1
|
Pelliccia S, Rogges E, Cardoni A, Lopez G, Conte E, Faccini AL, De Vito R, Girardi K, Bianchi A, Annibali O, Fratoni S, Remotti D, De Angelis G, Giordano C, Palumbo G, Scarpino S, Del Porto F, Bianchi MP, Di Gregorio F, Tafuri A, Di Napoli A. The application of a multidisciplinary approach in the diagnosis of Castleman disease and Castleman-like lymphadenopathies: A 20-year retrospective analysis of clinical and pathological features. Br J Haematol 2024; 204:534-547. [PMID: 37953489 DOI: 10.1111/bjh.19171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Castleman disease (CD) comprises a group of rare and heterogeneous haematological disorders, including unicentric (UCD) and multicentric (MCD) forms, the latter further subdivided into HHV8-MCD, POEMS-MCD and idiopathic-MCD (iMCD). However, according to the Castleman Disease Collaborative Network guidelines, the diagnosis of CD can only be achieved through collaboration between clinicians and pathologists. METHODS We applied these clinical and pathological criteria and implement with clonality testing to a retrospective cohort of 48 adult and paediatric Italian patients diagnosed with reactive lymphadenitis with CD-like histological features. RESULTS We confirmed the diagnosis of CD in 60% (29/48) of the cases, including 12 (41%) UCD and 17 (59%; five HHV8-MCD, three POEMS-MCD and nine iMCD) MCD. Of the remaining 19 cases (40%) with multiple lymphadenopathy, 5 (26%) were classified as autoimmune diseases, 1 (5%) as autoimmune lymphoproliferative disorder, 1 (5%) as IgG4-related disease, 11 (83%) as reactive lymphadenitis and 1 (5%) as nodal marginal zone lymphoma. CONCLUSIONS Our study emphasizes the importance of the multidisciplinary approach to reactive lymphadenitis with CD-like features in order to achieve a definitive diagnosis and choose the appropriate treatment.
Collapse
Affiliation(s)
- Sabrina Pelliccia
- Haematology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Evelina Rogges
- Pathology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | | | - Gianluca Lopez
- Pathology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Esmeralda Conte
- Haematology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Anna Laura Faccini
- Haematology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Rita De Vito
- Pathology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Katia Girardi
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Ombretta Annibali
- Haematology Stem Cell Transplantation Unit, Campus Biomedico University Hospital, Campus Bio Medico University, Rome, Italy
| | - Stefano Fratoni
- Surgical Pathology Department, Sant' Eugenio Hospital, Rome, Italy
| | | | | | - Carla Giordano
- Department of Translational and Precision Medicine, A.O.U. Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Giovanna Palumbo
- Haematology Unit, Department of Translational and Precision Medicine, A.O.U Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Stefania Scarpino
- Pathology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Flavia Del Porto
- Internal Medicine Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Maria Paola Bianchi
- Haematology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Francesca Di Gregorio
- Radiology Unit, Department of Surgical-Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Agostino Tafuri
- Haematology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Arianna Di Napoli
- Pathology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| |
Collapse
|
2
|
Scamuffa MC, Latagliata R, Carmosino I, Di Veroli A, Scalzulli E, Trapè G, Ciotti G, De Angelis G, Tartaglia G, Tarnani M, Breccia M, Girmenia C. Pulmonary infections in patients with acute myeloid leukemia receiving frontline treatment with hypomethylating agents. Leuk Lymphoma 2023; 64:1840-1846. [PMID: 37554018 DOI: 10.1080/10428194.2023.2239407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 08/10/2023]
Abstract
Pulmonary infections (PIs) are a major complication of Acute Myeloid Leukemia (AML) treated with hypomethylating agents (HMA). We retrospectively evaluated 147 AML patients treated frontline with HMA in 2 Centers. Total number of HMA cycles was 1397. There were 88 episodes of PI in 64 patients (43.5%). Thirty-five/147 patients at risk (23.8%) developed at least 1 episode of early PI (during cycles 1-2). Median OS in patients who developed early PI was 3.3 months (95% CI 0.8 - 5.8) versus 10.5 months (95% CI 8.4 - 12.7) in patients without PI or with PI beyond the 2nd cycle (p < .001). Early PIs were an independent factor predicting lower survival (OR 1.94, 95% CI 1.28 - 2.93; p = .002). In conclusion, early PIs are common in AML patients receiving HMA and are associated with an unfavorable outcome. The results of our study raise the issue of a tailored infection prevention strategy.
