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Mulas O, Efficace F, Orofino MG, Piroddi A, Piras E, Vacca A, Barella S, Costa A, Giesinger JM, La Nasa G, Caocci G. Health-Related Quality-of-Life Profile of Pediatric Patients with β Thalassemia after Hematopoietic Stem Cell Transplantation. J Clin Med 2023; 12:6047. [PMID: 37762987 PMCID: PMC10532003 DOI: 10.3390/jcm12186047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Matched hematopoietic stem cell transplantation (HSCT) is a feasible and curative treatment in pediatric patients with beta thalassemia major (β-TM). However, little data are available regarding patients and their parents' health-related quality of life (HRQoL) after the procedure. As such, we investigated the HRQoL of pediatric patients with β-TM after HSCT compared to that of patients treated with blood transfusions and iron chelation. The health-related quality of life of 43 β-TM pediatric patients and 43 parents were evaluated using the Pediatric Quality of Life Inventory (PedsQL). A total of 25 patients underwent HSCT: 15 from a sibling and 10 from an HLA-matched donor. The median follow-up time from HSCT was 5 years (range 1-13 years). The mean ages at the survey were 10.1 years (range 5-15) and 9.6 years (range 5-15) for transfused and transplanted patients, respectively. A significant reduction in HRQoL was reported in the group of transfused patients compared with that of patients transplanted in the following PedsQL domains: children's and parents' physical functions, Δ = -15.4, p = 0.009 and Δ = -11.3, p = 0.002, respectively; children's and parents' emotional functioning, Δ = -15.2, p = 0.026 and Δ = -15.2, p = 0.045, respectively; child's and parents' school functioning, Δ = -25, p = 0.005 and Δ = -22.5, p = 0.011, respectively; total child and parents scores, Δ = -14.5, p = 0.004 and Δ = -13.2, p = 0.005, respectively. The results of a multivariable analysis showed that the HSCT procedure was significantly associated with a higher total child PedsQL score (adjusted mean difference = 15.3, p = 0.001) and a higher total parent PedsQL score (adjusted mean difference = 14.1, p = 0.006). We found no significant difference in the HRQoL measured after sibling or unrelated human leukocyte antigen (HLA)-matched HSCT. Finally, a significant positive correlation across all the PedsQL domains was found between the scores reported by the children and those reported by their parents. In conclusion, our study shows that HSCT in pediatric patients with β-TM is associated with a good overall HRQoL profile. This information further supports physicians when counseling patients and their parents before the HSCT procedure.
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Affiliation(s)
- Olga Mulas
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center, 00161 Rome, Italy;
| | - Maria Grazia Orofino
- Bone Marrow Transplant Center, Pediatric Hospital “Microcitemico A. Cao”, 09121 Cagliari, Italy; (M.G.O.); (A.P.)
| | - Antonio Piroddi
- Bone Marrow Transplant Center, Pediatric Hospital “Microcitemico A. Cao”, 09121 Cagliari, Italy; (M.G.O.); (A.P.)
| | - Eugenia Piras
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Adriana Vacca
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Susanna Barella
- Pediatric Clinic, Thalassemia and Rare Diseases, Pediatric Hospital “Microcitemico A. Cao”, 09121 Cagliari, Italy;
| | - Alessandro Costa
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Johannes M. Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Giorgio La Nasa
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
| | - Giovanni Caocci
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (O.M.); (G.L.N.)
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Barabino L, Galitzia A, Murru R, Caocci G, Greco M, Targhetta C, Angioni G, Vacca A, Piras E, Frau V, Mulas O, La Nasa G. Three is better than two: humoral response in allogeneic HSCT after the third BNT162b2 SARS-CoV-2 mRNA vaccine. Eur Rev Med Pharmacol Sci 2023; 27:6914-6916. [PMID: 37606101 DOI: 10.26355/eurrev_202308_33262] [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] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- L Barabino
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
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Barabino L, Galitzia A, Murru R, Caocci G, Targhetta C, Greco M, Angioni G, Mulas O, Vacca A, Piras E, Frau V, Costa A, La Nasa G. Chronic graft vs. host disease and hypogammaglobulinemia predict a lower immunological response to the BNT162b2 mRNA COVID-19 vaccine after allogeneic hematopoietic stem cell transplantation. Eur Rev Med Pharmacol Sci 2022; 26:8984-8989. [PMID: 36524517 DOI: 10.26355/eurrev_202212_30572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Due to the high mortality rate of COVID-19, the assessment of BNT162b2 SARS-CoV-2 mRNA vaccine (Pfizer-BioNTech) efficacy in allogeneic hematopoietic stem cell transplant (HSCT) recipients is mandatory. PATIENTS AND METHODS We conducted a single-center pilot study with the main objective of evaluating the immunogenicity of the BNT162b2 mRNA vaccine in 31 hematological patients who underwent hematopoietic stem cell transplantation within the previous 12 months and/or were affected by chronic graft-vs.-host-disease (cGVHD), by the assessment of antibody levels at 30-45 days after the second dose of vaccine. RESULTS After the second dose of vaccine, 23 out of 31 patients (74%) showed a positive immune response. The presence of severe cGVHD or Ig deficiency identified 7 out of 8 (85%) of non-responders. The median absolute cluster of differentiation 19 (CD19) count was significantly lower in non-responders vs. responders (109/µl vs. 351/µl). Underlying pathology, comorbidities, type of donor, time intervals from transplant and cluster of differentiation 3/cluster of differentiation 4/cluster of differentiation 8 (CD3/CD4/CD8) subsets were not significantly associated with an effective immune response to vaccination. CONCLUSIONS Despite the limited sample of patients enrolled, our findings suggest that hypogammaglobulinemia and cGVHD could be associated with poor humoral response to the BNT162b2.
