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Mastrolorito F, Togo MV, Gambacorta N, Trisciuzzi D, Giannuzzi V, Bonifazi F, Liantonio A, Imbrici P, De Luca A, Altomare CD, Ciriaco F, Amoroso N, Nicolotti O. TISBE: A Public Web Platform for the Consensus-Based Explainable Prediction of Developmental Toxicity. Chem Res Toxicol 2024; 37:323-339. [PMID: 38200616 DOI: 10.1021/acs.chemrestox.3c00310] [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] [Indexed: 01/12/2024]
Abstract
Despite being extremely relevant for the protection of prenatal and neonatal health, the developmental toxicity (Dev Tox) is a highly complex endpoint whose molecular rationale is still largely unknown. The lack of availability of high-quality data as well as robust nontesting methods makes its understanding even more difficult. Thus, the application of new explainable alternative methods is of utmost importance, with Dev Tox being one of the most animal-intensive research themes of regulatory toxicology. Descending from TIRESIA (Toxicology Intelligence and Regulatory Evaluations for Scientific and Industry Applications), the present work describes TISBE (TIRESIA Improved on Structure-Based Explainability), a new public web platform implementing four fundamental advancements for in silico analyses: a three times larger dataset, a transparent XAI (explainable artificial intelligence) framework employing a fragment-based fingerprint coding, a novel consensus classifier based on five independent machine learning models, and a new applicability domain (AD) method based on a double top-down approach for better estimating the prediction reliability. The training set (TS) includes as many as 1008 chemicals annotated with experimental toxicity values. Based on a 5-fold cross-validation, a median value of 0.410 for the Matthews correlation coefficient was calculated; TISBE was very effective, with a median value of sensitivity and specificity equal to 0.984 and 0.274, respectively. TISBE was applied on two external pools made of 1484 bioactive compounds and 85 pediatric drugs taken from ChEMBL (Chemical European Molecular Biology Laboratory) and TEDDY (Task-Force in Europe for Drug Development in the Young) repositories, respectively. Notably, TISBE gives users the option to clearly spot the molecular fragments responsible for the toxicity or the safety of a given chemical query and is available for free at https://prometheus.farmacia.uniba.it/tisbe.
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Affiliation(s)
- Fabrizio Mastrolorito
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, 70125 Bari, Italy
| | - Maria Vittoria Togo
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, 70125 Bari, Italy
| | - Nicola Gambacorta
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, 70125 Bari, Italy
| | - Daniela Trisciuzzi
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, 70125 Bari, Italy
| | - Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, 70010 Valenzano (BA), Italy
| | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, 70010 Valenzano (BA), Italy
| | - Antonella Liantonio
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, 70125 Bari, Italy
| | - Paola Imbrici
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, 70125 Bari, Italy
| | - Annamaria De Luca
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, 70125 Bari, Italy
| | - Cosimo Damiano Altomare
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, 70125 Bari, Italy
| | - Fulvio Ciriaco
- Dipartimento di Chimica, Università degli Studi di Bari Aldo Moro, 70125 Bari, Italy
| | - Nicola Amoroso
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, 70125 Bari, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, 70125 Bari, Italy
| | - Orazio Nicolotti
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, 70125 Bari, Italy
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2
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Ceci A, Conte R, Didio A, Landi A, Ruggieri L, Giannuzzi V, Bonifazi F. Target therapy for high-risk neuroblastoma treatment: integration of regulatory and scientific tools is needed. Front Med (Lausanne) 2023; 10:1113460. [PMID: 37521350 PMCID: PMC10377668 DOI: 10.3389/fmed.2023.1113460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/16/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Several new active substances (ASs) targeting neuroblastoma (NBL) are under study. We aim to describe the developmental and regulatory status of a sample of ASs targeting NBL to underline the existing regulatory gaps in product development and to discuss possible improvements. Methods The developmental and regulatory statuses of the identified ASs targeting NBL were investigated by searching for preclinical studies, clinical trials (CTs), marketing authorizations, pediatric investigation plans (PIPs), waivers, orphan designations, and other regulatory procedures. Results A total of 188 ASs were identified. Of these, 55 were considered 'not under development' without preclinical or clinical studies. Preclinical studies were found for 115 ASs, of which 54 were associated with a medicinal product. A total of 283 CTs (as monotherapy or in combination) were identified for 70 ASs. Of these, 52% were at phases 1, 1/2, and 2 aimed at PK/PD/dosing activity. The remaining ones also included efficacy. Phase 3 studies were limited. Studies were completed for 14 ASs and suspended for 11. The highest rate of ASs involved in CTs was observed in the RAS-MAPK-MEK and VEGF groups. A total of 37 ASs were granted with a PIP, of which 14 involved NBL, 41 ASs with a waiver, and 18 ASs with both PIPs and waivers, with the PIP covering pediatric indications different from the adult ones. In almost all the PIPs, preclinical studies were required, together with early-phase CTs often including efficacy evaluation. Two PIPs were terminated because of negative study results, and eight PIPs are in progress. Variations in the SmPC were made for larotrectinib sulfate/Vitrakvi® and entrectinib/Rozlytrek® with the inclusion of a new indication. For both, the related PIPs are still ongoing. The orphan designation has been largely adopted, while PRIME designation has been less implemented. Discussion Several ASs entered early phase CTs but less than one out of four were included in a regulatory process, and only two were granted a pediatric indication extension. Our results confirm that it is necessary to identify a more efficient, less costly, and time-consuming "pediatric developmental model" integrating predictive preclinical study and innovative clinical study designs. Furthermore, stricter integration between scientific and regulatory efforts should be promoted.
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Affiliation(s)
- Adriana Ceci
- Research Department, Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
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3
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Vitrano A, Musallam KM, Meloni A, Karimi M, Daar S, Ricchi P, Costantini S, Vlachaki E, Di Marco V, El-Beshlawy A, Hajipour M, Ansari SH, Filosa A, Ceci A, Singer ST, Naserullah ZA, Pepe A, Cademartiri F, Pollina SA, Scondotto S, Dardanoni G, Bonifazi F, Sankaran VG, Vichinsky E, Taher AT, Maggio A. Development of a Thalassemia International Prognostic Scoring System (TIPSS). Blood Cells Mol Dis 2023; 99:102710. [PMID: 36463683 DOI: 10.1016/j.bcmd.2022.102710] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
A prognostic scoring system that can differentiate β-thalassemia patients based on mortality risk is lacking. We analysed data from 3145 β-thalassemia patients followed through a retrospective cohort design for the outcome of death. An a priori list of prognostic variables was collected. β Coefficients from a multivariate cox regression model were used from a development dataset (n = 2516) to construct a formula for a Thalassemia International Prognostic Scoring System (TIPSS) which was subsequently applied to a validation dataset (n = 629). The median duration of observation was 10.0 years. The TIPSS score formula was constructed as exp (1.4 × heart disease + 0.9 × liver disease + 0.9 × diabetes + 0.9 × sepsis + 0.6 × alanine aminotransferase ≥42 IU/L + 0.6 × hemoglobin ≤9 g/dL + 0.4 × serum ferritin ≥1850 ng/mL). TIPSS score thresholds of greatest differentiation were assigned as <2.0 (low-risk), 2.0 to <5.0 (intermediate-risk), and ≥5.0 (high-risk). The TIPSS score was a good predictor for the outcome of death in the validation dataset (AUC: 0.722, 95%CI: 0.641-0.804) and survival was significantly different between patients in the three risk categories (P < 0.001). Compared to low-risk patients, the hazard ratio for death was 2.778 (95%CI: 1.335-5.780) in patients with intermediate-risk and 6.431 (95%CI: 3.151-13.128) in patients with high-risk. This study provides a novel tool to support mortality risk categorization for patients with β-thalassemia that could help management and research decisions.
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Affiliation(s)
- Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Khaled M Musallam
- Thalassemia Center, Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Oman; Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | | | - Efthymia Vlachaki
- Thalassaemia Unit, Ippokratio University Hospital, Thessaloniki, Greece
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Sylvia Titi Singer
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | | | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Harvard Stem Cell Institute, Cambridge, MA, USA
| | - Elliott Vichinsky
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy.
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4
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Moretti F, Ruiz F, Bonifazi F, Pizzo E, Kindblom JM. Health technology assessment of paediatric medicines: European landscape, challenges and opportunities inside the conect4children project. Br J Clin Pharmacol 2022; 88:5052-5059. [PMID: 34931373 PMCID: PMC9786554 DOI: 10.1111/bcp.15190] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/25/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 12/30/2022] Open
Abstract
The medicine development process is complex and requires time and effort to ensure safety, efficacy and quality. In paediatrics, this process is even more challenging, as it involves a subgroup of the population that already faces a considerable gap in the clinical evaluation of medicines and devices compared to the adult population. Moreover, access to therapies is heavily influenced by national health technology assessment (HTA) recommendations, which often form the basis for pricing and reimbursement decisions that affect the availability of effective treatments within the national health systems. Yet performing an HTA to assess the relative effectiveness and cost-effectiveness of a new children's treatment has several non-trivial implications, creating a critical issue for the paediatric population. In addition, the advent of innovative health technologies for children emphasises the need to empower the role of HTAs in paediatrics. This article aims at describing the most relevant elements of the drug development process in the paediatric field by focusing on the HTA. Particular attention will be paid to the factors that influence market access for new paediatric medicines and patients' access to treatment. The article will also highlight some central methodological challenges in conducting HTA in the paediatric field. Finally, the article will provide insight into how initiatives, such as conect4children, may subsequently reinforce HTA awareness in the paediatric community and strengthen collaborations through network mechanisms.
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Affiliation(s)
- Francesco Moretti
- Arsenàl.IT—Centro Veneto Ricerca e Innovazione per la Sanità digitalePadovaItaly
| | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi OnlusBariItaly
| | - Elena Pizzo
- Department of Applied Health ResearchUniversity College LondonLondonUK
| | - Jenny M. Kindblom
- Pediatric Clinical Research Center at the Queen Silvia Children's Hospital at Sahlgrenska University HospitalGöteborgSweden
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5
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Musallam KM, Vitrano A, Meloni A, Pollina SA, Karimi M, El‐Beshlawy A, Hajipour M, Di Marco V, Ansari SH, Filosa A, Ricchi P, Ceci A, Daar S, Vlachaki E, Singer ST, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Sankaran VG, Vichinsky E, Taher AT, Maggio A. Risk of mortality from anemia and iron overload in nontransfusion-dependent β-thalassemia. Am J Hematol 2022; 97:E78-E80. [PMID: 34862982 DOI: 10.1002/ajh.26428] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/17/2022]
Affiliation(s)
| | - Angela Vitrano
- Campus of Haematology Franco and Piera Cutino AOOR Villa Sofia‐V, Cervello Palermo Italy
| | - Antonella Meloni
- MRI Unit, Fondazione G. Monasterio CNR‐Regione Toscana Pisa Italy
| | | | - Mehran Karimi
- Haematology Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Amal El‐Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine Cairo University Cairo Egypt
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica University of Palermo Palermo Italy
| | | | - Aldo Filosa
- Rare Blood Cell Disease Unit "Cardarelli" Hospital Naples Italy
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit "Cardarelli" Hospital Naples Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Valenzano (BA) Italy
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman; Wallenberg Research Centre, Stellenbosch Institute for Advanced Study Stellenbosch University Stellenbosch South Africa
| | - Efthymia Vlachaki
- Thalassaemia Unit Ippokratio University Hospital Thessaloniki Greece
| | - Sylvia Titi Singer
- Division of Hematology‐Oncology, Department of Pediatrics University of California San Francisco, UCSF Benioff Children's Hospital Oakland Oakland California USA
| | | | - Alessia Pepe
- MRI Unit, Fondazione G. Monasterio CNR‐Regione Toscana Pisa Italy
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Valenzano (BA) Italy
| | - Vijay G. Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana‐Farber Cancer Institute Harvard Medical School Boston Massachusetts USA
- Broad Institute of MIT and Harvard Cambridge Massachusetts USA
- Harvard Stem Cell Institute Cambridge Massachusetts USA
| | - Elliott Vichinsky
- Division of Hematology‐Oncology, Department of Pediatrics University of California San Francisco, UCSF Benioff Children's Hospital Oakland Oakland California USA
| | - Ali T. Taher
- Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino AOOR Villa Sofia‐V, Cervello Palermo Italy
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6
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Sultana J, Crisafulli S, Almas M, Antonazzo IC, Baan E, Bartolini C, Bertuccio MP, Bonifazi F, Capuano A, Didio A, Ehrenstein V, Felisi M, Ferrajolo C, Fontana A, Francisca R, Fourrier-Reglat A, Fortuny J, Gini R, Hyeraci G, Hoeve C, Kontogiorgis C, Isgrò V, Lalagkas PN, L'Abbate L, Layton D, Landi A, Narduzzi S, Pereira LR, Poulentzas G, Rafaniello C, Roberto G, Scondotto G, Sportiello L, Toma M, Toussi M, Verhamme K, Volpe E, Trifirò G. Overview of the EU PAS register post-authorization studies performed in Europe from September 2010 to December 2018. Pharmacoepidemiol Drug Saf 2022; 31:689-705. [PMID: 35092329 PMCID: PMC9303697 DOI: 10.1002/pds.5413] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The European post-authorisation study (EU PAS) register is a repository launched in 2010 by the European Medicines Agency (EMA). All EMA-requested PAS, commonly observational studies, must be recorded in this register. Multi-database studies (MDS) leveraging secondary data have become an important strategy to conduct PAS in recent years, as reflected by the type of studies registered in the EU PAS register. OBJECTIVES To analyse and describe PAS in the EU PAS register, with focus on MDS. METHODS Studies in the EU PAS register from inception to 31st December 2018 were described concerning transparency, regulatory obligations, scope, study type (e.g. observational study, clinical trial, survey, systematic review/meta-analysis), study design, type of data collection and target population. MDS were defined as studies conducted through secondary use of >1 data source not linked at patient-level. Data extraction was carried out independently by 14 centres with expertise in pharmacoepidemiology, using publicly available information in the EU PAS register including study protocol, whenever available, using a standardised data collection form. For validation purposes, a second revision of key fields for a 15% random sample of studies was carried out by a different centre. The inter-rater reliability (IRR) was then calculated. Finally, to identify predictors of primary data collection-based studies /vs those based on secondary use of healthcare databases) or MDS (vs. non-MDS), odds ratios (OR) and 95% confidence intervals (CI) were calculated fitting univariate logistic regression models. RESULTS Overall, 1,426 studies were identified. Clinical trials (N=30; 2%), systematic reviews/meta-analyses (N=16; 1%) and miscellaneous study designs (N=46; 3%) were much less common than observational studies (N=1,227; 86%). The protocol was available for 63% (N=360) of 572 observational studies requested by a competent authority. Overall, 36% (N=446) of observational studies were based fully or partially on primary data collection. Of 757 observational studies based on secondary use of data alone, 282 (37%) were MDS. Drug utilisation was significantly more common as a study scope in MDS compared to non-MDS studies. The overall percentage agreement among collaborating centres that collected the data concerning study variables was highest for study type (93.5%) and lowest for type of secondary data (67.8%). CONCLUSIONS Observational studies were the most common type of studies in the EU PAS register, but 30% used primary data, which is more resource-intensive. Almost half of observational studies using secondary data were MDS. Data recording in the EU PAS register may be improved further, including more widespread availability of study protocols to improve transparency.
