995, Université de Lille, Lille, France
| | - C Craddock
- Department of Haematology, University Hospital Birmingham NHS Trust, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, UK
| | - F Ciceri
- Haematology & Bone Marrow Transplant, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - T Schroeder
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - M Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - I Moiseev
- R.M.Gorbacheva Memorial Institute of Oncology, Haematology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation
| | - O Penack
- Department of Haematology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - H Schoemans
- Department of Haematology, University Hospitals Leuven, Leuven, Belgium
- Department of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium
| | - M Mohty
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - B Glass
- Klinik für Hämatologie und Stammzelltransplantation, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - A Sureda
- Department of Haematology, Institut Català d'Oncologia - Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
| | - G Basak
- Department of Haematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Z Peric
- School of medicine, University of Zagreb and University Hospital Centre Zagreb, Zagreb, Croatia
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9
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Pemmaraju N, Cuglievan B, Lasky J, Kheradpour A, Hijiya N, Stein AS, Meshinchi S, Mullen CA, Angelucci E, Vinti L, Mughal TI, Pawlowska AB. Efficacy and manageable safety of tagraxofusp in blastic plasmacytoid dendritic cell neoplasm: a case series of pediatric and adolescent/young adult patients. EJHaem 2024; 5:61-69. [PMID: 38406504 PMCID: PMC10887247 DOI: 10.1002/jha2.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/27/2024]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) predominantly occurs in adults ≥60 years old; 10-20% of cases are pediatric or adolescent/young adult (AYA) patients. Tagraxofusp (TAG, Elzonris®) is the only approved treatment for BPDCN; in the United States it is approved for patients aged ≥2 years. Data on treating pediatric and AYA BPDCN patients are limited. We present a case series of pediatric and AYA patients with BPDCN treated with TAG. Eight patients (five newly diagnosed; three relapsed/refractory [R/R]), aged 2-21 years, received 12 mcg/kg TAG. Seven patients were female; most had skin (n = 6) and/or bone marrow (n = 4) involvement. No new safety signals were identified. Grade 3 adverse events were headache (n = 1) and transaminitis (n = 2). Three patients with newly diagnosed BPDCN achieved complete response, one achieved partial response, and one had stable disease (SD). One patient with R/R BPDCN achieved a minor response; one had SD. Seven patients (88%) were bridged to stem cell transplant: 80% of newly diagnosed patients and 100% of R/R patients. Five patients remained alive at last follow-up. These cases highlight the efficacy and safety of TAG in pediatric and AYA patients for whom there is no other approved BPDCN therapy.
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Affiliation(s)
- Naveen Pemmaraju
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Branko Cuglievan
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Albert Kheradpour
- Department of Pediatric Hematology and OncologyLoma Linda University Children's HospitalLoma LindaCaliforniaUSA
| | - Nobuko Hijiya
- Division of Pediatric Oncology, Hematology, and Stem Cell TransplantationColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Anthony S. Stein
- Department of Hematology and Hematopoietic Cell TransplantationCity of Hope National Medical CenterDuarteCaliforniaUSA
| | - Soheil Meshinchi
- Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Craig A. Mullen
- Division of Pediatric Hematology/OncologyDepartment of PediatricsGolisano Children's HospitalUniversity of RochesterRochesterNew YorkUSA
| | - Emanuele Angelucci
- Hematology and Cellular Therapy Unit, IRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Luciana Vinti
- Department of Paediatric Haematology/Oncology, Cell and Gene TherapyBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Tariq I. Mughal
- Division of Hematology‐OncologyTufts University Medical SchoolBostonMassachusettsUSA
- Consultant to Stemline Therapeutics IncNew YorkNew YorkUSA
| | - Anna B. Pawlowska
- Department of PediatricsCity of Hope National Medical CenterDuarteCaliforniaUSA
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10
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Di Francesco A, Raiola AM, Dominietto A, Di Grazia C, Gualandi F, Van Lint MT, Bregante S, Chiusolo P, Laurenti L, Sora F, Giammarco S, Metafuni E, Fresa A, Sica S, Angelucci E, Bacigalupo A. Acute graft versus host disease 1976-2020: reduced incidence and predictive factors. Front Med (Lausanne) 2024; 10:1320692. [PMID: 38327272 PMCID: PMC10847269 DOI: 10.3389/fmed.2023.1320692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/28/2023] [Indexed: 02/09/2024] Open
Abstract
We studied the incidence of acute graft versus host disease (GvHD) and its outcome in three consecutive time frames (year <2000; 2000-2010; >2010), in 3,120 patients allografted in two transplant Centers between 1976 and 2020. The median age increased over the three periods from 32 to 42 to 54 years (p < 0.00001). The median day of onset of GvHD in the three periods was day +14, day +16, and day +30, respectively (p < 0.0001). The cumulative incidence (CI) of GvHD grades II-IV in the three periods was 47, 24, and 16%, respectively (p < 0.00001). The CI of GvHD grades III-IV was 13, 5, and 4% (p < 0.001). In multivariate analysis, significant predictive factors for GvHD II-IV, on top of year of transplant, were anti-thymocyte globulin (ATG) (RR 0.67, p > 0.001); post-transplant cyclophosphamide (PTCY) (RR 0.41, p < 0.001), a family mismatched donor (RR 1.31, p = 0.03) a matched unrelated donor (RR 2.1, p < 0.001), an unrelated mismatched donor (RR1.8, p = 0.001), donor age above 40 years (RR 1.27, p < 0.001), hematological malignancy-as compared to aplastic anemia (RR 2.3, p < 0.001). When selecting only GvHD grade II, in a multivariate analysis, there was a significant reduction of transplant-related mortality (TRM) for patients grafted in 2001-2010 (RR 0.62, p < 0.0001) and for patients grafted in 2011-2020 (RR 0.35, p < 0.0001) as compared to grafts before the year 2000. A similar reduction in time was seen for patients with GvHD grades III-IV. The overall TRM in the three periods was 30, 22, and 16% (p < 0.0001) and survival was 47, 51, and 58% (p < 0.0001). Relapse risk was unchanged. In conclusion, we showed improved prevention of acute GvHD with time, together with a significant delay in the onset of the disease. Treatment of GvHD has also improved over time, as suggested by both reduced TRM and improved survival in more recent transplant periods.
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Affiliation(s)
- Alessandra Di Francesco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | | | | | | | | | | | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Laurenti
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Federica Sora
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sabrina Giammarco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Alberto Fresa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Andrea Bacigalupo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
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11
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Zorzetto F, Scalas A, Longu F, Isoni MA, Angelucci E, Fozza C. Hemophagocytic Lymphohistiocytosis Secondary to Refractory Acute Myeloid Leukemia Resolved after Second-Line Treatment with Azacitidine plus Venetoclax. Mediterr J Hematol Infect Dis 2024; 16:e2024011. [PMID: 38223479 PMCID: PMC10786137 DOI: 10.4084/mjhid.2024.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH), also defined as hemophagocytic syndrome (HPS), represents a potentially life-threatening hyperinflammatory syndrome, characterized by impaired function of cytotoxic T lymphocytes, natural killer cells and macrophages. The main clinical features of HLH are prolonged fever, hepatosplenomegaly, cytopenia, hypertriglyceridemia, hyperferritinemia and hemophagocytosis in bone marrow, liver, spleen or lymph nodes. Secondary HLH typically occurs in conjunction with severe infections, malignancies or autoimmune disorders and intensive chemotherapy, potentially complicating treatment of acute myeloid leukemia (AML) in around 10% of cases. Herein we report for the first time a case of HLH secondary to refractory/relapsed AML resolved after a second line treatment with azacitidine plus venetoclax, thus offering a new potential therapeutic perspective in the context of a life-threatening clinical scenario.
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Affiliation(s)
- Francesco Zorzetto
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy; Ematologia e Terapie cellulari, IRCCS Ospedale Policlinico San Martino, Genova
| | - Alessandra Scalas
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy; Ematologia e Terapie cellulari, IRCCS Ospedale Policlinico San Martino, Genova
| | - Francesco Longu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy; Ematologia e Terapie cellulari, IRCCS Ospedale Policlinico San Martino, Genova
| | - Maria Antonia Isoni
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy; Ematologia e Terapie cellulari, IRCCS Ospedale Policlinico San Martino, Genova
| | - Emanuele Angelucci
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy; Ematologia e Terapie cellulari, IRCCS Ospedale Policlinico San Martino, Genova
| | - Claudio Fozza
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy; Ematologia e Terapie cellulari, IRCCS Ospedale Policlinico San Martino, Genova
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12
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Sonego B, Ibatici A, Rivoli G, Angelucci E, Sola S, Massone C. Histopathological Markers for Target Therapies in Primary Cutaneous Lymphomas. Cells 2023; 12:2656. [PMID: 37998391 PMCID: PMC10670482 DOI: 10.3390/cells12222656] [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: 10/04/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
In recent years, targeted (biological) therapies have become available also for primary cutaneous T-cell lymphomas (PCTCLs) including anti-CD30 (brentuximab vedotin) in mycosis fungoides, primary cutaneous anaplastic large T-cell lymphoma, lymphomatoid papulosis; anti-CCR4 (mogamulizumab) in Sezary syndrome; anti-CD123 (tagraxofusp) in blastic plasmocytoid cell neoplasm. Moreover, anti-PD1 (nivolumab), anti-PDL1 (pembrolizumab, atezolizumab), anti-CD52 (alemtuzumab), anti-KIR3DL2-CD158k (lacutamab), and anti-CD70 (cusatuzumab) have been tested or are under investigations in phase II trials. The expression of these epitopes on neoplastic cells in skin biopsies or blood samples plays a central role in the management of PCTCL patients. This narrative review aims to provide readers with an update on the latest advances in the newest therapeutic options for PCTCLs.
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Affiliation(s)
- Benedetta Sonego
- Dermatology Clinic, University of Trieste, 35125 Trieste, Italy;
| | - Adalberto Ibatici
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.I.); (G.R.); (E.A.)
| | - Giulia Rivoli
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.I.); (G.R.); (E.A.)
| | - Emanuele Angelucci
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.I.); (G.R.); (E.A.)
| | - Simona Sola
- Surgical Pathology, Galliera Hospital, 16128 Genoa, Italy;
| | - Cesare Massone
- Dermatology Unit & Scientific Directorate, Galliera Hospital, 16128 Genoa, Italy
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13
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Raiola AM, Angelucci E, Sica S, Bacigalupo A. Haploidentical bone marrow transplants with post transplant cyclophosphamide on day + 3 + 5: The Genova protocol. Blood Rev 2023; 62:101031. [PMID: 36435691 DOI: 10.1016/j.blre.2022.101031] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022]
Abstract
We report 634 patients who underwent unmanipulated haploidentical (HAPLO) bone marrow transplantation (BMT) in two Centers. The diagnosis was acute myeloid leukemia (AML) (n = 251), acute lymphoblastic leukemia (ALL)(n = 107), myelodysplastic syndrome and myelofibrosis (MDS + MF) (n = 125) and chronic lymphoproliferative disorders (n = 151). Median age was 52 years (16-74). Graft versus host disease (GvHD) prophylaxis was intravenous cyclosporin (CSA) starting on day 0, oral mycophenolate on day +1, and post-transplant cyclophosphamide (PTCY) on days +3 + 5. Primary graft failure was seen in 23 patients (3,6%); 17 /23 (74%) were rescued with second HAPLO graft, and were alive at one year. The cumulative incidence of acute GvHD grade II-IV was 29% and 3% for grade III-IV; the cumulative incidence of moderate severe chronic GvHD was 23%: older donor and patients age were significant predictors of both acute and chronic GvHD. The overall non relapse mortality (NRM) at 2 years was 19%: 8%, 21% and 30% in patients aged <40, 41-60 > 60 years. Disease free survival (DFS) at 5 years was 64% for acute leukemia in first remission, 51% for acute leukemia CR2, 25% for acute leukemia advanced disease and 49% for MDS/MPN. We confirm, on a relatively large number of patients, that unmanipulated HAPLO BMT with PTCY on days +3 + 5, mostly after a myeloablative conditioning regimen, is followed by a low incidence of graft failure and grade III-IV GvHD; moderate severe chronic GvHD is 23% and NRM at 2 years 19%; 5 year DFS is influenced by remission status of the underlying disease.
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Affiliation(s)
| | | | - Simona Sica
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma
| | - Andrea Bacigalupo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma
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14
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Morbelli S, Gambella M, Raiola AM, Ghiggi C, Bauckneht M, Raimondo TD, Lapucci C, Sambuceti G, Inglese M, Angelucci E. Brain FDG-PET findings in chimeric antigen receptor T-cell therapy neurotoxicity for diffuse large B-cell lymphoma. J Neuroimaging 2023; 33:825-836. [PMID: 37291470 DOI: 10.1111/jon.13135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Chimeric antigen receptor (CAR) T-cell therapy is potentially associated with treatment-related toxicities mainly consisting of cytokine release syndrome (CRS) and immune-effector cell-associated neurotoxicity syndrome (ICANS). We evaluated brain metabolic correlates of CRS with and without ICANS in diffuse large B-cell lymphoma patients treated with CAR-T. METHODS Twenty-one refractory DLCBLs underwent whole-body and brain [18 F]-fluorodeoxyglucose (FDG) PET before and 30 days after treatment with CAR-T. Five patients did not develop inflammatory-related side effects, 11 patients developed CRS, while in 5 patients CRS evolved in ICANS. Baseline and post-CAR-T brain FDG-PET were compared with a local controls dataset to identify hypometabolic patterns both at single-patient and group levels (p < .05 after correction for family-wise error [FWE). Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were computed on baseline FDG-PET and compared between patients' subgroups (t-test). RESULTS ICANS showed an extended and bilateral hypometabolic pattern mainly involving the orbitofrontal cortex, frontal dorsolateral cortex, and anterior cingulate (p < .003 FWE-corrected). CRS without ICANS showed significant hypometabolism in less extended clusters mainly involving bilateral medial and lateral temporal lobes, posterior parietal lobes, anterior cingulate, and cerebellum (p < .002 FWE-corrected). When compared, ICANS showed a more prominent hypometabolism in the orbitofrontal and frontal dorsolateral cortex in both hemispheres than CRS (p < .002 FWE-corrected). Mean baseline MTV and TLG were significantly higher in ICANS than CRS (p < .02). CONCLUSIONS Patients with ICANS are characterized by a frontolateral hypometabolic signature coherently with the hypothesis of ICANS as a predominant frontal syndrome and with the more prominent susceptibility of frontal lobes to cytokine-induced inflammation.
