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Passucci M, Laganà A, Donzelli L, Masucci C, Genoese A, Chistolini A, Baldacci E, Santoro C. Fostamatinib combined with TPO-RAs or steroids as a bridge to monotherapy or as time-limited continuous treatment in relapsed chronic ITP: A single-centre case series. Br J Haematol 2024. [PMID: 38563350 DOI: 10.1111/bjh.19450] [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: 12/04/2023] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Mauro Passucci
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I- Sapienza University, Rome, Italy
| | - Alessandro Laganà
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I- Sapienza University, Rome, Italy
| | - Livia Donzelli
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I- Sapienza University, Rome, Italy
| | - Chiara Masucci
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I- Sapienza University, Rome, Italy
| | - Angelo Genoese
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I- Sapienza University, Rome, Italy
| | - Antonio Chistolini
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I- Sapienza University, Rome, Italy
| | - Erminia Baldacci
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I- Sapienza University, Rome, Italy
| | - Cristina Santoro
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I- Sapienza University, Rome, Italy
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Mazzucconi MG, Rodeghiero F, Avvisati G, De Stefano V, Gugliotta L, Ruggeri M, Vianelli N, Fazi P, Paoloni F, Sargentini V, Baldacci E, Ferretti A, Martino B, Vincelli ID, Carli G, Fortuna S, Di Ianni M, Ranalli P, Palandri F, Polverelli N, Lugli E, Rivolti E, Patriarca A, Rago A, D'Adda M, Gentile M, Siragusa S, Sibilla S, Carella AM, Rossi E, Battistini R, Zaja F, Bocchia M, Di Renzo N, Musto P, Crugnola M, Giuffrida AC, Krampera M, Tafuri A, Santoro C. Prednisone vs high-dose dexamethasone in newly diagnosed adult primary immune thrombocytopenia: a randomized trial. Blood Adv 2024; 8:1529-1540. [PMID: 38231017 DOI: 10.1182/bloodadvances.2023010975] [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: 06/20/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
ABSTRACT A debate exists regarding which type of corticosteroids (standard-dose prednisone [PDN] or high-dose dexamethasone [HD-DXM]) is the best first-line treatment for adult patients with newly diagnosed untreated primary immune thrombocytopenia (pITP). An ad hoc study compared PDN with HD-DXM in newly diagnosed untreated patients with pITP (aged ≥18 but ≤80 years, platelet count of ≤20 or >20 but <50 × 109/L, and bleeding score of ≥8). Patients were randomised to receive PDN 1 mg/kg per day from days 0 to 28 (Arm A) or HD-DXM 40 mg per day for 4 days, every 14 days, for 3 consecutive courses (Arm B). Fifty-nine of 113 patients (52.2%) were randomized to Arm A and 54 of 113 (47.8%) to Arm B. In evaluable patients, total initial responses (complete response [CR], partial response [PR], minimal response [MR]) were 44 of 56 (78.57%) in Arm A and 46 of 49 (93.88%) in Arm B at days 42 and 46, respectively (P = 0.0284). Total final responses (at day 180 from initial response) were 26 of 43 (60.47%) in Arm A and 23 of 39 (58.97%) in Arm B (P = 0.8907). Total persistent responses (at 12 months from initial response) were 25 of 31 (80.65%) in Arm A and 20 of 36 (55.56%) in Arm B (P = 0.0292). Seven relapses occurred. Median follow-up was 44.4 months. Overall survival was 100% at 48 months, overall disease-free survival was 81.11% at 48 months from day 180. PDN and pulsed HD-DXM were well tolerated; HD-DXM allows effective initial responses but less long lasting than PDN. This trial was registered at www.clinicaltrials.gov as #NCT00657410.
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Affiliation(s)
- Maria Gabriella Mazzucconi
- Hematology, Dipartimento Medicina Traslazionale e di Precisione, Università degli Studi Sapienza, Rome, Italy
| | - Francesco Rodeghiero
- Hematology Project Foundation, Vicenza Affiliated to the Department of Hematology, San Bortolo Hospital, Vicenza, Italy
| | | | - Valerio De Stefano
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Luigi Gugliotta
- Unità Operativa Complessa di Ematologia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Marco Ruggeri
- Unità Operativa Complessa (UOC) Ematologia, Azienda Unità Locale Socio Sanitaria 8 Berica-Ospedale di Vicenza, Vicenza, Italy
| | - Nicola Vianelli
- Istituto di Ematologia Seràgnoli, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - Paola Fazi
- Gruppo Italiano Malattie EMatologiche Adulto Foundation, Franco Mandelli Onlus, Rome, Italy
| | - Francesca Paoloni
- Gruppo Italiano Malattie EMatologiche Adulto Foundation, Franco Mandelli Onlus, Rome, Italy
| | - Valeria Sargentini
- Gruppo Italiano Malattie EMatologiche Adulto Foundation, Franco Mandelli Onlus, Rome, Italy
| | - Erminia Baldacci
- UOC Ematologia, Azienda Ospedaliero Universitaria Policlinico Umberto I, Rome, Italy
| | - Antonietta Ferretti
- Hematology, Dipartimento Medicina Traslazionale e di Precisione, Università degli Studi Sapienza, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Bruno Martino
- Dipartimento Emato-Oncologia, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | | | - Giuseppe Carli
- Hematology Project Foundation, Vicenza Affiliated to the Department of Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Stefania Fortuna
- Hematology Project Foundation, Vicenza Affiliated to the Department of Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Mauro Di Ianni
- UOC Ematologia Clinica, Azienda Sanitaria Locale (ASL) Pescara PO Santo Spirito, Pescara, Italy
| | - Paola Ranalli
- UOC Ematologia Clinica, Azienda Sanitaria Locale (ASL) Pescara PO Santo Spirito, Pescara, Italy
| | - Francesca Palandri
- Istituto di Ematologia Seràgnoli, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - Nicola Polverelli
- Struttura Semplice a Valenza Dipartimentale Centro Trapianti Midollo per Adulti, Azienda Socio Sanitaria Territoriale (ASST) degli Spedali civili di Brescia, Brescia, Italy
| | - Elisabetta Lugli
- Ematology, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Elena Rivolti
- Ematology, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Andrea Patriarca
- Struttura Complessa a Direzione Universitaria Ematologia, Azienda Ospedlaiero Universitaria Maggiore della Carità di Novara, Novara, Italy
| | - Angela Rago
- UOC Ematologia, ASL Latina-Ospedale S.M. Goretti, Latina, Italy
| | - Mariella D'Adda
- Unità Operativa (UO) Ematologia, ASST degli Spedali Civili di Brescia, Brescia, Italy
| | - Massimo Gentile
- Hematology Unit, Azienda Ospedaliera of Cosenza, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Sergio Siragusa
- UOC di Ematologia, Azienda Ospedaliera Universitaria Policlinico di Palermo, Palermo, Italy
| | - Silvia Sibilla
- UO Ematologia, Ente Ecclesiastico Cardinale G. Panico, Tricase, Italy
| | - Angelo Michele Carella
- UOC Ematologia e Centro Trapianti Cellule Staminali Emopoietiche, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Elena Rossi
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Roberta Battistini
- UOC Ematologia e Centro Trapianti CSE, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Francesco Zaja
- Dipartimento Scienze Mediche, Università degli Studi di Trieste Unità Complessa Operativa Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Monica Bocchia
- UOC Ematologia e Trapianti, Azienda Ospedlaiero Universitaria Senese Policlinico Le Scotte, Siena, Italy
| | - Nicola Di Renzo
- UOC di Ematologia e Trapianto di Cellule Staminali, Ospedale Vito Fazzi ASL Lecce, Lecce, Italy
| | - Pellegrino Musto
- Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University School of Medicine and Unit of Hematology and Stem Cell Transplantation, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy
| | - Monica Crugnola
- Hematology Unit and Bone Marrow Transplantation Center, Azienda Ospedaliera Universitaria, Parma, Italy
| | - Anna Chiara Giuffrida
- UOC Medicina Trasfusionale, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Mauro Krampera
- UOC di Ematologia e Centro Trapianto di Midollo Osseo, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Agostino Tafuri
- Hematology, University Hospital Sant'Andrea, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Cristina Santoro
- UOC Ematologia, Azienda Ospedaliero Universitaria Policlinico Umberto I, Rome, Italy
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Laganà A, Assanto GM, Masucci C, Passucci M, Donzelli L, Serrao A, Baldacci E, Santoro C, Chistolini A. Secondary Prophylaxis of Venous Thromboembolism (VTE) with Low Dose Apixaban or Rivaroxaban: Results from a Patient Population with More than 2 Years of Median Follow-up. Mediterr J Hematol Infect Dis 2024; 16:e2024020. [PMID: 38468835 PMCID: PMC10927198 DOI: 10.4084/mjhid.2024.020] [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: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
Background Direct oral anticoagulants (DOACs) are widely used for the treatment and secondary prophylaxis of venous thromboembolism (VTE). Nowadays, DOACs represent the gold standard for long-term anticoagulation, with low-intensity DOACs administration becoming increasingly used worldwide in such scenario. Albeit low-intensity apixaban and rivaroxaban are approved for clinical usage as secondary VTE prophylaxis, there are few literature data regarding their efficacy and safety with a long follow-up. Objectives The aim of our study was to evaluate the efficacy and safety of low-dose DOACs for VTE secondary prophylaxis in patients at high risk of VTE recurrence. Methods We retrospectively evaluated patients who required long-term anticoagulant secondary prophylaxis to prevent recurrent VTE, treated with apixaban 2.5 mg BID or rivaroxaban 10 mg daily with a follow-up ≥ 12 months. Results The examined patients were 323. The median low-dose DOAC administration time was 25.40 months (IQR 13.93-45.90). Twelve (3.7%) VTE recurrences were observed; 21 bleeding events were registered (6.5%), including one episode of Major bleeding (MB) (0.3%), 8 Clinically relevant nonmajor bleeding (CRNMB) (2.5%) and 12 minor bleeding (3.7%). No statistically significant difference in the rate of VTE recurrence and/or bleeding events emerged between the rivaroxaban and apixaban groups. Patients included in the study for multiple episodes of VTE presented a significantly higher risk of a new VTE recurrence during low-intensity DOAC. Conclusions Our data suggest that low-dose DOACs may be effective and safe in secondary VTE prophylaxis in patients at high risk of VTE recurrence; however, attention might be needed in their choice in such a scenario for patients who experienced multiple episodes of VTE.