Collapse
Affiliation(s)
- Maria Cristina Scamuffa
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Emilia Scalzulli
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giulia Ciotti
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Germana Tartaglia
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Corrado Girmenia
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
3
|
Travaglini S, Gurnari C, Antonelli S, Marchesi F, De Angelis G, Ottone T, Divona M, Cristiano A, Hajrullaj H, Mengarelli A, Voso MT. Functional characterization and response to FLT3 inhibitors in acute myeloid leukaemia with a non-canonical FLT3 mutation: A proof of concept. Br J Haematol 2023; 203:327-330. [PMID: 37485586 DOI: 10.1111/bjh.18991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Serena Travaglini
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Carmelo Gurnari
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Silvia Antonelli
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Tiziana Ottone
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
- Neuro-Oncohematology, Santa Lucia Foundation, I.R.C.C.S., Rome, Italy
| | - Mariadomenica Divona
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
- Saint Camillus International University of Health Sciences, Rome, Italy
| | - Antonio Cristiano
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Hajro Hajrullaj
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | | | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
- Neuro-Oncohematology, Santa Lucia Foundation, I.R.C.C.S., Rome, Italy
| |
Collapse
|
4
|
Trapè G, De Angelis G, Morucci M, Tarnani M, De Gregoris C, Di Veroli A, Panichi V, Topini G, Bassi L, Isidori R, Poscente M, Innocenti V, Cippitelli EE, Talucci R, Bertelli S, Crocicchia A, Lippi A, Pezzuti G, Fuschino M, Randi R, Mastini C, Ciambella S, Pessina G, Montanaro M, Latagliata R. Treatment in patients with acute myeloid leukemia/high-risk myelodysplastic syndrome with hypomethylating agents: Day-hospital management compared to home care setting. Eur J Haematol 2023. [PMID: 37231885 DOI: 10.1111/ejh.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Aim of the study was to evaluate the role of a Domiciliary Hematologic Care Unit (DHCU) compared to standard DH setting in the active frontline treatment with hypomethylating agents (HMAs) +/- venetoclax of frail patients with acute myelogenous leukemia/high-risk myelodysplastic syndromes (AML/HR-MDS). METHODS All patients with newly diagnosed AML/HR-MDS unfit for intensive care and treated frontline with HMAs from January 2010 to April 2021 were retrospectively included. RESULTS Among 112 patients (62 AML/50 HR-MDS), 69 (61.6%) were treated in a standard DH setting and 43 (38.4%) were followed by DHCU, allocated to DH or DHCU by responsible physician. Overall response rate was 29/69 (42.0%) in DH versus 19/43 (44.1%) in DHCU (p = .797). Median response duration was 8.7 months (95%CI 7.0-10.3) in DH versus 13.0 months (95%CI 8.3-17.6) in DHCU (p = .460). Infections were also equally reported. Median overall survival of patients treated in DH was 13.7 months (95%CI 9.9-17.4) compared to 13.0 months (95%CI 6.7-19.3) of patients managed by DHCU (p = .753). CONCLUSIONS Home care management of HMA is feasible and effective, with results similar to standard DH setting: this approach is thus adequate to offer active therapies in frail patients with AML/HR-MDS considered up to now ineligible.
