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Cioce M, Grassi S, Borrelli I, Grassi VM, Ghisellini R, Nuzzo C, Zega M, Laurenti P, Raponi M, Rossi R, Boccia S, Moscato U, Oliva A, Vetrugno G. Predictive Power of Dependence and Clinical-Social Fragility Index and Risk of Fall in Hospitalized Adult Patients: A Case-Control Study. J Patient Saf 2024:01209203-990000000-00201. [PMID: 38470963 DOI: 10.1097/pts.0000000000001214] [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: 03/14/2024]
Abstract
OBJECTIVES Accidental falls are among the leading hospitals' adverse events, with incidence ranging from 2 to 20 events per 1.000 days/patients. The objective of this study is to assess the relationship between in-hospital falls and the score of 3 DEPendence and Clinical-Social Fragility indexes. METHODS A monocentric case-control study was conducted by retrieving data of in-hospital patients from the electronic health records. RESULTS Significant differences between the mean scores at the hospital admission and discharge were found. The BRASS scale mean (SD) values at the admission and at the discharge were also significantly higher in cases of in-hospital falls: at the admission 10.2 (±7.7) in cases versus 7.0 (±8.0) in controls (P = 0.003); at the discharge 10.0 (±6.4) versus 6.7 (±7.5) (P = 0.001). Barthel index mean (SD) scores also presented statistically significant differences: at the admission 60.3 (±40.6) in cases versus 76.0 (±34.8) in controls (P = 0.003); at discharge 51.3 (±34.9) versus 73.3 (±35.2) (P = 0.000).Odds ratios were as follows: for Barthel index 2.37 (95% CI, 1.28-4.39; P = 0.003); for Index of Caring Complexity 1.45 (95% CI, 0.72-2.91, P = 0. 255); for BRASS index 1.95 (95% CI, 1.03-3.70, P = 0.026). With BRASS index, the area under the curve was 0.667 (95% CI, 0.595-0.740), thus indicating a moderate predictive power of the scale. CONCLUSIONS The use of only Conley scale-despite its sensitivity and specificity-is not enough to fully address this need because of the multiple and heterogeneous factors that predispose to in-hospital falls. Therefore, the combination of multiple tools should be recommended.
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Affiliation(s)
- Marco Cioce
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Simone Grassi
- Forensic Medical Sciences, Department of Health Science, University of Florence
| | - Ivan Borrelli
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome
| | | | | | - Carmen Nuzzo
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Maurizio Zega
- From the Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | | | | | - Riccardo Rossi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefania Boccia
- Section of Hygiene - Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario 'Agostino Gemelli'
| | - Umberto Moscato
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Vetrugno
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Cannici C, Liptrott SJ, Serra N, Samarani E, De Cecco V, Caime A, Galgano L, Rostagno E, Orlando L, Gargiulo G, Cioce M, Lupo R, Capuano A, Rea T, Botti S. Predictive factors of sleep quality and burnout in nurses working in transplant units during the COVID-19 lockdown - A cross-sectional study. Contemp Nurse 2023; 59:362-376. [PMID: 37550812 DOI: 10.1080/10376178.2023.2244090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 07/26/2023] [Indexed: 08/09/2023]
Abstract
Background: There is minimal information regarding sleep disturbance and burnout during COVID-19 in nurses working within haematology-oncology and hematopoietic stem cell transplantation (HSCT) settings.Aim: To identify socio-demographic and professional factors that predicted burnout and sleep disturbance during COVID-19 in nurses working in HSCT settings.Design/Methods: Data were collected using the Maslach Burnout Inventory and the Pittsburgh Sleep Quality Index. Descriptive statistics and linear regression examined relationships.Results: 308 responses were received. Nurses working in outpatient settings had greater emotional exhaustion (Rpartial = -0.12, n = 308, p = 0.03). Negative predictors for quality of sleep were transplant programme setting (Rpartial = -0.19, n = 308, p < 0.01) and years working in HSCT (Rpartial = -0.17, n = 308, p < 0.01). Other relationships were found on univariate analysis.Conclusion: Institutions must offer programmes for nurses to develop sleep strategies, self-care, and work-related stress management.