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Affiliation(s)
- Alessandro Laganà
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | | | - Chiara Masucci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Mauro Passucci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Livia Donzelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Alessandra Serrao
- Haematology and Stem Cell Transplant Unit, A. O. San Camillo Forlanini (LR), Rome, Italy
| | - Erminia Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Cristina Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Antonio Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
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Chistolini A, Serrao A, Assanto GM, Genoese A, Baldacci E, Ligia S, Breccia M, Santoro C. Antithrombotic secondary prophylaxis with low dose of apixaban or rivaroxaban in the onco-hematologic patients: comparison with non-neoplastic patients. Ann Hematol 2023; 102:2599-2605. [PMID: 37479891 DOI: 10.1007/s00277-023-05369-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
Management of cancer-associated thrombosis (CAT) is usually performed employing low molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs). Low-intensity DOACs are the mainstay for extended duration therapy for VTE in non-oncologic patients. The aim of our study was to evaluate the efficacy and the safety of low doses of apixaban or rivaroxaban as secondary prophylaxis in patients affected by hematological malignancies with follow-up > 12 months. We report an observational, retrospective, single-center study that evaluated consecutive patients referred to our center between January 2016 and January 2023. The DOACs were administered at full dose during the acute phase of VTE and then at low dose for the extended phase. We included 154 patients: 53 patients affected by hematological malignancies compared to 101 non-neoplastic patients. During full-dose treatment, no thrombotic recurrences were observed in the two groups. During low-dose therapy, 2 (1.9%) thrombotic events (tAE) were observed in the control group. During full-dose treatment, the rate of bleeding events (bAE) was 9/154 (5.8%): 6/53 (11%) in hematological patients and 3/101 (2.9%) in non-hematological patients (p = 0.0003). During low-dose therapy, 4/154 (2.6%) bAE were observed: 3/53 (5.5%) in the hematologic group and 1 (1%) in the control group (p = 0.07). We found encouraging data on the safety and efficacy of low doses of DOACs as secondary prophylaxis in the onco-hematologic setting; no thrombotic complications were observed, and the incidence of hemorrhagic events was low.
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Affiliation(s)
- A Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy.
| | - A Serrao
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - G M Assanto
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - A Genoese
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - E Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - S Ligia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - M Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - C Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
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Ligia S, Musiu P, Serrao A, Santoro C, Taglietti A, Capriata M, Faccini A, Molinari MC, Baldacci E, Chistolini A. Low-dose apixaban or rivaroxaban as secondary prophylaxis of upper extremity deep vein thrombosis. J Thromb Thrombolysis 2023:10.1007/s11239-023-02842-6. [PMID: 37341894 DOI: 10.1007/s11239-023-02842-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
Upper extremity deep vein thrombosis (UEDVT) may occur without inciting factor or may be secondary to malignancy, surgery, trauma, central venous catheter or related to thoracic outlet syndrome (TOS). International guidelines recommend anticoagulant treatment for at least three months, in particular the use of vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). No data on extended anticoagulant therapy and reduced dose of DOACs have been reported in patients affected by UEDVT with persistent thrombotic risk (active cancer, major congenital thrombophilia) or without affected vein recanalization. In our retrospective observational study, including 43 patients, we treated secondary UEDVT with DOACs. In the acute phase of thrombosis (median time of 4 months), we used therapeutic dose of DOACs; the 32 patients with permanent thrombotic risk factors or without recanalization of the UEDVT were shifted to low-dose DOACs (apixaban 2.5 mg twice daily or rivaroxaban 10 mg daily). During therapy with full-dose DOACs, 1 patient presented recurrence of thrombosis; no thromboembolic events were observed during treatment with low-dose DOACs. During full-dose treatment, 3 patients presented minor hemorrhagic complications; no hemorrhagic events were observed during DOACs at low dose. We think our preliminary data could support the indication to extend the anticoagulation with dose reduction of DOACs in patients affected by UEDVT and no-transient thrombotic risk. These data should be confirmed in randomized controlled prospective study.
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Affiliation(s)
- S Ligia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - P Musiu
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - A Serrao
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - C Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - A Taglietti
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - M Capriata
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - A Faccini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - M C Molinari
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - E Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - Antonio Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy.
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Morfini M, Agnelli Giacchiello J, Baldacci E, Carulli C, Castaman G, Giuffrida AC, Malcangi G, Rocino A, Siragusa S, Zanon E. Managing Relevant Clinical Conditions of Hemophilia A/B Patients. Hematol Rep 2023; 15:384-397. [PMID: 37367088 DOI: 10.3390/hematolrep15020039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/21/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
The Medical Directors of nine Italian Hemophilia Centers reviewed and discussed the key issues concerning the replacement therapy of hemophilia patients during a one-day consensus conference held in Rome one year ago. Particular attention was paid to the replacement therapy needed for surgery using continuous infusion (CI) versus bolus injection (BI) of standard and extended half-life Factor VIII (FVIII) concentrates in severe hemophilia A patients. Among the side effects, the risk of development of neutralizing antibodies (inhibitors) and thromboembolic complications was addressed. The specific needs of mild hemophilia A patients were described, as well as the usage of bypassing agents to treat patients with high-responding inhibitors. Young hemophilia A patients may take significant advantages from primary prophylaxis three times or twice weekly, even with standard half-life (SHL) rFVIII concentrates. Patients affected by severe hemophilia B probably have a less severe clinical phenotype than severe hemophilia A patients, and in about 30% of cases may undergo weekly prophylaxis with an rFIX SHL concentrate. The prevalence of missense mutations in 55% of severe hemophilia B patients allows the synthesis of a partially changed FIX molecule that can play some hemostatic role at the level of endothelial cells or the subendothelial matrix. The flow back of infused rFIX from the extravascular to the plasma compartment allows a very long half-life of about 30 h in some hemophilia B patients. Once weekly, prophylaxis can assure a superior quality of life in a large severe or moderate hemophilia B population. According to the Italian registry of surgery, hemophilia B patients undergo joint replacement by arthroplasty less frequently than hemophilia A patients. Finally, the relationships between FVIII/IX genotypes and the pharmacokinetics of clotting factor concentrates have been investigated.
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Affiliation(s)
- Massimo Morfini
- Italian Association of Haemophilia Centers (AICE), 21121 Milan, Italy
| | - Jacopo Agnelli Giacchiello
- Hemostasis and Thrombosis Center, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Erminia Baldacci
- Haematology, "Umberto I" Policlinico, Department of Translational and Precision Medicine, Sapienza University of Rome, 00118 Rome, Italy
| | - Christian Carulli
- Department of Orthopaedic Surgery, Orthopaedic Clinic, University of Florence, 50121 Florence, Italy
| | - Giancarlo Castaman
- Department of Oncology, Center for Bleeding Disorders and Coagulation, Careggi University Hospital, 50121 Florence, Italy
| | | | - Giuseppe Malcangi
- UOSD Centro Emofilia e Trombosi, Azienda Ospedaliero Universitaria Policlinico di Bari, 70121 Bari, Italy
| | - Angiola Rocino
- Haemophilia and Thrombosis Centre, Haematology, S.M. di Loreto Nuovo Hospital, 80121 Naples, Italy
| | - Sergio Siragusa
- Department PROMISE, University of Palermo, 90121 Palermo, Italy
| | - Ezio Zanon
- Haemophilia Centre, General Medicine, Padua University Hospital, 35121 Padua, Italy
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Lapietra G, Ferretti A, Baldacci E, Chistolini A, Santoro C. Immune thrombocytopenia management during COVID‐19 pandemic: An Italian monocentric experience. eJHaem 2022; 3:453-456. [PMID: 35602248 PMCID: PMC9110988 DOI: 10.1002/jha2.406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 01/03/2023]
Abstract
Over the last 2 years, different cases of immune thrombocytopenia (ITP) in patients affected by SARS‐CoV2 have been reported. The management of SARS‐CoV2 in subjects with simultaneous or previous ITP can be challenging because of the great involvement of the haemostatic system in this viral infection. In this report, we describe the management and outcome of patients with newly diagnosed (ND), chronic and previous ITP, infected by COVID‐19, referred to the Haematology Institute of University Hospital Policlinico Umberto I in Rome. Steroids + immunoglobulins for ND or relapsed ITP and continuation of home therapy for chronic ITP are advised, although further knowledge is required.
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Affiliation(s)
- Gianfranco Lapietra
- Division of Hematology Department of Translational and Precision Medicine Policlinico Umberto I, Sapienza University of Rome Rome Italy
| | - Antonietta Ferretti
- Division of Hematology Department of Translational and Precision Medicine Policlinico Umberto I, Sapienza University of Rome Rome Italy
| | - Erminia Baldacci
- Division of Hematology Department of Translational and Precision Medicine Policlinico Umberto I, Sapienza University of Rome Rome Italy
| | - Antonio Chistolini
- Division of Hematology Department of Translational and Precision Medicine Policlinico Umberto I, Sapienza University of Rome Rome Italy
| | - Cristina Santoro
- Division of Hematology Department of Translational and Precision Medicine Policlinico Umberto I, Sapienza University of Rome Rome Italy
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Vianelli N, Auteri G, Buccisano F, Carrai V, Baldacci E, Clissa C, Bartoletti D, Giuffrida G, Magro D, Rivolti E, Esposito D, Podda GM, Palandri F. Refractory primary immune thrombocytopenia (ITP): current clinical challenges and therapeutic perspectives. Ann Hematol 2022; 101:963-978. [PMID: 35201417 PMCID: PMC8867457 DOI: 10.1007/s00277-022-04786-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/01/2022] [Indexed: 01/19/2023]
Abstract
Chronic primary immune thrombocytopenia (ITP) can today benefit from multiple therapeutic approaches with proven clinical efficacy, including rituximab, thrombopoietin receptor agonists (TPO-RA), and splenectomy. However, some ITP patients are unresponsive to multiple lines of therapy with prolonged and severe thrombocytopenia. The diagnosis of refractory ITP is mainly performed by exclusion of other disorders and is based on the clinician's expertise. However, it significantly increases the risk of drug-related toxicity and of bleedings, including life-threatening events. The management of refractory ITP remains a major clinical challenge. Here, we provide an overview of the currently available treatment options, and we discuss the emerging rationale of new therapeutic approaches and their strategic combination. Particularly, combination strategies may target multiple pathogenetic mechanisms and trigger additive or synergistic effects. A series of best practices arising both from published studies and from real-life clinical experience is also included, aiming to optimize the management of refractory ITP.
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Affiliation(s)
- Nicola Vianelli
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli, Bologna, Italy
| | - Giuseppe Auteri
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli, Bologna, Italy.,Dipartimento Di Medicina Specialistica, Diagnostica E Sperimentale, Università Di Bologna, Bologna, Italy
| | - Francesco Buccisano
- Dipartimento Di Biomedicina E Prevenzione, Università Tor Vergata, Rome, Italy
| | | | | | | | - Daniela Bartoletti
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli, Bologna, Italy.,Dipartimento Di Medicina Specialistica, Diagnostica E Sperimentale, Università Di Bologna, Bologna, Italy
| | | | | | - Elena Rivolti
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniela Esposito
- Presidio Ospedaliero San G. Moscati Di Aversa - ASL Caserta, Caserta, Italy
| | - Gian Marco Podda
- Medicina III, Ospedale San Paolo, ASST Santi Paolo E Carlo, Dipartimento Di Scienze Della Salute, Università Degli Studi Di Milano, Milano, Italy
| | - Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia "Seràgnoli, Bologna, Italy.