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Affiliation(s)
- Janet Sultana
- Pharmacy Department, Mater Dei Hospital, Malta.,Exeter College of Medicine and Health, Exeter
| | - Salvatore Crisafulli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Mariana Almas
- Real World Solutions Department, IQVIA, Lisbon, Portugal
| | - Ippazio Cosimo Antonazzo
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy.,Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Esme Baan
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Maria Paola Bertuccio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Fedele Bonifazi
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - Antonella Didio
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mariagrazia Felisi
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,CVBF Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy
| | - Carmen Ferrajolo
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Remy Francisca
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Annie Fourrier-Reglat
- Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Team of Pharmacoepidemiology, UMR 1219, Bordeaux, France
| | | | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Giulia Hyeraci
- Agenzia Regionale di Sanità della Toscana, Florence, Italy
| | - Christel Hoeve
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Valentina Isgrò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Luca L'Abbate
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Deborah Layton
- Data Science Hub, Real World Solutions, IQVIA, London, United Kingdom
| | - Annalisa Landi
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Silvia Narduzzi
- Data Science Hub, Real World Solutions, IQVIA, London, United Kingdom
| | - Leonardo Roque Pereira
- University Medical Center Utrecht, Department of Datascience & Biostatistics, Utrecht, the Netherlands
| | | | - Concetta Rafaniello
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | | | - Giulia Scondotto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, University of Campania "Vanvitelli", Naples, Italy.,Campania Regional Center of Pharmacovigilance and Pharmacoepidemiology, Naples, Italy
| | - Maddalena Toma
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Massoud Toussi
- Data Science Hub, Real World Solutions, IQVIA, London, United Kingdom
| | - Katia Verhamme
- Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Elisabetta Volpe
- TEDDY European Network of Excellence for Paediatric Clinical Research, Pavia, Italy.,Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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7
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Dimitri P, Pignataro V, Lupo M, Bonifazi D, Henke M, Musazzi UM, Ernst F, Minghetti P, Redaelli DF, Antimisiaris SG, Migliaccio G, Bonifazi F, Marciani L, Courtenay AJ, Denora N, Lopedota A. Medical Device Development for Children and Young People-Reviewing the Challenges and Opportunities. Pharmaceutics 2021; 13:pharmaceutics13122178. [PMID: 34959459 PMCID: PMC8706877 DOI: 10.3390/pharmaceutics13122178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023] Open
Abstract
Development of specific medical devices (MDs) is required to meet the healthcare needs of children and young people (CYP). In this context, MD development should address changes in growth and psychosocial maturation, physiology, and pathophysiology, and avoid inappropriate repurposing of adult technologies. Underpinning the development of MD for CYP is the need to ensure MD safety and effectiveness through pediatric MD-specific regulations. Contrary to current perceptions of limited market potential, the global pediatric healthcare market is expected to generate around USD 15,984 million by 2025. There are 1.8 billion young people in the world today; 40% of the global population is under 24, creating significant future healthcare market opportunities. This review highlights a number of technology areas that have led to successful pediatric MD, including 3D printing, advanced materials, drug delivery, and diagnostic imaging. To ensure the targeted development of MD for CYP, collaboration across multiple professional disciplines is required, facilitated by a platform to foster collaboration and drive innovation. The European Pediatric Translational Research Infrastructure (EPTRI) will be established as the European platform to support collaboration, including the life sciences industrial sector, to identify unmet needs in child health and support the development, adoption, and commercialization of pediatric MDs.
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Affiliation(s)
- Paul Dimitri
- Department of Pediatric Endocrinology, Sheffield Children’s NHS Foundation Trust & Sheffield Hallam University, Shefeld S10 2TH, UK;
| | - Valeria Pignataro
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via N. Putignani 178, 70122 Bari, Italy; (V.P.); (D.B.); (G.M.)
| | - Mariangela Lupo
- TEDDY European Network of Excellence for Paediatric Research, Via Luigi Porta 14, 27100 Pavia, Italy;
| | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via N. Putignani 178, 70122 Bari, Italy; (V.P.); (D.B.); (G.M.)
| | - Maria Henke
- Institute for Robotics and Cognitive Systems, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany; (M.H.); (F.E.)
| | - Umberto M. Musazzi
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via G. Colombo, 20133 Milan, Italy; (U.M.M.); (P.M.)
| | - Floris Ernst
- Institute for Robotics and Cognitive Systems, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany; (M.H.); (F.E.)
| | - Paola Minghetti
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via G. Colombo, 20133 Milan, Italy; (U.M.M.); (P.M.)
| | - Davide F. Redaelli
- Scientific Institute IRCCS E. Medea, Bosisio Parini, 23843 Lecco, Italy;
| | | | - Giovanni Migliaccio
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via N. Putignani 178, 70122 Bari, Italy; (V.P.); (D.B.); (G.M.)
| | - Fedele Bonifazi
- Fondazione per la ricerca farmacologica Gianni Benzionlus, Via Abate Eustasio, 30, 70010 Valenzano, Italy;
| | - Luca Marciani
- Translational Medical Sciences, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Derby Road, Nottingham NG7 2UH, UK;
| | - Aaron J. Courtenay
- School of Pharmacy and Pharmaceutical Sciences, Coleraine Campus, Ulster University, Cromore Road, Coleraine, Co. Londonderry, Northern Ireland BT52 1SA, UK;
| | - Nunzio Denora
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, Via E. Orabona 4, 70125 Bari, Italy
- Correspondence: (N.D.); (A.L.)
| | - Angela Lopedota
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, Via E. Orabona 4, 70125 Bari, Italy
- Correspondence: (N.D.); (A.L.)
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8
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Gutiérrez-García G, Martínez C, Boumendil A, Finel H, Malladi R, Afanasyev B, Tsoulkani A, Wilson KMO, Bloor A, Nikoloudis M, Richardson D, López-Corral L, Castagna L, Cornelissen J, Giltat A, Collin M, Fanin R, Bonifazi F, Robinson S, Montoto S, Peggs KS, Sureda A. Long-term outcome of patients receiving haematopoietic allogeneic stem cell transplantation as first transplant for high-risk Hodgkin lymphoma: a retrospective analysis from the Lymphoma Working Party-EBMT. Br J Haematol 2021; 196:1018-1030. [PMID: 34750806 DOI: 10.1111/bjh.17939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022]
Abstract
We analysed long-term outcome of patients receiving haematopoietic allogeneic stem cell transplantation (allo-HSCT) as a first transplant for high-risk Hodgkin lymphoma (HL). One hundred and ninety patients were included in this study, 63% of them had previously received brentuximab vedotin and/or checkpoint inhibitors. Seventy patients (37%) received an unrelated donor allo-HSCT, 99 (51%) had myeloablative conditioning (MAC) and 60% had in vivo T-cell/depleted grafts (TCD). The 100-day cumulative incidence (CI) of grade II-IV acute graft-versus-host disease (GVHD) was 25% and the 3-year CI of chronic GVHD was 38%. The 3-year CI of non-relapse mortality (NRM) and relapse rate were 21% and 38% respectively. After a median follow-up of 58 months, 3-year overall survival (OS) and progression-free survival (PFS) were 58% and 41% respectively. Multivariate analysis showed that, in comparison to reduced-intensity conditioning regimens with or without TCD, MAC using TCD had similar NRM and a lower risk of relapse leading to significantly better OS and PFS. MAC without TCD was associated with higher NRM and worse survival outcomes. These results suggest that in patients with high-risk HL and candidates of allo-HSCT, a MAC strategy with TCD might be the best option.
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Affiliation(s)
- G Gutiérrez-García
- Department of Haematology, Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, University of Barcelona, Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - C Martínez
- Department of Haematology, Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, University of Barcelona, Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | | | - H Finel
- Lymphoma Working Party, EBMT, Paris, France
| | - R Malladi
- School of Cancer Sciences, University of Birmingham, Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | - B Afanasyev
- State Medical Pavlov University, St. Petersburg, Russia
| | | | | | - A Bloor
- Haematology and Transplant Unit, Christie Hospital NHS Foundation Trust and University of Manchester, Manchester, UK
| | - M Nikoloudis
- Haematology Department Heart of England NHS Trust, Birmingham, UK
| | - D Richardson
- Department of Haematology, Southampton General Hospital, Southampton, UK
| | | | - L Castagna
- Department of Haematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - J Cornelissen
- Erasmus MC Cancer Institute University Medical Centre Rotterdam Department of Haematology, Rotterdam, Netherlands
| | - A Giltat
- Department of Haematology, Medical University Hospital, Angers, France
| | | | - R Fanin
- Department of Haematology and Cellular Therapy 'Carlo Melzi', S. Maria della Misericordia University Hospital, DAME, University of Udine, Udine, Italy
| | - F Bonifazi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - S Robinson
- Department of Haematology and Oncology, Bristol University Hospital, Bristol, UK
| | - S Montoto
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - K S Peggs
- Department of Haematology, University College London Cancer Institute, London, UK
| | - A Sureda
- Clinical Department of Haematology, Institut Català d'Oncologia-Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
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9
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Kountouris P, Stephanou C, Archer N, Bonifazi F, Giannuzzi V, Kuo KHM, Maggio A, Makani J, Mañú-Pereira MDM, Michailidou K, Nkya S, Nnodu OE, Trompeter S, Tshilolo L, Wonkam A, Zilfalil BA, Inusa BPD, Kleanthous M. The International Hemoglobinopathy Research Network (INHERENT): An international initiative to study the role of genetic modifiers in hemoglobinopathies. Am J Hematol 2021; 96:E416-E420. [PMID: 34406671 PMCID: PMC10390849 DOI: 10.1002/ajh.26323] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 01/09/2023]
Affiliation(s)
- Petros Kountouris
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | | | - Natasha Archer
- Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Kevin H M Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - María Del Mar Mañú-Pereira
- Translational Research in Child and Adolescent Cancer. Vall d'Hebron Institut de recerca, Barcelona, Spain
| | - Kyriaki Michailidou
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Siana Nkya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Dar es Salaam University College of Education, Dar es Salaam, Tanzania
| | - Obiageli E Nnodu
- Department of Haematology and Blood Transfusion, University of Abuja, Abuja, Nigeria
| | - Sara Trompeter
- University College London Hospitals NHS Trust, London, UK.,NHS Blood and Transplant, London, UK
| | - Léon Tshilolo
- Centre Hospitalier Monkole and CEFA-Institut de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | | | - Baba P D Inusa
- Paediatric Haematology, Evelina London Children's Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Marina Kleanthous
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, Nicosia, Cyprus
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10
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Musallam KM, Vitrano A, Meloni A, Addario Pollina S, Di Marco V, Hussain Ansari S, Filosa A, Ricchi P, Ceci A, Daar S, Vlachaki E, Singer ST, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Karimi M, El-Beshlawy A, Hajipour M, Bonifazi F, Vichinsky E, Taher AT, Sankaran VG, Maggio A. Primary HBB gene mutation severity and long-term outcomes in a global cohort of β-thalassaemia. Br J Haematol 2021; 196:414-423. [PMID: 34697800 DOI: 10.1111/bjh.17897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 01/19/2023]
Abstract
In β-thalassaemia, the severity of inherited β-globin gene mutations determines the severity of the clinical phenotype at presentation and subsequent transfusion requirements. However, data on associated long-term outcomes remain limited. We analysed data from 2109 β-thalassaemia patients with available genotypes in a global database. Genotype severity was grouped as β0 /β0 , β0 /β+ , β+ /β+ , β0 /β++ , β+ /β++ , and β++ /β++ . Patients were followed from birth until death or loss to follow-up. The median follow-up time was 34·1 years. Mortality and multiple morbidity outcomes were analyzed through five different stratification models of genotype severity groups. Interestingly, β0 and β+ mutations showed similar risk profiles. Upon adjustment for demographics and receipt of conventional therapy, patients with β0 /β0 , β0 /β+ , or β+ /β+ had a 2·104-increased risk of death [95% confidence interval (CI): 1·176-3·763, P = 0·011] and 2·956-increased odds of multiple morbidity (95% CI: 2·310-3·784, P < 0·001) compared to patients in lower genotype severity groups. Cumulative survival estimates by age 65 years were 36·8% for this subgroup compared with 90·2% for patients in lower genotype severity groups (P < 0·001). Our study identified mortality and morbidity risk estimates across various genotype severity groups in patients with β-thalassaemia and suggests inclusion of both β+ and β0 mutations in strata of greatest severity.
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Affiliation(s)
- Khaled M Musallam
- Thalassemia Center, Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Antonella Meloni
- MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | | | - Vito Di Marco
- Department of Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Saqib Hussain Ansari
- Department of Pediatric Haematology & Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.,Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
| | - Efthymia Vlachaki
- Thalassaemia Unit, Ippokratio University Hospital, Thessaloniki, Greece
| | - Sylvia T Singer
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | - Alessia Pepe
- MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Elliott Vichinsky
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Harvard Stem Cell Institute, Cambridge, MA, USA
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
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11
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Musallam KM, Vitrano A, Meloni A, Pollina SA, Karimi M, El-Beshlawy A, Hajipour M, Di Marco V, Ansari SH, Filosa A, Ricchi P, Ceci A, Daar S, Vlachaki E, Singer ST, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Sankaran VG, Vichinsky E, Taher AT, Maggio A. Survival and causes of death in 2,033 patients with non-transfusion-dependent β-thalassemia. Haematologica 2021. [PMID: 33882642 DOI: 10.3324/haematol.2021.278684.pmid:33882642;pmcid:pmc8409024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Affiliation(s)
| | - Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz
| | - Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran
| | - Vito Di Marco
- Department of Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Saqib Hussain Ansari
- Department of Pediatric Haematology and Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA)
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman; Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch
| | | | - Sylvia Titi Singer
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | | | - Alessia Pepe
- MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA)
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Harvard Stem Cell Institute, Cambridge, MA
| | - Elliott Vichinsky
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo
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12
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Musallam KM, Vitrano A, Meloni A, Pollina WA, Karimi M, El-Beshlawy A, Hajipour M, Di Marco V, Ansari SH, Filosa A, Ricchi P, Ceci A, Daar S, Vlachaki E, Singer ST, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Sankaran VG, Vichinsky E, Taher AT, Maggio A. Survival and causes of death in 2,033 patients with non-transfusion-dependent β-thalassemia. Haematologica 2021; 106:2489-2492. [PMID: 33882642 PMCID: PMC8409024 DOI: 10.3324/haematol.2021.278684] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz
| | - Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo
| | - Saqib Hussain Ansari
- Department of Pediatric Haematology and Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA)
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman; Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch
| | | | - Sylvia Titi Singer
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | | | - Alessia Pepe
- MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA)
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Harvard Stem Cell Institute, Cambridge, MA
| | - Elliott Vichinsky
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo.