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Affiliation(s)
- Chiara Cannici
- Division of Hematology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, via Venezia 16, Alessandria, 15121, Italy
| | - Sarah Jayne Liptrott
- Istituto Oncologico della Svizzera Italiana, EOC, via A. Gallino 12, 6500, Bellinzona, Switzerland
- Ospedale Regionale di Bellinzona e Valli, EOC, via A. Gallino 12, 6500 Bellinzona, Switzerland
| | - Nicola Serra
- Department of Public Health, University Federico II of Naples, via S. Pansini 5, 80131 Naples, Italy
| | - Emanuela Samarani
- Unit of Blood Diseases and Stem Cell Transplantation, ASST Spedali Civili, Piazzale Spedali Civili 1, 25100 Brescia, Italy
| | - Valentina De Cecco
- Department of Onco-Haematology and Cell and Gene Therapy, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Alessandro Caime
- Division of Hemato-Oncology, European Institute of Oncology IRCCS, via Ripamonti 435, 20141 Milan, Italy
| | - Letizia Galgano
- SOD Transfusion Medicine and Cell Therapies, AOU-Careggi, Largo Brambilla 3, 50139 Firenze, Italy
| | - Elena Rostagno
- SSD Oncoematologia Pediatrica, IRCCS Azienda Ospedaliero Universitaria di Bologna, via Giuseppe Massarenti 13, 40138 Bologna, Italy
| | - Laura Orlando
- Istituto Oncologico della Svizzera Italiana, EOC, via A. Gallino 12, 6500, Bellinzona, Switzerland
| | - Gianpaolo Gargiulo
- Haematology Unit, Federico II University Hospital of Naples, via S. Pansini 5, 80131 Naples, Italy
| | - Marco Cioce
- Hematology and Trasplant Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Roberto Lupo
- Emergency Unit, ASL Lecce "San Giuseppe da Copertino" Hospital, via Carmiano 1, 73043 Copertino Lecce, Italy
| | - Angela Capuano
- Department of Emergency, AORN Santobono-Pausilipon, via T. Ravaschieri n. 8, 80122 Naples, Italy
| | - Teresa Rea
- Department of Public Health, University Federico II of Naples, via S. Pansini 5, 80131 Naples, Italy
| | - Stefano Botti
- Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy
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Cioce M, Borrelli I, Cappucciati L, Giori M, Gobbi G, Lucifora R, Mabilia P, Marsullo M, Prendin C, Russo L, Zucca MS, Zega M, Sica S, Bacigalupo A, De Stefano V, Savoia V, Celli D, Garau P, Serra N, Botti S. The impact of education on patients' psycho-emotional status during allogeneic hematopoietic stem cell transplantation: a multicenter prospective study by thes Gruppo Italiano Trapianto di Midollo Osseo. J Psychosoc Oncol 2023; 41:687-703. [PMID: 36825453 DOI: 10.1080/07347332.2023.2181722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
PURPOSE Depressive disorders are the most common manifestation of psychological distress in allogenic hematopoietic stem cell transplantation. Few studies have yet investigated the relationship between therapeutic educational interventions and outcomes in these patients with specific attention to those related to mental health. Aim of this study was to understand how much educational intervention can represent a protective factor in preventing psycho-emotional distress-related issues in this setting. DESIGN A prospective observational study of a multicenter cohort was conducted. PARTICIPANTS Adult patients undergoing allogeneic hematopoietic stem cell transplantation. METHODS A pre-transplant therapeutic educational programme was offered to a cohort of adult patients undergoing allo-HSCT recruited in ten transplant centers of the GITMO network between May 2018 and January 2019. Depression, Anxiety and Stress scale was used to collect data on psycho-emotional distress at admission (T0), at the day of transplant (T1) and at discharge (T2). Descriptive data were collected and reported, and comparative analyses were done among patients who were compliant with the pre-transplant educational intervention and those who did not (for any reason). FINDINGS A cohort of 133 allo-HSCT patients was observed. In patients who did not receive pre-transplant educational intervention, higher levels of depression at admission (p = 0.01) and at the day of transplant (p = 0.03), higher levels of anxiety (p = 0.01 and p = 0.01 respectively) as well as higher levels of stress (p < 0.01 and p = 0.01) were observed. Problem solving and "face to face" interview were the best methods to provide education to patients. Those who received pre-transplant education through "face-to-face" interview reported significant low levels of depression during the whole hospital stay period (p < 0.01; p = 0.01; p = 0.01) and less anxiety and stress at admission (p < 0.05 and p = 0.01 respectively). Depression was more represented in female than male participants at T0 (16.5% vs 9.0%; p = 0.01), while among T0 and T2 the males had a significant higher increasing of depression than females (p = 0.03). CONCLUSION Our study demonstrated that pretreatment therapeutic educational programs with specific learning modalities can be effective in limiting the potential risk of developing moderate-to-severe anxiety-depressive states and stress symptoms related to allo-HSCT. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Further studies are needed to confirm our results and to understand whether containing psycho-emotional distress can have any relationship with medium- and long-term post-transplant complications.