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Affiliation(s)
- Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Massimiliano Gambella
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Anna Maria Raiola
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Ghiggi
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Bauckneht
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Tania Di Raimondo
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Caterina Lapucci
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
| | - Gianmario Sambuceti
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Matilde Inglese
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
| | - Emanuele Angelucci
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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15
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Filippini Velázquez G, Labopin M, Tischer J, Raiola AM, Angelucci E, Kulagin AD, Galieni P, Bermúdez A, Bulabois CE, Kröger N, Díez-Martín JL, Kwon M, Nagler A, Schmid C, Ciceri F, Mohty M. Second haploidentical stem cell transplantation (HAPLO-SCT2) after relapse from a first HAPLO-SCT in acute leukaemia-a study on behalf of the Acute Leukaemia Working Party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 2023; 58:907-915. [PMID: 37160941 PMCID: PMC10400422 DOI: 10.1038/s41409-023-01985-7] [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: 01/21/2023] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 05/11/2023]
Abstract
For patients with acute myeloid and lymphoblastic leukaemia (AML/ALL) lacking a matched sibling or unrelated donor, haploidentical stem cell transplantation (HAPLO-SCT) is increasingly used. However, available data on the treatment of relapse after HAPLO-SCT, including feasibility and efficacy of a second HAPLO-SCT (HAPLO-SCT2), is scarce. Hence, adults with AML/ALL, that had undergone HAPLO-SCT2 without ex-vivo manipulation after haematologic relapse from HAPLO-SCT1 were selected for a retrospective registry analysis. Eighty-two patients (AML, n = 63, ALL, n = 19, median follow-up: 33 months) were identified. Engraftment rate was 87%. At day +180, cumulative incidences of acute GvHD II-IV°/chronic GvHD were 23.9%/22.6%, respectively. Two-year overall survival/leukaemia-free survival (OS/LFS) were 34.3%/25.4%; 2-year non-relapse mortality (NRM) and relapse incidence (RI) were 17.6% and 57%. Leukaemia was the most frequent cause of death. Separated by disease, 2-year OS/LFS/NRM/RI were 28.7%/22.3%/16.2%/61.6% in AML, and 55.3%/38.4%/23.5%/38.2% in ALL patients. In a risk-factor analysis among patients with AML, stage at HAPLO-SCT1 and HAPLO-SCT2, and interval from HAPLO-SCT1 to relapse significantly influenced outcome. Our data demonstrate that HAPLO-SCT2 is a viable option in acute leukaemia relapse after HAPLO-SCT1. Engraftment, toxicity, risk factors and long-term outcome are comparable to data reported after allo-SCT2 in a matched donor setting.
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Affiliation(s)
| | - Myriam Labopin
- EBMT Paris Study Unit, Saint-Antoine Hospital, Paris, France
- Department of Haematology, Hôpital Saint-Antoine, Sorbonne University, INSERM UMRs 938, Paris, France
| | - Johanna Tischer
- Department of Internal Medicine III, University Hospital of Munich, Campus Grosshadern, Munich, Germany
| | - Anna Maria Raiola
- Hematology and cellular therapy unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Emanuele Angelucci
- Hematology and cellular therapy unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alexander D Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russian Federation
| | - Piero Galieni
- Haematology Service, Mazzoni Hospital, Ascoli Piceno, Italy
| | - Arancha Bermúdez
- Servicio de Hematología-Hemoterapia, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Claude-Eric Bulabois
- Service d'Hématologie, CHU Grenoble Alpes-Université Grenoble Alpes, Grenoble, France
| | - Nicolaus Kröger
- University Medical Center Hamburg-Eppendorf, Department of Stem Cell Transplantation, Hamburg, Germany
| | | | - Mi Kwon
- Sección de Trasplante de Médula Ósea, Hospital Gregorio Marañón, Madrid, Spain
| | - Arnon Nagler
- Hematology and Bone Marrow Transplant Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Christoph Schmid
- Section for Stem Cell Transplantation, Augsburg University Hospital and Medical Faculty, Augsburg, Germany.
| | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Mohamad Mohty
- Department of Haematology, Hôpital Saint-Antoine, Sorbonne University, INSERM UMRs 938, Paris, France
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16
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Mikulska M, Sepulcri C, Dentone C, Magne F, Balletto E, Baldi F, Labate L, Russo C, Mirabella M, Magnasco L, Di Grazia C, Ghiggi C, Raiola AM, Giacobbe DR, Vena A, Beltramini S, Bruzzone B, Lemoli RM, Angelucci E, Bassetti M. Triple Combination Therapy With 2 Antivirals and Monoclonal Antibodies for Persistent or Relapsed Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Immunocompromised Patients. Clin Infect Dis 2023; 77:280-286. [PMID: 36976301 DOI: 10.1093/cid/ciad181] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Severely immunocompromised patients are at risk for prolonged or relapsed Coronavirus Disease 2019 (COVID-19), leading to increased morbidity and mortality. We aimed to evaluate efficacy and safety of combination treatment in immunocompromised COVID-19 patients. METHODS We included all immunocompromised patients with prolonged/relapsed COVID-19 treated with combination therapy with 2 antivirals (remdesivir plus nirmatrelvir/ritonavir, or molnupiravir in case of renal failure) plus, if available, anti-spike monoclonal antibodies (mAbs), between February and October 2022. The main outcomes were virological response at day 14 (negative Severe Acute Respiratory Syndrome Coronavirus 2 [SARS-CoV-2] swab) and virological and clinical response (alive, asymptomatic, with negative SARS-CoV-2 swab) at day 30 and the last follow-up. RESULTS Overall, 22 patients (Omicron variant in 17/18) were included: 18 received full combination of 2 antivirals and mAbs and 4 received 2 antivirals only; in 20 of 22 (91%) patients, 2 antivirals were nirmatrelvir/ritonavir plus remdesivir. Nineteen (86%) patients had hematological malignancy, and 15 (68%) had received anti-CD20 therapy. All were symptomatic; 8 (36%) required oxygen. Four patients received a second course of combination treatment. The response rate at day 14, day 30, and last follow-up was 75% (15/20 evaluable), 73% (16/22), and 82% (18/22), respectively. Day 14 and 30 response rates were significantly higher when combination therapy included mAbs. Higher number of vaccine doses was associated with better final outcome. Two patients (9%) developed severe side effects (bradycardia leading to remdesivir discontinuation and myocardial infarction). CONCLUSIONS Combination therapy including 2 antivirals (mainly remdesivir and nirmatrelvir/ritonavir) and mAbs was associated with high rate of virological and clinical response in immunocompromised patients with prolonged/relapsed COVID-19.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Sepulcri
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Dentone
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federica Magne
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elisa Balletto
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federico Baldi
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Laura Labate
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Russo
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Michele Mirabella
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Laura Magnasco
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carmen Di Grazia
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Ghiggi
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Daniele Roberto Giacobbe
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonio Vena
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Bianca Bruzzone
- Department of Health Sciences, Hygiene Unit, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
| | - Roberto M Lemoli
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, Clinic of Hematology, University of Genoa, Genova, Italy
| | - Emanuele Angelucci
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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17
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Dominietto A, Vagge S, di Grazia C, Bregante S, Raiola AM, Varaldo R, Gualandi F, Gusinu M, Barra S, Agostinelli S, Angelucci E, Hui S. Total marrow irradiation for second allogeneic hematopoietic stem cell transplantation in patients with advanced acute leukemia. Transplant Cell Ther 2023:S2666-6367(23)01246-0. [PMID: 37094701 DOI: 10.1016/j.jtct.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Second allogeneic hematopoietic stem cell transplantation (HSCT) is a treatment option for patients with acute leukemia relapsing after a first HSCT. While a myeloablative (MA) conditioning regimen before the first HSCT is considered better than reduced intensity (RIC) in terms of disease control in acute leukemia patients, the optimal conditioning regimen for the second allogeneic HSCT remains controversial. The most important prognostic factors are the remission disease phase at the time of the second HSCT and more than 12 months from the first to the second HSCT. Total Marrow Irradiation (TMI) is an advanced high-precision radiation treatment that delivers therapeutic doses over extensively selected targets while substantially reducing radiation to vital organs compared to conventional Total Body Irradiation (TBI). Herein we report the results of a retrospective analysis on second allogeneic transplantation treated with TMI as a myeloablative conditioning regimen, intending to limit toxicity. OBJECTIVE We investigated the efficacy of a high dose per fraction TMI in combination with thiotepa, fludarabine and melphalan in 13 consecutive patients with acute leukemia relapsed after a first allogeneic HSCT treated between March 2018 and November 2021. STUDY DESIGN Donor type was haploidentical (HAPLO, n=10), unrelated (UD n=2), and HLA-identical sibling (SIB, n=1). The conditioning regimen consisted of TMI 8 Gy in 5 patients on day -8 -7 or TMI 12 Gy in 8 patients on day -9 -8 -7, plus Thiotepa 5 mg/Kg on day -6, Fludarabine 50 mg/mq on day -5 -4 -3, Melphalan 140 mg/mq on day -2. TMI was delivered in a hypofractionated daily single dose of 4 Gy for three consecutive fractions. The median age was 45 years (range, 19-70 years); 7 patients were in remission, and 6 had active disease at the time of the second allogeneic HSCT. RESULTS The median time to neutrophil counts of > 0.5×10e9/L was 16 days (range 13-22), and platelet counts of > 20×10e9/L were 20 days (range 14-34), respectively. All patients showed a complete donor chimerism on day 30 after the transplant. The cumulative incidence of grade I II acute GvHD (aGvHD) was 43%, and chronic GvHD (cGVHD) was 30%. The median follow-up was 1121 days (range 200-1540). Day +30 and +100 transplant-related mortality (TRM) was 0. Overall cumulative incidence of TRM, relapse rate, and disease free-survival (DFS) were respectively 27%,7%, and 67%. CONCLUSIONS This retrospective study showed the safety and efficacy of a hypofractionated TMI conditioning regimen in patients with acute leukemia receiving second HSCT with encouraging outcomes regarding engraftment, early toxicity, GvHD, and relapse.
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Affiliation(s)
- A Dominietto
- U.O. Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - S Vagge
- Department of Radiation Oncology, Galliera Hospital, Genoa, Italy
| | - C di Grazia
- U.O. Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Bregante
- U.O. Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A M Raiola
- U.O. Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - R Varaldo
- U.O. Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - F Gualandi
- U.O. Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Gusinu
- Department of Medical Physics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Barra
- Department of Radiation Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Agostinelli
- Department of Medical Physics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - E Angelucci
- U.O. Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Hui
- Department of Radiation Oncology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA 91010 USA
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18
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Boffa G, Signori A, Massacesi L, Mariottini A, Sbragia E, Cottone S, Amato MP, Gasperini C, Moiola L, Meletti S, Repice AM, Brescia Morra V, Salemi G, Patti F, Filippi M, De Luca G, Lus G, Zaffaroni M, Sola P, Conte A, Nistri R, Aguglia U, Granella F, Galgani S, Caniatti LM, Lugaresi A, Romano S, Iaffaldano P, Cocco E, Saccardi R, Angelucci E, Trojano M, Mancardi GL, Sormani MP, Inglese M. Hematopoietic Stem Cell Transplantation in People With Active Secondary Progressive Multiple Sclerosis. Neurology 2023; 100:e1109-e1122. [PMID: 36543569 PMCID: PMC10074454 DOI: 10.1212/wnl.0000000000206750] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Uncontrolled evidence suggests that autologous hematopoietic stem cell transplantation (AHSCT) can be effective in people with active secondary progressive multiple sclerosis (SPMS). In this study, we compared the effect of AHSCT with that of other anti-inflammatory disease-modifying therapies (DMTs) on long-term disability worsening in active SPMS. METHODS We collected data from the Italian Bone Marrow Transplantation Study Group and the Italian Multiple Sclerosis Register. Patients were considered eligible if treatment had been started after the diagnosis of SPMS. Disability worsening was assessed by the cumulative proportion of patients with a 6-month confirmed disability progression (CDP) according to the Expanded Disability Status Scale (EDSS) score. Key secondary endpoints were the EDSS time trend after treatment start and the prevalence of disability improvement over time. Time to first CDP was assessed by means of proportional hazard Cox regression models. A linear mixed model with a time × treatment group interaction was used to assess the longitudinal EDSS time trends. Prevalence of improvement was estimated using a modified Kaplan-Meier estimator and compared between groups by bootstrapping the area under the curve. RESULTS Seventy-nine AHSCT-treated patients and 1975 patients treated with other DMTs (beta interferons, azathioprine, glatiramer-acetate, mitoxantrone, fingolimod, natalizumab, methotrexate, teriflunomide, cyclophosphamide, dimethyl fumarate, and alemtuzumab) were matched to reduce treatment selection bias using propensity score and overlap weighting approaches. Time to first CDP was significantly longer in transplanted patients (hazard ratio [HR] = 0.50; 95% CI = 0.31-0.81; p = 0.005), with 61.7% of transplanted patients free from CPD at 5 years. Accordingly, EDSS time trend over 10 years was higher in patients treated with other DMTs than in AHSCT-treated patients (+0.157 EDSS points per year compared with -0.013 EDSS points per year; interaction p < 0.001). Patients who underwent AHSCT were more likely to experience a sustained disability improvement: 34.7% of patients maintained an improvement (a lower EDSS than baseline) 3 years after transplant vs 4.6% of patients treated by other DMTs (p < 0.001). DISCUSSION The use of AHSCT in people with active SPMS is associated with a slowing of disability progression and a higher likelihood of disability improvement compared with standard immunotherapy. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that autologous hematopoietic stem cell transplants prolonged the time to CDP compared with other DMTs.
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Affiliation(s)
- Giacomo Boffa
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Alessio Signori
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Luca Massacesi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Alice Mariottini
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Elvira Sbragia
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Salvatore Cottone
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Maria Pia Amato
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Claudio Gasperini
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Lucia Moiola
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Stefano Meletti
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Anna Maria Repice
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Vincenzo Brescia Morra
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Giuseppe Salemi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Francesco Patti
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Massimo Filippi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Giovanna De Luca
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Giacomo Lus
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Mauro Zaffaroni
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Patrizia Sola
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Antonella Conte
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Riccardo Nistri
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Umberto Aguglia
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Franco Granella
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Simonetta Galgani
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Luisa Maria Caniatti
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Alessandra Lugaresi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Silvia Romano
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Pietro Iaffaldano
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Eleonora Cocco
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Riccardo Saccardi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Emanuele Angelucci
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Maria Trojano
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Giovanni Luigi Mancardi
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Maria Pia Sormani
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy
| | - Matilde Inglese
- From the Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.B., E.S., G.L.M., M.I.), University of Genoa; Biostatistics Unit (A.S., M.P.S.), Department of Health Sciences, University of Genoa; Department of Neurosciences Drugs and Child Health (L. Massacesi, A.M.), University of Florence; and Department of Neurology 2 (L. Massacesi, A.M., A.M.R.), Careggi University Hospital, Florence; Department of Neurology (S.C.), A.R.N.A.S. CIVICO, Palermo; Department NEUROFARBA (M.P.A.), Section Neurological Sciences University of Florence; IRCCS Fondazione Don Carlo Gnocchi, (M.P.A) Florence; Department of Neurology (C.G.), Ospedale San Camillo-Forlanini, Rome; Neurology Unit (L. Moiola, M.F.), Neurorehabilitation Unit (F.M.), Neurophysiology Service (F.M.), Neuroimaging Research Unit, Division of Neuroscience (F.M.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (F.M.), Milan; Department Biomedical Metabolic and Neural Sciences (S.M.), University of Modena and Reggio Emilia, Modena, Italy; Department of Neuroscience, Neurology Unit (S.M., P.S.), Azienda Ospedaliera Universitaria, Modena; Neurosciences and Reproductive and Odontostomatological Sciences (V.B.M.), University "Federico II," Naples; Department of Biomedicine, Neurosciences and Advanced Diagnostics (G.S.), University of Palermo; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), AOU Policlinico-San Marco, University of Catania; MS Centre, Neurology Unit (G.D.L.), SS. Annunziata University Hospital, Chieti; Department of Advanced Medical and Surgical Sciences (G.L.), 2nd Division of Neurology, University of Campania "Luigi Vanvitelli," Naples; Centro Sclerosi Multipla (M.Z.), ASST della Valle Olona, Ospedale di Gallarate, Italy; IRCCS Neuromed (A.C.), Pozzilli (IS); Department of Human Neuroscience (A.C., R.N.) and Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS) (S.R.) Sapienza University, Rome; S.Andrea Multiple Sclerosis Center (R.N.), Sapienza University, Rome; S.Andrea Hospital (S.R.), Rome; Department of Medical and Surgical Sciences (U.A.), Magna Greacia University of Catanzaro; Unit of Neurosciences, Department of Medicine and Surgery (F.G.), University of Parma; Department of Neurosciences (S.G.), San Camillo-Forlanini Hospital, Rome; Department of Neuroscience and Rehabilitation (L.M.C.), Azienda Ospedaliero-Universitaria di Ferrara; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.); Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Department of Basic Medical Sciences, Neurosciences and Sense Organs (P.I., M.T.), University of Bari Aldo Moro; Department of Medical Science and Public Health (E.C), University of Cagliari, Cagliari; Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari; Department of Cellular Therapies and Transfusion Medicine (R.S.), Careggi University Hospital, Florence; Ematologia e Terapie Cellulari (E.A.), Ospedale Policlinico IRCCS San Martino (M.P.S.), Genoa; Istituti Clinici Scientifici Maugeri (G.L.M.), Pavia; Ospedale Policlinico IRCCS San Martino (M.I.), Genoa, Italy.
