1
|
Rossi G, Borlenghi E, Zappasodi P, Lussana F, Bernardi M, Basilico C, Molteni A, Lotesoriere I, Turrini M, Frigeni M, Fumagalli M, Cozzi P, Gigli F, Cattaneo C, Fracchiolla NS, Riva M, Martini G, Mancini V, Cairoli R, Todisco E. Adapting the Fitness Criteria for Non-Intensive Treatments in Older Patients with Acute Myeloid Leukemia to the Use of Venetoclax-Hypomethylating Agents Combination-Practical Considerations from the Real-Life Experience of the Hematologists of the Rete Ematologica Lombarda. Cancers (Basel) 2024; 16:386. [PMID: 38254875 PMCID: PMC10814062 DOI: 10.3390/cancers16020386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
A retrospective survey was conducted in hematologic centres of the Rete Ematologica Lombarda (REL) on 529 older AML patients seen between 2020-2022. Compared to 2008-2016, the use of intensive chemotherapy (ICT) decreased from 40% to 18.1% and of hypomethylating agents (HMAs) from 19.5% to 13%, whereas the combination of Venetoclax/HMA, initially not available, increased from 0% to 36.7%. Objective treatment-specific fitness criteria proposed by SIE/SIES/GITMO in 2013 allow an appropriate choice between ICT and HMAs by balancing their efficacy and toxicity. Venetoclax/HMA, registered for patients unfit to ICT, has a unique toxicity profile because of prolonged granulocytopenia and increased infectious risk. Aiming at defining specific fitness criteria for the safe use of Venetoclax/HMA, a preliminary investigation was conducted among expert REL hematologists, asking for modifications of SIE/SIES/GITMO criteria they used to select candidates for Venetoclax/HMA. While opinions among experts varied, a general consensus emerged on restricting SIE/SIES/GITMO criteria for ICT-unfit patients to an age limit of 80-85, cardiac function > 40%, and absence of recurrent lung infections, bronchiectasis, or exacerbating COPD. Also, the presence of an adequate caregiver was considered mandatory. Such expert opinions may be clinically useful and may be considered when treatment-specific fitness criteria are updated to include Venetoclax/HMA.
Collapse
Affiliation(s)
- Giuseppe Rossi
- Department of Hematology, ASST Spedali Civili of Brescia, 25100 Brescia, Italy; (E.B.); (C.C.)
| | - Erika Borlenghi
- Department of Hematology, ASST Spedali Civili of Brescia, 25100 Brescia, Italy; (E.B.); (C.C.)
| | - Patrizia Zappasodi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (P.Z.); (G.M.)
| | - Federico Lussana
- Department of Oncology and Hematology, University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, 24100 Bergamo, Italy; (F.L.); (M.F.)
| | - Massimo Bernardi
- Haematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, 20132 Milano, Italy;
| | - Claudia Basilico
- Division of Hematology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy;
| | - Alfredo Molteni
- Department of Hematology, ASST di Cremona, 26100 Cremona, Italy;
| | - Ivana Lotesoriere
- Department of Hematology, Ospedale Busto Arsizio, ASST Valle Olona, 21052 Busto Arsizio, Italy;
| | - Mauro Turrini
- Division of Hematology, Ospedale Valduce, 22100 Como, Italy; (M.T.); (E.T.)
| | - Marco Frigeni
- Department of Oncology and Hematology, University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, 24100 Bergamo, Italy; (F.L.); (M.F.)
| | - Monica Fumagalli
- Department of Hematology, Ospedale “San Gerardo” ASST di Monza, 20900 Monza, Italy;
| | - Paola Cozzi
- Unità Complessa di Ematologia, ASST Ovest Milanese, Ospedale Civile, 20025 Legnano, Italy;
| | - Federica Gigli
- Divisione di Emato-Oncologia, European Institute of Oncology, 20122 Milano, Italy;
| | - Chiara Cattaneo
- Department of Hematology, ASST Spedali Civili of Brescia, 25100 Brescia, Italy; (E.B.); (C.C.)
| | - Nicola Stefano Fracchiolla
- UOC Oncoematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and University of Milan, 20122 Milano, Italy;
| | - Marta Riva
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, 20162 Milano, Italy; (M.R.); (V.M.); (R.C.)
| | - Gianluca Martini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (P.Z.); (G.M.)
| | - Valentina Mancini
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, 20162 Milano, Italy; (M.R.); (V.M.); (R.C.)
| | - Roberto Cairoli
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, 20162 Milano, Italy; (M.R.); (V.M.); (R.C.)
| | - Elisabetta Todisco
- Division of Hematology, Ospedale Valduce, 22100 Como, Italy; (M.T.); (E.T.)
| |
Collapse
|
2
|
Petracca M, Carotenuto A, Scandurra C, Moccia M, Rosa L, Arena S, Ianniello A, Nozzolillo A, Turrini M, Streito LM, Abbadessa G, Cellerino M, Bucello S, Ferraro E, Mattioli M, Chiodi A, Inglese M, Bonavita S, Clerico M, Cordioli C, Moiola L, Patti F, Lavorgna L, Filippi M, Borriello G, D'Amico E, Pozzilli C, Brescia Morra V, Lanzillo R. Sexual dysfunction in multiple sclerosis: The impact of different MSISQ-19 cut-offs on prevalence and associated risk factors. Mult Scler Relat Disord 2023; 78:104907. [PMID: 37523809 DOI: 10.1016/j.msard.2023.104907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Although multiple sclerosis (MS) Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a widely applied tool, no unique definition of sexual dysfunction (SD) based on its score exists. OBJECTIVE To explore the impact of different MSISQ-19 cut-offs on SD prevalence and associated risk factors, providing relevant information for its application in research and clinical settings. METHODS After defining SD according to two different MSISQ-19 cut-offs in 1155 people with MS (pwMS), we evaluated SD prevalence and association with sociodemographic and clinical features, mood status and disability via logistic regression. RESULTS Depending on the chosen cut-off, 45% to 54% of pwMS reported SD. SD defined as MSISQ-19 score >30 was predicted by age (OR=1.01, p=0.047), cognition (OR=0.96, p=0.004) and anxiety (OR=1.03, p=0.019). SD defined as a score >3 on any MSISQ-19 item was predicted by motor disability (OR=1.12, p=0.003) and cognition (OR= 0.96, p=0.002). CONCLUSION Applying different MSISQ-19 cut-offs influences both the estimated prevalence and the identification of risk factors for SD, a finding that should be considered during study planning and data interpretation. Preserved cognition exerts a protective effect towards SD regardless from the specific study setting, representing a key point for the implementation of preventive and therapeutic strategies.
Collapse
Affiliation(s)
- M Petracca
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy
| | - A Carotenuto
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy
| | - C Scandurra
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy
| | - M Moccia
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Italy; MS Unit, Federico II University Hospital, Naples, Italy
| | - L Rosa
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - S Arena
- Department "G.F. Ingrassia", MS Center, University of Catania, Catania, Italy
| | - A Ianniello
- MS Center, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - A Nozzolillo
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Turrini
- Centro Sclerosi Multipla, ASST Spedali Civili di Brescia, Ospedale di Montichiari, Brescia, Italy
| | - L M Streito
- San Luigi Gonzaga Academic Hospital, Orbassano, TO 10043, Italy
| | - G Abbadessa
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - S Bucello
- Multiple Sclerosis Centre, "E. Muscatello" Hospital - ASP8, Augusta, SR, Italy
| | - E Ferraro
- S. Filippo Neri Hospital, Rome, Italy
| | - M Mattioli
- NCL-Istituto di Neuroscienze Gruppo Neuromed, Rome, Italy
| | - A Chiodi
- Intradepartmental Program of Clinical Psychology, Federico II University Hospital, Naples, Italy
| | - M Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Clerico
- San Luigi Gonzaga Academic Hospital, Orbassano, TO 10043, Italy; Department of Clinical and Biological Sciences, University of Torino, Torino 10128, Italy
| | - C Cordioli
- Centro Sclerosi Multipla, ASST Spedali Civili di Brescia, Ospedale di Montichiari, Brescia, Italy
| | - L Moiola
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - F Patti
- Department "G.F. Ingrassia", MS Center, University of Catania, Catania, Italy
| | - L Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - M Filippi
- Multiple Sclerosis Center, Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - G Borriello
- MS Center, San Pietro Hospital Fatebenefratelli, Rome, Italy
| | - E D'Amico
- Department "G.F. Ingrassia", MS Center, University of Catania, Catania, Italy
| | - C Pozzilli
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - V Brescia Morra
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy
| | - R Lanzillo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Naples 810145, Italy.
| |
Collapse
|
3
|
Turrini M. "There Are Many of Us": Online Testimonies From "Pill Victims" as a New Form of Health Activism. Qual Health Res 2023; 33:567-577. [PMID: 37014711 DOI: 10.1177/10497323231163741] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The French pill scare is usually presented as a "media debate" triggered by the case of Marion Larat, a young woman who suffered a stroke attributed to the pill she was taking. This article intends to focus on a practice that preceded, accompanied, and followed this health scare: the publication of online testimonies of thrombotic reactions posted on the website of the French Association of Victims of Pulmonary Embolism and Stroke Associated with Hormonal Contraception (Avep). Through a discourse analysis, we intend to analyze these online public self-reports as an activist practice aimed at criticizing the dominant medical discourse on contraception. Four discursive frames emerged: unpreparedness of women and doctors, denial of blame and search for the cause, breaking the silence and building solidarity, and collective action. The first two frames concern the process women put in place to obtain the right to speak about and criticize a medical practice. The right to speak is achieved through a concise narrative style focusing on facts, bodily manifestations, and risk factors. The second pair refers to the formation of pill victims as subjects with an ambivalent status and ephemeral agency. The testimonies build what we call "lone solidarity", that is, the creation of a social bond and action around a common experience of witnessing medical injustice that develops without any exchange between members. This proves to be inclusive and viral, but at the same time fiercely anti-representational with respect to political struggles or social identification.