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Affiliation(s)
- Marco Cioce
- Department UOC SITRA, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ivan Borrelli
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorella Cappucciati
- U.O. Ematologia e Centro Trapianti, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Manuela Giori
- Terapia Onco-Ematologica Intensiva Trapianto CSE, A.O.U San Luigi Gonzaga Regione Gonzole 10, Orbassano (TO), Italy
| | - Giorgia Gobbi
- SC Ematologia Trapianto Midollo, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | | | - Patrizia Mabilia
- U.O.C. di Ematologia e Trapianto Emopoietico A.O.R.N, San Giuseppe Moscati, Avellino, Italy
| | - Mauro Marsullo
- Trapianti di midollo osseo, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Chiara Prendin
- U.O. Ematologia, Azienda Ulss 8 "Berica", Ospedale San Bortolo, Vicenza, Italy
| | - Letteria Russo
- Hemato-Oncology and Radiotherapy Department, Grande OspedaleMetropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, RC, Italy
| | | | - Maurizio Zega
- Department UOC SITRA, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Sica
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Bacigalupo
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio De Stefano
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Vezio Savoia
- UOS Psicologia Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Celli
- Faculty of Medicine and Psychology, Università "La Sapienza", Rome, Italy
| | - Paola Garau
- Department UOC SITRA, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicola Serra
- Biostatistic Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Stefano Botti
- Hematology Unit, Azienda USL-IRCCS of Reggio, Emilia, Italy
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Cioce M, Botti S, Lohmeyer FM, Galli E, Magini M, Giraldi A, Garau P, Celli D, Zega M, Sica S, Bacigalupo A, De Stefano V, Borrelli I, Moscato U. Nutritional status and quality of life in adults undergoing allogeneic hematopoietic stem cell transplantation. Int J Hematol 2022; 116:266-275. [PMID: 35532878 PMCID: PMC9314297 DOI: 10.1007/s12185-022-03351-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/07/2023]
Abstract
Although the effects of malnutrition on morbidity and mortality in adult patients undergoing allogeneic hematopoietic stem cell transplantation are clear, the relationship with quality of life (QOL) is less clear. The purpose of this study was to assess the relationship between malnutrition and QOL. A prospective observational study was conducted in 36 adult patients undergoing allogeneic hematopoietic stem cell transplantation. Adapted criteria of the Global Leadership Initiative on malnutrition have been used for the diagnosis of malnutrition in clinical settings. A cancer linear analog scale was used to assess QOL. Overall QOL at 14 days after allogeneic hematopoietic stem cell transplantation was 37.1 (95% CI 2.9–45.39) in patients without severe malnutrition, versus 16.0 (95% CI − 6.6 to 38.6) in patients with severe malnutrition (p = 0.05). At discharge, it was 48.0 (95% CI 38.4–57.6) versus 34.0 (95% CI 4.1–63.9) (p = 0.27). The results of our study suggest that patients with severe malnutrition at discharge tend to have worse QOL. A larger cohort of patients is required to confirm this hypothesis.
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Affiliation(s)
- Marco Cioce
- Department UOC SITRA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Stefano Botti
- Haematology Unit, Oncology and Advanced Technology Department, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Eugenio Galli
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Marinella Magini
- UOC Clinical Nutrition, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Giraldi
- UOC Clinical Nutrition, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Paola Garau
- Department UOC SITRA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Danilo Celli
- Faculty of Medicine and Psychology, Università "La Sapienza", Rome, Italy
| | - Maurizio Zega
- Department UOC SITRA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Simona Sica
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy.
| | - Andrea Bacigalupo
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio De Stefano
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan Borrelli
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Moscato
- Department of Health Science of Woman and Child and Public Health-Occupational Health and Hygiene, Area-Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Cioce M, Lohmeyer FM, Botti S, Rostagno E, Orlando L, Vetrugno G, Oppedisano P, Zega M, Sica S, Valerio DS, Bacigalupo A, Fiore A. How to manage falls in hospitalized patients: A single center experience in allogeneic stem cell transplantation setting. Medicine (Baltimore) 2022; 101:e29132. [PMID: 35356952 PMCID: PMC10684116 DOI: 10.1097/md.0000000000029132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/23/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT In allogeneic hematopoietic stem cell transplantation (AHSCT), falls can lead to immediate and late consequences and in some cases to death. We analyzed risks and causes of falls with root cause analysis (RCA) based on which improvement interventions were implemented.A retrospective observational study was conducted to analyze with RCA data of incidence reports and medical records of patients admitted; an expert panel identified actions to prevent falls, which were collected in a checklist.Between December 2017 and November 2019, 214 patients were admitted to ordinary hospital stays for AHSCT or AHSCTrelated complications. In this period, 15 falls, involving 11 patients, occurred resulting in a 2.32 d/patient incidence. In 66.67% of cases minor head trauma occurred. Diuretic drugs (93.33%), induced hyper-diuresis in nonbladder catheter patients (93.33%) and antihypertensive drugs (93.33%) were reported as most common cause in our incident reports. The most frequent fall time slot was between 10 PM and 7 AM (60%). We determined with RCA diuretics and consequent induced hyper-diuresis (80%), self-insufficiency (40%), antihypertensive (33.3%) and noncompliance (33.3%) as the most common cause of falls. Finally, 16 actions, collected in a "safe comfort" checklist, were identified to prevent falls.Diuretic drugs inducing hyper-diuresis, self-insufficiency, poor patient compliance, orthostatic hypotension, fever, night-time and obstacles within inpatient units are the most common contributing factors. Therefore, administration of diuretic and antihypertensive drugs should be rescheduled and a multidimensional risk assessment scale integrated with a preventive action plan, such as the safe comfort checklist, should be implemented to reduce falls.
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Affiliation(s)
- Marco Cioce
- * Correspondence: Marco Cioce, Via Bernardo Barbiellini Amidei, n. 43 - 00168Rome, Italy (e-mail: ).