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Affiliation(s)
- L Barabino
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
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Mulas O, Caocci G, Efficace F, Piras E, Targhetta C, Frau V, Barella S, Piroddi A, Orofino MG, Vacca A, La Nasa G. Long-term health-related quality of life in patients with β-thalassemia after unrelated hematopoietic stem cell transplantation. Bone Marrow Transplant 2022; 57:1833-1836. [DOI: 10.1038/s41409-022-01823-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022]
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Mazza E, Marcia S, Mondaini F, Piras E, Giordan N, Torri T, Barbanti-Bròdano G, Parodi F. Efficacy and safety of a novel hydrogel (HYADD4-G) in degenerative disc disease patients: a multicentric open label study. Eur Rev Med Pharmacol Sci 2021; 24:2692-2703. [PMID: 32196620 DOI: 10.26355/eurrev_202003_20539] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In this premarket clinical study, we evaluated the efficacy and safety of a novel Hydrogel (HYADD4-G) for reducing low back pain (LBP) in patients with degenerative disc disease (DDD). PATIENTS AND METHODS Twenty-three patients with chronic LBP were enrolled. All patients presented with up to three lumbar black discs (Pfirrmann grade III or IV), LBP of at least 40 mm on the Visual Analogue Scale (VAS), and a Roland-Morris Disability Questionnaire (RMDQ) score of at least 9. Patients received a single 1.5 ml intradiscal injection of HYADD4-G (8 mg/ml), guided by X-ray. Our primary endpoint was the change in VAS score from baseline (day 0) to 4, 12, and 24 weeks. Our secondary endpoints were black disc hydration by Magnetic Resonance Imaging (MRI); the patient's therapeutic response according to the RMDQ; the quality of life, as determined by the EuroQol-5 Dimension (EQ-5D) Index; and a global assessment of patient health status, safety, and local tolerability. RESULTS Compared with baseline values, VAS score showed a significant reduction at each time point, and across the overall 24-week follow-up period (p < 0.0001). MRI scanning observed a significant reduction in Pfirrmann grade from baseline, by at least one grade, at both week 4 (p = 0.0039) and week 24 (p = 0.0010). Furthermore, compared with baseline values, there was a significant reduction in RMDQ score at each timepoint, and across the entire study period (p < 0.0001). The EQ-5D index increased significantly from baseline to week 24 (p = 0.0001). Finally, mean VAS scores for Patient Global Assessment (PTGA), and Clinical Observer Global Assessment (COGA), decreased significantly at each time point (p < 0.0001), except for week 4. CONCLUSIONS HYADD4-G proved to be an efficient reliever of low back pain due to DDD.
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Affiliation(s)
- E Mazza
- Interventional Radiology, Villa Donatello, Florence, Italy.
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Marcia S, Piras E, Spinelli A, Marini S, Saba L. Abstract No. 593 Efficacy of a vertebral augmentation system used for bone remodelling as treatment of vertebral fractures. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Sanna M, Caocci G, Orrù F, Ledda A, Vacca A, Piras E, Fozza C, Deias P, Tidore G, Dore F, La Nasa G. Safe fluoroquinolones prophylaxis in blood cancer patients with chemotherapy-induced neutropenia and Glucose-6-Phosphate-Dehydrogenase deficiency. J Clin Pharm Ther 2017; 42:733-737. [DOI: 10.1111/jcpt.12571] [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: 04/21/2017] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M. Sanna
- Hematology Unit; Department of Medical Sciences and Public Health; Bone Marrow Transplant Center; R. Binaghi Hospital; University of Cagliari; Cagliari Italy
| | - G. Caocci
- Hematology Unit; Department of Medical Sciences and Public Health; Bone Marrow Transplant Center; R. Binaghi Hospital; University of Cagliari; Cagliari Italy
| | - F. Orrù
- Hematology Unit; Department of Medical Sciences and Public Health; Bone Marrow Transplant Center; R. Binaghi Hospital; University of Cagliari; Cagliari Italy
| | - A. Ledda
- Hematology Unit; Department of Medical Sciences and Public Health; Bone Marrow Transplant Center; R. Binaghi Hospital; University of Cagliari; Cagliari Italy
| | - A. Vacca
- Hematology Unit; Department of Medical Sciences and Public Health; Bone Marrow Transplant Center; R. Binaghi Hospital; University of Cagliari; Cagliari Italy
| | - E. Piras
- Hematology Unit; Department of Medical Sciences and Public Health; Bone Marrow Transplant Center; R. Binaghi Hospital; University of Cagliari; Cagliari Italy
| | - C. Fozza
- Department of Clinical and Experimental Medicine; University of Sassari; Sassari Italy
| | - P. Deias
- Hematology Unit; Department of Medical Sciences and Public Health; Bone Marrow Transplant Center; R. Binaghi Hospital; University of Cagliari; Cagliari Italy
| | - G. Tidore
- Department of Clinical and Experimental Medicine; University of Sassari; Sassari Italy
| | - F. Dore
- Department of Clinical and Experimental Medicine; University of Sassari; Sassari Italy
| | - G. La Nasa
- Hematology Unit; Department of Medical Sciences and Public Health; Bone Marrow Transplant Center; R. Binaghi Hospital; University of Cagliari; Cagliari Italy
