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Martino EA, Conticello C, Zamagni E, Pavone V, Palmieri S, Musso M, Tacchetti P, Mele A, Catalano L, Vigna E, Bruzzese A, Mendicino F, Botta C, Vincelli ID, Farina G, Barone M, Cangialosi C, Mancuso K, Rizziello I, Rocchi S, Falcone AP, Mele G, Reddiconto G, Garibaldi B, Iaccino E, Tripepi G, Gamberi B, Di Raimondo F, Musto P, Neri A, Cavo M, Morabito F, Gentile M. Carfilzomib combined with lenalidomide and dexamethasone (KRd) as salvage therapy for multiple myeloma patients: italian, multicenter, retrospective clinical experience with 600 cases outside of controlled clinical trials. Hematol Oncol 2022; 40:1009-1019. [PMID: 35638723 DOI: 10.1002/hon.3035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/23/2022] [Indexed: 12/13/2022]
Abstract
In combination with lenalidomide and dexamethasone (KRd), Carfilzomib has been approved for the treatment of relapsed and refractory multiple myeloma (RRMM) on ASPIRE trial. Efficacy and safety of the triplet are still the object of investigation by many groups to confirm ASPIRE results in the setting of RRMM treated in real-life who don't meet trial restrictive inclusion criteria. Therefore, we report a retrospective multicenter analysis of 600 RRMM patients treated with KRd between December 2015 and December 2018. The median age was 64 years (range 33-85), and the median number of previous therapies was two (range 1-11). After a median of 11 KRd cycles, the overall response rate was 79.9%. The median progression-free survival (PFS) was 22 months, and the 2-year probability of PFS was 47.6%. Creatinine clearance<30 ml/min, >1 line of previous therapy, and high-risk FISH were all associated with a poor prognosis in multivariate analysis. The median overall survival (OS) was 34.8 months; the 2-year probability of OS was 63.5%. At multivariate analysis, creatinine clearance<30 ml/min, >1 line of previous therapy, and high-risk FISH were significantly associated with poor prognosis. After a median follow-up of 16 months (range 1-50), 259 withdrew from therapy. The main discontinuation reason was progressive disease (81.8%). Seventy-four patients (12.3%) discontinued therapy for toxicity. The most frequent side effects were hematological (anemia 49.3%, neutropenia 42.7%, thrombocytopenia 42.5%) and cardiovascular (hypertension 14.5%, heart failure 2.5%, arrhythmias 3.6%). Our study confirms the safety and efficacy of KRd in the real-life setting of RRMM patients and encourages its use in clinical practice.
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Affiliation(s)
| | - Concetta Conticello
- Division of Hematology, Azienda Policlinico-OVE, University of Catania, Catania, Italy
| | - Elena Zamagni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Università di Bologna, Diagnostica e Sperimentale, Bologna, Italy
| | - Vincenzo Pavone
- Department of Hematology and Bone Marrow Transplant, Hospital Card. G. Panico, Tricase (LE), Italy
| | | | - Maurizio Musso
- Dipartimento Oncologico, U.O.C. OncoEmatologia e TMO, La Maddalena, Palermo, Italy
| | - Paola Tacchetti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Anna Mele
- Department of Hematology and Bone Marrow Transplant, Hospital Card. G. Panico, Tricase (LE), Italy
| | | | | | | | | | | | - Iolanda Donatella Vincelli
- Hematology Unit, Department of Hemato-Oncology and Radiotherapy, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Giuliana Farina
- UOC Ematologia a Indirizzo Oncologico, AORN "Sant'Anna e San Sebastiano", Caserta, Italy
| | | | - Clotilde Cangialosi
- U.O.C. Ematologia A. O. Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Katia Mancuso
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Ilaria Rizziello
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Università di Bologna, Diagnostica e Sperimentale, Bologna, Italy
| | - Serena Rocchi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Università di Bologna, Diagnostica e Sperimentale, Bologna, Italy
| | - Antonietta Pia Falcone
- Department of Hematology and Bone Marrow Transplant, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Mele
- Department of Hematology, Hospital Perrino, Brindisi, Italy
| | | | - Bruno Garibaldi
- Division of Hematology, Azienda Policlinico-OVE, University of Catania, Catania, Italy
| | - Enrico Iaccino
- Department of Experimental and Clinical Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giovanni Tripepi
- Nephrology Center of National Research Institute of Biomedicine and Molecular Immunology, Reggio Calabria, Italy
| | - Barbara Gamberi
- Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Francesco Di Raimondo
- Division of Hematology, Azienda Policlinico-OVE, University of Catania, Catania, Italy
| | | | - Antonino Neri
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Università di Bologna, Diagnostica e Sperimentale, Bologna, Italy
| | - 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
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Iula R, De Novellis D, Trastulli F, Della Pepa R, Fontana R, Carobene A, Di Perna M, D’Ambrosio A, Romano M, Leone A, De Fazio L, Fiumarella A, Gaeta G, Marafioti V, Barbato S, Palmieri S, Rocco S, Serio B, Califano C, Pane F, Ferrara F, Giudice V, Selleri C, Catalano L. Efficacy and safety of belantamab-mafodotin in triple-refractory multiple myeloma patients: A multicentric real-life experience. Front Oncol 2022; 12:1026251. [PMID: 36457484 PMCID: PMC9705330 DOI: 10.3389/fonc.2022.1026251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/24/2022] [Indexed: 07/30/2023] Open
Abstract
Belantamab-mafodotin is an innovative and selective treatment for multi-refractory/relapsed multiple myeloma (MM) patients; however, available real-life experiences on efficacy and safety are limited. In this real-world multicentric retrospective study, we enrolled 28 MM patients treated in four Hematology units of Campania region, Italy, who received a median of six treatment lines prior to belantamab-mafodotin. The overall response rate (ORR) was 40% (complete remission, CR, 11%; very good partial remission, VGPR, 11%; and partial remission, PR, 18%), with a median progression-free survival (PFS) and overall survival (OS) of 3 and 8 months, respectively. One of the most frequent drug-related adverse events was keratopathy observed in nine (32%) patients, leading to therapy discontinuation in only three (11%) of them. Moreover, 22 out of 28 total patients who were treated with at least two administrations achieved an ORR of 50% (CR, 14%; VGPR, 14%; and PR, 22%) with a median PFS and OS of 5 and 11 months, respectively. In conclusion, our multicentric study confirmed efficacy and safety of belantamab-mafodotin in triple-refractory MM patients even in the real-life setting.
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Affiliation(s)
- Rossella Iula
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Danilo De Novellis
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Fabio Trastulli
- Hematology and Transplant Program, AORN “A. Cardarelli” Hospital, Naples, Italy
| | - Roberta Della Pepa
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Raffaele Fontana
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Angela Carobene
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Maria Di Perna
- Onco-Hematology Unit, “A. Tortora” Hospital, Pagani, Italy
| | - Alessandro D’Ambrosio
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Martina Romano
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Aldo Leone
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Laura De Fazio
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Alfonso Fiumarella
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Giuseppe Gaeta
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Violetta Marafioti
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Serafina Barbato
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Salvatore Palmieri
- Hematology and Transplant Program, AORN “A. Cardarelli” Hospital, Naples, Italy
| | - Stefano Rocco
- Hematology and Transplant Program, AORN “A. Cardarelli” Hospital, Naples, Italy
| | - Bianca Serio
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | | | - Fabrizio Pane
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Felicetto Ferrara
- Hematology and Transplant Program, AORN “A. Cardarelli” Hospital, Naples, Italy
| | - Valentina Giudice
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Carmine Selleri
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Lucio Catalano
- Hematology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
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3
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Morabito F, Zamagni E, Conticello C, Pavone V, Palmieri S, Bringhen S, Galli M, Mangiacavalli S, Derudas D, Rossi E, Ria R, Catalano L, Tacchetti P, Mele G, Vincelli ID, Martino EA, Vigna E, Bruzzese A, Mendicino F, Botta C, Mele A, Pantani L, Rocchi S, Garibaldi B, Cascavilla N, Ballanti S, Tripepi G, Frigeri F, Falcone AP, Cangialosi C, Reddiconto G, Farina G, Barone M, Rizzello I, Iaccino E, Mimmi S, Curci P, Gamberi B, Musto P, De Stefano V, Musso M, Petrucci MT, Offidani M, Di Raimondo F, Boccadoro M, Cavo M, Neri A, Gentile M. Survival Risk Scores for Real-Life Relapsed/Refractory Multiple Myeloma Patients Receiving Elotuzumab or Carfilzomib In Combination With Lenalidomide and Dexamethasone as Salvage Therapy: Analysis of 919 Cases Outside Clinical Trials. Front Oncol 2022; 12:890376. [PMID: 35924160 PMCID: PMC9341470 DOI: 10.3389/fonc.2022.890376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/17/2022] [Indexed: 11/20/2022] Open
Abstract
The present study aimed to develop two survival risk scores (RS) for overall survival (OS, SRSKRd/EloRd) and progression-free survival (PFS, PRSKRd/EloRd) in 919 relapsed/refractory multiple myeloma (RRMM) patients who received carfilzomib, lenalidomide, and dexamethasone (KRd)/elotuzumab, lenalidomide, and dexamethasone (EloRd). The median OS was 35.4 months, with no significant difference between the KRd arm versus the EloRd arm. In the multivariate analysis, advanced ISS (HR = 1.31; P = 0.025), interval diagnosis–therapy (HR = 1.46; P = 0.001), number of previous lines of therapies (HR = 1.96; P < 0.0001), older age (HR = 1.72; P < 0.0001), and prior lenalidomide exposure (HR = 1.30; P = 0.026) remained independently associated with death. The median PFS was 20.3 months, with no difference between the two strategies. The multivariate model identified a significant progression/death risk increase for ISS III (HR = 1.37; P = 0.002), >3 previous lines of therapies (HR = 1.67; P < 0.0001), older age (HR = 1.64; P < 0.0001), and prior lenalidomide exposure (HR = 1.35; P = 0.003). Three risk SRSKRd/EloRd categories were generated: low-risk (134 cases, 16.5%), intermediate-risk (467 cases, 57.3%), and high-risk categories (213 cases, 26.2%). The 1- and 2-year OS probability rates were 92.3% and 83.8% for the low-risk (HR = 1, reference category), 81.1% and 60.6% (HR = 2.73; P < 0.0001) for the intermediate-risk, and 65.5% and 42.5% (HR = 4.91; P < 0.0001) for the high-risk groups, respectively. Notably, unlike the low-risk group, which did not cross the median timeline, the OS median values were 36.6 and 18.6 months for the intermediate- and high-risk cases, respectively. Similarly, three PRSKRd/EloRd risk categories were engendered. Based on such grouping, 338 (41.5%) cases were allocated in the low-, 248 (30.5%) in the intermediate-, and 228 (28.0%) in the high-risk groups. The 1- and 2-year PFS probability rates were 71.4% and 54.5% for the low-risk (HR = 1, reference category), 68.9% and 43.7% (HR = 1.95; P < 0.0001) for the intermediate-risk, and 48.0% and 27.1% (HR = 3.73; P < 0.0001) for the high-risk groups, respectively. The PFS median values were 29.0, 21.0, and 11.7 months for the low-, intermediate-, and high-risk cases. This analysis showed 2.7- and 4.9-fold increased risk of death for the intermediate- and high-risk cases treated with KRd/EloRd as salvage therapy. The combined progression/death risks of the two categories were increased 1.3- and 2.2-fold compared to the low-risk group. In conclusion, SRSKRd/EloRd and PRSKRd/EloRd may represent accessible and globally applicable models in daily clinical practice and ultimately represent a prognostic tool for RRMM patients who received KRd or EloRd.
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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
- *Correspondence: Fortunato Morabito, ; Massimo Gentile, ; Antonino Neri,
| | - Elena Zamagni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Concetta Conticello
- Division of Hematology, Azienda Policlinico-S. Marco, University of Catania, Catania, Italy
| | - Vincenzo Pavone
- Department of Hematology and Bone Marrow Transplant, Hospital Card. G. Panico, Tricase, Italy
| | | | - Sara Bringhen
- Division of Hematology, AOU Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Monica Galli
- Hematology and Bone Marrow Transplant Unit, Azienda Socio-Sanitaria Territoriale-Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Mangiacavalli
- Hematology Division, Department of Hematology-Oncology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Elena Rossi
- Istituto di Ematologia, Università Cattolica, Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Roberto Ria
- Department of Biomedical Science, Internal Medicine “G. Baccelli”, Policlinico, University of Bari “Aldo Moro” Medical School, Bari, Italy
| | | | - Paola Tacchetti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
| | - Giuseppe Mele
- Department of Hematology, Hospital Perrino, Brindisi, Italy
| | - Iolanda Donatella Vincelli
- Hematology Unit, Department of Hemato-Oncology and Radiotherapy, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria, Italy
| | | | - Ernesto Vigna
- Department of Onco-Hematology, Hematology Unit AO of Cosenza, Cosenza, Italy
| | - Antonella Bruzzese
- Department of Onco-Hematology, Hematology Unit AO of Cosenza, Cosenza, Italy
| | - Francesco Mendicino
- Department of Onco-Hematology, Hematology Unit AO of Cosenza, Cosenza, Italy
| | - Cirino Botta
- Department of Onco-Hematology, Hematology Unit AO of Cosenza, Cosenza, Italy
| | - Anna Mele
- Department of Hematology and Bone Marrow Transplant, Hospital Card. G. Panico, Tricase, Italy
| | - Lucia Pantani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
| | - Serena Rocchi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Bruno Garibaldi
- Division of Hematology, Azienda Policlinico-S. Marco, University of Catania, Catania, Italy
| | - Nicola Cascavilla
- Department of Hematology and Bone Marrow Transplant, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Stelvio Ballanti
- Institute of Haematology and Stem Cell transplantation, Ospedale Santa Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Giovanni Tripepi
- Department of Internal Medicine, Nephrology Center of National Research Institute of Biomedicine and Molecular Immunology, Reggio Calabria, Italy
| | - Ferdinando Frigeri
- UOC Ematologia a Indirizzo Oncologico, AORN “Sant’Anna e San Sebastiano”, Caserta, Italy
| | - Antonetta Pia Falcone
- Department of Hematology and Bone Marrow Transplant, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Clotilde Cangialosi
- U.O.C. Ematologia A. O. Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | - Giuliana Farina
- UOC Ematologia a Indirizzo Oncologico, AORN “Sant’Anna e San Sebastiano”, Caserta, Italy
| | | | - Ilaria Rizzello
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Enrico Iaccino
- Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Selena Mimmi
- Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Paola Curci
- Department of Emergency and Organ Transplantation, “Aldo Moro” University School of Medicine and Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari, Italy
| | - Barbara Gamberi
- Division of Hematology, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Pellegrino Musto
- Department of Emergency and Organ Transplantation, “Aldo Moro” University School of Medicine and Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari, Italy
| | - Valerio De Stefano
- Istituto di Ematologia, Università Cattolica, Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Maurizio Musso
- U.O.C. OncoEmatologia e TMO, Dipartimento Oncologico, Palermo, Italy
| | - Maria Teresa Petrucci
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Roma, Italy
| | | | - Francesco Di Raimondo
- Division of Hematology, Azienda Policlinico-S. Marco, University of Catania, Catania, Italy
| | - Mario Boccadoro
- Division of Hematology, AOU Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Antonino Neri
- Scientific Directorate, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
- *Correspondence: Fortunato Morabito, ; Massimo Gentile, ; Antonino Neri,
| | - Massimo Gentile
- Department of Onco-Hematology, Hematology Unit AO of Cosenza, Cosenza, Italy
- *Correspondence: Fortunato Morabito, ; Massimo Gentile, ; Antonino Neri,
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Cerchione C, Nappi D, Catalano L, Ronconi S, Cangini D, Ceccolini M, Musuraca G, Martinelli G. Addition of carfilzomib as a third agent in lenalidomide-refractory multiple myeloma: Switching from doublet to triplet. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e20002] [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
e20002 Background: Carfilzomib is an epoxyketone proteasome inhibitor of second generation, proved to be effective and safe in relapsed and refractory Multiple Myeloma (rrMM), in combination with dexamethasone or lenalidomide and dexamethasone. In this retrospective observational trial, it has been evaluated efficacy and safety of carfilzomib, in combination with lenalidomide-dexamethasone (KRD) as salvage regimen in patients with rrMM, refractory to lenalidomide, where lenalidomide-based regimens have no proven efficacy. Methods: 41 patients (23 M/18 F), with rrMM, median age at diagnosis 63.7 years (r. 43-82), median age at start of treatment 67 years (r. 48-84) previously treated with several lines of treatments (median 3, r. 2-11), underwent to KRD regimen (ASPIRE trial schedule) for a median treatment cycles of 8 (r 2-18). ISS was equally distributed, and all patients had previously been treated with bortezomib and IMIDs, and were refractory to this agents. 61% (19/31) of them had undergone at least to a single ASCT. Results: According to IMWG criteria, after a median follow-up of 9 months (r. 2-18), ORR was 68,2% (28/41: 9 CR, 12 VGPR, 7 PR) with 5 progressive diseases (PD) and 8 patients in stable disease (SD): this can be considered as an impressive result in this subset of rrMM patients, refractory to lenalidomide. In particular, for 11 patients, KRD was, after having achieved at least a PR, a bridge to second/third autologous SCT. Median time to response was 1.3 months (r.1-4), median OS from diagnosis was 62 months (r. 9-170), median OS from start of Carfilzomib was 11 months (r. 2-18). Carfilzomib was well tolerated, with grade 2 anemia in 39%(16/41) of patients, successfully managed by ESAs, without necessity of blood transfusions; 29% (12/41) grade 3-4 neutropenia (pegfilgrastim in primary prophylaxis was given, no ospedalization was required, no septic shocks were observed); 34% (14/41) grade 2, 21% (9/41) grade 3 and 12% (5/41) grade 4 thrombocytopenia, without hemorrhagic events and transfusion-dependency. Moreover, it was observed pneumonia in 39% (16/41) of patients, treated by common antibiotic drugs and always solved. A cardiac monitoring was performed for all patients: hypertension (grade 2-3) in 34% (14/41) of patients; fatigue in 39% (16/31) of patients. Conclusions: Carfilzomib-Lenalidomide-Dexamethasone has shown significant efficacy in a particularly severe setting of patients, relapsed and refractory to all available therapeutic resources, also lenalidomide, and it could be considered as a bridge to a second autologous or allogenic SCT. Clinical trial information: A108.