Collapse
Affiliation(s)
- Mauro Turrini
- Institute of Public Goods and Policies (IPP), Spanish National Research Council (CSIC), Madrid, Spain
| |
Collapse
|
4
|
Lanino L, Restuccia F, Perego A, Ubezio M, Fattizzo B, Riva M, Consagra A, Musto P, Cilloni D, Oliva EN, Palmieri R, Poloni A, Califano C, Capodanno I, Itri F, Elena C, Fozza C, Pane F, Pelizzari AM, Breccia M, Di Bassiano F, Crisà E, Ferrero D, Giai V, Barraco D, Vaccarino A, Griguolo D, Minetto P, Quintini M, Paolini S, Sanpaolo G, Sessa M, Bocchia M, Di Renzo N, Diral E, Leuzzi L, Genua A, Guarini A, Molteni A, Nicolino B, Occhini U, Rivoli G, Bono R, Calvisi A, Castelli A, Di Bona E, Di Veroli A, Ferrara F, Fianchi L, Galimberti S, Grimaldi D, Marchetti M, Norata M, Frigeni M, Sancetta R, Selleri C, Tanasi I, Tosi P, Turrini M, Giordano L, Finelli C, Pasini P, Naldi I, Santini V, Della Porta MG. Real-world efficacy and safety of luspatercept and predictive factors of response in patients with lower risk myelodysplastic syndromes with ring sideroblasts. Am J Hematol 2023. [PMID: 37222267 DOI: 10.1002/ajh.26960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/25/2023]
Affiliation(s)
- Luca Lanino
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | - Marta Ubezio
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Bruno Fattizzo
- SC Ematologia, IRCCS Ca' Granda Ospedale Maggiore Policlinico & Dipartimento di Oncologia ed Emato-oncologia, University of Milan, Milan, Italy
| | - Marta Riva
- S.C. Ematologia, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angela Consagra
- MDS Unit, Dipartimento Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Pellegrino Musto
- Dipartimento di Medicina di Precisione e Rigenerativa e Area Ionica, Università degli Studi "Aldo Moro", AOU Consorziale Policlinico, Bari, Italy
| | - Daniela Cilloni
- AO Ordine Mauriziano, Università degli Studi di Torino, Turin, Italy
| | - Esther Natalie Oliva
- UOC Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | | | - Antonella Poloni
- Università Politecnica Marche, UOC Ematologia, AOU Marche, Ancona, Italy
| | | | - Isabella Capodanno
- Azienda Unità Sanitaria Locale- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federico Itri
- AOU San Luigi Gonzaga, SCDU Medicina Interna ad Indirizzo Ematologico, Università degli Studi di Torino, Torino, Italy
| | - Chiara Elena
- UOC Ematologia1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Fozza
- Dipartimento di Medicina, Chirurgia e Farmacia, Università di Sassari, Sassari, Italy
| | - Fabrizio Pane
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | | | | | | | - Elena Crisà
- AOU Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy
| | - Dario Ferrero
- SC Ematologia, AOU Città della Salute e della Scienza, Torino, Italy
| | - Valentina Giai
- SC Ematologia, AOU Città della Salute e della Scienza, Torino, Italy
| | - Daniela Barraco
- SC Ematologia, Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
| | | | - Davide Griguolo
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale Maggiore, Trieste, Italy
| | - Paola Minetto
- Clinica Ematologica, IRCCS-Policlinico San Martino, Genoa, Italy
| | - Martina Quintini
- Azienda Ospedaliera di Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Stefania Paolini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Grazia Sanpaolo
- UOC Ematologia e Trapianto di Cellule Staminali Emopoietiche - Ospedale Casa Sollievo della Sofferenza, IRCCS San Giovanni Rotondo, San Giovanni Rotondo, Italy
| | - Mariarosaria Sessa
- Hematology Section, Department of Medical Sciences, Azienda Ospedaliero-Universitaria, Arcispedale S.Anna, University of Ferrara, Ferrara, Italy
| | - Monica Bocchia
- UOC Ematologia, Azienda Ospedaliero Universitaria Senese, Università di Siena, Siena, Italy
| | - Nicola Di Renzo
- UOC Ematologia e Trapianto di Cellule Staminali P.O. "Vito Fazzi" -ASL Lecce, Lecce, Italy
| | - Elisa Diral
- Unità di Ematologia e Trapianto di Midollo Osseo, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Livia Leuzzi
- SC Oncologia, SS Oncoematologia, PO Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | | | | | - Barbara Nicolino
- SSD Ematologia, ASLTO4 Presidio Ospedaliero di Ivrea, Ivrea, Italy
| | | | - Giulia Rivoli
- IRCCS Ospedale Policlinico San Martino, U.O Ematologia e terapie Cellulari, Genoa, Italy
| | - Roberto Bono
- A.O.O.R Villa Sofia - Cervello, U.O.S.D. Unità Trapianti di Midollo Osseo, Palermo, Italy
| | - Anna Calvisi
- U.O.C. Ematologia - CTMO Ospedale San Francesco, Nuoro, Italy
| | | | - Eros Di Bona
- Oncoematologia, AULSS 7 Pedemontana, Bassano del Grappa, Italy
| | | | | | - Luana Fianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Sara Galimberti
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | | | - Monia Marchetti
- Hematology Unit, AO Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marianna Norata
- Hematology Unit, IRCCS - Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Marco Frigeni
- Dipartimento di Oncologia ed Ematologia, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Carmine Selleri
- UOC Ematologia, AOU San Giovanni Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy
| | - Ilaria Tanasi
- U.O.C. di Ematologia Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Patrizia Tosi
- UO Ematologia Ospedale Infermi Rimini, Rimini, Italy
| | - Mauro Turrini
- Division of Hematology, Valduce Hospital, Como, Italy
| | - Laura Giordano
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Carlo Finelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Paolo Pasini
- AIPASIM (Associazione Italiana Pazienti con Sindrome Mielodisplastica), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ilaria Naldi
- MDS Unit, Dipartimento Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Valeria Santini
- MDS Unit, Dipartimento Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Matteo Giovanni Della Porta
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| |
Collapse
|
5
|
Nardini C, Candelise L, Turrini M, Addimanda O. Semi-automated socio-anthropologic analysis of the medical discourse on rheumatoid arthritis: Potential impact on public health. PLoS One 2022; 17:e0279632. [PMID: 36580470 PMCID: PMC9799325 DOI: 10.1371/journal.pone.0279632] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The debilitating effects of noncommunicable diseases (NCDs) and the accompanying chronic inflammation represent a significant obstacle for the sustainability of our development, with efforts spreading worldwide to counteract the diffusion of NCDs, as per the United Nations Sustainable Development Goals (SDG 3). In fact, despite efforts of varied intensity in numerous directions (from innovations in biotechnology to lifestyle modifications), the incidence of NCDs remains pandemic. The present work wants to contribute to addressing this major concern, with a specific focus on the fragmentation of medical approaches, via an interdisciplinary analysis of the medical discourse, i.e. the heterogenous reporting that biomedical scientific literature uses to describe the anti-inflammatory therapeutic landscape in NCDs. The aim is to better capture the roots of this compartmentalization and the power relations existing among three segregated pharmacological, experimental and unstandardized biomedical approaches to ultimately empower collaboration beyond medical specialties and possibly tap into a more ample and effective reservoir of integrated therapeutic opportunities. METHOD Using rheumatoid arthritis (RA) as an exemplar disease, twenty-eight articles were manually translated into a nine-dimensional categorical variable of medical socio-anthropological relevance, relating in particular (but not only) to legitimacy, temporality and spatialization. This digitalized picture (9 x 28 table) of the medical discourse was further analyzed by simple automated learning approaches to identify differences and highlight commonalities among the biomedical categories. RESULTS Interpretation of these results provides original insights, including suggestions to: empower scientific communication between unstandardized approaches and basic biology; promote the repurposing of non-pharmacological therapies to enhance robustness of experimental approaches; and align the spatial representation of diseases and therapies in pharmacology to effectively embrace the systemic approach promoted by modern personalized and preventive medicines. We hope this original work can expand and foster interdisciplinarity among public health stakeholders, ultimately contributing to the achievement of SDG3.
Collapse
Affiliation(s)
- Christine Nardini
- Consiglio Nazionale delle Ricerche, Istituto per le Applicazioni del Calcolo "Mauro Picone", Roma, Italy
- * E-mail: (CN); (LC); (MT)
| | - Lucia Candelise
- ISS, Istitut Sciences Sociales, Université de Lausanne, Lausanne, Switzerland
- CEPED, Centre Population et Développement, Université de Paris, Paris, France
- * E-mail: (CN); (LC); (MT)
| | - Mauro Turrini
- Institute of Public Goods and Policies (IPP), Spanish National Research Council (CSIC), Madrid, Spain
- * E-mail: (CN); (LC); (MT)
| | - Olga Addimanda
- UOC Medicina Interna ad Indirizzo Reumatologico, Ospedale Maggiore, AUSL Bologna, Bologna, Italy
| |
Collapse
|
6
|
Marasco V, Piciocchi A, Candoni A, Pagano L, Guidetti A, Musto P, Bruna R, Bocchia M, Visentin A, Turrini M, Tucci A, Pilerci S, Fianchi L, Salvini M, Galimberti S, Coviello E, Selleri C, Luppi M, Crea E, Fazi P, Passamonti F, Corradini P. Neutralizing monoclonal antibodies in haematological patients paucisymptomatic for COVID-19: The GIMEMA EMATO-0321 study. Br J Haematol 2022; 199:54-60. [PMID: 35906881 PMCID: PMC9796521 DOI: 10.1111/bjh.18385] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 01/01/2023]
Abstract
COVID-19 continues to be a relevant issue among patients with haematological malignancies (HM). Vaccines are frequently not effective in subjects on active treatment. In this multicentre retrospective study of Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA), we collected data from 91 paucisymptomatic HM patients treated with anti-spike neutralizing monoclonal antibodies (nMoAbs) to determine time to viral clearance, referencing it to the expected value of 28 days from an historical group of untreated paucisymptomatic patients. Secondary endpoints included rate of hospitalization, intensive care unit (ICU) admission, COVID-19 related death and safety. SARS-CoV-2 molecular swab negativity was obtained in 86 patients (95%), with a median time of 18 days (IQR 13-26; p < 0.0001). We did not find significant variations according to age, diagnosis, treatment type, vaccination status or nMoAbs type. Rate of hospitalization due to COVID-19 progression was 12% (11/91), with 2 patients (2.2%) requiring ICU admission. With a median follow-up of 2.33 months, the overall mortality was 5.5% (5/91), with 3 deaths due to COVID-19. Side effects were rare and self-limiting. Our data suggest that nMoAbs can limit the detrimental effect of immunosuppressive treatments on COVID-19 clinical progression and time to viral clearance. The original trial was registered at www.clinicaltrials.gov as #NCT04932967.