Collapse
Affiliation(s)
- Giulio Trapè
- Hematology Unit-ASL Viterbo, Belcolle Hospital, Viterbo, Italy
| | | | - Marco Morucci
- Hematology Unit-ASL Viterbo, Belcolle Hospital, Viterbo, Italy
| | - Michela Tarnani
- Hematology Unit-ASL Viterbo, Belcolle Hospital, Viterbo, Italy
| | | | - Ambra Di Veroli
- Hematology Unit-ASL Viterbo, Belcolle Hospital, Viterbo, Italy
| | - Valentina Panichi
- Laboratory of Immunophenotyping-ASL Viterbo, Belcolle Hospital, Viterbo, Italy
| | - Giuseppe Topini
- Laboratory of Immunophenotyping-ASL Viterbo, Belcolle Hospital, Viterbo, Italy
| | - Loredana Bassi
- Laboratory of Medical Genetics-ASL Viterbo, Ospedale Belcolle, Viterbo, Italy
| | - Raffaella Isidori
- Laboratory of Medical Genetics-ASL Viterbo, Ospedale Belcolle, Viterbo, Italy
| | - Monica Poscente
- Laboratory of Medical Genetics-ASL Viterbo, Ospedale Belcolle, Viterbo, Italy
| | | | | | - Roberta Talucci
- Hematology Unit-ASL Viterbo, Belcolle Hospital, Viterbo, Italy
| | - Silvia Bertelli
- Hematology Unit-ASL Viterbo, Belcolle Hospital, Viterbo, Italy
| | | | - Annalisa Lippi
- Hematology Unit-ASL Viterbo, Belcolle Hospital, Viterbo, Italy
| | - Giulia Pezzuti
- Hematology Unit-ASL Viterbo, Belcolle Hospital, Viterbo, Italy
| | | | - Raffaella Randi
- Hematology Unit-ASL Viterbo, Belcolle Hospital, Viterbo, Italy
| | | | | | - Gloria Pessina
- Laboratory of Medical Genetics-ASL Viterbo, Ospedale Belcolle, Viterbo, Italy
| | - Marco Montanaro
- Hematology Unit-ASL Viterbo, Belcolle Hospital, Viterbo, Italy
| | | |
Collapse
|
5
|
Gaziev J, Marziali S, Paciaroni K, Isgrò A, Di Giuliano F, Rossi G, Marziali M, De Angelis G, Alfieri C, Ribersani M, Andreani M, Palmieri MG, Placidi F, Romigi A, Izzi F, Floris R, Mercuri NB. Posterior Reversible Encephalopathy Syndrome after Hematopoietic Cell Transplantation in Children with Hemoglobinopathies. Biol Blood Marrow Transplant 2017; 23:1531-1540. [PMID: 28602890 DOI: 10.1016/j.bbmt.2017.05.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/31/2017] [Indexed: 01/13/2023]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a serious adverse event associated with calcineurin inhibitors used for graft-versus-host disease (GVHD) prophylaxis. We compared the incidence of PRES in children with thalassemia (n = 222, 1.4 to 17.8 years old) versus sickle cell disease (SCD; n = 59, 2 to 17 years old) who underwent hematopoietic cell transplantation from HLA-matched siblings or alternative donors and analyzed the risk factors for PRES. Overall, 31 children developed calcineurin inhibitor-related PRES (11%), including 30 patients with seizures and 1 patient without seizures. PRES incidence was significantly higher in SCD patients (22%; 95% confidence interval [CI], 10% to 32%) than in thalassemia patients (8%; 95% CI, 5% to 12%;P = .002). In multivariate analysis, factors associated with PRES were hypertension (hazard ratio [HR], 5.87; 95% CI, 2.57 to 13.43; P = .0001), SCD (HR, 2.49; 95% CI, 1.25 to 4.99; P = .009), and acute GVHD (HR 2.27; 95% CI, 1.06 to 4.85; P= .031). In the entire cohort overall survival (OS) was significantly higher in patients without versus with PRES (90% versus 77%; P = .02). In a subgroup analysis that including matched sibling transplants, OS and disease-free survival (DFS) were similar in thalassemia patients without PRES (92% and 88%, respectively) and with PRES (82% and 73%, respectively), whereas SCD patients with PRES had significantly lower OS (67%) and DFS (67%) than patients without PRES (94% and 94%, respectively; P = .008). Thus, SCD patients had a significantly higher incidence of PRES than thalassemia patients, and hypertension and GVHD were the 2 main risk factors for PRES in patients with hemoglobinopathies. Although PRES did not significantly influence survival in patients with thalassemia, patients with SCD had significantly lower survival after PRES.