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Affiliation(s)
- Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Davide Nappi
- Hematology-University Federico II, Naples, Italy
| | | | - Sonia Ronconi
- Hematology Unit-Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”-IRST IRCCS, Meldola (FC), Italy
| | | | - Michela Ceccolini
- Hematology Unit-Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”-IRST IRCCS, Meldola, Italy
| | - Gerardo Musuraca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Giovanni Martinelli
- Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” (IRST)IRCCS, Meldola, Italy
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Cerchione C, Catalano L, Nappi D, Ronconi S, Cangini D, Ceccolini M, Musuraca G, Martinelli G. Chemo or chemo-free regimens in heavily pretreated multiple myeloma? Role of bendamustine-bortezomib-dexamethasone (BVD) in NOVEL agents' era. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e20010] [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
e20010 Background: The treatment of heavily pretreated Multiple Myeloma continues to be considered as an important unmet clinical need. Bendamustine is an old bi-functional alkylating agent which has proved to be effective in relapsed, refractory and in new diagnosed Multiple Myeloma (MM). Thus, aiming to provide further insights in this field, also in novel agents’era, we present here a retrospective, real-life analysis of patients with relapsed/refractory MM (rrMM), who had received salvage therapy with bendamustine in combination with bortezomib and dexamethasone (BVD). Methods: 81 patients (44 M/37 F), with rrMM, median age at diagnosis 59.4 years (r. 36-82), median age at start of treatment 63.6 years (r.37-86) treated with several lines of treatments (median 6, r. 2-11), every refractory to all the drugs previously received (also Bortezomib), received BVD (B 90 mg/sqm days 1,2; V 1.3 mg/sqm days 1,4,8,11, D 20 mg days 1,2,4,5,8,9,11,12, Pegfilgrastim day +4) every 28 days, until progression. All patients had previously received bortezomib-based and IMIDs-based treatments, and 32% (26/81) had also received radiotherapy. 69% (56/81) had undergone single or double autologous and three (2%) allogeneic stem cell transplant. All patients were relapsed and refractory to last therapies received before BVD. Results: Bendamustine was well tolerated, with grade 3-4 transfusion-dependent anemia in 56% (46/81) of patients, and 43% (35/81) grade 3-4 neutropenia (no ospedalization was required, no septic shocks were observed). No severe extrahematologic toxicity was observed, only grade 1 gastrointestinal side effect (nausea), treated by common antiemetic drugs. According to IMWG, ORR was 63% (51/81: 7 CR, 18 VGPR, 15 PR, 11 MR) with 11 PD and 19 patients in SD, which can be considered as an impressive result in this subset of rrMM patients. In particular, for 11 patients, BVD was, after having achieved at least a PR, a bridge to second auSCT, and for two patients a bridge to alloSCT. Eight patients have surprisingly achieved a notable PR after failure of novel agents (i.e. Carfilzomib, Daratumumab and Pomalidomide). Median time to response was 1.3 months (r.1-3), median OS from diagnosis was 67.3 months (r.6-151), median OS from start of Bendamustine was 9.6 months (r.2-36). Conclusions: The triplet Bendamustine-Bortezomib-Dexamethasone has shown significant efficacy in a particularly severe setting of patients, relapsed and refractory to all available therapeutic resources, and, in particular cases, it could be considered as a bridge to a second autologous or allogenic SCT, also after failure of novel agents. Clinical trial information: A101.
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Affiliation(s)
| | | | - Davide Nappi
- Hematology-University Federico II, Naples, Italy
| | - Sonia Ronconi
- Hematology Unit-Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”-IRST IRCCS, Meldola (FC), Italy
| | | | - Michela Ceccolini
- Hematology Unit-Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”-IRST IRCCS, Meldola, Italy
| | - Gerardo Musuraca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Giovanni Martinelli
- Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” (IRST)IRCCS, Meldola, Italy
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6
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Morabito F, Zamagni E, Conticello C, Pavone V, Palmieri S, Bringhen S, Galli M, Mangiacavalli S, Derudas D, Rossi E, Ria R, Catalano L, Tacchetti P, Mele G, Donatella Vincelli I, Antonia Martino E, Vigna E, Botta C, Bruzzese A, Mele A, Pantani L, Rocchi S, Garibaldi B, Cascavilla N, Ballanti S, Tripepi G, Frigeri F, Pia Falcone A, Cangialosi C, Reddiconto G, Farina G, Barone M, Rizzello I, Musto P, De Stefano V, Musso M, Teresa Petrucci M, Offidani M, Neri A, Di Renzo N, Di Raimondo F, Boccadoro M, Cavo M, Gentile M. Adjusted comparison between elotuzumab and carfilzomib in combination with lenalidomide and dexamethasone as salvage therapy for multiple myeloma patients. Eur J Haematol 2021; 108:178-189. [PMID: 34716957 DOI: 10.1111/ejh.13723] [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: 06/08/2021] [Revised: 10/16/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
The lack of a randomized trial comparing carfilzomib (K) versus elotuzumab (Elo) associated with lenalidomide and dexamethasone (Rd) prompted us to assess the relative usefulness of one triplet over the other. Five independent retrospective cohorts of 883 relapsed/refractory multiple myeloma (RRMM) patients, including 300 EloRd and 583 KRd cases, outside clinical trials, entered this non-randomized comparison. KRd cohort accounted for a higher incidence of younger patients, cases with ≥3 lines of therapy, already exposed to lenalidomide, International Staging System (ISS) stage III, and abnormal lactic dehydrogenase (LDH) level compared with EloRd cohort. Moreover, cytogenetic risk categories, detected in roughly one-third of cases, were equally distributed between the two therapy arms. The probability of CR+VGPR response was significantly higher in KRd (n = 314, 53.9%) than in EloRd patients (n = 111, 37.0%). Likewise, the cumulative incidence function of CR+VGPR, taking into account the competitive risk of death, was significantly higher in KRd arm patients than those in the EloRd arm (p = .003). Moreover, KRd treatment significantly reduced the progression or death risk by 46% in an adjusted multivariate analysis (HR: 0.54, 95% CI 0.42-0.69, p < .0001). Finally, in an adjusted illness-progression/death model, the effect of KRd versus EloRd was of higher magnitude among those who achieved CR+VGPR (-39% hazard ratio reduction, p = .02) than among those who achieved < VGPR (-29% hazard ratio reduction, p = .007). With limitations characteristic to any retrospective analysis, this current clinical practice study's overall results demonstrated potential benefits of KRd therapy compared with EloRd. This observation may help the daily clinical practice.
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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
| | - Elena Zamagni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Concetta Conticello
- Division of Hematology, Azienda Policlinico-OVE, University of Catania, Catania, Italy
| | - Vincenzo Pavone
- Department of Hematology and Bone Marrow Transplant, Hospital Card. G. Panico, Tricase (LE), Italy
| | | | - Sara Bringhen
- Division of Hematology, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Monica Galli
- Hematology and Bone Marrow Transplant Unit, Azienda Socio-Sanitaria Territoriale-Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Mangiacavalli
- Hematology Division, Department of Hematology-Oncology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Elena Rossi
- Istituto di Ematologia, Università Cattolica, Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Roberto Ria
- Department of Biomedical Science, University of Bari "Aldo Moro" Medical School, Internal Medicine "G. Baccelli", Policlinico, Bari, Italy
| | | | - Paola Tacchetti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Giuseppe Mele
- Department of Hematology, Hospital Perrino, Brindisi, Italy
| | - Iolanda Donatella Vincelli
- Hematology Unit, Department of Hemato-Oncology and Radiotherapy, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | | | | | | | | | - Anna Mele
- Department of Hematology and Bone Marrow Transplant, Hospital Card. G. Panico, Tricase (LE), Italy
| | - Lucia Pantani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Serena Rocchi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Bruno Garibaldi
- Division of Hematology, Azienda Policlinico-OVE, University of Catania, Catania, Italy
| | - Nicola Cascavilla
- Department of Hematology and Bone Marrow Transplant, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Stelvio Ballanti
- Institute of Haematology and Stem Cell transplantation, Ospedale Santa Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Giovanni Tripepi
- Nephrology Center of National Research Institute of Biomedicine and Molecular Immunology, Reggio Calabria, Italy
| | - Ferdinando Frigeri
- UOC Ematologia a Indirizzo Oncologico, AORN "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Antonetta Pia Falcone
- Department of Hematology and Bone Marrow Transplant, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Clotilde Cangialosi
- U.O.C. Ematologia A. O. Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | - Giuliana Farina
- UOC Ematologia a Indirizzo Oncologico, AORN "Sant'Anna e San Sebastiano", Caserta, Italy
| | | | - Ilaria Rizzello
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | | | - Valerio De Stefano
- Istituto di Ematologia, Università Cattolica, Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Maurizio Musso
- U.O.C. OncoEmatologia e TMO, Dipartimento Oncologico, La Maddalena, Palermo, Italy
| | - Maria Teresa Petrucci
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | | | - Antonino Neri
- Hematology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Francesco Di Raimondo
- Division of Hematology, Azienda Policlinico-OVE, University of Catania, Catania, Italy
| | - Mario Boccadoro
- Division of Hematology, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
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7
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Tacchetti P, Pantani L, Patriarca F, Petrucci MT, Zamagni E, Dozza L, Galli M, Di Raimondo F, Crippa C, Boccadoro M, Barbato S, Tosi P, Narni F, Montefusco V, Testoni N, Spadano A, Terragna C, Pescosta N, Marzocchi G, Cellini C, Galieni P, Ronconi S, Gobbi M, Catalano L, Lazzaro A, De Sabbata G, Cangialosi C, Ciambelli F, Musto P, Elice F, Cavo M. Bortezomib, thalidomide, and dexamethasone followed by double autologous haematopoietic stem-cell transplantation for newly diagnosed multiple myeloma (GIMEMA-MMY-3006): long-term follow-up analysis of a randomised phase 3, open-label study. Lancet Haematol 2020; 7:e861-e873. [PMID: 33242443 DOI: 10.1016/s2352-3026(20)30323-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/03/2020] [Accepted: 09/16/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND The phase 3 GIMEMA-MMY-3006 trial, which compared bortezomib, thalidomide, and dexamethasone (VTD) combination therapy with thalidomide and dexamethasone (TD) as induction therapy before and consolidation therapy after double autologous haematopoietic stem-cell transplantation (HSCT) for newly diagnosed multiple myeloma, showed the superiority of the triplet regimen over the doublet in terms of increased complete response rate and improved progression-free survival. We report the results from the final analysis of the study. METHODS In this randomised, open-label, phase 3 study, patients aged 18-65 years with previously untreated symptomatic multiple myeloma and a Karnofsky Performance Status of 60% or higher were enrolled at 73 centres in Italy. Patients were randomised (1:1) by a web-based system to receive three 21-day cycles of thalidomide (100 mg daily orally for the first 14 days and 200 mg daily thereafter) plus dexamethasone (total 320 mg per cycle; 40 mg on days 1-2, 4-5, 8-9, and 11-12 in the VTD regimen, and 40 mg on days 1-4 and 9-12 in the TD regimen), either alone (TD group) or with bortezomib (1·3 mg/m2 intravenously on days 1, 4, 8, and 11; VTD group). After double autologous HSCT, patients received two 35-day cycles of either the VTD or TD regimen, according to random assignment, as consolidation therapy. The primary outcome was the rate of complete response and near complete response after induction (already reported). In this updated analysis we assessed long-term progression-free survival and overall survival (secondary endpoints of the study) with an extended 10-year median follow-up, and analysed the variables influencing survival. Analysis was by intention to treat. The study is registered with ClinicalTrials.gov, NCT01134484. FINDINGS Between May 10, 2006, and April 30, 2008, 480 patients were enrolled and randomly assigned to receive VTD (241 patients) or TD (239 patients). Six patients withdrew consent before start of treatment. 236 (99 [42%] women) in the VTD group and 238 (102 [43%] women) in the TD group were included in the intention-to-treat analysis. The data cutoff date for this analysis was May 31, 2018. Median follow-up for surviving patients was 124·1 months (IQR 117·2-131·7). The 10-year progression-free survival estimate for patients in the VTD group was 34% (95% CI 28-41) compared with 17% (13-23) for the TD group (hazard ratio [HR] 0·62 [95% CI 0·50-0·77]; p<0·0001). 60% (95% CI 54-67) of patients in the VTD group were alive at 10 years versus 46% (40-54) of patients in the TD group (HR 0·68 [95% CI 0·51-0·90]; p=0·0068). VTD was an independent predictor of improved progression-free survival (HR 0·60 [95% CI 0·48-0·76]; p<0·0001) and overall survival (HR 0·68 [0·50-0·91]; p=0·010). The incidence of second primary malignancies per 100 person-years was 0·87 (95% CI 0·49-1·44) in the VTD group compared with 1·41 (0·88-2·13) in the TD group. INTERPRETATION Incorporation of VTD into double autologous HSCT resulted in clinically meaningful improvements in long-term progression-free survival and overall survival, confirming that a regimen including bortezomib and an immunomodulatory drug is the gold standard treatment for patients with newly diagnosed myeloma who are fit for high-dose chemotherapy. FUNDING Seràgnoli Institute of Haematology, University of Bologna, and BolognAIL.
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Affiliation(s)
- Paola Tacchetti
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Lucia Pantani
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Francesca Patriarca
- Clinical Hematology and Bone Marrow Transplant Centre, S Maria della Misericordia University Hospital, DAME, University of Udine, Udine, Italy
| | - Maria Teresa Petrucci
- Hematology Unit, and Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Elena Zamagni
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Luca Dozza
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Monica Galli
- Hematology and Bone Marrow Transplant Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Di Raimondo
- Division of Hematology, Azienda Ospedaliero-Universitaria Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Claudia Crippa
- Unità Operativa Complessa di Ematologia, Spedali Civili Brescia, Brescia, Italy
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Cittàdella Salute e della Scienza, Turin, Italy
| | - Simona Barbato
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Patrizia Tosi
- Unità Operativa, Ematologia, Ospedale Infermi di Rimini, Rimini, Italy
| | - Franco Narni
- Programma Trapianti Cellule Staminali Emopoietiche, Università di Modena e Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Vittorio Montefusco
- Department of Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nicoletta Testoni
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Antonio Spadano
- Unità Operativa Complessa, Ematologia Clinica, Azienda Sanitaria Locale di Pescara, Pescara, Italy
| | - Carolina Terragna
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Norbert Pescosta
- Reparto di Ematologia e Centro Trapianto Midollo Osseo, Ospedale Centrale, Bolzano, Italy
| | - Giulia Marzocchi
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy
| | - Claudia Cellini
- Unità Operativa Complessa Ematologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Piero Galieni
- Unità Operativa Complessa Ematologia e Terapia cellulare, Ospedale Costanzo e Giacomo Mazzoni, Ascoli Piceno, Italy
| | - Sonia Ronconi
- IRCCS, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Marco Gobbi
- Dipartimento di Medicina interna, Clinica Ematologica, Policlinico Ospedale San Martino, Genoa, Italy
| | - Lucio Catalano
- Unità Operativa Ematologia, Azienda Ospedaliero-Universitaria Federico II, Napoli, Italy
| | - Antonio Lazzaro
- Division of Hematology and Bone Marrow Transplant Center, Department of Oncology-Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Giovanni De Sabbata
- Struttura Complessa Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Clotilde Cangialosi
- Divisione di Ematologia ad indirizzo oncologico con Trapianto, Azienda Ospedali Riuniti "Villa Sofia Cervello", Presidio Ospedaliero "V Cervello", Palermo, Italy
| | - Fabrizio Ciambelli
- Struttura Complessa di Ematologia, Azienda Socio Sanitaria Territoriale della Valle Olona, Busto Arsizio, Italy
| | - Pellegrino Musto
- "Aldo Moro" University School of Medicine, Unit of Hematology and Stem Cell Transplantation, AOUCPoliclinico, Bari, Italy; Unit of Hematology and Stem Cell Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Francesca Elice
- Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Michele Cavo
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero-Universitaria di Bologna, Università di Bologna, Bologna, Italy.