Collapse
Affiliation(s)
- Vincenzo Marasco
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei TumoriUniversity of MilanoMilanItaly
| | | | - Anna Candoni
- Division of Hematology and Stem Cell TransplantationAzienda Sanitaria‐Universitaria Friuli Centrale, ASUFCUdineItaly
| | - Livio Pagano
- Hematology UnitFondazione Policlinico Universitario Agostino Gemelli ‐ IRCCSRomeItaly,Hematology UnitUniversità Cattolica del Sacro CuoreRomeItaly
| | - Anna Guidetti
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei TumoriUniversity of MilanoMilanItaly
| | - Pellegrino Musto
- Department of Emergency and Organ Transplantation"Aldo Moro" University School of MedicineBariItaly,Unit of Hematology and Stem Cell TransplantationAOU Consorziale PoliclinicoBariItaly
| | - Riccardo Bruna
- Division of Hematology, Department of Translational MedicineUniversity of Eastern Piedmont and Ospedale Maggiore della CaritàNovaraItaly
| | - Monica Bocchia
- Hematology Unit, University of SienaAzienda Ospedaliero Universitaria SeneseSienaItaly
| | - Andrea Visentin
- University of PadovaHematology and Clinical Immunology unit, Department of MedicinePaduaItaly
| | | | - Alessandra Tucci
- Department of HematologyAzienda Ospedaliera Spedali Civili di BresciaBresciaItaly
| | - Sofia Pilerci
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Luana Fianchi
- Hematology UnitFondazione Policlinico Universitario Agostino Gemelli – IRCCSRomeItaly
| | - Marco Salvini
- ASST Sette LaghiOspedale di Circolo of VareseVareseItaly
| | - Sara Galimberti
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Elisa Coviello
- Hematology and bone marrow transplantIstituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San MartinoGenoaItaly
| | - Carmine Selleri
- Hematology, Ospedale San Giovanni di Dio e Ruggi D'AragonaSalernoItaly
| | - Mario Luppi
- Department of Medical and Surgical SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | | | | | - Francesco Passamonti
- ASST Sette LaghiOspedale di Circolo of VareseVareseItaly,Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - Paolo Corradini
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei TumoriUniversity of MilanoMilanItaly
| |
Collapse
|
7
|
Zappasodi P, Cattaneo C, Valeria Ferretti V, Mina R, José María Ferreri A, Merli F, Oberti M, Krampera M, Romano A, Zerbi C, Ferrari J, Cavo M, Salvini M, Bertù L, Stefano Fracchiolla N, Marchesi F, Massaia M, Marasco V, Cairoli R, Maria Scattolin A, Maria Vannucchi A, Gambacorti‐Passerini C, Musto P, Gherlinzoni F, Cuneo A, Pinto A, Trentin L, Bocchia M, Galimberti S, Coviello E, Chiara Tisi M, Morotti A, Falini B, Turrini M, Tafuri A, Billio A, Gentile M, Massimo Lemoli R, Venditti A, Giovanni Della Porta M, Lanza F, Rigacci L, Tosi P, Mohamed S, Corso A, Luppi M, Giuliani N, Busca A, Pagano L, Bruno R, Antonio Grossi P, Corradini P, Passamonti F, Arcaini L. Secondary infections worsen the outcome of COVID-19 in patients with hematological malignancies: A report from the ITA-HEMA-COV. Hematol Oncol 2022; 40:846-856. [PMID: 35854643 PMCID: PMC9349965 DOI: 10.1002/hon.3048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/13/2022]
Abstract
The impact of secondary infections (SI) on COVID-19 outcome in patients with hematological malignancies (HM) is scarcely documented. To evaluate incidence, clinical characteristics, and outcome of SI, we analyzed the microbiologically documented SI in a large multicenter cohort of adult HM patients with COVID-19. Among 1741 HM patients with COVID-19, 134 (7.7%) had 185 SI, with a 1-month cumulative incidence of 5%. Median time between COVID-19 diagnosis and SI was 16 days (IQR: 5-36). Acute myeloid leukemia (AML) and lymphoma/plasma cell neoplasms (PCN) were more frequent diagnoses in SI patients compared to patients without SI (AML: 14.9% vs. 7.1%; lymphoma/PCN 71.7% vs. 65.3%). Patients with SI were older (median age 70 vs. 66 years, p = 0.002), with more comorbidities (median Charlson Comorbidity Index 5 vs. 4, p < 0.001), higher frequency of critical COVID-19 (19.5% vs. 11.5%, p = 0.046), and more frequently not in complete remission (75% vs. 64.7% p = 0.024). Blood and bronchoalveolar lavage were the main sites of isolation for SI. Etiology of infections was bacterial in 80% (n = 148) of cases, mycotic in 9.7% (n = 18) and viral in 10.3% (n = 19); polymicrobial infections were observed in 24 patients (18%). Escherichia coli represented most of Gram-negative isolates (18.9%), while coagulase-negative Staphylococci were the most frequent among Gram-positive (14.2%). The 30-day mortality of patients with SI was higher when compared to patients without SI (69% vs. 15%, p < 0.001). The occurrence of SI worsened COVID-19 outcome in HM patients. Timely diagnosis and adequate management should be considered to improve their prognosis.
Collapse
Affiliation(s)
- Patrizia Zappasodi
- Division of Hematology, Fondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Chiara Cattaneo
- Division of HematologyAzienda Socio‐Sanitaria Territoriale‐Spedali CiviliBresciaItaly
| | | | - Roberto Mina
- SSD Clinical Trial in Oncoematologia e Mieloma MultiploDivision of HematologyUniversity of TorinoAzienda Ospedaliero‐Universitaria Città della Salute e della Scienza di TorinoTorinoItaly
| | - Andrés José María Ferreri
- Division of HematologyIstituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific InstituteMilanItaly
| | - Francesco Merli
- Division of Hematology, AUSL‐IRCCS Reggio EmiliaReggio EmiliaItaly
| | - Margherita Oberti
- Division of Hematology and Transplant UnitASST Spedali CiviliBresciaItaly
| | - Mauro Krampera
- Division of HematologyAzienda Ospedaliera Integrata di VeronaVeronaItaly
| | - Alessandra Romano
- Division of Hematology and Bone Marrow TransplantationAzienda Ospedaliera Universitaria Policlinico “G. Rodolico—San Marco”CataniaItaly
| | - Caterina Zerbi
- Department of Molecular MedicineUniversity of PaviaPaviaItaly
| | | | - Michele Cavo
- Division of HematologyAzienda Ospedaliero‐Universitaria Policlinico S. Orsola‐MalpighiBolognaItaly
| | - Marco Salvini
- UOC Ematologia, Azienda Socio‐Sanitaria Territoriale Sette Laghi, Ospedale di Circolo of VareseVareseItaly,Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - Lorenza Bertù
- UOC Ematologia, Azienda Socio‐Sanitaria Territoriale Sette Laghi, Ospedale di Circolo of VareseVareseItaly,Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | | | | | | | - Vincenzo Marasco
- Division of HematologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei TumoriUniversity of MilanMilanItaly
| | - Roberto Cairoli
- HematologyAzienda Socio‐Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Anna Maria Scattolin
- Division of HematologyAzienda Unità Locale Socio‐Sanitaria 3 SerenissimaOspedale dell'AngeloVenezia‐MestreVeniceItaly
| | | | | | - Pellegrino Musto
- Department of Emergency and Organ Transplantation“Aldo Moro” University School of Medicine and Unit of Hematology and Stem Cell Transplantation, AOUC PoliclinicoBariItaly
| | | | - Antonio Cuneo
- Division of HematologyAzienda Ospedaliero Universitaria Arcispedale S. AnnaFerraraItaly
| | - Antonello Pinto
- Hematology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico “Fondazione G Pascale,” NaplesNaplesItaly
| | - Livio Trentin
- Division of HematologyAzienda Ospedaliera di PadovaPadovaItaly
| | - Monica Bocchia
- Division of HematologyPoliclinico Santa Maria alle ScotteSienaItaly
| | - Sara Galimberti
- Division of HematologyAzienda Ospedaliera Universitaria Pisana‐ Santa ChiaraPisaItaly
| | - Elisa Coviello
- Ematologia e terapie cellulari. IRCCS Ospedale Policlinico San MartinoGenovaItaly
| | | | - Alessandro Morotti
- Department of Clinical and Biological SciencesUniversity of TorinoOrbassanoItaly
| | - Brunangelo Falini
- Division of Hematology and Transplant UnitAzienda Ospedaliera di PerugiaPerugiaItaly
| | | | - Agostino Tafuri
- Division of HematologyUniversity Hospital Sant'AndreaSapienzaRomeItaly
| | - Atto Billio
- Division of Hematology and Transplant UnitOspedale di BolzanoBolzanoItaly
| | - Massimo Gentile
- Division of HematologyAzienda Ospedaliera di CosenzaCosenzaItaly
| | - Roberto Massimo Lemoli
- Department of Internal Medicine (DiMI)Clinic of Hematology, University of GenoaGenoaItaly,IRCCS‐ San Martino HospitalGenoaItaly
| | - Adriano Venditti
- Department of Biomedicine and PreventionUniversity Tor Vergata RomeRomeItaly
| | - Matteo Giovanni Della Porta
- Division of Hematology, Humanitas Clinical and Research Hospital Istituto di Ricovero e Cura a Carattere Scientifico and Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Francesco Lanza
- Division of HematologyOspedale Santa Maria delle CrociRavennaItaly
| | - Luigi Rigacci
- Division of Hematology and Transplant Unit, Azienda Ospedaliera S. Camillo‐ForlaniniRomeItaly
| | - Patrizia Tosi
- Division of HematologyOspedale degli InfermiRiminiItaly
| | - Sara Mohamed
- SC EmatologiaAzienda Sanitaria Universitaria Giuliano IsontinaTriesteItaly
| | | | - Mario Luppi
- Department of Medical and Surgical SciencesUNIMORE. Division of Hematology Azienda Ospedaliero Universitaria ModenaModenaItaly
| | - Nicola Giuliani
- Division of Hematology and Transplant UnitAzienda Ospedaliero‐Universitaria di ParmaSItaly
| | - Alessandro Busca
- SSD Clinical Trial in Oncoematologia e Mieloma MultiploDivision of HematologyUniversity of TorinoAzienda Ospedaliero‐Universitaria Città della Salute e della Scienza di TorinoTorinoItaly
| | - Livio Pagano
- Division of HematologyFondazione Policlinico Universitario Agostino Gemelli ‐ Istituto di Ricovero e Cura a Carattere ScientificoRomeItaly,Hematology, Università Cattolica del Sacro CuoreRomeItaly
| | - Raffaele Bruno
- Division of Infectious and Tropical DiseasesFondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San MatteoPaviaItaly,Department of ClinicalSurgical, Diagnostic, and Paediatric SciencesUniversity of PaviaPaviaItaly
| | - Paolo Antonio Grossi
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly,Division of Infectious and Tropical DiseasesAzienda Socio‐Sanitaria Territoriale Sette Laghi, Ospedale di Circolo of VareseVareseItaly
| | - Paolo Corradini
- Division of HematologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei TumoriUniversity of MilanMilanItaly
| | - Francesco Passamonti
- UOC Ematologia, Azienda Socio‐Sanitaria Territoriale Sette Laghi, Ospedale di Circolo of VareseVareseItaly,Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San MatteoPaviaItaly,Department of Molecular MedicineUniversity of PaviaPaviaItaly
| | | |
Collapse
|
8
|
Bocchia M, Carella AM, Mulè A, Rizzo L, Turrini M, Abbenante MC, Cairoli R, Calafiore V, Defina M, Gardellini A, Luzi G, Patti C, Pinazzi MB, Riva M, Rossi G, Sammartano V, Rigacci L. Therapeutic Management of Patients with FLT3 + Acute Myeloid Leukemia: Case Reports and Focus on Gilteritinib Monotherapy. Pharmgenomics Pers Med 2022; 15:393-407. [PMID: 35496349 PMCID: PMC9041600 DOI: 10.2147/pgpm.s346688] [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: 10/28/2021] [Accepted: 04/04/2022] [Indexed: 12/26/2022] Open
Abstract
Acute myeloid leukemia is a malignant disorder of the bone marrow, characterized by differentiation, clonal expansion, and uncontrolled proliferation of malignant myeloid progenitor cells and by several molecular and genetic abnormalities. A mutation of FMS-like tyrosine kinase 3 gene can be observed in about one-third of cases of acute myeloid leukemia. Two FLT3 inhibitors are actually approved for FLT3 mutated acute myeloid leukemia: midostaurin, a multikinase first generation inhibitor with lower affinity for FLT3 binding, and gilteritinib fumarate, a potent second-generation inhibitor of both FLT3-ITD and TKD. Gilteritinib is a new effective and well-tolerated drug for patients with relapsing or refractory FLT3-positive acute myeloid leukemia. Thanks to its efficacy, low toxicity, its good manageability (oral formulation), this drug is suitable for all the patients, including elderly frail patient with concomitant therapies or pre-existing or underlying diseases, and can be used also in the outpatient setting, reducing risks and costs related to the hospitalization. We report and discuss seven cases of different patients with FLT3 positive acute myeloid leukemia successfully managed with gilteritinib in the real clinical practice.