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Rostagno E, Campanati A, Mordini N, Cannici C, Cioce M, De Cecco V, Samarani E, Foà R, Olivieri A, Botti S. Phototherapy and topical treatments for cutaneous graft versus host disease in hematopoietic stem cell transplantation patients: A scoping review. J Eur Acad Dermatol Venereol 2022; 36:1003-1015. [DOI: 10.1111/jdv.18074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Affiliation(s)
- E. Rostagno
- Pediatric Oncology and Hematology Unit IRCCS Azienza Ospedaliero Universitaria di Bologna Via Massarenti 11 ‐ 40138 Bologna Italy
| | - A. Campanati
- Dermatology Unit Department of Clinical and Molecular Sciences United Hospitals of Ancona and Polytechnic Marche University Via Conca 70 ‐ 60200 Ancona Italy
| | - N. Mordini
- Hematology Division Azienda Ospedaliera S. Croce e Carle Via Coppino 26 ‐ 12100 Cuneo Italy
| | - C. Cannici
- Hematology Unit AO SS Antonio e Biagio e Cesare Arrigo di Alessandira Via Venezia 16 ‐ 15121 Alessandria Italy
| | - M. Cioce
- UOC SITRA Fondazione Policlinico Universitario A. Gemelli – IRCCS Largo Agostino Gemelli 00168 Roma Italy
| | - V. De Cecco
- Trapianto Emopoietico e Terapia Cellulare Ospedale Pediatrico Bambino Gesù Piazza di Sant'Onofrio 4 ‐ 00165 Roma Italy
| | - E. Samarani
- Unit of Blood Diseases and Stem Cell Transplantation Department of Clinical Oncology ASST Spedali Civili di Brescia Piazzale Spedali Civili 1 ‐ 25123 Brescia Italy
| | - R. Foà
- Department of Translational and Precision Medicine Sapienza University of Rome Via Benevento 6 ‐ 00165 Italy
| | - A. Olivieri
- Clinic of Hematology United Hospitals of Ancona and Polytechnic Marche University Via Conca 71 ‐ 60126 Ancona Italy
| | - S. Botti
- Hematology Unit Azienda USL‐IRCCS Reggio Emilia Viale Risorgimento 80 42123 Reggio Emilia Italy
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Liptrott SJ, Botti S, Bonifazi F, Cioce M, De Cecco V, Pesce AR, Caime A, Rostagno E, Samarani E, Galgano L, Ciceri F, Orlando L, Gargiulo G. Management of Pain and Anxiety during Bone Marrow Aspiration: An Italian National Survey. Pain Manag Nurs 2020; 22:349-355. [PMID: 33109451 DOI: 10.1016/j.pmn.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bone marrow aspiration (BMA) or biopsy is a necessary and frequent procedure for diagnosis and monitoring of hematological diseases. Pharmacological pain management approaches exist; however, previous experience and psychological preparation for BMA may impact pain perception. AIMS This study aimed to explore current practices in procedural pain management for BMA or biopsy. DESIGN/SETTING/PARTICIPANTS A cross-sectional internet-based survey was performed by the Nurses Group of the Italian Transplant Group (GITMO). Participants were nurses working in bone marrow transplant centers regularly performing BMA/biopsies. RESULTS Sixty out of 94 centers receiving the survey responded (63.8%), 47 adult and 13 pediatric centers. The majority of them (75%) provided only verbal information for patient preparation before BMA. . Injected local anesthetics were used in 55.4% of centers, and combined with topical anesthetics in 33.9% of centers. Use of oral anesthetics was rare; however, anxiolytics and benzodiazepines were occasionally used (18.3%, 18.3% respectively). All pediatric centers used deep sedation for the procedure (p < .001), but drug choice depended on anesthetist preference. Ice packs (35.0%) and oral analgesia as required (40.0%) were used for postprocedural pain. Nurses perceived their patients' pain scores as relatively low (3.5 on scale 0-10), but recognized that it was a painful procedure provoking anxiety, and that pain management could be improved. CONCLUSIONS Results revealed the lack of a standardized approach to procedural pain management for BMA in this study sample. Assessing a patient's pain experience is a key component to identifying effective pain management for BMA.
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Affiliation(s)
| | - Stefano Botti
- Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | | | - Marco Cioce
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valentina De Cecco
- Department of Onco-Haematology and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Rita Pesce
- Ematologia Azienda Ospedaliera S.S. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Elena Rostagno
- Pediatric Oncology and Hematology Unit, University of Bologna Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | | | | | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Laura Orlando
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Gianpaolo Gargiulo
- Haematology Unit, Federico II University Hospital of Naples, Naples, Italy
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8
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Cioce M, Moroni R, Gifuni MC, Botti S, Orlando L, Soave S, Serra I, Zega M, Gargiulo G. [Relevance of NANDA-I diagnoses in patients undergoing haematopoietic stem cell transplantation: a Delphi study]. Prof Inferm 2020; 72:120-128. [PMID: 31550428 DOI: 10.7429/pi.2019.722128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Haematopoietic Stem Cell Transplantation ( HSCT) has become the standard of care for some haematological diseases that do not respond to traditional treatments: pre-transplant therapy still causes high mortality and morbidity today. Due to the high risk, patient care requires careful evalua- tion and often complex, intensive and non-risk free interventions; the NANDA-I classification provides a way to classify and standardise areas of nursing interest. A previous consensus among experts had iden- tified 61 diagnoses, according to the classification NANDA-I 2018-2020, relevant in onco-haematolo- gical field. OBJECTIVE The aim of the study was to identify which of the 61 diagnoses were relevant for patients undergoing HSCT. METHOD A Delphi study was conducted in two rounds; a structured questionnaire on a 4 point Likert scale was used to build consensus, involving 57 experienced nurse enrolled in Italian GITMO Centres. RESULTS The present study has identified 34 relevant NANDA-I diagnoses in patients undergoing HSCT; it also defined 11 as important diagnoses having obtained absolute consensus. DISCUSSION Use the NANDA-I diagnoses to know, from a panel of experts, the most important and relevant health problems associated with the toxicity of pre- HCSE treatment, it can direct assistance and resources towards expercied and known outcomes so as to be able to intervene effectively with performances aimed at reducing risks and specific complications.
