1
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Del Giudice I, Foà R. Measurable residual disease in chronic lymphocytic leukemia. Where do we stand? Leukemia 2023; 37:2339-2342. [PMID: 37838758 DOI: 10.1038/s41375-023-02066-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
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2
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Moia R, Terzi di Bergamo L, Talotta D, Bomben R, Forestieri G, Spina V, Bruscaggin A, Cosentino C, Almasri M, Dondolin R, Bittolo T, Zucchetto A, Baldoni S, Del Giudice I, Mauro FR, Maffei R, Chiarenza A, Tafuri A, Laureana R, Del Principe MI, Zaja F, D'Arena G, Olivieri J, Rasi S, Mahmoud A, Al Essa W, Awikeh B, Kogila S, Bellia M, Mouhssine S, Sportoletti P, Marasca R, Scarfò L, Ghia P, Gattei V, Foà R, Rossi D, Gaidano G. XPO1 mutations identify early-stage CLL characterized by shorter time to first treatment and enhanced BCR signalling. Br J Haematol 2023; 203:416-425. [PMID: 37580908 DOI: 10.1111/bjh.19052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023]
Abstract
Here we evaluated the epigenomic and transcriptomic profile of XPO1 mutant chronic lymphocytic leukaemia (CLL) and their clinical phenotype. By ATAC-seq, chromatin regions that were more accessible in XPO1 mutated CLL were enriched of binding sites for transcription factors regulated by pathways emanating from the B-cell receptor (BCR), including NF-κB signalling, p38-JNK and RAS-RAF-MEK-ERK. XPO1 mutant CLL, consistent with the chromatin accessibility changes, were enriched with transcriptomic features associated with BCR and cytokine signalling. By combining epigenomic and transcriptomic data, MIR155HG, the host gene of miR-155, and MYB, the transcription factor that positively regulates MIR155HG, were upregulated by RNA-seq and their promoters were more accessible by ATAC-seq. To evaluate the clinical impact of XPO1 mutations, we investigated a total of 957 early-stage CLL subdivided into 3 independent cohorts (N = 276, N = 286 and N = 395). Next-generation sequencing analysis identified XPO1 mutations as a novel predictor of shorter time to first treatment (TTFT) in all cohorts. Notably, XPO1 mutations maintained their prognostic value independent of the immunoglobulin heavy chain variable status and early-stage prognostic models. These data suggest that XPO1 mutations, conceivably through increased miR-155 levels, may enhance BCR signalling leading to higher proliferation and shorter TTFT in early-stage CLL.
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Affiliation(s)
- Riccardo Moia
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Lodovico Terzi di Bergamo
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
- Bioinformatics Core Unit, Swiss Institute of Bioinformatics, Bellinzona, Switzerland
- Department of Health Science and Technology, Swiss Federal Institute of Technology (ETH Zürich), Zurich, Switzerland
| | - Donatella Talotta
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Gabriela Forestieri
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Valeria Spina
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Alessio Bruscaggin
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Chiara Cosentino
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Mohammad Almasri
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Riccardo Dondolin
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Tamara Bittolo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Stefano Baldoni
- Institute of Hematology, Center for Hemato-Oncology Research, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Rossana Maffei
- Section of Hematology, Department of Medical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Annalisa Chiarenza
- A.O.O. Policlinico "G. Rodolico-S. Marco", U.O.C. Ematologia, Catania, Italy
| | - Agostino Tafuri
- Department of Clinical and Molecular Medicine, Hematology Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | | | | | - Francesco Zaja
- SC Ematologia, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Giovanni D'Arena
- Ematologia, P.O. San Luca, ASL Salerno, Vallo della Lucania, Italy
| | - Jacopo Olivieri
- Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), SOC Clinica Ematologica, Udine, Italy
| | - Silvia Rasi
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Abdurraouf Mahmoud
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Wael Al Essa
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Bassel Awikeh
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Sreekar Kogila
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Matteo Bellia
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Samir Mouhssine
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Paolo Sportoletti
- Institute of Hematology, Center for Hemato-Oncology Research, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Roberto Marasca
- Section of Hematology, Department of Medical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lydia Scarfò
- IRCCS Ospedale San Raffaele, Università Vita Salute San Raffaele, Milan, Italy
| | - Paolo Ghia
- IRCCS Ospedale San Raffaele, Università Vita Salute San Raffaele, Milan, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Davide Rossi
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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3
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Assanto GM, Totaro M, Poggiali R, Delli Paoli A, Annechini G, D'Elia GM, Aji F, Petrucci L, Fazio F, Del Giudice I, Martelli M, Micozzi A, Gentile G. Impact of Sars-CoV-2 Prophylaxis with Tixagevimab-Cilgavimab in High-Risk Patients with B-Cell Malignancies: A Single-Center Retrospective Study. Mediterr J Hematol Infect Dis 2023; 15:e2023061. [PMID: 38028390 PMCID: PMC10631717 DOI: 10.4084/mjhid.2023.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Severe Acute Respiratory Syndrome CoronaVirus‐2 (SARS‐CoV‐2) infection can result in different clinical manifestations (COVID-19), starting from asymptomatic disease to life threatening respiratory insufficiency. Onco-haematologic patients are at higher risk to develop severe COVID-19. In particular, patients affected by lymphoproliferative diseases, given the impaired cell-mediated and antibody-mediated immunity and treatment toxicity, develop more often a symptomatic and a more serious disease of Covid-19. Various therapeutic and prophylactic agents are being used against COVID‐19 such as antiviral drugs, vaccines and antiviral S‐protein monoclonal antibodies. Pre-exposure prophylaxis with AZD442/Evusheld (tixagevimab-cilgavimab) may be a complementary strategy to decrease the incidence or severity of COVID-19 for patients with B-cell malignancies. Tixagevimab-cilgavimab is a combination of two monoclonal antibodies that bind SARS-CoV-2 spike protein and inhibits the attachment to the surface of cells, preventing viral entry in the cell and COVID-19 development. In the setting of hematology real-life, few data are available on the impact of pre-exposure prophylaxis, given the multiple factors involved in the clinical behavior of SARS-CoV-2 . Our aim was to evaluate the clinical benefit and the safety of this strategy at our center.
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Affiliation(s)
| | - Matteo Totaro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Rebecca Poggiali
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Adele Delli Paoli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giorgia Annechini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Gianna Maria D'Elia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Francesco Aji
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Luigi Petrucci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Francesca Fazio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alessandra Micozzi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giuseppe Gentile
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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4
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Rigolin GM, Traversa A, Caputo V, Del Giudice I, Bardi A, Saccenti E, Raponi S, Ilari C, Cafforio L, Giovannetti A, Pizzuti A, Guarini A, Foà R, Cuneo A. Additional lesions identified by genomic microarrays are associated with an inferior outcome in low-risk chronic lymphocytic leukaemia patients. Br J Haematol 2023; 202:953-959. [PMID: 37357817 DOI: 10.1111/bjh.18946] [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: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
We explored the relevance of genomic microarrays (GM) in the refinement of prognosis in newly diagnosed low-risk chronic lymphocytic leukaemia (CLL) patients as defined by isolated del(13q) or no lesions by a standard 4 probe fluorescence in situ hybridization (FISH) analysis. Compared to FISH, additional lesions were detected by GM in 27 of the 119 patients (22.7%). The concordance rate between FISH and GM was 87.4%. Discordant results between cytogenetic banding analysis (CBA) and GM were observed in 45/119 cases (37.8%) and were mainly due to the intrinsic characteristics of each technique. The presence of additional lesions by GM was associated with age > 65 years (p = 0.047), advanced Binet stage (p = 0.001), CLL-IPI score (p < 0.001), a complex karyotype (p = 0.004) and a worse time-to-first treatment in multivariate analysis (p = 0.009). Additional lesions by GM were also significantly associated with a worse time-to-first treatment in the subset of patients with wild-type TP53 and mutated IGHV (p = 0.025). In CLL patients with low-risk features, the presence of additional lesions identified by GM helps to identify a subset of patients with a worse outcome that could be proposed for a risk-adapted follow-up and for early treatment including targeted agents within clinical trials.
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Affiliation(s)
| | - Alice Traversa
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Viviana Caputo
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonella Bardi
- Hematology Section, St. Anna University Hospital, Ferrara, Italy
| | - Elena Saccenti
- Hematology Section, St. Anna University Hospital, Ferrara, Italy
| | - Sara Raponi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Caterina Ilari
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Luciana Cafforio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
- GenomeUp S.r.l., Rome, Italy
| | - Agnese Giovannetti
- Clinical Genomics Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy
| | - Antonio Pizzuti
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonio Cuneo
- Hematology Section, St. Anna University Hospital, Ferrara, Italy
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5
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Moia R, Dondolin R, De Propris MS, Talotta D, Mouhssine S, Perutelli F, Reda G, Mattiello V, Rigolin GM, Motta M, Olivieri J, Fanin R, Perbellini O, Ferrarini I, Mauro FR, Del Giudice I, Laurenti L, Tomasso A, Gentile M, Frustaci AM, Tedeschi A, Gozzetti A, Stelitano C, Visco C, Moreno C, Forconi F, Marasca R, Coscia M, Rossi D, Foà R, Gaidano G. Long-term benefit of IGHV mutated patients in a real-life multicenter cohort of FCR-treated chronic lymphocytic leukemia. Hematol Oncol 2023; 41:567-570. [PMID: 36190298 DOI: 10.1002/hon.3080] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Riccardo Moia
- Division of Hematology, Department of Translational Medicine, Università Del Piemonte Orientale, Novara, Italy
| | - Riccardo Dondolin
- Division of Hematology, Department of Translational Medicine, Università Del Piemonte Orientale, Novara, Italy
| | | | - Donatella Talotta
- Division of Hematology, Department of Translational Medicine, Università Del Piemonte Orientale, Novara, Italy
| | - Samir Mouhssine
- Division of Hematology, Department of Translational Medicine, Università Del Piemonte Orientale, Novara, Italy
| | - Francesca Perutelli
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Mattiello
- Hematology Unit, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gian Matteo Rigolin
- Department of Medical Sciences, Hematology Section, AOU Arcispedale S Anna, University of Ferrara, Ferrara, Italy
| | | | - Jacopo Olivieri
- Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), SOC Clinica Ematologica, Udine, Italy
| | - Renato Fanin
- Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), SOC Clinica Ematologica, Udine, Italy
| | - Omar Perbellini
- Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Isacco Ferrarini
- Department of Medicine, Section of Haematology, University of Verona, Verona, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Luca Laurenti
- Department of Hematology, Catholic University Hospital A. Gemelli, Rome, Italy
| | - Annamaria Tomasso
- Department of Hematology, Catholic University Hospital A. Gemelli, Rome, Italy
| | | | - Anna Maria Frustaci
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Alessandra Tedeschi
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Caterina Stelitano
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Di Calabria, Italy
| | - Carlo Visco
- Department of Medicine, Section of Haematology, University of Verona, Verona, Italy
| | - Carol Moreno
- Hospital de La Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Roberto Marasca
- Department of Medical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Davide Rossi
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Università Del Piemonte Orientale, Novara, Italy
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Assanto GM, Di Rocco A, Malfona F, Capriata M, Del Giudice I, Petrucci L, Girardi P, D’Elia GM, Martelli M, Gentile G, Micozzi A, Pulsoni A. Impact of anti-SARS-CoV-2 monoclonal antibodies in the management of patients with lymphoma and COVID19: A retrospective study. Hematol Oncol 2023; 41:343-353. [PMID: 36521843 PMCID: PMC9877821 DOI: 10.1002/hon.3113] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/16/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
COVID19 in patients affected by lymphoma represents an important challenge because of the higher mortality rate. Anti-SARS-CoV-2 monoclonal antibodies (anti-S MoAbs) appear promising in this setting. We report a monocentric retrospective study including 176 patients affected by lymphoma which developed SARS-CoV-2 infection since the start of COVID19 pandemic. Overall, mortality was 13.1%, with a decreasing trend between first waves to the last wave of pandemic (18.5% vs. 9.4%, p 0.076). Patients receiving anti-S MoAbs (41.3%) showed inferior mortality rate (overall survival, OS 93.2% vs. 82.7%, p 0.025) with no serious toxicity, reduced documented pneumonia (26% vs. 33%, p 0.005), and reduced need of oxygen support (14.5% vs. 35.7%, p 0.003). Among patients who received 3 doses of vaccine, the employment of anti-COVID MoAbs showed a trend of superior survival versus those who did not receive Anti-S MoAbs (OS rates 97.3% vs. 84.2%, p 0.064). On multivariate analysis, active haematological disease (OS 72% (HR 2.49 CI 1.00-6.41), bendamustine exposure (OS 60% HR 4.2 CI 1.69-10.45) and at least one comorbidity (HR 6.53 CI 1.88-22.60) were independent prognostic factors for death. Our study confirms the adverse prognostic role of COVID-19 in lymphoma patients in presence of active disease, comorbidities and previous exposure to bendamustine. In our experience, anti-S MoAbs represented a therapeutic option in vaccinated patients.
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Affiliation(s)
| | - Alice Di Rocco
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Francesco Malfona
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Marcello Capriata
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Ilaria Del Giudice
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Luigi Petrucci
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Paola Girardi
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Gianna Maria D’Elia
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Maurizio Martelli
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Giuseppe Gentile
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Alessandra Micozzi
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Alessandro Pulsoni
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
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7
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Gotti M, Sciarra R, Pulsoni A, Merli F, Luminari S, Zerbi C, Trentin L, Re A, Rusconi C, Viviani S, Rossi A, Cocito F, Botto B, Meli E, Pinto A, Dogliotti I, Gini G, Puccini B, Ricci F, Nassi L, Fabbri A, Liberati AM, Merli M, Filippi AR, Bonfichi M, Zoboli V, Tartaglia G, Annechini G, D’Elia GM, Del Giudice I, Alvarez I, Visentin A, Pravato S, Dalceggio D, Pagani C, Ferrari S, Cristinelli C, Lazic T, Ferretti VV, Ricardi U, Arcaini L. Role of Rituximab Addition to First-line Chemotherapy Regimens in Nodular Lymphocyte-predominant Hodgkin Lymphoma: A Study by Fondazione Italiana Linfomi. Hemasphere 2023; 7:e837. [PMID: 37034003 PMCID: PMC10079338 DOI: 10.1097/hs9.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/29/2022] [Indexed: 04/08/2023] Open
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare entity whose neoplastic cells retain a B-cell phenotype with expression of CD20. Radiotherapy is recommended for favorable stage IA disease while for other stages guidelines suggest therapeutic strategies similar to those used for classic HL. The role of rituximab, although quite widespread, is not completely elucidated. We retrospectively analyzed baseline characteristics of 308 consecutive patients with NLPHL diagnosed in 19 Italian centers from 2000 to 2018. With a median follow-up of 8.4 years (interquartile range: 4.5–12.4) for treated patients, median overall survival (OS) was not reached and estimated 5-year OS was 97.8% and 5-year progression-free survival (PFS) was 84.5%. Five-year cumulative incidence of histological transformation was 1.4%, 95% confidence interval (CI), 0.5%-3.8%. After adjusting for lymphocyte count, splenic involvement, bulky disease and B symptoms (fever, drenching night sweats, unintentional loss >10% of body weight within the preceding 6 months), patients with stage II or more showed superior PFS with immunochemotherapy in comparison to chemotherapy alone (hazard ratio = 0.4, 95% CI, 0.2-0.8; P = 0.015). Our data suggest an advantage of the use of rituximab combined with chemotherapy ± radiotherapy in the treatment of stage II–III–IV NLPHL.