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8
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Cerchione C, Catalano L, Nappi D, Rocco S, Palmieri S, Pareto A, Pane F, Ferrara F, Martinelli G. Bendamustine-bortezomib-dexamethasone (BVD) in heavily pretreated multiple myeloma: old/new in novel agents’ era. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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9
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Cerchione C, Catalano L, Nappi D, Musuraca G, Lucchesi A, Ronconi S, Pane F, Martinelli G. Carfilzomib-lenalidomide-dexamethasone in the management of lenalidomide-refractory multiple myeloma. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.09.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Palmieri S, Rocco S, Vitagliano O, Catalano L, Cerchione C, Vincelli ID, Scopelliti A, Gentile M, Farina G, Barone M, Gagliardi A, Esposito D, Arcamone M, Amico V, Fontana R, Sementa A, Sica A, Svanera G, Pane F, Ferrara F. KRD (carfilzomib and lenalidomide plus dexamethasone) for the treatment of relapsed or refractory multiple myeloma in the real-life: a retrospective survey in 123 patients. Ann Hematol 2020; 99:2903-2909. [PMID: 32583088 DOI: 10.1007/s00277-020-04158-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
From April 2016, carfilzomib, in combination with lenalidomide and dexamethasone (KRD), became available for use in the daily practice in Italy for patients with relapsed or refractory multiple myeloma (RRMM). We performed a retrospective survey at 14 different institutions from Southern Italy in order to evaluate patient characteristics and treatment results from an unselected series of patients treated accordingly so far. One hundred and twenty-three consecutive patients were included, with a median of 2 previous lines of therapy (range 1-9) and a median age of 63 years (range 39-82). At the time of analysis, median number of courses administered is 11 (range 1-34), and all patients are evaluable for response. Overall response rate including complete remission, very good partial remission, and partial remission is 85%. After a median follow-up of 27 months, median overall and progression-free survival are 33 and 23 months, respectively. Sixty-three patients are alive and between them, 45 (37%) are in continuous remission. Sixty patients have died (49%), mainly from progressive disease. There were 6 treatment-related deaths (5% of the whole patient population). Overall, hematological and non-hematological toxicity were manageable, mostly on outpatient basis. Arterial hypertension has been observed in 43 cases (35%) but did not lead to treatment interruption. Our data demonstrate that in real life, KRD is highly effective and well tolerated in the majority of patients with RRMM.
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Affiliation(s)
| | - S Rocco
- Hematology, "Cardarelli" Hospital, Naples, Italy
| | - O Vitagliano
- Hematology, "Cardarelli" Hospital, Naples, Italy
| | - L Catalano
- Hematology, AUOP "Federico II", Naples, Italy
| | - C Cerchione
- Hematology, AUOP "Federico II", Naples, Italy
| | - I D Vincelli
- Hematology Unit, "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - A Scopelliti
- Hematology Unit, "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - M Gentile
- Onco-Hematology, Hematology Unit, AO of Cosenza, Italy
| | - G Farina
- Onco-Hematology, "S. Anna e S. Sebastiano" Hospital, Caserta, Italy
| | - M Barone
- Onco-Hematology, "Tortora" Hospital, Pagani, SA, Italy
| | - A Gagliardi
- Hematology, "Santa Maria di Loreto Nuovo" Hospital, Naples, Italy
| | - D Esposito
- Hematology, "San Giuseppe Moscati" Hospital, Aversa, CE, Italy
| | - M Arcamone
- Hematology/Oncology and SCT Unit, National Cancer Institute, Fondazione "Pascale", Naples, Italy
| | - V Amico
- Hematology, "Rummo" Hospital, Benevento, Italy
| | - R Fontana
- Hematology, AOU "Ruggi d'Aragona", Salerno, Italy
| | - A Sementa
- Hematology and SCT Unit, "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - A Sica
- Onco-Hematology, AOU "Vanvitelli", Naples, Italy
| | - G Svanera
- Hematology, "San Giuliano" Hospital, Giugliano in Campania, Naples, Italy
| | - F Pane
- Hematology, AUOP "Federico II", Naples, Italy
| | - F Ferrara
- Hematology, "Cardarelli" Hospital, Naples, Italy
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Cerchione C, Catalano L, Nappi D, Pareto AE, Pane F, Martinelli G. Bendamustine-bortezomib-dexamethasone (BVD) in heavily pretreated multiple myeloma: Old/new in novel agents' era. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20517] [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
e20517 Background: Bendamustine is a bifunctional alkylating agent, with low toxicity, proved to be effective in relapsed, refractory and in new diagnosed Multiple Myeloma (MM). In this retrospective study, It has been evaluated efficacy and tolerance of Bendamustine, in combination with bortezomib-dexamethasone (BVD) in patients with relapsed and refractory MM (rrMM), whose prognosis is particularly severe. A retrospective real-life analysis of patients with rrMM who had been treated with BVD as salvage therapy has been performed. Methods: 56 patients (31 M/25 F), with rrMM, median age at diagnosis 57.3 years (r. 36-82), median age at start of treatment 61.8 years (r.37-83) treated with several lines of treatments (median 6, r. 2-11), every refractory to all the drugs previously received (also Bortezomib), received BVD (B 90 mg/sqm days 1,2; V 1.3 mg/sqm days 1,4,8,11, D 20 mg days 1,2,4,5,8,9,11,12, Pegfilgrastim day +4) every 28 days, until progression. All patients had previously been treated with schedule containing bortezomib and IMIDs, and 30% had also received radiotherapy. 67%of them had undergone at least to a single auSCT. All patients were relapsed and refractory to last therapies received before BVD. Results: Bendamustine was well tolerated, with grade 3 transfusion-dependent anemia in 41% of patients, and 37% grade 3 neutropenia (no ospedalization was required, no septic shocks were observed). No severe extrahematologic toxicity was observed, only grade 1 gastrointestinal side effect (nausea), treated by common antiemetic drugs. According to IMWG, after a median follow-up of 14 months (r.2-36), ORR was 64% (36/56: 4 CR, 7 VGPR, 16 PR, 9 MR) with 8 PD and 12 patients in SD, which can be considered as an impressive result in this subset of rrMM patients. In particular, for 11 patients, BVD was, after having achieved at least a PR, a bridge to second auSCT, and for two patients a bridge to alloSCT. Three patients have shown a notable PR after failure of novel agents (i.e. Carfilzomib and Pomalidomide). Median time to response was 1.2 months (r.1-3), median OS from diagnosis was 62.7 months (r.6-151), median OS from start of Bendamustine was 9.8 months (r.2-36). Conclusions: The triplet Bendamustine-Bortezomib-Dexamethasone has shown significant efficacy in a particularly severe setting of patients, relapsed and refractory to all available therapeutic resources, and, in particular cases, it could be considered as a bridge to a second autologous or allogenic SCT.
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Affiliation(s)
- Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Davide Nappi
- Hematology-University Federico II, Naples, Italy
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Cerchione C, Martinelli G, Nappi D, Pareto AE, Musuraca G, Lucchesi A, Pane F, Catalano L. Pegfilgrastim versus filgrastim in the supportive care of heavily pretreated multiple myeloma in treatment with pomalidomide-dexamethasone. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20514 Background: Pegfilgrastim is a pegylated long-acting recombinant form of G-CSF that extends the half-life and allows for once-per-cycle dosing, requiring less frequent dosing than nonpegylated G-CSF. The objective of this study was to compare the efficacy and safety of pegfilgrastim in patients affected by heavily pretreated MM, treated with pomalidomide-dexamethasone, in order to determine whether a single subcutaneous injection of pegfilgrastim is as effective as daily injections of standard filgrastim, in terms of haematological toxicity, febrile neutropenic episodes, antibiotic usage and hospedalization duration. Methods: We enrolled 57 patients (31 M, 26 F) median age at diagnosis 69 years (r. 52-84), and median age at start of treatment 76 years (r.56-90) treated with several lines of treatments (median 7, r. 2-12), every refractory to all the drugs previously received, received Pomalidomide-Dexamethasone (P 4 mg for 21 days, D 40 mg days 1,8,15,22, pegfilgrastim day +8) every 28 days, until progression. Results: Since first course, received in domestic setting, with a very good compliance, patients performed blood counts once weekly and received, day +8 to day +19, prophylactic oral chinolonic antibiotics and anti-fungal drugs. During neutropenia after first cycle, Filgrastim (5 μgr/kg/day for 3 d) was given if neutrophils count was < 1500 x 10^9 cells/L. Median number of filgrastim administrations was 4.6 (r. 3-6); nadir neutropenia was registered after a median of 10.4 days (r. 7-14); median of nadir neutrophil count was 1.13 x 10^9 cells/L (r.0.3–1.5), with maximum duration of 14 days. From the second course, all patients switched to pegfilgrastim (6 mg), injected subcutaneously with a single administration on day +3 independently from the neutrophil count at that time. During pegfilgrastim, neutropenia was never longer than 8 days, with a consequent reduction of neutropenia-related infections. Median nadir neutrophil count, evaluated for every patients for at least three courses of therapy (r. 3-6) registered at day +11, was 1.28 (r.0.9-2.2). Only 4 patients needed a supplement of 3 administrations of filgrastim. Pegfilgrastim was well tolerated in all patients: main side effects were mild fever and bone pain (21.2%). Conclusions: In conclusions, in patients affected by heavily pretreated MM treated with pomalidomide-dexamethasone, pegfilgrastim seems to reduce the incidence of severe neutropenia and infections and may increase the possibility to maintain the scheduled time of treatment.
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Affiliation(s)
- Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Davide Nappi
- Hematology-University Federico II, Naples, Italy
| | | | - Gerardo Musuraca
- Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori, Meldola, Italy
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Cerchione C, Martinelli G, Pedatella S, De Nisco M, Pugliese N, Manfra M, Marra N, Ronconi S, De Giorgi U, Altini M, Simonetti G, Di Rorà AGL, Bravaccini S, Catalano L, Dora Iula V, Pagano F, Picardi M, Bolognese A, Pane F, Martinelli V. An 1H NMR study of the cytarabine degradation in clinical conditions to avoid drug waste, decrease therapy costs and improve patient compliance in acute leukemia. Anticancer Drugs 2020; 31:67-72. [PMID: 31633499 PMCID: PMC6903421 DOI: 10.1097/cad.0000000000000850] [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: 07/29/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 11/25/2022]
Abstract
Cytarabine, the 4-amino-1-(β-D-arabinofuranosyl)-2(1H)-pyrimidinone, (ARA-C) is an antimetabolite cytidine analogue used worldwide as key drug in the management of leukaemia. As specified in the manufacturers' instructions, once the components-sterile water and cytarabine powder-are unpackaged and mixed, the solution begins to degrade after 6 hours at room temperature and 12 hours at 4°C. To evaluate how to avoid wasting the drug in short-term, low-dose treatment regimens, the reconstituted samples, stored at 25°C and 4°C, were analyzed every day of the test week by reversed-phase HPLC and high-field NMR spectroscopy. All the samples remained unchanged for the entire week, which corresponds to the time required to administer the entire commercial drug package during low-dose therapeutic regimens. The drug solution was stored in a glass container at 4°C in an ordinary freezer and drawn with sterile plastic syringes; during this period, no bacterial or fungal contamination was observed. Our findings show that an cytarabine solution prepared and stored in the original vials retains its efficacy and safety and can, therefore, be divided into small doses to be administered over more days, thus avoiding unnecessary expensive and harmful waste of the drug preparation. Moreover, patients who require daily administration of the drug could undergo the infusion at home without need to go to hospital. The stability of the aliquots would help decrease hospitalization costs.
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Affiliation(s)
- Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Giovanni Martinelli
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Silvana Pedatella
- Dipartimento di Scienze Chimiche, Università di Napoli Federico II, Naples
| | - Mauro De Nisco
- Dipartimento di Scienze, Università della Basilicata, Potenza
| | - Novella Pugliese
- Hematology, Department of Clinical Medicine and Surgery, AOU Federico II, Naples
| | - Michele Manfra
- Dipartimento di Scienze, Università della Basilicata, Potenza
| | | | - Sonia Ronconi
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Mattia Altini
- Healthcare Administration, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Giorgia Simonetti
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | | | - Sara Bravaccini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Lucio Catalano
- Hematology, Department of Clinical Medicine and Surgery, AOU Federico II, Naples
| | - Vita Dora Iula
- Microbiologia Clinica, Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples
| | - Francesco Pagano
- Dipartimento di Farmacia, Università di Salerno, Fisciano, Italy
| | - Marco Picardi
- Hematology, Department of Clinical Medicine and Surgery, AOU Federico II, Naples
| | - Adele Bolognese
- Dipartimento di Scienze Chimiche, Università di Napoli Federico II, Naples
| | - Fabrizio Pane
- Hematology, Department of Clinical Medicine and Surgery, AOU Federico II, Naples
| | - Vincenzo Martinelli
- Hematology, Department of Clinical Medicine and Surgery, AOU Federico II, Naples
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Landi F, Barillaro C, Bellieni A, Brandi V, Carfì A, D'Angelo M, Fusco D, Landi G, Lo Monaco R, Martone AM, Marzetti E, Pagano F, Pais C, Russo A, Salini S, Tosato M, Tummolo A, Benvenuto F, Bramato G, Catalano L, Ciciarello F, Martis I, Rocchi S, Rota E, Salerno A, Tritto M, Sgadari A, Zuccalà G, Bernabei R. The New Challenge of Geriatrics: Saving Frail Older People from the SARS-COV-2 Pandemic Infection. J Nutr Health Aging 2020; 24:466-470. [PMID: 32346682 PMCID: PMC7118362 DOI: 10.1007/s12603-020-1356-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022]
Affiliation(s)
- F Landi
- Francesco Landi, MD, PhD, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Catholic University of the Sacred Heart, L.go F. Vito 8, Rome 00168, Italy, Phone: +39 (06) 5190028, e-mail:
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Cerchione C, Martinelli G, Nappi D, Pareto AE, Di Perna M, Ferrara K, Pane F, Catalano L. Carfilzomib-lenalidomide-dexamethasone in the management of lenalidomide-refractory multiple myeloma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e19522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
e19522 Background: Carfilzomib is an epoxyketone proteasome inhibitor of second generation, proved to be effective and safe in relapsed and refractory Multiple Myeloma (rrMM), in combination with dexamethasone or lenalidomide and dexamethasone. In this retrospective observational trial, it has been evaluated efficacy and safety of carfilzomib, in combination with lenalidomide-dexamethasone (KRD) as salvage regimen in patients with rrMM, refractory to lenalidomide, whose prognosis is particularly severe. Methods: 41 patients (23 M/18 F), with rrMM, median age at diagnosis 63.7 years (r. 43-82), median age at start of treatment 67 years (r. 48-84) previously treated with several lines of treatments (median 3, r. 2-11), underwent to KRD regimen (ASPIRE trial schedule) for a median treatment cycles of 8 (r 2-18). ISS was equally distributed, and all patients had previously been treated with bortezomib and IMIDs, and were refractory to this agents. 61% (19/31) of them had undergone at least to a single ASCT. Results: According to IMWG criteria, after a median follow-up of 9 months (r. 2-18), ORR was 68,2% (28/41: 9 CR, 12 VGPR, 7 PR) with 5 progressive diseases (PD) and 8 patients in stable disease (SD): this can be considered as an impressive result in this subset of rrMM patients, refractory to lenalidomide. In particular, for 11 patients, KRD was, after having achieved at least a PR, a bridge to second/third autologous SCT. Median time to response was 1.3 months (r.1-4), median OS from diagnosis was 62 months (r. 9-170), median OS from start of Carfilzomib was 11 months (r. 2-18). Carfilzomib was well tolerated, with grade 2 anemia in 39% (16/41) of patients, successfully managed by ESAs, without necessity of blood transfusions; 29% (12/41) grade 3-4 neutropenia (pegfilgrastim in primary prophylaxis was given, no ospedalization was required, no septic shocks were observed); 34% (14/41) grade 2, 21% (9/41) grade 3 and 12% (5/41) grade 4 thrombocytopenia, without hemorrhagic events and transfusion-dependency. Moreover, it was observed pneumonia in 39% (16/41) of patients, treated by common antibiotic drugs and always solved. A cardiac monitoring was performed for all patients: hypertension (grade 2-3) in 34% (14/41) of patients; fatigue in 39% (16/31) of patients. Conclusions: Carfilzomib-Lenalidomide-Dexamethasone has shown significant efficacy in a particularly severe setting of patients, relapsed and refractory to all available therapeutic resources, also lenalidomide, and it could be considered as a bridge to a second autologous or allogenic SCT.