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Abstract
Mitapivat, an oral first-in-class activator of erythrocyte pyruvate kinase (PKR), was first investigated in patients with pyruvate kinase deficiency (PKD), where it was found to improve hemoglobin (Hb) concentrations in patients who did not regularly receive transfusions and to reduce transfusion burden in patients who receive regular transfusions. It was approved in 2022 for the treatment of PKD and is being explored in other hereditary chronic conditions that are associated with hemolytic mechanisms of anemia, such as sickle cell disease (SCD) and thalassemia. In a proof-of-concept phase I study in SCD, treatment with mitapivat demonstrated efficacy in increasing Hb concentrations, but also restored the thermostability of PKR, increasing its activity and decreasing 2,3-diphosphoglycerate (2,3-DPG) levels in sickle erythrocytes, which decreases Hb polymerization by increasing the affinity of Hb to oxygen. In thalassemia, mitapivat is hypothesized to increase adenosine triphosphate (ATP) production and mitigate harmful effects on red blood cells. This hypothesis is supported by preclinical data showing that mitapivat ameliorated ineffective erythropoiesis, iron overload and anemia in the Hbbth3/+ murine model of β-thalassemia intermedia. The efficacy and safety of mitapivat were confirmed in an open-label, multicenter, phase II study of patients with non-transfusion-dependent α-thalassemia or β-thalassemia, where activation of PKR improves anemia, and the drug showed a tolerable safety profile comparable to that in previous studies in other hemolytic anemias. Together, these efficacy and safety results provide rationale for continuing investigation of mitapivat for the treatment of thalassemia and SCD, developing other PK activators and starting investigational studies in other acquired diseases characterized by dyserythropoiesis and hemolytic anemia.
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Affiliation(s)
- Federica Pilo
- Hematology and Transplant Center, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Emanuele Angelucci
- Hematology and Cellular Therapy Center, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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Mikulska M, Testi D, Russo C, Balletto E, Sepulcri C, Bussini L, Dentone C, Magne F, Policarpo S, Campoli C, Miselli F, Cilli A, Ghiggi C, Aquino S, Di Grazia C, Giannella M, Giacobbe DR, Vena A, Raiola AM, Bonifazi F, Zinzani P, Cavo M, Lemoli R, Angelucci E, Viale P, Bassetti M, Bartoletti M. Outcome of early treatment of SARS-CoV-2 infection in patients with haematological disorders. Br J Haematol 2023; 201:628-639. [PMID: 36806152 DOI: 10.1111/bjh.18690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
Outcome of early treatment of COVID-19 with antivirals or anti-spike monoclonal antibodies (MABs) in patients with haematological malignancies (HM) is unknown. A retrospective study of HM patients treated for mild/moderate COVID-19 between March 2021 and July 2022 was performed. The main composite end-point was treatment failure (severe COVID-19 or COVID-19-related death). We included 328 consecutive patients who received MABs (n = 120, 37%; sotrovimab, n = 73) or antivirals (n = 208, 63%; nirmatrelvir/ritonavir, n = 116) over a median of two days after symptoms started; 111 (33.8%) had non-Hodgkin lymphoma (NHL); 89 (27%) were transplant/CAR-T (chimaeric antigen receptor T-cell therapy) recipients. Most infections (n = 309, 94%) occurred during the Omicron period. Failure developed in 31 patients (9.5%). Its independent predictors were older age, fewer vaccine doses, and treatment with MABs. Rate of failure was lower in the Omicron versus the pre-Omicron period (7.8% versus 36.8%, p < 0.001). During the Omicron period, predictors of failure were age, fewer vaccine doses and diagnosis of acute myeloid leukaemia/myelodysplastic syndrome (AML/MDS). Independent predictors of longer viral shedding were age, comorbidities, hospital admission at diagnosis, NHL/CLL, treatment with MABs. COVID-19-associated mortality was 3.4% (n = 11). The mortality in those who developed severe COVID-19 after early treatment was 26% in the Omicron period. Patients with HM had a significant risk of failure of early treatment, even during the Omicron period, with high mortality rate.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Diletta Testi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Chiara Russo
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Balletto
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Sepulcri
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Linda Bussini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Sílvia Policarpo
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Caterina Campoli
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Filippo Miselli
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandro Cilli
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Chiara Ghiggi
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Aquino
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carmen Di Grazia
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Daniele Roberto Giacobbe
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Bonifazi
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Institute of Hematology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - Pierluigi Zinzani
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Institute of Hematology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - Michele Cavo
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Institute of Hematology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - Roberto Lemoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Internal Medicine (DiMI), Clinic of Hematology, University of Genoa, Genoa, Italy
| | - Emanuele Angelucci
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Bartoletti
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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21
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Gazzo I, Massarotti C, Chiodi S, Spinelli S, Gualandi F, Passamonti U, Fulcheri E, Angelucci E, Cagnacci A. Pregnancy complications after allogeneic hematopoietic stem cells transplantation: Focus on the placenta. Placenta 2023; 132:27-31. [PMID: 36623416 DOI: 10.1016/j.placenta.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/02/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION hematopoietic stem cells transplantation (HSCT) is a treatment option for malignant and non-malignant haematological diseases. Because of the improved survival rates and the more widespread use of reproductive technologies in the last two decades, the number of patients who conceive is increasing while the pathogenesis of some obstetrical complications observed is not yet fully clarified. METHODS we present complete data about two pregnancies in women who had previously undergone HSTC, with conditioning regimen including total body irradiation. One pregnancy is spontaneous and one after oocytes donation. RESULTS In both pregnancies we observed relevant intrauterine growth retardation, attributable to a deficit in implantation and placentation. Ultrasound and histological data point to a defective placenta development, possibly sustained by uterine vessel damage caused by irradiation. A deeper understanding of factors influencing placentation post total body irradiation and HSCT, including the possible role of donor's sex and graft versus host disease, is pivotal to improve pregnancy outcomes in this specific population.
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Affiliation(s)
- Irene Gazzo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI Dept.), University of Genoa, Genova, Italy; Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Claudia Massarotti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI Dept.), University of Genoa, Genova, Italy; Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - Sandra Chiodi
- UO Hematology and Cell Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Simonetta Spinelli
- UO Hematology and Cell Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Gualandi
- UO Hematology and Cell Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Ezio Fulcheri
- Fetal-Perinatal Pathology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics, Università di Genova, Genoa, Italy
| | - Emanuele Angelucci
- UO Hematology and Cell Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Angelo Cagnacci
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI Dept.), University of Genoa, Genova, Italy; Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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22
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Wieczorek M, Labopin M, Castagna L, Brissot E, Socié G, Raiola AM, Angelucci E, Rodríguez AB, Yakoub-Agha I, Aljurf M, Crawley C, Mear JB, Musso M, Fanin R, Avenoso D, Turlure P, Tecchio C, Sanz J, Ciceri F, Nagler A, Mohty M. Post-transplant cyclophosphamide in acute leukemia patients receiving more than 5/10 HLA-mismatched allogeneic hematopoietic cell transplantation from related donors: A study on behalf of the ALWP of the EBMT. Am J Hematol 2023; 98:E41-E44. [PMID: 36398703 DOI: 10.1002/ajh.26782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/23/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Michele Wieczorek
- Department of Hematology, Hôpital Saint-Antoine, Paris, France.,Department of Medicine, Hematology and Bone Marrow Transplant Unit, Verona University, Verona, Italy
| | | | - Luca Castagna
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Eolia Brissot
- Department of Hematology, Hôpital Saint-Antoine, Paris, France
| | - Gerard Socié
- Department of Hematology - BMT, Hôpital Saint-Louis, Paris, France
| | | | | | | | - Ibrahim Yakoub-Agha
- Centre Hospitalier Universitaire de Lille, Université de Lille, INSERM U1286, Lille, France
| | - Mahmoud Aljurf
- Oncology (Section of Adult Hematolgy/BMT), King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Charles Crawley
- Department of Hematology, Addenbrooke's Hospital, Cambridge, UK
| | - Jean Baptiste Mear
- Department of Clinical Hematology of the Adult, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Maurizio Musso
- Department of Oncology, Oncohematology and Bone Marrow Transplant Unit, Ospedale La Maddalena, Palermo, Italy
| | - Renato Fanin
- Division of Hematology, Azienda Ospedaliero Universitaria di Udine, Udine, Italy
| | - Daniele Avenoso
- Department of Hematological Medicine, King's College Hospital, King's Denmark Hill Campus, London, UK
| | - Pascal Turlure
- Department of Clinical Hematology, CHU Limoges, Limoges, France
| | - Cristina Tecchio
- Department of Medicine, Hematology and Bone Marrow Transplant Unit, Verona University, Verona, Italy
| | - Jaime Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milano, Italy
| | - Arnon Nagler
- Acute Leukemia Working Party of EBMT, Paris, France.,Division of Hematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mohamad Mohty
- Department of Hematology, Hôpital Saint-Antoine, Paris, France.,Acute Leukemia Working Party of EBMT, Paris, France
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23
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Herling M, Deconinck E, Anant M, Manteigas D, Riggi M, Mughal T, Angelucci E. MPN-467 Findings From an Observational, Multicenter, Retrospective Analysis of Patients With Blastic Plasmacytoid Dendritic Cell Neoplasm Treated With Tagraxofusp in the European Expanded Access Program. Clin Lymphoma Myeloma Leuk 2022; 22 Suppl 2:S338. [PMID: 36164010 DOI: 10.1016/s2152-2650(22)01461-6] [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] [Indexed: 01/26/2023]
Abstract
CONTEXT Blastic plasmacytoid dendritic cell neoplasm (BPDCN), an aggressive hematologic malignancy with poor prognosis, is characterized by clonal expansion of plasmacytoid dendritic tumor cells expressing specific markers including the interleukin-3 receptor alpha (CD123). Tagraxofusp (TAG) is a CD123-targeted therapy approved by the FDA and EMA. A global expanded access program (EAP) was implemented prior to TAG's EMA authorization to provide access to patients in real-world practice. OBJECTIVE Main objectives were rates of complete response and incidence/severity of capillary leak syndrome (CLS). Key secondary objectives included rate of patients bridged to transplantation, survival, safety, number of cycles administered. DESIGN Non-interventional, retrospective analysis of BPDCN patients enrolled in the European EAP from 08.2019-12.2021. SETTING 57 European centers (Germany, France, Italy, Switzerland, United Kingdom, Spain, Austria). PATIENTS 76 adult (median age 64 years, range 21-85 years) and 4 pediatric patients with BPDCN confirmed by hematopathology with established marker panels (including CD123). INTERVENTIONS TAG 12 mcg/kg was administered intravenously once daily on days 1-5 (up to day 10 allowed) of a 21-day cycle. Hospitalization was required for the first cycle (subsequent cycles allowed outpatient administration). MAIN OUTCOME MEASURES Review of case report forms and individual records of patients who met criteria for TAG prior to regulatory approval. RESULTS Most patients were male (78%), representing real-world distribution. Sixty-three patients received TAG first-line and 17 patients as second/or further line of treatment. The median number of cycles was 2.5 (range 1-8) in first-line and 2.6 (range 1-13) in second-line/further, respectively. No deaths due to CLS were reported. Adverse events (AEs) mainly occurred in cycle 1, with similar rates and severity in older vs younger patients. Analysis is ongoing; data on safety, efficacy, transplantation, and time-related parameters will be reported. CONCLUSIONS The is the largest retrospective analysis of real-world clinical practice outside of a clinical trial in BPDCN patients treated with TAG. Adherence to the EAP and multidisciplinary training is thought to have positively affected prevention and management of CLS and other grade 3-4 AEs. These preliminary results confirm the feasibility and safety of TAG, including in elderly patients, with manageable safety.
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Affiliation(s)
- Marco Herling
- University Hospital Leipzig, Department of Hematology, Cell Therapy, and Hemostaseology, Leipzig, Germany
| | - Eric Deconinck
- Regional University Hospital of Besancon, Besancon, France
| | | | - David Manteigas
- Cmed (Clinical Research Services), Broadlands Business Campus, West Sussex, United Kingdom
| | | | - Tariq Mughal
- Stemline Therapeutics Inc, New York, USA; Tufts University School of Medicine, Boston, USA
| | - Emanuele Angelucci
- Hematology and Cellular Therapy Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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24
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Nagler A, Labopin M, Arat M, Reményi P, Koc Y, Blaise D, Angelucci E, Vydra J, Kulagin A, Socié G, Rovira M, Sica S, Aljurf M, Gülbas Z, Kröger N, Brissot E, Peric Z, Giebel S, Ciceri F, Mohty M. Posttransplant cyclophosphamide‐based anti–graft‐vs‐host disease prophylaxis in patients with acute lymphoblastic leukemia treated in complete remission with allogeneic hematopoietic cell transplantation from human leukocyte antigen‐mismatched unrelated donors versus haploidentical donors: A study on behalf of the
ALWP
of the
EBMT. Cancer 2022; 128:3959-3968. [DOI: 10.1002/cncr.34452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Arnon Nagler
- Hematology Division Chaim Sheba Medical Center Tel‐Hashomer Israel
| | - Myriam Labopin
- Sorbonne Université INSERM UMR‐S 938, CRSA, Service d'hématologie et Thérapie Cellulaire, AP‐HP, Hôpital Saint‐Antoine Paris France
- European Society for Blood and Marrow Transplantation Paris Study Office/CEREST‐TC Paris France
| | - Mutlu Arat
- Istanbul Florence Nightingale Hospital HSCT Unit Istanbul Turkey
| | - Péter Reményi
- Dél‐pesti Centrumkórház‐Országos Hematológiaiés Infektológiai Intézet Department of Haematology and Stem Cell Transplant Budapest Hungary
| | - Yener Koc
- Medicana International Hospital Istanbul Bone MarrowTransplant Unit Istanbul Turkey
| | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes Marseille France
| | | | - Jan Vydra
- Institute of Hematology and Blood Transfusion Servicio de Hematología Prague Czech Republic
| | - Aleksandr Kulagin
- First State Pavlov Medical University of St. Petersburg Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation St. Petersburg Russia
| | - Gerard Socié
- Hopital St. Louis, Department of Hematology‐BMT Paris France
| | - Montserrat Rovira
- Hospital Clinic, Department of Hematology Institute of Hematology and Oncology Barcelona Spain
| | - Simona Sica
- Universita Cattolica S. Cuore, Istituto di Ematologia Ematologia Rome Italy
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre Oncology (Section of Adult Haematolgy/BMT) Riyadh Saudi Arabia
| | - Zafer Gülbas
- Anadolu Medical Center Hospital Bone Marrow Transplantation Department Kocaeli Turkey
| | - Nicolaus Kröger
- University Hospital Eppendorf Bone Marrow Transplantation Centre Hamburg Germany
| | - Eolia Brissot
- Sorbonne Université INSERM UMR‐S 938, CRSA, Service d'hématologie et Thérapie Cellulaire, AP‐HP, Hôpital Saint‐Antoine Paris France
- European Society for Blood and Marrow Transplantation Paris Study Office/CEREST‐TC Paris France
| | - Zinaida Peric
- University of Zagreb School of Medicine Zagreb Croatia
| | - Sebastian Giebel
- Maria Sklodowska‐Curie National Research Institute of Oncology Gliwice Poland
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplant, IRCCS San Raffaele Scientific Institute Milan Italy
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy Saint‐Antoine Hospital, AP‐HP, Sorbonne University Paris France
- Sorbonne University INSERM, Saint‐Antoine Research Centre Paris France
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25
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Mariotti J, Raiola AM, Evangelista A, Harbi S, Patriarca F, Carella MA, Martino M, Risitano A, Busca A, Giaccone L, Brunello L, Merla E, Savino L, Loteta B, Console G, Fanin R, Sperotto A, Marano L, Marotta S, Frieri C, Sica S, Chiusolo P, Chabannon C, Furst S, Santoro A, Bacigalupo A, Bruno B, Blaise D, Mavilio D, Bramanti S, Devillier R, Angelucci E, Castagna L. Impact of second-degree related donor on the outcomes of T cell-replete haploidentical transplantation with post-transplant cyclophosphamide. Bone Marrow Transplant 2022; 57:1758-1764. [PMID: 36057732 DOI: 10.1038/s41409-022-01565-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 11/09/2022]
Abstract
Donor selection may contribute to improve clinical outcomes of T cell-replete haploidentical stem cell transplantation (Haplo-SCT) with post-transplant cyclophosphamide (PT-Cy). Impact of second-degree related donor (SRD) was not fully elucidated in this platform. We retrospectively compared the outcome of patients receiving Haplo-SCT either from a SRD (n = 31) or a first-degree related donor (FRD, n = 957). Median time to neutrophil and platelet recovery did not differ between a SRD and a FRD transplant (p = 0.599 and 0.587). Cumulative incidence of grade II-IV acute graft-versus host disease (GVHD) and moderate-severe chronic GVHD was 13% and 19% after SRD vs 24% (p = 0.126) and 13% (p = 0.395) after FRD transplant. One-year cumulative incidence of non-relapse mortality (NRM) was 19% for SRD and 20% for FRD (p = 0.435) cohort. The 3-year probability of overall survival (OS) and progression-free survival (PFS) was 42% vs 55% (p = 0.273) and 49% vs 35% (p = 0.280) after SRD and FRD transplant, respectively. After propensity score adjustment or matched pair analysis, the outcome of patients receiving Haplo-SCT from a SRD or a FRD did not differ in terms of NRM, OS, PFS, acute and chronic GVHD. Our results suggest that a SRD is a viable option for Haplo-SCT with PT-Cy when a FRD is not available.