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13
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Sacchi N, Ciceri F, Bonifazi F, Algeri M, Gallina A, Pollichieni S, Raggio E, Hadj-Amar B, Lombardini L, Pupella S, Liumbruno G, Cardillo M. Availability of HLA-allele-matched unrelated donors and registry size: Estimation from haplotype frequency in the Italian population. Hum Immunol 2021; 82:758-766. [PMID: 34353675 DOI: 10.1016/j.humimm.2021.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
In Italy, an HLA-matched unrelated donor is currently the primary donor when a HLA matched sibling is not found for allogeneic haematopoietic stem cell transplantation (HSCT). Better outcomes for transplantation require optimal matching between donor and recipient at least at the HLA-A, -B, -C, and -DRB1 loci; therefore, the availability of HLA-matched unrelated donors is important. The enormous HLA polymorphism has always necessitated registries with a large number of individuals in order to be able to provide well-matched donors to a substantial percentage of patients. In order to increase the efficiency of the Italian Bone Marrow Donor Registry (IBMDR) in providing Italian patients with a suitable donor, the probability of finding an HLA-A, -B, -C, and -DRB1 allele-matched (8/8) or a single mismatch unrelated donor (7/8) was estimated in this study according to IBMDR size. Using a biostatistical approach based on HLA haplotype frequencies of more than 100,000 Italian donors enrolled in the IBMDR and HLA-typed at high-resolution level, the probability of finding an 8/8 HLA-matched donor was 23.8%; 33.4%; and 41.4% in simulated registry sizes of 200,000; 500,000; and 1,000,000 donors; respectively. More than 2 million recruited donors are needed to increase the likelihood of identifying an HLA 8/8 matched donor for 50% of Italian patients. If one single mismatch at HLA I class loci was accepted, the probability of finding a 7/8 HLA-matched donor was 62.8%; 73.7%; and 80.3% in 200,000 donors; 500,000; and 1,000,000 donors; respectively. Using the regional haplotype frequencies of IBMDR donors, the probability of recruiting a donor with a new HLA phenotype, in the different Italian regions, was also calculated. Our findings are highly relevant in estimating the optimal size of the national registry, in planning a cost-effective strategy for donor recruitment in Italy, and determining the regional priority setting of recruitment activity in order to increase the phenotypic variability of IBMDR as well as its efficiency.
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Affiliation(s)
- N Sacchi
- E.O. Galliera, Italian Bone Marrow Donor Registry Genova, Italy.
| | - F Ciceri
- Department of Hematology and Stem Cell Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - F Bonifazi
- Istituto di Ematologia "Seràgnoli" IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - M Algeri
- Dipartimento di Oncoematologia Pediatrica, IRCCS, Ospedale Pediatrico Bambino Gesu', Sapienza, Università di Roma, Roma, Italy
| | - A Gallina
- E.O. Galliera, Italian Bone Marrow Donor Registry Genova, Italy
| | - S Pollichieni
- E.O. Galliera, Italian Bone Marrow Donor Registry Genova, Italy
| | - E Raggio
- E.O. Galliera, Italian Bone Marrow Donor Registry Genova, Italy
| | - B Hadj-Amar
- Department of Statistics, Rice University, Houston, TX, USA
| | - L Lombardini
- Italian National Transplant Centre, National Institute of Health, Rome, Italy
| | - S Pupella
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - G Liumbruno
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - M Cardillo
- Italian National Transplant Centre, National Institute of Health, Rome, Italy
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14
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Toma M, Felisi M, Bonifazi D, Bonifazi F, Giannuzzi V, Reggiardo G, de Wildt S, Ceci A. Paediatric Medicines in Europe: The Paediatric Regulation-Is It Time for Reform? Front Med (Lausanne) 2021; 8:593281. [PMID: 33604345 PMCID: PMC7884470 DOI: 10.3389/fmed.2021.593281] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/12/2021] [Indexed: 02/03/2023] Open
Abstract
Objectives: In this paper, we investigated the effects of the European Paediatric Regulation (EC) N° 1901/2006 with respect to satisfying the paediatric therapeutic needs, assessed in terms of the increased number of paediatric medicinal products, new therapeutic indications in specific high-need conditions (neonates, oncology, rare disease, etc.) and increased number of paediatric clinical studies supporting the marketing authorisation. Methods: We analysed the paediatric medicinal products approved by the European Medicines Agency in the period January 2007-December 2019, by collecting the following data: year of approval, active substance, legal basis for the marketing authorisation, type of medicinal product (i.e., chemical, biological, or ATMP), orphan drug status, paediatric indication, Anatomical Therapeutic Chemical code (first-level), number and type of paediatric studies. Data were compared with similar data collected in the period 1996–2006. Results: In the period January 1996–December 2019, in a total of 1,190 medicinal products and 843 active substances, 34 and 38%, respectively, were paediatric. In the two periods, before and after the Paediatric Regulation implementation, the paediatric/total medicinal products ratio was constant while the paediatric/total active substances ratio decreased. Moreover, excluding generics and biosimilars, a total of 106 and 175 paediatric medicines were granted a new paediatric indication, dosage or age group in the two periods; out of 175, 128 paediatric medicines had an approved Paediatric Investigational Plan. The remaining 47 were approved without an approved Paediatric Investigational Plan, following the provisions of Directive 2001/83/EC and repurposing an off-patent drug. The analysis of the clinical studies revealed that drugs with a Paediatric Investigational Plan were supported by 3.5 studies/drug while drugs without a Paediatric Investigational Plan were supported by only 1.6 studies/drug. Discussion: This report confirms that the expectations of the European Paediatric Regulation (EC) N° 1901/2006 have been mainly satisfied. However, the reasons for the limited development of paediatric medicines in Europe, should be further discussed, taking advantage of recent initiatives in the regulatory field, such as the Action Plan on Paediatrics, and the open consultation on EU Pharmaceutical Strategy.
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Affiliation(s)
- Maddalena Toma
- Fondazione per la Ricerca Farmacologica "Gianni Benzi" Onlus, Bari, Italy
| | | | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Bari, Italy
| | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica "Gianni Benzi" Onlus, Bari, Italy
| | - Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica "Gianni Benzi" Onlus, Bari, Italy
| | | | - Saskia de Wildt
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica "Gianni Benzi" Onlus, Bari, Italy
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Vitrano A, Meloni A, Addario Pollina W, Karimi M, El-Beshlawy A, Hajipour M, Di Marco V, Hussain Ansari S, Filosa A, Ricchi P, Ceci A, Daar S, Titi Singer S, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Vichinsky E, Maggio A. A complication risk score to evaluate clinical severity of thalassaemia syndromes. Br J Haematol 2021; 192:626-633. [PMID: 33216983 DOI: 10.1111/bjh.17203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/28/2020] [Indexed: 01/16/2023]
Abstract
The thalassaemia syndromes (TS) show different phenotype severity. Developing a reliable, practical and global tool to determine disease severity and tailor treatment would be of great value. Overall, 7910 patients were analysed with the aim of constructing a complication risk score (CoRS) to evaluate the probability of developing one or more complications. Nine independent variables were included in the investigation as predictors. Logistic regression models were used for Group A [transfusion-dependent thalassaemia (TDT)], Group B [transfused non-TDT (NTDT)] and Group C (non-transfused NTDT). Statistically significant predictors included age (years), haemoglobin levels, hepatic transaminases [alanine aminotransferase (ALT) and aspartate aminotransferase] and left-ventricular ejection fraction (LVEF) for Group A; age (years), age at first chelation (months), ALT and LVEF for Group B; and age (years), mean serum ferritin (SF) levels and LVEF for Group C. The area under the receiver operating characteristic curve was 84·5%, 82·1% and 80·0% for Groups A, Group B and Group C respectively, suggesting the models had good discrimination. Finally, the CoRS for each group was categorised into four risk classes (low, intermediate, high, and very high) using the centiles of its distribution. In conclusion, we have developed a CoRS for TS that can assist physicians in prospectively tailoring patients' treatment.
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Affiliation(s)
- Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahmoud Hajipour
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Saqib Hussain Ansari
- Department of Paediatric Haematology and Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano, BA, Italy
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
- Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Alessia Pepe
- U.O.C. MRI, Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano, BA, Italy
| | | | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
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Bonifazi F, Volpe E, Digregorio G, Giannuzzi V, Ceci A. Machine Learning Systems Applied to Health Data and System. Eur J Health Law 2020; 27:242-258. [PMID: 33652397 DOI: 10.1163/15718093-bja10009] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The use of machine learning (ML) in medicine is becoming increasingly fundamental to analyse complex problems by discovering associations among different types of information and to generate knowledge for medical decision support. Many regulatory and ethical issues should be considered. Some relevant EU provisions, such as the General Data Protection Regulation, are applicable. However, the regulatory framework for developing and marketing a new health technology implementing ML may be quite complex. Other issues include the legal liability and the attribution of negligence in case of errors. Some of the above-mentioned concerns could be, at least partially, resolved in case the ML software is classified as a 'medical device', a category covered by EU/national provisions. Concluding, the challenge is to understand how sustainable is the regulatory system in relation to the ML innovation and how legal procedures should be revised in order to adapt them to the current regulatory framework.
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Affiliation(s)
- Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
| | - Elisabetta Volpe
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
| | | | - Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
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17
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Olivieri A, Mancini G, Olivieri J, Marinelli Busilacchi E, Cimminiello M, Pascale SP, Nuccorini R, Patriarca F, Corradini P, Bacigalupo A, Angelini S, Poloni A, Grillo G, Onida F, Martino M, Di Renzo N, Nagler A, Mordini N, Bruno B, Ciceri F, Bonifazi F. Nilotinib in steroid-refractory cGVHD: prospective parallel evaluation of response, according to NIH criteria and exploratory response criteria (GITMO criteria). Bone Marrow Transplant 2020; 55:2077-2086. [PMID: 32332918 DOI: 10.1038/s41409-020-0902-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/19/2020] [Accepted: 04/03/2020] [Indexed: 11/10/2022]
Abstract
We conducted a phase I-II study to evaluate Nilotinib (NIL) safety and pharmacokinetics in 22 SR-cGVHD patients; we also evaluated ORR by using in parallel NIH criteria and an exploratory approach, combining objective improvement (OI) without failure criteria (GITMO criteria). Results: 22 patients were enrolled. After dose escalation up to 600 mg/day, MTD was not reached. Main toxicities were asthenia, headache, nausea, pruritus, cramps, and mild anemia. Mean and median plasma concentrations of NIL (C-NIL) were 817 (SD ± 450) and 773 ng/ml. ORR at 6 months, according to 2005 and 2014 NIH and GITMO criteria were 27.8%, 22.2%, and 55.6% respectively; close correspondence has been observed for ORR, according to 2014 NIH criteria, both assessed in a conventional way and assisted by dedicated software (CROSY). At 48 months OS was 75% while FFS, according to NIH and GITMO criteria, was 30 and 25%. In conclusion the safety profile of NIL and long-term outcome makes NIL an attractive option in SR-cGVHD. Exploratory GITMO criteria could represent an alternative tool for easy response evaluation in patients with prevalent skin and lung involvement, but require validation in a larger population; CROSY software showed excellent reliability in capturing ORR according to the 2014 NIH criteria.
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Affiliation(s)
- A Olivieri
- Unit of Hematology, AUO Ospedali Riuniti di Ancona, Ancona, Italy. .,Department of Clinical and Molecular Science, Università Politecnica delle Marche, Ancona, Italy.
| | - G Mancini
- Unit of Hematology, AUO Ospedali Riuniti di Ancona, Ancona, Italy
| | - J Olivieri
- Department of Hematology, Centro Trapianti e Terapie Cellulari, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - E Marinelli Busilacchi
- Department of Clinical and Molecular Science, Università Politecnica delle Marche, Ancona, Italy
| | - M Cimminiello
- Regional Department of Hematology, U.O.C. of Hematology and Stem Cell Transplantation, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - S P Pascale
- Regional Department of Hematology, U.O.C. of Hematology and Stem Cell Transplantation, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - R Nuccorini
- Regional Department of Hematology, U.O.C. of Hematology and Stem Cell Transplantation, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - F Patriarca
- Department of Hematology, Centro Trapianti e Terapie Cellulari, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - P Corradini
- Department of Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - A Bacigalupo
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Roma, Italy
| | - S Angelini
- U.O.C of Hematology, Ospedale C.G. Mazzoni, Ascoli Piceno, Italy
| | - A Poloni
- Unit of Hematology, AUO Ospedali Riuniti di Ancona, Ancona, Italy.,Department of Clinical and Molecular Science, Università Politecnica delle Marche, Ancona, Italy
| | - G Grillo
- Division of Hematology and Oncology, ASST Grande Ospedale Metropolitano Niguarda Milan, Milan, Italy
| | - F Onida
- BMT Center, Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - M Martino
- Stem Cell Transplantation Unit (CTMO), Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - N Di Renzo
- Haematology and BMT Unit, Ospedale Vito Fazzi, Lecce, Italy
| | - A Nagler
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Tel Aviv University, Tel Aviv, Israel
| | - N Mordini
- BMT Center, Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - B Bruno
- S.S.D. Allogenic Stem Cell Transplantation, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - F Ciceri
- IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milano, Italy
| | - F Bonifazi
- Institute of Hematology, "Seragnoli" University Hospital S. Orsola-Malpighi, Bologna, Italy
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18
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Ruggieri L, Bonifazi D, Landi A, Bonifazi F, Bartoloni F, Costello M, Felisi MG, Gasthuys E, Godo A, Martinon Torres F, Nadal D, Nuytinck L, Rocchi F, Turner M, Ceci A. Survey by TEDDY European Network of Excellence for Paediatric Clinical Research demonstrates potential for Europe-wide trials. Acta Paediatr 2020; 109:607-612. [PMID: 31532836 DOI: 10.1111/apa.15020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/27/2019] [Accepted: 09/16/2019] [Indexed: 01/11/2023]
Abstract
AIM The European Network of Excellence for Paediatric Clinical Research, known as the TEDDY Network, carried out a survey to determine the capacity and competence of paediatric centres to perform research studies. METHODS A cross-sectional, web-based pilot survey was conducted from October 2016 to April 2017 with paediatric clinical research centres in 11 countries: Albania, Austria, Belgium, Denmark, Iceland, Ireland, Italy, Norway, Spain, Switzerland and the United Kingdom. All were registered with the TEDDY Network database. RESULTS We approached 107 centres and 63 provided data on their experiences and expertise in paediatric clinical trials. Four groups of performance indicators were identified, referring to scientific experience, trial readiness, trial competence, regulatory issues, ethics and patients. Most centres were actively involved in paediatric clinical research: 53 centres (84.1%) had received funds for more than five paediatric studies in the last 5 years, and 42 (66.7%) had a specific clinical trial unit and dedicated study coordinators. We concluded that the European centres we studied had the capability and capacity to conduct paediatric trials, but there was still room for improvement, including enhanced collaboration. CONCLUSION This pilot survey demonstrated that there is potential for performing paediatric trials across Europe, but improvements are possible.