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Affiliation(s)
- Marco Cioce
- Fondazione Policlinico Gemelli IRCCS, Roma. UOC Ematologia e Trapianto di Cellule Staminali Emopoietiche. Cell +393472284176
| | - Rossana Moroni
- Fondazione Policlinico Gemelli IRCCS, Roma. Biostatistico presso Direzione Scientifica
| | - Maria Carola Gifuni
- Fondazione Policlinico Gemelli IRCC, Roma. UOC Ematologia e Trapianto di Cellule Staminali Emopoietiche
| | | | - Laura Orlando
- IEO Istituto Europeo di Oncologia, Milano. Area Assistenziale Omogenea Medica
| | - Sonia Soave
- Fondazione Policlinico Tor Vergata, Roma. UOC Ematologia
| | | | - Maurizio Zega
- Fondazione Policlinico Gemelli IRCCS, Roma. Direttore SITRA
| | - Giampaolo Gargiulo
- AOU Federico II, Napoli. UOC Ematologia e Trapianto di cellule Staminali Emopoie- tiche
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9
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Cioce M, Gifuni MC, Botti S, Orlando L, Soave S, Gargiulo G. [Relevance of NANDA-I Diagnosis in Hematopoietic stem cell transplantation patients]. Prof Inferm 2020; 73:42-52. [PMID: 32594678] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Haematopoietic stem cell transplantation (HSCT) has become the standard of care for many haematological diseases unresponsive to traditional treatments; pretransplant therapy still causes high mortality and morbidity today. Due to the high risk, patient care requires careful assessment and often complex, intensive and non-risk free interventions; the NANDA-I classification provides a way to classify and standardise areas of nursing interest. In 2011, Speksnijder, using the Delphi technique, identified 68 diagnoses relevant to identify health problems in the field of oncohaematology. AIM Based on Speksnijder's contribution, the study tries to identify which of these diagnoses were relevant in identifying health problems in HSCT patients. METHOD A quantitative-descriptive study was carried out; a structured questionnaire on a 4-point Likert scale was used to build consensus, involving 57 expert nurses enrolled in the Italian GITMO Centres. RESULTS Of the 68 NANDA-I diagnoses defined as relevant by Speksnijder in the oncohaematological field, this study identified 37 as relevant in detecting health problems in patients undergoing HSCT (34 in Round 1, 3 in Round 2) and also defined 12 as important diagnoses having obtained an absolute consensus. DISCUSSION Using the NANDA-I diagnoses to identify, from a panel of experts, the most important and relevant health problems associated with the toxicity of pre-TCSE treatment, allows to focus attention on expected and known outcomes in order to be able to intervene with performances aimed at reducing specific risks and complications.
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Affiliation(s)
- Marco Cioce
- UOC Ematologia e Trapianto di Cellule Staminali Emopoietiche. F. Policlinico Gemelli IRCC, Roma. Correspondence:
| | - Maria Carola Gifuni
- UOC Ematologia e Trapianto di Cellule Staminali Emopoietiche, F. Policlinico Gemelli IRCC, Roma
| | | | - Laura Orlando
- Area Assistenziale Omogenea, IEO Istituto Europeo di Oncologia, Milano. Medica
| | - Sonia Soave
- UOC Ematologia Fondazione Policlinico Tor Vergata, Roma
| | - Gianpaolo Gargiulo
- UOC Ematologia e Trapianto di cellule Staminali Emopoietiche Federico II, Napoli
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10
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Piredda M, Biagioli V, Gargiulo G, Annibali O, Tirindelli M, Pignatelli A, Marchesi F, Mauroni M, Soave S, Del Giudice E, Ponticelli E, Clari M, Cavallero S, Monni P, Ottani L, Sica S, Cioce M, Cappucciati L, Alvaro R, De Marinis M. Factors influencing the level of emotional support from nurses perceived by patients undergoing haematopoietic stem cell transplantation in protective isolation. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz275.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Biagioli V, Piredda M, Annibali O, Tirindelli MC, Pignatelli A, Marchesi F, Mauroni MR, Soave S, Del Giudice E, Ponticelli E, Clari M, Cavallero S, Monni P, Ottani L, Sica S, Cioce M, Cappucciati L, Bonifazi F, Alvaro R, De Marinis MG, Gargiulo G. Factors influencing the perception of protective isolation in patients undergoing haematopoietic stem cell transplantation: A multicentre prospective study. Eur J Cancer Care (Engl) 2019; 28:e13148. [PMID: 31429155 DOI: 10.1111/ecc.13148] [Citation(s) in RCA: 5] [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: 03/14/2019] [Revised: 05/04/2019] [Accepted: 08/01/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To identify which factors can influence the patients' perception of protective isolation following Haematopoietic Stem Cell Transplantation (HSCT). METHODS This is a prospective study conducted in 10 Italian centres, members of the Italian Group of stem cell transplant (GITMO). Patients' perception of protective isolation was assessed using the ISOLA scale between 7 and 9 days post-transplant. Statistical linear regression analysis was performed. RESULTS The participants were 182 adult patients receiving autologous (48%) or allogeneic (52%) HSCT in protective isolation. Male sex (β = .152), education level (β = -.245), double room (β = .186), satisfaction with visiting hours (β = -.174) and emotional support from nurses (β = -.169) were independently associated with isolation-related suffering. Significant predictors of the relationship with oneself included body temperature (β = -.179), fatigue (β = -.192) and emotional support from nurses (β = -.292). Factors independently associated with the relationship with others were education (β = -.230), chemotherapy cycles (β = -.218), pain (β = .150) and satisfaction with visiting hours (β = -.162). CONCLUSION Healthcare providers should pay greater attention in caring for those patients who are at risk for a negative isolation experience. Nurses should provide emotional support.