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Affiliation(s)
- Manuel Gotti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Sciarra
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Italy
| | - Alessandro Pulsoni
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Francesco Merli
- Division of Hematology, Azienda USL-IRCCS of Reggio Emilia, Italy
| | - Stefano Luminari
- Division of Hematology, Azienda USL-IRCCS of Reggio Emilia, Italy
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy
| | - Caterina Zerbi
- Department of Molecular Medicine, University of Pavia, Italy
| | - Livio Trentin
- Hematology Unit, Department of Medicine - DIMED, University of Padova, Italy
| | - Alessandro Re
- Division of Hematology, Spedali Civili, Brescia, Italy
| | - Chiara Rusconi
- Division of Hematology and Blood Marrow Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Simonetta Viviani
- Division of Hematology and Blood Marrow Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Rossi
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federica Cocito
- Division of Hematology, ASST Monza, Ospedale S. Gerardo, Monza, Italy
| | - Barbara Botto
- Division of Hematology, Azienda Ospedale Città della Salute e della Scienza, Torino, Italy
| | - Erika Meli
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Antonello Pinto
- Hematology-Oncology and Stem-Cell Transplantation Unit, Department of Hematology and Developmental Therapeutics, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Napoli, Italy
| | - Irene Dogliotti
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Italy
| | - Guido Gini
- Department of Hematology, Ospedali Riuniti, Ancona, Italy
| | | | - Francesca Ricci
- Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Luca Nassi
- Hematology, Department of Translational Medicine, AOU Maggiore della Carità and University of Eastern Piedmont, Novara, Italy
| | - Alberto Fabbri
- Division of Hematology, Azienda Ospedaliero- Universitaria Senese, Siena, Italy
| | - Anna Marina Liberati
- Division of Hematology, Azienda Ospedalaliera S. Maria di terni – Università degli Studi di Perugia, Italy
| | - Michele Merli
- Division of Hematology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Maurizio Bonfichi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Zoboli
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Germana Tartaglia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Giorgia Annechini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Gianna Maria D’Elia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Isabel Alvarez
- Division of Hematology, Azienda USL-IRCCS of Reggio Emilia, Italy
| | - Andrea Visentin
- Hematology Unit, Department of Medicine - DIMED, University of Padova, Italy
| | - Stefano Pravato
- Hematology Unit, Department of Medicine - DIMED, University of Padova, Italy
| | | | - Chiara Pagani
- Division of Hematology, Spedali Civili, Brescia, Italy
| | - Silvia Ferrari
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Tanja Lazic
- Department of Molecular Medicine, University of Pavia, Italy
| | - Virginia Valeria Ferretti
- Service of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Umberto Ricardi
- Radiation Oncology, Department of Oncology, University of Turin, Italy
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Italy
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8
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Assanto GM, Del Giudice I, Della Starza I, Soscia R, Cavalli M, Cola M, Bellomarino V, Di Trani M, Guarini A, Foà R. Research Topic: Measurable Residual Disease in Hematologic Malignancies. Can digital droplet PCR improve measurable residual disease monitoring in chronic lymphoid malignancies? Front Oncol 2023; 13:1152467. [PMID: 36998457 PMCID: PMC10043164 DOI: 10.3389/fonc.2023.1152467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/01/2023] [Indexed: 03/17/2023] Open
Abstract
Minimal/measurable residual disease (MRD) monitoring is progressively changing the management of hematologic malignancies. The possibility of detecting the persistence/reappearance of disease in patients in apparent clinical remission offers a refined risk stratification and a treatment decision making tool. Several molecular techniques are employed to monitor MRD, from conventional real-time quantitative polymerase chain reaction (RQ-PCR) to next generation sequencing and digital droplet PCR (ddPCR), in different tissues or compartments through the detection of fusion genes, immunoglobulin and T-cell receptor gene rearrangements or disease-specific mutations. RQ-PCR is still the gold standard for MRD analysis despite some limitations. ddPCR, considered the third-generation PCR, yields a direct, absolute, and accurate detection and quantification of low-abundance nucleic acids. In the setting of MRD monitoring it carries the major advantage of not requiring a reference standard curve built with the diagnostic sample dilution and of allowing to reduce the number of samples below the quantitative range. At present, the broad use of ddPCR to monitor MRD in the clinical practice is limited by the lack of international guidelines. Its application within clinical trials is nonetheless progressively growing both in acute lymphoblastic leukemia as well as in chronic lymphocytic leukemia and non-Hodgkin lymphomas. The aim of this review is to summarize the accumulating data on the use of ddPCR for MRD monitoring in chronic lymphoid malignancies and to highlight how this new technique is likely to enter into the clinical practice.
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Affiliation(s)
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
- *Correspondence: Ilaria Del Giudice, ; Robin Foà,
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
- Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA), Fondazione GIMEMA Franco Mandelli Onlus, Rome, Italy
| | - Roberta Soscia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Marzia Cavalli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Mattia Cola
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Vittorio Bellomarino
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Mariangela Di Trani
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
- *Correspondence: Ilaria Del Giudice, ; Robin Foà,
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9
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Del Giudice I, Cappelli LV, Delgado J, Niemann CU, Andersen MA, Rotbain EHC, Aarup K, Walewska R, Visentin A, Deodato M, Frustaci AM, Cavalloni C, Gentile M, Yassin MA, Lad D, Scarfò L, Flogegard M, Mattsson M, Raponi S, Ilari C, Starza ID, Orlandi EM, Tedeschi A, Trentin L, Semenzato G, Guarini A, Ghia P, Montserrat E, Foà R. Spontaneous regression in chronic lymphocytic leukaemia. Clinical features of 50 cases from the ERIC registry and review of the literature. Br J Haematol 2023; 201:353-356. [PMID: 36793194 DOI: 10.1111/bjh.18696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Luca Vincenzo Cappelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Julio Delgado
- Department of Hematology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Carsten Utoft Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Asger Andersen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emelie Hamotal Curovic Rotbain
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kathrine Aarup
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Renata Walewska
- Department of Haematology, University Hospitals Dorset, Bournemouth, UK
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Marina Deodato
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Anna Maria Frustaci
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Massimo Gentile
- Hematology Unit AO of Cosenza, Cosenza, Italy.,Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | | | - Deepesh Lad
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Lydia Scarfò
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Max Flogegard
- Hematology, Medicine Clinic, Falun Hospital, Falun, Sweden
| | - Mattias Mattsson
- Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Sara Raponi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Caterina Ilari
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Alessandra Tedeschi
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Gianpietro Semenzato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Emili Montserrat
- Department of Hematology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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10
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Natoni A, Cerreto M, De Propris MS, Del Giudice I, Soscia R, Peragine N, Intoppa S, Milani ML, Guarini A, Foà R. Sialylation regulates migration in chronic lymphocytic leukemia. Haematologica 2023:0. [PMID: 36779594 DOI: 10.3324/haematol.2022.281999] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Indexed: 02/11/2023] Open
Abstract
Sialylation is the terminal addition of sialic acid to underlying glycans and plays a prominent role in cell adhesion and immune regulation. Sialylated structures found on adhesion molecules, such as CD49d, mediate the interactions between cancer cells and the microenvironment, facilitating metastatic seeding in target organs. Chronic lymphocytic leukemia (CLL) is a clonal B-cell malignancy characterized by the accumulation of CD5- positive B cells in the peripheral blood, bone marrow and lymph nodes. CLL cells proliferate mainly in the lymph node "proliferation centers", where the microenvironment provides pro-survival signals. Thus, migration and homing into these protective niches play a crucial role in CLL biology. In recent years, therapeutic strategies aiming at inducing the egress of CLL cells from the lymph nodes and bone marrow into the circulation have been highly successful. In this study, the sialylation status of 79 untreated and 24 ibrutinibtreated CLL patients was characterized by flow cytometry. Moreover, the effect of sialic acid removal on migration was tested by a transwell assay. Finally, we examined the sialylation status of CD49d by Western blot analysis. We found that CLL cells are highly sialylated, particularly those characterized by an "activated" immune phenotype. Notably, sialylation regulates CLL migration through the post-translational modification of CD49d. Finally, we showed that therapeutic agents that induce CLL mobilization from their protective niches such as ibrutinib, modulate the levels of sialic acids. We propose that sialylation is an important regulator of CLL trafficking and may represent a novel target to further improve CLL therapy.
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Affiliation(s)
- Alessandro Natoni
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome.
| | - Marina Cerreto
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | | | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Roberta Soscia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Nadia Peragine
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Stefania Intoppa
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Maria Laura Milani
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome
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11
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Soscia R, Della Starza I, De Novi LA, Ilari C, Ansuinelli M, Cavalli M, Bellomarino V, Cafforio L, Di Trani M, Cazzaniga G, Fazio G, Santoro A, Salemi D, Spinelli O, Tosi M, Terragna C, Robustelli V, Bellissimo T, Colafigli G, Breccia M, Chiaretti S, Di Rocco A, Martelli M, Guarini A, Del Giudice I, Foà R. Circulating cell-free DNA for target quantification in hematologic malignancies: Validation of a protocol to overcome pre-analytical biases. Hematol Oncol 2023; 41:50-60. [PMID: 36251440 DOI: 10.1002/hon.3087] [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: 07/11/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 02/03/2023]
Abstract
Circulating tumor DNA (ctDNA) has become the most investigated analyte in blood. It is shed from the tumor into the circulation and represents a subset of the total cell-free DNA (cfDNA) pool released into the peripheral blood. In order to define if ctDNA could represent a useful tool to monitor hematologic malignancies, we analyzed 81 plasma samples from patients affected by different diseases. The results showed that: (i) the comparison between two different extraction methods Qiagen (Hilden, Germany) and Promega (Madison, WI) showed no significant differences in cfDNA yield, though the first recovered higher amounts of larger DNA fragments; (ii) cfDNA concentrations showed a notable inter-patient variability and differed among diseases: acute lymphoblastic leukemia and chronic myeloid leukemia released higher amounts of cfDNA than chronic lymphocytic leukemia, and diffuse large B-cell lymphoma released higher cfDNA quantities than localized and advanced follicular lymphoma; (iii) focusing on the tumor fraction of cfDNA, the quantity of ctDNA released was insufficient for an adequate target quantification for minimal residual disease monitoring; (iv) an amplification system proved to be free of analytical biases and efficient in increasing ctDNA amounts at diagnosis and in follow-up samples as shown by droplet digital PCR target quantification. The protocol has been validated by quality control rounds involving external laboratories. To conclusively document the feasibility of a ctDNA-based monitoring of patients with hematologic malignancies, more post-treatment samples need to be evaluated. This will open new possibilities for ctDNA use in the clinical practice.
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Affiliation(s)
- Roberta Soscia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.,GIMEMA Foundation, Rome, Italy
| | - Lucia Anna De Novi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Caterina Ilari
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Michela Ansuinelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Marzia Cavalli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Vittorio Bellomarino
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Luciana Cafforio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Mariangela Di Trani
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giovanni Cazzaniga
- Tettamanti Research Center, Department of Pediatrics, University of Milano-Bicocca/Fondazione MBBM, Monza, Italy
| | - Grazia Fazio
- Tettamanti Research Center, Department of Pediatrics, University of Milano-Bicocca/Fondazione MBBM, Monza, Italy
| | - Alessandra Santoro
- Division of Hematology and Bone Marrow Transplantation, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Domenico Salemi
- Division of Hematology and Bone Marrow Transplantation, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Orietta Spinelli
- Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Manuela Tosi
- Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Carolina Terragna
- Seràgnoli Institute of Hematology, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Valentina Robustelli
- Dipartimento di Medicina Specialistica Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Teresa Bellissimo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Gioia Colafigli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Sabina Chiaretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alice Di Rocco
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Anna Guarini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.,Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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12
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Mauro FR, Starza ID, Messina M, Reda G, Trentin L, Coscia M, Sportoletti P, Orsucci L, Arena V, Casaluci GM, Marasca R, Murru R, Laurenti L, Ilariucci F, Stelitano C, Mannina D, Massaia M, Rigolin GM, Scarfò L, Marchetti M, Levato L, Tani M, Arcari A, Musuraca G, Deodato M, Galieni P, Patrizi VB, Gottardi D, Liberati AM, Giordano A, Molinari MC, Pietrasanta D, Mattiello V, Visentin A, Vitale C, Albano F, Neri A, De Novi LA, De Propris MS, Nanni M, Del Giudice I, Guarini A, Fazi P, Vignetti M, Piciocchi A, Cuneo A, Foà R. High rate of durable responses with undetectable minimal residual disease with frontline venetoclax and rituximab in young and fit patients with chronic lymphocytic leukemia and an adverse biologic profile: results of the GIMEMA phase II LLC1518 - 'Veritas' study. Haematologica 2023. [PMID: 36632738 PMCID: PMC10388270 DOI: 10.3324/haematol.2022.282116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Indexed: 01/13/2023] Open
Abstract
The GIMEMA phase II LLC1518 VERITAS trial investigated the efficacy and safety of frontline, fixed-duration venetoclax and rituximab (VenR) combination in young (≤65 years) and fit patients with chronic lymphocytic leukemia (CLL) and unmutated IGHV and/or TP53 disruption. Treatment consisted of the Ven ramp-up, six-monthly courses of the VenR combination, followed by six monthly courses of Ven single agent. A centralized assessment of measurable minimal residual disease (MRD) was performed on the peripheral blood (PB) and bone marrow (BM) by ASO-PCR at the end of treatment (EOT) and during the follow-up. The primary endpoint was the complete remission (CR) rate at the EOT. Seventy-five patients were enrolled; the median age was 54 years (range 38-65), 96% had unmutated IGHV, 9 (12%) had TP53 disruption, and 4% were IGHV mutated with TP53 disruption. The overall response rate (ORR) at the EOT was 94.7%, with a CR rate of 76%. An undetectable (u) MRD was recorded in 69.3% of patients in the PB and 58.7% in the BM. The 12-month MRD-free survival in the 52 patients with uMRD in the PB at the EOT was 73.1%. After a median follow-up of 20.8 months, no disease progressions were observed. Three patients have died, two due to Covid-19 and 1 to tumor lysis syndrome. The first report of the VERITAS study shows that frontline VenR was associated with a high rate of CRs and durable responses with uMRD in young patients with CLL and unfavorable genetic characteristics.
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Affiliation(s)
- Francesca R Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University.