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Affiliation(s)
- Lucia Ruggieri
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
| | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche Bari Italy
| | - Annalisa Landi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
| | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
| | - Franco Bartoloni
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
| | - Mary Costello
- National Children’s Research Centre Our Lady’s Children’s Hospital Crumlin Dublin Ireland
| | | | | | - Anila Godo
- University Hospital Center Mother Teresa Tirana Albania
| | | | | | | | | | | | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
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Landi A, Thompson M, Giannuzzi V, Bonifazi F, Labastida I, da Silva Santos LOB, Roos M. The “A” of FAIR – As Open as Possible, as Closed as Necessary. Data Intellegence 2020. [DOI: 10.1162/dint_a_00027] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In order to provide responsible access to health data by reconciling benefits of data sharing with privacy rights and ethical and regulatory requirements, Findable, Accessible, Interoperable and Reusable (FAIR) metadata should be developed. According to the H2020 Program Guidelines on FAIR Data, data should be “as open as possible and as closed as necessary”, “open” in order to foster the reusability and to accelerate research, but at the same time they should be “closed” to safeguard the privacy of the subjects. Additional provisions on the protection of natural persons with regard to the processing of personal data have been endorsed by the European General Data Protection Regulation (GDPR), Reg (EU) 2016/679, that came into force in May 2018. This work aims to solve accessibility problems related to the protection of personal data in the digital era and to achieve a responsible access to and responsible use of health data. We strongly suggest associating each data set with FAIR metadata describing both the type of data collected and the accessibility conditions by considering data protection obligations and ethical and regulatory requirements. Finally, an existing FAIR infrastructure component has been used as an example to explain how FAIR metadata could facilitate data sharing while ensuring protection of individuals.
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Affiliation(s)
- Annalisa Landi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, 30 – 70010 Valenzano (BA), Italy
| | - Mark Thompson
- Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
| | - Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, 30 – 70010 Valenzano (BA), Italy
| | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, 30 – 70010 Valenzano (BA), Italy
| | - Ignasi Labastida
- Learning and Research Resources Centre (CRAI), Universitat de Barcelona, Catalunya 08007, Spain
| | | | - Marco Roos
- Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
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20
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Ceci A, Conte R, Didio A, Bonifazi D, Felisi M, Giannuzzi V, Bonifazi F. An overview of the efficacy and safety of deferiprone in paediatric patients with congenital haemoglobinopathies and chronic iron overload. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1613977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Adriana Ceci
- Department of Research, Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Rosa Conte
- Department of Research, Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Antonella Didio
- Department of Research, Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Donato Bonifazi
- Department of Clinical Research, Consorzio per Valutazioni Biologiche e Farmacologiche, Bari, Italy
| | - Mariagrazia Felisi
- Department of Clinical Research, Consorzio per Valutazioni Biologiche e Farmacologiche, Bari, Italy
| | - Viviana Giannuzzi
- Department of Research, Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Fedele Bonifazi
- Department of Research, Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
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21
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Giaccone L, Mancini G, Mordini N, Gargiulo G, De Cecco V, Angelini S, Arpinati M, Baronciani D, Bozzoli V, Bramanti S, Calore E, Cavattoni IM, Cimminiello M, Colombo AA, Facchini L, Falcioni S, Faraci M, Fedele R, Guidi S, Iori AP, Marotta S, Micò MC, Milone G, Onida F, Pastore D, Patriarca F, Pini M, Raimondi R, Rovelli A, Santarone S, Severino A, Skert C, Stanghellini MTL, Tecchio C, Vassallo E, Chiarucci M, Bruno B, Bonifazi F, Olivieri A. 'Real-life' report on the management of chronic GvHD in the Gruppo Italiano Trapianto Midollo Osseo (GITMO). Bone Marrow Transplant 2017; 53:58-63. [PMID: 29084200 DOI: 10.1038/bmt.2017.223] [Citation(s) in RCA: 6] [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] [Received: 04/18/2017] [Revised: 08/18/2017] [Accepted: 08/31/2017] [Indexed: 01/24/2023]
Abstract
Several guidelines have been published about management of chronic GvHD (cGvHD), but the clinical practice still remains demanding. The Gruppo Italiano Trapianto di Midollo Osseo (GITMO) has planned a prospective observational study on cGvHD, supported by a dedicated software, including the updated recommendations. In view of this study, two surveys have been conducted, focusing the management of cGvHD and ancillary therapy in cGvHD, to address the current 'real life' situation. The two surveys were sent to all 57 GITMO centers, performing allografting in Italy; the response rate was 57% and 66% of the interviewed centers, respectively. The first survey showed a great disparity especially regarding steroid-refractory cGvHD, although extracorporeal photo-apheresis resulted as the most indicated treatment in this setting. Another challenging issue was the strategy for tapering steroid: our survey showed a great variance, and this disagreement could be a real bias in evaluating outcomes in prospective studies. As for the second survey, the results suggest that the ancillary treatments are not standardized in many centers. All responding centers reported a strong need to standardize management of cGvHD and to participate in prospective trials. Before starting observational and/or interventional studies, a detailed knowledge of current practice should be encouraged.
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Affiliation(s)
- L Giaccone
- Department of Molecular Biotechnology and Health Sciences, University of Torino, and Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - G Mancini
- Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - N Mordini
- Division of Hematology, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - G Gargiulo
- UOC Ematology and TCSE, AOU Federico II, Napoli, Italy
| | - V De Cecco
- UOC Oncoematology Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Angelini
- Division of Hematology and Stem Cell Transplantation, Ospedale Mazzoni, Ascoli Piceno, Italy
| | - M Arpinati
- Division of Hematology, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
| | - D Baronciani
- Ospedale di Riferimento Regionale Businco, AO Brotzu, Cagliari, Italy
| | - V Bozzoli
- Divisione di Ematologia, Ospedale di Lecce, Lecce, Italy
| | - S Bramanti
- Division of Hematology, Ospedale Humanitas, Rozzano, Italy
| | - E Calore
- Department of Women's and Children's Health, Clinic of Pediatric Hemato-Oncology, University Hospital of Padova, Padova, Italy
| | - I M Cavattoni
- Hematology and Bone Marrow Transplant Unit, Ospedale Centrale di Bolzano, Bolzano, Italy
| | - M Cimminiello
- UOC di Ematologia con TMO, Ospedale San Carlo, Potenza, Italy
| | - A A Colombo
- Divisione di Ematologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - L Facchini
- Hematology Unit, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - S Falcioni
- U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy
| | - M Faraci
- Department of Pediatric Hematology-Oncology, IRCCS G. Gaslini, Genova, Italy
| | - R Fedele
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - S Guidi
- Department of Hematology, Bone Marrow Transplant Unit, University of Firenze, Firenze, Italy
| | - A P Iori
- Department of 'Cellular Biotechnologies and Hematology', Azienda Policlinico Umberto I, Università La Sapienza, Roma, Italy
| | - S Marotta
- UOC Ematology and TCSE, AOU Federico II, Napoli, Italy
| | - M C Micò
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - G Milone
- Hematology and Bone Marrow Transplant Unit, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - F Onida
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico-University of Milan, Milano, Italy
| | - D Pastore
- Dipartimento di Ematologia, Università di Bari, Bari, Italy
| | - F Patriarca
- Azienda Ospedaliera-Universitaria di Udine, DISM Università di Udine, Udine, Italy
| | - M Pini
- Hematology, AO SS Antonio e Biagio e C Arrigo, Alessandria, Italy
| | - R Raimondi
- Hematology and Bone Marrow Transplant Unit, Ospedale San Bortolo, Vicenza, Italy
| | - A Rovelli
- BMT Unit, MBBM Foundation, Paediatric Department, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - S Santarone
- Unità Terapia Intensiva Ematologica per il Trapianto Emopoietico, Ospedale Civile, Pescara, Italy
| | - A Severino
- Divisione di Ematologia, Ospedale San Camillo, Roma, Italy
| | - C Skert
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, AO Spedali Civili di Brescia, Brescia, Italy
| | - M T L Stanghellini
- Molecular Hematology Laboratory, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - C Tecchio
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - E Vassallo
- Pediatric Onco-Hematology and Stem Cell Transplant Division, AO Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Chiarucci
- Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - B Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Torino, and Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - F Bonifazi
- Division of Hematology, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
| | - A Olivieri
- Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
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22
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Giannuzzi V, Landi A, Bosone E, Giannuzzi F, Nicotri S, Torrent-Farnell J, Bonifazi F, Felisi M, Bonifazi D, Ceci A. Failures to further developing orphan medicinal products after designation granted in Europe: an analysis of marketing authorisation failures and abandoned drugs. BMJ Open 2017; 7:e017358. [PMID: 28893754 PMCID: PMC5595174 DOI: 10.1136/bmjopen-2017-017358] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The research and development process in the field of rare diseases is characterised by many well-known difficulties, and a large percentage of orphan medicinal products do not reach the marketing approval.This work aims at identifying orphan medicinal products that failed the developmental process and investigating reasons for and possible factors influencing failures. DESIGN Drugs designated in Europe under Regulation (European Commission) 141/2000 in the period 2000-2012 were investigated in terms of the following failures: (1) marketing authorisation failures (refused or withdrawn) and (2) drugs abandoned by sponsors during development.Possible risk factors for failure were analysed using statistically validated methods. RESULTS This study points out that 437 out of 788 designations are still under development, while 219 failed the developmental process. Among the latter, 34 failed the marketing authorisation process and 185 were abandoned during the developmental process. In the first group of drugs (marketing authorisation failures), 50% reached phase II, 47% reached phase III and 3% reached phase I, while in the second group (abandoned drugs), the majority of orphan medicinal products apparently never started the development process, since no data on 48.1% of them were published and the 3.2% did not progress beyond the non-clinical stage.The reasons for failures of marketing authorisation were: efficacy/safety issues (26), insufficient data (12), quality issues (7), regulatory issues on trials (4) and commercial reasons (1). The main causes for abandoned drugs were efficacy/safety issues (reported in 54 cases), inactive companies (25.4%), change of company strategy (8.1%) and drug competition (10.8%). No information concerning reasons for failure was available for 23.2% of the analysed products. CONCLUSIONS This analysis shows that failures occurred in 27.8% of all designations granted in Europe, the main reasons being safety and efficacy issues. Moreover, the stage of development reached by drugs represents a specific risk factor for failures.
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Affiliation(s)
- Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Valenzano, Italy
| | - Annalisa Landi
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Valenzano, Italy
| | - Enrico Bosone
- Società Italiana Attività Regolatorie (SIAR), Pavia, UK
| | - Floriana Giannuzzi
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Bari, Italy
| | - Stefano Nicotri
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione di Bari, Bari, Italy
| | - Josep Torrent-Farnell
- Department of Clinical Pharmacology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
| | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Valenzano, Italy
| | - Mariagrazia Felisi
- Consorzio per le Valutazioni Biologiche e Farmacologiche, Pavia, Lombardia, Italy
| | - Donato Bonifazi
- Consorzio per le Valutazioni Biologiche e Farmacologiche, Pavia, Lombardia, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Valenzano, Italy
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23
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Bonifazi F, Conte R, Baiardi P, Bonifazi D, Felisi M, Giordano P, Giannuzzi V, Iacono A, Padula R, Pepe A, Caterina Putti M, Ruggieri L, Carlo Del Vecchio G, Filosa A, Maggio A, Ceci A. Pattern of complications and burden of disease in patients affected by beta thalassemia major. Curr Med Res Opin 2017; 33:1525-1533. [PMID: 28471307 DOI: 10.1080/03007995.2017.1326890] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Despite the correct application of blood transfusions and chelation treatments, beta thalassemia patients have many complications. Systematic population analyses on types and frequency of these complications are very few. The aim of this study is to characterize the complications, their risk factors and their clinical and economic impact. METHODS Complications at baseline and events occurring during one observational year were analyzed in 272 patients aged >12 years. Risk factors were analyzed through chi-squared and unpaired t tests. Logistic regression was applied to perform the risk factors multivariate analysis. RESULTS A total of 554 complications (1-6 per patient) affected 82.3% of patients. Cardiac complications were less represented than expected. Musculoskeletal diseases were the most represented complications followed by hepatic, sexual and endocrine diseases. Splenectomized patients, born before 1970 and aged >40 years, starting iron chelation therapy when aged >4 years or after receiving more than 20 blood transfusions, presented a significantly higher number of complications. A total of 885 adverse events requiring 34125 additional medical services occurred in 1 year. Of these, 34.9% were related to treatments and 65.1% to other causes. Event numbers, additional medical interventions and cost increased progressively in patients affected by one or more complication compared to patients with no complications. CONCLUSIONS The pattern of complications changes according to birth cohort and differentiates older from younger patients. The burden of the disease and its costs increase after the onset of the first complication, therefore prevention of complications is fundamental in these patients.