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Affiliation(s)
- Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giovanni Martinelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Davide Nappi
- Hematology-University Federico II, Napoli, Italy
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Cerchione C, Martinelli G, Catalano L, Pugliese N, Della Pepa R, Gravetti A, Nappi D, Pane F, Martinelli V. Combined oral administration of analgesia and anxiolysis for pain associated with bone marrow aspiration and biopsy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
e18313 Background: Bone marrow aspiration and biopsy (BMAB) is a painful procedure, and the commonly adopted local infiltration anesthesia (LIA) with lidocaine is unable to relieve the pain during the most uncomfortable phases, or the anticipatory anxiety related to pain recalling thereafter. As there are no formal guidelines for adding a sedoanalgesic premedication before beginning the BMAB, many combinations have been adopted by several authors. Our randomized and patient blinded trial aimed to evaluate, as primary end point, the efficacy and safety of opioid and benzodiazepine agent combination plus LIA in patients who underwent BMAB for hematological malignancies. Two secondary end points were: 1) to define if patients who already underwent to BMAB without LIA prefer sedoanalgesia; 2) to demonstrate if sedoanalgesia can influence the quality of the biological specimen harvested. Methods: Patients were randomly assigned into two arms for receiving either placebo plus LIA (standard group, 48,6%) or oral fentanyl citrate 200 mcg + oral midazolam 5 mg in addition to LIA (combo-group, 51,4%) during BMAB. Pre-procedural anxiety and procedural pain were assessed according to the Numered Rating Scale (NRS: 0-10), dividing the time of the procedure into five intervals (T0, T1, T2a, T2b, and T3) and evaluating discomfort grade during each moment of procedure in both groups. Cognitive function was measured before and 30 minutes after the procedure. Possible side effects were recorded, as well as the adequacy of tissue samples harvested. A total number 116 patients were enrolled in the study. 9 patients did not meet inclusion criteria and were excluded. 52 patients were randomized and assigned to standard group and 55 to combo group. Results: At T2b and T3 (corresponding to the biopsy time and time after the biopsy, respectively) there was a significantly lower ( p< 0.05) perception of pain in the patients who received sedoanalgesia (combo-group) compared to those who did not (standard group). Moreover, 100 % of the patients in combo group who had previously undergone this procedure without premedication reported that they would prefer sedoanalgesia for the subsequent procedures. Conclusions: Administration of oral analgesia and anxiolysis is a safe and feasible option to be used in outpatient setting; sedoanalgesia is very effective in reducing pain during the biopsy and it diminishes the anticipatory anxiety related to a painful procedure. Patients should have the possibility to choose between local anesthesia alone or sedoanalgesia plus local anesthesia.
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Affiliation(s)
| | - Giovanni Martinelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | | | | | | | - Davide Nappi
- Hematology-University Federico II, Napoli, Italy
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Musto P, Simeon V, Cascavilla N, Falcone A, Petrucci MT, Cesini L, Di Raimondo F, Conticello C, Ria R, Catalano L, Salvatore D, Mastrullo L, Gagliardi A, Villani O, Pietrantuono G, D'Arena G, Mansueto G, Bringhen S, Genuardi M, Di Renzo N, Reddiconto G, Fragasso A, Caravita T, Scapicchio D, Marziano G, Boccadoro M, Mangiacavalli S, Corso A. Is re-challenge still an option as salvage therapy in multiple myeloma? The case of REal-life BOrtezomib re-Use as secoND treatment for relapsed patients exposed frontline to bortezomib-based therapies (the REBOUND Study). Ann Hematol 2018; 98:361-367. [PMID: 30353388 DOI: 10.1007/s00277-018-3524-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/14/2018] [Indexed: 12/15/2022]
Abstract
Therapeutic re-challenge is currently a debated issue in the field of multiple myeloma (MM), given the recent availability of several new drugs and combinations. However, very few specific evidences are available about bortezomib re-use at first relapse. This multicenter, observational, retrospective study enrolled 134 MM patients with significant response after bortezomib-based frontline regimens and who had received a first salvage treatment containing bortezomib at relapse. The overall response rate was 71%, including 40% partial responses, 24% very good partial responses, and 7% complete responses. Re-treatment was well-tolerated, with no significant new or unexpected toxicities observed. The median duration of second progression-free survival (PFS) was 15 months, while median PFS2 was 55 months. With a median follow-up of 56 months, overall survival was 94 months for the entire series, without significant differences between patients undergoing or not undergoing transplant procedures. This real-life survey indicates that re-treatment including bortezomib as a first salvage therapy could be still considered in MM patients achieving durable response after initial exposure to bortezomib.
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Affiliation(s)
- Pellegrino Musto
- Haematology and Stem Cell Transplantation Unit, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, PZ, Italy.
| | - Vittorio Simeon
- Department of Public, Clinical and Preventive Medicine, Medical Statistics Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Nicola Cascavilla
- Haematology and SCT Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
| | - Antonietta Falcone
- Haematology and SCT Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
| | - Maria Teresa Petrucci
- Haematology Unit, Department of Cellular Biotechnologies and Haematology, La Sapienza University, Rome, Italy
| | - Laura Cesini
- Haematology Unit, Department of Cellular Biotechnologies and Haematology, La Sapienza University, Rome, Italy
| | | | - Concetta Conticello
- Haematology Unit, Azienda Policlinico OVE, University of Catania, Catania, Italy
| | - Roberto Ria
- Internal Medicine and Clinical Oncology, AOU Policlinico Giovanni XXIII, University of Bari, Bari, Italy
| | - Lucio Catalano
- Haematology and SCT Unit, Federico II University, Naples, Italy
| | | | | | | | - Oreste Villani
- Haematology and Stem Cell Transplantation Unit, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, PZ, Italy
| | - Giuseppe Pietrantuono
- Haematology and Stem Cell Transplantation Unit, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, PZ, Italy
| | - Giovanni D'Arena
- Haematology and Stem Cell Transplantation Unit, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, PZ, Italy
| | - Giovanna Mansueto
- Haematology and Stem Cell Transplantation Unit, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, PZ, Italy
| | - Sara Bringhen
- Haematology Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Mariella Genuardi
- Haematology Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | | | | | | | | | - Daniele Scapicchio
- Management Control Unit, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, PZ, Italy
| | - Gioacchino Marziano
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, PZ, Italy
| | - Mario Boccadoro
- Haematology Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Silvia Mangiacavalli
- Haematology Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessandro Corso
- Haematology Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Ombrato A, Manzi AV, Palmieri D, Ferrara K, Catalano L, Savoia M. Multiple myeloma and macro creatine kinase type 1: the first case report. Clin Chem Lab Med 2018; 56:e239-e242. [PMID: 29652663 DOI: 10.1515/cclm-2018-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/09/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Angela Ombrato
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Valerio Manzi
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Daniela Palmieri
- Department of Laboratory Medicine, University of Naples Federico II, Naples, Italy
| | - Katia Ferrara
- Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Lucio Catalano
- Department of Clinical Medicine, University of Naples Federico II, Naples, Italy
| | - Marcella Savoia
- Department of Laboratory Medicine, University of Naples Federico II, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
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Cerchione C, Nappi D, Pareto AE, Di Perna M, Zacheo I, Picardi M, Pane F, Catalano L. Safety and comfort of domestic bortezomib injection in real-life experience. Support Care Cancer 2018; 26:3111-3116. [PMID: 29574618 DOI: 10.1007/s00520-018-4155-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/12/2018] [Indexed: 11/24/2022]
Abstract
Despite novel agents, multiple myeloma is still an incurable disease, especially for elderly and frail patients, who are difficult to manage for concomitant comorbidities as the therapeutic options are limited and the response to chemotherapy is often short. We report our evaluations upon safety and efficacy of domestic subcutaneous bortezomib in elderly and frail patients candidate to bortezomib-melphalan-prednisone (VMP) regimen. We confirmed that overall incidence of adverse events, including peripheral neuropathy, was low, and in no case required admission to emergency service, contributing to reduce the rate of therapy discontinuation. These results confirm the effectiveness and safety of subcutaneous bortezomib, in a real-life-experience, and define a new possibility of safe auto-administration in a comfortable domestic setting. We suggest that domestic treatment can significantly improve the quality of life of the patients, avoiding unnecessary transfer to the hospital without reducing treatment efficacy.
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Affiliation(s)
- Claudio Cerchione
- Hematology, Department of Clinical Medicine and Surgery, University Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Davide Nappi
- Hematology, Department of Clinical Medicine and Surgery, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Anna Emanuele Pareto
- Hematology, Department of Clinical Medicine and Surgery, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Maria Di Perna
- Hematology, Department of Clinical Medicine and Surgery, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Irene Zacheo
- Hematology, Department of Clinical Medicine and Surgery, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Marco Picardi
- Hematology, Department of Clinical Medicine and Surgery, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Fabrizio Pane
- Hematology, Department of Clinical Medicine and Surgery, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Lucio Catalano
- Hematology, Department of Clinical Medicine and Surgery, University Federico II, Via Pansini 5, 80131, Naples, Italy
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Cerchione C, Cerciello G, Avilia S, Della Pepa R, Pugliese N, Picardi M, Catalano L, Pane F. Management of iron overload in myelodysplastic syndromes: combined deferasirox and deferoxamine in a patient with liver disease. Blood Transfus 2018; 16:32-35. [PMID: 27893351 PMCID: PMC5770312 DOI: 10.2450/2016.0137-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/19/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Claudio Cerchione
- Correspondence: Claudio Cerchione Hematology, Azienda Ospedaliera Universitaria Federico II, Via Pansini 5, 80131 Naples, Italy, e-mail:
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Cantone E, Di Lullo AM, Marano L, Guadagno E, Mansueto G, Capriglione P, Catalano L, Iengo M. Strategy for the treatment and follow-up of sinonasal solitary extramedullary plasmacytoma: a case series. J Med Case Rep 2017; 11:219. [PMID: 28793931 PMCID: PMC5550939 DOI: 10.1186/s13256-017-1382-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 07/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extramedullary plasmacytoma is a rare neoplasm characterized by monoclonal proliferation of plasma cells outside bone marrow. It accounts for 4% of all non-epithelial sinonasal tumors. According to the literature, radiotherapy is the standard therapy for extramedullary plasmacytoma. However, the conversion rate of extramedullary plasmacytoma to multiple myeloma is reported to be between 11 and 33% over 10 years. The highest risk of conversion is reported during the first 2 years after diagnosis, but conversion has been noted up to 15 years after diagnosis. Once conversion to multiple myeloma is complete, less than 10% of patients will survive 10 years. CASE PRESENTATION We present three cases of sinonasal extramedullary plasmacytoma who underwent radiotherapy: a 61-year-old white man, a 60-year-old white man, and a 37-year-old white woman. We found long-term survival with stable disease in all three cases. CONCLUSIONS The management of solitary extramedullary plasmacytomas of the sinonasal tract is not well established yet. However, the possibility of recurrence and progression to multiple myeloma requires a thorough follow-up protocol. Due to the absence of a standardized protocol for these tumors, we tried to design a tailored long-term follow-up scheme.
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Affiliation(s)
- Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatologic Science, ENT Section, "Federico II" University of Naples-Italy, S. Pansini, 5, 80131, Naples, Italy
| | - Antonella Miriam Di Lullo
- Department of Neuroscience, Reproductive and Odontostomatologic Science, ENT Section, "Federico II" University of Naples-Italy, S. Pansini, 5, 80131, Naples, Italy. .,Università degli Studi di Napoli "Federico II", Via Pansini, 5, Naples, Italy.
| | - Luana Marano
- Department of Hematology, "Federico II" University of Naples-Italy, S. Pansini, 5, 80131, Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Pathology Section, "Federico II" University of Naples-Italy, S. Pansini, 5, 80131, Naples, Italy
| | - Gelsomina Mansueto
- Department of Advanced Biomedical Sciences, Pathology Section, "Federico II" University of Naples-Italy, S. Pansini, 5, 80131, Naples, Italy
| | - Pasquale Capriglione
- Department of Neuroscience, Reproductive and Odontostomatologic Science, ENT Section, "Federico II" University of Naples-Italy, S. Pansini, 5, 80131, Naples, Italy
| | - Lucio Catalano
- Department of Hematology, "Federico II" University of Naples-Italy, S. Pansini, 5, 80131, Naples, Italy
| | - Maurizio Iengo
- Department of Neuroscience, Reproductive and Odontostomatologic Science, ENT Section, "Federico II" University of Naples-Italy, S. Pansini, 5, 80131, Naples, Italy
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Dichiarante V, Tirotta I, Catalano L, Terraneo G, Raffaini G, Chierotti MR, Gobetto R, Baldelli Bombelli F, Metrangolo P. Superfluorinated and NIR-luminescent gold nanoclusters. Chem Commun (Camb) 2017; 53:621-624. [PMID: 27982144 DOI: 10.1039/c6cc09324h] [Citation(s) in RCA: 17] [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] [Indexed: 12/22/2022]
Abstract
A novel class of superfluorinated and NIR-luminescent gold nanoclusters were obtained starting from a branched thiol, bearing 27 equivalent 19F atoms per molecule. These unprecedented clusters combine in a unique nanosystem both NIR photoluminescence and 19F NMR properties, thus representing a promising multimodal platform for bioimaging applications.
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Affiliation(s)
- V Dichiarante
- Fondazione Centro Europeo Nanomedicina, Politecnico di Milano, Milan, Italy and Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
| | - I Tirotta
- Fondazione Centro Europeo Nanomedicina, Politecnico di Milano, Milan, Italy and Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy. and Center for Nano Science&Technology IIT@POLIMI (CNST), Milan, Italy
| | - L Catalano
- Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
| | - G Terraneo
- Fondazione Centro Europeo Nanomedicina, Politecnico di Milano, Milan, Italy and Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
| | - G Raffaini
- Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
| | - M R Chierotti
- Department of Chemistry and NIS, University of Turin, Italy
| | - R Gobetto
- Department of Chemistry and NIS, University of Turin, Italy
| | - F Baldelli Bombelli
- Fondazione Centro Europeo Nanomedicina, Politecnico di Milano, Milan, Italy and Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
| | - P Metrangolo
- Fondazione Centro Europeo Nanomedicina, Politecnico di Milano, Milan, Italy and Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy. and Center for Nano Science&Technology IIT@POLIMI (CNST), Milan, Italy and VTT-Technical Research Centre of Finland Ltd, Espoo, Finland
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Cantone E, Borzillo V, Di Lullo AM, Marano L, Guadagno E, Mansueto G, Di Franco R, Cammarota F, Catalano L, Muto P, Iengo M. Cyberknife® system: a new therapeutic strategy for sinonasal solitary extramedullary plasmacytomae. J BIOL REG HOMEOS AG 2017; 31:763-768. [PMID: 28958136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sino-nasal solitary extramedullary plasmacytoma (EMP) is a rare neoplasm with unpredictable progression to multiple myeloma. To improve the precision of irradiation delivery, preserving the healthy surrounding tissue and critical structures we used a CyberKnife® for the treatment of sinonasal solitary extramedullary plasmacytoma. We present the first case of sinonasal-EMP treated with CyberKnife®-stereotactic radiotherapy (SRT) with a complete remission without adverse events. Based on the post-therapeutic results and healthy tissue preservation, we believe that CyberKnife®-SRT represents a good therapeutic option for the treatment of sinonasal-EMP.
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Affiliation(s)
- E Cantone
- Department of Neuroscience, ENT Section; “Federico II” University of Naples, Italy
| | - V Borzillo
- Division of Radiotherapy, Istituto Nazionale Tumori Fondazione Pascale, Naples, Italy
| | - A M Di Lullo
- Department of Neuroscience, ENT Section; “Federico II” University of Naples, Italy
| | - L Marano
- Department of Hematology; “Federico II” University of Naples, Italy
| | - E Guadagno
- Department of Advanced Biomedical Sciences, Pathology Section; “Federico II” University of Naples, Italy
| | - G Mansueto
- Department of Advanced Biomedical Sciences, Pathology Section; “Federico II” University of Naples, Italy
| | - R Di Franco
- Division of Radiotherapy, Istituto Nazionale Tumori Fondazione Pascale, Naples, Italy
| | - F Cammarota
- Division of Radiotherapy, Istituto Nazionale Tumori Fondazione Pascale, Naples, Italy
| | - L Catalano
- Department of Hematology; “Federico II” University of Naples, Italy
| | - P Muto
- Division of Radiotherapy, Istituto Nazionale Tumori Fondazione Pascale, Naples, Italy
| | - M Iengo
- Department of Neuroscience, ENT Section; “Federico II” University of Naples, Italy
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Cerchione C, Nappi D, Di Perna M, Zacheo I, Migliaccio I, Salvatore D, Picardi M, Pane F, Catalano L. A case of efficacy of bendamustine in heavily pretreated multiple myeloma, refractory to pomalidomide. Clin Case Rep 2017; 5:505-507. [PMID: 28396778 PMCID: PMC5378832 DOI: 10.1002/ccr3.773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/19/2016] [Accepted: 10/25/2016] [Indexed: 11/23/2022] Open
Abstract
In this report, we would like to highlight the efficacy of bendamustine in a heavily pretreated patient, also refractory to pomalidomide. It is conceivable that different therapy combinations in heavily treated Multiple myeloma (MM) have to be explored, without “a priori” exclusion of ancient drugs, even after failure of the ultimate pharmacological options. In this report, we would like to highlight the efficacy of bendamustine in a heavily pretreated patient, also refractory to pomalidomide. It is conceivable that different therapy combinations in heavily treated Multiple myeloma (MM) have to be explored, without “a priori” exclusion of ancient drugs, even after failure of the ultimate pharmacological options.