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome; GIMEMA Foundation
| | | | - Gianluigi Reda
- Hematology Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino
| | - Paolo Sportoletti
- Department of Medicine and Surgery, Institute of Hematology, Centro di Ricerca Emato Oncologica (CREO), University of Perugia, Perugia
| | - Lorella Orsucci
- Department of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino
| | | | - Gloria Margiotta Casaluci
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and AOU Maggiore della Carità, Novara
| | - Roberto Marasca
- Hematology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, ARNAS "G. Brotzu", Cagliari
| | - Luca Laurenti
- Fondazione Policlinico Universitario A Gemelli, IRCCS
| | - Fiorella Ilariucci
- Division of Hematology, Hematology, Arcispedale Santa Maria Nuova, Reggio Emilia
| | - Caterina Stelitano
- Department of Hematology, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria
| | - Donato Mannina
- Division of Hematology, Azienda Ospedaliera Papardo, Messina
| | - Massimo Massaia
- Division of Hematology, Santa Croce e Carle Hospital, Via Michele Coppino 26, 12100 Cuneo
| | | | - Lydia Scarfò
- Strategic Research Program on CLL, IRCCS Ospedale San Raffaele and Università Vita- Salute San Raffaele, Milan
| | - Monia Marchetti
- Hematology and Transplant Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, University of Eastern Pedemont, Alessandria
| | - Luciano Levato
- Department of Hematology, Pugliese Ciaccio Hospital, Catanzaro
| | - Monica Tani
- Division of Hematology, Santa Maria delle Croci Hospital, Ravenna
| | - Annalisa Arcari
- Division of Hematology, Guglielmo da Saliceto Hospital, Piacenza
| | - Gerardo Musuraca
- Istituto Scientifico Romagnoli per lo Studio e la Cura dei Tumori-IRST, Meldola
| | | | | | | | | | - Anna Marina Liberati
- Università degli Studi di Perugia, Azienda Ospedaliera Santa Maria di Terni, Terni
| | - Annamaria Giordano
- University of Bari "Aldo Moro," Hematology and Stem Cell Transplantation Unit, Department of Emergency and Organ Transplantation, Bari
| | | | - Daniela Pietrasanta
- Hematology and Transplant Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, University of Eastern Pedemont, Alessandria
| | - Veronica Mattiello
- Hematology Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino
| | - Francesco Albano
- University of Bari "Aldo Moro," Hematology and Stem Cell Transplantation Unit, Department of Emergency and Organ Transplantation, Bari
| | - Antonino Neri
- Hematology Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan
| | - Lucia Anna De Novi
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | | | - Mauro Nanni
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | - Anna Guarini
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | | | | | | | - Antonio Cuneo
- Hematology Section, St. Anna University Hospital, Ferrara
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University
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13
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Peragine N, De Propris MS, Intoppa S, Milani ML, Mauro FR, Cuneo A, Rigolin GM, Del Giudice I, Foà R, Guarini A. Early CD49d downmodulation in chronic lymphocytic leukemia patients treated front-line with ibrutinib plus rituximab predicts long-term response. Leuk Lymphoma 2022; 63:2982-2986. [PMID: 35913400 DOI: 10.1080/10428194.2022.2105324] [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: 12/14/2022]
Affiliation(s)
- Nadia Peragine
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Stefania Intoppa
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maria Laura Milani
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonio Cuneo
- Hematology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Gian Matteo Rigolin
- Hematology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
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14
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De Propris MS, Musiu P, Intoppa S, Nardacci MG, Pucciarini A, Santi A, Peragine N, Canichella M, De Luca ML, D'Elia GM, Del Giudice I, Pulsoni A, Falini B, Guarini A, Martelli M, Tiacci E, Foà R. Hairy cell leukaemia with low CD103 expression: A rare but important diagnostic pitfall. Br J Haematol 2022; 198:e28-e31. [PMID: 35499213 DOI: 10.1111/bjh.18224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Paolo Musiu
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Stefania Intoppa
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maria Grazia Nardacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alessandra Pucciarini
- Hematology and Center for Hemato-Oncology Research, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
| | - Alessia Santi
- Hematology and Center for Hemato-Oncology Research, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
| | - Nadia Peragine
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Martina Canichella
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.,Hematology Unit, S. Eugenio Hospital, Rome, Italy
| | - Maria Lucia De Luca
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.,Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Gianna Maria D'Elia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alessandro Pulsoni
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Brunangelo Falini
- Hematology and Center for Hemato-Oncology Research, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Enrico Tiacci
- Hematology and Center for Hemato-Oncology Research, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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15
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Fazio F, Cunsolo G, Mancini F, De Propris MS, Piciocchi A, Arena V, Messina M, Ansuinelli M, Taherinasab AT, Apicella V, Vitale A, Chiaretti S, Guarini A, Del Giudice I, Foà R. Blast morphology in the diagnostic work-up of Ph-like acute lymphoblastic leukemia. Leuk Lymphoma 2022; 63:1512-1514. [PMID: 35133227 DOI: 10.1080/10428194.2022.2032035] [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: 10/19/2022]
Affiliation(s)
- Francesca Fazio
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Gabriella Cunsolo
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Francesca Mancini
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Maria Stefania De Propris
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | | | | | - Monica Messina
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy.,GIMEMA Data Center, Rome, Italy
| | - Michela Ansuinelli
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | | | - Valerio Apicella
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Antonella Vitale
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Sabina Chiaretti
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Ilaria Del Giudice
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
| | - Robin Foà
- Department of Translational and Precision Medicine, Hematology, Sapienza University of Rome, Rome, Italy
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16
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Zaccaria GM, Ferrero S, Hoster E, Passera R, Evangelista A, Genuardi E, Drandi D, Ghislieri M, Barbero D, Del Giudice I, Tani M, Moia R, Volpetti S, Cabras MG, Di Renzo N, Merli F, Vallisa D, Spina M, Pascarella A, Latte G, Patti C, Fabbri A, Guarini A, Vitolo U, Hermine O, Kluin-Nelemans HC, Cortelazzo S, Dreyling M, Ladetto M. A Clinical Prognostic Model Based on Machine Learning from the Fondazione Italiana Linfomi (FIL) MCL0208 Phase III Trial. Cancers (Basel) 2021; 14:cancers14010188. [PMID: 35008361 PMCID: PMC8750124 DOI: 10.3390/cancers14010188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/26/2021] [Indexed: 12/05/2022] Open
Abstract
Simple Summary The interest in using Machine-Learning (ML) techniques in clinical research is growing. We applied ML to build up a novel prognostic model from patients affected with Mantle Cell Lymphoma (MCL) enrolled in a phase III open-labeled, randomized clinical trial from the Fondazione Italiana Linfomi (FIL)—MCL0208. This is the first application of ML in a prospective clinical trial on MCL lymphoma. We applied a novel ML pipeline to a large cohort of patients for which several clinical variables have been collected at baseline, and assessed their prognostic value based on overall survival. We validated it on two independent data series provided by European MCL Network. Due to its flexibility, we believe that ML would be of tremendous help in the development of a novel MCL prognostic score aimed at re-defining risk stratification. Abstract Background: Multicenter clinical trials are producing growing amounts of clinical data. Machine Learning (ML) might facilitate the discovery of novel tools for prognostication and disease-stratification. Taking advantage of a systematic collection of multiple variables, we developed a model derived from data collected on 300 patients with mantle cell lymphoma (MCL) from the Fondazione Italiana Linfomi-MCL0208 phase III trial (NCT02354313). Methods: We developed a score with a clustering algorithm applied to clinical variables. The candidate score was correlated to overall survival (OS) and validated in two independent data series from the European MCL Network (NCT00209222, NCT00209209); Results: Three groups of patients were significantly discriminated: Low, Intermediate (Int), and High risk (High). Seven discriminants were identified by a feature reduction approach: albumin, Ki-67, lactate dehydrogenase, lymphocytes, platelets, bone marrow infiltration, and B-symptoms. Accordingly, patients in the Int and High groups had shorter OS rates than those in the Low and Int groups, respectively (Int→Low, HR: 3.1, 95% CI: 1.0–9.6; High→Int, HR: 2.3, 95% CI: 1.5–4.7). Based on the 7 markers, we defined the engineered MCL international prognostic index (eMIPI), which was validated and confirmed in two independent cohorts; Conclusions: We developed and validated a ML-based prognostic model for MCL. Even when currently limited to baseline predictors, our approach has high scalability potential.
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Affiliation(s)
- Gian Maria Zaccaria
- Unit of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (S.F.); (E.G.); (D.D.); (D.B.)
- Unit of Hematology and Cell Therapy, IRCCS-Istituto Tumori ‘Giovanni Paolo II’, 70124 Bari, Italy;
- Correspondence: or ; Tel.: +39-(0)8-0555-5446; Fax: +39-(0)8-0555-5407
| | - Simone Ferrero
- Unit of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (S.F.); (E.G.); (D.D.); (D.B.)
| | - Eva Hoster
- Institute of Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-University of Munich, 81377 Munich, Germany;
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, 10126 Turin, Italy;
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, CPO Piemonte, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Elisa Genuardi
- Unit of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (S.F.); (E.G.); (D.D.); (D.B.)
| | - Daniela Drandi
- Unit of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (S.F.); (E.G.); (D.D.); (D.B.)
| | - Marco Ghislieri
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy;
- PoliToBIOMedLab of Politecnico di Torino, 10129 Turin, Italy
| | - Daniela Barbero
- Unit of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (S.F.); (E.G.); (D.D.); (D.B.)
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Monica Tani
- Hematology Unit, Santa Maria delle Croci Hospital, 48121 Ravenna, Italy;
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (R.M.); (M.L.)
| | - Stefano Volpetti
- Unit of Hematology, Presidio Ospedaliero Universitario “Santa Maria della Misericordia”, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy;
| | | | - Nicola Di Renzo
- Unit of Hematology and Bone Marrow Transplant, ‘V. Fazzi’ Hospital, 73100 Lecce, Italy;
| | | | - Daniele Vallisa
- Unit of Hematology, Department of Oncology and Hematology, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy;
| | - Michele Spina
- Division of Medical Oncology and Immune-Related Tumors, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy;
| | - Anna Pascarella
- Unit of Hematology, dell’ Angelo Mestre-Venezia Hospital, 30174 Mestre-Venezia, Italy;
| | - Giancarlo Latte
- Unit of Hematology and Bone Marrow Transplant, ‘San Francesco’ Hospital, 08100 Nuoro, Italy;
| | - Caterina Patti
- Unit of Hematology, Azienda Ospedali Riuniti Villa Sofia-Cervello, 90146 Palermo, Italy;
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
| | - Attilio Guarini
- Unit of Hematology and Cell Therapy, IRCCS-Istituto Tumori ‘Giovanni Paolo II’, 70124 Bari, Italy;
| | - Umberto Vitolo
- Division of Hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Olivier Hermine
- Service D’hématologie, Hôpital Universitaire Necker, Université René Descartes, Assistance Publique Hôpitaux de Paris, 75015 Paris, France;
| | - Hanneke C Kluin-Nelemans
- Department of Haematology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands;
| | | | - Martin Dreyling
- Department of Medicine III, University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Marco Ladetto
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (R.M.); (M.L.)
- Division of Hematology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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17
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Mauro FR, Paoloni F, Molica S, Reda G, Trentin L, Sportoletti P, Marchetti M, Pietrasanta D, Marasca R, Gaidano G, Coscia M, Stelitano C, Mannina D, Di Renzo N, Ilariucci F, Liberati AM, Orsucci L, Re F, Tani M, Musuraca G, Gottardi D, Zinzani PL, Gozzetti A, Molinari A, Gentile M, Chiarenza A, Laurenti L, Varettoni M, Ibatici A, Murru R, Ruocco V, Del Giudice I, De Propris MS, Della Starza I, Raponi S, Nanni M, Fazi P, Neri A, Guarini A, Rigolin GM, Piciocchi A, Cuneo A, Foà R. Efficacy of Front-Line Ibrutinib and Rituximab Combination and the Impact of Treatment Discontinuation in Unfit Patients with Chronic Lymphocytic Leukemia: Results of the Gimema LLC1114 Study. Cancers (Basel) 2021; 14:cancers14010207. [PMID: 35008372 PMCID: PMC8750939 DOI: 10.3390/cancers14010207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary This prospective, multicenter study aimed to investigate the efficacy and safety of a front-line treatment with the ibrutinib and rituximab combination in 146 unfit patients with chronic lymphocytic leukemia (CLL). We observed an OR, CR, and 48-month PFS rates of 87%, 22.6%, and 77%, respectively. Responses with undetectable MRD were observed in 6.2% of all patients and 27% of CR patients. TP53 disruption and B-symptoms revealed a significant and independent impact on PFS. The 48-month cumulative treatment discontinuation rate due to adverse events in this patient population was 29.1%. It was significantly higher in male patients, in patients aged ≥70 years, and in those managed at centers that enrolled less than five patients. In conclusion, the ibrutinib and rituximab combination was an effective front-line treatment for unfit patients with CLL. However, a high rate of treatment discontinuations due to adverse events was observed in this unfit population. Abstract The GIMEMA group investigated the efficacy, safety, and rates of discontinuations of the ibrutinib and rituximab regimen in previously untreated and unfit patients with chronic lymphocytic leukemia (CLL). Treatment consisted of ibrutinib, 420 mg daily, and until disease progression, and rituximab (375 mg/sqm, given weekly on week 1–4 of month 1 and day 1 of months 2–6). This study included 146 patients with a median age of 73 years, with IGHV unmutated in 56.9% and TP53 disrupted in 22.2%. The OR, CR, and 48-month PFS rates were 87%, 22.6%, and 77%, respectively. Responses with undetectable MRD were observed in 6.2% of all patients and 27% of CR patients. TP53 disruption (HR 2.47; p = 0.03) and B-symptoms (HR 2.91; p = 0.02) showed a significant and independent impact on PFS. The 48-month cumulative rates of treatment discontinuations due to disease progression (DP) or adverse events (AEs) were 5.6% and 29.1%, respectively. AEs leading more frequently to treatment discontinuation were atrial fibrillation in 8% of patients, infections in 8%, and non-skin cancers in 6%. Discontinuation rates due to AEs were higher in male patients (HR: 0.46; p = 0.05), patients aged ≥70 years (HR 5.43, p = 0.0017), and were managed at centers that enrolled <5 patients (HR 5.1, p = 0.04). Patients who discontinued ibrutinib due to an AE showed a 24-month next treatment-free survival rate of 63%. In conclusion, ibrutinib and rituximab combination was an effective front-line treatment with sustained disease control in more than half of unfit patients with CLL. Careful monitoring is recommended to prevent and manage AEs in this patient population.
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Affiliation(s)
- Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
- Correspondence: ; Tel.: +39-06-499741; Fax: +39-06-44241984
| | | | - Stefano Molica
- Department of Hematology, Pugliese Ciaccio Hospital, 88100 Catanzaro, Italy;
| | - Gianluigi Reda
- Hematology Department, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy; (G.R.); (A.N.)
| | - Livio Trentin
- Hematology Division, Department of Medicine, University of Padua, 35128 Padua, Italy;
| | - Paolo Sportoletti
- Institute of Hematology-Centro di Ricerca Emato-Oncologica (CREO), Department of Medicine, University of Perugia, 06129 Perugia, Italy;
| | - Monia Marchetti
- Department of Hematology, SS. Antonio e Biagio e Cesare Arrigo Hospital and University of Eastern Piedmont, 15121 Alessandria, Italy;
| | - Daniela Pietrasanta
- Department of Hematology, Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Roberto Marasca
- Hematology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, AOU Maggiore della Carità, 28100 Novara, Italy;
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, 10100 Torino, Italy;
| | - Caterina Stelitano
- Department of Hematology, Azienda Ospedaliera Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy;
| | - Donato Mannina
- Division of Hematology, Azienda Ospedaliera Papardo, 98158 Messina, Italy;
| | - Nicola Di Renzo
- Hematology and Stem Cell Transplant Unit, “Vito Fazzi” Hospital, 73100 Lecce, Italy;
| | - Fiorella Ilariucci
- Hematology, Azienda Ospedaliera Arcispedale Santa Maria Nuova IRCCS, 42123 Reggio Emilia, Italy;
| | - Anna Marina Liberati
- Department of Hematology, Università degli Studi di Perugia, A.O.S., 05100 Terni, Italy;
| | - Lorella Orsucci
- Department of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, 10100 Torino, Italy;
| | - Francesca Re
- Hematology and Bone Marrow Transplant Center, Azienda Ospedaliera Universitaria di Parma, 43126 Parma, Italy;
| | - Monica Tani
- Division of Hematology, Santa Maria delle Croci Hospital, 48121 Ravenna, Italy;
| | - Gerardo Musuraca
- Istituto Scientifico Romagnoli per lo Studio e la Cura dei Tumori-IRST, 47014 Meldola, Italy;
| | - Daniela Gottardi
- A.O.U. S. Giovanni Battista A.O. Mauriziano-Umberto I, 10128 Torino, Italy;
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna-Istituto di Ematologia “Seràgnoli” and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, 40138 Bologna, Italy;
| | - Alessandro Gozzetti
- Hematology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy;
| | - Annalia Molinari
- Department of Oncology and Hematology, Infermi Hospital, 47923 Rimini, Italy;
| | | | | | - Luca Laurenti
- Fondazione Policlinico Universitario A Gemelli, IRCCS, 00168 Rome, Italy;
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Adalberto Ibatici
- U.O. Ematologia e Centro Trapianti di Midollo, Policlinico San Martino, 16132 Genova, Italy;
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, ARNAS “G. Brotzu”, 34121 Cagliari, Italy;
| | - Valeria Ruocco
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
| | - Maria Stefania De Propris
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
- GIMEMA Foundation, 00187 Rome, Italy; (F.P.); (P.F.); (A.P.)
| | - Sara Raponi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
| | - Mauro Nanni
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
| | - Paola Fazi
- GIMEMA Foundation, 00187 Rome, Italy; (F.P.); (P.F.); (A.P.)
| | - Antonino Neri
- Hematology Department, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy; (G.R.); (A.N.)
| | - Anna Guarini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
| | - Gian Matteo Rigolin
- Hematology Section, St. Anna University Hospital, 44121 Ferrara, Italy; (G.M.R.); (A.C.)
| | | | - Antonio Cuneo
- Hematology Section, St. Anna University Hospital, 44121 Ferrara, Italy; (G.M.R.); (A.C.)
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
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18
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Abstract
Among indolent non-Hodgkin lymphomas (iNHLs), the analysis of measurable/minimal residual disease (MRD) has been extensively applied to follicular lymphoma (FL). Treatment combinations have deeply changed over the years, as well as the techniques to measure MRD, which is currently evaluated only in the setting of clinical trials. Here, we discuss the evidence on the role of molecular monitoring in the management of FL. Mature data support the quantification of molecular tumor burden at diagnosis as a tool to stratify patients in risk categories and of MRD evaluation at the end of treatment to predict progression-free survival and overall survival. Moreover, MRD deserves further studies as a tool to refine the clinical/metabolic response and to modulate treatment intensity/duration. Patients with a higher relapse probability can be identified, but the relevance of continuous molecular follow-up should be clarified by kinetic models of MRD analysis. Being the BCL2/heavy chain immunoglobulin gene hybrid rearrangement detectable in about 50% to 60% of advanced FL and in 30% of positron emission tomography/computed tomography-staged localized FL, technical advancements such as next-generation sequencing/target locus amplification may allow broadening the FL population carrying a molecular marker. Droplet digital polymerase chain reaction can better quantify MRD at low levels, and novel sources of DNA, such as cell-free DNA, may represent a noninvasive tool to monitor MRD. Finally, MRD in other iNHLs, such as lymphoplasmacytic lymphoma/Waldenström macroglobulinemia and marginal zone lymphoma, is beginning to be explored.