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Affiliation(s)
- Fedele Bonifazi
- a Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus , Valenzano ( BA ), Italy
| | - Rosa Conte
- a Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus , Valenzano ( BA ), Italy
| | | | - Donato Bonifazi
- c Consorzio per Valutazioni Biologiche e Farmacologiche , Pavia , Italy
| | | | - Paola Giordano
- d Dipartimento di Biomedicina e oncologia umana Sezione pediatrica , Università "A. Moro" di Bari , Italy
| | - Viviana Giannuzzi
- a Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus , Valenzano ( BA ), Italy
| | - Angela Iacono
- e Fondazione "Leonardo Giambrone" per la Guarigione dalla Thalassemia , Castelvolturno ( CE ), Italy
| | - Rosa Padula
- c Consorzio per Valutazioni Biologiche e Farmacologiche , Pavia , Italy
| | - Alessia Pepe
- f Fondazione G. Monasterio C.N.R. , Regione Toscana , Pisa , Italy
| | - Maria Caterina Putti
- g Azienda Ospedaliera Padova Centro Leucemie Oncoematologia Pediatrica , Padova , Italy
| | - Lucia Ruggieri
- a Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus , Valenzano ( BA ), Italy
| | - Giovanni Carlo Del Vecchio
- h Azienda Ospedaliera Universitaria Consorziale Policlinico di Bari, Unità Operativa di Pediatria Generale e Specialistica "Federico Vecchio" Bari , Italy
| | - Aldo Filosa
- i Azienda Ospedaliera "A. Cardarelli" UOS Talassemia Pediatrica e Emoglobinopatie Pediatriche , Napoli , Italy
| | - Aurelio Maggio
- j Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello , Palermo , Italy
| | - Adriana Ceci
- a Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus , Valenzano ( BA ), Italy
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24
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Bazarbachi A, Boumendil A, Finel H, Mohty M, Castagna L, Blaise D, Peggs K, Afanasyev B, Diez-Martin J, Corradini P, Socié G, Robinson S, Gutiérrez-García G, Bonifazi F, Yakoub-Agha I, Gülbas Z, Bloor A, Delage J, Esquirol A, Malladi R, Scheid C, Ghesquières H, Montoto S, Dreger P, Sureda A. BRENTUXIMAB VEDOTIN FOR RELAPSED HODGKIN LYMPHOMA AFTER ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION: a RETROSPECTIVE STUDY OF THE EBMT LYMPHOMA WORKING PARTY. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_71] [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: 11/08/2022]
Affiliation(s)
- A. Bazarbachi
- Department of internal medicine; American University of Beirut; Beirut Lebanon
| | - A. Boumendil
- EBMT LWP Paris Office; Hôpital Saint-Antoine; Paris France
| | - H. Finel
- EBMT LWP Paris Office; Hôpital Saint-Antoine; Paris France
| | - M. Mohty
- Service d'Hématologie et Thérapie Cellulaire; Hôpital Saint Antoine; Paris France
| | - L. Castagna
- Department of Hematology; Istituto Clinico Humanitas; Milan Italy
| | - D. Blaise
- Department of internal medicine; Institut Paoli Calmettes; Marseille France
| | - K. Peggs
- Department of internal medicine; University College London Hospital; London UK
| | - B. Afanasyev
- Department of internal medicine; First State Pavlov Medical University of St. Petersburg; St. Petersburg Russian Federation
| | - J. Diez-Martin
- Department of internal medicine; Hospital Gregorio Marañón; Madrid Spain
| | - P. Corradini
- IRCCS Istituto Nazionale dei Tumori; University of Milano; Milan Italy
| | - G. Socié
- Department of internal medicine; Hopital St. Louis; Paris France
| | - S. Robinson
- Department of internal medicine; University Hospital Bristol; Bristol UK
| | | | - F. Bonifazi
- S.Orsola-Malpighi Hospital; Bologna University; Bologna Italy
| | | | - Z. Gülbas
- Department of internal medicine; Anadolu Medical Center Hospital; Kocaeli Turkey
| | - A. Bloor
- Department of internal medicine; Christie NHS Trust Hospital; Manchester UK
| | - J. Delage
- Department of internal medicine; CHU Lapeyronie; Montpellier France
| | - A. Esquirol
- Department of internal medicine; Hospital Santa Creu i Sant Pau; Barcelona Spain
| | - R. Malladi
- Department of internal medicine; Queen Elizabeth Hospital; Birmingham UK
| | - C. Scheid
- Department of internal medicine; University of Cologne; Cologne Germany
| | - H. Ghesquières
- Department of internal medicine; Centre Hospitalier Lyon Sud; Lyon France
| | - S. Montoto
- Department of Haemato-oncology; St Bartholomew's Hospital; London UK
| | - P. Dreger
- Dept Medicine V; University of Heidelberg; Heidelberg Germany
| | - A. Sureda
- Department of Haematology; Institut Catala d'Oncologia, Hospital Duran I Reynals; Barcelona Spain
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25
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Giannaccare G, Bonifazi F, Sessa M, Dan E, Arpinati M, Fresina M, Bandini G, Cavo M, Versura P, Campos EC. Ocular surface analysis in hematological patients before and after allogeneic hematopoietic stem cell transplantation: implication for daily clinical practice. Eye (Lond) 2017; 31:1417-1426. [PMID: 28524885 DOI: 10.1038/eye.2017.78] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 02/23/2017] [Indexed: 12/16/2022] Open
Abstract
PurposeTo evaluate ocular surface parameters before and after hematopoietic stem cell transplantation (HSCT) and to correlate them with clinical and transplant variables.MethodsThis is a retrospective analysis of data from 93 patients affected by hematological malignancies undergoing HSCT. Values from Ocular Surface Disease Index, Schirmer test, Break-up Time, ocular surface staining, and Meibomian Gland Dysfunction score obtained before HSCT and 3-6 months after were retrieved from charts. Diagnosis and staging of dry eye (DE) disease was performed according to Dry Eye WorkShop criteria. Graft-versus-host-disease (GVHD) was classified according to the NIH criteria. Odds ratios for DE onset after HSCT were estimated for demographic, ocular, hematological and transplant variables.ResultsDE was diagnosed before HSCT in 50 (53%) of the patients, mostly of hyperevaporative profile. After HSCT, all ocular parameters significantly worsened with no change in DE profile. A 51% incident cases (22 of the 43 non-DE subjects) were reported. Increasing recipient age and female sex, higher CD34+ cells infused, donor-recipient sex mismatch (males receiving from females), related donors, and peripheral blood cells as stem cell source were associated with a significant higher incidence of DE after HSCT. Systemic chronic GVHD was diagnosed in 42% while ocular GVHD in 35.5% of the patients, which decreased to 12% when taking into account only incident cases.ConclusionsHigh DE prevalence was shown already before HSCT. A pre-HSCT ocular surface assessment is recommended for early DE diagnosis and treatment. This new protocol also influences the prevalence of ocular GVHD.
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Affiliation(s)
- G Giannaccare
- Ophthalmology Unit, DIMES, Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - F Bonifazi
- Haematology Institute 'L.A. Seragnoli', DIMES, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - M Sessa
- Haematology Institute 'L.A. Seragnoli', DIMES, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - E Dan
- Haematology Institute 'L.A. Seragnoli', DIMES, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - M Arpinati
- Haematology Institute 'L.A. Seragnoli', DIMES, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - M Fresina
- Ophthalmology Unit, DIMES, Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - G Bandini
- Haematology Institute 'L.A. Seragnoli', DIMES, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - M Cavo
- Haematology Institute 'L.A. Seragnoli', DIMES, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - P Versura
- Ophthalmology Unit, DIMES, Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - E C Campos
- Ophthalmology Unit, DIMES, Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy
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26
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Giannuzzi V, Conte R, Landi A, Ottomano SA, Bonifazi D, Baiardi P, Bonifazi F, Ceci A. Orphan medicinal products in Europe and United States to cover needs of patients with rare diseases: an increased common effort is to be foreseen. Orphanet J Rare Dis 2017; 12:64. [PMID: 28372595 PMCID: PMC5376695 DOI: 10.1186/s13023-017-0617-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/21/2017] [Indexed: 11/17/2022] Open
Abstract
Background In the European Union (EU) and United States (US), specific regulations have been released to provide incentives to develop and sell orphan medicinal products. We analysed the status of orphan drugs designated that not yet received a marketing authorisation or already marketed for patients affected by rare diseases in the EU and US up to December 2015. For each drug, the following data were extracted: designation date, active substance(s), orphan condition and indication, trade name, approved therapeutic indication, approved ages, genetic nature of disease and if affects children. Results In the EU, 1264 Orphan Drug Designations have been granted and 133 medicinal products were approved covering a total of 179 indications and 122 rare conditions. Among these, 79 were approved under Regulation (EC)141/2000 (65 still listed in the Orphan Medicinal Products Register and 14 lost the orphan designation but still authorised) and 23 were approved centrally by the European Agency before the Orphan Regulation entered into force. On the other hand, in the US 3082 designations and 415 orphan products, covering a total of 521 indications and 300 rare conditions, were granted. As a result, the mean of designations per year is 79 in the EU and 93.4 in the US, while the mean of approved indications per year is 8.5 in the EU and 15.8 in the US. No orphan product is marketed in the EU for bone and connective tissue, ophthalmic, poisoning/overdose, renal, urinary and reproductive rare diseases. Among the marketed medicinal products, only 46.6% in the EU and 35.2% in the US are approved for children. If all the existing market approvals were merged, 362 additional therapeutic indications in the EU and 72 in the US would be covered. Conclusions Our data show that notwithstanding the incentives issued, the number of medicines for rare diseases is still limited, and this is more evident in certain therapeutic areas. However, by merging all the existing approvals, patients would benefit of substantial advantages in both geographic areas. Efforts and cooperation between EU and US seem the only way to speed up the development and marketing of drugs for rare diseases.
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Affiliation(s)
- Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Via Abate Eustasio, 30 - 70010, Valenzano, Italy.
| | - Rosa Conte
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Via Abate Eustasio, 30 - 70010, Valenzano, Italy
| | - Annalisa Landi
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Via Abate Eustasio, 30 - 70010, Valenzano, Italy
| | | | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via L. Porta, 14 - 27100, Pavia, Italy
| | - Paola Baiardi
- Istituti Clinici Scientifici Maugeri SpA SB, Via Salvatore Maugeri, 4 - 27100, Pavia, Italy
| | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Via Abate Eustasio, 30 - 70010, Valenzano, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Via Abate Eustasio, 30 - 70010, Valenzano, Italy
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27
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Giannuzzi V, Devlieger H, Margari L, Odlind VL, Ragab L, Bellettato CM, D’Avanzo F, Lampe C, Cassis L, Cortès-Saladelafont E, Cazorla ÁG, Barić I, Cvitanović-Šojat L, Fumić K, Dali CI, Bartoloni F, Bonifazi F, Scarpa M, Ceci A. The ethical framework for performing research with rare inherited neurometabolic disease patients. Eur J Pediatr 2017; 176:395-405. [PMID: 28093642 PMCID: PMC5321701 DOI: 10.1007/s00431-017-2852-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 11/26/2022]
Abstract
The need for performing clinical trials to develop well-studied and appropriate medicines for inherited neurometabolic disease patients faces ethical concerns mainly raising from four aspects: the diseases are rare; include young and very young patients; the neurological impairment may compromise the capability to provide 'consent'; and the genetic nature of the disease leads to further ethical implications. This work is intended to identify the ethical provisions applicable to clinical research involving these patients and to evaluate if these cover the ethical issues. Three searches have been performed on the European regulatory/legal framework, the literature and European Union-funded projects. The European legal framework offers a number of ethical provisions ruling the clinical research on paediatric, rare, inherited diseases with neurological symptoms. In the literature, relevant publications deal with informed consent, newborn genetic screenings, gene therapy and rights/interests of research participants. Additional information raised from European projects on sharing patients' data from different countries, the need to fill the gap of the regulatory framework and to improve information to stakeholders and patients/families. CONCLUSION Several recommendations and guidelines on ethical aspects are applicable to the inherited neurometabolic disease research in Europe, even though they suffer from the lack of a common ethical approach. What is Known: • When planning and conducting clinical trials, sponsors and researchers know that clinical trials are to be performed according to well-established ethical rules, and patients should be aware about their rights. • In the cases of paediatric patients, vulnerable patients unable to provide consent, genetic diseases' further rules apply. What is New: • This work discusses which ethical rules apply to ensure protection of patient's rights if all the above-mentioned features coexist. • This work shows available data and information on how these rules have been applied.
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Affiliation(s)
- Viviana Giannuzzi
- Fondazione Per la Ricerca Farmacologica Gianni Benzi Onlus, Via Abate Eustasio 30, 70010 Valenzano, BA Italy
| | - Hugo Devlieger
- Department of Development and Regeneration, University of Leuven, O&N IV Herestraat 49-box 805, 3000 Leuven, Belgium
| | - Lucia Margari
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, “Aldo Moro” University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Viveca Lena Odlind
- Department of Obstetrics and Gynaecology, Uppsala Universitet, 751 85 Uppsala, SE Sweden
| | - Lamis Ragab
- Cairo University, Al Orman Guiza, Giza, 12613 Egypt
| | | | | | - Christina Lampe
- Brains for Brain Foundation – onlus, Padova, Italy
- Department of Pediatric and Adolescent Medicine, Centre for Rare Diseases, Horst Schmidt Klinik Wiesbaden, Wiesbaden, Germany
| | - Linda Cassis
- Neurology, Gastroenterology Pathology and Clinical Biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Elisenda Cortès-Saladelafont
- Neurology, Gastroenterology Pathology and Clinical Biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Ángels Garcia Cazorla
- Neurology, Gastroenterology Pathology and Clinical Biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Ivo Barić
- University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | - Christine I Dali
- Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Franco Bartoloni
- Fondazione Per la Ricerca Farmacologica Gianni Benzi Onlus, Via Abate Eustasio 30, 70010 Valenzano, BA Italy
| | - Fedele Bonifazi
- Fondazione Per la Ricerca Farmacologica Gianni Benzi Onlus, Via Abate Eustasio 30, 70010 Valenzano, BA Italy
| | - Maurizio Scarpa
- Brains for Brain Foundation – onlus, Padova, Italy
- Department of Pediatric and Adolescent Medicine, Centre for Rare Diseases, Horst Schmidt Klinik Wiesbaden, Wiesbaden, Germany
| | - Adriana Ceci
- Fondazione Per la Ricerca Farmacologica Gianni Benzi Onlus, Via Abate Eustasio 30, 70010 Valenzano, BA Italy
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28
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Genadieva-Stavrik S, Boumendil A, Dreger P, Peggs K, Briones J, Corradini P, Bacigalupo A, Socié G, Bonifazi F, Finel H, Velardi A, Potter M, Bruno B, Castagna L, Malladi R, Russell N, Sureda A. Myeloablative versus reduced intensity allogeneic stem cell transplantation for relapsed/refractory Hodgkin's lymphoma in recent years: a retrospective analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Ann Oncol 2016; 27:2251-2257. [DOI: 10.1093/annonc/mdw421] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/16/2016] [Accepted: 08/29/2016] [Indexed: 11/14/2022] Open
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Cassis L, Cortès-Saladelafont E, Molero-Luis M, Yubero D, González MJ, Ormazábal A, Fons C, Jou C, Sierra C, Ponce EC, Ramos F, Armstrong J, O'Callaghan MM, Casado M, Montero R, Meavilla-Olivas S, Artuch R, Barić I, Bartoloni F, Bellettato CM, Bonifazi F, Ceci A, Cvitanović-Šojat L, Dali CI, D'Avanzo F, Fumic K, Giannuzzi V, Lampe C, Scarpa M, Garcia-Cazorla Á. Erratum to: Review and evaluation of the methodological quality of the existing guidelines and recommendations for inherited neurometabolic disorders. Orphanet J Rare Dis 2016; 11:147. [PMID: 27809869 PMCID: PMC5095956 DOI: 10.1186/s13023-016-0431-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Linda Cassis
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Elisenda Cortès-Saladelafont
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Marta Molero-Luis
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Delia Yubero
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Maria Julieta González
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Aida Ormazábal
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Carme Fons
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Cristina Jou
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Cristina Sierra
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Esperanza Castejon Ponce
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Federico Ramos
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Judith Armstrong
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - M Mar O'Callaghan
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Mercedes Casado
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Raquel Montero
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Silvia Meavilla-Olivas
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Rafael Artuch
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Ivo Barić
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb & University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Franco Bartoloni
- Gianni Benzi Pharmacological Research Foundation, Valenzano, BA, Italy
| | | | - Fedele Bonifazi
- Gianni Benzi Pharmacological Research Foundation, Valenzano, BA, Italy
| | - Adriana Ceci
- Gianni Benzi Pharmacological Research Foundation, Valenzano, BA, Italy
| | - Ljerka Cvitanović-Šojat
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb & University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Christine I Dali
- Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Francesca D'Avanzo
- Department of Women and Children Health, Brains for Brain Foundation, Padova, Italy
| | - Ksenija Fumic
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb & University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Viviana Giannuzzi
- Gianni Benzi Pharmacological Research Foundation, Valenzano, BA, Italy
| | - Christina Lampe
- Department of Women and Children Health, Brains for Brain Foundation, Padova, Italy.,Department of Pediatric and Adolescent Medicine, Centre for Rare Diseases, Horst Schmidt Klinik Wiesbaden, Wiesbaden, Germany
| | - Maurizio Scarpa
- Department of Women and Children Health, Brains for Brain Foundation, Padova, Italy.,Department of Pediatric and Adolescent Medicine, Centre for Rare Diseases, Horst Schmidt Klinik Wiesbaden, Wiesbaden, Germany.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Ángels Garcia-Cazorla
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain.