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Affiliation(s)
- Valentina Biagioli
- Department of Biomedicine and Prevention, Faculty of Medicine, School of Nursing, Tor Vergata University, Rome, Italy
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| | - Ombretta Annibali
- Haematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy Unit, Campus Bio-Medico di Roma University, Rome, Italy
| | - Maria Cristina Tirindelli
- Haematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy Unit, Campus Bio-Medico di Roma University, Rome, Italy
| | | | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Sonia Soave
- Stem Cell Transplant Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Elena Ponticelli
- Department of Oncology, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Marco Clari
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | | | - Pierina Monni
- Haematology/Oncology and Specialised Medicine Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Ottani
- Bone Marrow Transplant Centre, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Sica
- Institute of Haematology, Cattolica del Sacro Cuore University, Rome, Italy
| | - Marco Cioce
- Haematology Unit, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | - Francesca Bonifazi
- Institute of Hematology and Medical Oncology "Seràgnoli", S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, Faculty of Medicine, School of Nursing, Tor Vergata University, Rome, Italy
| | | | - Gianpaolo Gargiulo
- Haematology and Haematopoietic Stem Cell Transplantation Unit, Federico II University Hospital, Naples, Italy
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12
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Biagioli V, Piredda M, Annibali O, Tirindelli MC, Pignatelli A, Marchesi F, Mauroni MR, Soave S, Del Giudice E, Ponticelli E, Clari M, Cavallero S, Monni P, Ottani L, Sica S, Cioce M, Cappucciati L, Bonifazi F, Alvaro R, De Marinis MG, Gargiulo G. Development and initial validation of a questionnaire to assess patients’ perception of protective isolation following haematopoietic stem cell transplantation. Eur J Cancer Care (Engl) 2018; 28:e12955. [DOI: 10.1111/ecc.12955] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/22/2018] [Accepted: 09/24/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Valentina Biagioli
- Faculty of Medicine, Department of Biomedicine and Prevention, School of Nursing; Tor Vergata University; Rome Italy
| | - Michela Piredda
- Research Unit Nursing Science; Campus Bio-Medico di Roma University; Rome Italy
| | - Ombretta Annibali
- Haematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy Unit; Campus Bio-Medico di Roma University; Rome Italy
| | - Maria Cristina Tirindelli
- Haematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy Unit; Campus Bio-Medico di Roma University; Rome Italy
| | | | - Francesco Marchesi
- Haematology and Stem Cell Transplant Unit; Regina Elena National Cancer Institute; Rome Italy
| | | | - Sonia Soave
- Stem Cell Transplant Unit; Fondazione Policlinico Tor Vergata; Rome Italy
| | | | - Elena Ponticelli
- Department of Oncology; Città della Salute e della Scienza University Hospital; Turin Italy
| | - Marco Clari
- Department of Quality and Safety of Care; Città della Salute e della Scienza University Hospital; Turin Italy
| | | | - Pierina Monni
- Haematology/Oncology and Specialised Medicine Unit; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; Milan Italy
| | - Laura Ottani
- Bone Marrow Transplant Centre; Fondazione IRCCS Ca' Granda; Milan Italy
| | - Simona Sica
- Institute of Haematology; Cattolica del Sacro Cuore University; Rome Italy
| | - Marco Cioce
- Haematology Unit; Fondazione Policlinico Universitario Agostino Gemelli; Rome Italy
| | | | - Francesca Bonifazi
- Alma Mater Studiorum University of Bologna; Bologna Italy
- Institute of Hematology and Medical Oncology ‘Seràgnoli’; S. Orsola-Malpighi University Hospital; Bologna Italy
| | - Rosaria Alvaro
- Faculty of Medicine, Department of Biomedicine and Prevention, School of Nursing; Tor Vergata University; Rome Italy
| | | | - Gianpaolo Gargiulo
- Haematology and Haematopoietic Stem Cell Transplantation Unit; Federico II University Hospital; Naples Italy
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13
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Cioce M, Canino C, Goparaju C, Yang H, Carbone M, Pass HI. Autocrine CSF-1R signaling drives mesothelioma chemoresistance via AKT activation. Cell Death Dis 2014; 5:e1167. [PMID: 24722292 PMCID: PMC5424113 DOI: 10.1038/cddis.2014.136] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/21/2014] [Accepted: 02/28/2014] [Indexed: 01/02/2023]
Abstract
Clinical management of malignant pleural mesothelioma (MPM) is very challenging because of the uncommon resistance of this tumor to chemotherapy. We report here increased expression of macrophage colony-stimulating-factor-1-receptor (M-CSF/CSF-1R) mRNA in mesothelioma versus normal tissue specimens and demonstrate that CSF-1R expression identifies chemoresistant cells of mesothelial nature in both primary cultures and mesothelioma cell lines. By using RNAi or ligand trapping, we demonstrate that the chemoresistance properties of those cells depend on autocrine CSF-1R signaling. At the single-cell level, the isolated CSF-1Rpos cells exhibit a complex repertoire of pluripotency, epithelial–mesenchymal transition and detoxifying factors, which define a clonogenic, chemoresistant, precursor-like cell sub-population. The simple activation of CSF-1R in untransformed mesothelial cells is sufficient to confer clonogenicity and resistance to pemetrexed, hallmarks of mesothelioma. In addition, this induced a gene expression profile highly mimicking that observed in the MPM cells endogenously expressing the receptor and the ligands, suggesting that CSF-1R expression is mainly responsible for the phenotype of the identified cell sub-populations. The survival of CSF1Rpos cells requires active AKT (v-akt murine thymoma viral oncogene homolog 1) signaling, which contributed to increased levels of nuclear, transcriptionally competent β-catenin. Inhibition of AKT reduced the transcriptional activity of β-catenin-dependent reporters and sensitized the cells to senescence-induced clonogenic death after pemetrexed treatment. This work expands what is known on the non-macrophage functions of CSF-1R and its role in solid tumors, and suggests that CSF-1R signaling may have a critical pathogenic role in a prototypical, inflammation-related cancer such as MPM and therefore may represent a promising target for therapeutic intervention.