Collapse
Affiliation(s)
- Monica Bocchia
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Angelo Michele Carella
- Division of Hematology with Hematologic Intensive Care Unit and Cellular Therapies, Department of Medical Science, Fondazione IRCCS Casa Sollievo Della Sofferenza, Foggia, Italy
- Correspondence: Angelo Michele Carella, Division of Hematology with Hematologic Intensive Care Unit and Cellular Therapies, Department of Medical Science, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo, Foggia, 71013, Italy, Tel +390882410054, Fax +390882410322, Email
| | - Antonino Mulè
- UOC Hematology and Oncology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Lorenzo Rizzo
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mauro Turrini
- Division of Hematology, Valduce Hospital, Como, Italy
| | - Maria Chiara Abbenante
- Division of Hematology with Hematologic Intensive Care Unit and Cellular Therapies, Department of Medical Science, Fondazione IRCCS Casa Sollievo Della Sofferenza, Foggia, Italy
| | - Roberto Cairoli
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valeria Calafiore
- UOC Hematology and Oncology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Marzia Defina
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Giovanni Luzi
- UOC Hematology and Stem Cell Transplant Unit, Ospedale S, Camillo, Rome, Italy
| | - Caterina Patti
- UOC Hematology and Oncology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | - Marta Riva
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Rossi
- Division of Hematology with Hematologic Intensive Care Unit and Cellular Therapies, Department of Medical Science, Fondazione IRCCS Casa Sollievo Della Sofferenza, Foggia, Italy
| | - Vincenzo Sammartano
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Luigi Rigacci
- UOC Hematology and Stem Cell Transplant Unit, Ospedale S, Camillo, Rome, Italy
| |
Collapse
|
9
|
Giannandrea D, Platonova N, Colombo M, Mazzola M, Citro V, Adami R, Maltoni F, Ancona S, Dolo V, Giusti I, Basile A, Pistocchi A, Cantone L, Bollati V, Casati L, Calzavara E, Turrini M, Lesma E, Chiaramonte R. Extracellular vesicles mediate the communication between multiple myeloma and bone marrow microenvironment in a NOTCH dependent way. Haematologica 2022; 107:2183-2194. [PMID: 35263984 PMCID: PMC9425323 DOI: 10.3324/haematol.2021.279716] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Indexed: 11/24/2022] Open
Abstract
Multiple myeloma (MM) is an incurable hematologic neoplasm, whose poor prognosis is deeply affected by the propensity of tumor cells to localize in the bone marrow (BM) and induce the protumorigenic activity of normal BM cells, leading to events associated with tumor progression, including tumor angiogenesis, osteoclastogenesis, and the spread of osteolytic bone lesions. The interplay between MM cells and the BM niche does not only rely on direct cell-cell interaction, but a crucial role is also played by MM-derived extracellular vesicles (MM-EV). Here, we demonstrated that the oncogenic NOTCH receptors are part of MM-EV cargo and play a key role in EV protumorigenic ability. We used in vitro and in vivo models to investigate the role of EV-derived NOTCH2 in stimulating the protumorigenic behavior of endothelial cells and osteoclast progenitors. Importantly, MM-EV can transfer NOTCH2 between distant cells and increase NOTCH signaling in target cells. MM-EV stimulation increases endothelial cell angiogenic ability and osteoclast differentiation in a NOTCH2-dependent way. Indeed, interfering with NOTCH2 expression in MM cells may decrease the amount of NOTCH2 also in MM-EV and affect their angiogenic and osteoclastogenic potential. Finally, we demonstrated that the pharmacologic blockade of NOTCH activation by γ-secretase inhibitors may hamper the biological effect of EV derived by MM cell lines and by the BM of MM patients. These results provide the first evidence that targeting the NOTCH pathway may be a valid therapeutic strategy to hamper the protumorigenic role of EV in MM as well as other tumors.
Collapse
Affiliation(s)
| | | | - Michela Colombo
- Department of Health Sciences, Università degli Studi di Milano
| | - Mara Mazzola
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano
| | - Valentina Citro
- Department of Health Sciences, Università degli Studi di Milano
| | - Raffaella Adami
- Department of Health Sciences, Università degli Studi di Milano
| | - Filippo Maltoni
- Department of Health Sciences, Università degli Studi di Milano
| | - Silvia Ancona
- Department of Health Sciences, Università degli Studi di Milano
| | - Vincenza Dolo
- Department of Life, Health and Environment Sciences, Università degli Studi dell'Aquila
| | - Ilaria Giusti
- Department of Life, Health and Environment Sciences, Università degli Studi dell'Aquila
| | - Andrea Basile
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano
| | - Anna Pistocchi
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano
| | - Laura Cantone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano
| | - Valentina Bollati
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano
| | - Lavinia Casati
- Department of Health Sciences, Università degli Studi di Milano
| | | | | | - Elena Lesma
- Department of Health Sciences, Università degli Studi di Milano
| | | |
Collapse
|
10
|
Gardellini A, Guidotti F, Zancanella M, Maino E, Steffanoni S, Turrini M. Lichen planopilaris-like eruption in chronic myeloid leukemia patient during treatment with nilotinib as second-line therapy. J Oncol Pharm Pract 2022; 28:969-971. [PMID: 35037787 DOI: 10.1177/10781552211073957] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Chronic myeloid leukemia (CML) is a malignant clonal disorder of hematopoietic stem cells characterized by a translocation of genetic material between chromosomes 9 and 22 resulting in the BCR-ABL fusion oncogene expression. Nilotinib is a potent second-generation tyrosine kinase inhibitor available as first line treatment. Among side effects QTc interval prolongation, pancreatitis, metabolic disorders and skin reactions are the most commonly seen. CASE REPORT Here we describe a rare case of lichen planopilaris eruption that developed during therapy with nilotinib. MANAGEMENT & OUTCOME Nilotinib dosage was reduced together with introduction of hydroxychloroquine with progressive improvement of alopecia. DISCUSSION Collaboration with dermatologist and nilotinib dose reduction allowed to continue the drug maintaining major molecular response and patient's quality of life.
Collapse
Affiliation(s)
- Angelo Gardellini
- Division of Hematology, Department of Medicine, 9349Valduce Hospital, Como, Italy
| | - Francesca Guidotti
- Division of Hematology, Department of Medicine, 9349Valduce Hospital, Como, Italy
| | - Michelle Zancanella
- Division of Hematology, Department of Medicine, 9349Valduce Hospital, Como, Italy
| | - Elena Maino
- Division of Hematology, Department of Medicine, 9349Valduce Hospital, Como, Italy
| | - Sara Steffanoni
- Division of Hematology, Department of Medicine, 9349Valduce Hospital, Como, Italy
| | - Mauro Turrini
- Division of Hematology, Department of Medicine, 9349Valduce Hospital, Como, Italy
| |
Collapse
|
11
|
Gardellini A, Guidotti F, Feltri M, Zancanella M, Maino E, Ambrosiani L, Turrini M. Eltrombopag as second line treatment in patients with primary immune thrombocytopenia: A single center real life experience. Blood Cells Mol Dis 2021; 92:102620. [PMID: 34715450 DOI: 10.1016/j.bcmd.2021.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 10/20/2022]
Abstract
Glucocorticoid treatment is the standard initial therapy for patients with immune thrombocytopenia (ITP). Despite a rate of 60-80% of initial remissions, only 30 to 50% of adults have a sustained response after discontinuation. Second line options are splenectomy, thrombopoietin-receptor agonists (TPO-RAs), rituximab and intravenous immunoglobulin. Third line treatments include a mix of immunosuppressive drugs (e.g. azathioprine, ciclosporin, etc.). Recently international guidelines have proposed a treatment algorithm formalizing TPO-RAs and splenectomy as second and third line respectively, confirming splenectomy as second line choice only in emergency. Here we present a single center observational retrospective study of eltrombopag as second line treatment. We evaluated 48 adult primary chronic ITP patients since 2003. Forty-four out of 48 patients received a first line treatment with glucocorticoids. Twenty-two (61%) patients needed a second line treatment: 18 received eltrombopag, 3 a second course of steroid and one patient underwent splenectomy. Every patient before starting eltrombopag or receiving splenectomy underwent bone marrow examination. Overall response rate to eltrombopag was 94% with a CR rate of 76% and a PR of 23%; only one patient was non responder, underwent splenectomy and received subsequent treatment with rituximab, romiplostim and cyclosporin obtaining CR. One patient developed an autoimmune pancytopenia about a month after starting TPO-RA and in addition to eltrombopag received steroid and rituximab with blood count improvement. After a median follow up of 21,1 months (range 0,4-64,7 months) 16 patients (89%) are still on therapy maintaining response. As regards safety, gastrointestinal side effects were rare and low grade; only one patient discontinued eltrombopag after few weeks, because of dizziness. One patient had a relapse of deep venous thrombosis while no major bleeding complications were observed. Our real-life single center experience confirms efficacy and safety of eltrombopag as second line treatment in chronic ITP patients.
Collapse
Affiliation(s)
- Angelo Gardellini
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Francesca Guidotti
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy.
| | | | - Michelle Zancanella
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Elena Maino
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | | | - Mauro Turrini
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| |
Collapse
|
12
|
Gardellini A, Guidotti F, Maino E, Steffanoni S, Zancanella M, Turrini M. Severe immune thrombocytopenia after COVID-19 vaccination: Report of four cases and review of the literature. Blood Cells Mol Dis 2021; 92:102615. [PMID: 34653943 PMCID: PMC8494992 DOI: 10.1016/j.bcmd.2021.102615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Angelo Gardellini
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Francesca Guidotti
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy.
| | - Elena Maino
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Sara Steffanoni
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Michelle Zancanella
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Mauro Turrini
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| |
Collapse
|
13
|
Vannucchi AM, Mortara A, D’Alessio A, Morelli M, Tedeschi A, Festuccia MB, Monforte AD, Capochiani E, Selleri C, Simonetti F, Saracino A, Rapezzi D, Badagliacca MR, Falasca K, Molteni A, Palazzolo R, Schettino G, Bocchia M, Turrini M, Ascierto PA, Zuurman M, Paley C, Coco P, Saglio G. JAK Inhibition with Ruxolitinib in Patients with COVID-19 and Severe Pneumonia: Multicenter Clinical Experience from a Compassionate Use Program in Italy. J Clin Med 2021; 10:jcm10163752. [PMID: 34442045 PMCID: PMC8397012 DOI: 10.3390/jcm10163752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022] Open
Abstract
Jak inhibitors are potent anti-inflammatory drugs that have the potential to dampen the hyperactive inflammatory response associated with severe COVID-19. We reviewed the clinical outcomes of 218 patients with COVID-19 hospitalized for severe pneumonia and treated with ruxolitinib through a compassionate use program. Data on the duration of treatment; outcomes at 4, 7, 14, and 28 days; oxygen support requirements; clinical status; and laboratory parameters were retrospectively collected. Overall, according to the physician evaluation, 66.5% of patients showed improvement at follow-up; of these, 83.5% showed improvement by day 7. Oxygen support status also showed improvement, and by day 7, 21.6% of patients were on ambient air, compared with 1.4% at baseline, which increased to 48.2% by day 28. Significant decreases in C-reactive protein and increases in the lymphocyte total count were already observed by day 4, which seemed to correlate with a positive outcome. At the end of the observation period, 87.2% of patients were alive. No unexpected safety findings were observed, and grade 3/4 adverse events were reported in 6.9% of patients.