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30
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Saraceni F, Bruno B, Lemoli RM, Meloni G, Arcese W, Falda M, Ciceri F, Alessandrino EP, Specchia G, Scimè R, Raimondi R, Bacigalupo A, Bosi A, Onida F, Rambaldi A, Bonifazi F, Olivieri A. Autologous stem cell transplantation is still a valid option in good- and intermediate-risk AML: a GITMO survey on 809 patients autografted in first complete remission. Bone Marrow Transplant 2016; 52:163-166. [PMID: 27668760 DOI: 10.1038/bmt.2016.233] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- F Saraceni
- Hematology and Bone Marrow Transplantation, Polytechnic University of Marche-Ospedali Riuniti, Ancona, Italy
| | - B Bruno
- National Registry GITMO & Data Managing, Ospedale San Martino, Genova, Italy
| | - R M Lemoli
- Hematology Clinic, Department of Internal Medicine (DiMI), University of Genoa, IRCCS AOU S. Martino-IST, Genova, Italy
| | - G Meloni
- Hematology, Department of Cellular Biotechnologies and Hematology, 'Sapienza' University of Rome, Rome, Italy
| | - W Arcese
- Rome Transplant Network, Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy
| | - M Falda
- Hematology 2 Unit, San Giovanni Battista Hospital and University, Turin, Italy
| | - F Ciceri
- Hematology and BMT Unit, Department of Oncology, San Raffaele Scientific Institute, Milano, Italy
| | - E P Alessandrino
- Department of Hematology, University of Pavia, Policlinico S Matteo-IRCCS, Pavia, Italy
| | - G Specchia
- Hematology Department, University of Bari, Bari, Italy
| | - R Scimè
- Department of Hematology and Bone Marrow Transplant Unit Ospedale Cervello, Palermo, Italy
| | - R Raimondi
- Department of Hematology, S Bortolo Hospital, Vicenza, Italy
| | - A Bacigalupo
- Institute of Haematology, Università Cattolica Sacro Cuore, Roma, Italy
| | - A Bosi
- Haematology Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - F Onida
- Hematology - BMT Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - A Rambaldi
- Hematology and BMT Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - F Bonifazi
- Hematology Clinic, Department of Internal Medicine (DiMI), University of Genoa, IRCCS AOU S. Martino-IST, Genova, Italy
| | - A Olivieri
- Hematology and Bone Marrow Transplantation, Polytechnic University of Marche-Ospedali Riuniti, Ancona, Italy
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Sobh M, Michallet M, Gahrton G, Iacobelli S, van Biezen A, Schönland S, Petersen E, Schaap N, Bonifazi F, Volin L, Meijer E, Niederwieser D, El-Cheikh J, Tabrizi R, Fegeux N, Finke J, Bunjes D, Cornelissen J, Einsele H, Bruno B, Potter M, Fanin R, Mohty M, Garderet L, Kröger N. Allogeneic hematopoietic cell transplantation for multiple myeloma in Europe: trends and outcomes over 25 years. A study by the EBMT Chronic Malignancies Working Party. Leukemia 2016; 30:2047-2054. [DOI: 10.1038/leu.2016.101] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 12/15/2022]
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Conte R, Ruggieri L, Gambino A, Bartoloni F, Baiardi P, Bonifazi D, Bonifazi F, Felisi M, Giannuzzi V, Padula R, Pepe A, Putti MC, Del Vecchio GC, Maggio A, Filosa A, Iacono A, Mangiarini L, Ceci A. The Italian multiregional thalassemia registry: Centers characteristics, services, and patients' population. ACTA ACUST UNITED AC 2016; 21:415-24. [PMID: 26863102 DOI: 10.1080/10245332.2015.1101971] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 10/22/2022]
Abstract
OBJECTIVES The prognosis of beta-Thalassemia major and other congenital hemoglobinopathies has profoundly changed over the last decades. Moreover, only few countries in Europe provide dedicated services and the description of the measures for patients monitoring and treatment is overall very scarce. The HTA-Thal project is aimed to identify the services available in Italy and to collect epidemiological and clinical data on the thalassemic population (HTA-Thal Registry). METHODS A map of the existing centers was created and two electronic questionnaires were completed with information on the services and patients. RESULTS On 182 centers identified, 60 completed the two questionnaires. Centers resulted to be extremely heterogeneous in terms of size, age of patients in care, and services availability. The transition of pediatric patients to adult centers was not guaranteed. Thousand eight hundred and seventy-three beta-Thalassemia major patients (of which 259 pediatrics), regularly transfused, were registered. Deferasirox is the most used chelator as monotherapy (616 patients) and its use prevails in younger patients. A higher number of patients (847 patients) use Deferoxamine, either alone (448 patients) or in combination with DFP (399 patients), while 782 patients use Deferiprone alone (383 patients) or in combination (399 patients). 31.6 and 66.6% of centers were not equipped for specialized visits or local MRI, respectively. Centers with 30-80 patients show the high percentage of patients appropriately monitored when compared to smaller or bigger centers. CONCLUSIONS This analysis confirms the importance of patients' registries for the collection of large datasets and the need for dedicated 'specialized centers' equipped to provide the best standard treatment to patients.
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Affiliation(s)
- Rosa Conte
- a Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus , Via Abate Eustasio 30, 70010 Valenzano (BA) , Italy
| | - Lucia Ruggieri
- a Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus , Via Abate Eustasio 30, 70010 Valenzano (BA) , Italy
| | - Arianna Gambino
- b Consorzio per Valutazioni Biologiche e Farmacologiche , Via L. Porta 14, 27100 Pavia , Italy
| | - Franco Bartoloni
- a Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus , Via Abate Eustasio 30, 70010 Valenzano (BA) , Italy
| | - Paola Baiardi
- c Fondazione Salvatore Maugeri , Via S. Maugeri, 4, 27100 Pavia , Italy
| | - Donato Bonifazi
- b Consorzio per Valutazioni Biologiche e Farmacologiche , Via L. Porta 14, 27100 Pavia , Italy
| | - Fedele Bonifazi
- a Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus , Via Abate Eustasio 30, 70010 Valenzano (BA) , Italy
| | - Mariagrazia Felisi
- b Consorzio per Valutazioni Biologiche e Farmacologiche , Via L. Porta 14, 27100 Pavia , Italy
| | - Viviana Giannuzzi
- a Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus , Via Abate Eustasio 30, 70010 Valenzano (BA) , Italy
| | - Rosa Padula
- b Consorzio per Valutazioni Biologiche e Farmacologiche , Via L. Porta 14, 27100 Pavia , Italy
| | - Alessia Pepe
- d Fondazione G. Monasterio C.N.R.- Regione Toscana , Via Moruzzi 1, 56124 Pisa , Italy
| | - Maria Caterina Putti
- e Azienda Ospedaliera Padova Centro Leucemie Oncoematologia Pediatrica , Via N. Giustiniani 3, 35128 Padova , Italy
| | - Giovanni Carlo Del Vecchio
- f Azienda Ospedaliera Universitaria Consorziale Policlinico di Bari, Unità Operativa di Pediatria Generale e Specializtica "Federico Vecchio" , P.zza G. Cesare, 11, 70124 Bari , Italy
| | - Aurelio Maggio
- g Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello , Via Trabucco, 180, 90146 Palermo , Italy
| | - Aldo Filosa
- h Azienda Ospedaliera "A. Cardarelli" UOS Talassemia Pediatrica e Emoglobinopatie Pediatriche , Via A. Cardarelli, 9, 80131 Napoli , Italy
| | - Angela Iacono
- i Fondazione "Leonardo Giambrone" per la Guarigione dalla Thalassemia , Via Savona, 56, 81030 Castelvolturno (CE) , Italy
| | - Laura Mangiarini
- b Consorzio per Valutazioni Biologiche e Farmacologiche , Via L. Porta 14, 27100 Pavia , Italy
| | - Adriana Ceci
- a Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus , Via Abate Eustasio 30, 70010 Valenzano (BA) , Italy.,b Consorzio per Valutazioni Biologiche e Farmacologiche , Via L. Porta 14, 27100 Pavia , Italy
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Cassis L, Cortès-Saladelafont E, Molero-Luis M, Yubero D, González MJ, Ormazábal A, Fons C, Jou C, Sierra C, Castejon Ponce E, Ramos F, Armstrong J, O'Callaghan MM, Casado M, Montero R, Meavilla-Olivas S, Artuch R, Barić I, Bartoloni F, Bellettato CM, Bonifazi F, Ceci A, Cvitanović-Šojat L, Dali CI, D'Avanzo F, Fumic K, Giannuzzi V, Lampe C, Scarpa M, Garcia-Cazorla Á. Review and evaluation of the methodological quality of the existing guidelines and recommendations for inherited neurometabolic disorders. Orphanet J Rare Dis 2015; 10:164. [PMID: 26714856 PMCID: PMC4696316 DOI: 10.1186/s13023-015-0376-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 08/12/2015] [Accepted: 12/10/2015] [Indexed: 12/30/2022] Open
Abstract
Background Inherited neurometabolic disorders (iNMDs) represent a group of almost seven hundred rare diseases whose common manifestations are clinical neurologic or cognitive symptoms that can appear at any time, in the first months/years of age or even later in adulthood. Early diagnosis and timely treatments are often pivotal for the favorable course of the disease. Thus, the elaboration of new evidence-based recommendations for iNMD diagnosis and management is increasingly requested by health care professionals and patients, even though the methodological quality of existing guidelines is largely unclear. InNerMeD-I-Network is the first European network on iNMDs that was created with the aim of sharing and increasing validated information about diagnosis and management of neurometabolic disorders. One of the goals of the project was to determine the number and the methodological quality of existing guidelines and recommendations for iNMDs. Methods We performed a systematic search on PubMed, the National Guideline Clearinghouse (NGC), the Guidelines International Network (G-I-N), the Scottish Intercollegiate Guideline Network (SIGN) and the National Institute for Health and Care Excellence (NICE) to identify all the published guidelines and recommendations for iNMDs from January 2000 to June 2015. The methodological quality of the selected documents was determined using the AGREE II instrument, an appraisal tool composed of 6 domains covering 23 key items. Results A total of 55 records met the inclusion criteria, 11 % were about groups of disorders, whereas the majority encompassed only one disorder. Lysosomal disorders, and in particular Fabry, Gaucher disease and mucopolysaccharidoses where the most studied. The overall methodological quality of the recommendation was acceptable and increased over time, with 25 % of the identified guidelines strongly recommended by the appraisers, 64 % recommended, and 11 % not recommended. However, heterogeneity in the obtained scores for each domain was observed among documents covering different groups of disorders and some domains like 'stakeholder involvement' and 'applicability' were generally scarcely addressed. Conclusions Greater efforts should be devoted to improve the methodological quality of guidelines and recommendations for iNMDs and AGREE II instrument seems advisable for new guideline development. The elaboration of new guidelines encompassing still uncovered disorders is badly needed. Electronic supplementary material The online version of this article (doi:10.1186/s13023-015-0376-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Linda Cassis
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Elisenda Cortès-Saladelafont
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Marta Molero-Luis
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Delia Yubero
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Maria Julieta González
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Aida Ormazábal
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Carme Fons
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Cristina Jou
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Cristina Sierra
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Esperanza Castejon Ponce
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Federico Ramos
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Judith Armstrong
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - M Mar O'Callaghan
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Mercedes Casado
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Raquel Montero
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Silvia Meavilla-Olivas
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Rafael Artuch
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Ivo Barić
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb & University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Franco Bartoloni
- Gianni Benzi Pharmacological Research Foundation, Valenzano, BA, Italy
| | | | - Fedele Bonifazi
- Gianni Benzi Pharmacological Research Foundation, Valenzano, BA, Italy
| | - Adriana Ceci
- Gianni Benzi Pharmacological Research Foundation, Valenzano, BA, Italy
| | - Ljerka Cvitanović-Šojat
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb & University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Christine I Dali
- Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Francesca D'Avanzo
- Department of Women and Children Health, Brains for Brain Foundation, Padova, Italy
| | - Ksenija Fumic
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb & University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Viviana Giannuzzi
- Gianni Benzi Pharmacological Research Foundation, Valenzano, BA, Italy
| | - Christina Lampe
- Department of Women and Children Health, Brains for Brain Foundation, Padova, Italy.,Department of Pediatric and Adolescent Medicine, Centre for Rare Diseases, Horst Schmidt Klinik Wiesbaden, Wiesbaden, Germany
| | - Maurizio Scarpa
- Department of Women and Children Health, Brains for Brain Foundation, Padova, Italy.,Department of Pediatric and Adolescent Medicine, Centre for Rare Diseases, Horst Schmidt Klinik Wiesbaden, Wiesbaden, Germany.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Ángels Garcia-Cazorla
- Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain.
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Cahu X, Labopin M, Giebel S, Aljurf M, Kyrcz-Krzemien S, Socié G, Eder M, Bonifazi F, Bunjes D, Vigouroux S, Michallet M, Stelljes M, Zuckerman T, Finke J, Passweg J, Yakoub-Agha I, Niederwieser D, Sucak G, Sengeløv H, Polge E, Nagler A, Esteve J, Mohty M. Impact of conditioning with TBI in adult patients with T-cell ALL who receive a myeloablative allogeneic stem cell transplantation: a report from the acute leukemia working party of EBMT. Bone Marrow Transplant 2015; 51:351-7. [PMID: 26618548 DOI: 10.1038/bmt.2015.278] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/15/2015] [Accepted: 09/14/2015] [Indexed: 01/01/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a therapeutic option for adult patients with T-cell ALL (T-ALL). Meanwhile, few allo-SCT data specific to adult T-ALL have been described thus far. Specifically, the optimal myeloablative conditioning regimen is unknown. In this retrospective study, 601 patients were included. Patients received allo-SCT in CR1, CR2, CR >2 or in advanced disease in 69%, 15%, 2% and 14% of cases, respectively. With an overall follow-up of 58 months, 523 patients received a TBI-based regimen, whereas 78 patients received a chemotherapy-based regimen including IV busulfan-cyclophosphamide (IV Bu-Cy) (n=46). Unlike patients aged ⩾35 years, patients aged <35 years who received a TBI-based regimen displayed an improved outcome compared with patients who received a chemotherapy-based regimen (5-year leukemia-free survival (LFS) of 50% for TBI versus 18% for chemo-only regimen or IV Bu-Cy regimens, P=10(-5) and 10(-4), respectively). In multivariate analysis, use of TBI was associated with an improved LFS (hazard ratio (HR)=0.55 (0.34-0.86), P=0.01) and overall survival (HR=0.54 (0.34-0.87), P=0.01) in patients aged <35 years. In conclusion, younger adult patients with T-ALL entitled to receive a myeloablative allo-SCT may benefit from TBI-based regimens.