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Affiliation(s)
- Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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19
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Luminari S, Manni M, Galimberti S, Versari A, Tucci A, Boccomini C, Farina L, Olivieri J, Marcheselli L, Guerra L, Ferrero S, Arcaini L, Cavallo F, Kovalchuk S, Skrypets T, Del Giudice I, Chauvie S, Patti C, Stelitano C, Ricci F, Pinto A, Margiotta Casaluci G, Zilioli VR, Merli A, Ladetto M, Bolis S, Pavone V, Chiarenza A, Arcari A, Anastasia A, Dondi A, Mannina D, Federico M. Response-Adapted Postinduction Strategy in Patients With Advanced-Stage Follicular Lymphoma: The FOLL12 Study. J Clin Oncol 2021; 40:729-739. [PMID: 34709880 DOI: 10.1200/jco.21.01234] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE We compared 2 years of rituximab maintenance (RM) with a response-adapted postinduction approach in patients with follicular lymphoma who responded to induction immunochemotherapy. METHODS We randomly assigned treatment-naïve, advanced-stage, high-tumor burden follicular lymphoma patients to receive standard RM or a response-adapted postinduction approach on the basis of metabolic response and molecular assessment of minimal residual disease (MRD). The experimental arm used three types of postinduction therapies: for complete metabolic response (CMR) and MRD-negative patients, observation; for CMR and MRD-positive (end of induction or follow-up) patients, four doses of rituximab (one per week, maximum three courses) until MRD-negative; and for non-CMR patients, one dose of ibritumomab tiuxetan followed by standard RM. The study was designed as noninferiority trial with progression-free survival (PFS) as the primary end point. RESULTS Overall, 807 patients were randomly assigned. After a median follow-up of 53 months (range 1-92 months), patients in the standard arm had a significantly better PFS than those in the experimental arm (3-year PFS 86% v 72%; P < .001). The better PFS of the standard vs experimental arm was confirmed in all the study subgroups except non-CMR patients (n = 65; P = .274). The 3-year overall survival was 98% (95% CI, 96 to 99) and 97% (95% CI, 95 to 99) in the reference and experimental arms, respectively (P = .238). CONCLUSION A metabolic and molecular response-adapted therapy as assessed in the FOLL12 study was associated with significantly inferior PFS compared with 2-year RM. The better efficacy of standard RM was confirmed in the subgroup analysis and particularly for patients achieving both CMR and MRD-negative.
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Affiliation(s)
- Stefano Luminari
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unitа Sanitaria Locale-IRCCS, Arcispedale Santa Maria Nuova-Ematologia, Reggio Emilia, Italy
| | - Martina Manni
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Annibale Versari
- Nuclear Medicine Division, Azienda USL IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Carola Boccomini
- A.O.U. Città della Salute e della Scienza di Torino-SC Ematologia, Torino, Italy
| | - Lucia Farina
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Division of Hematology, Milano, Italy
| | - Jacopo Olivieri
- Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), SOC Clinica Ematologica, Udine, Italy
| | | | - Luca Guerra
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Nuclear Medicine, San Gerardo Hospital, ASST Monza, Italy
| | - Simone Ferrero
- A.O.U. Città della Salute e della Scienza di Torino, Ematologia Universitaria, Torino, Italy
| | - Luca Arcaini
- IRCCS Policlinico S. Matteo di Pavia, Div di Ematologia, Pavia, Italy
| | - Federica Cavallo
- A.O.U. Città della Salute e della Scienza di Torino, Ematologia Universitaria, Torino, Italy
| | - Sofya Kovalchuk
- Azienda Ospedaliera Universitaria Careggi, Unità funzionale di Ematologia, Firenze, Italy
| | - Tetiana Skrypets
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | - Ilaria Del Giudice
- Policlinico Umberto I, Università "La Sapienza," Istituto Ematologia, Dipartimento di Medicina Traslazionale e di Precisione, Roma, Italy
| | - Stephane Chauvie
- Medical Physics Division, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Caterina Patti
- A.O. Ospedali Riuniti Villa Sofia-Cervello, Div di Ematologia, Palermo, Italy
| | - Caterina Stelitano
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli-Ematologia, Reggio Calabria, Italy
| | | | - Antonello Pinto
- Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, UOC Ematologia Oncologica, Napoli, Italy
| | | | - Vittorio R Zilioli
- ASST Grande Ospedale Metropolitano Niguarda, SC Ematologia, Milano, Italy
| | - Anna Merli
- Ospedale degli Infermi di Rimini, U.O. di Ematologia, Rimini, Italy
| | - Marco Ladetto
- Dipartimento di Medicina Traslazionale Università del Piemonte Orientale, Alessandria, Italy.,SC Ematologia, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Vincenzo Pavone
- A.O. C. Panico, U.O.C Ematologia e Trapianto, Tricase, Italy
| | - Annalisa Chiarenza
- A.O.O. Policlinico "G. Rodolico-S. Marco," U.O.C. Ematologia, Catania, Italy
| | - Annalisa Arcari
- Ospedale Guglielmo da Saliceto, U.O.Ematologia, Piacenza, Italy
| | | | | | - Donato Mannina
- Azienda Ospedaliera Papardo-UOC di Ematologia, Messina, Italy
| | - Massimo Federico
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Cafforio L, Raponi S, Cappelli LV, Ilari C, Soscia R, De Propris MS, Mariglia P, Rigolin GM, Bardi A, Peragine N, Piciocchi A, Arena V, Mauro FR, Cuneo A, Guarini A, Foa R, Del Giudice I. Treatment with ibrutinib does not induce a TP53 clonal evolution in chronic lymphocytic leukemia. Haematologica 2021; 107:334-337. [PMID: 34647439 PMCID: PMC8719070 DOI: 10.3324/haematol.2020.263715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Indexed: 11/09/2022] Open
Abstract
Not available.
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Affiliation(s)
- Luciana Cafforio
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | - Sara Raponi
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | | | - Caterina Ilari
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | - Roberta Soscia
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | | | - Paola Mariglia
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | - Gian Matteo Rigolin
- Hematology Section, Department of Medical Science, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, University of Ferrara
| | - Antonella Bardi
- Hematology Section, Department of Medical Science, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, University of Ferrara
| | - Nadia Peragine
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | | | | | | | - Antonio Cuneo
- Hematology Section, Department of Medical Science, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, University of Ferrara
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome
| | - Robin Foa
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University.
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21
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Morabito F, Del Poeta G, Mauro FR, Reda G, Sportoletti P, Laurenti L, Coscia M, Herishanu Y, Bossio S, Varettoni M, Murru R, Chiarenza A, Visentin A, Condoluci A, Moia R, Pietrasanta D, Loseto G, Consoli U, Scortechini I, Recchia AG, Rossi FM, Zucchetto A, Al‐Janazreh H, Martino EA, Vigna E, Tripepi G, D'Arrigo G, Galimberti S, Rago A, Angeletti I, Biagi A, Del Giudice I, Bomben R, Neri A, Fronza G, Cutrona G, Jaksic O, Olivieri J, Rossi D, Di Raimondo F, Cuneo A, Gaidano G, Polliack A, Trentin L, Foà R, Ferrarini M, Gattei V, Gentile M. TP53 disruption as a risk factor in the era of targeted therapies: A multicenter retrospective study of 525 chronic lymphocytic leukemia cases. Am J Hematol 2021; 96:E306-E310. [PMID: 33989438 DOI: 10.1002/ajh.26235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Fortunato Morabito
- Biotechnology Research Unit AO of Cosenza Cosenza Italy
- Hematology and Bone Marrow Transplant Unit, Hemato‐Oncology Department Augusta Victoria Hospital East Jerusalem Israel
| | - Giovanni Del Poeta
- Division of Hematology S. Eugenio Hospital and University of Tor Vergata Rome Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine 'Sapienza' University Rome Italy
| | - Gianluigi Reda
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milan Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato‐Oncologica (CREO) University of Perugia Perugia Italy
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di Roma Rome Italy
| | - Marta Coscia
- Division of Hematology A.O.U. Città della Salute e della Scienza di Torino Torino Italy
| | - Yair Herishanu
- Sourasky Medical Center, Institute of Hematology, and Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | | | - Marzia Varettoni
- Division of Haematology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit Ospedale A. Businco Cagliari Italy
| | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties University of Catania Catania Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch University of Padova Padova Italy
| | - Adalgisa Condoluci
- Hematology, Oncology Institute of Southern Switzerland Bellinzona Switzerland
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Daniela Pietrasanta
- Division of Hematology Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo Alessandria Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit IRCCS‐Istituto Tumori 'Giovanni Paolo II' Bari Italy
| | - Ugo Consoli
- Hematology Department G. Garibaldi Hospital Catania Italy
| | | | | | - Francesca Maria Rossi
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Hamdi Al‐Janazreh
- Hematology and Bone Marrow Transplant Unit, Hemato‐Oncology Department Augusta Victoria Hospital East Jerusalem Israel
| | | | | | | | | | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | | | - Ilaria Angeletti
- Reparto di Oncoematologia Azienda Ospedaliera Santa Maria di Terni Terni Italy
| | - Annalisa Biagi
- Division of Hematology S. Eugenio Hospital and University of Tor Vergata Rome Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine 'Sapienza' University Rome Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Antonino Neri
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milan Italy
| | - Gilberto Fronza
- Mutagenesis and Cancer Prevention Unit IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Giovanna Cutrona
- Molecular Pathology Unit IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Ozren Jaksic
- Department of Hematology Dubrava University Hospital Zagreb Croatia
| | | | - Davide Rossi
- Hematology, Oncology Institute of Southern Switzerland Bellinzona Switzerland
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties University of Catania Catania Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences University of Ferrara Ferrara Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Aaron Polliack
- Department of Hematology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch University of Padova Padova Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine 'Sapienza' University Rome Italy
| | - Manlio Ferrarini
- Department of Experimental Medicine University of Genoa Genoa Italy
| | - Valter Gattei
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
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22
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Morabito F, Tripepi G, Del Poeta G, Mauro FR, Reda G, Sportoletti P, Laurenti L, Coscia M, Herishanu Y, Bossio S, Varettoni M, Murru R, Chiarenza A, Visentin A, Condoluci A, Moia R, Pietrasanta D, Loseto G, Consoli U, Scortechini I, Rossi FM, Zucchetto A, Al‐Janazreh H, Vigna E, Martino EA, Cassin R, D′Arrigo G, Galimberti S, Rago A, Angeletti I, Biagi A, Del Giudice I, Bomben R, Neri A, Fronza G, Monti P, Menichini P, Olivieri J, Cutrona G, Rossi D, Cuneo A, Di Raimondo F, Gaidano G, Polliack A, Trentin L, Foà R, Ferrarini M, Gattei V, Gentile M. Effectiveness of ibrutinib as first-line therapy for chronic lymphocytic leukemia patients and indirect comparison with rituximab-bendamustine: Results of study on 486 cases outside clinical trials. Am J Hematol 2021; 96:E269-E272. [PMID: 33878220 DOI: 10.1002/ajh.26201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Fortunato Morabito
- Biothecnology Research Unit, AO of Cosenza Cosenza Italy
- Hematology and Bone Marrow Transplant Unit, Hemato‐Oncology Department Augusta Victoria Hospital East Jerusalem Israel
| | | | - Giovanni Del Poeta
- Division of Hematology S. Eugenio Hospital and University of Tor Vergata Rome Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | - Gianluigi Reda
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milan Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato‐Oncologica (CREO) University of Perugia Perugia Italy
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di Roma Rome Italy
| | - Marta Coscia
- Division of Hematology A.O.U. Città della Salute e della Scienza di Torino Torino Italy
| | - Yair Herishanu
- Sourasky Medical Center, Institute of Hematology, and Sackler Faculty of Medicine Tel‐Aviv University Tel Aviv Israel
| | - Sabrina Bossio
- Biothecnology Research Unit, AO of Cosenza Cosenza Italy
| | - Marzia Varettoni
- Division of Haematology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco Cagliari Italy
| | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties University of Catania Catania Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch University of Padova Padova Italy
| | - Adalgisa Condoluci
- Hematology, Oncology Institute of Southern Switzerland Bellinzona Switzerland
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Daniela Pietrasanta
- Division of Hematology Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo Alessandria Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit, IRCCS‐Istituto Tumori ‘Giovanni Paolo II’ Bari Italy
| | - Ugo Consoli
- Hematology Department G. Garibaldi Hospital Catania Italy
| | | | - Francesca Maria Rossi
- Clinical and Experimental Onco‐Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco‐Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Hamdi Al‐Janazreh
- Hematology and Bone Marrow Transplant Unit, Hemato‐Oncology Department Augusta Victoria Hospital East Jerusalem Israel
| | | | | | - Ramona Cassin
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milan Italy
| | | | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | | | - Ilaria Angeletti
- Reparto di Oncoematologia Azienda Ospedaliera Santa Maria di Terni Terni Italy
| | - Annalisa Biagi
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | | | - Antonino Neri
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milan Italy
| | - Gilberto Fronza
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Paola Monti
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Paola Menichini
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Jacopo Olivieri
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari “Carlo Melzi”, Azienda Sanitaria Universitaria Integrata di Udine Udine Italy
| | - Giovanna Cutrona
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Davide Rossi
- Hematology, Oncology Institute of Southern Switzerland Bellinzona Switzerland
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences University of Ferrara Ferrara Italy
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties University of Catania Catania Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Aaron Polliack
- Department of Hematology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch University of Padova Padova Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | - Manlio Ferrarini
- Department of Experimental Medicine University of Genoa Genoa Italy
| | - Valter Gattei
- Clinical and Experimental Onco‐Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
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23
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Assanto GM, Ciotti G, Brescini M, De Luca ML, Annechini G, D’Elia GM, Agrippino R, Del Giudice I, Martelli M, Chiaravalloti A, Pulsoni A. High Basal Maximal Standardized Uptake Value (SUV max) in Follicular Lymphoma Identifies Patients with a Low Risk of Long-Term Relapse. Cancers (Basel) 2021; 13:cancers13122876. [PMID: 34207518 PMCID: PMC8227030 DOI: 10.3390/cancers13122876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite that the unfavorable prognostic role of a high Total Metabolic Tumor Volume (TMTV) in Follicular Lymphoma has been demonstrated, the role of SUVmax alone at baseline PET/CT could have a different prognostic role. PATIENTS AND METHODS We performed a retrospective observational monocentric cohort study. All patients affected by FL who underwent a basal PET/CT were included. Two subgroups were identified and compared in terms of PFS and OS: (A) Basal SUVmax ≤ 6; and (B) Basal SUVmax > 6. RESULTS Ninety-four patients were included, 34 in group A (36.2%) and 60 in group B (63.8%). The PFS at two years was comparable in the two groups (97%). The five-year PFS was 73.5% for group A and 95% for group B (p 0.005). The five-year PFS in the whole cohort was 87.5%. A clear advantage was confirmed in group A in the absence of other risk factors. Patients with SUVmax ≤ 6 and no risk factors showed a 5-year PFS of 73% against 83% for patients with SUVmax > 6 and at least two risk factors. CONCLUSION A high FDG uptake favorably correlated with PFS. A low basal SUVmax reflected a higher rate of late relapse requiring a prolonged follow-up. The basal SUVmax is an approachable parameter with prognostic implications.
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Affiliation(s)
- Giovanni Manfredi Assanto
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161 Rome, Italy; (G.M.A.); (G.C.); (M.B.); (M.L.D.L.); (G.A.); (G.M.D.); (R.A.); (I.D.G.); (M.M.)
| | - Giulia Ciotti
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161 Rome, Italy; (G.M.A.); (G.C.); (M.B.); (M.L.D.L.); (G.A.); (G.M.D.); (R.A.); (I.D.G.); (M.M.)
| | - Mattia Brescini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161 Rome, Italy; (G.M.A.); (G.C.); (M.B.); (M.L.D.L.); (G.A.); (G.M.D.); (R.A.); (I.D.G.); (M.M.)
| | - Maria Lucia De Luca
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161 Rome, Italy; (G.M.A.); (G.C.); (M.B.); (M.L.D.L.); (G.A.); (G.M.D.); (R.A.); (I.D.G.); (M.M.)
| | - Giorgia Annechini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161 Rome, Italy; (G.M.A.); (G.C.); (M.B.); (M.L.D.L.); (G.A.); (G.M.D.); (R.A.); (I.D.G.); (M.M.)
| | - Gianna Maria D’Elia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161 Rome, Italy; (G.M.A.); (G.C.); (M.B.); (M.L.D.L.); (G.A.); (G.M.D.); (R.A.); (I.D.G.); (M.M.)
| | - Roberta Agrippino
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161 Rome, Italy; (G.M.A.); (G.C.); (M.B.); (M.L.D.L.); (G.A.); (G.M.D.); (R.A.); (I.D.G.); (M.M.)
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161 Rome, Italy; (G.M.A.); (G.C.); (M.B.); (M.L.D.L.); (G.A.); (G.M.D.); (R.A.); (I.D.G.); (M.M.)
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161 Rome, Italy; (G.M.A.); (G.C.); (M.B.); (M.L.D.L.); (G.A.); (G.M.D.); (R.A.); (I.D.G.); (M.M.)
| | - Agostino Chiaravalloti
- Nuclear Medicine, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy;
- Nuclear Medicine, Istituto Neurologico Mediterraneo IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Alessandro Pulsoni
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161 Rome, Italy; (G.M.A.); (G.C.); (M.B.); (M.L.D.L.); (G.A.); (G.M.D.); (R.A.); (I.D.G.); (M.M.)