Collapse
Affiliation(s)
- Javid Gaziev
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Rome, Italy.
| | - Simone Marziali
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Department of Diagnostic and Molecular Imaging, Interventional Radiology, Radiotherapy and Neuroradiology Unità Operativa Complessa, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Katia Paciaroni
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Rome, Italy
| | - Antonella Isgrò
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Rome, Italy
| | - Francesca Di Giuliano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Department of Diagnostic and Molecular Imaging, Interventional Radiology, Radiotherapy and Neuroradiology Unità Operativa Complessa, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Giorgia Rossi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Department of Diagnostic and Molecular Imaging, Interventional Radiology, Radiotherapy and Neuroradiology Unità Operativa Complessa, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Marco Marziali
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Rome, Italy
| | - Gioia De Angelis
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Rome, Italy
| | - Cecilia Alfieri
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Rome, Italy
| | - Michela Ribersani
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Rome, Italy
| | - Marco Andreani
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Rome, Italy
| | | | - Fabio Placidi
- Neurophysiopathology Service, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Andrea Romigi
- Neurophysiopathology Service, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Francesca Izzi
- Neurophysiopathology Service, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Department of Diagnostic and Molecular Imaging, Interventional Radiology, Radiotherapy and Neuroradiology Unità Operativa Complessa, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | | |
Collapse
|
6
|
Bianchi N, Cosenza LC, Lampronti I, Finotti A, Breveglieri G, Zuccato C, Fabbri E, Marzaro G, Chilin A, De Angelis G, Borgatti M, Gallucci C, Alfieri C, Ribersani M, Isgrò A, Marziali M, Gaziev J, Morrone A, Sodani P, Lucarelli G, Gambari R, Paciaroni K. Structural and Functional Insights on an Uncharacterized Aγ-Globin-Gene Polymorphism Present in Four β0-Thalassemia Families with High Fetal Hemoglobin Levels. Mol Diagn Ther 2016; 20:161-73. [PMID: 26897028 DOI: 10.1007/s40291-016-0187-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Several DNA polymorphisms have been associated with high production of fetal hemoglobin (HbF), although the molecular basis is not completely understood. In order to identify and characterize novel HbF-associated elements, we focused on five probands and their four families (from Egypt, Iraq and Iran) with thalassemia major (either β(0)-IVSII-1 or β(0)-IVSI-1) and unusual HbF elevation (>98 %), congenital or acquired after rejection of bone marrow transplantation, suggesting an anticipated favorable genetic background to high HbF expression. METHODS Patient recruitment, genomic DNA sequencing, western blotting, electrophoretic mobility shift assays, surface plasmon resonance (SPR) biospecific interaction analysis, bioinformatics analyses based on docking experiments. RESULTS A polymorphism of the Aγ-globin gene is here studied in four families with β(0)-thalassemia (β(0)-IVSII-1 and β(0)-IVSI-1) and expressing unusual high HbF levels, congenital or acquired after rejection of bone marrow transplantation. This (G→A) polymorphism is present at position +25 of the Aγ-globin genes, corresponding to a 5'-UTR region of the Aγ-globin mRNA and, when present, is physically linked in chromosomes 11 of all the familiar members studied to the XmnI polymorphism and to the β(0)-thalassemia mutations. The region corresponding to the +25(G→A) polymorphism of the Aγ-globin gene belongs to a sequence recognized by DNA-binding protein complexes, including LYAR (Ly-1 antibody reactive clone), a zinc-finger transcription factor previously proposed to be involved in down-regulation of the expression of γ-globin genes in erythroid cells. CONCLUSION We found a novel polymorphism of the Aγ-globin gene in four families with β(0)-thalassemia and high levels of HbF expression. Additionally, we report evidence suggesting that the Aγ-globin gene +25(G→A) polymorphism decreases the efficiency of the interaction between this sequence and specific DNA binding protein complexes.