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Affiliation(s)
- Jacopo Mariotti
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Anna Maria Raiola
- Hematology and Bone Marrow Transplant Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Samia Harbi
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Francesca Patriarca
- Hematology and Transplant Center Unit, Udine University Hospital, DAME, University of Udine, 33100, Udine, Italy
| | - Michele Angelo Carella
- Department of Oncology and Hematology Bone Marrow Transplant Unit Fondazione Casa Sollievo della Sofferenza San Giovanni Rotondo, Torino, Italy
| | - Massimo Martino
- Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Antonio Risitano
- Department of Clinical Medicine and Surgery, Bone Marrow Transplant Center, Federico II University of Naples, Naples, Italy
| | - Alessandro Busca
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Luisa Giaccone
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Lucia Brunello
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Emanuela Merla
- Department of Oncology and Hematology Bone Marrow Transplant Unit Fondazione Casa Sollievo della Sofferenza San Giovanni Rotondo, Torino, Italy
| | - Lucia Savino
- Department of Oncology and Hematology Bone Marrow Transplant Unit Fondazione Casa Sollievo della Sofferenza San Giovanni Rotondo, Torino, Italy
| | - Barbara Loteta
- Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Giuseppe Console
- Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Renato Fanin
- Hematology and Transplant Center Unit, Udine University Hospital, DAME, University of Udine, 33100, Udine, Italy
| | - Alessandra Sperotto
- Hematology and Transplant Center Unit, Udine University Hospital, DAME, University of Udine, 33100, Udine, Italy
| | - Luana Marano
- Department of Clinical Medicine and Surgery, Bone Marrow Transplant Center, Federico II University of Naples, Naples, Italy
| | - Serena Marotta
- Department of Clinical Medicine and Surgery, Bone Marrow Transplant Center, Federico II University of Naples, Naples, Italy
| | - Camilla Frieri
- Department of Clinical Medicine and Surgery, Bone Marrow Transplant Center, Federico II University of Naples, Naples, Italy
| | - Simona Sica
- Istituto di Ematologia, Fondazione Policlinico Universitario A.Gemelli, Universita' Cattolica, Roma, Italy
| | - Patrizia Chiusolo
- Istituto di Ematologia, Fondazione Policlinico Universitario A.Gemelli, Universita' Cattolica, Roma, Italy
| | - Christian Chabannon
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Sabine Furst
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Armando Santoro
- Department of Oncology/Hematology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Andrea Bacigalupo
- Istituto di Ematologia, Fondazione Policlinico Universitario A.Gemelli, Universita' Cattolica, Roma, Italy
| | - Benedetto Bruno
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Didier Blaise
- Department of Hematology, Transplantation Program, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano-Milan, Italy.,Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Stefania Bramanti
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Raynier Devillier
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Emanuele Angelucci
- Hematology and Bone Marrow Transplant Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Castagna
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, via Manzoni 56, 20089, Rozzano, Milan, Italy
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26
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Einsele H, Moreau P, De Stefano V, Dytfeld D, Angelucci E, Benjamin R, Goldschmidt H, van de Donk NW, Besemer B, Scheid C, Vij R, in ’t Groen-Damen E, Semerjian M, Strulev V, Schecter JM, Roccia T, Nesheiwat T, Wapenaar R, Weisel K, Mateos MV. Subgroup analyses in patients with relapsed/refractory multiple myeloma (RRMM) receiving real-life current standard of care (SOC) in the LocoMMotion study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8031 Background: Patients (pts) with RRMM who are triple-class exposed (proteasome inhibitor [PI], immunomodulatory drug [IMiD], and anti-CD38 monoclonal antibody [mAb]) have an urgent and currently unmet clinical need. LocoMMotion (NCT04035226) is the first prospective multinational study of real-life SOC in triple-class exposed pts with RRMM. Here we present efficacy in subgroups of pts treated with SOC therapies in the LocoMMotion study. Methods: LocoMMotion is a noninterventional study across 76 sites (63 European; 13 US). Eligible pts had received ≥3 prior lines of therapy (LOT) or were double refractory to a PI and an IMiD; received a PI, an IMiD, and anti-CD38 mAb; and had disease progression during/after their last LOT. Real-life SOC treatments were defined as those used in local clinical practice. Responses and disease progression were assessed by response review committee, per IMWG criteria. Subgroups were defined by baseline (BL) characteristics: age, Eastern Cooperative Oncology Group performance status (ECOG PS), renal function, ISS stage, presence of extramedullary plasmacytoma, LDH level, % of bone marrow plasma cells, number of prior LOT, triple-class or penta-drug exposure, and refractoriness. Results: As of May 21, 2021 (median follow-up 11.0 mo), 248 pts were enrolled and treated with median 4.0 (range, 1–20) cycles of SOC therapy. Evaluation of efficacy outcomes in subgroups demonstrated that refractoriness to 3 classes of antimyeloma therapy, presence of extramedullary plasmacytomas, high LDH, and ECOG PS ≥1 were associated with generally worse outcomes, compared with pts who did not have these characteristics (Table). Overall response rate (ORR) ranged from 20.0–43.1% across all subgroups. Age and number of prior LOT did not have an impact on efficacy outcomes. Conclusions: Subgroup analyses of this first prospective study of real-life SOC tx in triple-class exposed pts with RRMM indicate that specific pt and disease characteristics were associated with poor outcomes. Triple-class refractory and non-triple-class refractory pts had poor outcomes, although the latter had longer median progression-free survival (PFS). These findings should be considered when planning bridging strategy for CAR-T therapy. Clinical trial information: NCT04035226. [Table: see text]
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Affiliation(s)
- Hermann Einsele
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
| | - Philippe Moreau
- Hematology Clinic, University Hospital Hôtel-Dieu, Nantes, France
| | - Valerio De Stefano
- Section of Hematology, Catholic University, Fondazione Policlinico A Gemelli, IRCCS, Rome, Italy
| | | | - Emanuele Angelucci
- Hematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Reuben Benjamin
- Department of Haematology, King’s College Hospital, London and School of Cancer and Pharmaceutical Sciences, King’s College, London, United Kingdom
| | | | | | | | | | - Ravi Vij
- Washington University School of Medicine, St. Louis, MO
| | | | | | | | | | - Tito Roccia
- Janssen Research & Development, High Wycombe, NJ, United Kingdom
| | | | | | - Katja Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Mateos MV, Weisel K, De Stefano V, Goldschmidt H, Delforge M, Mohty M, Cavo M, Vij R, Lindsey-Hill J, Dytfeld D, Angelucci E, Perrot A, Benjamin R, van de Donk NWCJ, Ocio EM, Scheid C, Gay F, Roeloffzen W, Rodriguez-Otero P, Broijl A, Potamianou A, Sakabedoyan C, Semerjian M, Keim S, Strulev V, Schecter JM, Vogel M, Wapenaar R, Nesheiwat T, San-Miguel J, Sonneveld P, Einsele H, Moreau P. LocoMMotion: a prospective, non-interventional, multinational study of real-life current standards of care in patients with relapsed and/or refractory multiple myeloma. Leukemia 2022; 36:1371-1376. [PMID: 35332278 PMCID: PMC9061296 DOI: 10.1038/s41375-022-01531-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 11/14/2022]
Abstract
Despite treatment advances, patients with multiple myeloma (MM) often progress through standard drug classes including proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), and anti-CD38 monoclonal antibodies (mAbs). LocoMMotion (ClinicalTrials.gov identifier: NCT04035226) is the first prospective study of real-life standard of care (SOC) in triple-class exposed (received at least a PI, IMiD, and anti-CD38 mAb) patients with relapsed/refractory MM (RRMM). Patients (N = 248; ECOG performance status of 0–1, ≥3 prior lines of therapy or double refractory to a PI and IMiD) were treated with median 4.0 (range, 1–20) cycles of SOC therapy. Overall response rate was 29.8% (95% CI: 24.2–36.0). Median progression-free survival (PFS) and median overall survival (OS) were 4.6 (95% CI: 3.9–5.6) and 12.4 months (95% CI: 10.3–NE). Treatment-emergent adverse events (TEAEs) were reported in 83.5% of patients (52.8% grade 3/4). Altogether, 107 deaths occurred, due to progressive disease (n = 74), TEAEs (n = 19), and other reasons (n = 14). The 92 varied regimens utilized demonstrate a lack of clear SOC for heavily pretreated, triple-class exposed patients with RRMM in real-world practice and result in poor outcomes. This supports a need for new treatments with novel mechanisms of action.
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Affiliation(s)
| | - Katja Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Valerio De Stefano
- Section of Hematology, Catholic University, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | | | | | - Mohamad Mohty
- Service d'Hematologie Clinique et Therapie Cellulaire, Sorbonne University, INSERM UMRs 938, Paris, France
| | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia Seràgnoli, Bologna University School of Medicine, Bologna, Italy
| | - Ravi Vij
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Emanuele Angelucci
- Hematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Aurore Perrot
- Centre Hospitalier Universitaire de Toulouse, Service d'Hématologie, Toulouse, France
| | - Reuben Benjamin
- Department of Haematology, King's College Hospital, London and School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | - Enrique M Ocio
- Hospital Universitario Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jesus San-Miguel
- Clínica Universidad de Navarra, CIMA, CIBERONC, IDISNA, Pamplona, Spain
| | | | - Hermann Einsele
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
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Nagler A, Labopin M, Pioltelli P, Arat M, Yakoub-Agha I, Kulagin A, Angelucci E, Ozdogu H, Risitano A, Ciceri F, Ozkurt ZN, Sanz J, Brissot E, Zina P, Giebel S, Mohty M. Allogeneic Stem Cell Transplantation from Haploidentical Versus Matched Sibling Donors for Adult Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia: A Study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gambella M, Carlomagno S, Raiola AM, Giannoni L, Ghiggi C, Setti C, Giordano C, Luchetti S, Serio A, Bo A, Falco M, Della Chiesa M, Angelucci E, Sivori S. CD19-Targeted Immunotherapies for Diffuse Large B-Cell Lymphoma. Front Immunol 2022; 13:837457. [PMID: 35280988 PMCID: PMC8911710 DOI: 10.3389/fimmu.2022.837457] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 12/15/2022] Open
Abstract
Surgical resection, chemotherapy and radiotherapy were, for many years, the only available cancer treatments. Recently, the use of immune checkpoint inhibitors and adoptive cell therapies has emerged as promising alternative. These cancer immunotherapies are aimed to support or harness the patient's immune system to recognize and destroy cancer cells. Preclinical and clinical studies, based on the use of T cells and more recently NK cells genetically modified with chimeric antigen receptors retargeting the adoptive cell therapy towards tumor cells, have already shown remarkable results. In this review, we outline the latest highlights and progress in immunotherapies for the treatment of Diffuse Large B-cell Lymphoma (DLBCL) patients, focusing on CD19-targeted immunotherapies. We also discuss current clinical trials and opportunities of using immunotherapies to treat DLBCL patients.
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Affiliation(s)
- Massimiliano Gambella
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Simona Carlomagno
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Livia Giannoni
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Ghiggi
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Setti
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Chiara Giordano
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Silvia Luchetti
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Serio
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Bo
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michela Falco
- Laboratory of Clinical and Experimental Immunology, Integrated Department of Services and Laboratories, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Emanuele Angelucci
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simona Sivori
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
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Mikulska M, Furfaro E, Dettori S, Giacobbe DR, Magnasco L, Dentone C, Ball L, Russo C, Taramasso L, Vena A, Angelucci E, Pelosi P, Bassetti M. Aspergillus-PCR in bronchoalveolar lavage diagnostic accuracy for invasive pulmonary aspergillosis in critically ill patients. Mycoses 2022; 65:411-418. [PMID: 35138675 DOI: 10.1111/myc.13428] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/12/2022] [Accepted: 02/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diagnosis of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU) patients is challenging and the role of Aspergillus-PCR in bronchoalveolar lavage (BAL) is unknown. OBJECTIVES This study evaluated diagnostic accuracy of Aspergillus-PCR in BAL in IPA in three different cohorts: ICU-admitted patients with COVID-19, ICU-admitted patients without COVID-19 and immunocompromised patients. METHODS All stored available BAL samples collected from three patient groups were tested with Aspergillus-PCR (AsperGenius®). IPA was diagnosed according to appropriate criteria for each patient group. RESULTS We included 111 BAL samples from 101 patients: 52 (51%) patients admitted to ICU for COVID-19, 24 (24%) admitted to ICU for other reasons and 25 (25%) immunocompromised. There were 31 cases of IPA (28%). Aspergillus-PCR sensitivity was 64% (95%CI 47-79), specificity 99% (95%CI 93-100). Aspergillus-PCR sensitivity was 40% (95%CI 19-64) in ICU COVID-19, 67% (95%CI 21-93) in non-COVID-19 ICU patients and 92% (95%CI 67-98) in the immunocompromised. The concordance between positive BAL-GM and BAL-PCR in patients with and without IPA was significantly lower in ICU patients (32%; 43% in COVID-19, 18% in non-COVID-19) than in the immunocompromised (92%), p<0.001. CONCLUSIONS Aspergillus-PCR in BAL improves the diagnostic accuracy of BAL-GM in ICU patients.