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Affiliation(s)
- Claudio Cerchione
- Hematology Azienda Ospedaliera Universitaria Federico II Via Pansini 5 Naples 80131 Italy
| | - Davide Nappi
- Hematology Azienda Ospedaliera Universitaria Federico II Via Pansini 5 Naples 80131 Italy
| | - Maria Di Perna
- Hematology Azienda Ospedaliera Universitaria Federico II Via Pansini 5 Naples 80131 Italy
| | - Irene Zacheo
- Hematology Azienda Ospedaliera Universitaria Federico II Via Pansini 5 Naples 80131 Italy
| | - Ilaria Migliaccio
- Hematology Azienda Ospedaliera Universitaria Federico II Via Pansini 5 Naples 80131 Italy
| | - Dalila Salvatore
- Hematology Azienda Ospedaliera Universitaria Federico II Via Pansini 5 Naples 80131 Italy
| | - Marco Picardi
- Hematology Azienda Ospedaliera Universitaria Federico II Via Pansini 5 Naples 80131 Italy
| | - Fabrizio Pane
- Hematology Azienda Ospedaliera Universitaria Federico II Via Pansini 5 Naples 80131 Italy
| | - Lucio Catalano
- Hematology Azienda Ospedaliera Universitaria Federico II Via Pansini 5 Naples 80131 Italy
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Gay F, Oliva S, Petrucci MT, Montefusco V, Conticello C, Musto P, Catalano L, Evangelista A, Spada S, Campbell P, Ria R, Salvini M, Offidani M, Carella AM, Omedé P, Liberati AM, Troia R, Cafro AM, Malfitano A, Falcone AP, Caravita T, Patriarca F, Nagler A, Spencer A, Hajek R, Palumbo A, Boccadoro M. Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: a pooled analysis. Leukemia 2016; 31:1727-1734. [PMID: 28008174 DOI: 10.1038/leu.2016.381] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 12/22/2022]
Abstract
In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.
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Affiliation(s)
- F Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - S Oliva
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M T Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Roma, Roma, Italy
| | - V Montefusco
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - C Conticello
- Division of Hematology, Azienda Policlinico 'Vittorio Emanuele', University of Catania, Catania, Italy
| | - P Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Potenza, Italy
| | - L Catalano
- Hematology, Department of Clinical Medicine and Surgery, AOU Federico II, Napoli, Italy
| | - A Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - S Spada
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - P Campbell
- Haematology Department, Cancer Services, Barwon Health, Geelong, Australia
| | - R Ria
- Department of Biomedical Science, University of Bari 'Aldo Moro' Medical School, Internal Medicine 'G. Baccelli' Policlinico, Bari, Italy
| | - M Salvini
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Offidani
- Hematology Department, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - A M Carella
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Martino-Ist, Genova, Italy
| | - P Omedé
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Liberati
- Department of Oncohematology, AO S.Maria di Terni, Terni, Italy
| | - R Troia
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A M Cafro
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - A Malfitano
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - A P Falcone
- Division of Hematology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - T Caravita
- UOC Ematologia S. Eugenio ASL RM2 Roma, Roma, Italy
| | - F Patriarca
- Department of Hematology, Azienda Ospedaliera-Universitaria di Udine, DISM, Università di Udine, Udine, Italy
| | - A Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - A Spencer
- Department of Clinical Haematology, Alfred Health-Monash University, Melbourne, Australia
| | - R Hajek
- Blood Cancer Research Group, Department of Haematooncology, Faculty Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - A Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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Schiano-Lomoriello V, Galderisi M, Mele D, Esposito R, Cerciello G, Buonauro A, Della Pepa R, Picardi M, Catalano L, Trimarco B, Pane F. Longitudinal strain of left ventricular basal segments and E
/e
′ ratio differentiate primary cardiac amyloidosis at presentation from hypertensive hypertrophy: an automated function imaging study. Echocardiography 2016; 33:1335-43. [DOI: 10.1111/echo.13278] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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] Open
Affiliation(s)
| | | | - Donato Mele
- Department of Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | - Roberta Esposito
- Department of Clinical Medicine and Surgery; Federico II University Hospital; Naples Italy
| | - Giuseppe Cerciello
- Department of Clinical Medicine and Surgery; Federico II University Hospital; Naples Italy
| | - Agostino Buonauro
- Department of Clinical Medicine and Surgery; Federico II University Hospital; Naples Italy
| | - Roberta Della Pepa
- Department of Clinical Medicine and Surgery; Federico II University Hospital; Naples Italy
| | - Marco Picardi
- Department of Clinical Medicine and Surgery; Federico II University Hospital; Naples Italy
| | - Lucio Catalano
- Department of Clinical Medicine and Surgery; Federico II University Hospital; Naples Italy
| | - Bruno Trimarco
- Cardiology Department; University Hospital of Ferrara; Ferrara Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery; Federico II University Hospital; Naples Italy
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Cerchione C, Lucignano M, Pane F, Catalano L. Salvage therapy with pegylated liposomial doxorubicin-based regimen in relapsed/refractory multiple myeloma: comments to the article by Romano et al. Eur J Haematol 2015; 96:544. [PMID: 26589779 DOI: 10.1111/ejh.12705] [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: 11/29/2022]
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Gay F, Oliva S, Petrucci MT, Conticello C, Catalano L, Corradini P, Siniscalchi A, Magarotto V, Pour L, Carella A, Malfitano A, Petrò D, Evangelista A, Spada S, Pescosta N, Omedè P, Campbell P, Liberati AM, Offidani M, Ria R, Pulini S, Patriarca F, Hajek R, Spencer A, Boccadoro M, Palumbo A. Chemotherapy plus lenalidomide versus autologous transplantation, followed by lenalidomide plus prednisone versus lenalidomide maintenance, in patients with multiple myeloma: a randomised, multicentre, phase 3 trial. Lancet Oncol 2015; 16:1617-29. [PMID: 26596670 DOI: 10.1016/s1470-2045(15)00389-7] [Citation(s) in RCA: 238] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/04/2015] [Accepted: 10/01/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND High-dose melphalan plus autologous stem-cell transplantation (ASCT) is the standard approach in transplant-eligible patients with newly diagnosed myeloma. Our aims were to compare consolidation with high-dose melphalan plus ASCT versus chemotherapy (cyclophosphamide and dexamethasone) plus lenalidomide, and maintenance with lenalidomide plus prednisone versus lenalidomide alone. METHODS We did an open-label, randomised, multicentre, phase 3 study at 59 centres in Australia, Czech Republic, and Italy. We enrolled transplant-eligible patients with newly diagnosed myeloma aged 65 years or younger. Patients received a common induction with four 28-day cycles of lenalidomide (25 mg, days 1-21) and dexamethasone (40 mg, days 1, 8, 15, and 22) and subsequent chemotherapy with cyclophosphamide (3 g/m(2)) followed by granulocyte colony-stimulating factor for stem-cell mobilisation and collection. Using a 2 × 2 partial factorial design, we randomised patients to consolidation with either chemotherapy plus lenalidomide (six cycles of cyclophosphamide [300 mg/m(2), days 1, 8, and 15], dexamethasone [40 mg, days 1, 8, 15, and 22], and lenalidomide [25 mg, days 1-21]) or two courses of high-dose melphalan (200 mg/m(2)) and ASCT. We also randomised patients to maintenance with lenalidomide (10 mg, days 1-21) plus prednisone (50 mg, every other day) or lenalidomide alone. A simple randomisation sequence was used to assign patients at enrolment into one of the four groups (1:1:1:1 ratio), but the treatment allocation was disclosed only when the patient reached the end of the induction and confirmed their eligibility for consolidation. Both the patient and the treating clinician did not know the consolidation and maintenance arm until that time. The primary endpoint was progression-free survival assessed by intention-to-treat. The trial is ongoing and some patients are still receiving maintenance. This study is registered at ClinicalTrials.gov, number NCT01091831. FINDINGS 389 patients were enrolled between July 6, 2009, and May 6, 2011, with 256 eligible for consolidation (127 high-dose melphalan and ASCT and 129 chemotherapy plus lenalidomide) and 223 eligible for maintenance (117 lenalidomide plus prednisone and 106 lenalidomide alone). Median follow-up was 52·0 months (IQR 30·4-57·6). Progression-free survival during consolidation was significantly shorter with chemotherapy plus lenalidomide compared with high-dose melphalan and ASCT (median 28·6 months [95% CI 20·6-36·7] vs 43·3 months [33·2-52·2]; hazard ratio [HR] for the first 24 months 2·51, 95% CI 1·60-3·94; p<0·0001). Progression-free survival did not differ between maintenance treatments (median 37·5 months [95% CI 27·8-not evaluable] with lenalidomide plus prednisone vs 28·5 months [22·5-46·5] with lenalidomide alone; HR 0·84, 95% CI 0·59-1·20; p=0·34). Fewer grade 3 or 4 adverse events were recorded with chemotherapy plus lenalidomide than with high-dose melphalan and ASCT; the most frequent were haematological (34 [26%] of 129 patients vs 107 [84%] of 127 patients), gastrointestinal (six [5%] vs 25 [20%]), and infection (seven [5%] vs 24 [19%]). Haematological serious adverse events were reported in two (2%) patients assigned chemotherapy plus lenalidomide and no patients allocated high-dose melphalan and ASCT. Non-haematological serious adverse events were reported in 13 (10%) patients assigned chemotherapy plus lenalidomide and nine (7%) allocated high-dose melphalan and ASCT. During maintenance, adverse events did not differ between groups. The most frequent grade 3 or 4 adverse events were neutropenia (nine [8%] of 117 patients assigned lenalidomide plus prednisone vs 14 [13%] of 106 allocated lenalidomide alone), infection (eight [8%] vs five [5%]), and systemic toxicities (seven [6%] vs two [2%]). Non-haematological serious adverse events were reported in 13 (11%) patients assigned lenalidomide plus prednisone versus ten (9%) allocated lenalidomide alone. Four patients died because of adverse events, three from infections (two during induction and one during consolidation) and one because of cardiac toxic effects. INTERPRETATION Consolidation with high-dose melphalan and ASCT remains the preferred option in transplant-eligible patients with multiple myeloma, despite a better toxicity profile with chemotherapy plus lenalidomide. FUNDING Celgene.
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Affiliation(s)
- Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefania Oliva
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Maria Teresa Petrucci
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Concetta Conticello
- Divisione di Ematologia, Azienda Policlinico-OVE, Università di Catania, Catania, Italy
| | | | - Paolo Corradini
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Valeria Magarotto
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luděk Pour
- Department of Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | - Alessandra Malfitano
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Daniela Petrò
- Hematology Department, Niquarda Ca'Granda Hospital, Milan, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Turin, Italy
| | - Stefano Spada
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Norbert Pescosta
- Ematologia e Centro TMO Ospedale Centrale Bolzano, Bolzano, Italy
| | - Paola Omedè
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Philip Campbell
- Haematology Department, Cancer Services, Barwon Health, Geelong, VIC, Australia
| | | | | | - Roberto Ria
- University of Bari Aldo Moro Medical School, Department of Biomedical Science, Internal Medicine G Baccelli Policlinico, Bari, Italy
| | - Stefano Pulini
- Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, U O Ematologia Clinica, Ospedale Civile Spirito Santo, Pescara, Italy
| | | | - Roman Hajek
- Department of Haematooncology, University Hospital Ostrava and University of Ostrava, Ostrava, Czech Republic
| | - Andrew Spencer
- Department of Clinical Haematology, Alfred Health, Monash University, Melbourne, VIC, Australia
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
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Brioli A, Perrone G, Patriarca F, Pezzi A, Nobile F, Ballerini F, Motta MR, Ronconi S, Tacchetti P, Catalano L, Zannetti BA, Rizzi S, Volpe S, Zamagni E, Liberati AM, Mancuso K, Boccadoro M, Davies FE, Morgan GJ, Palumbo A, Cavo M. Successful mobilization of PBSCs predicts favorable outcomes in multiple myeloma patients treated with novel agents and autologous transplantation. Bone Marrow Transplant 2015; 50:673-8. [DOI: 10.1038/bmt.2014.322] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/29/2014] [Accepted: 12/02/2014] [Indexed: 01/08/2023]
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Cerchione C, Catalano L, Pareto AE, Picardi M, Pane F. Pegfilgrastim in primary prophylaxis of febrile neutropenia during chemotherapy of relapsed and refractory multiple myeloma: a real-life experience. Support Care Cancer 2014; 23:301-2. [PMID: 25341551 DOI: 10.1007/s00520-014-2490-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 10/17/2014] [Indexed: 11/26/2022]
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Palumbo A, Cavallo F, Gay F, Di Raimondo F, Ben Yehuda D, Petrucci MT, Pezzatti S, Caravita T, Cerrato C, Ribakovsky E, Genuardi M, Cafro A, Marcatti M, Catalano L, Offidani M, Carella AM, Zamagni E, Patriarca F, Musto P, Evangelista A, Ciccone G, Omedé P, Crippa C, Corradini P, Nagler A, Boccadoro M, Cavo M. Autologous transplantation and maintenance therapy in multiple myeloma. N Engl J Med 2014; 371:895-905. [PMID: 25184862 DOI: 10.1056/nejmoa1402888] [Citation(s) in RCA: 569] [Impact Index Per Article: 56.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND This open-label, randomized, phase 3 study compared melphalan at a dose of 200 mg per square meter of body-surface area plus autologous stem-cell transplantation with melphalan-prednisone-lenalidomide (MPR) and compared lenalidomide maintenance therapy with no maintenance therapy in patients with newly diagnosed multiple myeloma. METHODS We randomly assigned 273 patients 65 years of age or younger to high-dose melphalan plus stem-cell transplantation or MPR consolidation therapy after induction, and 251 patients to lenalidomide maintenance therapy or no maintenance therapy. The primary end point was progression-free survival. RESULTS The median follow-up period was 51.2 months. Both progression-free and overall survival were significantly longer with high-dose melphalan plus stem-cell transplantation than with MPR (median progression-free survival, 43.0 months vs. 22.4 months; hazard ratio for progression or death, 0.44; 95% confidence interval [CI], 0.32 to 0.61; P<0.001; and 4-year overall survival, 81.6% vs. 65.3%; hazard ratio for death, 0.55; 95% CI, 0.32 to 0.93; P=0.02). Median progression-free survival was significantly longer with lenalidomide maintenance than with no maintenance (41.9 months vs. 21.6 months; hazard ratio for progression or death, 0.47; 95% CI, 0.33 to 0.65; P<0.001), but 3-year overall survival was not significantly prolonged (88.0% vs. 79.2%; hazard ratio for death, 0.64; 95% CI, 0.36 to 1.15; P=0.14). Grade 3 or 4 neutropenia was significantly more frequent with high-dose melphalan than with MPR (94.3% vs. 51.5%), as were gastrointestinal adverse events (18.4% vs. 0%) and infections (16.3% vs. 0.8%); neutropenia and dermatologic toxic effects were more frequent with lenalidomide maintenance than with no maintenance (23.3% vs. 0% and 4.3% vs. 0%, respectively). CONCLUSIONS Consolidation therapy with high-dose melphalan plus stem-cell transplantation, as compared with MPR, significantly prolonged progression-free and overall survival among patients with multiple myeloma who were 65 years of age or younger. Lenalidomide maintenance, as compared with no maintenance, significantly prolonged progression-free survival. (Funded by Celgene; ClinicalTrials.gov number, NCT00551928.).