Collapse
Affiliation(s)
- Nicoletta Bianchi
- Department of Life Sciences and Biotechnology, Ferrara University, Ferrara, Italy
| | | | - Ilaria Lampronti
- Department of Life Sciences and Biotechnology, Ferrara University, Ferrara, Italy
| | - Alessia Finotti
- Department of Life Sciences and Biotechnology, Ferrara University, Ferrara, Italy
| | - Giulia Breveglieri
- Department of Life Sciences and Biotechnology, Ferrara University, Ferrara, Italy
| | - Cristina Zuccato
- Department of Life Sciences and Biotechnology, Ferrara University, Ferrara, Italy
| | - Enrica Fabbri
- Department of Life Sciences and Biotechnology, Ferrara University, Ferrara, Italy
| | - Giovanni Marzaro
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padua, Italy
| | - Adriana Chilin
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padua, Italy
| | - Gioia De Angelis
- International Centre for Transplantation in Thalassemia and Sickle Cell Anaemia, Mediterranean Institute of Haematology, Policlinic of "Tor Vergata" University, Rome, Italy
| | - Monica Borgatti
- Department of Life Sciences and Biotechnology, Ferrara University, Ferrara, Italy
| | - Cristiano Gallucci
- International Centre for Transplantation in Thalassemia and Sickle Cell Anaemia, Mediterranean Institute of Haematology, Policlinic of "Tor Vergata" University, Rome, Italy
| | - Cecilia Alfieri
- International Centre for Transplantation in Thalassemia and Sickle Cell Anaemia, Mediterranean Institute of Haematology, Policlinic of "Tor Vergata" University, Rome, Italy
| | - Michela Ribersani
- International Centre for Transplantation in Thalassemia and Sickle Cell Anaemia, Mediterranean Institute of Haematology, Policlinic of "Tor Vergata" University, Rome, Italy
| | - Antonella Isgrò
- International Centre for Transplantation in Thalassemia and Sickle Cell Anaemia, Mediterranean Institute of Haematology, Policlinic of "Tor Vergata" University, Rome, Italy
| | - Marco Marziali
- International Centre for Transplantation in Thalassemia and Sickle Cell Anaemia, Mediterranean Institute of Haematology, Policlinic of "Tor Vergata" University, Rome, Italy
| | - Javid Gaziev
- International Centre for Transplantation in Thalassemia and Sickle Cell Anaemia, Mediterranean Institute of Haematology, Policlinic of "Tor Vergata" University, Rome, Italy
| | - Aldo Morrone
- International Centre for Transplantation in Thalassemia and Sickle Cell Anaemia, Mediterranean Institute of Haematology, Policlinic of "Tor Vergata" University, Rome, Italy
| | - Pietro Sodani
- International Centre for Transplantation in Thalassemia and Sickle Cell Anaemia, Mediterranean Institute of Haematology, Policlinic of "Tor Vergata" University, Rome, Italy
| | - Guido Lucarelli
- International Centre for Transplantation in Thalassemia and Sickle Cell Anaemia, Mediterranean Institute of Haematology, Policlinic of "Tor Vergata" University, Rome, Italy
| | - Roberto Gambari
- Department of Life Sciences and Biotechnology, Ferrara University, Ferrara, Italy.
- Biotechnology Center, Ferrara University, Ferrara, Italy.
| | - Katia Paciaroni
- International Centre for Transplantation in Thalassemia and Sickle Cell Anaemia, Mediterranean Institute of Haematology, Policlinic of "Tor Vergata" University, Rome, Italy
| |
Collapse
|
7
|
Isgrò A, Paciaroni K, Gaziev J, Sodani P, Gallucci C, Marziali M, Angelis GD, Alfieri C, Ribersani M, Roveda A, Akinyanju OO, Wakama TT, Olowoselu FO, Adediran A, Lucarelli G. Haematopoietic stem cell transplantation in Nigerian sickle cell anaemia children patients. Niger Med J 2015; 56:175-9. [PMID: 26229224 PMCID: PMC4518332 DOI: 10.4103/0300-1652.160355] [Citation(s) in RCA: 6] [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] [Indexed: 11/25/2022] Open
Abstract
Background: Sickle cell anaemia (SCA) remains associated with high risks of morbidity and early death. Children with SCA are at high risk for ischaemic stroke and transient ischaemic attacks, secondary to intracranial arteriopathy involving carotid and cerebral arteries. Allogeneic haematopoietic stem cell transplantation (HSCT) is the only curative treatment for SCA. We report our experience with transplantation in a group of patients with the Black African variant of SCA. Patients and Methods: This study included 31 consecutive SCA patients who underwent bone marrow transplantation from human leukocyte antigen (HLA)-identical sibling donors between 2010 and 2014 following a myeloablative-conditioning regimen. Results: The median patient age was 10 years (range 2–17 years). Before transplantation, 14 patients had recurrent, painful, vaso-occlusive crisis; ten patients had recurrent painful crisis in association with acute chest syndrome; three patients experienced ischaemic stroke and recurrent vaso-occlusive crisis; two patients experienced ischaemic stroke; one patient exhibited leukocytosis; and one patient exhibited priapism. Of the 31 patients, 28 survived without sickle cell disease, with Lansky/Karnofsky scores of 100. All surviving patients remained free of any SCA-related events after transplantation. Conclusion: The protocols used for the preparation to the transplant in thalassaemia are very effective also in the other severe haemoglobinopathy as in the sickle cell anaemia with 90% disease free survival. Today, if a SCA patient has a HLA identical family member, the cellular gene therapy through the transplantation of the allogeneic haemopoietic cell should be performed. Tomorrow, hopefully, the autologous genetically corrected stem cell will break down the wall of the immunological incompatibility.