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Caocci G, Orofino MG, Vacca A, Piroddi A, Piras E, Addari MC, Caria R, Pilia MP, Origa R, Moi P, La Nasa G. Long-term survival of beta thalassemia major patients treated with hematopoietic stem cell transplantation compared with survival with conventional treatment. Am J Hematol 2017; 92:1303-1310. [PMID: 28850704 DOI: 10.1002/ajh.24898] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 11/12/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) in thalassemia remains a challenge. We reported a single-centre case-control study of a large cohort of 516 children and adult patients treated with HSCT or blood transfusion support and iron chelation therapy; 258 patients (median age 12, range 1-45) underwent sibling (67%) or unrelated (33%) HSCT; 97 patients were adults (age ≥ 16 years). The median follow-up after HSCT was 11 years (range 1-30). The conditioning regimen was busulfan (80.6%) or treosulfan-based (19.4%). A cohort of 258 age-sex matched conventionally treated (CT) patients was randomly selected. In transplanted patients the 30-year overall survival (OS) and thalassemia-free survival (TFS) were 82.6 ± 2.7% and 77.8 ± 2.9%, compared to the OS of 85.3 ± 2.7% in CT patients (P = NS); The incidence of grade II-IV acute and chronic graft versus host disease (GvHD) was 23.6% and 12.9% respectively. The probability of rejection was 6.9%. Transplant-related mortality (TRM) (13.8%) was similar to the probability of dying of cardiovascular events in CT patients (12.2%). High-risk Pesaro score (class 3) was associated with lower OS (OR = 1.99, 95% C.I.=1.31-3.03) and TFS (OR = 1.54, 95% C.I.=1.12-2.12). In adult patients, the 23-years OS and TFS after HSCT were 70 ± 5% and 67.3 ± 5%, compared to 71.2 ± 5% of OS in CT (P = NS). Finally, treosulfan was associated with lower risk of acute GvHD (P = .004; OR = 0.28, 95% C.I.=0.12-0.67). In conclusion, the 30-year survival rate of ex-thalassemia patients after HSCT was similar to that expected in CT thalassemia patients, with the vast majority of HSCT survivors cured from thalassemia.
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Affiliation(s)
- Giovanni Caocci
- Bone Marrow Transplant Center, Hospital Binaghi and Microcitemico; Cagliari Italy
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
| | - Maria Grazia Orofino
- Bone Marrow Transplant Center, Hospital Binaghi and Microcitemico; Cagliari Italy
| | - Adriana Vacca
- Bone Marrow Transplant Center, Hospital Binaghi and Microcitemico; Cagliari Italy
| | - Antonio Piroddi
- Bone Marrow Transplant Center, Hospital Binaghi and Microcitemico; Cagliari Italy
| | - Eugenia Piras
- Bone Marrow Transplant Center, Hospital Binaghi and Microcitemico; Cagliari Italy
| | - Maria Carmen Addari
- Bone Marrow Transplant Center, Hospital Binaghi and Microcitemico; Cagliari Italy
| | - Rossella Caria
- Bone Marrow Transplant Center, Hospital Binaghi and Microcitemico; Cagliari Italy
| | - Maria Paola Pilia
- Pediatric Clinic, Thalassemias and Rare Diseases; Pediatric Hospital “Microcitemico A. Cao”; Cagliari Italy
| | - Raffaella Origa
- Pediatric Clinic, Thalassemias and Rare Diseases; Pediatric Hospital “Microcitemico A. Cao”; Cagliari Italy
| | - Paolo Moi
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
- Pediatric Clinic, Thalassemias and Rare Diseases; Pediatric Hospital “Microcitemico A. Cao”; Cagliari Italy
| | - Giorgio La Nasa
- Bone Marrow Transplant Center, Hospital Binaghi and Microcitemico; Cagliari Italy
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
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Pisu S, Caocci G, d’Aloja E, Efficace F, Vacca A, Piras E, Orofino MG, Addari C, Pintor M, Demontis R, Demuru F, Pittau MR, Collins GS, La Nasa G. Reassessing the approach to informed consent: the case of unrelated hematopoietic stem cell transplantation in adult thalassemia patients. Philos Ethics Humanit Med 2014; 9:13. [PMID: 25115172 PMCID: PMC4136633 DOI: 10.1186/1747-5341-9-13] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 06/29/2014] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION The informed consent process is the legal embodiment of the fundamental right of the individual to make decisions affecting his or her health., and the patient's permission is a crucial form of respect of freedom and dignity, it becomes extremely important to enhance the patient's understanding and recall of the information given by the physician. This statement acquires additional weight when the medical treatment proposed can potentially be detrimental or even fatal. This is the case of thalassemia patients pertaining to class 3 of the Pesaro classification where Allogenic hematopoietic stem cell transplantation (HSCT) remains the only potentially curative treatment. Unfortunately, this kind of intervention is burdened by an elevated transplantation-related mortality risk (TRM: all deaths considered related to transplantation), equal to 30% according to published reports. In thalassemia, the role of the patient in the informed consent process leading up to HSCT has not been fully investigated. This study investigated the hypothesis that information provided by physicians in the medical scenario of HSCT is not fully understood by patients and that misunderstanding and communication biases may affect the clinical