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Affiliation(s)
- Antonio Palumbo
- From the Myeloma Unit, Division of Hematology, University of Turin (A.P., F.C., F.G., C. Cerrato, M.G., P.O., M.B.), and Unit of Clinical Epidemiology and Centro di Referimento per l'Epidemiologia-Piemonte, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino (A.E., G.C.), Turin, Division of Hematology, Ospedale Ferrarotto, Azienda Policlinico-Ospedale Vittorio Emanuele, University of Catania, Catania (F.D.R.), Hematology, Sapienza University of Rome (M.T.P.), and Cattedra di Ematologia, Ospedale S. Eugenio-University Tor Vergata (T.C.), Rome, Divisione di Ematologia, Ospedale S. Gerardo, Monza (S.P.), La Struttura Complessa di Ematologia, Dipartimento di Ematologia ed Oncologia, Azienda Ospedaliera Niguarda Ca' Granda (A.C.), Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute (M.M.), and Division of Hematology and Bone Marrow Transplantation, IRCCS Istituto Nazionale dei Tumori-University of Milan (P.C.), Milan, Ematologia, Policlinico Federico II, Naples (L.C.), Clinica di Ematologia, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona (M.O.), Unità Operativa Complessa Ematologia 1, IRCCS Azienda Ospedaliera Universitaria San Martino-Istituto Nazionale per la Ricerca sul Cancro, Genoa (A.M.C.), Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna (E.Z., M.C.), Clinica Ematologia, Dipartimento di Scienze Mediche Sperimentali e Cliniche, Azienda Ospedaliera-Universitaria di Udine, Udine (F.P.), Scientific Direction, IRCCS, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (P.M.), and Struttura Complessa Ematologia e Dipartimento Oncologia Medica, Spedali Civili di Brescia, Brescia (C. Crippa) - all in Italy; and the Hematology Division, Hadassah University Hospital, Jerusalem (D.B.Y.), and the Hematology Institute, Chaim Sheba Medical Center, Tel Hashomer (E.R., A.N.) - both in Israel
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Cerchione C, Catalano L, Cerciello G, Avilia S, Picardi M, Risitano AM, Pisano I, Alfinito F, Pane F. Role of lenalidomide in the management of myelodysplastic syndromes with del(5q) associated with pure red cell aplasia (PRCA). Ann Hematol 2014; 94:531-4. [DOI: 10.1007/s00277-014-2192-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022]
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Morabito F, Bringhen S, Larocca A, Wijermans P, Victoria Mateos M, Gimsing P, Mazzone C, Gottardi D, Omedè P, Zweegman S, José Lahuerta J, Zambello R, Musto P, Magarotto V, Schaafsma M, Oriol A, Juliusson G, Cerrato C, Catalano L, Gentile M, Isabel Turel A, Marina Liberati A, Cavalli M, Rossi D, Passera R, Rosso S, Beksac M, Cavo M, Waage A, San Miguel J, Boccadoro M, Sonneveld P, Palumbo A, Offidani M. Bortezomib, melphalan, prednisone (VMP) versus melphalan, prednisone, thalidomide (MPT) in elderly newly diagnosed multiple myeloma patients: A retrospective case-matched study. Am J Hematol 2014; 89:355-62. [PMID: 24273190 DOI: 10.1002/ajh.23641] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 12/11/2022]
Abstract
Novel agents in combination with melphalan and prednisone (MP) significantly improved progression-free survival (PFS) and overall survival (OS) in multiple myeloma (MM). Randomized trials comparing MP plus bortezomib (VMP) versus MP plus thalidomide (MPT) are lacking. Nine hundred and fifty-six elderly (>65 years) newly diagnosed MM patients from six European randomized trials were retrospectively analyzed and matched for age, albumin, and beta2-microglobulin at diagnosis, 296 patients were selected from the VMP groups, and 294 from MPT. Complete response rate was 21% in the VMP patients and 13% in the MPT patients (P = 0.007). After a median follow-up of 34 months (range, 1-92), VMP significantly prolonged both PFS (median 32.5 vs. 22.9 months, HR 0.65; 95% CI 0.52-0.82; P < 0.001) and OS (median 79.7 vs. 45.1 months, HR 0.44; 95% CI 0.32-0.59; P < 0.001) in comparison with MPT. The benefit in terms of OS of the VMP group was quite similar among patients with different risk factors defined by sex, ISS, ECOG performance status, or serum creatinine but not among patients ≥ 75 years. Multivariate analysis confirmed that VMP was an independent predictor of longer PFS and OS. In a control-case matched analysis, PFS and OS were prolonged in patients who received VMP in comparison with those treated with MPT.
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Affiliation(s)
| | - Sara Bringhen
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | - Alessandra Larocca
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | - Pierre Wijermans
- Department of Hematology; Haga Hospital; the Hague The Netherlands
| | | | - Peter Gimsing
- Department of Hematology; Rigs hospitalet and University of Copenhagen; Denmark
| | | | - Daniela Gottardi
- SCDU Ematologia e Terapie Cellulari; A.O. Ordine Mauriziano - Umberto I; Torino Italy
| | - Paola Omedè
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | - Sonja Zweegman
- Department of Hematology; VU University Medical Center; Amsterdam The Netherlands
| | | | - Renato Zambello
- Padova University School of Medicine; Department of Clinical and Experimental Medicine; Hematology and Clinical Immunology; Padova Italy
| | - Pellegrino Musto
- Department of Onco-Haematology; IRCCS, Referral Cancer Centre of Basilicata; Rionero in Vulture (Pz) Italy
| | - Valeria Magarotto
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | | | - Albert Oriol
- Clinical Hematology; Institut Català d'Oncologia, Hospital Germans Trias i Pujol; Badalona Spain
| | - Gunnar Juliusson
- Department of Hematology; Stem Cell Center, Lund University, and Skåne University Hospital; Lund Sweden
| | - Chiara Cerrato
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | - Lucio Catalano
- Divisione di Ematologia; Università Federico II; Napoli Italy
| | | | - Ana Isabel Turel
- Hematology and Oncology Service; Hospital Clínico Universitario; Valencia Spain
| | - Anna Marina Liberati
- Department of Transplant Oncohematology; Perugia University; S. Maria Terni Italy
| | - Maide Cavalli
- Divisione di Ematologia; Ospedale Ferrarotto, Universtà di Catania; Catania Italy
| | - Davide Rossi
- Division of Hematology; Department of Translational Medicine; Amedeo Avogadro University of Eastern Piedmont; Novara Italy
| | - Roberto Passera
- Divisione di Medicina Nucleare 2 AO Città della Salute e della Scienza di Torino; Italy
| | - Stefano Rosso
- Registro Tumori Regione Piemonte AO Città della Salute e della Scienza di Torino; Italy
| | - Meral Beksac
- Department of Hematology; Faculty of Medicine, Ankara University; Ankara Turkey
| | - Michele Cavo
- Seràgnoli Institute of Hematology; Bologna University School of Medicine; Bologna Italy
| | - Anders Waage
- Department of Hematology; St Olavs Hospital/NTNU; Trondheim Norway
| | - Jesus San Miguel
- Servicio de Hematología; Hospital Universitario de Salamanca, CIC, IBMCC (USAL-CSIC); Spain
| | - Mario Boccadoro
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | | | - Antonio Palumbo
- Myeloma Unit; Division of Hematology; AOU S. Giovanni Battista Torino Italy
| | - Massimo Offidani
- Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona; Ancona Italy
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Rocci A, Gambella M, Aschero S, Baldi I, Trusolino L, Cavallo F, Gay F, Larocca A, Magarotto V, Omedè P, Isaia G, Bertotti A, Liberati AM, Catalano L, De Rosa L, Musto P, Vallone R, Falcone A, Drandi D, Ladetto M, Comoglio PM, Boccadoro M, Palumbo A. MET dysregulation is a hallmark of aggressive disease in multiple myeloma patients. Br J Haematol 2014; 164:841-50. [PMID: 24450886 DOI: 10.1111/bjh.12719] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/02/2013] [Indexed: 11/30/2022]
Abstract
Abnormal activation of MET/HGF (Hepatocyte Growth Factor) pathway has been described in several tumours and increased HGF plasmatic levels have been detected in patients with aggressive multiple myeloma (MM). MET and HGF mRNA expression was investigated in 105 samples of purified plasma cells derived from newly diagnosed MM patients treated with bortezomib-based induction therapy. Gene expression was compared with response to therapy and clinical outcome. MET gene copy number was also evaluated. MET mRNA expression was higher in CD138(+) than in CD138(-) cells (median 76·90 vs. 11·24; P = 0·0009). Low MET mRNA expression characterized patients with better response (complete response or very good partial response) compared to other patients (median 56·10 vs. 134·83; P = 0·0006). After a median follow-up of 50 months, patients with high MET mRNA expression displayed a worse progression-free survival (PFS; P = 0·0029) and overall survival (OS; P = 0·0023) compared to those with low MET mRNA levels. Patients with both high MET mRNA expression and high β2-microglobulin level (>5·5 mg/l) had further worse median PFS (P < 0·0001) and OS (P < 0·0001). Patients carrying 4 MET gene copies (8 out of 82, 9·8%) also had a short PFS. High MET mRNA expression identifies patients with dismal PFS and OS and the combination with high β2-microglobulin further characterizes patients with worse outcome.
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Affiliation(s)
- Alberto Rocci
- Myeloma Unit, Division of Haematology, University of Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Torino, Italy
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Di Crescenzo V, Garzi A, Petruzziello F, Cinelli M, Catalano L, Zeppa P, Vitale M. Nodular goiter with amyloid deposition in an elderly patient: fine-needle cytology diagnosis and review of the literature. BMC Surg 2013; 13 Suppl 2:S43. [PMID: 24267036 PMCID: PMC3851267 DOI: 10.1186/1471-2482-13-s2-s43] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Amyloidosis is a systemic disease characterized by the extracellular deposition of amyloid fibrils in different organs and tissues. The thyroid gland may be affected by diffuse or nodular amyloid deposits, along with multiple myeloma (MM) (Amyloid Light-Chain Amyloidosis, AL amyloidosis) or chronic inflammatory diseases (Amyloid A Amyloidosis, AA amyloidosis), but thyroid gland involvement rarely appears as the first clinical manifestation in both conditions. The present study reports a case of primary thyroidal nodular amyloid goiter diagnosed by fine-needle cytology (FNC) in an elderly patient. Case report A 66-year-old female patient presented with dysphagia and hoarseness; the patient suffered from rheumatoid arthritis but did not have kidney failure or altered thyroid function. Ultrasound examination (US) showed a 30 mm irregular, hypoechoic area in the left thyroid lobe. FNC showed abundant, dense and amorphous material similar to the one stained in purple at Diff-Quik stain and pinkish at the Papanicolaou. Spindle cells with thin, bland and bent nuclei were scattered in this material; few thyroid follicular cells were also present. An alcohol-fixed smear was stained with Congo red: the amyloid material appeared cherry red and it also showed apple-green birefringence when observed with a polarizing microscope. A differential diagnosis between different thyroid pathologies was considered and the cytological diagnosis of nodular amyloid goiter was pointed out. The patient underwent thyroid lobectomy and the subsequent histological examination confirmed the cytological diagnosis. Conclusions FNC is a safe and effective procedure for the diagnosis of thyroid amyloidosis. Congo red-stained smears can be used to demonstrate the presence of amyloid material, showing the typical green birefringence under polarized light. An early and accurate cytological diagnosis may suggest an hematological screening and the appropriate treatment for the thyroid nodule.
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Fonti R, Larobina M, Del Vecchio S, De Luca S, Fabbricini R, Catalano L, Pane F, Salvatore M, Pace L. Metabolic tumor volume assessed by 18F-FDG PET/CT for the prediction of outcome in patients with multiple myeloma. J Nucl Med 2012; 53:1829-35. [PMID: 23071351 DOI: 10.2967/jnumed.112.106500] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED (18)F-FDG PET/CT allows the direct measurement of metabolic tumor burden in a variety of different malignancies. The aim of this study was to assess whether metabolic tumor volume (MTV) determined by (18)F-FDG PET/CT could be used in the prediction of progression-free and overall survival in multiple myeloma patients. METHODS Forty-seven patients (18 women, 29 men; mean age ± SD, 63 ± 11 y) with stage IIIA disease who had undergone whole-body (18)F-FDG PET/CT were retrospectively evaluated. Images underwent a 3-dimensional region-of-interest analysis including all focal lesions with a maximum standardized uptake value > 2.5. The MTV of each lesion was calculated using an automated contouring program based on the standardized uptake value and developed with a threshold of 40% of the maximum standardized uptake value. The total MTV of each patient was defined as the sum of metabolic volume of all focal lesions. Patients were treated and then subjected to a mean follow-up period of 24 mo. RESULTS In the 47 patients studied, MTV range was 1.3-316.3 mL, with a median of 23.7 mL. A direct, significant correlation was found between MTV and the percentage of diffuse infiltration of bone marrow by plasma cells (r = 0.46, P = 0.006), whereas hemoglobin levels were inversely correlated with MTV (r = -0.56, P = 0.0001). At follow-up, patients who developed progressive disease (n = 18) showed a significantly higher MTV (74.7 ± 19.3 vs. 29.8 ± 5.1 mL, P = 0.009) than patients without progressive disease (n = 29). Furthermore, patients who died of myeloma (n = 9) had a significantly higher MTV (123.2 ± 30.6 vs. 28.9 ± 4.2 mL, P = 0.0001) than survivors (n = 38). No differences in age, plasma cell infiltration, M protein, albumin, β2-microglobulin, performance status, International Staging System score, and presence or absence of a bone marrow transplant were found between groups. The MTV cutoff level was determined by receiver-operating-characteristic curve analysis, and the best discriminative value found for predicting progression-free and overall survival was 42.2 and 77.6 mL, respectively. By Kaplan-Meier analysis and log-rank testing, progression-free and overall survival at follow-up were significantly better in patients showing an MTV lower than the cutoff than in those having an MTV higher than the cutoff (χ(2) = 3.9, P = 0.04, and χ(2) = 56.3, P < 0.0001, respectively). CONCLUSION The direct measurement of tumor burden obtained by calculating MTV on (18)F-FDG PET/CT images may be used in the prediction of progression-free and overall survival in myeloma patients.
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Affiliation(s)
- Rosa Fonti
- Institute of Biostructures and Bioimages-National Research Council, University Federico II, Naples, Italy.