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Affiliation(s)
- X Cahu
- Hématologie Clinique, Hôpital Pontchaillou, CHU Rennes, France
| | - M Labopin
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France.,Université Pierre and Marie Curie, Paris, France.,INSERM, UMR_S 938, INSERM, Paris, France
| | - S Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - M Aljurf
- Adult Hematology/HSCT, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - S Kyrcz-Krzemien
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | - G Socié
- Hematology-Transplantation, Hospital St Louis, APHP, Paris, France
| | - M Eder
- Hannover Medical School, Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany
| | - F Bonifazi
- Institute of Hematology, Department of Hematology and Oncological Sciences 'L. and A. Seràgnoli,' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - D Bunjes
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Germany
| | - S Vigouroux
- Hématologie Clinique et Thérapie Cellulaire, Hôpital Haut Levêque, Pessac, France
| | - M Michallet
- Hématologie Clinique, Hospices Civils de Lyon, Lyon, France
| | - M Stelljes
- Department of Medicine A/Hematology and Oncology, University of Muenster Muenster, Germany
| | - T Zuckerman
- Department of Hematology and Bone Marrow Transplantation, Rambam MCH, Haifa, Israel
| | - J Finke
- Department of Medecine-Hematology, Oncology, University of Freiburg, Freiburg, Germany
| | - J Passweg
- Hematology, University Hospital of Basel, Basel, Switzerland
| | - I Yakoub-Agha
- Hématologie Clinique, Hôpital Claude Huriez, Lille, France
| | - D Niederwieser
- University Hospital Leipzig, Clinic for Hematology and Oncology, Leipzig, Germany
| | - G Sucak
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - H Sengeløv
- National University Hospital, Copenhagen, Denmark
| | - E Polge
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France.,Université Pierre and Marie Curie, Paris, France.,INSERM, UMR_S 938, INSERM, Paris, France
| | - A Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - J Esteve
- Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - M Mohty
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France.,Université Pierre and Marie Curie, Paris, France.,INSERM, UMR_S 938, INSERM, Paris, France
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Abstract
While most complications are related to haemoglobinopathies and their treatment, it is also possible to observe substantial differences in comorbidities’ onset and seriousness which depend also to the different HPs genotypes. These differences should be carefully considered when health authorities set up and manage adequate care systems and treatments plans. We describe services organisation in Italy including the availability of multispecialty care and tools, in the HPs units participating to the HTA-THAL Multiregional Registry, with the aim to derive the impact of the services and multispecialty care availability on the management of the disease and on the patients wellbeing. The high dispersion and heterogeneity of services demonstrated, exposes the Italian system to a high risk of: (a) inappropriate use of economical and medical resources, (b) limited access to multidisciplinary care of some patients with apparent inequality among different centres, and (c) low patients satisfaction with the services provided. The identification of a ‘standard for HPs services’ is necessary not only at national but also at interventional level in order to implement collaborative research and the identification and networking of reference’ centres worldwide. Following the big efforts provided in the last years here there is a new challenging mission for the TIF.
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Nettis E, Bonifazi F, Bonini S, Di Leo E, Maggi E, Melioli G, Passalacqua G, Senna G, Triggiani M, Vacca A, Canonica GW. Molecular diagnosis and the Italian Board for ISAC. Eur Ann Allergy Clin Immunol 2014; 46:68-73. [PMID: 24739125] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Component Resolved Diagnostic (CRD) approach has been developed when highly purified or recombinant allergen molecules have become available. These molecules are the allergenic proteins toward which the specific and clinically relevant IgE immune response is directed. So, the identification of protein families and cross-reactivity patterns of importance in allergy have been possible. The Italian advisory BOARD for ISAC was born: to evaluate the advantages, disadvantages and placement in diagnosis of CRD studying its application in allergic patients; to facilitate the interpretation of molecular diagnostics for clinical allergists; to evaluate the effectiveness of CRD in improving diagnostic risk assessment and early preventive treatment of allergic diseases. In the last years, its fields of interest have been: the evaluation of the performance of CRD on multi-sensitized allergic patients with respiratory symptoms and on poly-sensitized athletes; the evolution of IgE repertoire directed to single allergenic components by evaluating allergic patients with different age at a molecular level; the relevance of results obtained using allergen microarray technique for describing the IgE repertoire in allergic patients by reviewing the main articles focused on CRD published in the last 2 years; the need for an educational program focused on this new diagnostic tool also through the creation of an exhaustive and interactive explanation of the laboratory report molecular allergy; the investigation of the performance and potential additional diagnostic values of the ISAC microarray in a real-life clinical setting, taking into account also the economic values.
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Affiliation(s)
- E Nettis
- Section of Allergy and Clinical Immunology, Dept. of Internal Medicine, University of Bari, Bari, Italy
| | - F Bonifazi
- Allergy Unit, Dept. of Respiratory and Allergic Diseases, Azienda Ospedaliera Umberto I, Torrette, Ancona, Italy
| | - S Bonini
- Institute of Translational Pharmacology, Italian National Research Council, Second University of Naples, Naples, Italy
| | - E Di Leo
- Section of Allergy and Clinical Immunology, Dept. of Internal Medicine, University of Bari, Bari, Italy
| | - E Maggi
- Section of Immunoallergology, University of Florence, Florence, Italy
| | - G Melioli
- Laboratories of Analysis, Istituto Giannina Gaslini, Genoa, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS IST San Martino, University of Genoa, Genoa, Italy
| | - G Senna
- Allergy Unit, Azienda Ospedale Università, Verona, Italy
| | - M Triggiani
- Immunoallergology Unit, University of Salerno, Salerno, Italy
| | - A Vacca
- Section of Allergy and Clinical Immunology, Dept. of Internal Medicine, University of Bari, Bari, Italy
| | - G W Canonica
- Allergy and Respiratory Diseases, IRCCS IST San Martino, University of Genoa, Genoa, Italy
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De Nettis E, Bonifazi F, Bonini S, Di Leo E, Maggi E, Melioli G, Passalacqua G, Senna G, Triggiani M, Vacca A, Canonica G. Molecular diagnosis and the Italian Board for ISAC. Eur Ann Allergy Clin Immunol 2014. [DOI: 10.23822/eurannaci.1764-1489.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- E. De Nettis
- Section of Allergy and Clinical Immunology, Dept. of Internal Medicine, University of Bari, Bari, Italy
| | - F. Bonifazi
- Allergy Unit, Dept. of Respiratory and Allergic Diseases, Azienda Ospedaliera Umberto I, Torrette, Ancona, Italy
| | - S. Bonini
- Institute of Translational Pharmacology, Italian National Research Council, Second University of Naples, Naples, Italy
| | - E. Di Leo
- Section of Allergy and Clinical Immunology, Dept. of Internal Medicine, University of Bari, Bari, Italy
- Section of Allergy and Clinical Immunology, Internal Medicine Unit, Ente Ecclesiastico Ospedale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - E. Maggi
- Section of Immunoallergology, University of Florence, Florence, Italy
| | - G. Melioli
- Laboratories of Analysis, Istituto Giannina Gaslini, Genoa, Italy
| | - G. Passalacqua
- Allergy and Respiratory Diseases, IRCCS IST San Martino, University of Genoa, Genoa, Italy
| | - G. Senna
- Allergy Unit, Azienda Ospedale Università, Verona, Italy
| | - M. Triggiani
- Immunoallergology Unit, University of Salerno, Salerno, Italy
| | - A. Vacca
- Section of Allergy and Clinical Immunology, Dept. of Internal Medicine, University of Bari, Bari, Italy
| | - G.W. Canonica
- Allergy and Respiratory Diseases, IRCCS IST San Martino, University of Genoa, Genoa, Italy
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Moscato G, Maestrelli P, Bonifazi F, Troise C, Caminati M, Crivellaro M, Olivieri M, Senna G. OCCUPATION study (OCCUPationl asthma: a naTIONal based study): a survey on occupational asthma awareness among Italian allergists. Eur Ann Allergy Clin Immunol 2014; 46:26-29. [PMID: 24702870] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Occupational asthma (OA) is the most common work-related respiratory disease. Case identification still remains underperformed. The present survey aimed at investigating the awareness about OA among Italian allergists. 538 Italian Allergists completed a web anonymous questionnaire concerning: patient profile, occupational history, disease features, diagnostic work-up, causal agents, management after diagnosis. 80 cases were registered by 14 members (2.4%). Patients were mostly between 30 and 62 years old; noteworthy, 19% were between 18 and 30. All the patients had a concomitant rhinitis, usually preceding asthma onset. Bakers, hairdressers and healthcare workers were more frequently involved. Diagnostic process included: skin prick test (85%), stop/resume test (57%), specific IgE dosage for occupational allergens (52.5%), peak expiratory flow monitoring (32.5%). Noteworthy, only 27,5% of patients underwent specific challenge. After the diagnosis 50% of patients did not change job. One third of the subjects were not referred to the national Workers Compensation Authority. Our data show that OA is quite neglected by Italian allergists, despite they have a pivotal role both in early identification and in primary prevention of OA. Thus, it is worth increasing awareness concerning OA and creating an easy-access network involving allergists and referral centers for Occupational respiratory diseases.
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Affiliation(s)
- G Moscato
- Fondazione "Salvatore Maugeri", Institute of Care and Research, Scientific Institute of Pavia, Allergy Unit, Pavia, Italy
| | - P Maestrelli
- University of Padova, Department of Environmental Medicine and Public Health, Padova, Italy
| | - F Bonifazi
- University Hospital, Ospedali Riuniti of Ancona, Department of Immunology, Allergy & Respiratory Diseases, Ancona, Italy
| | - C Troise
- San Martino Hospital, Allergy Unit, Genoa, Italy
| | - M Caminati
- Verona University Hospital, Allergy Unit, Verona, Italy.
| | - M Crivellaro
- University of Padua, Occupational and Environmental Medicine, Padua, Italy
| | - M Olivieri
- Verona University Hospital, Occupational Medicine Unit, Verona, Italy
| | - G Senna
- Verona University Hospital, Allergy Unit, Verona, Italy
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Antonicelli L, Massaccesi C, Braschi MC, Cinti B, Bilò MB, Bonifazi F. Component resolved diagnosis in real life: the risk assessment of food allergy using microarray-based immunoassay. Eur Ann Allergy Clin Immunol 2014; 46:30-34. [PMID: 24702871] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The development of component-resolved diagnostics constitutes a potential breakthrough in food allergy testing, as detection of specific IgE (sIgE) to individual allergens may make it possible to establish the risk of a mild versus severe reaction. OBJECTIVE To compare allergists' risk assessment based on the current decision making process with that of virtual allergen-oriented risk assessment through microarray-based immunoassay. METHODS An observational, real-life study was performed on 86 adults with food allergy. The prescription of epinephrine was the surrogate marker of a severe reaction. In the same patients, the prescription of epinephrine based on the current decision making of the allergist and the independently established allergen-oriented risk assessment determined by microarray-based immunoassay were compared. RESULTS Fair degree of agreement between the specialists' risk assessment and that of the microarray-based immunoassay (k index 0.372 (95% CI: 0.185- 0.559) p < 0.001) was documented. Three causes of discrepancy emerged: the poor sensitivity of the allergen microarray-immunoassay (51.9%), the differences in risk assessment established by the specialist and the microarray-immunoassay (33.3%), the non-inclusion of the causative allergen in the microarray-immunoassay platform (14.8%). CONCLUSION Improvement of the diagnostic accuracy of microarray-immunoassay, combined with marrying its results to clinical information, could one day soon lead to changes in clinical practice in food allergy.
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Affiliation(s)
- L Antonicelli
- Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy.
| | - C Massaccesi
- Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy
| | - M C Braschi
- Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy
| | - B Cinti
- Laboratory of Clinical Pathology and Microbiology, General Service Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy
| | - M B Bilò
- Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy
| | - F Bonifazi
- Allergy Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy
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40
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Passalacqua G, Melioli G, Bonifazi F, Bonini S, Maggi E, Senna G, Triggiani M, Nettis E, Rossi RE, Vacca A, Canonica GW. The additional values of microarray allergen assay in the management of polysensitized patients with respiratory allergy. Allergy 2013; 68:1029-33. [PMID: 23889678 DOI: 10.1111/all.12194] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The IgE response is directed against specific components from an allergenic source. The traditional diagnostic methods use whole extracts, containing allergenic, nonallergenic and cross-reactive molecules. This may pose diagnostic challenges in polysensitized patients. Microarray techniques detect specific IgE against multiple molecules, but their value in term of additional information and economic saving has not been yet defined. OBJECTIVE We assessed the additional diagnostic information provided by an allergen microarray in a large population of polysensitized subjects. METHODS In this multicentre study, allergists were required to carefully record diagnosis and treatment of consecutive patients referred for asthma/rhinitis, using the standard methodology (history, skin prick test, IgE assay). Then, a microarray allergen assay was carried out. Clinicians were required to review their diagnosis/treatment according to microarray results. RESULTS 318 allergic patients (30% reporting also nonrespiratory symptoms) and 91 controls were enrolled. The clinicians reported at least one additional information from the microarray in about 60% of patients, this resulting in therapeutic adjustments. In 66% of patients IgE to pan-allergens were detectable, being this clinically relevant in 38% of patients with polysensitization to pollens. CONCLUSION Microarray IgE assay represents an advancement in allergy diagnosis, as a third-level approach in polysensitized subjects, when the traditional diagnosis may be problematic.
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Affiliation(s)
- G. Passalacqua
- Allergy and Respiratory Diseases; IRCCS San Martino Hospital-University of Genoa-IST; Genoa; Italy
| | - G. Melioli
- Laboratorio Centrale di Analisi; Istituto Giannina Gaslini; Genoa; Italy
| | - F. Bonifazi
- Department of Respiratory and Allergic Diseases; Allergy Unit; Azienda Ospedaliera Umberto I; Ancona; Italy
| | - S. Bonini
- Institute of Translational Pharmacology; Italian National Research Council; Second University of Naples; Naples; Italy
| | - E. Maggi
- Section of Immunoallergology; University of Florence; Florence; Italy
| | - G. Senna
- Allergy Unit; Azienda Ospedale Università; Verona; Italy
| | - M. Triggiani
- Immunoallergology Unit; University of Salerno; Salerno; Italy
| | - E. Nettis
- Department of Internal Medicine; Section of Allergy and Clinical Immunology; University of Bari; Bari; Italy
| | - R. E. Rossi
- Rete di Allergologia Regione Piemonte; Azienda Sanitaria Cuneo 1; Cuneo; Italy
| | - A. Vacca
- Department of Internal Medicine; Section of Allergy and Clinical Immunology; University of Bari; Bari; Italy
| | - G. W. Canonica
- Allergy and Respiratory Diseases; IRCCS San Martino Hospital-University of Genoa-IST; Genoa; Italy
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41
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Dodero A, Spina F, Narni F, Patriarca F, Cavattoni I, Benedetti F, Ciceri F, Baronciani D, Scimè R, Pogliani E, Rambaldi A, Bonifazi F, Dalto S, Bruno B, Corradini P. Allogeneic transplantation following a reduced-intensity conditioning regimen in relapsed/refractory peripheral T-cell lymphomas: long-term remissions and response to donor lymphocyte infusions support the role of a graft-versus-lymphoma effect. Leukemia 2011; 26:520-6. [PMID: 21904377 DOI: 10.1038/leu.2011.240] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Rescue chemotherapy or autologous stem cell transplantation (autoSCT) gives disappointing results in relapsed peripheral T-cell lymphomas (PTCLs). We have retrospectively evaluated the long-term outcome of 52 patients receiving allogeneic SCT for relapsed disease. Histologies were PTCL-not-otherwise specified (n=23), anaplastic large-cell lymphoma (n=11), angioimmunoblastic T-cell lymphomas (n=9) and rare subtypes (n=9). Patients were allografted from related siblings (n=33, 64%) or alternative donors (n=13 (25%) from unrelated and 6 (11%) from haploidentical family donors), following reduced-intensity conditioning (RIC) regimens including thiotepa, fludarabine and cyclophosphamide. Most of the patients had chemosensitive disease (n=39, 75%) and 27 (52%) failed a previous autoSCT. At a median follow-up of 67 months, 27 of 52 patients were found to be alive (52%) and 25 (48%) were dead (n=19 disease progression, n=6 non-relapse mortality (NRM)). The cumulative incidence (CI) of NRM was 12% at 5 years. Extensive chronic graft-versus-host disease increased the risk of NRM (33% versus 8%, P=0.04). The CI of relapse was 49% at 5 years, influenced by disease status at the time of allografting (P=0.0009) and treatment lines (P=0.007). Five-year overall survival and progression-free survival (PFS) were 50% (95% CI, 36 - 63%) and 40% (95% CI, 27 - 53%), respectively. The current PFS was 44% (95% CI, 30-57%). In all, 8 out of 12 patients (66%) who received donor-lymphocytes infusions for disease progression had a response. At multivariable analysis, refractory disease and age over 45 years were independent adverse prognostic factors. RIC allogeneic SCT is an effective salvage treatment with a better outcome for younger patients with chemosensitive disease.