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9
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Di Minno MND, Napolitano M, Giuffrida AC, Baldacci E, Carulli C, Boccalandro E, Bruno C, Forneris E, Ricca I, Passeri W, Martinelli M, Rivolta GF, Solimeno LP, Martinoli C, Rocino A, Pasta G. Diagnosis and treatment of chronic synovitis in patients with haemophilia: consensus statements from the Italian Association of Haemophilia Centres. Br J Haematol 2021; 196:871-883. [PMID: 34923621 PMCID: PMC9299781 DOI: 10.1111/bjh.17919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/28/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023]
Abstract
Although synovitis is recognized as a marker of joint disease activity, its periodic assessment is not included in routine clinical surveillance of patients with haemophilia (PwH). In order to evaluate the current knowledge and to identify controversial issues, a preliminary literature search by the Musculoskeletal Committee of the Italian Association of Haemophilia Centres (AICE) has been conducted. Statements have been established and sent to the Italian AICE members to collect their level of agreement or disagreement by a Delphi process. Thirty‐seven consensus recommendations have been drafted. We found a general agreement on the indication to consider the presence of synovitis as a marker of joint disease activity in PwH. Accordingly, there was agreement on the indication to search for synovitis both in patients reporting joint pain and in asymptomatic ones, recognizing ultrasound as the most practical imaging technique to perform periodic joint screening. Interestingly, after detection of synovitis, there was agreement on the indication to modify the therapeutic approach, suggesting prophylaxis in patients treated on demand and tailoring treatment in patients already under prophylaxis. Whereas the need of an early consultation with a physiotherapist is recommended for PwH affected by chronic synovitis, the exact timing for an orthopaedic surgeon consultation is currently unknown.
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Affiliation(s)
| | - Mariasanta Napolitano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | | | - Erminia Baldacci
- Hematology, University Hospital Policlinico Umberto I, Rome, Italy
| | - Christian Carulli
- Department of Health Sciences, Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Elena Boccalandro
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, IRCCS Cà Granda Foundation, Maggiore Hospital Policlinic, Milan, Italy
| | - Clarissa Bruno
- Haemophilia Center and Thrombosis, Policlinico, Bari, Italy
| | - Eleonora Forneris
- Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Irene Ricca
- Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Walter Passeri
- Rehabilitation Service, "Domus Salutis" Casa di Cura, "Teresa Camplani" Foundation, Brescia, Italy
| | - Marco Martinelli
- Rehabilitation Service, "Domus Salutis" Casa di Cura, "Teresa Camplani" Foundation, Brescia, Italy
| | - Gianna Franca Rivolta
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Luigi Piero Solimeno
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, IRCCS Cà Granda Foundation, Maggiore Hospital Policlinic, Traumatology and Orthopaedic Unit, Milan, Italy
| | - Carlo Martinoli
- Department of Health Science (DISSAL), University of Genoa, Unit of Radiology and IRCCS San Martino Hospital, Genoa, Italy
| | - Angiola Rocino
- Haemophilia and Thrombosis Centre, Haematology, Ospedale del Mare, ASL Napoli 1 Centro, Naples, Italy
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10
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Carpenedo M, Baldacci E, Baratè C, Borchiellini A, Buccisano F, Calvaruso G, Chiurazzi F, Fattizzo B, Giuffrida G, Rossi E, Palandri F, Scalzulli PR, Siragusa SM, Vitucci A, Zaja F. Second-line administration of thrombopoietin receptor agonists in immune thrombocytopenia: Italian Delphi-based consensus recommendations. Ther Adv Hematol 2021; 12:20406207211048361. [PMID: 34646432 PMCID: PMC8504223 DOI: 10.1177/20406207211048361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/06/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction: In patients with primary immune thrombocytopenia (ITP), a short course of steroids is routinely given as first-line therapy. However, the response is often transient and additional therapy is usually needed. Thrombopoietin receptor agonists (TPO-RAs) are frequently used as second-line therapy, although there is little clinical guidance on the timing of their administration and on tapering/discontinuation of the drug. To provide clinical recommendations, we used the Delphi technique to obtain consensus for statements regarding administration and on tapering/discontinuation of second-line TPO-RAs among a group of Italian clinicians with expertise in management of ITP. Methods: The Delphi process was used to obtain agreement on five statements regarding initiation and on tapering/discontinuation of second-line TPO-RAs. Agreement was considered when 75% of participants approved the statement. Eleven experts participated in the voting. Results: Full consensus was reached for three of the five statements. The experts held that an early switch from corticosteroids to a TPO-RA has the dual advantage of sparing patients from corticosteroid abuse and improve long-term clinical outcomes. All felt that dose reduction of TPO-RAs can be considered in patients with a stable response and platelet count >100 × 109/L that is maintained for at least 6 months in the absence of concomitant treatments, although there was less agreement in patients with a platelet count >50 × 109/L. Near consensus was reached regarding the statement that early treatment with a TPO-RA is associated with an increase in clinically significant partial or complete response. The experts also agreed that optimization of tapering and discontinuation of TPO-RA therapy in selected patients can improve the quality of life. Conclusion: The present consensus can help to provide guidance on use of TPO-RAs in daily practice in patients with ITP. Plain language summary Second-line administration of thrombopoietin receptor agonists in immune thrombocytopenia
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Affiliation(s)
- Monica Carpenedo
- Hematology and Transplantation Unit, ASST San Gerardo Hospital, Via G. B. Pergolesi, 33, 20900 Monza MB, Italy
| | - Erminia Baldacci
- Department of Hematology, Policlinico Umberto I University Hospital, Rome, Italy
| | - Claudia Baratè
- Hematology and Bone Marrow Transplant Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandra Borchiellini
- Regional Reference Center of Haemostasis and Thrombosis Haematology Unit, Città della Salute e della Scienza, Turin, Italy
| | - Francesco Buccisano
- Hematology, Department of BioMedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Giuseppina Calvaruso
- Campus of Hematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Federico Chiurazzi
- Department of Clinical Medicine, University "Federico II" of Naples, Naples, Italy
| | - Bruno Fattizzo
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaetano Giuffrida
- Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Elena Rossi
- Department of Radiological and Hematological Sciences, Universita Cattolica del Sacro Cuore and Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Potito Rosario Scalzulli
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | | | - Angelantonio Vitucci
- Haematology with Transplant Unit, Az. Universitario-Ospedaliera Consorziale Policlinico, Bari, Italy
| | - Francesco Zaja
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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11
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Mendicino F, Santoro C, Martino E, Botta C, Baldacci E, Ferretti A, Muto B, Lucia E, Caracciolo D, Vigna E, Morelli M, Gentile M. Eltrombopag treatment for severe immune thrombocytopenia during pregnancy: a case report. Blood Coagul Fibrinolysis 2021; 32:519-521. [PMID: 34520405 DOI: 10.1097/mbc.0000000000001085] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia (platelet count <100 × 109/l) in the absence of other causes or disorders associated. The incidence of ITP in pregnancy is one to two cases per 1000 gestations. ITP could be diagnosed before or during pregnancy; sometimes a relapse of a previously diagnosed ITP can occur. Intravenous immune globulins (IVIg) and corticosteroids are the standard frontline therapy because of their well known safety profile either for the mother or for the neonate. Treatments for refractory patients are limited by potential fetal risk. We report the case of a patient with ITP along pregnancy, refractory to corticosteroids and IVIg, successfully treated with, the thrombopoietin receptor agonist (TPO-RA) eltrombopag. Patient received this compound for almost the whole pregnancy and in particular for the whole first trimester, without any complication for the mother and the neonate. Although transient administration of TPO-RAs in pregnancy seems to be well tolerated, their use during the whole gestation is still controversial; this is the reason of the description of this case, which did not show any complications, and thus it could add useful information on this field.
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Affiliation(s)
| | | | | | | | | | - Antonietta Ferretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome
| | | | | | | | | | - Michele Morelli
- Obstetrics and Gynecology Unit AO of Cosenza, Cosenza, Italy
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12
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Porrazzo M, Baldacci E, Ferretti A, De Luca ML, Barone F, Serrao A, Aprile SM, Capria S, Minotti C, Martelli M, Mazzucconi MG, Chistolini A, Santoro C. Single centre experience on Acquired Haemophilia A patients: Diagnosis, clinical management and analysis of factors predictive of response and outcome. Haemophilia 2021; 27:e667-e674. [PMID: 34382302 DOI: 10.1111/hae.14395] [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: 01/11/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acquired Haemophilia A (AHA) patients show a high response rate to immunosuppressive therapy (IST) but few information about predictors of response and outcome are reported. AIMS We describe a large single-centre AHA cohort, investigating prognostic variables for the 'best response' (BR), time to BR (TTBR) and overall survival (OS). METHODS A total of 61 patients were included, collecting data from clinical charts. RESULTS A progressive increase in diagnoses, from 1978 to 2019, was observed. Fifty/56 patients (89%) underwent haemostatic therapy (rFVIIa 46%, aPCC 34%) with no significant differences in the response (rFVIIa 92.3% vs aPCC 100%) and no thromboembolic events. Sixty/61 patients underwent first-line IST with an initial response rate of 58.4%. The 12-months OS was 85%, the bleeding associated mortality rate 3% (2/61). The response rates at last observation were: CR 64%, PR 8%. We evaluated the influence of age, gender, associated conditions, IST, haemoglobin levels, FVIII:C, inhibitor titre on BR, TTBR and OS: post-partum AHA achieved the BR after a longer time than AHA related to other aetiologies or idiopathic (p = .05); in univariate analysis female sex (p = .03) and the achievement of BR (p = .001) had a positive impact on the OS while AHA secondary to neoplasms showed a shorter survival (p = .04); only the BR achievement remained significant in multivariate analysis (p = .02). CONCLUSIONS Our data on response and survival confirmed those from the main registries. Post-partum AHA and BR achievement were significantly associated to a longer TTBR and a longer OS, respectively. Other predictors of outcome deserve to be explored in prospective studies.