Collapse
Affiliation(s)
- Alessandro Maria Vannucchi
- Center Research Innovation of Myeloproliferative Neoplasms (CRIMM), SOD Hematology, University of Florence and AOU Careggi, 50134 Florence, Italy;
| | - Andrea Mortara
- Department of Clinical Cardiology, Policlinico di Monza, 28100 Monza, Italy;
| | - Andrea D’Alessio
- COVID Medical Department, Policlinico S. Marco, Gruppo San Donato University and Research Hospital, 24040 Zingonia, Italy;
| | - Mara Morelli
- Novartis Farma SpA, 21040 Origgio, Italy; (M.M.); (M.Z.); (P.C.)
| | - Alberto Tedeschi
- U.O.C. Medicina Generale, Ospedale Bolognini, ASST Bergamo Est, 24068 Seriate, Italy;
| | | | | | - Enrico Capochiani
- UOC Ematologia, Azienda USL Toscana Nord Ovest, 57124 Livorno, Italy;
| | - Carmine Selleri
- Hematology, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy;
| | | | - Annalisa Saracino
- Clinica Malattie Infettive, Dip. Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari, 70124 Bari, Italy;
| | - Davide Rapezzi
- S.C. Ematologia Ospedale S. Croce e Carle, 12100 Cuneo, Italy;
| | - Maria Rita Badagliacca
- UOS UFA UOC Farmacia Ospedaliera Distretto Ospedaliero CL1-P.O.S. Elia, Azienda Sanitaria Provinciale di Caltanissetta, 93100 Caltanissetta, Italy;
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University G. d’Annunzio, Chieti-Pescara, 66100 Chieti, Italy;
| | | | | | | | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy;
| | - Mauro Turrini
- Division of Hematology, Department of Medicine, Valduce Hospital, 22100 Como, Italy;
| | - Paolo A. Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale per lo Studio e la Cura dei Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy;
| | - Mike Zuurman
- Novartis Farma SpA, 21040 Origgio, Italy; (M.M.); (M.Z.); (P.C.)
- Novartis Pharma BV, 1101 Amsterdam, The Netherlands
| | | | - Paola Coco
- Novartis Farma SpA, 21040 Origgio, Italy; (M.M.); (M.Z.); (P.C.)
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi University Hospital, 10143 Orbassano, Italy
- Correspondence:
| |
Collapse
|
14
|
Turrini M, Bourgain C. Appraising screening, making risk in/visible. The medical debate over Non-Rare Thrombophilia (NRT) testing before prescribing the pill. Sociol Health Illn 2021; 43:1627-1642. [PMID: 34293180 DOI: 10.1111/1467-9566.13348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
Non-rare thrombophilia (NRT) are hereditary predispositions to thromboembolism, the most severe side effect of combined hormonal contraception. In the mid-1990s, the identification of NRT stirred up a controversy over the possibility of investigating these genetic variants in women wishing to use contraception. Through a review of literature, this article reconstructs the debate over whether and how this genetic test should be prescribed as a way to reconfigure the risk visibility on pharmacological contraception. The main arguments identified concern the epidemiological, social, economic and clinical aspects of the test. In a context where the overall thrombotic risk for hormonal contraception is largely invisible, the genetic tests turn to embody the thrombotic risk itself. Those who opt for selective screening argue that a better estimation of risk implies a test prescription embed in a global medical assessment of women's individual risk. To advocates of universal or 'extended' screening, the tests are valuable tools to inform women on the thrombotic risk and, as such, appraised as a moral/legal obligation, whatever their predictive power. Risk visibility thus appears as an insightful concept to analyse a complex setting associating clinical, political, social and cultural considerations that touches upon medical power, women's responsibility and drug safety.
Collapse
|
15
|
Pungolino E, D'adda M, De Canal G, Trojani A, Perego A, Elena C, Lunghi F, Turrini M, Borin L, Iurlo A, Latargia ML, Carraro MC, Spina F, Artale S, Anghilieri M, Molteni A, Caramella M, Baruzzo G, Nichelatti M, Di Camillo B, Cairoli R. Nilotinib-induced bone marrow CD34+/lin-Ph+ cells early clearance in newly diagnosed CP-Chronic Myeloid Leukemia: Final report of the PhilosoPhi34 study. Eur J Haematol 2021; 107:436-448. [PMID: 34139044 PMCID: PMC9292618 DOI: 10.1111/ejh.13680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 01/06/2023]
Abstract
Chronic Myeloid Leukemia is a clonal disorder characterized by the presence of the Ph‐chromosome and the BCR‐ABL tyrosine‐kinase (TK). Target‐therapy with Imatinib has greatly improved its outcome. Deeper and faster responses are reported with the second‐generation TKI Nilotinib. Sustained responses may enable TKI discontinuation. However, even in a complete molecular response, some patients experience disease recurrence possibly due to persistence of quiescent leukemic CD34+/lin−Ph+ stem cells (LSCs). Degree and mechanisms of LSCs clearance during TKI treatment are not clearly established. The PhilosoPhi34 study was designed to verify the in‐vivo activity and timecourse of first‐line Nilotinib therapy on BM CD34+/lin−Ph+ cells clearance. Eighty‐seven CP‐CML patients were enrolled. BM cells were collected and tested for Ph+ residual cells, at diagnosis, 3, 6 and 12 months of treatment. FISH analysis of unstimulated CD34+/lin− cells in CCyR patients were positive in 8/65 (12.3%), 5/71 (7%), 0/69 (0%) evaluable tests, respectively. Per‐Protocol analysis response rates were as follows: CCyR 95% at 12 months, MR4.5 31% and 46% at 12 and 36 months, respectively. An exploratory Gene Expression Profiling (GEP) study of CD34+/lin− cells was performed on 30 patients at diagnosis and after, on 79 patients at diagnosis vs 12 months of nilotinib treatment vs 10 healthy subjects. Data demonstrated some genes significantly different expressed: NFKBIA, many cell cycle genes, ABC transporters, JAK‐STAT signaling pathway (JAK2). In addition, a correlation between different expression of some genes (JAK2, OLFM4, ICAM1, NFKBIA) among patients at diagnosis and their achievement of an early and deeper MR was observed.
Collapse
Affiliation(s)
- Ester Pungolino
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Mariella D'adda
- Department of Hematology, ASST Spedali Civili, Brescia, Italy
| | - Gabriella De Canal
- Pathology Department, Cytogenetics, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Alessandra Trojani
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Chiara Elena
- Hematology Hunit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplant Unit, San Raffaele Hospital, Milano, Italy
| | - Mauro Turrini
- Division of Hematology, Valduce Hospital, Como, Italy
| | | | - Alessandra Iurlo
- Oncohematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, University of Milan, Milano, Italy
| | | | | | - Francesco Spina
- Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Artale
- Division of Oncology, Ospedale di Gallarate, ASST Valle Olona, Gallarate, Italy
| | | | | | - Marianna Caramella
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giacomo Baruzzo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Michele Nichelatti
- Clinical Research Coordination Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Barbara Di Camillo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Roberto Cairoli
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| |
Collapse
|
16
|
Turrini M, Gardellini A, Beretta L, Buzzi L, Ferrario S, Vasile S, Clerici R, Colzani A, Liparulo L, Scognamiglio G, Imperiali G, Corrado G, Strada A, Galletti M, Castiglione N, Zanon C. Clinical Course and Risk Factors for In-Hospital Mortality of 205 Patients with SARS-CoV-2 Pneumonia in Como, Lombardy Region, Italy. Vaccines (Basel) 2021; 9:vaccines9060640. [PMID: 34208017 PMCID: PMC8230614 DOI: 10.3390/vaccines9060640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/18/2022] Open
Abstract
The aim of this study is to explore risk factors for in-hospital mortality and describe the effectiveness of different treatment strategies of 205 laboratory-confirmed cases infected with SARS-CoV-2 during the Lombardy outbreak. All patients received the best supportive care and specific interventions that included the main drugs being tested for repurposing to treat COVID-19, such as hydroxychloroquine, anticoagulation and antiviral drugs, steroids, and interleukin-6 pathway inhibitors. Clinical, laboratory, and treatment characteristics were analyzed with univariate and multivariate logistic regression methods to explore their impact on in-hospital mortality. Univariate analyses showed prognostic significance for age greater than 70 years, the presence of two or more relevant comorbidities, a P/F ratio less than 200 at presentation, elevated LDH (lactate dehydrogenase) and CRP (C-reactive protein) values, intermediate- or therapeutic-dose anticoagulation, hydroxychloroquine, early antiviral therapy with lopinavir/ritonavir, short courses of steroids, and tocilizumab therapy. Multivariable regression confirmed increasing odds of in-hospital death associated with age older than 70 years (OR 3.26) and a reduction in mortality for patients treated with anticoagulant (−0.37), antiviral lopinavir/ritonavir (−1.22), or steroid (−0.59) therapy. In contrast, hydroxychloroquine and tocilizumab have not been confirmed to have a significant effect in the treatment of SARS-CoV-2 pneumonia. Results from this real-life single-center experience are in agreement and confirm actual literature data on SARS-CoV-2 pneumonia in terms of both clinical risk factors for in-hospital mortality and the effectiveness of the different therapies proposed for the management of COVID19 disease.
Collapse
Affiliation(s)
- Mauro Turrini
- Department of Medicine, Division of Hematology, Valduce Hospital, 22100 Como, Italy;
- Correspondence: ; Tel.: +39-031324419
| | - Angelo Gardellini
- Department of Medicine, Division of Hematology, Valduce Hospital, 22100 Como, Italy;
| | - Livia Beretta
- Risk Management, Valduce Hospital, 22100 Como, Italy;
| | - Lucia Buzzi
- Quality Management System, Valduce Hospital, 22100 Como, Italy;
| | - Stefano Ferrario
- Department of Medicine, Division of Pneumology, Valduce Hospital, 22100 Como, Italy; (S.F.); (A.C.)
| | - Sabrina Vasile
- Department of Mother and Child, Division of Paediatric and Neonatology, Infectious Diseases Consultant, Valduce Hospital, 22100 Como, Italy;
| | - Raffaella Clerici
- Department of Medicine, Division of Neurology, Valduce Hospital, 22100 Como, Italy;
| | - Andrea Colzani
- Department of Medicine, Division of Pneumology, Valduce Hospital, 22100 Como, Italy; (S.F.); (A.C.)
| | - Luigi Liparulo
- Department of Medicine, Division of Internal Medicine, Valduce Hospital, 22100 Como, Italy;
| | | | - Gianni Imperiali
- Department of Medicine, Division of Gastroenterology, Valduce Hospital, 22100 Como, Italy;
| | - Giovanni Corrado
- Department of Medicine, Division of Cardiology, Valduce Hospital, 22100 Como, Italy;
| | - Antonello Strada
- Department of Emergency Medicine, Valduce Hospital, 22100 Como, Italy;
| | - Marco Galletti
- Department of Intensive Care Medicine, Valduce Hospital, 22100 Como, Italy;
| | - Nunzio Castiglione
- Hospital Health Management, Valduce Hospital, 22100 Como, Italy; (N.C.); (C.Z.)
| | - Claudio Zanon
- Hospital Health Management, Valduce Hospital, 22100 Como, Italy; (N.C.); (C.Z.)
| |
Collapse
|
17
|
Nardini C, Osmani V, Cormio PG, Frosini A, Turrini M, Lionis C, Neumuth T, Ballensiefen W, Borgonovi E, D'Errico G. The evolution of personalized healthcare and the pivotal role of European regions in its implementation. Per Med 2021; 18:283-294. [PMID: 33825526 DOI: 10.2217/pme-2020-0115] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Personalized medicine (PM) moves at the same pace of data and technology and calls for important changes in healthcare. New players are participating, providing impulse to PM. We review the conceptual foundations for PM and personalized healthcare and their evolution through scientific publications where a clear definition and the features of the different formulations are identifiable. We then examined PM policy documents of the International Consortium for Personalised Medicine and related initiatives to understand how PM stakeholders have been changing. Regional authorities and stakeholders have joined the race to deliver personalized care and are driving toward what could be termed as the next personalized healthcare. Their role as a key stakeholder in PM is expected to be pivotal.