- Correspondence:
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Morabito F, Tripepi G, Del Poeta G, Mauro FR, Reda G, Sportoletti P, Laurenti L, Coscia M, Herishanu Y, Varettoni M, Murru R, Chiarenza A, Visentin A, Condoluci A, Moia R, Pietrasanta D, Loseto G, Consoli U, Scortechini I, Rossi FM, Zucchetto A, Vigna E, Martino EA, Mendicino F, Botta C, Caracciolo D, Cassin R, D'Arrigo G, Galimberti S, Rago A, Angeletti I, Biagi A, Del Giudice I, Bomben R, Neri A, Fronza G, Cutrona G, Rossi D, Di Raimondo F, Cuneo A, Gaidano G, Polliack A, Trentin L, Foà R, Ferrarini M, Gattei V, Gentile M. Assessment of the 4-factor score: Retrospective analysis of 586 CLL patients receiving ibrutinib. A campus CLL study. Am J Hematol 2021; 96:E168-E171. [PMID: 33580969 DOI: 10.1002/ajh.26127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Fortunato Morabito
- Department of Onco‐Hematology Biotechnology Research Unit, AO of Cosenza Cosenza Italy
- Hematology and Bone Marrow Transplant Unit Hemato‐Oncology Department, Augusta Victoria Hospital East Jerusalem Israel
| | - Giovanni Tripepi
- Department of Medicine CNR‐IFC, Research Unit of Reggio Calabria Reggio Calabria Italy
| | - Giovanni Del Poeta
- Division of Hematology S. Eugenio Hospital and University of Tor Vergata Rome Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | - Gianluigi Reda
- Department of Onco‐Hematology Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato‐Oncologica (CREO) University of Perugia Perugia Italy
| | - Luca Laurenti
- Department of Onco‐Hematology Fondazione Universitaria Policlinico A Gemelli di Roma Roma Italy
| | - Marta Coscia
- Division of Hematology A.O.U. Città della Salute e della Scienza di Torino Torino Italy
| | - Yair Herishanu
- Sourasky Medical Center Institute of Hematology, and Sackler Faculty of Medicine, Tel‐Aviv University Tel‐Aviv Israel
| | - Marzia Varettoni
- Division of Haematology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit Ospedale A. Businco Cagliari Italy
| | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties University of Catania Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch University of Padova Padova Italy
| | - Adalgisa Condoluci
- Department of Onco‐Hematology Hematology, Oncology Institute of Southern Switzerland Bellinzona Switzerland
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Daniela Pietrasanta
- Division of Hematology Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo Alessandria Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit IRCCS‐Istituto Tumori ‘Giovanni Paolo II’ Bari Italy
| | - Ugo Consoli
- Department of Onco‐Hematology Hematology Department, G. Garibaldi Hospital Catania Italy
| | - Ilaria Scortechini
- Department of Onco‐Hematology Clinica di Ematologia Ospedali Riuniti Ancona Italy
| | - Francesca Maria Rossi
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Ernesto Vigna
- Department of Onco‐Hematology Biotechnology Research Unit, AO of Cosenza Cosenza Italy
- Department of Onco‐Hematology Hematology Unit AO of Cosenza Cosenza Italy
| | | | | | - Cirino Botta
- Department of Onco‐Hematology Hematology Unit AO of Cosenza Cosenza Italy
| | - Daniele Caracciolo
- Department of Onco‐Hematology Hematology Unit AO of Cosenza Cosenza Italy
| | - Ramona Cassin
- Department of Onco‐Hematology Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Graziella D'Arrigo
- Department of Medicine CNR‐IFC, Research Unit of Reggio Calabria Reggio Calabria Italy
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Angela Rago
- Department of Onco‐Hematology UOSD Ematologia ASL Roma 1 Roma Italy
| | - Ilaria Angeletti
- Department of Onco‐Hematology Reparto di Oncoematologia Azienda Ospedaliera Santa Maria di Terni Terni Italy
| | - Annalisa Biagi
- Division of Hematology S. Eugenio Hospital and University of Tor Vergata Rome Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Antonino Neri
- Department of Onco‐Hematology Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Gilberto Fronza
- Mutagenesis and Cancer Prevention Unit IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Giovanna Cutrona
- Molecular Pathology Unit IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Davide Rossi
- Department of Onco‐Hematology Hematology, Oncology Institute of Southern Switzerland Bellinzona Switzerland
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties University of Catania Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences University of Ferrara Ferrara Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Aaron Polliack
- Department of Hematology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch University of Padova Padova Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | - Manlio Ferrarini
- Department of Experimental Medicine University of Genoa Genoa Italy
| | - Valter Gattei
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Massimo Gentile
- Department of Onco‐Hematology Biotechnology Research Unit, AO of Cosenza Cosenza Italy
- Department of Onco‐Hematology Hematology Unit AO of Cosenza Cosenza Italy
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Puzzolo MC, Del Giudice I, Peragine N, Mariglia P, De Propris MS, Cappelli LV, Trentin L, Reda G, Cuneo A, Molica S, Piciocchi A, Arena V, Mauro FR, Guarini A, Foà R. TH2/TH1 Shift Under Ibrutinib Treatment in Chronic Lymphocytic Leukemia. Front Oncol 2021; 11:637186. [PMID: 33937038 PMCID: PMC8082026 DOI: 10.3389/fonc.2021.637186] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/01/2021] [Indexed: 12/16/2022] Open
Abstract
Ibrutinib may revert the T-helper (Th)2 polarization observed in chronic lymphocytic leukemia (CLL) by targeting the IL-2-inducible kinase, that shows a significant homology with the Bruton tyrosine kinase. In the front-line GIMEMA LLC1114 trial (ibrutinib+rituximab for 6 months, followed by ibrutinib maintenance), we investigated the modulation of T-cell cytokine production in 208 peripheral blood paired samples from 71 CLL patients: 71 samples prior to treatment (Day 0, D0) and at day +14 (D14; n=50), at month +8 (M8; 30), +12 (M12; 25), +18 (M18; 22) and +24 (M24; 10) of treatment. We documented a progressive decrease of CD3+CD4+IL-4+ T cells (Th2), that was significant at M8 and at M12 (p=0.019, p=0.002), a relative increase in the CD3+CD4+IFNγ+ T cells (Th1) and a decrease of CD3+CD4+IL-17+ (Th17) cells that was maintained up to M18 (M8 vs D0 p=0.003, M12 vs D0 p=0.003, M18 vs D0 p=0.004) of ibrutinib treatment. The Th2/Th1 ratio significantly decreased already after 14 days of treatment and was maintained thereafter (D14 vs D0 p=0.037, M8 vs D0 p=0.001, M12 vs D0 p=0.005, M18 vs D0 p=0.002). The Th2/Th1 modulation over time was significant only among patients with unmutated IGHV. The Th2/Th1 ratio below a cut-off of 0.088 at M8 was associated with the achievement of a complete response (CR) (p=0.016). Ibrutinib may shape the CLL T-cell profile, limiting Th2 activation and inducing a shift in the Th2/Th1 ratio. The association between the Th2/Th1 ratio decrease and the CR achievement suggests the in vivo generation of a potential host anti-tumor immune activation induced by ibrutinib.
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Affiliation(s)
- Maria Cristina Puzzolo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Nadia Peragine
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Paola Mariglia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Luca Vincenzo Cappelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Science, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Stefano Molica
- Hematology, Azienda Ospedaliera "Pugliese Ciaccio", Presidio Ospedaliero A. Pugliese - Unità Operativa di Ematologia, Catanzaro, Italy
| | | | | | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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26
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Morabito F, Tripepi G, Del Poeta G, Mauro FR, Reda G, Sportoletti P, Laurenti L, Coscia M, Herishanu Y, Bossio S, Varettoni M, Murru R, Chiarenza A, Visentin A, Condoluci A, Moia R, Pietrasanta D, Loseto G, Consoli U, Scortechini I, Rossi FM, Zucchetto A, Al-Janazreh H, Vigna E, Martino EA, Mendicino F, Cassin R, D'Arrigo G, Galimberti S, Rago A, Angeletti I, Biagi A, Del Giudice I, Bomben R, Neri A, Fronza G, Monti P, Menichini P, Cutrona G, Jaksic O, Rossi D, Di Raimondo F, Cuneo A, Gaidano G, Polliack A, Trentin L, Foà R, Ferrarini M, Gattei V, Gentile M. Comparison of ibrutinib and idelalisib plus rituximab in real-life relapsed/resistant chronic lymphocytic leukemia cases. Eur J Haematol 2021; 106:493-499. [PMID: 33378569 DOI: 10.1111/ejh.13573] [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: 11/17/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To compare the capacity of ibrutinib (IB) and idelalisib-rituximab (IDELA-R) of prolonging overall survival (OS) as in CLL patients, previously treated with chemotherapy only. METHODS A real-life cohort of 675 cases has been identified and investigated in the database of the groups participating in the study. RESULTS At an unadjusted univariate analysis, a significant death risk reduction was observed favoring IB (IDELA-R vs IB HR = 0.5, 95% CI = 0.36-0.71) although with some limitations due to the non-randomized and retrospective nature of the study and to the lower number of patients in the IDELA-R group (112 cases) related to the current prescribing practice. To overcome the potential problem of confounding by indication, we adjusted the association between the type of therapy and mortality for all variables significantly associated with OS at Cox univariate analysis. Furthermore, those variables, differently distributed between the two study groups, were introduced into the multivariate Cox model to improve the effectiveness of the analysis. By introducing all these variables into the multiple Cox regression model, we confirmed the protective effect of IB vs IDELA-R (HR = 0.67, 95% CI = 0.45-0.98, P = .04) independent of potential confounders. CONCLUSIONS Although our analysis presents some constraints, that is, the unavailability of additional potential confounders, and the retrospective nature of the study, this observation may be of help for the daily clinical practice, particularly in the absence of randomized trials comparing the two schedules.
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Affiliation(s)
- Fortunato Morabito
- Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy.,Hematology and Bone Marrow Transplant Unit, Hemato-Oncology Department, Augusta Victoria Hospital, East Jerusalem, Israel
| | - Giovanni Tripepi
- CNR-IFC, Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Giovanni Del Poeta
- Division of Hematology, S. Eugenio Hospital and University of Tor Vergata, Rome, Italy
| | | | - Gianluigi Reda
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato-Oncologica (CREO), University of Perugia, Perugia, Italy
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di Roma, Roma, Italy
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Yair Herishanu
- Sourasky Medical Center, Institute of Hematology and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sabrina Bossio
- Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy
| | - Marzia Varettoni
- Division of Haematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, Cagliari, Italy
| | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova, Italy
| | | | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Daniela Pietrasanta
- Division of Hematology, Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Ugo Consoli
- Hematology Department, G. Garibaldi Hospital, Catania, Italy
| | | | - Francesca Maria Rossi
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Hamdi Al-Janazreh
- Hematology and Bone Marrow Transplant Unit, Hemato-Oncology Department, Augusta Victoria Hospital, East Jerusalem, Israel
| | - Ernesto Vigna
- Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy.,Hematology Unit AO of Cosenza, Cosenza, Italy
| | | | | | - Ramona Cassin
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | | | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Ilaria Angeletti
- Reparto di Oncoematologia Azienda Ospedaliera Santa Maria di Terni, Terni, Italy
| | - Annalisa Biagi
- Division of Hematology, S. Eugenio Hospital and University of Tor Vergata, Rome, Italy
| | - Ilaria Del Giudice
- Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Antonino Neri
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Gilberto Fronza
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Monti
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Menichini
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanna Cutrona
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ozren Jaksic
- Department of Hematology, Dubrava Univerisity Hospital, Zagreb, Croatia
| | - Davide Rossi
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, University of Ferrara, Cona, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Aaron Polliack
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova, Italy
| | - Robin Foà
- Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Manlio Ferrarini
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Massimo Gentile
- Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy.,Hematology Unit AO of Cosenza, Cosenza, Italy
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27
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Mauro FR, Molica S, Soddu S, Ilariucci F, Coscia M, Zaja F, Angelucci E, Re F, Liberati AM, Tedeschi A, Reda G, Pietrasanta D, Gozzetti A, Battistini R, Del Poeta G, Musolino C, Nanni M, Piciocchi A, Vignetti M, Neri A, Albano F, Cuneo A, Del Giudice I, Starza ID, De Propris MS, Raponi S, Guarini AR, Foà R. High rate of MRD-responses in young and fit patients with IGHV mutated chronic lymphocytic leukemia treated with front-line fludarabine, cyclophosphamide, and intensified dose of ofatumumab (FCO2). Haematologica 2020; 105:2671-2674. [PMID: 33131259 PMCID: PMC7604632 DOI: 10.3324/haematol.2019.235705] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Francesca R. Mauro
- Department of Hematology and Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Stefano Molica
- Department of Hematology, Pugliese Ciaccio Hospital, Catanzaro
| | - Stefano Soddu
- Italian Group for Adult Hematologic Diseases (GIMEMA) Foundation, Rome
| | | | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino
| | - Francesco Zaja
- SC Ematologia, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Emanuele Angelucci
- Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genova
| | | | - Anna Marina Liberati
- Department of Onco-Hematology, University of Perugia, Santa Maria Hospital, Terni
| | | | - Gianluigi Reda
- Department of Hematology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan, Milan
| | - Daniela Pietrasanta
- Department of Hematology, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria
| | - Alessandro Gozzetti
- Hematology, Department of Medical Science Surgery and Neurosciences, University of Siena, Siena
| | | | - Giovanni Del Poeta
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome
| | | | - Mauro Nanni
- Department of Hematology and Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Alfonso Piciocchi
- Italian Group for Adult Hematologic Diseases (GIMEMA) Foundation, Rome
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA) Foundation, Rome
| | - Antonino Neri
- Department of Hematology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan, Milan
| | - Francesco Albano
- Emergency and Transplantation Department, Hematology Section, University of Bari, Bari
| | - Antonio Cuneo
- Department of Hematology, S. Anna Hospital, Ferrara, Italy
| | - Ilaria Del Giudice
- Department of Hematology and Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Irene Della Starza
- Department of Hematology and Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Maria Stefania De Propris
- Department of Hematology and Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Sara Raponi
- Department of Hematology and Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Anna R Guarini
- Department of Hematology and Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Robin Foà
- Department of Hematology and Department of Translational and Precision Medicine, 'Sapienza' University, Rome
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28
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Peragine N, De Propris MS, Intoppa S, Milani ML, Mariglia P, Mauro FR, Raponi S, Soddu S, Cuneo A, Rigolin GM, Del Giudice I, Foà R, Guarini A. Modulated expression of adhesion, migration and activation molecules may predict the degree of response in chronic lymphocytic leukemia patients treated with ibrutinib plus rituximab. Haematologica 2020; 106:1500-1503. [PMID: 33054124 PMCID: PMC8094098 DOI: 10.3324/haematol.2020.262071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/05/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nadia Peragine
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | | | - Stefania Intoppa
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Maria Laura Milani
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Paola Mariglia
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Sara Raponi
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Stefano Soddu
- Italian Group for Adult Hematologic Diseases (GIMEMA) Foundation, Rome
| | - Antonio Cuneo
- Hematology, Department of Medical Sciences, University of Ferrara, Ferrara
| | | | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome .
| | - Anna Guarini
- Department of Molecular Medicine, "Sapienza" University, Rome, Italy
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29
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Della Starza I, De Novi LA, Cavalli M, Novelli N, Soscia R, Genuardi E, Mantoan B, Drandi D, Ferrante M, Monitillo L, Barbero D, Ciabatti E, Grassi S, Bomben R, Degan M, Gattei V, Galimberti S, Di Rocco A, Martelli M, Cortelazzo S, Guarini A, Foà R, Ladetto M, Ferrero S, Del Giudice I. Immunoglobulin kappa deleting element rearrangements are candidate targets for minimal residual disease evaluation in mantle cell lymphoma. Hematol Oncol 2020; 38:698-704. [PMID: 32816326 DOI: 10.1002/hon.2792] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 11/09/2022]
Abstract
Minimal residual disease (MRD) assessment is of high clinical relevance in patients with mantle cell lymphoma (MCL). In mature B-cell malignancies, the presence of somatic hypermutations (SHM) in Variable-Diversity-Joining Heavy chain (VDJH) rearrangements leads to frequent mismatches between primers, probes, and the target, thus impairing tumor cells quantification. Alternative targets, such as immunoglobulin kappa-deleting-element (IGK-Kde) rearrangements, might be suitable for MRD detection. We aimed at evaluating the applicability of IGK-Kde rearrangements for MRD quantification in MCL patients by real-time quantitative polymerase chain reaction (RQ-PCR)/digital-droplet-PCR (ddPCR). IGK screening was performed on bone marrow samples from two cohorts: the first from Turin (22 patients enrolled in the FIL-MCL0208 trial, NCT02354313) and the second from Rome (15 patients). IGK-Kde rearrangements were found in 76% (28/37) of cases, representing the sole molecular marker in 73% (8/11) of IGH-BCL1/IGH negative cases. MRD RQ-PCR monitoring was possible in 57% (16/28) of cases, showing a 100% concordance with the conventional targets. However, the frequent background amplification affected the sensitivity of the assay, that was lower in MCL compared to acute lymphoblastic leukemia and in line with multiple myeloma published results. ddPCR had a good concordance with RQ-PCR and it might help to identify false positive/negative results. From a clinical perspective, we suggest that IGK-Kde can be a candidate target for MRD monitoring and deserves a validation of its predictive value in prospective MCL series.