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Affiliation(s)
- Marika Porrazzo
- Haematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Erminia Baldacci
- Haematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Antonietta Ferretti
- Haematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Maria Lucia De Luca
- Haematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Francesco Barone
- Haematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Alessandra Serrao
- Haematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Simona Michela Aprile
- Haematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Saveria Capria
- Haematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Clara Minotti
- Haematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Maurizio Martelli
- Haematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | | | - Antonio Chistolini
- Haematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Cristina Santoro
- Haematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
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13
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Franchini M, Coppola A, Santoro C, De Cristofaro R, Barillari G, Giordano P, Gresele P, Lassandro G, Napolitano M, Lucchini G, Luciani M, Ferretti A, Baldacci E, Riccardi F, Santoro RC, Pasca S, Zanon E, Tagliaferri A. ABO Blood Group and Inhibitor Risk in Severe Hemophilia A Patients: A Study from the Italian Association of Hemophilia Centers. Semin Thromb Hemost 2021; 47:84-89. [PMID: 33525041 DOI: 10.1055/s-0040-1718870] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Considering the profound influence exerted by the ABO blood group system on hemostasis, mainly through the von Willebrand factor and factor VIII (FVIII) complex, we have conducted a study evaluating the possible role of blood type on the risk of inhibitor development in hemophilia A. A total of 287 consecutive Caucasian patients with severe hemophilia A (202 without FVIII inhibitors and 85 with FVIII inhibitors) followed at seven Italian Hemophilia Treatment Centers belonging to the Italian Association of Hemophilia Centers (AICE) were included in the study. A higher prevalence of O blood group was detected in patients without inhibitors as compared in inhibitor patients (55 vs. 30.6%; p < 0.001). Among the other variables analyzed (age, F8 mutation, type and intensity of treatment and treatment regimen), F8 mutation class (high-risk vs. low-risk), and treatment regimen (on-demand vs. prophylaxis) were significantly correlated with inhibitor development. However, on a multivariate analysis, only the effects of F8 mutation and ABO blood type were independent of other covariates, being that non-O blood type is associated with a 2.89-fold increased risk of inhibitor development. In conclusion, our study supports the protective effect of O blood type on inhibitor risk in severely affected hemophilia A patients.
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Affiliation(s)
- Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Antonio Coppola
- Regional Reference Center for Inherited Bleeding Disorders, University Hospital, Parma, Italy
| | - Cristina Santoro
- Department of Hematology, Policlinico Umberto I University Hospital, Rome, Italy
| | - Raimondo De Cristofaro
- Hemorrhagic and Thrombotic Diseases Service, Area of Hematology, Fondazione Policlinico Universitario "A. Gemelli," IRCCS, Rome, Italy
| | - Giovanni Barillari
- Center for Hemorrhagic and Thrombotic Disorders, General and University Hospital, Udine, Italy
| | - Paola Giordano
- Pediatric Unit "B. Trambusti," Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro," Bari, Italy
| | - Paolo Gresele
- Section of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Giuseppe Lassandro
- Pediatric Unit "B. Trambusti," Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro," Bari, Italy
| | - Mariasanta Napolitano
- Hematology Unit, Department of Health Promotion, Mother and Child Care, Reference Regional Center for Thrombosis and Haemostasis, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Giuseppe Lucchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantova, Italy
| | - Matteo Luciani
- Oncohematology Department, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Antonietta Ferretti
- Department of Hematology, Policlinico Umberto I University Hospital, Rome, Italy
| | - Erminia Baldacci
- Department of Hematology, Policlinico Umberto I University Hospital, Rome, Italy
| | - Federica Riccardi
- Regional Reference Center for Inherited Bleeding Disorders, University Hospital, Parma, Italy
| | - Rita Carlotta Santoro
- Center for Hemorrhagic and Thrombotic Disorders, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy
| | - Samantha Pasca
- Hemophilia Center, University Hospital of Padua, Padua, Italy
| | - Ezio Zanon
- Hemophilia Center, University Hospital of Padua, Padua, Italy
| | - Annarita Tagliaferri
- Regional Reference Center for Inherited Bleeding Disorders, University Hospital, Parma, Italy
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14
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Cartoni C, Breccia M, Giesinger JM, Baldacci E, Carmosino I, Annechini G, Palumbo G, Armiento D, Niscola P, Tendas A, Brunetti GA, Minotti C, Marini MG, Reale L, Martone N, Martelli M, Efficace F. Early Palliative Home Care versus Hospital Care for Patients with Hematologic Malignancies: A Cost-Effectiveness Study. J Palliat Med 2020; 24:887-893. [PMID: 33270529 DOI: 10.1089/jpm.2020.0396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There is paucity of data on the potential value of early palliative home care for patients with hematologic malignancies. Objective: To compare costs, use of resources, and clinical outcomes between an early palliative home care program and standard hospital care for active-advanced or terminal phase patients. Patients and Methods: In this real-life, nonrandomized comparative study, the allocation of advanced/terminal phase patients to either home or hospital was based on pragmatic considerations. Analysis focused on resources use, events requiring blood unit transfusions or parenteral therapy, patient-reported symptom burden, mean weekly cost of care (MWC), cost-minimization difference, and incremental cost-effectiveness ratio (ICER). Results: Of 119 patients, 59 patients cared at home were more debilitated and had a shorter survival than the 60 in hospital group (p = 0.001). Nevertheless, symptom burden was similar in both groups. At home the mean weekly number of transfusions (1.45) was lower than that at hospital (2.77). Higher rate of infections occurred at hospital (54%) versus home (21%; <0.001). MWC for hospitalization was significantly higher in a 3:1 ratio versus home care. Compared with hospital, domiciliary assistance produced a weekly saving of € 2314.9 for the health provider, with a charge of € 85.9 for the family, and was cost-effective by an ICER of € -7013.9 of prevented days of care for avoided infections. Conclusions: Current findings suggest that costs of early palliative home care for patients with hematologic malignancies are lower than standard hospital care costs. Domiciliary assistance may also be cost-effective by reducing the number of days to treat infections.
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Affiliation(s)
- Claudio Cartoni
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Erminia Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giorgia Annechini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giovanna Palumbo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | | | | | | | - Clara Minotti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Luigi Reale
- Fondazione ISTUD, Institute of Management Studies, Milan, Italy
| | | | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Health Outcomes Research Unit, Rome, Italy
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15
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Serrao A, Lucani B, Baldacci E, Fiori L, Chistolini A. Direct oral anticoagulants for the treatment of Mondor’s disease not responding to low-molecular weight heparin. Phlebology 2020; 35:734-735. [DOI: 10.1177/0268355520925022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mondor’s disease is a rare condition and usually treated with low-molecular weight heparin and non-steroidal anti-inflammatory drugs. Because of paucity of cases and for the usually spontaneous resolution, there is not a standard treatment strategy and the use of oral anticoagulation in controversial. We reported the efficacy of direct oral anticoagulants in the recurrent Mondor’s disease refractory to standard therapy.
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Affiliation(s)
- Alessandra Serrao
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Benedetta Lucani
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Erminia Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Luciano Fiori
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonio Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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16
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Ferretti A, Baldacci E, Fazio F, Abbruzzese R, Barone F, De Luca ML, Petrucci MT, Chistolini A, Mazzucconi MG, Santoro C. Acquired FXIII deficiency and AL amyloidosis: A case of a rare association. Transfus Apher Sci 2020; 59:102903. [PMID: 32839100 DOI: 10.1016/j.transci.2020.102903] [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: 05/29/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/19/2022]
Affiliation(s)
- A Ferretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy.
| | - E Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - F Fazio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - R Abbruzzese
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - F Barone
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - M L De Luca
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - M T Petrucci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - A Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - M G Mazzucconi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
| | - C Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto, Rome, Italy
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17
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Ferretti A, Baldacci E, Chistolini A, Santoro C. Right elbow arthropathy in a patient with severe haemophilia A. Br J Haematol 2020; 190:484. [PMID: 32383238 DOI: 10.1111/bjh.16707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Antonietta Ferretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Erminia Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Cristina Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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18
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De Padua V, Romeo U, Santoro C, Bosco R, Baldacci E, Ferretti A, Malaspina F, Mazzucconi MG, Gaglioti D. Dental invasive procedures in von Willebrand disease outpatients treated with high purity FVIII/VWF complex concentrate (Fanhdi®): experience of a single center. Heliyon 2020; 6:e03426. [PMID: 32140581 PMCID: PMC7044789 DOI: 10.1016/j.heliyon.2020.e03426] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/18/2019] [Accepted: 02/12/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To retrospectively assess the effectiveness and safety of customized hemostatic protocols using a plasma-derived, von Willebrand Factor (VWF)-containing Factor VIII concentrate (pdVWF/FVIII) in von Willebrand disease (VWD) patients undergoing dental invasive procedures. METHODS Protocol for each patient was drawn up by the Blood Unit based on the VWD type, disease severity, and type of treatment. pdFVIII/VWF infusions and doses were registered at 30-60 min before intervention (t0) and at 12-24-36-48-72 h after intervention (t12-t72) and up to day 7. Any peri- or postoperative bleeding, complication or adverse event was registered. RESULTS Forty-five dental procedures were performed on 20 VWD patients (six type-1, two type-2a, six type-2b, six type-3). Most pdFVIII/VWF infusions at t0 were 60 IU/kg (n = 7) and 50 IU/kg (n = 9). Subsequent infusions were mostly 30-50 IU/kg. No bleeding complications or adverse events were reported. CONCLUSION This study supports the safety and efficacy of pdFVIII/VWF to prevent peri- and postoperative bleeding after invasive oral procedures.
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Affiliation(s)
| | - Umberto Romeo
- Department Head-Neck, Sapienza University, Rome, Italy
| | - Cristina Santoro
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
| | | | - Erminia Baldacci
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
| | - Antonietta Ferretti
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
| | - Francesco Malaspina
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
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19
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Bruzzese A, Santoro C, Baldacci E, Ferretti A, Pieroni S, Serrao A, Foà R, Chistolini A. Antithrombin concentrate during pregnancy in congenital antithrombin deficiency: a single-center experience. Blood Coagul Fibrinolysis 2019; 30:304-307. [PMID: 31419212 DOI: 10.1097/mbc.0000000000000835] [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: 11/25/2022]
Abstract
: Pregnancy carries a high risk of thromboembolic complications, especially in the postpartum period. This risk is particularly high in women with inherited thrombophilias, among these antithrombin deficiency seems to carry the highest risk. In this case, the use of low molecular weight heparin (LMWH) is recommended, while the use of antithrombin concentrate is controversial. We report our experience of seven pregnancies occurred in five women: two, with a personal and familiar history negative for venous thromboembolism, were treated with LMWH during pregnancy and antithrombin concentrate immediately before and after the delivery. The other three women had a personal and familiar history positive for venous thromboembolism and were treated with LMWH and antithrombin concentrate during all the pregnancy and the postpartum period. No thromboembolic or hemorrhagic complications were observed in both groups, demonstrating that our strategy could be safe and effective.