Collapse
Affiliation(s)
| | - Venet Osmani
- Fondazione Bruno Kessler Research Institute, Trento 38123, Italy
| | - Paola G Cormio
- Sant'Anna School of Advanced Studies, Istituto di BioRobotica, Pisa 56127, Italy
| | | | - Mauro Turrini
- Institute of Public Goods & Policies - Consejo Superior de Investigaciones Científicas, Madrid 28037, Spain
| | - Christos Lionis
- School of Medicine, University of Crete, Clinic of Social & Family Medicine (CSFM), Crete 71003, Greece
| | - Thomas Neumuth
- University of Leipzig, Innovation Center Computer Assisted Surgery (ICCAS), Leipzig 04103, Germany
| | - Wolfgang Ballensiefen
- Deutsche Zentrum für Luft- und Raumfahrt Projektträger (DLR PT), Bonn 53227, Germany
| | - Elio Borgonovi
- Department of Social & Political Sciences, Bocconi University, Milan 20136, Italy
| | | |
Collapse
|
18
|
Bonneau V, Nizon M, Latypova X, Gaultier A, Hoarau E, Bézieau S, Minguet G, Turrini M, Jourdain M, Isidor B. First French study relative to preconception genetic testing: 1500 general population participants' opinion. Orphanet J Rare Dis 2021; 16:130. [PMID: 33712027 PMCID: PMC7955630 DOI: 10.1186/s13023-021-01754-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 02/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Until very recently, preconception genetic testing was only conducted in particular communities, ethnic groups or families for which an increased risk of genetic disease was identified. To detect in general population a risk for a couple to have a child affected by a rare, recessive or X-linked, genetic disease, carrier screening is proposed in several countries. We aimed to determine the current public opinion relative to this approach in France, using either a printed or web-based questionnaire. Results Among the 1568 participants, 91% are favorable to preconception genetic tests and 57% declare to be willing to have the screening if the latter is available. A medical prescription by a family doctor or a gynecologist would be the best way to propose the test for 73%, with a reimbursement from the social security insurance. However, 19% declare not to be willing to use the test because of their ethic or moral convictions, and the fear that the outcome would question the pregnancy. Otherwise, most participants consider that the test is a medical progress despite the risk of an increased medicalization of the pregnancy. Conclusion This first study in France highlights a global favorable opinion for the preconception genetic carrier testing under a medical prescription and a reimbursement by social security insurance. Our results emphasize as well the complex concerns underpinned by the use of this screening strategy. Therefore, the ethical issues related to these tests include the risk of eugenic drift mentioned by more than half of the participants. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01754-z.
Collapse
Affiliation(s)
- Valérie Bonneau
- Département de Médecine Générale, Université de Nantes, 44000, Nantes, France.,USR 3491 Maison Des Sciences de L'Homme Ange Guepin, 44000, Nantes, France
| | - Mathilde Nizon
- Service de Génétique Médicale, CHU Nantes, 9 quai Moncousu, 44093, Nantes Cedex 1, France
| | - Xenia Latypova
- Service de Génétique Médicale, CHU Nantes, 9 quai Moncousu, 44093, Nantes Cedex 1, France
| | - Aurélie Gaultier
- Plateforme de Méthodologie Et de Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Eugénie Hoarau
- Département de Médecine Générale, Université de Nantes, 44000, Nantes, France.,USR 3491 Maison Des Sciences de L'Homme Ange Guepin, 44000, Nantes, France
| | - Stéphane Bézieau
- Service de Génétique Médicale, CHU Nantes, 9 quai Moncousu, 44093, Nantes Cedex 1, France
| | | | - Mauro Turrini
- Université de Nantes, Droit et Changement Social UMR 6297, Maison Des Sciences de L'Homme Ange Guépin, Nantes, France
| | - Maud Jourdain
- Département de Médecine Générale, Université de Nantes, 44000, Nantes, France.,USR 3491 Maison Des Sciences de L'Homme Ange Guepin, 44000, Nantes, France
| | - Bertrand Isidor
- Service de Génétique Médicale, CHU Nantes, 9 quai Moncousu, 44093, Nantes Cedex 1, France.
| |
Collapse
|
19
|
Borlenghi E, Pagani C, Zappasodi P, Bernardi M, Basilico C, Cairoli R, Fracchiolla N, Todisco E, Turrini M, Cattaneo C, Da Vià M, Ciceri F, Passamonti F, Mancini V, Sciumè M, Cerqui E, Sciumè M, Rossi G. Validation of the "fitness criteria" for the treatment of older patients with acute myeloid leukemia: A multicenter study on a series of 699 patients by the Network Rete Ematologica Lombarda (REL). J Geriatr Oncol 2020; 12:550-556. [PMID: 33097455 DOI: 10.1016/j.jgo.2020.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/19/2020] [Accepted: 10/07/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Treatment of older patients with acute myeloid leukemia (AML) is still controversial. To facilitate treatment decisions, the "fitness criteria" proposed by Ferrara et al. (Leukemia, 2013), including age > 75 years, performance status and comorbidities, were verified retrospectively in 699 patients with AML (419 de-novo, 280 secondary AML), diagnosed at 8 Hematological Centers (REL). METHODS Patients were categorized in FIT to intensive chemotherapy (i-T) (292, 42.5%), UNFIT to i-T (289, 42.1%), or unfit even to non-intensive therapy (non i-T) (FRAIL) (105, 15.3%). Biological characteristics and treatment actually received by patients [i-T, 274 patients (39.2%); non i-T, 134 (19.2%), best-supportive care (BSC), 291 (41.6%)] were recorded. RESULTS "Fitness criteria" were easily applicable in 98.1% of patients. Overall concordance between "fitness criteria" and treatment actually received by patients was high (79.4%), 76% in FIT, 82.7% in UNFIT and 80% in FRAIL patients. Fitness independently predicted survival (median survival: 10.9, 4.2 and 1.8 months in FIT, UNFIT and FRAIL patients, respectively; p = 0.000), as confirmed also by multivariate analysis. In FRAIL patients, survival with any treatment was no better than with BSC, in UNFIT non i-T was as effective as i-T and better than BSC, and in FIT patients i-T was better than non i-T or BSC. In addition, a non-adverse risk AML, an ECOG PS <2, and receiving any treatment other than BSC had a favorable effect on survival (p < 0.001). CONCLUSION These simple "fitness criteria" applied at the time of diagnosis could facilitate, together with AML biologic risk evaluation, the choice of the most appropriate treatment intensity in older AML patients.
Collapse
Affiliation(s)
- Erika Borlenghi
- Department of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Chiara Pagani
- Department of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Patrizia Zappasodi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Massimo Bernardi
- San Raffaele Scientific Institute Haematology, Bone Marrow Transplantation Unit, Milano, Italy
| | - Claudia Basilico
- Division of Hematology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Roberto Cairoli
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, Milano, Italy
| | - Nicola Fracchiolla
- U.O. Oncoematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | | | - Mauro Turrini
- Division of Haematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Chiara Cattaneo
- Department of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Matteo Da Vià
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Fabio Ciceri
- San Raffaele Scientific Institute Haematology, Bone Marrow Transplantation Unit, Milano, Italy
| | - Francesco Passamonti
- Division of Hematology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Valentina Mancini
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, Milano, Italy
| | - Mariarita Sciumè
- U.O. Oncoematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Elisa Cerqui
- Department of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Margherita Sciumè
- Department of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giuseppe Rossi
- Department of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| |
Collapse
|
20
|
Passamonti F, Cattaneo C, Arcaini L, Bruna R, Cavo M, Merli F, Angelucci E, Krampera M, Cairoli R, Della Porta MG, Fracchiolla N, Ladetto M, Gambacorti Passerini C, Salvini M, Marchetti M, Lemoli R, Molteni A, Busca A, Cuneo A, Romano A, Giuliani N, Galimberti S, Corso A, Morotti A, Falini B, Billio A, Gherlinzoni F, Visani G, Tisi MC, Tafuri A, Tosi P, Lanza F, Massaia M, Turrini M, Ferrara F, Gurrieri C, Vallisa D, Martelli M, Derenzini E, Guarini A, Conconi A, Cuccaro A, Cudillo L, Russo D, Ciambelli F, Scattolin AM, Luppi M, Selleri C, Ortu La Barbera E, Ferrandina C, Di Renzo N, Olivieri A, Bocchia M, Gentile M, Marchesi F, Musto P, Federici AB, Candoni A, Venditti A, Fava C, Pinto A, Galieni P, Rigacci L, Armiento D, Pane F, Oberti M, Zappasodi P, Visco C, Franchi M, Grossi PA, Bertù L, Corrao G, Pagano L, Corradini P. Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study. Lancet Haematol 2020; 7:e737-e745. [PMID: 32798473 PMCID: PMC7426107 DOI: 10.1016/s2352-3026(20)30251-9] [Citation(s) in RCA: 372] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several small studies on patients with COVID-19 and haematological malignancies are available showing a high mortality in this population. The Italian Hematology Alliance on COVID-19 aimed to collect data from adult patients with haematological malignancies who required hospitalisation for COVID-19. METHODS This multicentre, retrospective, cohort study included adult patients (aged ≥18 years) with diagnosis of a WHO-defined haematological malignancy admitted to 66 Italian hospitals between Feb 25 and May 18, 2020, with laboratory-confirmed and symptomatic COVID-19. Data cutoff for this analysis was June 22, 2020. The primary outcome was mortality and evaluation of potential predictive parameters of mortality. We calculated standardised mortality ratios between observed death in the study cohort and expected death by applying stratum-specific mortality rates of the Italian population with COVID-19 and an Italian cohort of 31 993 patients with haematological malignancies without COVID-19 (data up to March 1, 2019). Multivariable Cox proportional hazards model was used to identify factors associated with overall survival. This study is registered with ClinicalTrials.gov, NCT04352556, and the prospective part of the study is ongoing. FINDINGS We enrolled 536 patients with a median follow-up of 20 days (IQR 10-34) at data cutoff, 85 (16%) of whom were managed as outpatients. 440 (98%) of 451 hospitalised patients completed their hospital course (were either discharged alive or died). 198 (37%) of 536 patients died. When compared with the general Italian population with COVID-19, the standardised mortality ratio was 2·04 (95% CI 1·77-2·34) in our whole study cohort and 3·72 (2·86-4·64) in individuals younger than 70 years. When compared with the non-COVID-19 cohort with haematological malignancies, the standardised mortality ratio was 41·3 (38·1-44·9). Older age (hazard ratio 1·03, 95% CI 1·01-1·05); progressive disease status (2·10, 1·41-3·12); diagnosis of acute myeloid leukaemia (3·49, 1·56-7·81), indolent non-Hodgin lymphoma (2·19, 1·07-4·48), aggressive non-Hodgkin lymphoma (2·56, 1·34-4·89), or plasma cell neoplasms (2·48, 1·31-4·69), and severe or critical COVID-19 (4·08, 2·73-6·09) were associated with worse overall survival. INTERPRETATION This study adds to the evidence that patients with haematological malignancies have worse outcomes than both the general population with COVID-19 and patients with haematological malignancies without COVID-19. The high mortality among patients with haematological malignancies hospitalised with COVID-19 highlights the need for aggressive infection prevention strategies, at least until effective vaccination or treatment strategies are available. FUNDING Associazione italiana contro le leucemie, linfomi e mieloma-Varese Onlus.