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Affiliation(s)
- M Cioce
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Langone Medical Center, New York University, New York, NY, USA
| | - C Canino
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Langone Medical Center, New York University, New York, NY, USA
| | - C Goparaju
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Langone Medical Center, New York University, New York, NY, USA
| | - H Yang
- University of Hawaii Cancer Center, John A Burns School of Medicine, University of Hawaii, Honolulu, HA, USA
| | - M Carbone
- University of Hawaii Cancer Center, John A Burns School of Medicine, University of Hawaii, Honolulu, HA, USA
| | - H I Pass
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Langone Medical Center, New York University, New York, NY, USA
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14
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Scapigliati A, Cioce M, Gaetani C, Sandroni C, Semeraro F, Barelli A, Sanna T, De Paulis S, Arlotta G. A peer-to-peer model for training nurses for inhospital resuscitation: Preliminary data. Resuscitation 2008. [DOI: 10.1016/j.resuscitation.2008.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Pearson M, Carbone R, Sebastiani C, Cioce M, Fagioli M, Saito S, Higashimoto Y, Appella E, Minucci S, Pandolfi PP, Pelicci PG. PML regulates p53 acetylation and premature senescence induced by oncogenic Ras. Nature 2000; 406:207-10. [PMID: 10910364 DOI: 10.1038/35018127] [Citation(s) in RCA: 521] [Impact Index Per Article: 21.7] [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: 12/11/2022]
Abstract
The tumour suppressor p53 induces cellular senescence in response to oncogenic signals. p53 activity is modulated by protein stability and post-translational modification, including phosphorylation and acetylation. The mechanism of p53 activation by oncogenes remains largely unknown. Here we report that the tumour suppressor PML regulates the p53 response to oncogenic signals. We found that oncogenic Ras upregulates PML expression, and overexpression of PML induces senescence in a p53-dependent manner. p53 is acetylated at lysine 382 upon Ras expression, an event that is essential for its biological function. Ras induces re-localization of p53 and the CBP acetyltransferase within the PML nuclear bodies and induces the formation of a trimeric p53-PML-CBP complex. Lastly, Ras-induced p53 acetylation, p53-CBP complex stabilization and senescence are lost in PML-/- fibroblasts. Our data establish a link between PML and p53 and indicate that integrity of the PML bodies is required for p53 acetylation and senescence upon oncogene expression.
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Affiliation(s)
- M Pearson
- European Institute of Oncology, Department of Experimental Oncology, Milan, Italy
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16
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Minucci S, Maccarana M, Cioce M, De Luca P, Gelmetti V, Segalla S, Di Croce L, Giavara S, Matteucci C, Gobbi A, Bianchini A, Colombo E, Schiavoni I, Badaracco G, Hu X, Lazar MA, Landsberger N, Nervi C, Pelicci PG. Oligomerization of RAR and AML1 transcription factors as a novel mechanism of oncogenic activation. Mol Cell 2000; 5:811-20. [PMID: 10882117 DOI: 10.1016/s1097-2765(00)80321-4] [Citation(s) in RCA: 238] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
RAR and AML1 transcription factors are found in leukemias as fusion proteins with PML and ETO, respectively. Association of PML-RAR and AML1-ETO with the nuclear corepressor (N-CoR)/histone deacetylase (HDAC) complex is required to block hematopoietic differentiation. We show that PML-RAR and AML1-ETO exist in vivo within high molecular weight (HMW) nuclear complexes, reflecting their oligomeric state. Oligomerization requires PML or ETO coiled-coil regions and is responsible for abnormal recruitment of N-CoR, transcriptional repression, and impaired differentiation of primary hematopoietic precursors. Fusion of RAR to a heterologous oligomerization domain recapitulated the properties of PML-RAR, indicating that oligomerization per se is sufficient to achieve transforming potential. These results show that oligomerization of a transcription factor, imposing an altered interaction with transcriptional coregulators, represents a novel mechanism of oncogenic activation.