Collapse
Affiliation(s)
- Antonella Isgrò
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic Tor Vergata, Rome, Italy
| | - Katia Paciaroni
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic Tor Vergata, Rome, Italy
| | - Javid Gaziev
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic Tor Vergata, Rome, Italy
| | - Pietro Sodani
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic Tor Vergata, Rome, Italy
| | - Cristiano Gallucci
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic Tor Vergata, Rome, Italy
| | - Marco Marziali
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic Tor Vergata, Rome, Italy
| | - Gioia De Angelis
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic Tor Vergata, Rome, Italy
| | - Cecilia Alfieri
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic Tor Vergata, Rome, Italy
| | - Michela Ribersani
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic Tor Vergata, Rome, Italy
| | - Andrea Roveda
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic Tor Vergata, Rome, Italy
| | | | | | - Festus Olusola Olowoselu
- Department of Haematology and Blood Transfusion, College of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adewumi Adediran
- Department of Haematology and Blood Transfusion, College of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Guido Lucarelli
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic Tor Vergata, Rome, Italy
| |
Collapse
|
8
|
Gaziev J, Isgrò A, Mozzi AF, Petain A, Nguyen L, Ialongo C, Dinallo V, Sodani P, Marziali M, Andreani M, Testi M, Paciaroni K, Gallucci C, De Angelis G, Alfieri C, Ribersani M, Lucarelli G. New insights into the pharmacokinetics of intravenous busulfan in children with sickle cell anemia undergoing bone marrow transplantation. Pediatr Blood Cancer 2015; 62:680-6. [PMID: 25557687 DOI: 10.1002/pbc.25376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 10/09/2014] [Accepted: 11/04/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Busulfan (Bu) is an integral part of conditioning regimens for patients with sickle cell anemia (SCA) undergoing transplantation. Patients with SCA might predispose to transplant-related neurological and pulmonary toxicities due to pre-existing disease-related cerebrovascular and lung injury. Bu therapy appears to be an important contributing factor in this context. PROCEDURE We studied the pharmacokinetics of intravenous Bu and clinical outcomes of 36 children with SCA undergoing bone marrow transplantation. Most patients had pre-existing organ system damage. Busulfan was administered every 6 hr for 4 days with pharmacokinetic-guided dose adjustment to target a conservative area under the concentration versus time curve (AUC) range of 900-1,350 µMol*min. RESULTS We found that the first-dose Bu clearance was significantly higher (P < 0.0005) than the subsequent daily clearance, which remained unchanged during the following days. After the first-dose, 69% of patients achieved the target range. We adapted a new dose-adjustment strategy targeting exposures to the lower end (900 µMol*min) of the AUC range after the first dose of Bu to avoid unnecessary dose increases on subsequent days due to differences in clearance. This strategy enabled most patients to maintain the AUC within therapeutic range following dose adjustments. CONCLUSIONS Differences in Bu clearance after the first-dose and subsequent daily doses in patients with SCA should be considered for pharmacokinetic-guided dose adjustment. Conservative AUC range and targeting exposures to the lower end of the range after the first dose was associated with negligible toxicity, and high engraftment and sickle cell-free survival rates.