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Affiliation(s)
- Antonella Bruzzese
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome Italy
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20
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Ferretti A, Baldacci E, Miulli E, Canichella M, Di Rocco A, Pulsoni A, Martelli M, Serrao A, Chistolini A, Gabriella Mazzucconi M, Foà R, Santoro C. Thrombopoietin receptor agonists to control immune thrombocytopenia in patients with active lymphoma. Br J Haematol 2019; 186:e217-e219. [PMID: 31364154 DOI: 10.1111/bjh.16114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Antonietta Ferretti
- Department of Translational and Precision Medicine, Hematology, Sapienza University, Rome, Italy
| | - Erminia Baldacci
- Department of Translational and Precision Medicine, Hematology, Sapienza University, Rome, Italy
| | - Eleonora Miulli
- Department of Translational and Precision Medicine, Hematology, Sapienza University, Rome, Italy
| | - Martina Canichella
- Department of Translational and Precision Medicine, Hematology, Sapienza University, Rome, Italy
| | - Alice Di Rocco
- Department of Translational and Precision Medicine, Hematology, Sapienza University, Rome, Italy
| | - Alessandro Pulsoni
- Department of Translational and Precision Medicine, Hematology, Sapienza University, Rome, Italy
| | - Maurizio Martelli
- Department of Translational and Precision Medicine, Hematology, Sapienza University, Rome, Italy
| | - Alessandra Serrao
- Department of Translational and Precision Medicine, Hematology, Sapienza University, Rome, Italy
| | - Antonio Chistolini
- Department of Translational and Precision Medicine, Hematology, Sapienza University, Rome, Italy
| | | | - Roberto Foà
- Department of Translational and Precision Medicine, Hematology, Sapienza University, Rome, Italy
| | - Cristina Santoro
- Department of Translational and Precision Medicine, Hematology, Sapienza University, Rome, Italy
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21
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Porrazzo M, Baldacci E, Ferretti A, Miulli E, Chistolini A, Pecci A, Mazzucconi MG, Foà R, Santoro C. The role of an accurate diagnosis of inherited thrombocytopenia as the basis for an effective treatment. A case of MYH9 syndrome treated with a TPO-RA. Haemophilia 2019; 25:e288-e290. [PMID: 30993846 DOI: 10.1111/hae.13757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/04/2019] [Accepted: 03/18/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Marika Porrazzo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Erminia Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonietta Ferretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Eleonora Miulli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonio Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | | | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Cristina Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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22
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Di Minno G, Santagostino E, Morfini M, Ettorre C, Cultrera D, Baldacci E, Russo E, Gallucci C. Patient satisfaction and acceptability of an on-demand and on-prophylaxis device for factor VIII delivery in patients with hemophilia A. Patient Prefer Adherence 2019; 13:233-240. [PMID: 30774319 PMCID: PMC6362933 DOI: 10.2147/ppa.s175254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND FuseNGO is a relatively new device consisting of a prefilled dual-chamber syringe (DCS) that was recently introduced for the reconstitution of recombinant factor VIII. Herein, the DCS device was assessed using five questionnaires with the primary aim of evaluating patient perceptions and preferences. METHODS An observational, non-interventional, longitudinal study on 86 patients with a confirmed diagnosis of hemophilia A was carried out at 21 sites in Italy. Each patient underwent a baseline visit and final study visit within 3-6 months. Patients were administered five questionnaires: HemoPREF; Treatment Satisfaction Questionnaire for Medication (TSQM); VeritasPRO; Hemophilia Well-being Index (HWBI); Work Productivity and Activity Impairment Questionnaire (WPAI) + Classroom Impairment Questions (CIQ): Hemophilia Specific (HS). RESULTS Compared to baseline, scores for HemoPREF were higher at follow-up; significant increases in the percentage of positive responses were seen for all questions regarding the ease of use (P<0.05). The mean time needed for the reconstruction of the device at baseline was 11 minutes (range 1-30 minutes), which decreased to 6 minutes (range 30 seconds to 25 minutes) at follow-up. All scores in the TSQM indicated good satisfaction with the device. Patients reported an adherence of >70% in the VeritasPRO questionnaire, and the majority of patients reported in the HWBI that hemophilia A did not affect their lives in a significant way. The perceived level of overall impairment was 30% as reported in the WPAI + CIQ: HS, indicating little impairment. There were no safety concerns. CONCLUSION Considering patient-reported outcomes, the DCS device was associated with easier preparation, storage, disposal of equipment, and overall use. Of particular note, preparation times were reduced by around 50%. The majority of patients were satisfied with the device and overall adherence scores were high. Considering these results, the device has the potential to increase adherence to therapy and, possibly, reduce healthcare costs.
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Affiliation(s)
- Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Azienda Universitaria Policlinico Federico II, Naples, Italy,
| | - Elena Santagostino
- Hemophilia and Thrombosis Center, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Morfini
- Scientific Committee, Italian Association of Haemophilia Centres (AICE), Florence, Italy
| | - Cosimo Ettorre
- Haemophilia and Thrombosis Center, Policlinico Giovanni XXIII, Bari, Italy
| | - Dorina Cultrera
- Hematology Unit, Regional Center for Hemophilia, Italy Ospedaliera-Universitaria "Policlinico - Vittorio Emanuele", Catania, Italy
| | - Erminia Baldacci
- Hemophilia, Thrombosis, and Hematology Center, Dipartimento Biotecnologie cellulari ed Ematologia, Università la Sapienza, Rome, Italy
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Abstract
AbstractHemophilia B (HB) is an X-linked bleeding disorder caused by deficiency of factor IX (FIX). Patients with the severe form (FIX <1%) account approximately for 30 to 45% of persons with HB and usually suffer from recurrent joint, soft-tissue, and muscle bleeds. The availability of safe plasma-derived and recombinant products has virtually abolished the risk of viral infections and the adoption of prophylactic regimens has attenuated the impact of hemophilic arthropathy. Therefore, the development of an inhibitor against FIX is currently the most serious complication that can still occur in the new generations of HB patients. The development of an inhibitor in HB is a rare event (1.5–3% of all patients) but is associated with a significant morbidity, related not only to the bleeding risk but also to the frequent occurrence of allergic/anaphylactic reactions and nephrotic syndrome. Due to the relative rarity of this event, few data exist about risk factors, pathophysiology, and clinical aspects of inhibitors in HB. The induction of immune tolerance is often unsuccessful and can be otherwise affected by many complications in patients with history of allergy or anaphylaxis. Therefore, alternative therapeutic strategies and new approaches are developing. The aim of this narrative review is to discuss current knowledge about risk factors, pathophysiology, and clinical aspects of this rare but serious complication.
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Affiliation(s)
- Gabriele Quintavalle
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Erminia Baldacci
- Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Antonietta Ferretti
- Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Federica Riccardi
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Annarita Tagliaferri
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Cristina Santoro
- Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
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24
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Cantoni S, Carpenedo M, Mazzucconi MG, De Stefano V, Carrai V, Ruggeri M, Specchia G, Vianelli N, Pane F, Consoli U, Artoni A, Zaja F, D'adda M, Visentin A, Ferrara F, Barcellini W, Caramazza D, Baldacci E, Rossi E, Ricco A, Ciminello A, Rodeghiero F, Nichelatti M, Cairoli R. Alternate use of thrombopoietin receptor agonists in adult primary immune thrombocytopenia patients: A retrospective collaborative survey from Italian hematology centers. Am J Hematol 2018; 93:58-64. [PMID: 28983953 DOI: 10.1002/ajh.24935] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 01/09/2023]
Abstract
Sequential use of the TPO-RAs romiplostim and eltrombopag in ITP patients failing either agent was retrospectively evaluated to assess efficacy and impact of clinical characteristics on outcome. Patients were grouped into 5 categories: efficacy issues: 1st TPO-RA failure; loss of response; non-efficacy issues: platelet fluctuations; patient's preference; adverse event development. Either one TPO-RA sequence was analyzed at 3 month and at last follow-up. 106/546 patients on TPO-RA underwent switch and 65% achieved, regained or maintained a short- term response independent of switch sequence, gender or age; lower response rates were associated with lines of previous therapy; disease duration lowers probability to respond. Clinically, patients switched for efficacy issue did not differ from those switched for non-efficacy issues. Response was achieved/regained in 57.8% of patients switched for efficacy issues, the lowest response rates were observed in non-responders to 1st TPO-RA; 80% of patients switched for non-efficacy issues maintained a response. Platelet fluctuation resolved in 44.4%. Of the 49 patients evaluable for long-term outcome, 27 were in response on therapy; 16 discontinued the TPO-RA for reasons other than efficacy, while only 6 were non responders. We confirm the efficacy of TPO-RA switch; once achieved, response to the 2nd TPO-RA seems durable.
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Affiliation(s)
- Silvia Cantoni
- Hematology and Oncology Department; Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda; Milan
| | - Monica Carpenedo
- Hematology and Transplant Unit, ASST San Gerardo Hospital; Monza
| | | | | | | | - Marco Ruggeri
- Hematology Department; San Bortolo Hospital; Vicenza
| | | | - Nicola Vianelli
- “L. e A. Seragnoli” Hematology and Oncology Institute, Sant'Orsola Hospital; Bologna
| | - Fabrizio Pane
- Hematology and Transplant Department; Federico II University; Naples
| | - Ugo Consoli
- Hematology Department; G.Garibaldi Hospital; Catania
| | - Andrea Artoni
- “Angelo Bianchi Bonomi” Haemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan
| | - Francesco Zaja
- Hematology Department; DISM, S. M. Misericordia University Hospital; Udine
| | | | - Andrea Visentin
- Hematology and Clinical Immunology Department; University Hospital; Padua
| | | | - Wilma Barcellini
- Oncohematology Department; Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico; Milan
| | | | - Erminia Baldacci
- Hematology and Cell Biology Department; La Sapienza University; Rome
| | - Elena Rossi
- Hematology Department; Catholic University; Rome
| | - Alessandra Ricco
- Hematology and Transplant Department; Policlinico Consorziale; Bari
| | | | | | - Michele Nichelatti
- Biostatistics, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda; Milan
| | - Roberto Cairoli
- Hematology and Oncology Department; Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda; Milan
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25
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Ferretti A, Santoro C, Ferrara G, Baldacci E, Barone F, Mazzucconi MG. Anticoagulant therapy in patients with Glanzmann's Thrombasthenia: Is it possible? Haemophilia 2017; 23:e531-e533. [PMID: 28940852 DOI: 10.1111/hae.13350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- A Ferretti
- Haematology, Department of Cellular Biotechnologies and Haematology, "Sapienza" University of Rome, Rome, Italy
| | - C Santoro
- Haematology, Department of Cellular Biotechnologies and Haematology, "Sapienza" University of Rome, Rome, Italy
| | - G Ferrara
- Haematology, Department of Cellular Biotechnologies and Haematology, "Sapienza" University of Rome, Rome, Italy
| | - E Baldacci
- Haematology, Department of Cellular Biotechnologies and Haematology, "Sapienza" University of Rome, Rome, Italy
| | - F Barone
- Haematology, Department of Cellular Biotechnologies and Haematology, "Sapienza" University of Rome, Rome, Italy
| | - M G Mazzucconi
- Haematology, Department of Cellular Biotechnologies and Haematology, "Sapienza" University of Rome, Rome, Italy
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26
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Santoro C, Volpicelli P, Baldacci E, Ferrara G, Di Rocco A, Ferretti A, Porrazzo M, Mazzucconi MG. Repeated successful use of eltrombopag in chronic primary immune thrombocytopenia: description of an intriguing case. Clin Case Rep 2017; 5:1385-1388. [PMID: 28781864 PMCID: PMC5538052 DOI: 10.1002/ccr3.920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 11/21/2022] Open
Abstract
Thrombopoietin receptor agonists (TPO‐RAs) are used as effective alternative treatments in ITP patients unresponsive to first‐/second‐line therapies. TPO‐RAs can also be used to normalize platelet count to safely perform invasive procedures and chemotherapy, in case of malignancies. In few responsive patients, TPO‐RAs can be suspended maintaining a sustained response.