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MESH Headings
- Cell Transformation, Neoplastic
- Core Binding Factor Alpha 2 Subunit
- Histone Deacetylases/metabolism
- Humans
- Leukemia/etiology
- Leukemia/genetics
- Leukemia, Myeloid/etiology
- Leukemia, Myeloid/genetics
- Leukemia, Promyelocytic, Acute/etiology
- Leukemia, Promyelocytic, Acute/genetics
- Neoplasm Proteins/metabolism
- Nuclear Proteins/metabolism
- Nuclear Receptor Co-Repressor 1
- Oncogene Proteins, Fusion/metabolism
- Peptide Fragments/metabolism
- Protein Binding
- Protein Structure, Quaternary
- RUNX1 Translocation Partner 1 Protein
- Repressor Proteins/metabolism
- Response Elements
- Transcription Factors/metabolism
- Transcription, Genetic
- Tretinoin
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Affiliation(s)
- S Minucci
- European Institute of Oncology, Department of Experimental Oncology, Milan, Italy.
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17
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Minucci S, Cioce M, Maccarana M, Pelicci PG. The APL-associated fusion proteins. Haematologica 1999; 84 Suppl EHA-4:70-1. [PMID: 10907473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
MESH Headings
- Animals
- Cell Differentiation/genetics
- Cell Survival/genetics
- Chromosomes, Human, Pair 15/genetics
- Chromosomes, Human, Pair 15/ultrastructure
- Chromosomes, Human, Pair 17/genetics
- Chromosomes, Human, Pair 17/ultrastructure
- Gene Expression Regulation, Leukemic/genetics
- Hematopoietic Stem Cells/pathology
- Humans
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/pathology
- Mice
- Mice, Transgenic
- Neoplasm Proteins/genetics
- Neoplasm Proteins/physiology
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/physiology
- Transcription, Genetic/genetics
- Translocation, Genetic
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Affiliation(s)
- S Minucci
- European Institute of Oncology, Department of Experimental Oncology, Milan, Italy
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18
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Grignani F, De Matteis S, Nervi C, Tomassoni L, Gelmetti V, Cioce M, Fanelli M, Ruthardt M, Ferrara FF, Zamir I, Seiser C, Grignani F, Lazar MA, Minucci S, Pelicci PG. Fusion proteins of the retinoic acid receptor-alpha recruit histone deacetylase in promyelocytic leukaemia. Nature 1998; 391:815-8. [PMID: 9486655 DOI: 10.1038/35901] [Citation(s) in RCA: 848] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The transforming proteins of acute promyelocytic leukaemias (APL) are fusions of the promyelocytic leukaemia (PML) and the promyelocytic leukaemia zinc-finger (PLZF) proteins with retinoic acid receptor-alpha (RARalpha). These proteins retain the RARalpha DNA- and retinoic acid (RA)-binding domains, and their ability to block haematopoietic differentiation depends on the RARalpha DNA-binding domain. Thus RA-target genes are downstream effectors. However, treatment with RA induces differentiation of leukaemic blast cells and disease remission in PML-RARalpha APLs, whereas PLZF-RARa APLs are resistant to RA. Transcriptional regulation by RARs involves modifications of chromatin by histone deacetylases, which are recruited to RA-target genes by nuclear co-repressors. Here we show that both PML-RARalpha and PLZF-RARalpha fusion proteins recruit the nuclear co-repressor (N-CoR)-histone deacetylase complex through the RARalpha CoR box. PLZF-RARalpha contains a second, RA-resistant binding site in the PLZF amino-terminal region. High doses of RA release histone deacetylase activity from PML-RARalpha, but not from PLZF-RARalpha. Mutation of the N-CoR binding site abolishes the ability of PML-RARalpha to block differentiation, whereas inhibition of histone deacetylase activity switches the transcriptional and biological effects of PLZF-RARalpha from being an inhibitor to an activator of the RA signalling pathway. Therefore, recruitment of histone deacetylase is crucial to the transforming potential of APL fusion proteins, and the different effects of RA on the stability of the PML-RARalpha and PLZF-RARalpha co-repressor complexes determines the differential response of APLs to RA.
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MESH Headings
- Binding Sites
- Cell Differentiation/drug effects
- Cell Differentiation/physiology
- Cell Line
- Cloning, Molecular
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/physiology
- Enzyme Inhibitors/pharmacology
- Gene Expression Regulation, Neoplastic
- Histone Deacetylase Inhibitors
- Histone Deacetylases/genetics
- Histone Deacetylases/physiology
- Hydroxamic Acids/pharmacology
- Leukemia, Promyelocytic, Acute/enzymology
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/metabolism
- Mutagenesis
- Neoplasm Proteins/genetics
- Neoplasm Proteins/physiology
- Nuclear Proteins/genetics
- Nuclear Proteins/physiology
- Nuclear Receptor Co-Repressor 1
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/physiology
- Protein Binding
- Receptors, Retinoic Acid/genetics
- Receptors, Retinoic Acid/physiology
- Repressor Proteins/genetics
- Repressor Proteins/physiology
- Retinoic Acid Receptor alpha
- Transcription Factors/genetics
- Transcription Factors/physiology
- Tretinoin/pharmacology
- Tumor Suppressor Proteins
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Affiliation(s)
- F Grignani
- Istituto di Medicina Interna e Scienze Oncologiche, Perugia University, Italy
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