Collapse
Affiliation(s)
- Javid Gaziev
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Isgrò A, Sodani P, Marziali M, Gaziev J, Fraboni D, Paciaroni K, Gallucci C, De Angelis G, Alfieri C, Ribersani M, Armiento D, Roveda A, Andreani M, Testi M, Lucarelli G. Reduction of intramedullary apoptosis after stem cell transplantation in black african variant of pediatric sickle cell anemia. Mediterr J Hematol Infect Dis 2014; 6:e2014054. [PMID: 25045462 PMCID: PMC4103501 DOI: 10.4084/mjhid.2014.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 03/28/2014] [Accepted: 07/04/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND PURPOSE Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment for sickle cell anemia (SCA). We report our experience with transplantation in children with the Black African variant of SCA and the effects of transplant on erythroid compartment in bone marrow (BM). PATIENTS AND METHODS Twenty-seven consecutive patients who underwent BM transplantation from HLA-identical donors following a myeloablative conditioning regimen were included. Using both CD71 and FSC parameters, we obtained three erythroid populations: EryA-C. Ery A (CD71(high) FSC(high)) are basophilic; Ery B (CD71(high) FSC(low)) are late basophilic and polychromatic; and Ery C (CD71(low) FSC(low)) are orthochromatic erythroblasts and reticulocytes. To analyze the effect of transplantation on intramedullary apoptosis, we studied Fas (CD95+) and caspase-3 expression in erythroblast subpopulations. RESULTS All patients experienced sustained engraftment, and all surviving patients remained free of SCA-related events after transplantation. The erythroid population showed expansion in the BM at baseline. After transplant, levels decreased, especially of Ery C, in parallel to reduced Fas expression and an initial caspase 3 increase in erythroid population, similar to reported later steps of "normal" erythroid maturation. CONCLUSIONS The results suggest a good chance of cure for children with SCA, with an excellent survival rate. We also observed "normalization" of erythroid populations in parallel with a decreased intramedullary apoptosis rate, suggesting normal erythroid maturation in ex-SCA patients after HSCT.
Collapse
Affiliation(s)
- Antonella Isgrò
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Pietro Sodani
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Marco Marziali
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Javid Gaziev
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Daniela Fraboni
- Laboratory of Oncohematology, Department of Laboratory Medicine, Policlinic of the University of Roma Tor Vergata, Rome, Italy
| | - Katia Paciaroni
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Cristiano Gallucci
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Gioia De Angelis
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Cecilia Alfieri
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Michela Ribersani
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Daniele Armiento
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Andrea Roveda
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Marco Andreani
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Manuela Testi
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| | - Guido Lucarelli
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinic of the University of Roma Tor Vergata., Rome, Italy
| |
Collapse
|
10
|
Isgrò A, Marziali M, Sodani P, Gaziev J, Erer B, Polchi P, Paciaroni K, Roveda A, De Angelis G, Gallucci C, Alfieri C, Simone MD, Zinno F, Isacchi G, Adorno G, Lanti A, Leti W, Aiuti F, Fraboni D, Andreani M, Lucarelli G. Immunohematologic Reconstitution in Pediatric Patients after T Cell-Depleted HLA-Haploidentical Stem Cell Transplantation for Thalassemia. Biol Blood Marrow Transplant 2010; 16:1557-66. [DOI: 10.1016/j.bbmt.2010.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 05/12/2010] [Indexed: 11/25/2022]
|
11
|
Gaziev J, Paba P, Miano R, Germani S, Sodani P, Bove P, Perno CF, Marziali M, Gallucci C, Isgrò A, Paciaroni K, Roveda A, Simone MD, De Angelis G, Alfieri C, Lucarelli G. Late-onset hemorrhagic cystitis in children after hematopoietic stem cell transplantation for thalassemia and sickle cell anemia: a prospective evaluation of polyoma (BK) virus infection and treatment with cidofovir. Biol Blood Marrow Transplant 2009; 16:662-71. [PMID: 20026413 DOI: 10.1016/j.bbmt.2009.12.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 12/12/2009] [Indexed: 01/31/2023]