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Affiliation(s)
- Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Lucia Anna De Novi
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Marzia Cavalli
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Noemi Novelli
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Roberta Soscia
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Elisa Genuardi
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Barbara Mantoan
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Daniela Drandi
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Martina Ferrante
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Luigia Monitillo
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Daniela Barbero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Elena Ciabatti
- Division of Hematology, Department of Oncology, Santa Chiara Hospital, Pisa, Italy
| | - Susanna Grassi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano, Italy
| | - Massimo Degan
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano, Italy
| | - Sara Galimberti
- Division of Hematology, Department of Oncology, Santa Chiara Hospital, Pisa, Italy
| | - Alice Di Rocco
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Sergio Cortelazzo
- Hematology, Medical Oncology and Hematology Division, "Istituto Clinico Humanitas Gavazzeni", Bergamo, Italy
| | - Anna Guarini
- Department of Molecular Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Marco Ladetto
- Division of Hematology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy.,Division of Hematology, AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
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30
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Pulsoni A, Tosti ME, Ferrero S, Luminari S, Liberati AM, Cenfra N, Renzi D, Zanni M, Boccomini C, Ferreri AJ, Rattotti S, Zilioli VR, Bolis SAM, Grapulin L, Della Starza I, Ricardi U, Galimberti S, Ladetto M, Del Giudice I, Foà R. “Miro” Study, a FIL multicenter phase II trial combining local radiotherapy and MRD-driven immunotherapy in early-stage follicular lymphoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20073 Background: Early stage follicular lymphoma (FL) is usually managed with involved field radiotherapy (IFRT), allowing eradication of the disease in 40-50% of patients (pts). The aim of this multicenter phase II prospective study was to evaluate the role of minimal residual disease (MRD) in identifying pts unlikely to be cured by IFRT, for whom an immunotherapy-based consolidation could improve outcome. Methods: 110 pts with stage I/II FL were enrolled and treated with 24 Gy IFRT. Peripheral blood (PB) and bone marrow (BM) samples were centralized to the FIL (Federazione Italiani Linfomi) MRD Network of EuroMRD-certified laboratories. In BCL2/IGH+ pts at baseline, MRD was analyzed by nested PCR (NEST) and RQ-PCR (RQ) in BM and/or PB after IFRT and every 6 months over a 3-year period. Pts with positive MRD by both NEST and RQ in the BM and/or PB after IFRT or who became positive during the follow-up (FU) were treated with 8 weekly doses of the anti-CD20 MoAb ofatumumab (OFA). Primary objective: efficacy of immunotherapy in obtaining a negative MRD. Results: 49 of 106 pts were males. Median age was 55 y (29-83). 69% of pts had inguinal involvement. At baseline, 30% of pts had a BCL2/IGH rearrangement (30 MBR, 1 MBR and mcr, 1 mcr) in BM and/or PB; the concordance between compartments was 90%. All pts obtained a clinical response after IFRT, with persistence of BCL2/IGH+ cells in PB and/or BM in 60% of cases. MRD-positive pts, either after IFRT (n = 18) or in case of conversion to a positive signal during the FU (n = 7), received OFA, obtaining a conversion to MRD negativity, in 20/22 cases (91% - CI 65.1-97.1), significantly superior to the expected 50%. After a median FU of 25 months, all but 2 pts who achieved a negative MRD with OFA are still negative. A clinical relapse or progression was observed in 17 pts: 13 (18%) among the 73 “no marker” pts; 2 relapses (16%) were observed among the 12 MRD-negative pts after IFRT and 2 among the 25 treated with OFA (8%), 1 having achieved a MRD negativity and 1 not. No significant differences in PFS have so far been observed between the three groups. Conclusions: In early stage FL RT alone is often insufficient to eradicate the disease, inducing a negative MRD only in 40% of pts, long-lasting only in half of them. The primary objective of this study - MRD negativity after immunotherapy - was achieved. The strategy of an immunotherapy consolidation after IFRT in MRD-positive pts allowed to increase molecular responses. A longer FU and further studies will allow to define the impact of this MRD-driven strategy also on clinical outcome. Clinical trial information: EudraCT number: 2012-001676-11 .
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Affiliation(s)
- Alessandro Pulsoni
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino/AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Stefano Luminari
- Hematology Unit, Arcispedale S. Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | | | - Natalia Cenfra
- Hematology Unit, S. Maria Goretti Hospital, AUSL Latina, Latina, Italy
| | - Daniela Renzi
- Hematology and Stem Cells Transplantation Unit, IRCCS Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | - Manuela Zanni
- Division of Hematology, SS. Antonio e Biagio Hospital, Alessandria, Italy
| | - Carola Boccomini
- Hematology Department, Città della Salute e della Scienza, Torino, Italy
| | | | - Sara Rattotti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Lavinia Grapulin
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University, Roma, Italy
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Umberto Ricardi
- Radiation Oncology, Department of Oncology, University of Turin, Torino, Italy
| | | | - Marco Ladetto
- Universita di Torino, Dip. di Medicina e Oncologia, Alessandria, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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31
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Affiliation(s)
- Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
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32
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Gentile M, Morabito F, Del Poeta G, Mauro FR, Reda G, Sportoletti P, Laurenti L, Coscia M, Herishanu Y, Recchia AG, Varettoni M, Murru R, Chiarenza A, Condoluci A, Moia R, Pietrasanta D, Loseto G, Consoli U, Scortechini I, Rossi FM, Zucchetto A, Fraticelli V, Vigna E, Botta C, Tripepi G, Arrigo GD, Rago A, Angeletti I, Biagi A, Del Giudice I, Bomben R, Rigolin GM, Rossi D, Di Raimondo F, Gaidano G, Polliack A, Cuneo A, Foà R, Gattei V. Survival risk score for real-life relapsed/refractory chronic lymphocytic leukemia patients receiving ibrutinib. A campus CLL study. Leukemia 2020; 35:235-238. [PMID: 32286543 DOI: 10.1038/s41375-020-0833-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Massimo Gentile
- Hematology Unit AO of Cosenza, Cosenza, Italy. .,Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy.
| | - Fortunato Morabito
- Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy.,Hematology Oncology Department, Augusta Victoria Hospital, East Jerusalem, Israel
| | - Giovanni Del Poeta
- Division of Hematology, S. Eugenio Hospital and University of Tor Vergata, Rome, Italy
| | - Francesca Romana Mauro
- Division of Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Gianluigi Reda
- Division of Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato-Oncologica (CREO), University of Perugia, Perugia, Italy
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di Roma, Roma, Italy
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Yair Herishanu
- Sourasky Medical Center, Institute of Hematology, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Marzia Varettoni
- Division of Haematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, Cagliari, Italy
| | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Adalgisa Condoluci
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Daniela Pietrasanta
- Division of Hematology, Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Ugo Consoli
- Department of Hematology, G. Garibaldi Hospital, Catania, Italy
| | | | - Francesca Maria Rossi
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, (PN), Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, (PN), Italy
| | - Vincenzo Fraticelli
- Hematology Unit AO of Cosenza, Cosenza, Italy.,Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy
| | - Ernesto Vigna
- Hematology Unit AO of Cosenza, Cosenza, Italy.,Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy
| | - Cirino Botta
- Hematology Unit AO of Cosenza, Cosenza, Italy.,Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy
| | - Giovanni Tripepi
- CNR-IFC, Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | | | | | - Ilaria Angeletti
- Reparto di Oncoematologia Azienda Ospedaliera Santa Maria di Terni, Terni, Italy
| | - Annalisa Biagi
- Division of Hematology, S. Eugenio Hospital and University of Tor Vergata, Rome, Italy
| | - Ilaria Del Giudice
- Division of Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, (PN), Italy
| | - Gian Matteo Rigolin
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Davide Rossi
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Aaron Polliack
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Robin Foà
- Division of Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, (PN), Italy.
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33
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Raponi S, Ilari C, Della Starza I, Cappelli LV, Cafforio L, Piciocchi A, Arena V, Mariglia P, Mauro FR, Gentile M, Cutrona G, Moia R, Favini C, Morabito F, Rossi D, Gaidano G, Guarini A, Del Giudice I, Foà R. Redefining the prognostic likelihood of chronic lymphocytic leukaemia patients with borderline percentage of immunoglobulin variable heavy chain region mutations. Br J Haematol 2020; 189:853-859. [PMID: 32064595 DOI: 10.1111/bjh.16434] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/02/2019] [Accepted: 11/19/2019] [Indexed: 01/03/2023]
Abstract
In chronic lymphocytic leukaemia (CLL), caution is warranted regarding the clinical implications of immunoglobulin variable heavy chain region (IGHV) rearrangements with a 'borderline' (BL) percentage of mutations (i.e. 97-97·9% IGHV identity). We analysed the IGHV mutational status in 759 untreated CLL patients (cohort 1). BL-CLL (n = 36, 5%) showed a time to first treatment (TFT) similar to that of M-CLL (n = 338) and significantly longer than that of UM-CLL (n = 385), despite the enrichment in subset #2 cases. In fact, CLLs belonging to subset #2 (n = 15/759, 2%) were significantly more frequent among BL-CLLs (n = 5/36, 14%), with a brief TFT. TFT of BL-CLL remained comparable to that of M-CLL also considering the 327 CLL patients evaluated at diagnosis. These findings were then validated in an independent cohort 2 of 759 newly diagnosed CLL patients (BL-CLL: n = 11, 1·4%) and in all newly diagnosed patients from cohorts 1 and 2 (n = 1 086, 84% stage A; BL-CLL: n = 47, 4·3%). BL-CLL at diagnosis showed a biological profile comparable to that of M-CLL with a low frequency of unfavourable prognostic markers, except for a significant enrichment in subset #2. Our data suggest that the prognosis of BL-CLL is good and similar to that of M-CLL, with the exception of subset #2 cases.
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Affiliation(s)
- Sara Raponi
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Caterina Ilari
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Luca V Cappelli
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Luciana Cafforio
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Paola Mariglia
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesca R Mauro
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Massimo Gentile
- Haematology Unit, Department of Haemato-Oncology, Ospedale Annunziata, Cosenza, Italy.,Aprigliano, Biotechnology Research Unit, Cosenza, Italy
| | - Giovanna Cutrona
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Riccardo Moia
- Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Chiara Favini
- Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Fortunato Morabito
- Aprigliano, Biotechnology Research Unit, Cosenza, Italy.,Haematology Department and Bone Marrow Transplant Unit, Cancer Care Center, Augusta Victoria Hospital, East Jerusalem, Israel
| | - Davide Rossi
- Department of Haematology, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Gianluca Gaidano
- Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Robin Foà
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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34
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Diop F, Moia R, Favini C, Spaccarotella E, De Paoli L, Bruscaggin A, Spina V, Terzi-di-Bergamo L, Arruga F, Tarantelli C, Deambrogi C, Rasi S, Adhinaveni R, Patriarca A, Favini S, Sagiraju S, Jabangwe C, Kodipad AA, Peroni D, Mauro FR, Giudice ID, Forconi F, Cortelezzi A, Zaja F, Bomben R, Rossi FM, Visco C, Chiarenza A, Rigolin GM, Marasca R, Coscia M, Perbellini O, Tedeschi A, Laurenti L, Motta M, Donaldson D, Weir P, Mills K, Thornton P, Lawless S, Bertoni F, Poeta GD, Cuneo A, Follenzi A, Gattei V, Boldorini RL, Catherwood M, Deaglio S, Foà R, Gaidano G, Rossi D. Biological and clinical implications of BIRC3 mutations in chronic lymphocytic leukemia. Haematologica 2020; 105:448-456. [PMID: 31371416 PMCID: PMC7012473 DOI: 10.3324/haematol.2019.219550] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/24/2019] [Indexed: 12/14/2022] Open
Abstract
BIRC3 is a recurrently mutated gene in chronic lymphocytic leukemia (CLL) but the functional implications of BIRC3 mutations are largely unexplored. Furthermore, little is known about the prognostic impact of BIRC3 mutations in CLL cohorts homogeneously treated with first-line fludarabine, cyclophosphamide, and rituximab (FCR). By immunoblotting analysis, we showed that the non-canonical nuclear factor-κB pathway is active in BIRC3-mutated cell lines and in primary CLL samples, as documented by the stabilization of MAP3K14 and by the nuclear localization of p52. In addition, BIRC3-mutated primary CLL cells are less sensitive to flu-darabine. In order to confirm in patients that BIRC3 mutations confer resistance to fludarabine-based chemoimmunotherapy, a retrospective multicenter cohort of 287 untreated patients receiving first-line FCR was analyzed by targeted next-generation sequencing of 24 recurrently mutated genes in CLL. By univariate analysis adjusted for multiple comparisons BIRC3 mutations identify a poor prognostic subgroup of patients in whom FCR treatment fails (median progression-free survival: 2.2 years, P<0.001) similar to cases harboring TP53 mutations (median progression-free survival: 2.6 years, P<0.0001). BIRC3 mutations maintained an independent association with an increased risk of progression with a hazard ratio of 2.8 (95% confidence interval 1.4-5.6, P=0.004) in multivariate analysis adjusted for TP53 mutation, 17p deletion and IGHV mutation status. If validated, BIRC3 mutations may be used as a new molecular predictor to select high-risk patients for novel frontline therapeutic approaches.
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Affiliation(s)
- Fary Diop
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Chiara Favini
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Elisa Spaccarotella
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Alessio Bruscaggin
- Institute of Oncology Research and Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Valeria Spina
- Institute of Oncology Research and Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Lodovico Terzi-di-Bergamo
- Institute of Oncology Research and Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Francesca Arruga
- Department of Medical Sciences, University of Turin & Italian Institute for Genomic Medicine, Turin, Italy
| | - Chiara Tarantelli
- Università della Svizzera Italiana, Institute of Oncology Research, Bellinzona, Switzerland
| | - Clara Deambrogi
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Silvia Rasi
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Ramesh Adhinaveni
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Simone Favini
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Sruthi Sagiraju
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Clive Jabangwe
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Ahad A Kodipad
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Denise Peroni
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Francesca R Mauro
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Francesco Forconi
- Cancer Sciences Unit, Southampton Cancer Research UK and National Institute for Health Research Experimental Cancer Medicine Centre, University of Southampton, Southampton, UK
- Division of Hematology, University of Siena, Siena, Italy
| | - Agostino Cortelezzi
- Department of Hematology Oncology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Francesco Zaja
- Clinica Ematologica, DAME, University of Udine, Udine, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Francesca Maria Rossi
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Carlo Visco
- Department of Cell Therapy and Hematology, Ospedale San Bortolo, Vicenza, Italy
| | - Annalisa Chiarenza
- Division of Hematology, Azienda Ospedaliera Universitaria Policlinico-OVE, Catania, Italy
| | - Gian Matteo Rigolin
- Hematology Section, Azienda Ospedaliero Universitaria Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Roberto Marasca
- Division of Hematology, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marta Coscia
- Division of Hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Omar Perbellini
- Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandra Tedeschi
- Department of Oncology/Haematology, Niguarda Cancer Center, Niguarda Ca Granda Hospital, Milan, Italy
| | - Luca Laurenti
- Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Marina Motta
- Department of Hematology, Spedali Civili, Brescia, Italy
| | - David Donaldson
- Clinical Haematology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Phil Weir
- Clinical Haematology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Ken Mills
- Centre for Cancer Research and Cell Biology (CCRCB), Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Sarah Lawless
- Clinical Haematology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Francesco Bertoni
- Università della Svizzera Italiana, Institute of Oncology Research, Bellinzona, Switzerland
| | | | - Antonio Cuneo
- Hematology Section, Azienda Ospedaliero Universitaria Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Antonia Follenzi
- Department of Health Sciences, University of Eastern Piedmont Amedeo Avogadro, Novara, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | | | - Mark Catherwood
- Clinical Haematology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Silvia Deaglio
- Department of Medical Sciences, University of Turin & Italian Institute for Genomic Medicine, Turin, Italy
| | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Davide Rossi
- Institute of Oncology Research and Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Giudice ID, Foà R. Response to Comment by Amato T. et al.. Haematologica 2019; 104:e541. [PMID: 31666346 DOI: 10.3324/haematol.2019.224303] [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: 11/09/2022] Open
Affiliation(s)
- Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Fazio F, Barberi W, Cazzaniga G, Fazio G, Messina M, Della Starza I, De Propris MS, Mancini F, Mohamed S, Del Giudice I, Chiaretti S, Moleti ML, Guarini A, Foà R, Testi AM. Efficacy of imatinib and chemotherapy in a pediatric patient with Philadelphia-like acute lymphoblastic leukemia with Ebf1-Pdgfrb fusion transcript. Leuk Lymphoma 2019; 61:469-472. [PMID: 31558067 DOI: 10.1080/10428194.2019.1668938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Francesca Fazio
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Walter Barberi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Gianni Cazzaniga
- Centro Ricerca Tettamanti, Pediatric Department, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Grazia Fazio
- Centro Ricerca Tettamanti, Pediatric Department, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Monica Messina
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | | | - Francesca Mancini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Sara Mohamed
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Sabina Chiaretti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maria Luisa Moleti
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Anna Maria Testi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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37
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Del Giudice I, Raponi S, Della Starza I, De Propris MS, Cavalli M, De Novi LA, Cappelli LV, Ilari C, Cafforio L, Guarini A, Foà R. Minimal Residual Disease in Chronic Lymphocytic Leukemia: A New Goal? Front Oncol 2019; 9:689. [PMID: 31555576 PMCID: PMC6727319 DOI: 10.3389/fonc.2019.00689] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 03/27/2019] [Accepted: 07/12/2019] [Indexed: 12/18/2022] Open
Abstract
In chronic lymphocytic leukemia (CLL), there is a growing interest for minimal residual disease (MRD) monitoring, due to the availability of drug combinations capable of unprecedented complete clinical responses. The standardized and most commonly applied methods to assess MRD in CLL are based on flow cytometry (FCM) and, to a lesser extent, real-time quantitative PCR (RQ-PCR) with allele-specific oligonucleotide (ASO) primers of immunoglobulin heavy chain genes (IgH). Promising results are being obtained using droplet digital PCR (ddPCR) and next generation sequencing (NGS)-based approaches, with some advantages and a potential higher sensitivity compared to the standardized methodologies. Plasma cell-free DNA can also be explored as a more precise measure of residual disease from all different compartments, including the lymph nodes. From a clinical point of view, CLL MRD quantification has proven an independent prognostic marker of progression-free survival (PFS) and overall survival (OS) after chemoimmunotherapy as well as after allogeneic transplantation. In the era of mechanism-driven drugs, the paradigms of CLL treatment are being revolutionized, challenging the use of chemoimmunotherapy even in first-line. The continuous administration of ibrutinib single agent has led to prolonged PFS and OS in relapsed/refractory and treatment naïve CLL, including those with TP53 deletion/mutation or unmutated IGHV genes, though the clinical responses are rarely complete. More recently, chemo-free combinations of venetoclax+rituximab, venetoclax+obinutuzumab or ibrutinib+venetoclax have been shown capable of inducing undetectable MRD in the bone marrow, opening the way to protocols exploring a MRD-based duration of treatment, aiming at disease eradication. Thus, beside a durable disease control desirable particularly for older patients and/or for those with comorbidities, a MRD-negative complete remission is becoming a realistic prospect for CLL patients in an attempt to obtain a long-lasting eradication and possibly cure of the disease. Here we discuss the standardized and innovative technical approaches for MRD detection in CLL, the clinical impact of MRD monitoring in chemoimmunotherapy and chemo-free trials and the future clinical implications of MRD monitoring in CLL patients outside of clinical trials.