decision-making process. METHODS A questionnaire was either mailed or given personally to 25 patients. A second questionnaire was administered to the 12 physicians attending the patients enrolled in this study. Descriptive statistics were used to evaluate the communication factors. RESULTS The results pointed out the difference between the risks communicated by physicians and the risks perceived by patients. Besides the study highlighted the mortality risk considered to be acceptable by patients and that considered to be acceptable by physicians. CONCLUSIONS Several solutions have been suggested to reduce the gap between communicated and perceived data. A multi-disciplinary approach may possibly help to attenuate some aspects of communication bias. Several tools have also been proposed to fill or to attenuate the gap between communicated and perceived data. But the most important tool is the ability of the physician to comprehend the right place of conscious consent in the relationship with the patient.
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Affiliation(s)
- Salvatore Pisu
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
- Mediterranean Center of Clinical Bioethics, University of Cagliari-Sardegna Ricerche, Cagliari, Italy
| | - Giovanni Caocci
- Hematology, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
- Bone Marrow Transplantation Center, Hospital “R. Binaghi”, Cagliari, Italy
| | - Ernesto d’Aloja
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
- Mediterranean Center of Clinical Bioethics, University of Cagliari-Sardegna Ricerche, Cagliari, Italy
| | - Fabio Efficace
- Health Outcome Research Unit, Gruppo Italiano Malattie Ematologiche dell’Adulto (GIMEMA), Data Centre, Rome, Italy
| | - Adriana Vacca
- Bone Marrow Transplantation Center, Hospital “R. Binaghi”, Cagliari, Italy
| | - Eugenia Piras
- Bone Marrow Transplantation Center, Hospital “R. Binaghi”, Cagliari, Italy
| | - Maria Grazia Orofino
- Department of Biomedical Science and Biotechnology, Pediatric Clinic of the Bone Marrow Transplant Centre, University of Cagliari, Cagliari, Italy
| | - Carmen Addari
- Department of Biomedical Science and Biotechnology, Pediatric Clinic of the Bone Marrow Transplant Centre, University of Cagliari, Cagliari, Italy
| | - Michela Pintor
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
- Mediterranean Center of Clinical Bioethics, University of Cagliari-Sardegna Ricerche, Cagliari, Italy
| | - Roberto Demontis
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Federica Demuru
- Mediterranean Center of Clinical Bioethics, University of Cagliari-Sardegna Ricerche, Cagliari, Italy
| | - Maria Rita Pittau
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Gary S Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Giorgio La Nasa
- Hematology, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
- Bone Marrow Transplantation Center, Hospital “R. Binaghi”, Cagliari, Italy
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Piras E, Caocci G, Pisano V, Orrù F, Murgia F, Sanna M, Vacca A, La Nasa G. Guillain–Barré syndrome after human herpesvirus-6 reactivation in unrelated hematopoietic stem cell transplantation. Leuk Lymphoma 2013; 54:1332-3. [DOI: 10.3109/10428194.2012.740560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Caocci G, Efficace F, Ciotti F, Roncarolo MG, Vacca A, Piras E, Littera R, Markous RSD, Collins GS, Ciceri F, Mandelli F, Marktel S, La Nasa G. Health related quality of life in Middle Eastern children with beta-thalassemia. BMC Blood Disord 2012; 12:6. [PMID: 22726530 PMCID: PMC3496588 DOI: 10.1186/1471-2326-12-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 05/18/2012] [Indexed: 11/16/2022]
Abstract
Background Thalassemia is a common disorder worldwide with a predominant incidence in Mediterranean countries, North Africa, the Middle East, India, Central Asia, and Southeast Asia. Whilst substantial progress has been made towards the improvement of Health related quality of life (HRQoL) in western countries, scarce evidence-based data exists on HRQol of thalassemia children and adolescents living in developing countries. Methods We studied 60 thalassemia children from Middle Eastern countries with a median age of 10 years (range 5 to 17 years). HRQoL was assessed with the Pediatric Quality of Life Inventory (PedsQL) 4.0. The Questionnaire was completed at baseline by all patients and their parents. The agreement between child-self and parent-proxy HRQoL reports and the relationship between HRQoL profiles and socio-demographic and clinical factors were investigated. Results The scores of parents were generally lower than those of their children for Emotional Functioning (mean 75 vs 85; p = 0.002), Psychosocial Health Summary (mean 70.3 vs 79.1; p = 0.015) and the Total Summary Score (mean 74.3 vs 77.7 p = 0.047). HRQoL was not associated with ferritin levels, hepatomegaly or frequency of transfusions or iron chelation therapy. Multivariate analysis showed that a delayed start of iron chelation had a negative impact on total PedsQL scores of both children (p = 0.046) and their parents (p = 0.007). Conclusions The PedsQL 4.0 is a useful tool for the measurement of HRQoL in pediatric thalassemia patients. This study shows that delayed start of iron chelation has a negative impact on children’s HRQoL.