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Affiliation(s)
- Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Elisa Furfaro
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Silvia Dettori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Laura Magnasco
- Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Chiara Dentone
- Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Chiara Russo
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Emanuele Angelucci
- Hematology and Transplant Center, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Surgical Science and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
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Cocco P, Piro S, Meloni F, Montagna A, Pani M, Pilia I, Padoan M, Miligi L, Magnani C, Gambelunghe A, Muzi G, Ferri GM, Vimercati L, Zanotti R, Scarpa A, Zucca M, Latte GC, Angelucci E, De Matteis S, Puligheddu M. Night shift work and lymphoma: results from an Italian multicentre case-control study. Occup Environ Med 2022; 79:452-459. [PMID: 35027441 DOI: 10.1136/oemed-2021-107845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Night shift work can disrupt circadian rhythm and cause chronic sleep deprivation, which might increase the risk of lymphoma through immunosuppression and oxidative stress. MATERIAL AND METHODS We investigated the association between night shift work and risk of lymphoma subtypes in 867 incident cases and 774 controls, who participated in a multicentre Italian study between 2011 and 2017. Based on questionnaire information, occupational experts assessed the lifetime probability of night shift work, the total number of night shifts and years of night shift work among study participants. OR and 95% CI for lymphoma and its major subtypes associated with night shift work was calculated with logistic regression, adjusting by age, gender, education, study area, marital status and family history of haemolymphatic cancer. RESULTS Ever working night shifts was associated with an increase in the risk of chronic lymphocytic leukaemia (CLL) (OR 1.9, 95% CI 1.14 to 3.32), which was highest after a 15-34 years latency. However, there was not a linear increase in risk by probability of exposure, years of night shift work, nor lifetime number of night shifts whether under rotating or permanent work schedules. Risk of lymphoma overall, B cell lymphoma (BCL), its major subtypes other than CLL, and other less prevalent BCL subtypes combined did not show an association. CONCLUSIONS We found conflicting evidence of an association between night shift work and the risk of CLL. We did not observe an association with other lymphoma subtypes.
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Affiliation(s)
- Pierluigi Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy .,Centre for Occupational and Environmental Health, Division of Population Health, The University of Manchester, Manchester, UK
| | - Sara Piro
- Environmental and Occupational Epidemiology Branch - Cancer Risk Factors and Lifestyle Epidemiology Unit, ISPRO - Institute for Prevention, Research, and Cancer Network, Florence, Italy
| | - Federico Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Andrea Montagna
- Department of Medicine and Surgery, Occupational Medicine, Respiratory Diseases and Toxicology Section, University of Perugia, Perugia, Italy
| | - Michele Pani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Ilaria Pilia
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Marina Padoan
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, University of Eastern Piedmont Amedeo Avogadro School of Medicine, Novara, Italy
| | - Lucia Miligi
- Environmental and Occupational Epidemiology Branch - Cancer Risk Factors and Lifestyle Epidemiology Unit, ISPRO - Institute for Prevention, Research, and Cancer Network, Florence, Italy
| | - Corrado Magnani
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, University of Eastern Piedmont Amedeo Avogadro School of Medicine, Novara, Italy
| | - Angela Gambelunghe
- Department of Medicine and Surgery, Occupational Medicine, Respiratory Diseases and Toxicology Section, University of Perugia, Perugia, Italy
| | - Giacomo Muzi
- Department of Medicine and Surgery, Occupational Medicine, Respiratory Diseases and Toxicology Section, University of Perugia, Perugia, Italy
| | - Giovanni Maria Ferri
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University of Bari, Bari, Italy
| | - Luigi Vimercati
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University of Bari, Bari, Italy
| | - Roberta Zanotti
- Department of Haematology, University of Verona, Verona, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Mariagrazia Zucca
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Emanuele Angelucci
- Deaprtment of Haematology, IST - National Institute for Cancer Research, Genova, Italy
| | - Sara De Matteis
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Lüftinger R, Zubarovskaya N, Galimard JE, Cseh A, Salzer E, Locatelli F, Algeri M, Yesilipek A, de la Fuente J, Isgrò A, Alseraihy A, Angelucci E, Smiers FJ, La La Nasa G, Zecca M, Fisgin T, Unal E, Kleinschmidt K, Peters C, Lankester A, Corbacioglu S. Busulfan–fludarabine- or treosulfan–fludarabine-based myeloablative conditioning for children with thalassemia major. Ann Hematol 2022; 101:655-665. [DOI: 10.1007/s00277-021-04732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
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Peffault de Latour R, Kulasekararaj A, Iacobelli S, Terwel SR, Cook R, Griffin M, Halkes CJM, Recher C, Barraco F, Forcade E, Vallejo JC, Drexler B, Mear JB, Smith AE, Angelucci E, Raymakers RAP, de Groot MR, Daguindau E, Nur E, Barcellini W, Russell NH, Terriou L, Iori AP, La Rocca U, Sureda A, Sánchez-Ortega I, Xicoy B, Jarque I, Cavenagh J, Sicre de Fontbrune F, Marotta S, Munir T, Tjon JML, Tavitian S, Praire A, Clement L, Rabian F, Marano L, Hill A, Palmisani E, Muus P, Cacace F, Frieri C, van Lint MT, Passweg JR, Marsh JCW, Socié G, Mufti GJ, Dufour C, Risitano AM. Eltrombopag Added to Immunosuppression in Severe Aplastic Anemia. N Engl J Med 2022; 386:11-23. [PMID: 34986284 DOI: 10.1056/nejmoa2109965] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND A single-group, phase 1-2 study indicated that eltrombopag improved the efficacy of standard immunosuppressive therapy that entailed horse antithymocyte globulin (ATG) plus cyclosporine in patients with severe aplastic anemia. METHODS In this prospective, investigator-led, open-label, multicenter, randomized, phase 3 trial, we compared the efficacy and safety of horse ATG plus cyclosporine with or without eltrombopag as front-line therapy in previously untreated patients with severe aplastic anemia. The primary end point was a hematologic complete response at 3 months. RESULTS Patients were assigned to receive immunosuppressive therapy (Group A, 101 patients) or immunosuppressive therapy plus eltrombopag (Group B, 96 patients). The percentage of patients who had a complete response at 3 months was 10% in Group A and 22% in Group B (odds ratio, 3.2; 95% confidence interval [CI], 1.3 to 7.8; P = 0.01). At 6 months, the overall response rate (the percentage of patients who had a complete or partial response) was 41% in Group A and 68% in Group B. The median times to the first response were 8.8 months (Group A) and 3.0 months (Group B). The incidence of severe adverse events was similar in the two groups. With a median follow-up of 24 months, a karyotypic abnormality that was classified as myelodysplastic syndrome developed in 1 patient (Group A) and 2 patients (Group B); event-free survival was 34% and 46%, respectively. Somatic mutations were detected in 29% (Group A) and 31% (Group Β) of the patients at baseline; these percentages increased to 66% and 55%, respectively, at 6 months, without affecting the hematologic response and 2-year outcome. CONCLUSIONS The addition of eltrombopag to standard immunosuppressive therapy improved the rate, rapidity, and strength of hematologic response among previously untreated patients with severe aplastic anemia, without additional toxic effects. (Funded by Novartis and others; RACE ClinicalTrials.gov number, NCT02099747; EudraCT number, 2014-000363-40.).
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Affiliation(s)
- Régis Peffault de Latour
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Austin Kulasekararaj
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Simona Iacobelli
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Sofie R Terwel
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Riley Cook
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Morag Griffin
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Constantijn J M Halkes
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Christian Recher
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Fiorenza Barraco
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Edouard Forcade
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Juan-Carlos Vallejo
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Beatrice Drexler
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Jean-Baptiste Mear
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Alexander E Smith
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Emanuele Angelucci
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Reinier A P Raymakers
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Marco R de Groot
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Etienne Daguindau
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Erfan Nur
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Wilma Barcellini
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Nigel H Russell
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Louis Terriou
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Anna-Paola Iori
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Ursula La Rocca
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Anna Sureda
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Isabel Sánchez-Ortega
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Blanca Xicoy
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Isidro Jarque
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - James Cavenagh
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Flore Sicre de Fontbrune
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Serena Marotta
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Talha Munir
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Jennifer M L Tjon
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Suzanne Tavitian
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Aline Praire
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Laurence Clement
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Florence Rabian
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Luana Marano
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Anita Hill
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Elena Palmisani
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Petra Muus
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Fabiana Cacace
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Camilla Frieri
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Maria-Teresa van Lint
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Jakob R Passweg
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Judith C W Marsh
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Gérard Socié
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Ghulam J Mufti
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Carlo Dufour
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
| | - Antonio M Risitano
- From the French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Saint-Louis Hospital and Université de Paris (R.P.L., F.S.F., C.F., G.S.), and the Adolescent and Young Adult Hematology Unit, Saint-Louis Hospital (F.R.), Paris, the Hematology Department, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse (C.R., S.T.), Centre Hospitalier Universitaire Lyon Sud, Lyon (F.B., A.P.), Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévêque, Pessac (E.F., L.C.), the Department of Clinical Hematology, Rennes University Hospital, Rennes (J.-B.M.), Service d'Hématologie, Hôpital Jean Minjoz, Besançon (E.D.), and Hôpital Claude Huriez, Lille (L.T.) - all in France; the Clinical Study Unit, European Society for Blood and Marrow Transplantation (R.P.L., A.K., S.I., S.R.T., I.S.-O., C.F., C.D., A.M.R.), and the Department of Hematology, Leiden University Medical Center (C.J.M.H., J.M.L.T.), Leiden, the Department of Hematology, University Medical Center Utrecht, Utrecht (R.A.P.R.), the Department of Hematology, University Medical Center Groningen, Groningen (M.R.G.), and the Department of Clinical Hematology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam (E.N.) - all in the Netherlands; the Department of Haematological Medicine, King's College Hospital NHS Foundation Trust (A.K., R.C., A.E.S., P.M., J.C.W.M., G.J.M.), and Barts Health NHS Trust, St. Bartholomew's Hospital (J.C.), London, the Department of Haematology, St. James's University Hospital, Leeds (M.G., T.M., A.H., P.M.), and the Centre for Clinical Haematology, Nottingham University Hospital, Nottingham (N.H.R.) - all in the United Kingdom; the Department of Biology, Università Tor Vergata (S.I.), and the Department of Translational and Precision Medicine, Division of Hematology, Sapienza University (A.P.I., U.L.R.), Rome, Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino (E.A., M.T.L.), and the Hematology Unit, IRCCS Istituto Giannina Gaslini (E.P., C.D.), Genoa, Unità Operativa Complessa di Ematologia, Unità Operativa Complessa di Fisiopatologia delle Anemie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (W.B.), the Department of Clinical Medicine and Surgery, Federico II University, Naples (S.M., L.M., F.C., C.F., A.M.R.), and Ematologia e Trapianto Emopoietico, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati, Avellino (L.M., C.F., A.M.R.) - all in Italy; University Hospital Donostia, San Sebastián (J.C.V.), the Department of Hematology, Catalan Institute of Oncology Bellvitge Hospital-Hospital Duran i Reynals, L'Hospitalet de Llobregat (A.S.), Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Barcelona (B.X.), and Servicio de Hematología y Hemoterapia, Hospital Universitario y Politécnico La Fe, Valencia (I.J.) - all in Spain; and the Department of Hematology, University Hospital Basel, Basel, Switzerland (B.D., J.R.P.)
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34
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Abstract
Beta-thalassemia is one of the most common monogenic disorders. Standard treatment of the most severe forms, i.e., transfusion-dependent thalassemia (TDT) with long-term transfusion and iron chelation, represents a considerable medical, psychological, and economic burden. Allogeneic hematopoietic stem cell transplantation from an HLA-identical donor is a curative treatment with excellent results in children. Recently, several gene therapy approaches were evaluated in academia or industry-sponsored clinical trials as alternative curative options for children and young adults without an HLA-identical donor. Gene therapy by addition of a functional beta-globin gene using self-inactivating lentiviral vectors in autologous stem cells resulted in transfusion independence for a majority of TDT patients across different age groups and genotypes, with a current follow-up of multiple years. More recently, promising results were reported in TDT patients treated with autologous hematopoietic stem cells edited with the clustered regularly interspaced short palindromic repeats-Cas9 technology targeting erythroid BCL11A expression, a key regulator of the normal switch from fetal to adult globin production. Patients achieved high levels of fetal hemoglobin allowing for discontinuation of transfusions. Despite remarkable clinical efficacy, 2 major hurdles to gene therapy access for TDT patients materialized in 2021: (1) a risk of secondary hematological malignancies that is complex and multifactorial in origin and not limited to the risk of insertional mutagenesis, (2) the cost—even in high-income countries—is leading to the arrest of commercialization in Europe of the first gene therapy medicinal product indicated for TDT despite conditional approval by the European Medicines Agency.
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Affiliation(s)
- Isabelle Thuret
- Department of Pediatric Onco-Hematology, Center for Hemoglobinopathies, La Timone Hospital, Marseille University, Marseille, France
| | - Annalisa Ruggeri
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Eurocord, Hopital Saint Louis, Paris, France
- EBMT Cellular Therapy and Immunobiology Working Party, Leiden, the Netherlands
| | - Emanuele Angelucci
- Hematology and Cellular Therapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Christian Chabannon
- Corresponding author: Christian Chabannon, MD, PhD, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France. Tel: +33 491 223 441;
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35
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Casaccia M, Mora M, Santori G, Ghiggi C, Angelucci E. Laparoscopic lymph node biopsy for lymphoma with a novel use of indocyanine green fluorescence in a 66-year-old male patient. Int J Surg Case Rep 2022; 90:106692. [PMID: 34952317 PMCID: PMC8715068 DOI: 10.1016/j.ijscr.2021.106692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Indocyanine green (ICG) near-infrared fluorescence is primarily employed in detecting Intraoperative sentinel lymph node (SLN) mapping or to evaluate the extent of radical lymphadenectomy mainly in colo-rectal and gastric cancer. To date there are no reports indicating the use of this dye to detect pathologic lymphatic tissue when a lymph node biopsy for suspected lymphoproliferative disease is performed. Presentation of case A 66-year-old male patient was admitted to the hospital for severe pain of left renal colic type. A computed tomography (CT) scan and a positron emission tomography (PET) showed a left hydroureteronephrosis due to ureter compression by paraortic solid tissue of lymphomatous aspect with a standardized uptake value (SUV) of 15. Multiple lymphadenopathies on paracaval, para-aortic and common iliac sites were present as well. Discussion A laparoscopic lymph node biopsy (LLB) was planned for diagnostic purposes. After induction of anesthesia a ICG solution was injected Intradermally at both inguinal regions. At laparoscopy a complete visualization of the pathologic lymphnodes was achieved, enabling incisional biopsies of the lymphomatous mass. Histopathological examination showed an extranodal localization of an aggressive B-cell non-Hodgkin lymphoma. Conclusion ICG-fluorescence seems to offer a simple and safe method for pathologic lymph node detection. LLB in the suspicion of intra abdominal lymphoma can largely take advantage by this novel opportunity not yet tested to date. More studies with large case series are needed to confirm the efficacy of ICG-fluorescence for detecting pathologic lymph nodes. First report in literature concerning the use of indocyanine green (ICG) for laparoscopic lymph node biopsy Periaortic and iliac lymph nodes visualized at PET as pathological, at laparoscopy turned out to be stained up by ICG. Deep lymph nodes staining with ICG is possible by means of a preoperative injection of an ICG solution into the inguinal regions. ICG-fluorescence seems to offer a useful, expeditious, and easy reproductible method for pathologic lymph node [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]] laparoscopic lymph node biopsy (LLB).