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Affiliation(s)
- Cristina Santoro
- Hematology Department of Cellular Biotechnology and Hematology "Sapienza" University of Rome Italy
| | - Paola Volpicelli
- Hematology Department of Cellular Biotechnology and Hematology "Sapienza" University of Rome Italy
| | - Erminia Baldacci
- Hematology Department of Cellular Biotechnology and Hematology "Sapienza" University of Rome Italy
| | - Grazia Ferrara
- Hematology Department of Cellular Biotechnology and Hematology "Sapienza" University of Rome Italy
| | - Alice Di Rocco
- Hematology Department of Cellular Biotechnology and Hematology "Sapienza" University of Rome Italy
| | - Antonietta Ferretti
- Hematology Department of Cellular Biotechnology and Hematology "Sapienza" University of Rome Italy
| | - Marika Porrazzo
- Hematology Department of Cellular Biotechnology and Hematology "Sapienza" University of Rome Italy
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27
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Santoro C, Sperduti I, Latagliata R, Baldacci E, Anaclerico B, Avvisati G, Breccia M, Buccisano F, Cedrone M, Cimino G, De Gregoris C, De Muro M, Di Veroli A, Leonetti Crescenzi S, Montanaro M, Montefusco E, Porrini R, Rago A, Spadea A, Spirito F, Villivà N, Andriani A, Alimena G, Mazzucconi MG. Role of treatment on the development of secondary malignancies in patients with essential thrombocythemia. Cancer Med 2017; 6:1233-1239. [PMID: 28544749 PMCID: PMC5463060 DOI: 10.1002/cam4.1081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/15/2016] [Revised: 03/21/2017] [Accepted: 03/30/2017] [Indexed: 01/11/2023] Open
Abstract
Aim of this study is to explore the role of different treatments on the development of secondary malignancies (SMs) in a large cohort of essential thrombocythemia (ET) patients. We report the experience of a regional cooperative group in a real‐life cohort of 1026 patients with ET. We divided our population into five different groups: group 0, no treatment; group 1, hydroxyurea (HU); group 2, alkylating agents (ALK); group 3, ALK + HU sequentially or in combination; and group 4, anagrelide (ANA) and/or α‐interferon (IFN) only. Patients from groups 1, 2, and 3 could also have been treated either with ANA and/or IFN in their medical history, considering these drugs not to have an additional cytotoxic potential. In all, 63 of the 1026 patients (6%) developed 64 SM during the follow‐up, after a median time of 50 months (range: 2–158) from diagnosis. In univariate analysis, a statistically significant difference was found only for gender (P = 0.035) and age (P = 0.0001). In multivariate analysis, a statistically significant difference was maintained for both gender and age (gender HR1.7 [CI 95% 1.037–2.818] P = 0.035; age HR 4.190 [CI 95% 2.308–7.607] P = 0.0001). The impact of different treatments on SMs development was not statistically significant. In our series of 1026 ET patients, diagnosed and followed during a 30‐year period, the different therapies administered, comprising HU and ALK, do not appear to have impacted on the development of SM. A similar rate of SMs was observed also in untreated patients. The only two variables which showed a statistical significance were male gender and age >60 years.
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Affiliation(s)
- Cristina Santoro
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Roberto Latagliata
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Erminia Baldacci
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | | | | | - Massimo Breccia
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | - Angela Rago
- Hematology, Polo Universitario Pontino, Latina, Italy
| | - Antonio Spadea
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Unit, Rome, Italy
| | | | - Nicoletta Villivà
- Hematology, Nuovo Regina Margherita Hospital ASL Roma 1, Rome, Italy
| | | | - Giuliana Alimena
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Maria Gabriella Mazzucconi
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
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Mazzucconi MG, Santoro C, Baldacci E, De Angelis F, Chisini M, Ferrara G, Volpicelli P, Foà R. TPO-RAs in pITP: description of a case series and analysis of predictive factors for response. Eur J Haematol 2016; 98:242-249. [DOI: 10.1111/ejh.12822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Maria Gabriella Mazzucconi
- Hematology; Department of Cellular Biotechnologies and Hematology; ‘Sapienza’ University of Rome; Rome Italy
| | - Cristina Santoro
- Hematology; Department of Cellular Biotechnologies and Hematology; ‘Sapienza’ University of Rome; Rome Italy
| | - Erminia Baldacci
- Hematology; Department of Cellular Biotechnologies and Hematology; ‘Sapienza’ University of Rome; Rome Italy
| | - Federico De Angelis
- Hematology; Department of Cellular Biotechnologies and Hematology; ‘Sapienza’ University of Rome; Rome Italy
| | - Marta Chisini
- Hematology; Department of Cellular Biotechnologies and Hematology; ‘Sapienza’ University of Rome; Rome Italy
| | - Grazia Ferrara
- Hematology; Department of Cellular Biotechnologies and Hematology; ‘Sapienza’ University of Rome; Rome Italy
| | - Paola Volpicelli
- Hematology; Department of Cellular Biotechnologies and Hematology; ‘Sapienza’ University of Rome; Rome Italy
| | - Roberto Foà
- Hematology; Department of Cellular Biotechnologies and Hematology; ‘Sapienza’ University of Rome; Rome Italy
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29
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Cafolla A, Gentili A, Cafolla C, Perez V, Baldacci E, Pasqualetti D, Demasi B, Curini R. Plasma Vitamin K1 Levels in Italian Patients Receiving Oral Anticoagulant Therapy for Mechanical Heart Prosthesis: A Case-Control Study. Am J Cardiovasc Drugs 2016; 16:267-274. [PMID: 27084708 DOI: 10.1007/s40256-016-0169-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral anticoagulant therapy (OAT) with a vitamin K antagonist (VKA) is the choice of treatment for preventing thromboembolism in patients with mechanical heart valve prosthesis (MHP). The percentage of time in the therapeutic range (TTR%) expresses the OAT quality. We planned a case-control study in order to determine vitamin K1 plasmatic concentrations in MHP patients and to correlate these with TTR%. MATERIALS AND METHODS Of 756 MHP patients receiving OAT, 125 patients (61 younger than 65 years, and 64 older than 65 years) and 120 healthy blood donors, matched for sex and age, were enrolled in the study. All subjects completed a living questionnaire regarding diet, and underwent blood collection. Vegetable and fruit intake was categorized as optimal or suboptimal, and the high-performance liquid chromatography method was used to determine vitamin K1 levels. RESULTS Neither the patients nor controls had been taking vitamin supplements prior to the start of the study. The median vitamin K1 level was 290 pg/mL in 72 controls with optimal intake, and 274 pg/mL in 48 controls with suboptimal intake, while the median vitamin K1 level in MHP patients with optimal intake was 409 pg/mL, significantly higher (p < 0.001) than the 133.5 pg/mL in patients with suboptimal intake. Vitamin K1 concentration in MHP patients appears to be linked to an age-related threshold: in patients younger than 65 years of age, the median vitamin K1 level was 431 pg/mL, significantly higher (p < 0.05) than the 290 pg/mL in patients older than 65 years of age. No clear relation was found between vitamin K1 levels and TTR% (Pearson = 0.14). However, patients with vitamin K1 >160 pg/mL showed a TTR% >60 %. Among patients younger than 65 years, subjects with vitamin K1 >160 pg/mL showed a median TTR of 66 %, this being significantly higher (p < 0.001) than the 46 % level shown by patients with vitamin K1 <160 pg/mL. CONCLUSIONS Vitamin K1 concentrations in MHP patients seem to be related to both diet and age.
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Affiliation(s)
- Arturo Cafolla
- Hematology, Department of Cellular Biotechnology and Hematology, "Sapienza" Università, Via Benevento 6, 00161, Rome, Italy.
| | | | | | - Virginia Perez
- Department of Chemistry, "Sapienza" Università, Rome, Italy
| | - Erminia Baldacci
- Hematology, Department of Cellular Biotechnology and Hematology, "Sapienza" Università, Via Benevento 6, 00161, Rome, Italy
| | | | - Bruna Demasi
- Immunohematology, Policlinico "Umberto I", Rome, Italy
| | - Roberta Curini
- Department of Chemistry, "Sapienza" Università, Rome, Italy
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Coppola A, Marrone E, Conca P, Cimino E, Mormile R, Baldacci E, Santoro C. Safety of Switching Factor VIII Products in the Era of Evolving Concentrates: Myths and Facts. Semin Thromb Hemost 2016; 42:563-76. [DOI: 10.1055/s-0036-1581102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Recent advances in the development of factor VIII (FVIII) concentrates offer patients with hemophilia the opportunity to switch to products considered safer or with improved properties. In some cases, product switch occurs due to side effects, convenience issues, or economic reasons affecting clinical choices. Reluctance to change FVIII concentrates is shown by patients and also by their physicians, because of concerns in particular about the risk of inhibitor development. A literature review was performed to retrieve the best evidence regarding safety issues of switching FVIII concentrate in patients with severe hemophilia A. Product switch was not associated with an increased inhibitor risk in four studies in patients during the first 50 to 75 exposure days, or in three studies reporting national switches in Canada and United Kingdom. The latter, the only available study comparing switcher and nonswitcher patients, showed an inhibitor incidence similar to that historically reported in the United Kingdom. In 16 phase III clinical trials and 6 postmarketing studies of FVIII concentrates, few de novo inhibitors were detected in previously treated patients, mostly transient and low-titer, with some additional recurrent inhibitors in patients with previous positive testing. On the whole, although rigorous controlled studies are lacking, literature data do not support increased risk of inhibitor development or other safety issues related to product switch. Therefore, in the presence of clinical needs, the advantages of switching FVIII products should not be missed because of perceived more than evidence-based challenges, in particular in this era of products with improved properties recently introduced or available in few years. Caution, however, is suggested in patients with high inhibitor risk, including in those in concomitance with surgery or intensive treatment. A careful inhibitor testing prior to and after product switch is always needed, to identify real de novo inhibitors and to gather further information in the current evolving scenario, in particular comparing switch and nonswitch patients.