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Affiliation(s)
- Giovanni Caocci
- Centro Trapianti di Midollo Osseo, P,O, "R, Binaghi", Via Is Guadazzonis, 3, 09126, Cagliari, Italy.
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Nedelcu I, Piras E, Rossi A, Pasaribu HR. XPS analysis on the influence of water on the evolution of zinc dialkyldithiophosphate-derived reaction layer in lubricated rolling contacts. SURF INTERFACE ANAL 2012. [DOI: 10.1002/sia.4853] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- I. Nedelcu
- SKF Engineering and Research Centre; Kelvinbaan 16; 3439 MT; Nieuwegein; The Netherlands
| | - E. Piras
- Department of Inorganic and Analytical Chemistry; University of Cagliari, INSTM; Cagliari; Italy
| | | | - H. R. Pasaribu
- SKF Engineering and Research Centre; Kelvinbaan 16; 3439 MT; Nieuwegein; The Netherlands
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Littera R, Orrù N, Caocci G, Sanna M, Mulargia M, Piras E, Vacca A, Giardini C, Orofino MG, Visani G, Bertaina A, Giorgiani G, Locatelli F, Carcassi C, La Nasa G. Interactions between killer immunoglobulin-like receptors and their human leucocyte antigen Class I ligands influence the outcome of unrelated haematopoietic stem cell transplantation for thalassaemia: a novel predictive algorithm. Br J Haematol 2011; 156:118-28. [PMID: 22077388 DOI: 10.1111/j.1365-2141.2011.08923.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In a study conducted on 114 patients undergoing unrelated donor haematopoietic stem cell transplantation (HSCT) for thalassaemia, we observed that the lack of activating killer immunoglobulin-like receptors (KIRs) on donor natural killer (NK) cells significantly increased the risk of graft-versus-host disease (GvHD) [hazard risk (HR) 4.2, 95% confidence interval (CI) 1.7-10.1, P = 0.002] and transplantation-related mortality (HR 4.7, 95% CI 1.6-14.2, P = 0.01). The risk of GvHD furthermore increased when recipients heterozygous for HLA-C KIR ligand groups (C1/C2) were transplanted from donors completely lacking activating KIRs (HR 6.1, 95% CI 1.9-19.2, P = 0.002). We also found that the risk of rejection was highest when the recipient was homozygous for the C2 HLA-KIR ligand group and the donor carried two or more activating KIRs (HR 6.8, 95% CI 1.9-24.4, P = 0.005). By interpolating the number of donor activating KIRs with recipient HLA-C KIR ligands, we created an algorithm capable of stratifying patients according to the immunogenetic risk of complications following unrelated HSCT. In clinical practice, this predictive tool could serve as an important supplement to clinical judgement and decision-making.
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Affiliation(s)
- Roberto Littera
- Centro Regionale Trapianti, Ospedale R. Binaghi - ASL 8, Cagliari, Italy.
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14
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Caocci G, Efficace F, Ciotti F, Roncarolo MG, Vacca A, Piras E, Littera R, Dawood Markous RS, Collins GS, Ciceri F, Mandelli F, Marktel S, La Nasa G. Prospective Assessment of Health-Related Quality of Life in Pediatric Patients with Beta-Thalassemia following Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2011; 17:861-6. [DOI: 10.1016/j.bbmt.2010.09.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 09/08/2010] [Indexed: 11/16/2022]
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15
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Marcia S, Bellini M, Piras E, Marras M, Ledda G, Sannia S, Romano D, Marini S, Mallarini G. Abstract No. 196: Efficacy of Discogel® radiopaque gelified ethanol + etilcellulose in the treatment of contained disc herniations: A preliminary experience. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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Marcia S, Anselmetti G, Piras E, Sanna A, Boi C, Marini S, Marras M, Mallarini G. Abstract No. 306: Efficacy of percutaneous interspinous spacer in the treatment of neurogenic intermittent claudication due to lumbar spinal stenosis. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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17
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Littera R, Orrù N, Vacca A, Bertaina A, Caocci G, Mulargia M, Giardini C, Piras E, Mastronuzzi A, Vinti L, Orrù S, Locatelli F, Carcassi C, Nasa GL. The role of killer immunoglobulin-like receptor haplotypes on the outcome of unrelated donor haematopoietic SCT for thalassaemia. Bone Marrow Transplant 2010; 45:1618-24. [DOI: 10.1038/bmt.2010.24] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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18
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Bernardo ME, Zecca M, Piras E, Vacca A, Giorgiani G, Cugno C, Caocci G, Comoli P, Mastronuzzi A, Merli P, La Nasa G, Locatelli F. Treosulfan-based conditioning regimen for allogeneic haematopoietic stem cell transplantation in patients with thalassaemia major. Br J Haematol 2009; 143:548-51. [PMID: 18986389 DOI: 10.1111/j.1365-2141.2008.07385.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The safety and efficacy of a preparation with treosulfan/thiotepa/fludarabine were explored in 20 thalassaemia patients given allogeneic marrow transplantation. Seventeen patients were transplanted from unrelated donors after receiving anti-thymocyte globulin. The regimen was well tolerated. Two patients experienced secondary graft failure; one died of acute graft-versus-host disease. Cumulative incidence (95% confidence interval, CI) of transplantation-related mortality and graft failure was 5% (95% CI, 0-34%) and 11% (95% CI, 3-43%), respectively. Two-year probability of survival and thalassaemia-free survival was 95% (95% CI, 85-100%) and 85% (95% CI, 66-100%), respectively. This regimen might find elective application in patients at high risk of developing life-threatening complications.