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Affiliation(s)
- Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Sara Raponi
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.,GIMEMA Foundation, Rome, Italy
| | - Maria Stefania De Propris
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marzia Cavalli
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Lucia Anna De Novi
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Luca Vincenzo Cappelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Caterina Ilari
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Luciana Cafforio
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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38
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Della Starza I, Cavalli M, De Novi LA, Genuardi E, Mantoan B, Drandi D, Barbero D, Ciabatti E, Grassi S, Gazzola A, Mannu C, Agostinelli C, Piccaluga PP, Bomben R, Degan M, Gattei V, Guarini A, Foà R, Galimberti S, Ladetto M, Ferrero S, Del Giudice I. Minimal residual disease (MRD) in non‐Hodgkin lymphomas: Interlaboratory reproducibility on marrow samples with very low levels of disease within the FIL (Fondazione Italiana Linfomi) MRD Network. Hematol Oncol 2019; 37:368-374. [PMID: 31325190 DOI: 10.1002/hon.2652] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 01/08/2023]
Abstract
In 2009, the four laboratories of the Fondazione Italiana Linfomi (FIL) minimal residual disease (MRD) Network started a collaborative effort to harmonize and standardize their methodologies at the national level, performing quality control (QC) rounds for follicular lymphoma (FL) and mantle cell lymphoma (MCL) MRD assessment. In 16 QC rounds between 2010 and 2017, the four laboratories received 208 bone marrow (BM) samples (126 FL; 82 MCL); 187 were analyzed, according to the EuroMRD Consortium guidelines, by both nested (NEST) polymerase chain reaction (PCR) and real-time quantitative (RQ) PCR for BCL2/IGH MBR or IGHV rearrangements. Here, we aimed at analyzing the samples that challenged the interlaboratory reproducibility and data interpretation. Overall, 156/187 BM samples (83%) were concordantly classified as NEST+/RQ+ or NEST-/RQ- by all the four laboratories. The remaining 31 samples (17%) resulted alternatively positive and negative in the interlaboratory evaluations, independently of the method and the type of rearrangement, and were defined "borderline" (brd) samples: 12 proved NEST brd/RQ brd, 7 NEST-/RQ brd, 10 NEST brd/RQ positive not quantifiable (PNQ), and 2 NEST brd/RQ-. Results did not change even increasing the number of replicates/sample. In 6/31 brd samples, droplet digital PCR (ddPCR) was tested and showed no interlaboratory discordance. Despite the high interlaboratory reproducibility in the MRD analysis obtained and maintained by the QC round strategy, samples with the lowest MRD levels can still represent a challenge: 17% (31/187) of our samples showed discordant results in interlaboratory assessments, with 6.4% (12/187) remained brd even applying the two methods. Thus, although representing a minority, brd samples are still problematic, especially when a clinically oriented interpretation of MRD results is required. Alternative, novel methods such as ddPCR and next-generation sequencing have the potential to overcome the current limitations.
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Affiliation(s)
- Irene Della Starza
- Hematology, Department of Translational and Precision Medicine “Sapienza” University of Rome Rome Italy
| | - Marzia Cavalli
- Hematology, Department of Translational and Precision Medicine “Sapienza” University of Rome Rome Italy
| | - Lucia Anna De Novi
- Hematology, Department of Translational and Precision Medicine “Sapienza” University of Rome Rome Italy
| | - Elisa Genuardi
- Department of Molecular Biotechnologies and Health Sciences, Division of Hematology University of Torino Turin Italy
| | - Barbara Mantoan
- Department of Molecular Biotechnologies and Health Sciences, Division of Hematology University of Torino Turin Italy
| | - Daniela Drandi
- Department of Molecular Biotechnologies and Health Sciences, Division of Hematology University of Torino Turin Italy
| | - Daniela Barbero
- Department of Molecular Biotechnologies and Health Sciences, Division of Hematology University of Torino Turin Italy
| | - Elena Ciabatti
- Division of Hematology, Department of Oncology Santa Chiara Hospital Pisa Italy
| | - Susanna Grassi
- Department of Medical Biotechnologies University of Siena Siena Italy
| | - Anna Gazzola
- Hematopathology Section, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola‐Malpighi Hospital University of Bologna Bologna Italy
| | - Claudia Mannu
- Hematopathology Section, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola‐Malpighi Hospital University of Bologna Bologna Italy
| | - Claudio Agostinelli
- Hematopathology Section, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola‐Malpighi Hospital University of Bologna Bologna Italy
| | - Pier Paolo Piccaluga
- Hematopathology Section, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola‐Malpighi Hospital University of Bologna Bologna Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco‐Haematology Unit Centro di Riferimento Oncologico, I.R.C.C.S. Aviano Italy
| | - Massimo Degan
- Clinical and Experimental Onco‐Haematology Unit Centro di Riferimento Oncologico, I.R.C.C.S. Aviano Italy
| | - Valter Gattei
- Clinical and Experimental Onco‐Haematology Unit Centro di Riferimento Oncologico, I.R.C.C.S. Aviano Italy
| | - Anna Guarini
- Department of Molecular Medicine “Sapienza” University of Rome Rome Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine “Sapienza” University of Rome Rome Italy
| | - Sara Galimberti
- Division of Hematology, Department of Oncology Santa Chiara Hospital Pisa Italy
| | - Marco Ladetto
- Division of Hematology Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo Alessandria Italy
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Division of Hematology University of Torino Turin Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine “Sapienza” University of Rome Rome Italy
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Pulsoni A, Della Starza I, Cappelli LV, Tosti ME, Annechini G, Cavalli M, De Novi LA, D’Elia GM, Grapulin L, Guarini A, Del Giudice I, Foà R. Minimal residual disease monitoring in early stage follicular lymphoma can predict prognosis and drive treatment with rituximab after radiotherapy. Br J Haematol 2019; 188:249-258. [DOI: 10.1111/bjh.16125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/21/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Alessandro Pulsoni
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Irene Della Starza
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Luca V. Cappelli
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Maria E. Tosti
- National Centre for Global Health Istituto Superiore di Sanità RomeItaly
| | - Giorgia Annechini
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Marzia Cavalli
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Lucia A. De Novi
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Gianna M. D’Elia
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Lavinia Grapulin
- Department of Radiology and Radiotherapy Sapienza University RomeItaly
| | - Anna Guarini
- Department of Molecular Medicine Sapienza University Rome Italy
| | - Ilaria Del Giudice
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
| | - Robin Foà
- Haematology, Department of Translational and Precision Medicine Sapienza University RomeItaly
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40
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Guarini A, Peragine N, Messina M, Marinelli M, Ilari C, Cafforio L, Raponi S, Bonina S, Mariglia P, Mauro FR, Gaidano G, Del Giudice I, Foà R. Unravelling the suboptimal response of TP53-mutated chronic lymphocytic leukaemia to ibrutinib. Br J Haematol 2018; 184:392-396. [PMID: 30338509 DOI: 10.1111/bjh.15613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/17/2018] [Indexed: 12/31/2022]
Abstract
TP53-disrupted chronic lymphocytic leukaemia (CLL) patients show a suboptimal long-term response to ibrutinib. We hereby report that ibrutinib-induced in vitro apoptosis and proliferation inhibition were significantly lower in TP53-mutated (TP53-M) CLL cells compared to TP53 wild-type cells. Contrariwise, venetoclax effectively killed TP53-M cells. Gene expression profile analysis of TP53-M cells revealed a downmodulation of B-cell receptor (BCR)-related genes and an upmodulation of genes with anti-apoptotic/pro-survival activity, suggesting that the survival and proliferation of TP53-M cells are less dependent on the BCR pathway. These observations further support the use of drug combinations for the optimal management of TP53-M CLL patients.
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Affiliation(s)
- Anna Guarini
- Department of Molecular Medicine, "Sapienza" University, Rome, Italy
| | - Nadia Peragine
- Department of Cellular Biotechnologies and Haematology, "Sapienza" University, Rome, Italy
| | - Monica Messina
- Department of Cellular Biotechnologies and Haematology, "Sapienza" University, Rome, Italy
| | - Marilisa Marinelli
- Department of Cellular Biotechnologies and Haematology, "Sapienza" University, Rome, Italy
| | - Caterina Ilari
- Department of Cellular Biotechnologies and Haematology, "Sapienza" University, Rome, Italy
| | - Luciana Cafforio
- Department of Cellular Biotechnologies and Haematology, "Sapienza" University, Rome, Italy
| | - Sara Raponi
- Department of Cellular Biotechnologies and Haematology, "Sapienza" University, Rome, Italy
| | - Silvia Bonina
- Department of Cellular Biotechnologies and Haematology, "Sapienza" University, Rome, Italy
| | - Paola Mariglia
- Department of Cellular Biotechnologies and Haematology, "Sapienza" University, Rome, Italy
| | - Francesca R Mauro
- Department of Cellular Biotechnologies and Haematology, "Sapienza" University, Rome, Italy
| | - Gianluca Gaidano
- Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Ilaria Del Giudice
- Department of Cellular Biotechnologies and Haematology, "Sapienza" University, Rome, Italy
| | - Robin Foà
- Department of Cellular Biotechnologies and Haematology, "Sapienza" University, Rome, Italy
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41
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Raponi S, Del Giudice I, Ilari C, Cafforio L, Messina M, Cappelli LV, Bonina S, Piciocchi A, Marinelli M, Peragine N, Mariglia P, Mauro FR, Rigolin GM, Rossi F, Bomben R, Dal Bo M, Del Poeta G, Diop F, Favini C, Rossi D, Gaidano G, Cuneo A, Gattei V, Guarini A, Foá R. Biallelic BIRC3 inactivation in chronic lymphocytic leukaemia patients with 11q deletion identifies a subgroup with very aggressive disease. Br J Haematol 2018; 185:156-159. [PMID: 29785734 DOI: 10.1111/bjh.15405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sara Raponi
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Caterina Ilari
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Luciana Cafforio
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Monica Messina
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Luca V Cappelli
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Silvia Bonina
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | | | - Marilisa Marinelli
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Nadia Peragine
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Paola Mariglia
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Francesca R Mauro
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
| | - Gian M Rigolin
- Haematology Section, Azienda Ospedaliero Universitaria Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Francesca Rossi
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano, PN, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano, PN, Italy
| | - Michele Dal Bo
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano, PN, Italy
| | | | - Fary Diop
- Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Chiara Favini
- Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Davide Rossi
- Department of Haematology, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Gianluca Gaidano
- Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Antonio Cuneo
- Haematology Section, Azienda Ospedaliero Universitaria Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano, PN, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Robin Foá
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto 1, Sapienza University, Rome, Italy
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42
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Chan TSY, Lee YS, Del Giudice I, Marinelli M, Ilari C, Cafforio L, Guarini A, Tan D, Phipps C, Goh YT, Hwang W, Goh AZK, Siu LLP, Wu S, Ha CY, Lin SY, Kwok CH, Lau CK, Wong KF, Foà R, Kwong YL, Tse E. Clinicopathological features and outcome of chronic lymphocytic leukaemia in Chinese patients. Oncotarget 2018; 8:25455-25468. [PMID: 28424415 PMCID: PMC5421943 DOI: 10.18632/oncotarget.16037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/13/2017] [Indexed: 12/27/2022] Open
Abstract
Chronic lymphocytic leukaemia (CLL) is uncommon in Chinese population and its biology, genetics and treatment outcome in Chinese patients have not been comprehensively investigated. In this study, we studied the clinicopathological features and outcome of 212 Chinese patients with newly diagnosed CLL in Hong Kong and Singapore. The median age at diagnosis was 64 years. The majority of patients presented with early-stage disease (Binet stage A, 56.1%). Del(13)(q14) was the most frequent abnormality (41.7%) detected by fluorescence in situ hybridization (FISH) analysis. Del(17p) and TP53 gene mutations were detected in 7.8% and 8.2% of patients, respectively. MYD88 mutations were found at a higher frequency (11.5%) than expected. CLL with unmutated variable region of the immunoglobulin heavy chain genes (IGHV) occurred in only 31.2% of cases, and was associated with advanced-stage disease (p <0.01) and adverse FISH abnormalities (p<0.01). With a median follow-up of 39 months, the median overall survival (OS) was 108 months. The presence of del(17p) or TP53 mutations was associated with a significantly shorter time to first treatment and an inferior OS (p <0.01). Unmutated IGHV was also associated with a significantly shorter time to treatment (p <0.01). Among patients who required treatment, the median OS and progression-free survival (PFS) were 107 and 23 months, respectively. The presence of del(17p) was associated with a significantly inferior OS and PFS (p <0.01). In summary, Chinese CLL patients had similar genetic aberrations at diagnosis compared with those of Western populations. FISH abnormalities are major factors affecting outcome.