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36
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Mikulska M, Knelange N, Nicolini LA, Tridello G, Santarone S, Di Bartolomeo P, de la Camara R, Cuéllar C, Velardi A, Perruccio K, Ljungman P, Zaucha J, Piekarska A, Basak G, Karakulska-Prystupiuk E, Angelucci E, Ciceri F, Lupo-Stanghellini MT, Fouillard L, García-Cadenas I, Menconi M, Blau IW, Nassi L, Cesaro S, Styczynski J. Efficacy, safety and feasibility of treatment of chronic HCV infection with directly acting agents in hematopoietic stem cell transplant recipients - Study of infectious diseases working party of EBMT. J Infect 2021; 84:71-79. [PMID: 34757138 DOI: 10.1016/j.jinf.2021.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Limited data is available on HCV directly acting agents (DAAs) in haematopoietic stem cell transplant (HSCT) recipients. This study aimed at reporting the characteristics, treatment practices and treatment efficacy in HSCT recipients with chronic HCV. METHODS Prospective observational study from EBMT Infectious Diseases Working Party (IDWP). Patients with chronic HCV infection were included. RESULTS Between 12/2015 and 07/2018, 45 patients were included: male in 53%; median age 49 years (range, 8-75); acute leukaemia in 48.9%, lymphoma in 17.7%, non-malignant disorders in 22.3%; allogeneic HSCT in 84%; 77.8% no immunosuppressive treatment. Genotypes 1, 2, 3 and 4 were detected in 54.5%, 20.5%, 13.6% and 11.4%, respectively; advanced fibrosis in 40%, including cirrhosis in 11.4%. Overall, 37 (82.2%) patients received DAAs, at a median of 8.4 years after HSCT (16.2% within 6 months from HSCT). Sofosbuvir-based treatment was given to 62.2%. Thirty-five patients completed planned treatment course, with sustained virological response (SVR) of 89.1%, and 94.3% (33/35) in those who completed the treatment. Side effects possibly related to DAAs were reported in 5 (14%) and did not require treatment discontinuation. CONCLUSIONS DAAs treatment was effective, safe and feasible in this cohort of mainly allogeneic HSCT recipients with mild/moderate liver damage.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa (DISSAL) and IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genova 16132, Italy.
| | - Nina Knelange
- Department Medical Statistics & Bioinformatics, EBMT Data Office, Leiden, the Netherlands
| | - Laura Ambra Nicolini
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Gloria Tridello
- Paediatric Haematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stella Santarone
- Dipartimento Oncologia Ematologia, Terapia Intensiva Ematologica, Ospedale Civile, Pescara, Italy
| | - Paolo Di Bartolomeo
- Dipartimento Oncologia Ematologia, Terapia Intensiva Ematologica, Ospedale Civile, Pescara, Italy
| | | | - Clara Cuéllar
- Department of Hematology, Hospital 12 de Octubre, Madrid, Spain
| | - Andrea Velardi
- Department of Medicine, Division of Hematology and Clinical Immunology, University of Perugia, Perugia, Italy
| | - Katia Perruccio
- Pediatric Oncology Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Per Ljungman
- Department for Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jan Zaucha
- University Hospital Department of Haematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Piekarska
- University Hospital Department of Haematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Basak
- Department of Hematology, Transplantation and Internal Medicine, University Clinical Center of the Medical University of Warsaw, Warsaw, Poland; Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Karakulska-Prystupiuk
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Emanuele Angelucci
- Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy; School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | | | | | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - Mariacristina Menconi
- Unità Operativa Oncoematologia Pediatrica, Azienda Ospedaliera Universitaria Pisa, Pisa, Italy
| | | | - Luca Nassi
- Division of Hematology, Department of Translational Medicine, Universita' del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, Italy
| | - Simone Cesaro
- Paediatric Haematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, University Hospital, Collegium Medicum UMK Torun, Bydgoszcz, Poland
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Matis S, Rossi M, Brondolo L, Cardillo M, Reverberi D, Massara R, Colombo M, Ibatici A, Angelucci E, Vaisitti T, Bruno S, Fabris S, Neri A, Gentile M, Morabito F, Cutrona G, Briata P, Gherzi R, Fais F. LINC00152 expression in normal and Chronic Lymphocytic Leukemia B cells. Hematol Oncol 2021; 40:40-47. [PMID: 34679195 PMCID: PMC9297877 DOI: 10.1002/hon.2938] [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: 09/20/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022]
Abstract
Long non‐coding RNAs are emerging as essential regulators of gene expression, but their role in normal and neoplastic B cells is still largely uncharacterized. Here, we report on the expression pattern of the LINC00152 in normal B cells and Chronic Lymphocytic Leukemia B cell clones. Higher LINC00152 levels were consistently observed in memory B cell populations when compared to naïve B cells in the normal tissues analyzed [peripheral blood (PB), tonsils, and spleen]. In addition, independent stimulation via Immunoglobulins (IG), CD40, or Toll‐like Receptor 9 (TLR9) upregulated LINC00152 in PB B cells. The expression of LINC00152 in a cohort of 107 early stage Binet A CLL patients was highly variable and did not correlate with known prognostic markers or clinical evolution. TLR9 stimulation, but not CD40 or IG challenge, was able to upregulate LINC00152 expression in CLL cells. In addition, LINC00152 silencing in CLL cell lines expressing LINC00152 failed to induce significant cell survival or apoptosis changes. These data suggest that, in normal B cells, the expression of LINC00152 is regulated by immunomodulatory signals, which are only partially effective in CLL cells. However, LINC00152 does not appear to contribute to CLL cell expansion and/or survival in a cohort of newly diagnosed CLL patients.
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Affiliation(s)
- Serena Matis
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Martina Rossi
- Gene Expression Regulation Laboratory, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lorenzo Brondolo
- Gene Expression Regulation Laboratory, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Martina Cardillo
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniele Reverberi
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rosanna Massara
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Monica Colombo
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Adalberto Ibatici
- Hematology Unit and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emanuele Angelucci
- Hematology Unit and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Tiziana Vaisitti
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Silvia Bruno
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Sonia Fabris
- Fondazione Cà Granda IRCCS, Hematology Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Antonino Neri
- Fondazione Cà Granda IRCCS, Hematology Ospedale Maggiore Policlinico Milano, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | | | - Fortunato Morabito
- Biotechnology Research Unit, AO, Cosenza, Italy.,Hematology and Bone Marrow Transplant Unit, Hemato-Oncology Department, Augusta Victoria Hospital, East Jerusalem, Israel
| | - Giovanna Cutrona
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Briata
- Gene Expression Regulation Laboratory, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberto Gherzi
- Gene Expression Regulation Laboratory, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Franco Fais
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Experimental Medicine, University of Genoa, Genoa, Italy
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38
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Schenone D, Dominietto A, Campi C, Frassoni F, Cea M, Aquino S, Angelucci E, Rossi F, Torri L, Bignotti B, Tagliafico AS, Piana M. Radiomics and Artificial Intelligence for Outcome Prediction in Multiple Myeloma Patients Undergoing Autologous Transplantation: A Feasibility Study with CT Data. Diagnostics (Basel) 2021; 11:diagnostics11101759. [PMID: 34679456 PMCID: PMC8535117 DOI: 10.3390/diagnostics11101759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/08/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Multiple myeloma is a plasma cell dyscrasia characterized by focal and non-focal bone lesions. Radiomic techniques extract morphological information from computerized tomography images and exploit them for stratification and risk prediction purposes. However, few papers so far have applied radiomics to multiple myeloma. A retrospective study approved by the institutional review board: n = 51 transplanted patients and n = 33 (64%) with focal lesion analyzed via an open-source toolbox that extracted 109 radiomics features. We also applied a dedicated tool for computing 24 features describing the whole skeleton asset. The redundancy reduction was realized via correlation and principal component analysis. Fuzzy clustering (FC) and Hough transform filtering (HTF) allowed for patient stratification, with effectiveness assessed by four skill scores. The highest sensitivity and critical success index (CSI) were obtained representing each patient, with 17 focal features selected via correlation with the 24 features describing the overall skeletal asset. These scores were higher than the ones associated with a standard cytogenetic classification. The Mann–Whitney U-test showed that three among the 17 imaging descriptors passed the null hypothesis. This AI-based interpretation of radiomics features stratified relapsed and non-relapsed MM patients, showing some potentiality for the determination of the prognostic image-based biomarkers in disease follow-up.
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Affiliation(s)
- Daniela Schenone
- LISCOMP, Dipartimento di Matematica, Università di Genova, Via Dodecaneso 35, 16146 Genova, Italy; (D.S.); (C.C.); (F.F.)
| | - Alida Dominietto
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
| | - Cristina Campi
- LISCOMP, Dipartimento di Matematica, Università di Genova, Via Dodecaneso 35, 16146 Genova, Italy; (D.S.); (C.C.); (F.F.)
| | - Francesco Frassoni
- LISCOMP, Dipartimento di Matematica, Università di Genova, Via Dodecaneso 35, 16146 Genova, Italy; (D.S.); (C.C.); (F.F.)
| | - Michele Cea
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
- Dipartimento di Medicina Interna, Università di Genova, Viale Benedetto XV, 16132 Genova, Italy
| | - Sara Aquino
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
| | - Emanuele Angelucci
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
| | - Federica Rossi
- Dipartimento di Medicina Sperimentale, Università di Genova, Via L. B. Alberti 1, 16132 Genova, Italy;
| | - Lorenzo Torri
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
| | - Bianca Bignotti
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
- Dipartimento di Medicina Sperimentale, Università di Genova, Via L. B. Alberti 1, 16132 Genova, Italy;
| | - Alberto Stefano Tagliafico
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
- Dipartimento di Scienze della Salute, Università di Genova, Via Pastore 1, 16132 Genova, Italy
- Correspondence: (A.S.T.); (M.P.)
| | - Michele Piana
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
- CNR-SPIN Genova, Via Dodecaneso 33, 16146 Genova, Italy
- Correspondence: (A.S.T.); (M.P.)
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Sahebi F, Eikema DJ, Koster L, Kroger N, Meijer E, van Doesum JA, Rovira M, Koc Y, Angelucci E, Blaise D, Sammassimo S, McDonald A, Arroyo CH, Sanchez JF, Forcade E, Castagna L, Stölzel F, Sanz J, Tischer J, Ciceri F, Valcarcel D, Proia A, Hayden PJ, Beksac M, Yakoub-Agha I, Schönland S. Post-Transplantation Cyclophosphamide for Graft-versus- Host Disease Prophylaxis in Multiple Myeloma Patients Who Underwent Allogeneic Hematopoietic Cell Transplantation: First Comparison by Donor Type. A Study from the Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2021; 27:999.e1-999.e10. [PMID: 34543768 DOI: 10.1016/j.jtct.2021.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/12/2021] [Indexed: 01/11/2023]
Abstract
Graft-versus-host disease (GVHD) remains among the major causes of treatment failure in patients with multiple myeloma (MM) undergoing allogeneic hematopoietic cell transplantation (allo-HCT). The use of post-transplantation cyclophosphamide (PT-Cy) is now a well-established and widely used method for GVHD prophylaxis after HLA haploidentical HCT. However, the rationale for using PT-Cy in the setting of matched donor transplantation is less apparent, given the lesser degree of bidirectional alloreactivity. In this retrospective study, we investigated the role of PT-Cy as GVHD prophylaxis in patients with multiple myeloma underoing allo-HCT, among different donor types, to determine cumulative incidence of acute and chronic GVHD and impact on engraftment, progression-free survival (PFS), GVHD-free/relapse- free survival (GRFS), overall survival (OS), and NRM A total of 295 patients with MM underwent allo-HCT using grafts from a matched related donor (MRD; n = 67), matched unrelated donor (MUD; n = 72), mismatched related or unrelated donor (MMRD/MMUD, 1 antigen; n = 27), or haploidentical donor (haplo; n = 129) using PT-Cy between 2012 and 2018. In addition to PT-Cy, agents used in GVHD prophylaxis included calcineurin inhibitors in 239 patients (81%), with mycophenolate mofetil in 184 of those 239 (77%). For grade II-IV acute GVHD, the cumulative incidence at day +100 was 30% (95% confidence interval [CI], 25% to 36%), 9% (95% CI, 5% to 12%) for grade III-IV acute GVHD, and 27% (95% CI, 21% to 32%) for chronic GVHD (limited, 21%; extensive, 6%), with no differences by donor type. The median time to neutrophil engraftment was 19d (95% CI, 18-19), with no significant difference by donor type. The median time to platelet engraftment was delayed in haploidentical donor graft recipients (27 days versus 21 days; P < .001). Two-year OS, PFS, GRFS, and NRM were 51% (95% CI, 45% to 58%), 26% (95% CI, 20% to 32%), 24% (95% CI, 18% to 30%), and 19% (95% CI, 14% to 24%), respectively, with no significant difference between different donor types. In multivariable analyses, compared with the haplo donors, the use of MRDs was associated with significantly better OS (hazard ratio [HR], 0.6; 95% CI, 0.38 to 0.95; P = .029), and the use of MUDs was associated with a significantly higher GRFS (HR, 0.63; 95% CI, 0.42 to 0.97; P = .034). There was a trend toward improved PFS with use of MUDs (HR, 0.69; 95% CI, 0.46 to 1.04; P = .08). Our data show that PT-Cy in MM patients undergoing allo-HCT resulted in low rates of acute and chronic GVHD and led to favorable survival, especially in the matched related donor setting. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Firoozeh Sahebi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California/ Southern California Kaiser Permanente Medical Group, Los Angeles, California; Southern California Kaiser Permanente Medical Group, Los Angeles, California.
| | - Dirk-Jan Eikema
- European Society for Blood and Marrow Transplantation Data Office, Leiden, The Netherlands
| | | | - Nicolaus Kroger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ellen Meijer
- Department of Haematology, VU Medical Centre, Amsterdam, the Netherlands
| | - Jaap A van Doesum
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Montserrat Rovira
- Institute of Hematology and Oncology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Yener Koc
- Stem Cell Transplant Unit, Medical Park Hospitals, Antalya, Turkey
| | | | - Didier Blaise
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | | | - Andrew McDonald
- Department of Hematology, Netcare Pretoria East Hospital, Pretoria Gauteng, South Africa
| | | | - James F Sanchez
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California/ Southern California Kaiser Permanente Medical Group, Los Angeles, California
| | | | - Luca Castagna
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | | | - Jaime Sanz
- Medical Clinic III, Grosshadern Clinic, Munich, Germany
| | | | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - David Valcarcel
- Hematology Department of Hospital Universitario Vall d'Hebron, Barcelona, Barcelona, Spain
| | | | - Patrick J Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | - Meral Beksac
- Hematology Department, Ankara University School of Medicine, Ankara, Turkey
| | | | - Stefan Schönland
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
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Vagge S, Esposito D, Tramontano D, Corvò R, Angelucci E, Dominietto A. PO-1076 Hypofractionated Total Marrow Irradiation in second allogeneic hematopoietic stem cell transplantats. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07527-7] [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: 11/16/2022]
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Guolo F, Di Grazia C, Minetto P, Raiola AM, Clavio M, Miglino M, Tedone E, Contini P, Mangerini R, Kunkl A, Colombo N, Pugliese G, Carminati E, Marcolin R, Passannante M, Bagnasco S, Galaverna F, Lamparelli T, Ballerini F, Cagnetta A, Cea M, Gobbi M, Bacigalupo A, Lemoli RM, Angelucci E. Pre-transplant minimal residual disease assessment and transplant-related factors predict the outcome of acute myeloid leukemia patients undergoing allogeneic stem cell transplantation. Eur J Haematol 2021; 107:573-582. [PMID: 34297437 DOI: 10.1111/ejh.13694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 12/27/2022]
Abstract
We studied pretransplant minimal residual disease (MRD) in 224 patients (median age 44 years; range 17-65) with acute myeloid leukemia (AML) undergoing allogeneic stem cell transplant (HSCT) in complete remission. MRD was evaluated on marrow samples using multicolor flow cytometry and assessment of WT1 gene expression. Both methods showed a strong prognostic value and their combination allowed the identification of three groups of patients with different risk of relapse. In multivariate analysis, combined MRD was the only predictor of cumulative incidence of relapse, regardless of donor type, conditioning regimen, first or second CR at HSCT, HSCT year, and ELN risk group. Multivariate regression model showed that only negative combined MRD status (P < .001) and myeloablative conditioning (P = .004) were independently associated with better OS. Among MRD-positive patients, a reduced incidence of relapse was observed in patients receiving haplo transplant (P < .05) and in patients who showed grade II-IV aGVHD (P < .03). In patients with negative combined MRD, the intensity of conditioning regimen did not affect the overall favorable outcome. We suggest that pretransplant MRD evaluation combined with transplant-related factors can identify AML patients at higher risk for relapse and might help in defining the overall transplant strategy.