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Affiliation(s)
- Maria Ester Bernardo
- Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Italy.
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19
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La Nasa G, Littera R, Locatelli F, Lai S, Alba F, Caocci G, Lisini D, Nesci S, Vacca A, Piras E, Bernardo ME, Di Cesare-Merlone A, Orrù S, Carcassi C. The human leucocyte antigen-G 14-basepair polymorphism correlates with graft-versus-host disease in unrelated bone marrow transplantation for thalassaemia. Br J Haematol 2007; 139:284-8. [PMID: 17897304 DOI: 10.1111/j.1365-2141.2007.06779.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The presence of the 14-bp insertion polymorphism of the human leucocyte antigen (HLA)-G gene (HLA-G) promotes immune tolerance through increased synthesis of HLA-G molecules. We investigated this polymorphism in a large cohort of 53 thalassaemia patients transplanted from an unrelated donor. Sixteen patients (30.2%) homozygous for the 14-bp deletion had a higher risk of developing acute graft-versus-host disease (aGvHD) than patients homozygous for the 14-bp insertion (-14-bp/-14-bp vs +14-bp/+14-bp: Relative Risk = 15.0; 95% confidence interval 1.59-141.24; P = 0.008). Therefore, the 14-bp polymorphism could be an important predictive factor for aGvHD following bone marrow transplantation.
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Affiliation(s)
- Giorgio La Nasa
- Cattedra di Ematologia, Centro Trapianti Midollo osseo, Ospedale R. Binaghi, Dipartimento di Scienze Mediche Internistiche, University of Cagliari, Cagliari, Italy
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20
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La Nasa G, Argiolu F, Giardini C, Pession A, Fagioli F, Caocci G, Vacca A, De Stefano P, Piras E, Ledda A, Piroddi A, Littera R, Nesci S, Locatelli F. Unrelated bone marrow transplantation for beta-thalassemia patients: The experience of the Italian Bone Marrow Transplant Group. Ann N Y Acad Sci 2006; 1054:186-95. [PMID: 16339665 DOI: 10.1196/annals.1345.023] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [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: 11/12/2022]
Abstract
Bone marrow transplantation (BMT) remains the only potentially curative treatment for patients with thalassemia major. However, most candidates for BMT do not have a suitable family donor. In order to evaluate whether BMT from an HLA-matched unrelated volunteer donor can offer a probability of cure comparable to that obtained when the donor is a compatible sibling, we carried out a study involving 68 thalassemia patients transplanted in six Italian BMT Centers. Thirty-three males and 35 females (age range, 2-37 years; median age, 15) were transplanted from unrelated volunteer donors, all selected using high-resolution molecular typing of both HLA class I and II loci. Fourteen patients were classified in risk class 1; 16 in risk class 2; and 38 in risk class III of the Pesaro classification system. Nine patients (13%) had either primary or secondary graft failure. Fourteen patients (20%) died from transplant-related causes. Grade II-IV acute graft-versus-host disease (GVHD) developed in 24 cases (40%), and chronic GVHD in 10 cases (18%). Overall survival (OS) in the cohort of 68 patients was 79.3% (CI 67-88%), whereas the Kaplan-Meier estimates of disease-free survival (DFS) with transfusion independence was 65.8% (CI 54-77%). In the group of 30 thalassemic patients in risk classes 1 and 2, the probability of OS and DFS were 96.7% (CI 90-100%) and 80.0% (CI 65-94%), respectively, whereas in the 38 patients in class 3 OS was 65.2% (CI 49-80%) and DFS was 54.5% (CI 38-70%). These data show that when donor selection is based on stringent compatibility criteria, the results of unrelated transplantation in thalassemia patients are comparable to those obtained when the donor is a compatible sibling.
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Affiliation(s)
- Giorgio La Nasa
- Centro Trapianti Midollo Osseo, Ospedale "R. Binaghi" ASL 8, via Is Guadazzonis 3, 09126 Cagliari, Italy.