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Fayolle G, Levick W, Lajiness-O'Neill R, Fastenau P, Briskin S, Bass N, Silva M, Critchfield E, Nakase-Richardson R, Hertza J, Loughan A, Perna R, Northington S, Boyd S, Anderson A, Peery S, Chafetz M, Maris M, Ramezani A, Sylvester C, Goldberg K, Constantinou M, Karekla M, Hall J, Edwards M, Balldin V, Strutt A, Pavlik V, Marquez de la Plata C, Cullum M, lacritz L, Reisch J, Massman P, Royall D, Barber R, Younes S, Wiechmann A, O'Bryant S, Patel K, Suhr J, Patel K, Suhr J, Chari S, Yokoyama J, Bettcher B, Karydas A, Miller B, Kramer J, Zec R, Fritz S, Kohlrus S, Robbs R, Ala T, Gifford K, Cantwell N, Romano R, Jefferson A, Holland A, Newton S, Bunting J, Coe M, Carmona J, Harrison D, Puente A, Terry D, Faraco C, Brown C, Patel A, Watts A, Kent A, Siegel J, Miller S, Ernst W, Chelune G, Holdnack J, Sheehan J, Duff K, Pedraza O, Crawford J, Terry D, Puente A, Brown C, Faraco C, Watts A, Patel A, Kent A, Siegel J, Miller L, Younes S, Hobson Balldin V, Benavides H, Johnson L, Hall J, Tshuma L, O'Bryant S, Dezhkam N, Hayes L, Love C, Stephens B, Webbe F, Allen C, Lemann E, Davis A, Pierson E, Lutz J, Piehl J, Holler K, Kavanaugh B, Tayim F, Llanes S, Mulligan K, Poston K, Riccio C, Beathard J, Cohen M, Stolberg P, Hart J, Jones W, Mayfield J, Allen D, Weller J, Dunham K, Demireva P, McInerney K, Suhr J, Dykstra J, Riddle T, Suhr J, Primus M, Riccio C, Highsmith J, Everhart D, Shadi S, Lehockey K, Sullivan S, Lucas M, Mandava S, Murphy B, Donovick P, Lalwani L, Rosselli M, Coad S, Carrasco R, Sofko C, Scarisbrick D, Golden C, Coad S, Zuckerman S, Golden C, Perna R, Loughan A, Hertza J, Brand J, Rivera Mindt M, Denney R, Schaffer S, Alper K, Devinsky O, Barr W, Langer K, Fraiman J, Scagliola J, Roman E, Martinez A, Cohen M, Dunham K, Riccio C, Martin P, Robbins J, Golden C, Axelrod B, Etherton J, Konopacki K, Moses J, Juliano A, Whiteside D, Rolin S, Widmann G, Franzwa M, Sokal B, Mark V, Doyle K, Morgan E, Weber E, Bondi M, Delano-Wood L, Grant I, Sibson J, Woods S, Andrews P, McGregor S, Golden C, Etherton J, Allen C, Cormier R, Cumley N, Elek M, Green M, Ogbeide S, Kruger A, Pacheco L, Robinson G, Welch H, Etherton J, Allen C, Cormier R, Cumley N, Kruger A, Pacheco L, Glover M, Parriott D, Jones W, Loe S, Hughes L, Natta L, Moses J, Vincent A, Roebuck-Spencer T, Bryan C, Padua M, Denney R, Moses J, Quenicka W, McGoldirck K, Bennett T, Soper H, Collier S, Connolly M, Hanratty A, Di Pinto M, Magnuson S, Dunham K, Handel E, Davidson K, Livers E, Frantz S, Allen J, Jerard T, Moses J, Pierce S, Sakhai S, Newton S, Warchol A, Holland A, Bunting J, Coe M, Carmona J, Harrison D, Barney S, Thaler N, Sutton G, Strauss G, Allen D, Hunter B, Bennett T, Quenicka W, McGoldrick K, Soper H, Sordahl J, Torrence N, John S, Gavett B, O'Bryant S, Shadi S, Denney R, Nichols C, Riccio C, Cohen M, Dennison A, Wasserman T, Schleicher-Dilks S, Adler M, Golden C, Olivier T, Schleicher-Dilks S, Golden C, LeMonda B, McGinley J, Pritchett A, Chang L, Cloak C, Cunningham E, Lohaugen G, Skranes J, Ernst T, Parke E, Thaler N, Etcoff L, Allen D, Andrews P, McGregor S, Golden C, Northington S, Daniels R, Loughan A, Perna R, Hertza J, Hochsztein N, Miles-Mason E, Granader Y, Vasserman M, MacAllister W, Casto B, Peery S, Patrick K, Hurewitz F, Chute D, Booth A, Koch C, Roid G, Balkema N, Kiefel J, Bell L, Maerlender A, Belkin T, Katzenstein J, Semerjian C, Culotta V, Band E, Yosick R, Burns T, Arenivas A, Bearden D, Olson K, Jacobson K, Ubogy S, Sterling C, Taub E, Griffin A, Rickards T, Uswatte G, Davis D, Sweeney K, Llorente A, Boettcher A, Hill B, Ploetz D, Kline J, Rohling M, O'Jile J, Holler K, Petrauskas V, Long J, Casey J, Long J, Petrauskas V, Duda T, Hodsman S, Casey J, Stricker S, Martner S, Hansen R, Ferraro F, Tangen R, Hanratty A, Tanabe M, O'Callaghan E, Houskamp B, McDonald L, Pick L, Guardino D, Pick L, Pietz T, Kayser K, Gray R, Letteri A, Crisologo A, Witkin G, Sanders J, Mrazik M, Harley A, Phoong M, Melville T, La D, Gomez R, Berthelson L, Robbins J, Lane E, Golden C, Rahman P, Konopka L, Fasfous A, Zink D, Peralta-Ramirez N, Perez-Garcia M, Puente A, Su S, Lin G, Kiely T, Gomez R, Schatzberg A, Keller J, Dykstra J, Suhr J, Feigon M, Renteria L, Fong M, Piper L, Lee E, Vordenberg J, Contardo C, Magnuson S, Doninger N, Luton L, Balkema N, Drane D, Phelan A, Stricker W, Poreh A, Wolkenberg F, Spira J, Lin G, Su S, Kiely T, Gomez R, Schatzberg A, Keller J, DeRight J, Jorgensen R, Fitzpatrick L, Crowe S, Woods S, Doyle K, Weber E, Cameron M, Cattie J, Cushman C, Grant I, Blackstone K, Woods S, Weber E, Grant I, Moore D, Roberg B, Somogie M, Thelen J, Lovelace C, Bruce J, Gerstenecker A, Mast B, Litvan I, Hargrave D, Schroeder R, Buddin W, Baade L, Heinrichs R, Thelen J, Roberg B, Somogie M, Lovelace C, Bruce J, Boseck J, Berry K, Koehn E, Davis A, Meyer B, Gelder B, Sussman Z, Espe-Pfeifer P, Musso M, Barker A, Jones G, Gouvier W, Weber E, Woods S, Grant I, Johnson V, Zaytsev L, Freier-Randall M, Sutton G, Thaler N, Ringdahl E, Allen D, Olsen J, Byrd D, Rivera-Mindt M, Fellows R, Morgello S, Wheaton V, Jaehnert S, Ellis C, Olavarria H, Loftis J, Huckans M, Pimental P, Frawley J, Welch M, Jennette K, Rinehardt E, Schoenberg M, Strober L, Genova H, Wylie G, DeLuca J, Chiaravalloti N, Hertza J, Loughan A, Perna R, Northington S, Boyd S, Hertza J, Loughan A, Perna R, Northington S, Boyd S, Ibrahim E, Seiam A, Ibrahim E, Bohlega S, Rinehardt E, Lloyd H, Goldberg M, Marceaux J, Fallows R, McCoy K, Yehyawi N, Luther E, Hilsabeck R, Fulton R, Stevens P, Erickson S, Dodzik P, Williams R, Dsurney J, Najafizadeh L, McGovern J, Chowdhry F, Acevedo A, Bakhtiar A, Karamzadeh N, Amyot F, Gandjbakhche A, Haddad M, Taub E, Johnson M, Wade J, Harper L, Rickards T, Sterling C, Barghi A, Uswatte G, Mark V, Balkema N, Christopher G, Marcus D, Spady M, Bloom J, Wiechmann A, Hall J, Loughan A, Perna R, Hertza J, Northington S, Zimmer A, Webbe F, Miller M, Schuster D, Ebner H, Mortimer B, Webbe F, Palmer G, Happe M, Paxson J, Jurek B, Graca J, Meyers J, Lange R, Brickell T, French L, Lange R, Iverson G, Shewchuk J, Madler B, Heran M, Brubacher J, Brickell T, Lange R, Ivins B, French L, Baldassarre M, Paper T, Herrold A, Chin A, Zgaljardic D, Oden K, Lambert M, Dickson S, Miller R, Plenger P, Jacobson K, Olson K, Sutherland E, Glatts C, Schatz P, Walker K, Philip N, McClaughlin S, Mooney S, Seats E, Carnell V, Raintree J, Brown D, Hodges C, Amerson E, Kennedy C, Moore J, Schatz P, Ferris C, Roebuck-Spencer T, Vincent A, Bryan C, Catalano D, Warren A, Monden K, Driver S, Chau P, Seegmiller R, Baker M, Malach S, Mintz J, Villarreal R, Peterson A, Leininger S, Strong C, Donders J, Merritt V, Vargas G, Rabinowitz A, Arnett P, Whipple E, Schultheis M, Robinson K, Iacovone D, Biester R, Alfano D, Nicholls M, Vargas G, Rabinowitz A, Arnett P, Rabinowitz A, Vargas G, Arnett P, Klas P, Jeffay E, Zakzanis K, Vandermeer M, Jeffay E, Zakzanis K, Womble M, Rohling M, Hill B, Corley E, Considine C, Fichtenberg N, Harrison J, Pollock M, Mouanoutoua A, Brimager A, Lebby P, Sullivan K, Edmed S, Silva M, Nakase-Richardson R, Critchfield E, Kieffer K, McCarthy M, Wiegand L, Lindsey H, Hernandez M, Puente A, Noniyeva Y, Lapis Y, Padua M, Poole J, Brooks B, McKay C, Mrazik M, Meeuwisse W, Emery C, Brooks B, Mazur-Mosiewicz A, Sherman E, Brooks B, Mazur-Mosiewicz A, Kirkwood M, Sherman E, Gunner J, Miele A, Silk-Eglit G, Lynch J, McCaffrey R, Stewart J, Tsou J, Scarisbrick D, Chan R, Bure-Reyes A, Cortes L, Gindy S, Golden C, Hunter B, Biddle C, Shah D, Jaberg P, Moss R, Horner M, VanKirk K, Dismuke C, Turner T, Muzzy W, Dunnam M, Miele A, Warner G, Donnelly K, Donnelly J, Kittleson J, Bradshaw C, Alt M, Margolis S, Ostroy E, Rolin S, Higgins K, Denney R, Rolin S, Eng K, Biddle C, Akeson S, Wall J, Davis J, Hansel J, Hill B, Rohling M, Wang B, Womble M, Gervais R, Greiffenstein M, Denning J, Denning J, Schroeder R, Buddin W, Hargrave D, VonDran E, Campbell E, Brockman C, Heinrichs R, Baade L, Buddin W, Hargrave D, Schroeder R, Teichner G, Waid R, Buddin W, Schroeder R, Teichner G, Waid R, Buican B, Armistead-Jehle P, Bailie J, Dilay A, Cottingham M, Boyd C, Asmussen S, Neff J, Schalk S, Jensen L, DenBoer J, Hall S, DenBoer J, Schalk S, Jensen L, Hall S, Miele A, Lynch J, McCaffrey R, Holcomb E, Axelrod B, Demakis G, Rimland C, Ward J, Ross M, Bailey M, Stubblefield A, Smigielski J, Geske J, Karpyak V, Reese C, Larrabee G, Suhr J, Silk-Eglit G, Gunner J, Miele A, Lynch J, McCaffrey R, Allen L, Celinski M, Gilman J, Davis J, Wall J, LaDuke C, DeMatteo D, Heilbrun K, Swirsky-Sacchetti T, Lindsey H, Puente A, Dedman A, Withers K, Chafetz M, Deneen T, Denney R, Fisher J, Spray B, Savage R, Wiener H, Tyer J, Ningaonkar V, Devlin B, Go R, Sharma V, Tsou J, Golden C, Fontanetta R, Calderon C, Coad S, Golden C, Calderon C, Fontaneta R, Coad S, Golden C, Ringdahl E, Thaler N, Sutton G, Vertinski M, Allen D, Verbiest R, Thaler N, Snyder J, Kinney J, Allen D, Rach A, Young J, Crouse E, Schretlen D, Weaver J, Buchholz A, Gordon B, Macciocchi S, Seel R, Godsall R, Brotsky J, DiRocco A, Houghton-Faryna E, Bolinger E, Hollenbeck C, Hart J, Thaler N, Vertinski M, Ringdahl E, Allen D, Lee B, Strauss G, Adams J, Martins D, Catalano L, Waltz J, Gold J, Haas G, Brown L, Luther J, Goldstein G, Kiely T, Kelley E, Lin G, Su S, Raba C, Gomez R, Trettin L, Solvason H, Schatzberg A, Keller J, Vertinski M, Thaler N, Allen D, Gold J, Buchanan R, Strauss G, Baldock D, Ringdahl E, Sutton G, Thaler N, Allen D, Fallows R, Marceaux J, McCoy K, Yehyawi N, Luther E, Hilsabeck R, Etherton J, Phelps T, Richmond S, Tapscott B, Thomlinson S, Cordeiro L, Wilkening G, Parikh M, Graham L, Grosch M, Hynan L, Weiner M, Cullum C, Hobson Balldin V, Menon C, Younes S, Hall J, Strutt A, Pavlik V, Marquez de la Plata C, Cullum M, Lacritz L, Reisch J, Massman P, Royall D, Barber R, O'Bryant S, Castro-Couch M, Irani F, Houshyarnejad A, Norman M, Peery S, Fonseca F, Bure-Reyes A, Browne B, Alvarez J, Jiminez Y, Baez V, Cortes L, Golden C, Fonseca F, Bure-Reyes A, Coad S, Alvarez J, Browne B, Baez V, Golden C, Resendiz C, Scott B, Farias G, York M, Lozano V, Mahoney M, Strutt A, Hernandez Mejia M, Puente A, Bure-Reyes A, Fonseca F, Baez V, Alvarez J, Browne B, Coad S, Jiminez Y, Cortes L, Golden C, Bure-Reyes A, Pacheco E, Homs A, Acevedo A, Ownby R, Nici J, Hom J, Lutz J, Dean R, Finch H, Pierce S, Moses J, Mann S, Feinberg J, Choi A, Kaminetskaya M, Pierce C, Zacharewicz M, Axelrod B, Gavett B, Horwitz J, Edwards M, O'Bryant S, Ory J, Gouvier W, Carbuccia K, Ory J, Carbuccia K, Gouvier W, Morra L, Garcon S, Lucas M, Donovick P, Whearty K, Campbell K, Camlic S, Donovick P, Edwards M, Balldin V, Hall J, Strutt A, Pavlik V, Marquez de la Plata C, Cullum C, Lacritz L, Reisch J, Massman P, Barber R, Royall D, Younes S, O'Bryant S, Brinckman D, Schultheis M, Ehrhart L, Weisser V, Medaglia J, Merzagora A, Reckess G, Ho T, Testa S, Gordon B, Schretlen D, Woolery H, Farcello C, Klimas N, Thaler N, Allen D, Meyer J, Vargas G, Rabinowitz A, Barwick F, Arnett P, Womble M, Rohling M, Hill B, Corley E, Drayer K, Rohling M, Ploetz D, Womble M, Hill B, Baldock D, Ringdahl E, Sutton G, Thaler N, Allen D, Galusha J, Schmitt A, Livingston R, Stewart R, Quarles L, Pagitt M, Barke C, Baker A, Baker N, Cook N, Ahern D, Correia S, Resnik L, Barnabe K, Gnepp D, Benjamin M, Zlatar Z, Garcia A, Harnish S, Crosson B, Rickards T, Mark V, Taub E, Sterling C, Vaughan L, Uswatte G, Fedio A, Sexton J, Cummings S, Logemann A, Lassiter N, Fedio P, Gremillion A, Nemeth D, Whittington T, Hansen R, Reckow J, Ferraro F, Lewandowski C, Cole J, Lewandowski A, Spector J, Ford-Johnson L, Lengenfelder J, Genova H, Sumowski J, DeLuca J, Chiaravalloti N, Loughan A, Perna R, Hertza J, Morse C, McKeever J, Zhao L, Leist T, Schultheis M, Marcinak J, Piecora K, Al-Khalil K, Webbe F, Mulligan K, Robbins J, Berthelson L, Martin P, Golden C, Piecora K, Marcinak J, Al-Khalil K, Webbe F, Mulligan K, Stewart J, Acevedo A, Ownby R, Thompson L, Kowalczyk W, Golub S, Davis A, Lemann E, Piehl J, Rita N, Moss L, Davis A, Boseck J, Berry K, Koehn E, Meyer B, Gelder B, Davis A, Nogin R, Moss L, Drapeau C, Malm S, Davis A, Lemann E, Koehn E, Drapeau C, Malm S, Boseck J, Armstrong L, Glidewell R, Orr W, Mears G. Grand Rounds. Arch Clin Neuropsychol 2012. [DOI: 10.1093/arclin/acs070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Camera L, Fusari M, Calabrese M, Sirignano C, Catalano L, Santoro A, Galderisi M, Salvatore M. Isolated unilateral absence of pulmonary artery mimicking chronic pulmonary embolism at chest X-ray: multidetector-row CT angiographic findings. Clin Imaging 2012; 36:845-9. [PMID: 23154021 DOI: 10.1016/j.clinimag.2012.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 01/18/2012] [Indexed: 12/01/2022]
Abstract
Unilateral absence of pulmonary artery (UAPA) is a rare congenital anomaly which can seldom be isolated (1:200,000) and incidentally discovered in adulthood. We describe the case of a 54-year-old male patient who was found to have isolated UAPA (IUAPA) during the clinical and radiological investigation of a single episode of hemoptysis. Although abnormal, chest X-ray findings differed considerably from those previously reported and the diagnosis was only achieved by multidetector-row computed tomography angiography and later confirmed by bed-side echocardiography. Further clinical and instrumental investigation revealed systemic hypertension (158/95 mmHg) and bilateral mild hydronephrosis which both remitted after transurethral prostatic adenomyomectomy.
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Affiliation(s)
- Luigi Camera
- Department of Radiology, University Federico II, Naples, Italy.
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Maiorana E, Catalano L, Colloca G. Same patient in different European countries: Assessment and management pressure ulcers in Italy. Eur Geriatr Med 2011. [DOI: 10.1016/j.eurger.2011.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Petruzziello F, Zeppa P, Ciancia G, Cozzolino I, Fernandez LS, Cervasio M, Musto P, D'Auria F, Vita G, Morabito F, Piro E, Ponti MRC, Pettinato G, Ciancia R, Pane F, Catalano L. Cytological and histological detection of amyloid deposits in bone marrow of patients affected by multiple myeloma. Leuk Lymphoma 2011; 52:2304-7. [PMID: 21718137 DOI: 10.3109/10428194.2011.594192] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We recently published a study aiming to verify the frequency of amyloid deposits in the bone marrow of patients with multiple myeloma (MM) who did not present any signs or symptoms of systemic amyloidosis, applying the Congo red technique on bone marrow smears obtained by aspiration from the posterior iliac spine. The results suggested that nearly 40% of patients affected by MM may have amyloid deposits in their bone marrow. Subsequently, this finding has not been confirmed by another study performed with histological specimens of bone marrow in a similar clinical setting. To explain this discrepancy, we performed a comparative study on the bone marrows of 36 patients affected by MM, evaluated by both cytological and histological techniques. The results of this study confirm the high frequency of amyloid deposits in the bone marrow of patients affected by MM when the analysis is made on cytological smears, and indicate that the presence of amyloid on marrow smears is confirmed by core biopsies simultaneously performed in only 25% of cases. Should further studies confirm our findings, cytological assessment could be considered a sensitive technique to detect bone marrow amyloid deposits.
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Affiliation(s)
- Fara Petruzziello
- Hematology, Department of Biochemistry and Medical Biotechnology, University Federico II, Napoli, Italy
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Cavallo F, Bringhen S, Milone G, Ben-Yehuda D, Nagler A, Calabrese E, Cascavilla N, Montefusco V, Lupo B, Liberati AM, Crippa C, Rossini F, Passera R, Patriarca F, Cafro AM, Omedè P, Carella AM, Peccatori J, Catalano L, Caravita T, Musto P, Petrucci MT, Boccadoro M, Palumbo A. Stem cell mobilization in patients with newly diagnosed multiple myeloma after lenalidomide induction therapy. Leukemia 2011; 25:1627-31. [PMID: 21637283 DOI: 10.1038/leu.2011.131] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Lenalidomide has raised concerns regarding its potential impact on the ability to collect stem cells for autologous stem cell transplantation, especially after prolonged exposure. The use of cyclophosphamide plus granulocyte colony-stimulating factor (G-CSF) to mobilize peripheral blood stem cells may overcome this concern. In newly diagnosed multiple myeloma (MM) patients, we investigated the influence of lenalidomide on stem cell collection. In a prospective study, 346 patients received four cycles of lenalidomide-dexamethasone (Rd). Stem cells were mobilized with cyclophosphamide and G-CSF. Patients failing to collect a minimum of 4 × 10(6) CD34(+)/kg cells received a second mobilization course. After mobilization, a median yield of 8.7 × 10(6) CD34(+)/kg was obtained from patients receiving Rd induction. After first mobilization, inadequate yield was observed in 21% of patients, whereas only 9% of patients failed to collect the target yield after the second mobilization attempt. In conclusion, we confirm that a short induction with lenalidomide allowed sufficient stem cells collection to perform autologous transplantation in 91% of newly diagnosed patients.