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Affiliation(s)
- Fabio Guolo
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Paola Minetto
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Marino Clavio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Maurizio Miglino
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Paola Contini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | | | - Girolamo Pugliese
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Enrico Carminati
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Riccardo Marcolin
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Monica Passannante
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Samuele Bagnasco
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Federica Galaverna
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Filippo Ballerini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Antonia Cagnetta
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Michele Cea
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Marco Gobbi
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Roberto Massimo Lemoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
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42
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Battipaglia G, Mauff K, Wendel L, Angelucci E, Mohty M, Arcese W, Santarone S, Rubio MT, Kroger N, Fox ML, Blaise D, Iori AP, Fanin R, Chalandon Y, Pioltelli P, Marotta G, Chiusolo P, Sever M, Solano C, Contentin N, de Wreede LC, Czerw T, Hernandez-Boluda JC, Hayden P, McLornan D, Yakoub-Agha I. Thiotepa-busulfan-fludarabine (TBF) conditioning regimen in patients undergoing allogeneic hematopoietic cell transplantation for myelofibrosis: an outcome analysis from the Chronic Malignancies Working Party of the EBMT. Bone Marrow Transplant 2021; 56:1593-1602. [PMID: 33526919 DOI: 10.1038/s41409-021-01222-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/20/2020] [Accepted: 01/11/2021] [Indexed: 01/31/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only curative option in MF. There is no consensus on the optimal conditioning regimen. We report outcomes of 187 patients with MF transplanted between 2010 and 2017 conditioned with TBF. Median age was 58 years. Median interval from diagnosis to allo-HCT was 44 months. Donors were haploidentical (41%), unrelated (36%) or HLA-identical siblings (23%). Stem cell source was PB in 60%. Conditioning was myeloablative in 48% of cases. Antithymocyte globulin (ATG) was used in 41% of patients. At 100 days, neutrophil and platelet engraftment were 91% and 63% after a median of 21 and 34 days, respectively. Grade II-IV and III-IV acute GVHD occurred in 24% and 12%, while at 3 years, all grade chronic GVHD and chronic extensive GVHD had been diagnosed in 38% and 11%. At 3 years, OS, RFS and GRFS were 55%, 49% and 43%, respectively. RI and NRM were 17% and 33%. On multivariate analysis, poor KPS and the use of unrelated donors were associated with worse GRFS and a higher grade II-IV acute GVHD, respectively. Neither donor type nor intensity of the conditioning regimen influenced survival outcomes. TBF is a feasible conditioning regimen in allo-HCT for MF in all donor settings although longer term outcomes are required.
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Affiliation(s)
- Giorgia Battipaglia
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
| | | | | | | | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France
| | - William Arcese
- Hematology, Stem Cell Transplant Unit, University Tor Vergata, Rome, Italy
| | - Stella Santarone
- Ospedale Civile Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Pescara, Italy
| | - Marie Therese Rubio
- Department of Hematology, Hôpital Brabois, CHRU Nancy and CNRS UMR 7365, Biopole del'Université del Lorraine, Vendoeuvre les Nancy, France
| | - Nicolaus Kroger
- Department of Stem Cell Transplantation, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Laura Fox
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), University Hospital Vall d'Hebron, Barcelona, Spain
| | - Didier Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Anna Paola Iori
- Hematology, Department of Translational and Precision Medicine, University Sapienza, Rome, Italy
| | - Renato Fanin
- Division of Hematology and Stem Cell Transplantation, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Yves Chalandon
- Division of Hematology, University of Geneva Hospitals, Geneva, Switzerland
| | - Pietro Pioltelli
- Hematology Division and Bone Marrow Transplantation Unit, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Marotta
- Department of Oncology, UOSA Transplant and Cellular Therapy Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Patrizia Chiusolo
- Fondazione Policlinico A. Gemelli IRCCS, Roma, Italy.,Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Matjaz Sever
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Carlos Solano
- Hematology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain
| | | | - Liesbeth C de Wreede
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Tomasz Czerw
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
| | | | - Patrick Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | - Donal McLornan
- Department of Haematology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
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43
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Orlando A, Mocciaro F, Ventimiglia M, Renna S, Rispo A, Scribano ML, Testa A, Aratari A, Bossa F, Angelucci E, Onali S, Cappello M, Giunta M, Scimeca D, Macaluso FS, Castiglione F, Papi C, Annese V, Biancone L, Kohn A, Di Mitri R, Cottone M. Azathioprine for prevention of clinical recurrence in Crohn's disease patients with severe endoscopic recurrence: an IG-IBD randomized double-blind trial. Eur Rev Med Pharmacol Sci 2021; 24:11356-11364. [PMID: 33215456 DOI: 10.26355/eurrev_202011_23627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The recurrence of Crohn's Disease after ileo-colonic resection is a crucial issue. Severe endoscopic lesions increase the risk of developing early symptoms. Prevention and treatment of post-operative Endoscopic Recurrence (ER) have been studied with conflicting results. We compare effi cacy of azathioprine (AZA) vs. high-dose 5-aminosalicylic acid (5-ASA) in preventing clinical recurrence and treating severe post-operative ER. PATIENTS AND METHODS We performed a 1-year multicenter randomized double-blind double-dummy trial. Primary end-points were endoscopic improvement and therapeutic failure (clinical recurrence or drug discontinuation due to lack of efficacy or adverse events) 12 months after randomization. We also performed a post-trial analysis on symptomatic and endoscopic outcomes 10 years after the beginning of the trial, with a median follow-up of 60 months. RESULTS Therapeutic failure occurred in 8 patients (17.4%) within 12 months from randomization, with no significant difference between patients treated with 5-ASA (20.8%, 5 patients) and those with AZA (13.6%, 3 patients). Therapeutic failure was due to clinical recurrence in the 5-ASA group and to adverse events in the AZA group. Endoscopic improvement at 12 months was observed in 8 patients, 2 (11.8%) in the 5-ASA group and 6 (30%) in the AZA group. No serious adverse event was recorded. At the post-trial analysis (median follow-up 60 months), 47.8% (22/46) of patients experienced clinical recurrence: 54.2% (13/24) in the 5-ASA group and 40.9% (9/22) in the AZA group, p=0.546. Patients treated with AZA had lower risk of drug escalation. Clinical recurrence was associated with smoking (p=0.031) and previous surgery (p=0.003). CONCLUSIONS Our trial indicates that there was no difference in terms of treatment failure between 5-ASA and AZA in patients with severe ER. The main limit of AZA is its less favorable safety profile.
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Affiliation(s)
- A Orlando
- IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy.
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44
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Nagler A, Kanate AS, Labopin M, Ciceri F, Angelucci E, Koc Y, Gülbas Z, Arcese W, Tischer J, Pioltelli P, Ozdogu H, Afanasyev B, Wu D, Arat M, Peric Z, Giebel S, Savani B, Mohty M. Post-transplant cyclophosphamide versus anti-thymocyte globulin for graft-versus-host disease prevention in haploidentical transplantation for adult acute lymphoblastic leukemia. Haematologica 2021; 106:1591-1598. [PMID: 32354866 PMCID: PMC8168508 DOI: 10.3324/haematol.2020.247296] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 01/12/2020] [Accepted: 04/28/2020] [Indexed: 11/16/2022] Open
Abstract
Graft-versus-host disease (GVHD) prophylaxis for unmanipulated haploidentical hematopoietic cell transplantation (haplo-HCT) include post-transplant cyclophosphamide (PTCy) and anti-thymocyte globulin (ATG). Utilizing EBMT registry, we compared ATG versus PTCy based GVHD prophylaxis in adult acute lymphoblastic leukemia (ALL) patients undergoing haplo-HCT. Included were 434 patients; ATG (n=98) and PTCy (n=336). Median follow-up was ~2 years. Baseline characteristics were similar between the groups except that the ATG-group was more likely to have relapsed/refractory ALL (P=0.008), non-TBI conditioning (P<0.001), peripheral blood graft source (P=<0.001) and transplanted at an earlier time-period (median year of HCT 2011 vs. 2015). The 100-day grade II-IV and III-IV acute-GVHD was similar between ATG and PTCy, as was 2-year chronic-GVHD. On multivariate analysis (MVA), leukemia-free survival (LFS) and overall survival (OS) was better with PTCy compared to ATG prophylaxis. Relapse incidence (RI) was lower in the PTCy group (P=0.03), while non-relapse mortality (NRM) was not different. Advanced disease and lower performance score were associated with poorer LFS and OS and advanced disease with inferior GVHD-free/relapse-free survival (GRFS). Peripheral grafts were associated with higher GVHD compared to bone marrow grafts. In ALL patients undergoing unmanipulated haplo-HCT, PTCy for GVHD prevention resulted in lower RI and improved LFS and OS compared to ATG.
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Affiliation(s)
- Arnon Nagler
- Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | | | - Myriam Labopin
- Haematology and EBMT Paris study office / CEREST-TC, Saint Antoine Hospital, Paris, France
| | | | | | - Yener Koc
- Medical Park Hospitals, Stem Cell Transplant Unit, Antalya, Turkey
| | - Zafer Gülbas
- Anadolu Medical Center Hospital, Bone Marrow Transplantation Department, Kocaeli, Turkey
| | - William Arcese
- Tor Vergata University of Rome, Stem Cell Transplant Unit, Rome, Italy
| | | | - Pietro Pioltelli
- Ospedale San Gerardo, Clinica Ematologica dell`Universita Milano-Biocca, Monza, Italy
| | - Hakan Ozdogu
- Baskent University Hospital, Haematology Division, BMT Unit, Adana, Turkey
| | - Boris Afanasyev
- First State Pavlov Medical University of St. Petersburg, Russia
| | - Depei Wu
- First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, China
| | - Mutlu Arat
- Florence Nightingale Sisli Hospital, Hematopoietic SCT Unit, Istanbul, Turkey
| | - Zinaida Peric
- University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sebastian Giebel
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Bipin Savani
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohamad Mohty
- Saint Antoine Hospital and Université Pierre et Marie Curie, Paris, France
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45
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Sanz J, Galimard JE, Labopin M, Afanasyev B, Sergeevich MI, Angelucci E, Kröger N, Koc Y, Ciceri F, Diez-Martin JL, Arat M, Sica S, Rovira M, Aljurf M, Tischer J, Savani B, Ruggeri A, Nagler A, Mohty M. Post-transplant cyclophosphamide containing regimens after matched sibling, matched unrelated and haploidentical donor transplants in patients with acute lymphoblastic leukemia in first complete remission, a comparative study of the ALWP of the EBMT. J Hematol Oncol 2021; 14:84. [PMID: 34049582 PMCID: PMC8161915 DOI: 10.1186/s13045-021-01094-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no information on the impact of donor type in allogeneic hematopoietic stem cell transplantation (HCT) using homogeneous graft-versus-host (GVHD) prophylaxis with post-transplant cyclophosphamide (PTCy) in acute lymphoblastic leukemia (ALL). METHODS We retrospectively analyzed outcomes of adult patients with ALL in CR1 that had received HCT with PTCy as GVHD prophylaxis from HLA-matched sibling (MSD) (n = 78), matched unrelated (MUD) (n = 94) and haploidentical family (Haplo) (n = 297) donors registered in the EBMT database between 2010 and 2018. The median follow-up period of the entire cohort was 2.2 years. RESULTS Median age of patients was 38 years (range 18-76). Compared to MSD and MUD, Haplo patients received peripheral blood less frequently. For Haplo, MUD, and MSD, the cumulative incidence of 100-day acute GVHD grade II-IV and III-IV, and 2-year chronic and extensive chronic GVHD were 32%, 41%, and 34% (p = 0.4); 13%, 15%, and 15% (p = 0.8); 35%, 50%, and 42% (p = 0.01); and 11%, 17%, and 21% (p = 0.2), respectively. At 2 years, the cumulative incidence of relapse and non-relapse mortality was 20%, 20%, and 28% (p = 0.8); and 21%, 18%, and 21% (p = 0.8) for Haplo, MUD, and MSD, respectively. The leukemia-free survival, overall survival and GVHD-free, relapse-free survival for Haplo, MUD, and MSD was 59%, 62%, and 51% (p = 0.8); 66%, 69%, and 62% (p = 0.8); and 46%, 44%, and 35% (p = 0.9), respectively. On multivariable analysis, transplant outcomes did not differ significantly between donor types. TBI-based conditioning was associated with better LFS. CONCLUSIONS Donor type did not significantly affect transplant outcome in patient with ALL receiving SCT with PTCy.
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Affiliation(s)
- Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
- CIBERONC, Instituto Carlos III, Madrid, Spain.
| | - Jacques-Emmanuel Galimard
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Myriam Labopin
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Boris Afanasyev
- RM Gorbacheva Research Institute, Pavlov University, Lva Tolstogo 6/8, 197022, Saint-Petersburg, Russian Federation
| | - Moiseev Ivan Sergeevich
- RM Gorbacheva Research Institute, Pavlov University, Lva Tolstogo 6/8, 197022, Saint-Petersburg, Russian Federation
| | - Emanuele Angelucci
- Hematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Nicolaus Kröger
- Bone Marrow Transplantation Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Yener Koc
- Medicana International, Istanbul, Turkey
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milan, Italy
| | - J L Diez-Martin
- Hematology Department, Hospital GU Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense Madrid, Madrid, Spain
| | - Mutlu Arat
- Florence Nightingale Sisli Hospital, Hematopoietic SCT Unit, Istanbul, Turkey
| | - Simona Sica
- Istituto di Ematologia, Universita Cattolica S. Cuore, Rome, Italy
| | - Montserrat Rovira
- Department of Hematology, Hospital Clinic, Institute of Hematology and Oncology, Barcelona, Spain
- August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre Oncology (Section of Adult Haematolgy/BMT), Riyadh, Saudi Arabia
| | - Johanna Tischer
- Department of Internal Medicine III, Grosshadern, LMU, University Hospital of Munich, Munich, Germany
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Mohamad Mohty
- Department of Hematology, and INSERM UMRs 938, Hopital Saint Antoine, Sorbonne University, Paris, France
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46
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Nabergoj M, Mauff K, Robin M, Kröger N, Angelucci E, Poiré X, Passweg J, Radujkovic A, Platzbecker U, Robinson S, Rambaldi A, Petersen SL, Stölzel F, Stelljes M, Ciceri F, Mayer J, Ladetto M, de Wreede LC, Koster L, Hayden PJ, Czerw T, Hernández-Boluda JC, McLornan D, Chalandon Y, Yakoub-Agha I. Outcomes following second allogeneic haematopoietic cell transplantation in patients with myelofibrosis: a retrospective study of the Chronic Malignancies Working Party of EBMT. Bone Marrow Transplant 2021; 56:1944-1952. [PMID: 33824436 DOI: 10.1038/s41409-021-01271-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/10/2021] [Accepted: 03/10/2021] [Indexed: 11/09/2022]
Abstract
Therapeutic management of patients with primary or secondary myelofibrosis (MF) who experience relapse or graft failure following allogeneic haematopoietic cell transplantation (allo-HCT) remains heterogeneous. We retrospectively analyzed 216 patients undergoing a second allo-HCT for either relapse (56%) or graft failure (31%) between 2010 and 2017. Median age was 57.3 years (range 51-63). The same donor as for the first allo-HCT was chosen in 66 patients (31%) of whom 19 received an HLA-identical sibling donor, whereas a different donor was chosen for 116 patients (54%). Median follow-up was 40 months. Three-year overall survival (OS) and relapse-free survival (RFS) were 42% and 39%, respectively. Three-year non-relapse mortality (NRM) and relapse rates were 36% and 25%, respectively. Grade II-IV and III-IV acute GVHD occurred in 25% and 11% of patients, respectively, and the 3-year incidence of chronic GVHD was 33% including 14% for extensive grade. Graft-failure incidence at 1 year was 14%. In conclusion, our data suggest that a second allo-HCT is a potential option for patients failing first allo-HCT for MF albeit careful patient assessment is fundamental to identify individual patients who could benefit from this approach.