Abstract
Little is known about late-onset hemorrhagic cystitis (HC) in children, its relationship to BK virus, and treatment with cidofovir (CDV) following hematopoietic stem cell transplantation (HSCT). We prospectively investigated BK virus reactivation in children who underwent HSCT from a matched related donor for thalassemia or sickle cell anemia following busulfan-cyclophosphamide-based conditioning regimens and analyzed risk factors for development of HC and its treatment with CDV. Grade 2-4 HC occurred in 30 patients with a cumulative incidence of 26% (95% confidence interval [CI] = 18%-34%). The cumulative incidences of BK viruria and viremia were 81% (95% CI = 69%-89%) and 28% (95% CI = 18%-40%), respectively. Multivariate analysis revealed that use of antithymocyte globulin (ATG) (hazard ratio [HR] = 10.5; P = .001), peak BK viruria >100,000 copies/mL (HR = 6.2; P = .004), and grade II-IV acute graft-versus-host disease (HR = 5.3; P = .007) were predictive factors for HC. Nineteen patients with HC were given CDV at 1.5 mg/kg/day 3 times a week, or 5 mg/kg/week. The median duration of therapy was 27 days (range, 21-180 days), and a median of 9 doses were given (range, 6-22). All patients had a complete clinical response (CCR), and 69% had a microbiological response at 4 weeks. Eleven patients with BK virus-related HC receiving supportive care also had CCR. The median duration of HC in these patients was similar to that in patients treated with CDV. None of the patients with HC cleared BK viruria when CCR was achieved. We conclude that late-onset HC is more prevalent in children with sustained high BK viruria who are treated with ATG or who develop graft-versus-host disease. Randomized clinical trials are urgently needed to better define the role of CDV in treating BK virus-related HC.
Collapse
Affiliation(s)
- Javid Gaziev
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Paciaroni K, Gallucci C, De Angelis G, Alfieri C, Roveda A, Lucarelli G. Sustained and full fetal hemoglobin production after failure of bone marrow transplant in a patient homozygous for beta 0-thalassemia: a clinical remission despite genetic disease and transplant rejection. Am J Hematol 2009; 84:372-3. [PMID: 19373892 DOI: 10.1002/ajh.21392] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An adult patient affected by beta(0)-thalassemia major underwent allogeneic bone marrow transplant (BMT) from a matched related donor. Forty days after transplant, allogeneic engraftment failure and autologous beta(0)-thalassemic bone marrow recovery were documented. Red blood cell transfusions were required until 118 days post-transplant. Thereafter, the haemoglobin (Hb) levels stabilized over 11.8 gr/dl throughout the ongoing 34-month follow-up, abolishing the need for transfusion support. The Hb electrophoresis showed 100% Hb Fetal (HbF). This unexplained case suggests full HbF production may occur in an adult patient with beta(0)-thalassemia major.
Collapse
|
13
|
Martini V, Minotti C, Breccia M, De Angelis G, Buffolino S, Mariella M, Lo-Coco F, Avvisati G, Cimino G. Prolonged molecular remission in a newly diagnosed acute promyelocytic leukaemia with a severe cardiomyopathy using low-dose gemtuzumab ozogamicin and all-trans retinoic acid. Ann Hematol 2006; 86:295-7. [PMID: 17136541 DOI: 10.1007/s00277-006-0219-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 10/18/2006] [Indexed: 10/23/2022]
MESH Headings
- Aminoglycosides/therapeutic use
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/therapeutic use
- Arsenic Trioxide
- Arsenicals/therapeutic use
- Cardiomyopathies/complications
- Cardiomyopathies/pathology
- Cardiomyopathies/physiopathology
- Drug Therapy, Combination
- Echocardiography
- Gemtuzumab
- Humans
- Leukemia, Promyelocytic, Acute/complications
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/genetics
- Male
- Middle Aged
- Oncogene Proteins, Fusion/genetics
- Oxides/therapeutic use
- Remission Induction
- Reverse Transcriptase Polymerase Chain Reaction
- Treatment Outcome
- Tretinoin/therapeutic use
Collapse
|