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21
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Caocci G, Pisu S, Argiolu F, Giardini C, Locatelli F, Vacca A, Orofino MG, Piras E, De Stefano P, Addari MC, Ledda A, La Nasa G. Decision-making in adult thalassemia patients undergoing unrelated bone marrow transplantation: quality of life, communication and ethical issues. Bone Marrow Transplant 2005; 37:165-9. [PMID: 16299541 DOI: 10.1038/sj.bmt.1705236] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [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: 11/12/2022]
Abstract
Bone marrow transplantation (BMT) represents a potentially curative treatment of thalassemia. For patients without an HLA-identical sibling donor, recourse to an unrelated donor is a practicable option but the candidates and their families are faced with a difficult decision. They can either choose to continue the supportive therapy, with no chance of definitive cure, or they accept the mortality risk of BMT in the hope of obtaining a definitive resolution of the disease. We investigated the communication strategies and the post transplantation quality of life (QoL) in 19 adult thalassemia patients surviving after an unrelated donor BMT. The patients were given two questionnaires: a questionnaire to evaluate pre-transplantation communication factors and the EORTC QLQ-C30 questionnaire to assess global QoL. All patients were satisfied with the communication modalities employed by the physicians. The global post transplantation QoL in our patient cohort was found to be good. The approach used in this study may offer a contribution to understanding the decision-making process leading to the choice of a treatment with a high mortality risk for a chronic, non-malignant disease. Finally, some ethical issues of this therapeutic approach are briefly addressed.
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Affiliation(s)
- G Caocci
- Unità Operativa Centro Trapianti di Midollo Osseo, P.O. R. Binaghi, Cagliari, Italy.
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22
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La Nasa G, Caocci G, Argiolu F, Giardini C, Locatelli F, Vacca A, Orofino MG, Piras E, Addari MC, Ledda A, Contu L. Unrelated donor stem cell transplantation in adult patients with thalassemia. Bone Marrow Transplant 2005; 36:971-5. [PMID: 16205730 DOI: 10.1038/sj.bmt.1705173] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [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: 11/09/2022]
Abstract
Allogeneic SCT remains the only potential cure for patients with thalassemia. However, most BMT candidates lack a suitable family donor and require an unrelated donor (UD). We evaluated whether BMT using UDs in high-risk adult thalassemia patients can offer a probability of cure comparable to that reported employing an HLA-compatible sibling as donor. A total of 27 adult thalassemia patients (15 males and 12 females, median age 22 years) underwent BMT from a UD selected by high-resolution HLA molecular typing. The conditioning regimen consisted of Busulphan (BU, 14 mg/kg) plus Cyclophosphamide (CY, 120 or 160 mg/kg) in 12 cases and BU (14 mg/kg), Thiotepa (10 mg/kg) and CY (120-160 mg/kg) in the remaining 15 cases. Cyclosporine-A and short-term Methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. In all, 19 patients (70%) are alive and transfusion-independent after a median follow-up of 43 months (range 16-137). A total of 10 patients (37%) developed grade II-IV acute GVHD and six (27%) chronic GVHD. Eight patients (30%) died from transplant-related causes. UD-BMT can cure more than two-thirds of adult thalassemia patients, and is a particularly attractive option for patients who are not compliant with conventional treatment.
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Affiliation(s)
- G La Nasa
- Unità Operativa Centro Trapianti di Midollo Osseo, Centro Regionale Trapianti, P.O. R. Binaghi, Cagliari, Italy.
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23
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La Nasa G, Giardini C, Locatelli F, Argiolu F, Vassallo E, Prete A, Caocci G, Floris R, Garau P, Littera R, Mantovani D, Oppi S, Piras E, De Stefano P, Sanna MA, Mulargia M, Carcassi C, Contu L. Unrelated bone marrow transplantation in thalassemia. The experience of the Italian Bone Marrow Transplant Group (GITMO). Haematologica 2002; 87:58-61. [PMID: 12412392] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Allogeneic bone marrow transplantation (BMT) is a widely accepted therapeutic approach in homozygous beta-thalassemia. However, the majority of patients do not have a genotypically identical donor within the family. This prompted us to conduct a pilot study to investigate the feasibility of matched unrelated bone marrow transplantation in thalassemia. The major drawback was the high risk of immunologic and transplant-related complications, mainly graft-versus-host disease (GvHD) and graft failure. DESIGN AND METHODS Our aim was to reduce this risk through careful selection of donor/recipient pairs. HLA haplotypes that show a high linkage disequilibrium among their class I, class II and class III alleles are considered extended or ancestral haplotypes. RESULTS These haplotypes are conserved and can be shared by apparently unrelated individuals. Our study shows that matching for these haplotypes significantly improves the outcome of unrelated bone marrow transplantation in thalassemia. In fact, results were comparable to those obtained in transplants using HLA-identifical family donors. INTERPRETATION AND CONCLUSIONS Better results were obtained in patients with lesser iron overload and when the donor shared an identity for the DPB1 alleles.
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Affiliation(s)
- G La Nasa
- Centro Trapianti Midollo Osseo, Ospedale R. Binaghi, Cattedra di Genetica Medica, Università di Cagliari, Italy.