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Affiliation(s)
- F Cavallo
- Myeloma Unit, Division of Hematology, University of Torino, AOU S Giovanni Battista, Torino, Italy
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Devine DV, Reesink HW, Panzer S, Irving DO, Körmöczi GF, Mayr WR, Blais Y, Zhu Y, Qian K, Zhu Z, Greinacher A, Grazzini G, Pupella S, Catalano L, Vaglio S, Liumbruno GM, Smeenk JW, Josemans EAJ, Briët E, Letowska M, Lachert E, Antoniewicz-Papis J, Brojer E, Gulliksson H, Scott M, Williamson L, Prowse C, AuBuchon JP, López JA, Hoffman P, Busch MP, Norris PJ, Tomasulo P, Dodd RY. Research and development. Vox Sang 2010; 99:382-401. [DOI: 10.1111/j.1423-0410.2010.01379.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Saponari M, De Bac G, Breithaupt J, Loconsole G, Yokomi RK, Catalano L. First Report of 'Candidatus Liberibacter asiaticus' Associated with Huanglongbing in Sweet Orange in Ethiopia. Plant Dis 2010; 94:482. [PMID: 30754508 DOI: 10.1094/pdis-94-4-0482a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Huanglongbing (HLB) is a serious disease of citrus worldwide. Three different 'Candidatus Liberibacter' species are associated with HLB: 'Ca. Liberibacter asiaticus', 'Ca. L. africanus', and 'Ca. L. americanus' (1). 'Ca. L. africanus' and its vector, Trioza erytreae, are both heat sensitive, and when present, occur in citrus when temperatures remain below 30 to 32°C. In Africa, 'Ca. L. africanus' and T. erytreae have been reported in South Africa, Zimbabwe, Malawi, Burundi, Kenya, Somalia, Ethiopia, Cameroon, and Madagascar (1). Inspection of citrus trees in orchards and budwood sources in nurseries located in the warmer citrus-growing areas of Tigray and North Wollo in northern Ethiopia revealed nearly 100 trees with symptoms of leaf yellowing with a blotchy mottle pattern, dead branches, and decreased fruit quality and yield. Two symptomatic sweet orange budwood trees and three symptomatic orchard plants were sampled in April 2009, along with three healthy-looking sweet orange plants. DNA was extracted from 200 mg of desiccated leaf midribs using the CTAB method (4) and subjected to conventional PCR using the primer pairs A2/J5 (2) and OI2/23S1 (3) that amplify the ribosomal protein gene in the rplKAJL-rpoBC operon and the 16S/23S ribosomal intergenic regions, respectively, of 'Ca. L. africanus' and 'Ca. L. asiaticus'. Positive PCR reactions were obtained for all five symptomatic samples with both primer pairs. PCR amplicons of 703 bp (A2/J5) and 892 bp (OI2/23S) recovered from two of these samples were purified, cloned, and sequenced. BLAST analysis revealed that the nucleotide sequences we obtained for the ribosomal protein (GenBank Accessions Nos. GQ890155 and GQ890156) shared 100% identity with each other and 99% identity with sequences of 'Ca. L. asiaticus' from Brazil (DQ471904), Indonesia (AB480161), China (DQ157277), and Florida (CP001677). Similarly, the 16S/23S ribosomal intergenic sequences (GU296538 and GU296539) shared 100% identity with each other and 99% identity with homologous 'Ca. L. asiaticus' sequences from Brazil (DQ471903), Indonesia (AB480102), China (DQ778016), and Florida (CP001677) and contained two tRNA genes as occurs in 'Ca. L. asiaticus' but not in 'Ca. L. africanus' (3). To our knowledge, this is the first report of 'Ca. L. asiaticus' in Africa. The presence of 'Ca. L. asiaticus' is a threat for warmer citrus-growing areas of Africa that are less favorable for 'Ca. L. africanus' and T. erytreae. In areas where 'Ca. L. asiaticus' was confirmed, symptomatic trees must be promptly eradicated and surveys to determine spread of the disease and its vectors are necessary. References: (1) J. M. Bove. J. Plant Pathol. 88:7, 2006. (2) A. Hocquellet et al. Mol. Cell. Probes 13:373, 1999. (3) S. Jagoueix et al. Int. J. Syst. Bacteriol. 47:224, 1997. (4) M. G. Murray and W. F Thompson. Nucleic Acids Res. 8:4321, 1980.
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Affiliation(s)
- M Saponari
- Institute of Plant Virology, CNR, Bari, Italy
| | - G De Bac
- FAO Plant Protection Office, Rome, Italy
| | | | - G Loconsole
- Department of Plant Protection and Applied Microbiology, University of Bari, Italy
| | - R K Yokomi
- United States Department of Agriculture-Agricultural Research Service (USDA-ARS) Parlier, CA
| | - L Catalano
- Consorzio Vivaistico Pugliese, Bari, Italy
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Reesink HW, Panzer S, Gonzalez CA, Lena N, Muntaabski P, Gimbatti S, Wood E, Lambermont M, Deneys V, Sondag D, Alport T, Towns D, Devine D, Turek P, Auvinen MK, Koski T, Lin CK, Lee CK, Tsoi WC, Lawlor E, Grazzini G, Piccinini V, Catalano L, Pupella S, Kato H, Takamoto S, Okazaki H, Hamaguchi I, Wiersum-Osselton JC, Van Tilborgh AJW, Zijlker-Jansen PY, Mangundap KM, Schipperus MR, Dinesh D, Flanagan P, Flesland Ø, Steinsvåg CT, Espinosa A, Letowska M, Rosiek A, Antoniewicz-Papis J, Lachert E, Koh MBC, Alcantara R, Corral Alonso M, Muñiz-Diaz E. Haemovigilance for the optimal use of blood products in the hospital. Vox Sang 2010; 99:278-93. [DOI: 10.1111/j.1423-0410.2010.01323.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cini M, Zamagni E, Valdré L, Palareti G, Patriarca F, Tacchetti P, Legnani C, Catalano L, Masini L, Tosi P, Gozzetti A, Cavo M. Thalidomide-dexamethasone as up-front therapy for patients with newly diagnosed multiple myeloma: thrombophilic alterations, thrombotic complications, and thromboprophylaxis with low-dose warfarin. Eur J Haematol 2010; 84:484-92. [PMID: 20192986 DOI: 10.1111/j.1600-0609.2010.01434.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major complication of myeloma therapy recently observed with the increasing use of up-front thalidomide and dexamethasone (thal-dex). The pathogenesis of thal-induced VTE is not well recognized, and the role of prothrombotic factors, especially of thrombophilic abnormalities, is not yet determined. MATERIAL AND METHODS Two hundred and sixty-six patients with newly diagnosed multiple myeloma (MM) were primarily treated with thal-dex in preparation for subsequent high-dose therapy and autologous stem-cell transplantation. Out of these 266 patients, 190 were evaluated for thrombophilic alterations at baseline, and 125 of them were also re-assessed after thal-dex therapy. RESULTS The presence of genetic thrombophilic polymorphisms among patients with MM was superimposable to that of normal controls and was associated with a twofold increase in the relative risk of VTE. aAPCR and elevated factor VIII levels were frequent, albeit transient, alterations and were not associated with a significant increase in the risk of VTE. Two hundred and forty-six patients received a thromboprophylaxis with fixed low-dose warfarin (1.25 mg/day) during thal-dex therapy. Of these patients (or 10.6%), 26 had symptomatic VTE events. Their patients-years rate of VTE (35.5%) was significantly lower in comparison with the 86.2% rate recorded among the first 19 patients who initially entered the study and did not receive any kind of thromboprophylaxis (P = 0.043). CONCLUSIONS On the basis of these data, a baseline thrombophilic work up is not recommended in patients with receiving up-front thal-dex. For these patients, fixed low-dose warfarin may be a valuable prophylaxis against VTE.
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Affiliation(s)
- Michela Cini
- Unità Operativa di Angiologia e della Coagulazione "Marino Golinelli", Azienda Ospedaliera-Universitaria S. Orsola-Malpighi, Bologna
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Morabito F, Gentile M, Ciolli S, Petrucci MT, Galimberti S, Mele G, Casulli AF, Mannina D, Piro E, Pinotti G, Palmieri S, Catalano L, Callea V, Offidani M, Musto P, Bringhen S, Baldini L, Tosi P, Di Raimondo F, Boccadoro M, Palumbo A, Cavo M. Safety and efficacy of bortezomib-based regimens for multiple myeloma patients with renal impairment: a retrospective study of Italian Myeloma Network GIMEMA. Eur J Haematol 2009; 84:223-8. [PMID: 19930441 DOI: 10.1111/j.1600-0609.2009.01385.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Renal impairment (RI) is a severe complication throughout the course of multiple myeloma (MM). Bortezomib has been shown to be highly active in MM patients with RI. We designed this retrospective analysis to investigate the safety and efficacy of bortezomib-based therapy in 117 MM patients with RI, 14 cases required dialysis. A total of 603 cycles of bortezomib were administered (median number, five cycles/patient). Ten patients required early discontinuation of bortezomib because of WHO grade IV toxicity. The rate of bortezomib discontinuation in cases with severe, moderate and mild RI was 11%, 5% and 0%, respectively (P = NS). Overall, 91 episodes of WHO grade III/IV toxicity were observed. At least a partial response was documented in 83/113 evaluable patients (73%), including complete response (19%) and near complete response (8%). The overall response rate was similar across RI subgroups. Reversal of RI was documented in 41% of patients after a median of 2.3 months (range 0.4-7.9). In three of 14 patients on dialysis, renal replacement therapy was discontinued after 1, 1 and 4 months. The 2-yr estimate of response duration and overall survival was 70% and 51%, respectively. In conclusion, bortezomib-based regimens are safe and effective and should be considered as appropriate treatment options for MM patients with any degree of RI.
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Affiliation(s)
- Fortunato Morabito
- Unità Operativa di Ematologia, Azienda Ospedaliera dell'Annunziata, 87100 Cosenza, Italy.
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Innelli P, Galderisi M, Catalano L, Martorelli MC, Olibet M, Pardo M, Rotoli B, de Divitiis O. Detection of increased left ventricular filling pressure by pulsed tissue Doppler in cardiac amyloidosis. J Cardiovasc Med (Hagerstown) 2009; 7:742-7. [PMID: 17001235 DOI: 10.2459/01.jcm.0000247321.49912.23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the incremental diagnostic role of tissue Doppler in primary cardiac amyloidosis (CA). METHODS Eleven patients with CA at diagnosis and 11 healthy controls, matched for sex and age, underwent standard Doppler echocardiography and pulsed tissue Doppler of the left ventricular (LV) lateral annulus, in the apical four-chamber view. The ratio of early transmitral flow velocity to early diastolic mitral annular velocity (E/E(m) ratio) was derived as an index of LV filling pressure. RESULTS The two groups were comparable for body mass index, blood pressure, heart rate and standard Doppler diastolic measurements. Patients with CA had a significantly higher sum of wall thickness (SWT) and LV mass, a lower E(m) peak velocity (P < 0.002) and a higher E/E(m) ratio (P < 0.001) than controls. By dividing CA patients according to the transmitral E/A ratio, patients with an E/A ratio < 1 (abnormal relaxation) (n = 5) and patients with an E/A ratio > 1 (likely pseudonormal/restrictive pattern) (n = 6) did not show any difference in the E/E(m) ratio (14.5 + or - 7.1 vs. 15.1 + or - 6.4, P = NS). In the overall population, the E/E(m) ratio was related to SWT (r = 0.84, P < 0.0001) and LV mass index (r = 0.72, P < 0.0001). After adjusting for age and heart rate by separate multivariate models, SWT (beta = 0.78, P < 0.0001; cumulative r(2) = 0.63, SE = 3.38, P < 0.0001) and LV mass index (beta = 0.71, P < 0.0001; cumulative r(2) = 0.53, SE = 3.80, P < 0.002) were both independently associated with the E/E(m) ratio. CONCLUSIONS Pulsed tissue Doppler is able to detect early myocardial diastolic impairment in CA. The E/E(m) ratio is very useful in diagnosing increased LV filling pressure, regardless of the transmitral pattern, and may, therefore, be helpful in the clinical management of these patients.
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Affiliation(s)
- Pasquale Innelli
- Cardioangiology Unit, Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy
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Fabbricini R, Catalano L, Pace L, Del Vecchio S, Fonti R, Salvatore M, Rotoli B. Bone scintigraphy and SPECT/CT in bisphosphonate-induced osteonecrosis of the jaw. J Nucl Med 2009; 50:1385; author reply 1385. [PMID: 19617329 DOI: 10.2967/jnumed.109.064568] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rotoli B, Catalano L, Galderisi M, Luciano L, Pollio G, Guerriero A, D'Errico A, Mecucci C, La Starza R, Frigeri F, Di Francia R, Pinto A. Rapid Reversion of Loeffler's Endocarditis by Imatinib in Early Stage Clonal Hypereosinophilic Syndrome. Leuk Lymphoma 2009; 45:2503-7. [PMID: 15621768 DOI: 10.1080/10428190400002293] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Endomyocardial fibrosis (Loeffler's endocarditis) is the main cause of poor outcome in Hyper Eosinophilic Syndrome (HES) and Eosinophilic Leukemia (EL). Reversion of the cardiac damage has been seldom reported, and thrombi can superimpose on infiltrated walls, originating oembolic complications. The tyrosine kynase inhibitor imatinib has been recently employed in patients affected by HES or EL, with impressive results. We have treated with imatinib a young patient affected by Loeffler's endocarditis during EL. Loeffler's endocarditis was studied by transthoracic Doppler echocardiography with and without the contrast agent SonoVue. Cytogenetics, FISH and molecular analysis showed the presence of the FIP1L1/PDGFRA fusion gene, recently detected in a majority of HES patients. Standard echocardiography revealed a large infiltration of the apical region, with apparently pedunculate corpora floating in the LV chamber; after SonoVue injection, a thick endo-myocardial infiltration involving papillary muscles and tendinous chords appeared, which simulated mobile thrombi at standard echography. Treatment with low dose imatinib caused rapid regression of both eosinophilic proliferation and endomyocardiopathy. The fusion gene FIP1L1-PDGFRA was found significantly decreased after a few months of treatment. Using a contrast echocardiographic approach, we demonstrated the non-thrombotic origin of the "in plus" image in our patient and its rapid resolution following imatinib treatment. Imatinib is an excellent candidate for first line treatment of Loeffler's endocarditis, especially when the FIP1L1/PDGFA fusion gene is detected.
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Affiliation(s)
- Bruno Rotoli
- Department of Medicina Clinica e Sperimentale Università Federico II Napoli Italy.
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La Rocca R, Fulciniti M, Lakshmikanth T, Mesuraca M, Ali TH, Mazzei V, Amodio N, Catalano L, Rotoli B, Ouerfelli O, Grieco M, Gulletta E, Bond HM, Morrone G, Ferrone S, Carbone E. Early hematopoietic zinc finger protein prevents tumor cell recognition by natural killer cells. J Immunol 2009; 182:4529-37. [PMID: 19342626 DOI: 10.4049/jimmunol.0802109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Early hematopoietic zinc finger/zinc finger protein 521 (EHZF/ZNF521) is a novel zinc finger protein expressed in hematopoietic stem and progenitor cells and is down-regulated during their differentiation. Its transcript is also abundant in some hematopoietic malignancies. Analysis of the changes in the antigenic profile of cells transfected with EHZF cDNA revealed up-regulation of HLA class I cell surface expression. This phenotypic change was associated with an increased level of HLA class I H chain, in absence of detectable changes in the expression of other Ag-processing machinery components. Enhanced resistance of target cells to NK cell-mediated cytotoxicity was induced by enforced expression of EHZF in the cervical carcinoma cell line HeLa and in the B lymphoblastoid cell line IM9. Preincubation of transfected cells with HLA class I Ag-specific mAb restored target cell susceptibility to NK cell-mediated lysis, indicating a specific role for HLA class I Ag up-regulation in the NK resistance induced by EHZF. A potential clinical significance of these findings is further suggested by the inverse correlation between EHZF and MHC class I expression levels, and autologous NK susceptibility of freshly explanted multiple myeloma cells.
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Affiliation(s)
- Rosanna La Rocca
- Department of Experimental and Clinical Medicine G Salvatore, University of Catanzaro Magna Graecia, Catanzaro, Italy
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