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Affiliation(s)
- A Dodero
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
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42
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Antonicelli L, Braschi MC, Bilò MB, Angino A, Pala AP, Baldacci S, Maio S, Bonifazi F. Congruence between international guidelines and mite specific immunotherapy prescribing practices. Respir Med 2011; 105:1441-8. [PMID: 21628094 DOI: 10.1016/j.rmed.2011.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/01/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
Abstract
Both rhinitis (ARIA) and asthma (GINA) guidelines recommend allergen-specific immunotherapy (SIT) tailored to the specific levels of severity of each disease. Real world studies evaluating congruence between these recommendations and prescribing practice in the single patient with comorbidity are lacking. An observational polycentric study was carried out in 518 patients recruited from 34 allergy centers throughout Italy. A questionnaire was administered to each consecutive patient over a span of four months. Taking into account guideline recommendations for both diseases, concomitant in the same patient, three subsets resulted: patients not eligible for SIT (11%); patients eligible for SIT for one disease only (60%); patients eligible for SIT for both diseases (29%). SIT was prescribed in 257 (49.6%) subjects. The level of SIT prescription was about 50% in all three groups. Consistent with the ARIA guidelines, a correlation between the prescription of SIT and the severity of rhinitis was documented (r=0.87; p=0.001). An association with asthma severity was found (p=0.02), but the trend was inconsistent with the GINA recommendations. Young age was the most important factor for SIT prescription both in the eligible for one disease and in the eligible for both diseases subset. The tendency towards worsening of symptoms was a factor for SIT in the eligible for one disease subset. In mite allergic patients with rhinitis and asthma comorbidity, the severity of rhinitis and the young age are the most important factors driving the SIT prescription. The congruence of SIT prescription was better for the ARIA than GINA guidelines.
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Affiliation(s)
- L Antonicelli
- Allergy Unit, Department of Immuno-Allergic and Respiratory Diseases, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Via Conca 71, Ancona, Italy.
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43
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Antonicelli L, Ruello ML, Monsalve RI, González R, Fava G, Bonifazi F. Assessment of airborne soy-hull allergen (Gly m 1) in the Port of Ancona, Italy. Eur Ann Allergy Clin Immunol 2010; 42:178-85. [PMID: 21192626] [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: 05/30/2023]
Abstract
BACKGROUND Epidemic asthma outbreaks are potentially a very high-risk medical situation in seaport towns where large volumes of soybean are loaded and unloaded Airborne allergen assessment plays a pivotal role in evaluating the resulting environmental pollution. OBJECTIVE The aim of this study was to measure the airborne Gly m 1 allergen level in the seaport of Ancona in order assess the soybean-specific allergenic risk for the city. METHODS Allergen and PM10 were evaluated at progressive distances from the port area. Allergen analysis was performed by monoclonal antibody-based immunoassay on the sampled filters. Daily meteorological data were obtained from the local meteorological station. For estimating the assimilative capacity of the atmosphere, an approach based on dispersive ventilation coefficient was tried. RESULTS The allergen concentrations detected were low (range = 0.4-171 ng/m3). A decreasing gradient of the airborne allergen from the unloading area (22.1 +/- 41.2 ng/m3) to the control area (0.6 +/- 0.7 ng/m3) was detected. The concentration of the airborne Gly m 1 was not coupled with the presence of the soy-carrying ships in the port. A statistically significant relationship between airborne allergen, PM10 and local meteorological parameters quantifies the association with the atmospheric condition. CONCLUSION Airborne Gly m 1 is part of the atmospheric dust of Ancona. The low level of this allergen seems consistent with the absence of asthma epidemic outbreak.
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Affiliation(s)
- L Antonicelli
- Department of Internal Medicine, Immuno-Allergic and Respiratory Diseases, Ospedali Riuniti, Ancona, Italy
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44
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de Marco R, Accordini S, Antonicelli L, Bellia V, Bettin MD, Bombieri C, Bonifazi F, Bugiani M, Carosso A, Casali L, Cazzoletti L, Cerveri I, Corsico AG, Ferrari M, Fois AG, Lo Cascio V, Marcon A, Marinoni A, Olivieri M, Perbellini L, Pignatti P, Pirina P, Poli A, Rolla G, Trabetti E, Verlato G, Villani S, Zanolin ME. The Gene-Environment Interactions in Respiratory Diseases (GEIRD) Project. Int Arch Allergy Immunol 2010; 152:255-63. [PMID: 20150743 DOI: 10.1159/000283034] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 09/22/2009] [Indexed: 11/19/2022] Open
Abstract
The role of genetic and environmental factors, as well as their interaction, in the natural history of asthma, allergic rhinitis and chronic obstructive pulmonary disease (COPD) is largely unknown. This is mainly due to the lack of large-scale analytical epidemiological/genetic studies aimed at investigating these 3 respiratory conditions simultaneously. The GEIRD project is a collaborative initiative designed to collect information on biomarkers of inflammation and oxidative stress, individual and ecological exposures, diet, early-life factors, smoking habits, genetic traits and medication use in large and accurately defined series of asthma, allergic rhinitis and COPD phenotypes. It is a population-based multicase-control design, where cases and controls are identified through a 2-stage screening process (postal questionnaire and clinical examination) in pre-existing cohorts or new samples of subjects. It is aimed at elucidating the role that modifiable and genetic factors play in the occurrence, persistence, severity and control of inflammatory airway diseases, by way of the establishment of a historical multicentre standardized databank of phenotypes, contributed by and openly available to international epidemiologists. Researchers conducting population-based surveys with standardized methods may contribute to the public-domain case-control database, and use the resulting increased power to answer their own scientific questions.
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45
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Bonini S, Bonifazi F, Maggi E, Mascialino B, Melioli G, Mussap M, Passalacqua G, Rossi R, Vacca A, Canonica G. Allergen Component Resolved Diagnostics in Multi-Sensitized Patients with Respiratory Symptoms. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.536] [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]
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47
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Farabollini B, Braschi MC, Bonifazi F. Allergic rhinitis and associated pathologies: the rationale for steroid options. Eur Ann Allergy Clin Immunol 2009; 41:67-79. [PMID: 20556932] [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: 05/29/2023]
Abstract
The aim of this review article is to provide greater insight into the relationship between allergic rhinitis and the three most frequently diagnosed conditions of exacerbating viral infections, chronic rhinosinusitis with polyps and obstructive sleep apnoea syndrome. The alleged physiopathological effects of steroids are also investigated within the scope of this paper. Regarding the exacerbating viral infections, seems to establish a dynamic and counter relationship between the load and nature of the viral infection on one hand and widespread and pre-existing allergic inflammation on the other. If chronic rhinosinusitis with polyps and allergic rhinitis present overlapping picture of inflammatory cell and cytokine, the etyiological relationship between the two conditions appears to be influenced by the type of antigenic stimulus. Allergic rhinitis can influence the presence of OSAS through both obstructive and inflammatory mechanical factors. Topical corticosteroid therapy is a promising candidate as a new therapeutic tool able to improve symptoms and quality of life in patient with chronic rhinosinusitis with polyps and obstructive sleep apnoea syndrome. Other study are necessary to elucidate relationship between corticosteroids therapy and hypothetical benefit effect on viral infection when concomitant atopy inpatient.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Animals
- Clinical Trials as Topic
- Humans
- Nasal Polyps
- Respiratory Tract Infections/complications
- Respiratory Tract Infections/drug therapy
- Respiratory Tract Infections/immunology
- Respiratory Tract Infections/physiopathology
- Rhinitis
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/physiopathology
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/physiopathology
- Sinusitis
- Sleep Apnea, Obstructive
- Virus Diseases/complications
- Virus Diseases/drug therapy
- Virus Diseases/immunology
- Virus Diseases/physiopathology
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Affiliation(s)
- B Farabollini
- Allergy Unit, Department of Internal Medicine, Immuno-Allergic and Respiratory Deseases, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy
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48
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Ceci A, Giaquinto C, Aboulker JP, Baiardi P, Bonifazi F, Della Pasqua O, Nicolosi A, Taruscio D, Sturkenboom M, Wong I. The Task-force in Europe for Drug Development for the Young (TEDDY) Network of Excellence. Paediatr Drugs 2009; 11:18-21. [PMID: 19127946 DOI: 10.2165/0148581-200911010-00008] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The Task-force in Europe for Drug Development for the Young (TEDDY) was established in 2005 to contribute to the promotion of safe and efficacious medicines for children in the context of the impending European Paediatric Regulation that finally came into force in January 2007. The project includes seven objectives and 12 Work-Packages encompassing the main aspects of the development and use of pediatric drugs. TEDDY represents a new entity in the pediatric pharmaceutical field, differing from a Scientific Society, a network for developing research or trials, or a consultative regulatory body. The ambition of TEDDY is to support the existing pediatric networks, societies, and regulatory bodies in performing innovative initiatives, including those in areas in which such undertakings would not be feasible without supportive action. To accomplish its aim, TEDDY has focused on three different actions: (i) increasing awareness about the Paediatric Regulation revolution; (ii) reaching consensus on terms and instruments to be used for common research; and (iii) favoring close relationships among different stakeholders and partners from different EU Member States. After 3 years of activities, many results have been produced by the Network: surveys, databases, expert opinions, and recommendations. Linking together different stakeholders, including industry and patient associations, as well as academia and research centers, the Network has contributed to increasing awareness and participation in the Paediatric Regulation. In addition, many papers detailing original results have either been published or submitted for publication in peer-reviewed journals. TEDDY is an original Network whose identity and role as a catalyzer of initiatives related to the use and development of pediatric drugs needs to be better clarified in the near future. Of particular importance is the need to reach consensus on best practices. The lack of a common view on pediatric research requirements among stakeholders across Member States remains the main challenge to be overcome.
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Affiliation(s)
- Adriana Ceci
- Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy.
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Verhamme K, Bonifazi F, Ceci A, Elferink-Stinkens P, Murray M, Neubert A, Nicolosi A, Stricker B, Wong I, Sturkenboom M. Adverse drug reactions reporting in children. ACTA ACUST UNITED AC 2009. [DOI: 10.3233/ppl-2009-0204] [Citation(s) in RCA: 3] [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] [Indexed: 11/15/2022]
Affiliation(s)
- K. Verhamme
- Pharmacoepidemiology Unit, Departments of Medical Informatics and Epidemiology & Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F. Bonifazi
- I.RI.D.I.A. srl, Health Care Engineering, Bari, Italy
| | - A. Ceci
- Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy
| | - P. Elferink-Stinkens
- Pharmacoepidemiology Unit, Departments of Medical Informatics and Epidemiology & Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M. Murray
- Centre for Paediatric Pharmacy Research, The School of Pharmacy and Institute of Child Health, University of London, London, UK
| | - A. Neubert
- Centre for Paediatric Pharmacy Research, The School of Pharmacy and Institute of Child Health, University of London, London, UK
| | - A. Nicolosi
- Consiglio Nazionale delle Ricerche - Istituto di Tecnologie Biomediche, Milan, Italy
| | - B. Stricker
- Pharmacoepidemiology Unit, Departments of Medical Informatics and Epidemiology & Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - I. Wong
- Centre for Paediatric Pharmacy Research, The School of Pharmacy and Institute of Child Health, University of London, London, UK
| | - M. Sturkenboom
- Pharmacoepidemiology Unit, Departments of Medical Informatics and Epidemiology & Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
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Altavilla A, Giaquinto C, Giocanti D, Manfredi C, Aboulker JP, Bartoloni F, Cattani E, Lo Giudice M, Mellado Peña M, Nagler R, Peterson C, Vajnerova O, Bonifazi F, Ceci A. Activity of Ethics Committees in Europe on issues related to clinical trials in paediatrics: Results of a survey. ACTA ACUST UNITED AC 2009. [DOI: 10.3233/ppl-2009-0208] [Citation(s) in RCA: 2] [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] [Indexed: 11/15/2022]
Affiliation(s)
- A. Altavilla
- Mediterranean University – Espace Ethique Méditerranéen, Bioethics Research Centre, Marseille, France
| | - C. Giaquinto
- Department of Paediatrics, University of Padova, Padova, Italy
| | - D. Giocanti
- Mediterranean University – Division of Legal Medicine, Marseille, France
| | - C. Manfredi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy
| | - J.-P. Aboulker
- Institut National de la Sante et Recherche Medicale, Villejuif, France
| | - F. Bartoloni
- I.RI.D.I.A. srl, Health Care Engineering, Bari, Italy
| | - E. Cattani
- Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy
| | - M. Lo Giudice
- Family paediatrician, AUSL 6 Palermo, Palermo, Italy
| | | | - R. Nagler
- Department of Oral and Maxillofacial Surgical and Oral Biochemistry Laboratory, Rambam Medical Center and Rappaport, Faculty of Medicine, Israel Institute of Technology-Technion, Haifa, Israel
| | - C. Peterson
- Department of Clinical Pharmacology, Linkopings Universitet, Linkopings, Sweden
| | - O. Vajnerova
- Department of Neurophysiology of Memory and Computational Neuroscience, Institute of Physiology, Academy of Sciences, Prague, Czech Republic
| | - F. Bonifazi
- I.RI.D.I.A. srl, Health Care Engineering, Bari, Italy
| | - A. Ceci
- Consorzio per Valutazioni Biologiche e Farmacologiche, Pavia, Italy
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