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24
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Velluzzi F, Caradonna A, Boy MF, Pinna MA, Cabula R, Lai MA, Piras E, Corda G, Mossa P, Atzeni F, Loviselli A, Usai P, Mariotti S. Thyroid and celiac disease: clinical, serological, and echographic study. Am J Gastroenterol 1998; 93:976-9. [PMID: 9647032 DOI: 10.1111/j.1572-0241.1998.291_u.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [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: 12/11/2022]
Abstract
OBJECTIVE We sought to reevaluate the prevalence of thyroid dysfunction and thyroid autoimmunity in 47 patients with celiac disease; 91 healthy subjects were studied as controls. Both patients and controls were from Sardinia, Italy. METHODS Diagnosis of celiac disease was made on the basis of clinical history, presence of positive antigliadin IgA (AGA-A) and IgG (AGA-G) antibodies, antireticulin antibodies (ARA), antiendomysium antibodies (EMA), and was confirmed by jejunal biopsy. HLA class II typing for DQB1 and DQA1 alleles was performed in 36/47 celiac patients. Thyroid was evaluated by palpation and echography; serum free thyroid hormones (FT4, FT3), thyrotropic hormone (TSH), and antithyroid peroxidase autoantibodies (anti-TPO) were assayed by radioimmunoassays. RESULTS The prevalence of anti-TPO was higher in celiac patients (29.7%) than in healthy controls (9.6%) (p < 0.001) and thyroid echography frequently displayed (42.5%) a hypoechogenic pattern. Five anti-TPO-positive celiac patients were hypothyroid (two overt, three subclinical). A higher but not significantly different prevalence of anti-TPO (3/7 = 42.8%) was found in celiac patients displaying the DQB1*0502 genotype, when compared with the remaining patients (8/29 = 27.6%). CONCLUSIONS An elevated prevalence of clinical and subclinical autoimmune thyroid autoimmunity was found in Sardinian celiac patients, especially in those displaying the DQB1*0502 genotype; this finding could be related to a particular genetic background of the Sardinian population.
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Affiliation(s)
- F Velluzzi
- Department of Endocrinology, Institute of Internal Medicine, University of Cagliari, Italy
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Usai P, Usai Satta P, Lai M, Corda MG, Piras E, Calcara C, Boy MF, Morelli A, Balestrieri A, Bassotti G. Autonomic dysfunction and upper digestive functional disorders in untreated adult coeliac disease. Eur J Clin Invest 1997; 27:1009-15. [PMID: 9466129 DOI: 10.1046/j.1365-2362.1997.2340781.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [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: 02/06/2023]
Abstract
There is recent evidence that upper-gut motor abnormalities may be present in coeliac disease. However, to date, the pathophysiological mechanisms responsible for the above have not been explored. The purpose of the present study was to investigate upper-gut motor activity in coeliac disease and explore the role played by the autonomic nervous system in motility disturbances. Thirty untreated adult coeliac patients were recruited into the study. Oesophageal manometry and cardiovascular autonomic tests were performed in all patients; oesophageal pH-metry was carried out in 20 patients, gastrointestinal manometry in eight and scintigraphic gastric emptying in 13. Oesophageal motor abnormalities were detected in about 50% of patients, pH-metry was abnormal in 30% of them, and up to 75% of coeliac patients displayed gastrointestinal motility alterations. Delayed gastric emptying was documented in about 50% of patients and was correlated with manometric post-prandial hypomotility. Autonomic tests were positive in 45% of patients as a group, and reached pathological score in 19% of them. Autonomic score correlated significantly with the percentage of bi-peaked waves and with the number of fasting intestinal clusters. This study confirms that upper-gut motor abnormalities are frequently present in adult coeliac disease. Extrinsec autonomic neuropathy may play a role, although other pathophysiological mechanisms are likely to occur.
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Affiliation(s)
- P Usai
- Istituto di Medicina Interna, Università degli Studi di Cagliari, Italy
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Usai P, Boi MF, Piga M, Cacace E, Lai MA, Beccaris A, Piras E, La Nasa G, Mulargia M, Balestrieri A. Adult celiac disease is frequently associated with sacroiliitis. Dig Dis Sci 1995; 40:1906-8. [PMID: 7555441 DOI: 10.1007/bf02208654] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
No data are available on the presence and frequency of peripheral or central joint disease, routinely determined by bone scintigraphy with 740 MBq of [99mTc]MDP, in adult celiac disease. Bone scintigraphy was carried out to detect early acute inflammatory lesions in 22 adult celiac patients (15 females and seven males; mean age 36.72 years, range 17-63). Bone scintigraphy was positive for sacroiliitis in 14 cases (63.6%). Except in the case of one patient suffering from rheumatoid arthritis, laboratory data were normal. Our data suggest that as in other chronic intestinal diseases, celiac disease in adults, is frequently associated with central joint disease. This high incidence of sacroiliitis, the joint disease most frequently found in our patients, has not been previously reported in other series. We believe, therefore, this difference could be explained by the different methodology used for the screening of joint disease.
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Affiliation(s)
- P Usai
- Istituto di Medicina Interna, University of Cagliari, Italy
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