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Affiliation(s)
- Antonio Coppola
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital Naples, Naples, Italy
| | - Emiliana Marrone
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital Naples, Naples, Italy
| | - Paolo Conca
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital Naples, Naples, Italy
| | - Ernesto Cimino
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital Naples, Naples, Italy
| | - Rosaria Mormile
- Regional Reference Center for Coagulation Disorders, Federico II University Hospital Naples, Naples, Italy
| | - Erminia Baldacci
- Hematology, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Cristina Santoro
- Hematology, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
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Santoro C, Massaro F, Venosi S, Capria S, Baldacci E, Foà R, Mazzucconi M. Severe Thrombotic Complications in Congenital Afibrinogenemia: A Pathophysiological and Management Dilemma. Semin Thromb Hemost 2016; 42:577-82. [DOI: 10.1055/s-0036-1581103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Congenital afibrinogenemia (CA) is a disease characterized by a complex pathophysiology, involving both the procoagulant and fibrinolytic systems, as well as platelet activity. Although hemorrhagic diathesis represents the most frequent clinical presentation of this disorder, severe thrombotic events can occur. It is not yet clear if these events are strictly related to the disease itself or to the fibrinogen replacement therapy. Different hypotheses on the pathophysiological mechanisms have been proposed. It is well known that fibrinogen/fibrin has a role in the downregulation of thrombin generation in plasma. In the absence of circulating fibrinogen, this “antithrombin” activity is missing and plasma thrombin levels rise; this excess of thrombin could promote clotting of the infused fibrinogen, initiating the thrombotic process. Furthermore, the observation of impaired plasmin generation in the plasma of CA patients has raised the hypothesis of a fibrinolytic system deficiency. We report the case of a CA male patient who at the age of 36 years experienced an arterial thrombosis in his left lower limb. Despite an aggressive medical treatment with low-molecular-weight heparin, fibrinolytic and antiplatelet agents, the arterial thrombosis progressed to the obstruction of the whole left arterial district and the patient underwent the amputation of the left lower limb. This case demonstrates the complexity of pathophysiology and clinical management of a “so-called” bleeding disorder as CA.
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Affiliation(s)
- Cristina Santoro
- Hematology Division, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Fulvio Massaro
- Hematology Division, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Salvatore Venosi
- Department of Vascular Surgery, Sapienza University of Rome, Rome, Italy
| | - Saveria Capria
- Hematology Division, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Erminia Baldacci
- Hematology Division, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Roberto Foà
- Hematology Division, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Maria Mazzucconi
- Hematology Division, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
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Molica M, Massaro F, Annechini G, Baldacci E, D’Elia GM, Rosati R, Trisolini SM, Volpicelli P, Foà R, Capria S. Life-Threatening Autoimmune Hemolytic Anemia and Idhiopatic Thrombocytopenic Purpura. Successful Selective Splenic Artery Embolization. Mediterr J Hematol Infect Dis 2016; 8:e2016020. [PMID: 27158433 PMCID: PMC4848020 DOI: 10.4084/mjhid.2016.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/08/2016] [Accepted: 03/14/2016] [Indexed: 11/08/2022] Open
Abstract
Selective splenic artery embolization (SSAE) is a nonsurgical intervention characterized by the transcatheter occlusion of the splenic artery and/or its branch vessels using metallic coils or other embolic devices. It has been applied for the management of splenic trauma, hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia and splenic hemangioma. We hereby describe a case of a patient affected by idiopathic thrombocytopenic purpura (ITP) and warm auto-immune hemolytic anemia (AIHA) both resistant to immunosuppressive and biological therapies, not eligible for a surgical intervention because of her critical conditions. She underwent SSAE and achieved a hematologic complete response within a few days without complications. SSAE is a minimally invasive procedure to date not considered a standard option in the management of AIHA and ITP. However, following the progressive improvement of the techniques, its indications have been extended, with a reduction in morbidity and mortality compared to splenectomy in patients with critical clinical conditions. SSAE was a lifesaving therapeutic approach for our patient and it may represent a real alternative for the treatment of resistant AIHA and ITP patients not eligible for splenectomy.
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Affiliation(s)
- Matteo Molica
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Fulvio Massaro
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Giorgia Annechini
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Erminia Baldacci
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Gianna Maria D’Elia
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Riccardo Rosati
- Department of Radiological Sciences, Vascular and Interventional Unit, “Sapienza” University of Rome, Rome, Italy
| | | | - Paola Volpicelli
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Robin Foà
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Saveria Capria
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
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Brunetti GA, Palumbo G, Morano GS, Baldacci E, Carmosino I, Annechini G, Talone R, Kiflom S, Mastrogiacomo G, Grammatico S, Chisini M, Costa A, Tendas A, Scaramucci L, Giovannini M, Niscola P, Petrucci MT, Cartoni C. Tapentadol PR for Pain Syndromes in Real Life Patients with Hematological Malignancy. Cardiovasc Hematol Agents Med Chem 2016; 14:68-74. [PMID: 27048320 DOI: 10.2174/1871525714666160405110833] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/02/2016] [Revised: 02/25/2016] [Accepted: 03/14/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND More than 50% of oncohematological patients suffer from pain syndrome, mostly originating from the bone, which often include nociceptive and neuropathic complaints. Tapentadol, a recently available treatment option for cancer pain, exerts a dual analgesic mechanisms (opioid and noradrenergic), allowing for a high clinical efficacy as well as for a reduction in adverse events compared to traditional opioids. AIM To explore the safety and efficacy of tapentadol as a suitable agent for the pain management in the setting of oncohematology. METHODS Our observational study included 36 patients with basal pain intensity (NRS) ranging from 5 to 10. Tapentadol prolonged release (PR) was given at the initial dose of 50 mg BID and careful titrated according to the achieved pain control. RESULTS Tapentadol PR was given at the dosages ranging from 200 and 260 mg/day after a careful titration, allowed for a clinically (-7 points NRS) remarkable reduction of pain intensity without any significant side effects. CONCLUSION In oncohematological patients on pain, tapentadol PR was effective and well tolerated, so representing a suitable treatment option in this difficult setting.
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Affiliation(s)
- Gregorio A Brunetti
- Department of Cellular Biotechnology and Hematology, University La Sapienza of Rome, Italy.
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Cafolla A, Manisco L, Baldacci E, Porcu A, Campanelli M, Cursano MC, Rossi E, Dragoni F, Foà R. Effectiveness and Safety of Therapy with Vitamin K Antagonists in Italian Patients Aged 80 Years or Older: a Multicentre Retrospective Study Comparing the Zeus Algorithm with the PARMA Algorithm or Manual Therapy. Drugs Aging 2015; 32:235-41. [DOI: 10.1007/s40266-015-0247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Santoro C, Di Mauro R, Baldacci E, De Angelis F, Abbruzzese R, Barone F, Bochicchio RA, Ferrara G, Guarini A, Foà R, Mazzucconi MG. Bleeding phenotype and correlation with factor XI (FXI) activity in congenital FXI deficiency: results of a retrospective study from a single centre. Haemophilia 2015; 21:496-501. [DOI: 10.1111/hae.12628] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 01/08/2023]
Affiliation(s)
- C. Santoro
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - R. Di Mauro
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - E. Baldacci
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - F. De Angelis
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - R. Abbruzzese
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - F. Barone
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - R. A. Bochicchio
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - G. Ferrara
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - A. Guarini
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - R. Foà
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - M. G. Mazzucconi
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
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Mazzucconi MG, De Sanctis V, Alfò M, Amendolea MA, Conti L, Santoro C, Baldacci E, Peraino M, Masala C. Maternal thrombophilia and adverse pregnancy outcome: a case-control study. Acta Haematol 2014; 133:242-8. [PMID: 25401392 DOI: 10.1159/000363048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 08/22/2013] [Accepted: 04/18/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the risk of adverse pregnancy outcomes in patients with acquired and/or congenital thrombophilia factors. PATIENTS AND METHODS A cohort of 130 women with a history of pregnancy loss and no successful gestation were investigated for the presence of congenital and acquired thrombophilia factors, and then compared with a control group of 130 healthy women who had had at least one successful gestation and no pregnancy loss, and were screened for congenital and acquired thrombophilia factors. RESULTS Acquired and congenital thrombophilia factors were found in 30 (23%) patients and in 14 (10.8%) controls (p < 0.015). The presence of ≥1 congenital thrombophilia factor was associated with pregnancy loss with an odds ratio of 2.46 (p = 0.040). Moreover, women who had had >1 early fetal loss had a 2.85-fold risk of being carriers of congenital thrombophilia factors, compared to the controls. CONCLUSION Our study showed the increased risk of miscarriage in patients with congenital thrombophilia factors and >1 early fetal loss.