Collapse
Affiliation(s)
- Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy.
| | | | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Bruna
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and Ospedale Maggiore della Carità, Novara, Italy
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, Bologna, Italy
| | - Francesco Merli
- Hematology, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Mauro Krampera
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Roberto Cairoli
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Giovanni Della Porta
- Humanitas Clinical and Research Hospital-IRCCS and Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Marco Ladetto
- Hematology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Marco Salvini
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Monia Marchetti
- Hematology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Roberto Lemoli
- Dipartimento di Medicina interna e Specialità mediche, University of Genoa, Genoa, Italy
| | | | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Antonio Cuneo
- Hematology, Azienda Ospedaliero Universitaria Sant'Anna, Ferrara, Italy
| | - Alessandra Romano
- Hematology, Dipartimento di Chirurgia e Specialità Medico Chirurgiche, Università degli Studi di Catania, Catania, Italy
| | - Nicola Giuliani
- Dipartimento di Medicina e Chirurgia, University of Parma, Parma, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Alessandro Morotti
- Department of Clinical and Biological Sciences, Università di Torino, Turin, Italy
| | | | | | | | - Giuseppe Visani
- Dipartimento di Onco- Ematologia, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Agostino Tafuri
- Hematology, University Hospital Sant'Andrea, Sapienza, Rome, Italy; Department of Clinical and Molecular Medicine, Sapienza, University of Rome, Rome, Italy
| | - Patrizia Tosi
- Hematology, Ospedale degli Infermi di Rimini, Rimini, Italy
| | | | | | | | | | - Carmela Gurrieri
- Dipartimento Strutturale Aziendale Medicina, University of Padova, Padova, Italy
| | | | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
| | | | | | | | | | - Laura Cudillo
- Hematology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Domenico Russo
- Dipartimento di Scienze Cliniche e Sperimentali, University of Brescia, Brescia, Italy
| | | | | | - Mario Luppi
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, University of Modena and Reggio Emilia, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Carmine Selleri
- Hematology, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Elettra Ortu La Barbera
- UOC Ematologia con Trapianto, Ospedale Santa Maria Goretti, Latina, Italy; Hematology, Ospedale Santa Maria Goretti, Latina, Italy
| | - Celestino Ferrandina
- Hematology, Ospedali Riuniti Azienda Ospedaliera Universitaria di Foggia, Foggia, Italy
| | - Nicola Di Renzo
- Hematology and Transplant Unit, Ospedale Vito Fazzi, Lecce, Italy
| | | | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | | | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Pellegrino Musto
- Department of Emergency and Organ Transplantation, "Aldo Moro" University School of Medicine and Unit of Hematology and Stem Cell Transplantation, AOU Consorziale Policlinico, Bari, Italy
| | | | - Anna Candoni
- Dipartimento di Medicina Specialistica, University of Udine, Udine, Italy
| | | | - Carmen Fava
- Department of Clinical and Biological Sciences, Università di Torino, Turin, Italy
| | - Antonio Pinto
- Hematology, Istituto Nazionale Tumori IRCCS "Fondazione G Pascale", Naples, Italy
| | | | | | - Daniele Armiento
- Unit of Hematology, Stem Cell Transplantation, University Campus Bio-Medico, Rome, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Federico II Hospital, Naples, Italy
| | | | - Patrizia Zappasodi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Matteo Franchi
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Milan, Italy; National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Paolo Antonio Grossi
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Lorenza Bertù
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Giovanni Corrao
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Milan, Italy; National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Livio Pagano
- Dipartimento di Scienze Radiologiche ed Ematologiche, Fondazione Policlinico Universitario A Gemelli-IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Corradini
- Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano
| |
Collapse
|
21
|
Guidotti F, Gardellini A, Feltri M, Zancanella M, Saccà V, Ambrosiani L, Turrini M. Myeloid Sarcoma Involving Kidneys: From Diagnosis to Treatment. Case Report and Literature Review. CMI 2020. [DOI: 10.7175/cmi.v14i1.1460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Myeloid sarcomas (MS) are rare extramedullary hematological tumors which generally occur during the natural course of acute myeloid leukemia or chronic myeloid leukemia. Rarely, their onset precedes peripheral blood and bone marrow manifestations of disease. Common sites of involvement are skin, bone, soft tissue, lymph nodes, reproductive or digestive organs, and central nervous system.Herein, we report the case of a 72-year-old man affected by JAK2 V617F mutated myeloproliferative neoplasm who developed MS involving collecting system of both kidneys. MS and MS-related obstructive nephropathy were the first signs of the acute evolution of a known chronic hematological malignancy, preceding by some weeks the onset of leukocytosis.
Collapse
|
22
|
Congedo P, Gardellini A, Corich L, Papa A, Turrini M. The first case of Mycobacterium vaccae sepsis in a non-Hodgkin lymphoma patient: biological understandings and clinical consequencies. Access Microbiol 2020; 2:acmi000161. [PMID: 33195975 PMCID: PMC7660240 DOI: 10.1099/acmi.0.000161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022] Open
Abstract
Mycobacterium vaccae is a rapidly growing nonpathogenic species of the Mycobacteriaceae family of bacteria that can cause pulmonary and disseminated disease in particular in immunocompromised individuals. Here we describe a first case of matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass-spectrometry (MS) identification of this pathogen in a patient with non-Hodgkin’s lymphoma during chemoimmunotherapy salvage treatment, and its impact on clinical decision making.
Collapse
Affiliation(s)
- Pierluigi Congedo
- Operative Unit of Chemical-Clinical and Microbiological Analysis, Ospedale Valduce, Como, Italy.,Clinical Pathology Laboratory Vimercate Hospital, Italy
| | - Angelo Gardellini
- Division of Hematology, Department of Medicin, Ospedale Valduce, Como, Italy
| | - Lucia Corich
- Clinical Pathology Laboratory Vimercate Hospital, Italy
| | - Angela Papa
- Operative Unit of Chemical-Clinical and Microbiological Analysis, Ospedale Valduce, Como, Italy
| | - Mauro Turrini
- Division of Hematology, Department of Medicin, Ospedale Valduce, Como, Italy
| |
Collapse
|
23
|
Abstract
Introduit au lendemain de l’identification des « thrombophilies non rares » (TNR), au milieu des années 1990 afin de prédire et de prévenir la maladie thromboembolique veineuse (MTEV), le bilan génétique pour ces thrombophilies est un exemple assez rare de test génétique de susceptibilité pour une maladie complexe, à avoir franchi le pas d’un véritable usage de routine en clinique. Bien que ce test soit le plus répandu des tests de génétique post-natale en France, son usage (À qui proposer le test ? Que faire des résultats?) fait encore l’objet de débats. Cet article analyse la trajectoire de régulation clinique de ce test et illustre l’importance du contexte spécifique d’usage pour comprendre sa diffusion. Cette analyse vise à nourrir une réflexion plus générale sur les enjeux que pose l’intégration clinique des tests génétiques pour les maladies communes, en considérant notamment les modalités de définition de l’utilité clinique d’un test (statistiqueversusbiologique), des sujets du test (le cas indexversusses apparentés), et des critères en sous-tendant l’accès (modalités des calculs médico-économiques).
Collapse
|
24
|
Turrini M, Bourgain C. Genomic susceptibility in practice: The regulatory trajectory of non-rare thrombophilia (NRT) genetic tests in the clinical management of venous thrombo-embolism (VTE). Soc Sci Med 2020; 304:112903. [DOI: 10.1016/j.socscimed.2020.112903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 01/23/2023]
|
25
|
Colombo M, Garavelli S, Mazzola M, Platonova N, Giannandrea D, Colella R, Apicella L, Lancellotti M, Lesma E, Ancona S, Palano MT, Barbieri M, Taiana E, Lazzari E, Basile A, Turrini M, Pistocchi A, Neri A, Chiaramonte R. Multiple myeloma exploits Jagged1 and Jagged2 to promote intrinsic and bone marrow-dependent drug resistance. Haematologica 2019; 105:1925-1936. [PMID: 31582544 PMCID: PMC7327642 DOI: 10.3324/haematol.2019.221077] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022] Open
Abstract
Multiple myeloma is still incurable due to an intrinsic aggressiveness or, more frequently, to the interactions of malignant plasma cells with the bone marrow (BM) microenvironment. Myeloma cells educate BM cells to support neoplastic cell growth, survival, acquisition of drug resistance resulting in disease relapse. Myeloma microenvironment is characterized by Notch signaling hyperactivation due to the increased expression of Notch1 and 2 and the ligands Jagged1 and 2 in tumor cells. Notch activation influences myeloma cell biology and promotes the reprogramming of BM stromal cells. In this work we demonstrate, in vitro, ex vivo and by using a zebrafish multiple myeloma model, that Jagged inhibition causes a decrease in both myeloma-intrinsic and stromal cell-induced resistance to currently used drugs, i.e. bortezomib, lenalidomide and melphalan. The molecular mechanism of drug resistance involves the chemokine system CXCR4/SDF1α. Myeloma cell-derived Jagged ligands trigger Notch activity in BM stromal cells. These, in turn, secrete higher levels of SDF1α in the BM microenvironment increasing CXCR4 activation in myeloma cells, which is further potentiated by the concomitant increased expression of this receptor induced by Notch activation. Consistently with the augmented pharmacological resistance, SDF1α boosts the expression of BCL2, Survivin and ABCC1. These results indicate that a Jagged-tailored approach may contribute to disrupting the pharmacological resistance due to intrinsic myeloma cell features or to the pathological interplay with BM stromal cells and, conceivably, improve patients' response to standard-of-care therapies.