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Affiliation(s)
- Thomas Sau-Yan Chan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yuh-Shan Lee
- Department of Haematology, Singapore General Hospital, Outram, Singapore
| | - Ilaria Del Giudice
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Marilisa Marinelli
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Caterina Ilari
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Luciana Cafforio
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Daryl Tan
- Department of Haematology, Singapore General Hospital, Outram, Singapore
| | - Colin Phipps
- Department of Haematology, Singapore General Hospital, Outram, Singapore
| | - Yeow-Tee Goh
- Department of Haematology, Singapore General Hospital, Outram, Singapore
| | - William Hwang
- Department of Haematology, Singapore General Hospital, Outram, Singapore
| | - Allan Zhi-Kai Goh
- Department of Haematology, Singapore General Hospital, Outram, Singapore
| | | | - Saliangi Wu
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - Chun-Yin Ha
- Department of Medicine, Tuen Mun Hospital, Hong Kong, China
| | - Shek-Ying Lin
- Department of Medicine, United Christian Hospital, Hong Kong, China
| | - Chi-Hang Kwok
- Department of Medicine, Princess Margaret Hospital, Hong Kong, China
| | - Chi-Kuen Lau
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - Kit-Fai Wong
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong, China
| | - Robin Foà
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Yok-Lam Kwong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Eric Tse
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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De Luca G, Trasarti S, Bizzoni L, Del Giudice I, Della Starza I, De Propris MS, Gentile G, Mancini F, Mantovani S, Petrucci L, Tabanelli V, Guarini A, Vignetti M, Foà R. Lymphomatoid granulomatosis and large granular lymphocyte leukemia, a rare association of two lymphoproliferative disorders. Leuk Lymphoma 2018; 59:2715-2718. [PMID: 29473430 DOI: 10.1080/10428194.2018.1439583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Giulia De Luca
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Stefania Trasarti
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Luisa Bizzoni
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Ilaria Del Giudice
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Irene Della Starza
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Maria Stefania De Propris
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Giuseppe Gentile
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Francesca Mancini
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | | | - Luigi Petrucci
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | | | - Anna Guarini
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Marco Vignetti
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Robin Foà
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
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Marinelli M, Ilari C, Xia Y, Del Giudice I, Cafforio L, Della Starza I, Raponi S, Mariglia P, Bonina S, Yu Z, Yang W, Qiu L, Chan T, Piciocchi A, Kwong YL, Tse E, Li J, Guarini A, Xu W, Foà R. Immunoglobulin gene rearrangements in Chinese and Italian patients with chronic lymphocytic leukemia. Oncotarget 2018; 7:20520-31. [PMID: 26943037 PMCID: PMC4991472 DOI: 10.18632/oncotarget.7819] [Citation(s) in RCA: 28] [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: 12/22/2015] [Accepted: 02/16/2016] [Indexed: 01/12/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in the Western world, whereas in Asia the incidence is about 10 times lower. The basis for this ethnic and geographic variation is currently unknown. The aim of this study was to characterize IGHVDJ rearrangements and stereotype of the HCDR3 region in a series of 623 Chinese CLL, in order to identify possible differences in immunoglobulin gene usage and their potential pathogenetic implications. Chinese CLL were compared to 789 Italian CLL. Chinese patients showed a higher proportion of mutated IGHV and a more frequent usage of IGHV3-7, IGHV3-74, IGHV4-39 and IGHV4-59 genes. A significantly lower usage of IGHV1-69 and IGHV1-2 was documented, with comparable IGHV3-21 frequency (3% Chinese vs 3.8% Italian CLL). The proportion of known stereotyped receptors was significantly lower in Chinese (19.7%) than in Italian CLL (25.8%), despite a significantly higher frequency of subset #8 (p= 0.0001). Moreover, new paired clusters were identified among Chinese cases. Overall, these data support a potential different antigenic exposure between Eastern and Western CLL.
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Affiliation(s)
- Marilisa Marinelli
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy
| | - Caterina Ilari
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy
| | - Yi Xia
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Ilaria Del Giudice
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy
| | - Luciana Cafforio
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy
| | - Irene Della Starza
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy
| | - Sara Raponi
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy
| | - Paola Mariglia
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy
| | - Silvia Bonina
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy
| | - Zhen Yu
- Department of Lymphoma & Myeloma Institute of Hematology, CAMS & PUMC, Tianjin, China
| | - Wenjuan Yang
- Department of Lymphoma & Myeloma Institute of Hematology, CAMS & PUMC, Tianjin, China
| | - Lugui Qiu
- Department of Lymphoma & Myeloma Institute of Hematology, CAMS & PUMC, Tianjin, China
| | - Thomas Chan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | | | - Yok-Lam Kwong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Eric Tse
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Anna Guarini
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Robin Foà
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy
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45
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Cavalli M, De Novi LA, Della Starza I, Cappelli LV, Nunes V, Pulsoni A, Del Giudice I, Guarini A, Foà R. Comparative analysis between RQ-PCR and digital droplet PCR of BCL2/IGH gene rearrangement in the peripheral blood and bone marrow of early stage follicular lymphoma. Br J Haematol 2017; 177:588-596. [PMID: 28419517 DOI: 10.1111/bjh.14616] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/31/2016] [Indexed: 01/30/2023]
Abstract
BCL2/IGH rearrangements were analysed by polymerase chain reaction (PCR) at diagnosis in paired peripheral blood (PB) and bone marrow (BM) samples from 67 patients with stage I/II follicular lymphoma (FL). Real time quantitative PCR (RQ-PCR) and digital droplet PCR (ddPCR) were performed in cases with a major breakpoint region (MBR+) at diagnosis and after localized radiotherapy and rituximab administration in order to investigate the applicability of ddPCR. The overall ddPCR/RQ-PCR concordance was 81·9% (113/138 samples) and 97·5% in the 40/138 with quantifiable disease (RQ-PCR≥10-5 ). At baseline, ddPCR allowed the recovery of a MBR+ marker in 8/18 (44·4%) samples that resulted MBR-negative/minor cluster region-negative/minor BCL2-negative by qualitative PCR. Moreover, the tumour burden at diagnosis significantly predicted progression-free survival (PSF) only when quantified by ddPCR. Paired PB and BM samples analysis demonstrated a high concordance in the detection of BCL2/IGH+ cells by qualitative and quantitative methods; in particular, 40/62 samples were positive by ddPCR (25 PB+/BM+; 9 PB+/BM-; 6 PB-/BM+), with 34/40 (85%) identified by the study of PB only. In conclusion, in localized FL, ddPCR is a promising tool for monitoring minimal residual disease (MRD) that is at least comparable to RQ-PCR and potentially more accurate. PB is a suitable source for serial BCL2/IGH MRD assessments, regardless of the methodology utilized.
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Affiliation(s)
- Marzia Cavalli
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Lucia Anna De Novi
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Irene Della Starza
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Luca Vincenzo Cappelli
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Vittorio Nunes
- San Gerardo Hospital, Fondazione Matilde Tettamanti Menotti De Marchi Onlus, Monza, Italy
| | - Alessandro Pulsoni
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Anna Guarini
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto I, Sapienza University, Rome, Italy.,Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Haematology, Department of Cellular Biotechnologies and Haematology, Policlinico Umberto I, Sapienza University, Rome, Italy
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46
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Della Starza I, Nunes V, Cavalli M, De Novi LA, Ilari C, Apicella V, Vitale A, Testi AM, Del Giudice I, Chiaretti S, Foà R, Guarini A. Comparative analysis between RQ-PCR and digital-droplet-PCR of immunoglobulin/T-cell receptor gene rearrangements to monitor minimal residual disease in acute lymphoblastic leukaemia. Br J Haematol 2016; 174:541-9. [DOI: 10.1111/bjh.14082] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/06/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Irene Della Starza
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Vittorio Nunes
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Marzia Cavalli
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Lucia Anna De Novi
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Caterina Ilari
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Valerio Apicella
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Antonella Vitale
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Anna Maria Testi
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Ilaria Del Giudice
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Sabina Chiaretti
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Robin Foà
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Anna Guarini
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
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47
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Del Giudice I, Marinelli M, Wang J, Bonina S, Messina M, Chiaretti S, Ilari C, Cafforio L, Raponi S, Mauro FR, Di Maio V, De Propris MS, Nanni M, Ciardullo C, Rossi D, Gaidano G, Guarini A, Rabadan R, Foà R. Inter- and intra-patient clonal and subclonal heterogeneity of chronic lymphocytic leukaemia: evidences from circulating and lymph nodal compartments. Br J Haematol 2015; 172:371-383. [PMID: 26597680 DOI: 10.1111/bjh.13859] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 07/01/2015] [Accepted: 09/22/2015] [Indexed: 02/02/2023]
Abstract
Whole exome sequencing and copy number aberration (CNA) analysis were performed on cells taken from peripheral blood (PB) and lymph nodes (LN) of patients with chronic lymphocytic leukaemia (CLL). Of 64 non-silent somatic mutations, 54 (84·4%) were clonal in both compartments, 3 (4·7%) were PB-specific and 7 (10·9%) were LN-specific. Most of the LN- or PB-specific mutations were subclonal in the other corresponding compartment (variant frequency 0·5-5·3%). Of 41 CNAs, 27 (65·8%) were shared by both compartments and 7 (17·1%) were LN- or PB-specific. Overall, 6 of 9 cases (66·7%) showed genomic differences between the compartments. At subsequent relapse, Case 10, with 6 LN-specific lesions, and Case 100, with 6 LN-specific and 8 PB-specific lesions, showed, in the PB, the clonal expansion of LN-derived lesions with an adverse impact: SF3B1 mutation, BIRC3 deletion, del8(p23·3-p11·1), del9(p24·3-p13·1) and gain 2(p25·3-p14). CLL shows an intra-patient clonal heterogeneity according to the disease compartment, with both LN and PB-specific mutations/CNAs. The LN microenvironment might contribute to the clonal selection of unfavourable lesions, as LN-derived mutations/CNAs can appear in the PB at relapse.
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Affiliation(s)
- Ilaria Del Giudice
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Marilisa Marinelli
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Jiguang Wang
- Department of Biomedical Informatics, Center for Computational Biology and Bioinformatics, Columbia University, New York, US
| | - Silvia Bonina
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Monica Messina
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Sabina Chiaretti
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Caterina Ilari
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Luciana Cafforio
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Sara Raponi
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Francesca Romana Mauro
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Valeria Di Maio
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Maria Stefania De Propris
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Mauro Nanni
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Carmela Ciardullo
- Division of Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Davide Rossi
- Division of Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Anna Guarini
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
| | - Raul Rabadan
- Department of Biomedical Informatics, Center for Computational Biology and Bioinformatics, Columbia University, New York, US
| | - Robin Foà
- Division of Haematology, Department of Cellular Biotechnologies and Haematology, Sapienza University, Rome, Italy
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48
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Cavalli M, Ilari C, Del Giudice I, Marinelli M, Della Starza I, De Propris MS, De Novi LA, Nunes V, Cafforio L, Raponi S, Mancini F, Mauro FR, Tiacci E, Falini B, Guarini A, Foà R. A case of concomitant chronic lymphocytic leukaemia and hairy cell leukaemia evaluated forIGHV-D-Jrearrangements andBRAF-V600E mutation: lack of evidence for a common origin. Br J Haematol 2015; 174:329-31. [DOI: 10.1111/bjh.13770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Marzia Cavalli
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Caterina Ilari
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Ilaria Del Giudice
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Marilisa Marinelli
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Irene Della Starza
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | | | - Lucia Anna De Novi
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Vittorio Nunes
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Luciana Cafforio
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Sara Raponi
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Francesca Mancini
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Francesca Romana Mauro
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Enrico Tiacci
- Institute of Haematology and Centre for Haemato-Oncology Research (C.R.E.O.); University and Hospital of Perugia; Perugia Italy
| | - Brunangelo Falini
- Institute of Haematology and Centre for Haemato-Oncology Research (C.R.E.O.); University and Hospital of Perugia; Perugia Italy
| | - Anna Guarini
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
| | - Robin Foà
- Department of Cellular Biotechnologies and Haematology; “Sapienza” University of Rome; Rome Italy
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49
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Tavolaro S, Colombo T, Chiaretti S, Peragine N, Fulci V, Ricciardi MR, Messina M, Bonina S, Brugnoletti F, Marinelli M, Di Maio V, Mauro FR, Del Giudice I, Macino G, Foà R, Guarini A. Increased chronic lymphocytic leukemia proliferation upon IgM stimulation is sustained by the upregulation of miR-132 and miR-212. Genes Chromosomes Cancer 2015; 54:222-34. [PMID: 25645730 DOI: 10.1002/gcc.22236] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 12/25/2022] Open
Abstract
To assess the involvement of microRNAs (miRNAs) in B-cell receptor (BCR) stimulation, we first evaluated miRNA profiling following IgM cross-linking in chronic lymphocytic leukemia (CLL) cells and in normal B lymphocytes. Second, we combined miRNA and gene expression data to identify putative miRNA functional networks. miRNA profiling showed distinctive patterns of regulation after stimulation in leukemic versus normal B lymphocytes and identified a differential responsiveness to BCR engagement in CLL subgroups according to the immunoglobulin heavy chain variable region mutational status and clinical outcome. The most significantly modulated miRNAs in stimulated CLL are miR-132 and miR-212. Notably, these miRNAs appeared regulated in progressive but not in stable CLL. Accordingly, gene profiling showed a significant transcriptional response to stimulation exclusively in progressive CLL. Based on these findings, we combined miRNA and gene expression data to investigate miR-132 and miR-212 candidate interactions in this CLL subgroup. Correlation analysis pointed to a link between these miRNAs and RB/E2F and TP53 cascades with proproliferative effects, as corroborated by functional analyses. Finally, basal levels of miR-132 and miR-212 were measured in an independent cohort of 20 unstimulated CLL cases and both showed lower expression in progressive compared to stable patients, suggesting an association between the expression of these molecules and disease prognosis. Overall, our results support a model involving miR-132 and miR-212 upregulation in sustaining disease progression in CLL. These miRNAs may therefore provide new valuable strategies for therapeutic intervention.
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Affiliation(s)
- Simona Tavolaro
- Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy
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50
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Galimberti S, Luminari S, Ciabatti E, Grassi S, Guerrini F, Dondi A, Marcheselli L, Ladetto M, Piccaluga PP, Gazzola A, Mannu C, Monitillo L, Mantoan B, Del Giudice I, Della Starza I, Cavalli M, Arcaini L, Tucci A, Palumbo GA, Rigacci L, Pulsoni A, Vitolo U, Boccomini C, Vallisa D, Bertoldero G, Gaidano G, Musto P, Petrini M, Federico M. Minimal residual disease after conventional treatment significantly impacts on progression-free survival of patients with follicular lymphoma: the FIL FOLL05 trial. Clin Cancer Res 2014; 20:6398-405. [PMID: 25316810 DOI: 10.1158/1078-0432.ccr-14-0407] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The role of the minimal residual disease (MRD) in follicular lymphoma is still debated. In this study, we assessed whether the BCL2/IGH rearrangement could have a prognostic role in patients receiving R-CHOP, R-FM, or R-CVP. EXPERIMENTAL DESIGN DNAs from 415 patients among the 504 cases enrolled in the FOLL05 trial (NCT00774826) were centralized and assessed for the BCL2/IGH at diagnosis, at the end of treatment, and after 12 and 24 months. RESULTS At diagnosis, the molecular marker was detected in 53% of cases. Patients without molecular marker or with a low molecular tumor burden (<1 × 10(-4) copies) showed higher complete remission (CR) rate and longer progression-free survival (PFS; 3-year PFS 80% vs. 59%; P = 0.015). PFS was significantly conditioned by the PCR status at 12 and 24 months, with 3-year PFS of 66% for MRD(-) cases versus 41% for those MRD(+) at 12 months (P = 0.015), and 84% versus 50% at 24 months (P = 0.014). The MRD negativity at 12 and 24 months resulted in an improved PFS both in CR and in partial remission (PR) patients (3-year PFS = 72% for cases CR/PCR(-) vs. 32% for those CR/PCR(+) vs. 62% for those PR/PCR(-) and 25% for patients in PR/PCR(+); P = 0.001). The prognostic value of MRD at 12 and 24 months of follow-up was confirmed also in multivariate analysis. CONCLUSIONS In this study, standardized molecular techniques have been adopted and applied on bone marrow samples from a large cohort. Data reported show that the MRD detection is a powerful independent predictor of PFS in patients with follicular lymphoma receiving conventional chemoimmunotherapy.
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Affiliation(s)
- Sara Galimberti
- Department of Clinical and Experimental Medicine - University of Pisa, Pisa, Italy.
| | - Stefano Luminari
- Department of Diagnostic, Clinics and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Ciabatti
- Department of Clinical and Experimental Medicine - University of Pisa, Pisa, Italy. GenOMec School of University of Siena, Italy
| | - Susanna Grassi
- Department of Clinical and Experimental Medicine - University of Pisa, Pisa, Italy
| | - Francesca Guerrini
- Department of Clinical and Experimental Medicine - University of Pisa, Pisa, Italy
| | - Alessandra Dondi
- Department of Diagnostic, Clinics and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Marcheselli
- Department of Diagnostic, Clinics and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Pier Paolo Piccaluga
- Department of Experimental, Diagnostic, and Speciality Medicine, Bologna University, Bologna, Italy
| | - Anna Gazzola
- Department of Experimental, Diagnostic, and Speciality Medicine, Bologna University, Bologna, Italy
| | - Claudia Mannu
- Department of Experimental, Diagnostic, and Speciality Medicine, Bologna University, Bologna, Italy
| | | | | | - Ilaria Del Giudice
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Irene Della Starza
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Marzia Cavalli
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Luca Arcaini
- Department of Oncology and Hematology, IRCSS "San Matteo", University of Pavia, Italy
| | | | | | | | - Alessandro Pulsoni
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | | | | | | | - Gianluca Gaidano
- SCDU Hematology, Department of Translational Medicine, University of East Piedmont, Novara, Italy
| | - Pellegrino Musto
- Scientific Direction, IECCS, Referral Cancer Center of basilicata, Rionero In vulture (Pz), Italy
| | - Mario Petrini
- Department of Clinical and Experimental Medicine - University of Pisa, Pisa, Italy
| | - Massimo Federico
- Department of Diagnostic, Clinics and Public Health, University of Modena and Reggio Emilia, Modena, Italy
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