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Santoro C, Biondo F, Baldacci E, De Propris MS, Guarini A, Paoloni F, Foà R, Mazzucconi MG. Rituximab in previously treated primary immune thrombocytopenia patients: evaluation of short- and long-term efficacy and safety. Acta Haematol 2013; 132:24-9. [PMID: 24356282 DOI: 10.1159/000355650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 03/27/2013] [Accepted: 09/12/2013] [Indexed: 01/29/2023]
Abstract
The anti-CD20 chimeric monoclonal antibody rituximab has been effectively used in the treatment of patients with primary immune thrombocytopenia (pITP). We retrospectively evaluated 19 patients affected by pITP resistant to 2 or more lines of therapy who were treated with rituximab. Nine of the 19 patients showed an initial response (47.4%). The sustained response rate was 31.6% (6/19). The median follow-up of the patients was 53.2 months (range 9.2-92.9). Disease-free survival at 48 months was 62.2%. Following rituximab treatment, a proportion of patients (42%) recovered a normal B lymphocyte number. During the follow-up, no opportunistic or severe infectious complications were observed. These data confirm, over a long period of observation, the efficacy and safety of rituximab treatment in the management of patients with resistant pITP.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- B-Lymphocytes/immunology
- Disease-Free Survival
- Female
- Humans
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Lymphocyte Count
- Male
- Middle Aged
- Purpura, Thrombocytopenic, Idiopathic/blood
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Retrospective Studies
- Rituximab
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Cristina Santoro
- Hematology, Department of Cellular Biotechnologies and Hematology, 'Sapienza' University of Rome, Rome, Italy
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Affiliation(s)
- Erminia Baldacci
- Division of Hematology, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Caterina Mercanti
- Division of Hematology, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Maria Mazzucconi
- Division of Hematology, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Cristina Santoro
- Division of Hematology, Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
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Cafolla A, Campanelli M, Baldacci E, Potasso L, Bochicchio R, Dragoni F, Foà R. Oral anticoagulant therapy in Italian patients 80 yr of age or older with atrial fibrillation: a pilot study of low vs. standard PT/INR targets. Eur J Haematol 2012; 89:81-6. [PMID: 22519759 DOI: 10.1111/j.1600-0609.2012.01786.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral anticoagulation therapy (OAT), which aims to prevent thromboembolism in patients with atrial fibrillation (AF), is underused in subjects who are over the age of 80 yr because of the associated bleeding risk. The aim of this study was to evaluate the efficacy and safety of OAT with low (2.0) vs. standard (2.5) PT/international normalised ratio (INR) targets in patients over the age of 80. MATERIALS AND METHODS Of 233 patients aged 80 yr or older with AF on OAT, 58 had unstable PT/INR values and achieved reduced targets. These patients were enrolled as a group (A) in a case-control study and were treated with a low (2.0) PT/INR target. They were compared with a second group (B) of 58 additional patients who were matched for age and CHADS scores and treated with a standard (2.5) PT/INR target. Group A OAT parameters were also compared before and after the PT/INR reduction. The time in the therapeutic range (TTR%), PT/INR values >5, haemorrhages and strokes were prospectively evaluated in the two groups after 2 yr of follow-up. RESULTS Of the 116 enrolled patients, 55 group A and 57 group B patients were evaluated. The TTR was 72.59% in group A and 64.43% in group B (P < 0.01). The percent of PT/INR values >5 was 0.68% for group A and 1.42% for group B (P < 0.05). Haemorrhages and thromboses occurred only in group B patients. The before and after analysis in group A showed that a low INR target produced an increase in the TTR (53.05% vs. 72.59%; P < 0.0001) and a reduction in the PT/INR values > 5 (1.72% vs. 0.68%; P < 0.001). CONCLUSIONS A low PT/INR target seems effective and safe in Italian patients with AF over the age of 80. Further trials are needed to confirm the hypothesis generated by this study.
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Affiliation(s)
- Arturo Cafolla
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy.
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Cafolla A, D’Andrea G, Baldacci E, Margaglione M, Mazzucconi MG, Foà R. Hereditary protein C deficiency and thrombosis risk: genotype and phenotype relation in a large Italian family. Eur J Haematol 2012; 88:336-9. [DOI: 10.1111/j.1600-0609.2011.01742.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Biondo F, Matturro A, Santoro C, Leporace A, D'Elia G, Baldacci E, Pignoloni P, Pulsoni A, Foà R, Mazzucconi M. Remission of acquired von Willebrand syndrome after successful treatment of gastric MALT lymphoma. Haemophilia 2011; 18:e34-5. [PMID: 22059776 DOI: 10.1111/j.1365-2516.2011.02681.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Cafolla A, Melizzi R, Baldacci E, Pignoloni P, Dragoni F, Campanelli M, Caraccini R, Foà R. "Zeus" a new oral anticoagulant therapy dosing algorithm: a cohort study. Thromb Res 2011; 128:325-30. [PMID: 21600633 DOI: 10.1016/j.thromres.2011.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 03/31/2011] [Accepted: 04/04/2011] [Indexed: 11/30/2022]
Abstract
The demand for oral anticoagulant therapy (OAT) has constantly increased during the last ten years with an extended use of computer assistance. Many mathematical algorithms have been projected to suggest doses and time to next visit for patients on OAT. We designed a new algorithm: "Zeus". A "before-after" study was planned to compare the efficacy and safety of this algorithm dosing OAT with manual dosage decided by the same expert physicians according to the target of International Normalized Ratio (INR). The study analysed data of 1876 patients managed with each of the two modalities for eight months, with an interval of two years between them. The aim was to verify the increased quality of therapy by time spent in INR target and efficiency and safety of Zeus algorithm. Time in therapeutic range (TTR) was significantly (p < 0.0001) higher during the algorithm dosing period in comparison with the TTR during manual management period (62.3% vs 50.3%). The number of PT/INR tests above 5 was significantly (p < 0.001) reduced by algorithm suggested prescriptions in comparison with manual those (254 vs 537 times). The anticoagulant drug amount prescribed according to the algorithm suggestions was significantly (p < 0.0001) lower than that of the manual method. The number of clinical events observed in patients during the algorithm management time was significantly (p < 0.05) lower than that in those managed with the manual dosage. This study confirms the clinical utility of the computer-assisted OAT and shows the efficacy and safety of the Zeus algorithm.
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Affiliation(s)
- A Cafolla
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sapienza Università Roma, Italy.
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Capria S, Petrucci MT, Pulsoni A, Ribersani M, Baldacci E, de Propris MS, Meloni G. High-dose idarubicin, busulphan and melphalan for autologous stem cell transplantation in multiple myeloma responsive to DAV chemotherapy: comparison with a historical control. Acta Haematol 2006; 115:9-14. [PMID: 16424643 DOI: 10.1159/000089459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 06/08/2004] [Accepted: 02/22/2005] [Indexed: 11/19/2022]
Abstract
Since 1997, 32 newly diagnosed multiple myeloma patients responsive to DAV chemotherapy were autografted with idarubicin-intensified busulphan-melphalan (ida-bu-mel). Main endpoints of the study were transplant-related toxicity, overall survival (OS) and progression-free survival (PFS). The results were compared with a historical control group of 38 patients treated with the 'standard' bu-mel regimen. Concerning time to engraftment, no significant difference was observed between the two groups, while toxicity was significantly higher in the intensive conditioning group, regarding grade IV mucositis, duration of profound neutropenia, incidence of infections and platelet requirement. Five-year OS and PFS are 73 versus 78% and 37 versus 48% for the intensive and standard regimen, respectively (p value not significant). The ida-bu-mel schedule appears to be a feasible and effective regimen for newly diagnosed multiple myeloma patients; nevertheless, no apparent benefit in OS and PFS arises from the comparison with a historical control treated with standard bu-mel, which is better tolerated and at least equally effective.
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Affiliation(s)
- Saveria Capria
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università La Sapienza, Rome, Italy
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Meloni G, Trisolini SM, Capria S, Torelli GF, Baldacci E, Torromeo C, Valesini G, Mandelli F. How long can we give interleukin-2? Clinical and immunological evaluation of AML patients after 10 or more years of IL2 administration. Leukemia 2002; 16:2016-8. [PMID: 12357352 DOI: 10.1038/sj.leu.2402566] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2001] [Accepted: 03/03/2002] [Indexed: 11/09/2022]
Abstract
We have treated 20 patients, affected by acute myelogenous leukemia in advanced phase of the disease, with intravenous high-dose recombinant interleukin-2 (IL2) as induction treatment, achieving a complete remission (CR) in 11/20 of patients (55%). All CR patients were planned to receive a maintenance program with lower subcutaneous doses of IL2 until relapse. Currently, 5/11 patients are alive in continuous complete remission with a minimum follow-up of 9 years from IL2 induction. In the aim to investigate the treatment's side-effects during or after prolonged IL2 therapy, we decided to submit these patients to a clinical and immunological evaluation. Four patients have been evaluated as one, who independently stopped IL2 after 6 years, refused the check-up. No organ-specific treatment sequelae that may decrease the quality of life or may be life-threatening were found, concerning renal, liver and cardiovascular function. Endocrine abnormalities were detected in three patients, the most serious being a severe hypothyroidism, which prompted cessation of IL2 maintenance after 6 years and required thyroid supplementation treatment. Immunological studies were carried out prior to the last IL2 cycle and showed high levels of CD3-positive T cells expressing the IL2 receptor alpha chain (CD25), both in the peripheral blood and in the bone marrow. Our study shows that low-dose IL2 can be given for a prolonged period of time without serious organ-specific late sequelae and with a good quality of life.
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Affiliation(s)
- G Meloni
- Department of Biotecnologie Cellulari ed Ematologia, University La Sapienza, Rome, Italy
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Bousso A, Baldacci E, Ejzenberg B, Otoch JP, Okay Y. The role of lung biopsy in deteriorating lung disease with unfavorable evolution. J Pediatr 2001; 138:786-7. [PMID: 11343069 DOI: 10.1067/mpd.2001.112762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Baldacci E, Lugaresi S. Social expenditure and demographic evolution: a dynamic approach. Genus 1997; 53:61-78. [PMID: 12293338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
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Yamashita CA, Mielle A, Renko NS, Nascimento S, Gilio A, Pahl M, Ejzenberg B, Baldacci E, Okay Y. Parinaud syndrome caused by Bartonella henselae: case report. Rev Inst Med Trop Sao Paulo 1996; 38:437-40. [PMID: 9293091 DOI: 10.1590/s0036-46651996000600009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The authors report a case of Parinaud syndrome (conjunctivitis with pre-auricular satellite adenitis) caused by Bartonella henselae, the etiologic agent of Cat Scratch Disease. The etiologic assessment of this case was performed by serum indirect immunofluorescence reaction and allowed for a better therapeutics and follow up, avoiding ineffective antibiotics and surgical interventions.
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Affiliation(s)
- C A Yamashita
- University Hospital, Pediatric Department, School of Medicine, University of São Paulo
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Campos MM, Arruda J, Eliias Gilio A, Ejzenberg B, Baldacci E, Okay Y. Left ventricular pseudoaneurysm: an unusual complication of pericarditis and Staphylococcus aureus septicemia. Pediatr Infect Dis J 1996; 15:380-2. [PMID: 8866814 DOI: 10.1097/00006454-199604000-00021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- M M Campos
- Department of Pediatrics, Universidade de Sao Paulo, Brazil
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Conti GG, Baldacci E, Torreggiani D. [Reduction of pesticide residues in vegetables by means of processing and canning operations (author's transl)]. S TA NU 1975; 5:9-12. [PMID: 1243938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pesticide residues may be present in vegetables and may affect human health. Processing and canning operations substantially reduce these residues and help to maintain them at acceptable levels. The percentage of removal depends on the type of vegetable, the type of pesticide used and the processing procdure applied. The effects of washing, blanching, peeling and juice extraction on the removal of some insecticide residues from different vegetables are described and discussed, also with regerence to the present day situation in Italy.
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Baldacci E, Locci R, Farina G. [Study of a new species of Streptomyces: Streptomyces nobilis sp. nov. and examination of related strains belonging to the genera Streptomyces, Streptoverticillium and Nocardia]. Mycopathol Mycol Appl 1965; 26:333-48. [PMID: 5877226 DOI: 10.1007/bf02049562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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