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Affiliation(s)
- Mitja Nabergoj
- Division of Hematology, Hôpitaux Universitaires De Genève and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Katya Mauff
- EBMT Statistical Unit Date Office, Leiden, the Netherlands
| | - Marie Robin
- Hôpital Saint-Louis, APHP, Université Paris 7, Paris, France
| | | | - Emanuele Angelucci
- Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium
| | | | | | - Uwe Platzbecker
- Department of Hematology and Cellular Therapy, University Hospital of Leipzig, Leipzig, Germany
| | | | - Alessandro Rambaldi
- University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | | | | | - Jiri Mayer
- University Hospital Brno, Brno, Czech Republic
| | | | - Liesebeth C de Wreede
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Patrick J Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | - Tomasz Czerw
- Maria Skłodowska-Curie Institute - Cancer Center, Gliwice Branch, Gliwice, Poland
| | | | - Donal McLornan
- Department of Haematology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Yves Chalandon
- Division of Hematology, Hôpitaux Universitaires De Genève and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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47
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Nagler A, Labopin M, Houhou M, Aljurf M, Mousavi A, Hamladji RM, Al Zahrani M, Bondarenko S, Arat M, Angelucci E, Koc Y, Gülbas Z, Sica S, Bourhis JH, Canaani J, Brissot E, Giebel S, Mohty M. Outcome of haploidentical versus matched sibling donors in hematopoietic stem cell transplantation for adult patients with acute lymphoblastic leukemia: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. J Hematol Oncol 2021; 14:53. [PMID: 33794963 PMCID: PMC8017786 DOI: 10.1186/s13045-021-01065-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background Non-T-cell depleted haploidentical hematopoietic stem cell transplantation (HaploSCT) is being increasingly used in acute lymphoblastic leukemia (ALL) with improving patient outcomes. We have recently reported that outcomes of adult patients (pts) with ALL in complete remission (CR) receiving HaploSCT are comparable to unrelated donor transplants. We now compared HaploSCT and matched sibling donor (MSD) transplants in pts with ALL. Aim To assess transplantation outcomes of HaploSCT and MSD transplants in pts with ALL in CR. Methods We retrospectively analyzed adult patients (≥ 18 years) with ALL who underwent their first allogeneic stem cell transplantation (alloSCT) in first or second CR between 2012 and 2018, either from a T cell replete Haplo or MSD donor, and whose data were reported to the Acute Leukemia Working Party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT). Multivariate analysis (MVA) adjusting for differences between the groups was performed using the Cox proportional hazards regression model. Propensity score matching was also performed to reduce confounding effects. Results The analysis comprised 2304 patients: HaploSCT-413; MSD-1891. Median follow-up was 25 months. Median age was 37 (range 18–75) and 38 (18–76) years in HaploSCT and MSD, respectively. HaploSCT patients were transplanted more recently than those transplanted from MSD (2016 vs 2015, p < 0.0001). A higher rate of HaploSCT was in CR2 (33.4% vs 16.7%, p < 0.0001), respectively, and fewer received myeloablative conditioning (68% vs 83.2%, p < 0.0001). Cytomegalovirus (CMV) seropositivity was lower in HaploSCT patients (22% vs 28%, p = 0.01) and donors (27.1% vs 33%, p < 0.02), and a higher proportion of the HaploSCTs were performed using a bone marrow (BM) graft (46.2% vs 18.6%, p < 0.0001). The 2 groups did not differ with regard to gender, Karnofsky performance status score, ALL phenotype, Philadelphia chromosome (Ph) positivity and pre-alloSCT measurable residual disease (MRD). Graft versus host disease (GVHD) prophylaxis was mainly post-transplant cyclophosphamide (PTCy) based (92.7%) in the HaploSCT setting, while it was mostly pharmacologic in the setting of MSD (18.7% received ATG). Cumulative incidence of engraftment at day 60 was higher in MSD transplants compared to HaploSCT (98.7% vs 96.3%, p = 0.001), respectively. Day 180 incidence of acute (a) GVHD II-IV and III-IV was higher in HaploSCT vs. MSD: 36.3% vs 28.9% (p = 0.002 and 15.2% vs 10.5% (p = 0.005), respectively. Conversely, the 2-year chronic (c) GVHD and extensive cGVHD were 32% vs 38.8% (p = 0.009) and 11.9% vs 19.5% (p = 0.001) in HaploSCT vs MSD, respectively. Main causes of death were leukemia (31.8% vs 45%), infection (33.1% vs 19.7%) and GVHD (16.6% vs 19.7%) for HaploSCT and MSD, respectively. Two-year relapse incidence (RI), non-relapse mortality (NRM), leukemia-free survival (LFS), overall survival (OS) and GVHD-free, relapse-free survival (GRFS) were 26% vs 31.6%, 22.9% vs 13%, 51% vs 55.4%, 58.8% vs 67.4% and 40.6% vs 39% for HaploSCT and MSD, respectively. In the MVA, RI was significantly lower in HaploSCT in comparison with MSD, hazard ratio (HR) = 0.66 (95% CI 0.52–0.83, p = 0.004), while NRM was significantly higher, HR = 1.9 (95% CI 1.43–2.53, p < 0.0001). aGVHD grade II-IV and grade III-IV were higher in HaploSCT than in MSD HR = 1.53 (95% CI 1.23–1.9, p = 0.0002) and HR = 1.54 (95% CI 1.1–2.15, p = 0.011), respectively. Extensive cGVHD was lower in HaploSCT compared with MSD, HR = 0.61 (95% CI 0.43–0.88, p = 0.007), while total cGVHD did not differ significantly, HR = 0.94 (95% CI 0.74–1.18, p = 0.58). LFS, OS and GRFS did not differ significantly between the 2 transplant groups, HR = 0.96 (95% CI 0.81–1.14, p = 0.66); HR = 1.18 (95% CI 0.96–1.43, p = 0.11) and HR = 0.93 (95% CI 0.79–1.09, p = 0.37), respectively. These results were confirmed in a matched-pair analysis. Conclusions Outcomes of adult patients with ALL in CR receiving alloSCT from haploidentical donors are not significantly different from those receiving transplants from MSD in terms of LFS, OS and GRFS. Supplementary Information The online version contains supplementary material available at 10.1186/s13045-021-01065-7.
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Affiliation(s)
- Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | | | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ashrafsadat Mousavi
- Shariati Hospital, Hematology-Oncology and BMT Research, Tehran, Islamic Republic of Iran
| | - Rose-Marie Hamladji
- Service Hématologie Greffe de Moëlle, Centre Pierre Et Marie Curie, Alger, Algeria
| | | | - Sergey Bondarenko
- Raisa Gorbacheva Memorial Institute of Children Oncology Hematology and Transplantation, First Pavlov State Medical University, Saint-Petersburg, Russian Federation
| | - Mutlu Arat
- Hematopoietic Stem Cell Transplantation Unit, Sisli Florence Nightingale Hospital, Istanbul, Turkey
| | - Emanuele Angelucci
- Hematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Yener Koc
- Medicana International, Istanbul, Turkey
| | - Zafer Gülbas
- Bone Marrow Transplantation Department, Anadolu Medical Center Hospital, Kocaeli, Turkey
| | - Simona Sica
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.,Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, France
| | - Jean Henri Bourhis
- Department of Hematology, Gustave Roussy Cancer Center, Villejuif, France
| | - Jonathan Canaani
- Hematology Division, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eolia Brissot
- Hematology Department, Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, Paris, France
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Hematology-Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Mohamad Mohty
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
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48
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Nagler A, Labopin M, Koc Y, Angelucci E, Tischer J, Arat M, Pioltelli P, Bernasconi P, Chiusolo P, Diez-Martin JL, Sanz J, Ciceri F, Peric Z, Giebel S, Canaani J, Mohty M. Outcome of T-cell-replete haploidentical stem cell transplantation improves with time in adults with acute lymphoblastic leukemia: A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Cancer 2021; 127:2507-2514. [PMID: 33739471 DOI: 10.1002/cncr.33522] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/31/2021] [Accepted: 02/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of haploidentical hematopoietic cell transplantation (haplo-HCT) with posttransplantation cyclophosphamide prophylaxis is gaining traction in patients with acute lymphoblastic leukemia (ALL). METHODS The Acute Leukemia Working Party/European Society for Blood and Marrow Transplantation registry was used to evaluate the outcomes of adult patients with ALL who underwent haplo-HCT during 2011 through 2015 and compared them with the outcomes of those who underwent transplantation during 2016 through 2018. RESULTS The analysis consisted of 195 patients, including 79 who underwent transplantation during 2011 through 2015 and 116 who underwent transplantation during 2016 through 2018. Overall, the 2-year leukemia-free survival and relapse incidence rates were 56.5% and 21%, respectively. The 100-day incidence of grade 2 through 4 acute graft-vs-host disease (GVHD) was 34.5%. The rates of nonrelapse mortality (NRM) and overall survival (OS) were 22.5% and 64.7%, respectively. Patients who underwent transplantation during 2016 through 2018 experienced improved rates of leukemia-free survival (64.9% vs 47.3%; P = .019) and OS (75.5% vs 53.5%; P = .006). Patients who underwent transplantation during 2016 through 2018 developed more grade 2 through 4 acute GVHD (42% vs 26.4%; P = .047). The incidence of relapse, GVHD-free/relapse-free survival, grade 3 and 4 acute GVHD, chronic GVHD, and extensive chronic GVHD did not differ significantly between groups. In multivariate analysis, more recently transplanted patients had a significantly reduced risk of NRM (hazard ratio, 0.44; 95% CI, 0.22-0.89; P = .022) and improved OS (hazard ratio, 0.47; 95% CI, 0.26-0.86; P = .014). A comparable analysis of patients who had acute myeloid leukemia during the same timeframes did not reveal any statistically significant differences in any outcomes. CONCLUSIONS The outcome of adult patients with ALL who receive posttransplant cyclophosphamide has improved over time, with an impressive 2-year OS of 75% and, most recently, an NRM rate of only 17%.
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Affiliation(s)
- Arnon Nagler
- Hematology Division, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat-Gan, Israel.,European Society for Blood and Marrow Transplantation Acute Leukemia Working Party, St Anthony Hospital, Paris, France
| | - Myriam Labopin
- European Society for Blood and Marrow Transplantation Acute Leukemia Working Party, St Anthony Hospital, Paris, France
| | - Yener Koc
- Bone Marrow Transplant Unit, Medicana International, Istanbul, Turkey
| | - Emanuele Angelucci
- Hematology and Transplant Unit, IRCCS San Martino Hospital Polyclinic, Genoa, Italy
| | | | - Mutlu Arat
- Hematopoietic Stem Cell Transplant Unit, Florence Nightingale Sisli Hospital, Istanbul, Turkey
| | - Pietro Pioltelli
- Hematological Clinic of the University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Paolo Bernasconi
- Bone Marrow Transplant Unit, Hematology Clinic, IRCCS Foundation San Matteo Polyclinic, Pavia, Italy
| | - Patrizia Chiusolo
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - J L Diez-Martin
- Bone Marrow Transplant Section, Gregorio Maranon Hospital, Madrid, Spain
| | - Jamie Sanz
- Hematology Department, University Hospital LaFe, Valencia, Spain
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation, San Raffaele Hospital, Milan, Italy
| | - Zinaida Peric
- Bone Marrow Transplant Unit, University Hospital Center Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sebastian Giebel
- Institute of Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Gliwice, Poland
| | - Jonathan Canaani
- Hematology Division, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat-Gan, Israel
| | - Mohamad Mohty
- European Society for Blood and Marrow Transplantation Acute Leukemia Working Party, St Anthony Hospital, Paris, France
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49
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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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50
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Ruggeri A, Labopin M, Angelucci E, Blaise D, Ciceri F, Koc Y, Chiusolo P, Diez-Martin JL, Gülbas Z, Castagna L, Bruno B, Arat M, Martino M, Nagler A, Mohty M. Prognostic factors for neutrophil engraftment after haploidentical cell transplantation with PT-Cy in patients with acute myeloid leukemia in complete remission, on behalf of the ALWP-EBMT. Bone Marrow Transplant 2021; 56:1842-1849. [PMID: 33674790 DOI: 10.1038/s41409-021-01248-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 11/09/2022]
Abstract
The use of haplo-HCT with posttransplant cyclophosphamide (PT-Cy) is a new standard in the treatment of hematological diseases. A paucity of data exists on risk factors for engraftment failure in haplo-HCT with PT-Cy. We analyzed 1939 adults with acute myeloid leukemia (AML) who received a first haplo-HCT from 2010 to 2019. Status at haplo-HCT was first complete remission (CR1) in 72.5% of patients, secondary AML was reported in 9.9%. Median follow-up was 24.4 months and median age at haplo-HCT was 51 years. Stem cell source was bone marrow (BM) in 42% and peripheral blood stem cell (PBSC) in 58%, and 64% of patients received a myeloablative conditioning (MAC) regimen. Cumulative incidence of primary graft failure (GF) was 6%; GF was reported in 110 patients and 54 died before day +30 with no sign of cell recovery. Overall, 33 patients underwent a second HCT in a median time of 45 days and 13 were alive at last follow-up, the 2-year overall survival (OS) after second HCT being 32.4%. In multivariate analysis, factors independently associated with the risk of nonengraftment were: secondary AML (HR 1.30, p = 0.003), use of RIC (HR 1.22, p < 0.001), and use of BM (HR 1.21, p < 0.001). At 2 years, leukemia-free survival (LFS) and OS for the entire population was 55.2% (95% CI: 52.6-57.6) and 60.9% (95% CI: 58.4-63.3), respectively. Incidence of GF after haplo-HCT with PT-Cy is lower than reported T-cell-depleted haplo-HCT. Optimization of conditioning regimen and graft source should be considered for reducing the risk of GF in haplo-HCT recipients using PT-Cy.
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Affiliation(s)
- Annalisa Ruggeri
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Myriam Labopin
- Department of Haematology and EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Paris, France
| | - Emanuele Angelucci
- Hematology and Transplant Center, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Didier Blaise
- Department of Hematology, Institute Paoli-Calmettes, Marseille, France
| | - Fabio Ciceri
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Yener Koc
- Medicana International, Istanbul, Turkey
| | - Patrizia Chiusolo
- Istituto di Ematologia, Fondazione Policlinico Universitario Gemelli, IRCCS, Roma, Italy
| | - Jose Luiz Diez-Martin
- Haematology and Haemotherapy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Zafer Gülbas
- Bone Marrow Transplantation Department, Anadolu Medical Center Hospital, Kocaeli, Turkey
| | - Luca Castagna
- Department of Hematology, Humanitas Clinical and Research Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rozzano, Italy
| | - Benedetto Bruno
- SSCVD Trapianto di Cellule Staminali, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mutlu Arat
- Hematopoietic SCT Unit, Florence Nightingale Sisli Hospital, Istanbul, Turkey
| | - Massimo Martino
- Stem Cell Transplant and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano, Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mohamad Mohty
- Department of Haematology and EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Paris, France.,Sorbonne University and INSERM UMRs 938, Paris, France
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