Collapse
Affiliation(s)
- Michela Colombo
- Department of Health Sciences, Università degli Studi di Milano, Milano
| | - Silvia Garavelli
- Department of Health Sciences, Università degli Studi di Milano, Milano
| | - Mara Mazzola
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milano
| | - Natalia Platonova
- Department of Health Sciences, Università degli Studi di Milano, Milano
| | | | - Raffaella Colella
- Department of Health Sciences, Università degli Studi di Milano, Milano
| | - Luana Apicella
- Department of Health Sciences, Università degli Studi di Milano, Milano
| | | | - Elena Lesma
- Department of Health Sciences, Università degli Studi di Milano, Milano
| | - Silvia Ancona
- Department of Health Sciences, Università degli Studi di Milano, Milano
| | | | - Marzia Barbieri
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano.,Hematology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano
| | - Elisa Taiana
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano.,Hematology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano
| | - Elisa Lazzari
- Department of Health Sciences, Università degli Studi di Milano, Milano
| | - Andrea Basile
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano
| | - Mauro Turrini
- Department of Hematology, Division of Medicine, Valduce Hospital, Como, Italy
| | - Anna Pistocchi
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milano
| | - Antonino Neri
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano.,Hematology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano
| | | |
Collapse
|
26
|
Stoeklé HC, Turrini M, Charlier P, Deleuze JF, Hervé C, Vogt G. Genetic Data, Two-Sided Markets and Dynamic Consent: United States Versus France. Sci Eng Ethics 2019; 25:1597-1602. [PMID: 30864046 DOI: 10.1007/s11948-019-00085-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/16/2019] [Indexed: 06/09/2023]
Abstract
Networks for the exchange and/or sharing of genetic data are developing in many countries. We focus here on the situations in the US and France. We highlight some recent and remarkable differences between these two countries concerning the mode of access to, and the storage and use of genetic data, particularly as concerns two-sided markets and dynamic consent or dynamic electronic informed consent (e-IC). This brief overview suggests that, even though the organization and function of these two-sided markets remain open to criticism, dynamic e-IC should be more widely used, especially in France, if only to determine its real effectiveness.
Collapse
Affiliation(s)
- Henri-Corto Stoeklé
- Laboratory of Neglected Human Genetics (NHG), CNRGH-CEA, Evry, France
- Centre National de Recherche en Génomique Humaine (CNRGH), Direction de la recherche fondamentale, CEA, Institut de biologie François Jacob, Université Paris Saclay, Evry, France
| | - Mauro Turrini
- Université de Nantes - Maison des Sciences de l'Homme (MSH), Nantes, France
| | - Philipe Charlier
- Département de la Recherche et de l'Enseignement, Musée du Quai Branly - Jacques Chirac, 222 rue de l'Université, 75007, Paris, France
- UVSQ (Laboratoire DANTE - EA 4498), 2 avenue de la source de la Bièvre, 78180, Montigny-le-Bretonneux, France
| | - Jean-François Deleuze
- Centre National de Recherche en Génomique Humaine (CNRGH), Direction de la recherche fondamentale, CEA, Institut de biologie François Jacob, Université Paris Saclay, Evry, France
- LaBex GenMed, Fondation Jean Dausset, Paris, France
- Centre d'études du polymorphisme humain (CEPH), Fondation Jean Dausset, Paris, France
| | - Christian Hervé
- International Academy of Ethics, Medicine and Public Health, Paris Descartes University, Paris, France
| | - Guillaume Vogt
- Laboratory of Neglected Human Genetics (NHG), CNRGH-CEA, Evry, France.
- Centre National de Recherche en Génomique Humaine (CNRGH), Direction de la recherche fondamentale, CEA, Institut de biologie François Jacob, Université Paris Saclay, Evry, France.
- Laboratoire Neglected Human Genetics, INSERM, Université Paris Descartes, Paris, France.
| |
Collapse
|
27
|
Trojani A, Pungolino E, Dal Molin A, Lodola M, Rossi G, D’Adda M, Perego A, Elena C, Turrini M, Borin L, Bucelli C, Malato S, Carraro MC, Spina F, Latargia ML, Artale S, Spedini P, Anghilieri M, Di Camillo B, Baruzzo G, De Canal G, Iurlo A, Morra E, Cairoli R. Nilotinib interferes with cell cycle, ABC transporters and JAK-STAT signaling pathway in CD34+/lin- cells of patients with chronic phase chronic myeloid leukemia after 12 months of treatment. PLoS One 2019; 14:e0218444. [PMID: 31318870 PMCID: PMC6638825 DOI: 10.1371/journal.pone.0218444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/03/2019] [Indexed: 01/05/2023] Open
Abstract
Chronic myeloid leukemia (CML) is characterized by the constitutive tyrosine kinase activity of the oncoprotein BCR-ABL1 in myeloid progenitor cells that activates multiple signal transduction pathways leading to the leukemic phenotype. The tyrosine-kinase inhibitor (TKI) nilotinib inhibits the tyrosine kinase activity of BCR-ABL1 in CML patients. Despite the success of nilotinib treatment in patients with chronic-phase (CP) CML, a population of Philadelphia-positive (Ph+) quiescent stem cells escapes the drug activity and can lead to drug resistance. The molecular mechanism by which these quiescent cells remain insensitive is poorly understood. The aim of this study was to compare the gene expression profiling (GEP) of bone marrow (BM) CD34+/lin- cells from CP-CML patients at diagnosis and after 12 months of nilotinib treatment by microarray, in order to identify gene expression changes and the dysregulation of pathways due to nilotinib action. We selected BM CD34+/lin- cells from 78 CP-CML patients at diagnosis and after 12 months of first-line nilotinib therapy and microarray analysis was performed. GEP bioinformatic analyses identified 2,959 differently expressed probes and functional clustering determined some significantly enriched pathways between diagnosis and 12 months of nilotinib treatment. Among these pathways, we observed the under expression of 26 genes encoding proteins belonging to the cell cycle after 12 months of nilotinib treatment which led to the up-regulation of chromosome replication, cell proliferation, DNA replication, and DNA damage checkpoint at diagnosis. We demonstrated the under expression of the ATP-binding cassette (ABC) transporters ABCC4, ABCC5, and ABCD3 encoding proteins which pumped drugs out of the cells after 12 months of nilotinib. Moreover, GEP data demonstrated the deregulation of genes involved in the JAK-STAT signaling pathway. The down-regulation of JAK2, IL7, STAM, PIK3CA, PTPN11, RAF1, and SOS1 key genes after 12 months of nilotinib could demonstrate the up-regulation of cell cycle, proliferation and differentiation via MAPK and PI3K-AKT signaling pathways at diagnosis.
Collapse
Affiliation(s)
- Alessandra Trojani
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
- * E-mail:
| | - Ester Pungolino
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Milena Lodola
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giuseppe Rossi
- Department of Hematology, ASST Spedali Civili, Brescia, Italy
| | - Mariella D’Adda
- Department of Hematology, ASST Spedali Civili, Brescia, Italy
| | | | - Chiara Elena
- Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mauro Turrini
- Division of Hematology, Department of Internal Medicine, Valduce Hospital, Como, Italy
| | - Lorenza Borin
- Hematology Division, San Gerardo Hospital, Monza, Italy
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Simona Malato
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy
| | | | - Francesco Spina
- Division of Hematology–Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | - Barbara Di Camillo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giacomo Baruzzo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Gabriella De Canal
- Pathology Department, Cytogenetics, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Enrica Morra
- Executive Committee, Rete Ematologia Lombarda, Italy
| | - Roberto Cairoli
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| |
Collapse
|
28
|
Isidor B, Julia S, Saugier-Veber P, Weil-Dubuc PL, Bézieau S, Bieth E, Bonnefont JP, Munnich A, Bourdeaut F, Bourgain C, Chassaing N, Corradini N, Haye D, Plaisancie J, Dupin-Deguine D, Calvas P, Mignot C, Cogné B, Manouvrier S, Pasquier L, Héron D, Boycott KM, Turrini M, Vears DF, Nizon M, Vincent M. Searching for secondary findings: considering actionability and preserving the right not to know. Eur J Hum Genet 2019; 27:1481-1484. [PMID: 31186543 DOI: 10.1038/s41431-019-0438-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/04/2019] [Accepted: 05/21/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Bertrand Isidor
- Service de génétique médicale, CHU Nantes, 9 quai Moncousu, 44093, Nantes, France.
| | - Sophie Julia
- Service de génétique médicale, Hôpital Purpan, Centre Hospitalier Universitaire, 31059, Toulouse, France
| | - Pascale Saugier-Veber
- Normandie Univ, UNIROUEN, Inserm U1245, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France.,Department of Genetics, Rouen University Hospital, Normandy Centre for Genomic and Personalized Medicine, 76000, Rouen, France
| | - Paul-Loup Weil-Dubuc
- Espace éthique Ile-de-France, Laboratoire d'excellence Distalz, Université Paris-Sud, Paris-Saclay, France
| | - Stéphane Bézieau
- Service de génétique médicale, CHU Nantes, 9 quai Moncousu, 44093, Nantes, France
| | - Eric Bieth
- Service de génétique médicale, Hôpital Purpan, Centre Hospitalier Universitaire, 31059, Toulouse, France
| | - Jean-Paul Bonnefont
- Service de génétique médicale, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Arnold Munnich
- Service de génétique médicale, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | | | - Catherine Bourgain
- Cermes3 (Centre de recherche médecine, sciences, santé, santé mentale, société), Inserm U988, site CNRS, 7 rue Guy Môquet, 94801, Villejuif, France
| | - Nicolas Chassaing
- Service de génétique médicale, Hôpital Purpan, Centre Hospitalier Universitaire, 31059, Toulouse, France
| | - Nadège Corradini
- Institut d'hémato-oncologie pédiatrique, Centre Léon Bérard, Lyon, France
| | - Damien Haye
- APHP, Département de Génétique, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Julie Plaisancie
- Service de génétique médicale, Hôpital Purpan, Centre Hospitalier Universitaire, 31059, Toulouse, France
| | - Delphine Dupin-Deguine
- Service de génétique médicale, Hôpital Purpan, Centre Hospitalier Universitaire, 31059, Toulouse, France.,Service d'otoneurologie et ORL pédiatrique, Hôpital Purpan, Centre Hospitalier Universitaire, 31059, Toulouse, France
| | - Patrick Calvas
- Service de génétique médicale, Hôpital Purpan, Centre Hospitalier Universitaire, 31059, Toulouse, France
| | - Cyril Mignot
- APHP, Département de Génétique, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Benjamin Cogné
- Service de génétique médicale, CHU Nantes, 9 quai Moncousu, 44093, Nantes, France
| | - Sylvie Manouvrier
- Clinique de génétique, CHU de Lille, 59000, Lille, France.,EA7364 Faculté de Médecine Université de Lille, 59000, Lille, France
| | - Laurent Pasquier
- CHU Rennes, Service de Génétique Clinique, 16 Boulevard de Bulgarie, 35203, Rennes, France
| | - Delphine Héron
- APHP, Département de Génétique, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ontario, Canada
| | - Mauro Turrini
- DCS- Droit et Changement Social Université de Nantes, Nantes, France
| | - Danya F Vears
- Department of Public Health and Primary Care, Center for Biomedical Ethics and Law, KU Leuven, Belgium.,Leuven Institute for Human Genetics and Society, Leuven, Belgium.,Melbourne Law School, University of Melbourne, Carlton, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Australia
| | - Mathilde Nizon
- Service de génétique médicale, CHU Nantes, 9 quai Moncousu, 44093, Nantes, France
| | - Marie Vincent
- Service de génétique médicale, CHU Nantes, 9 quai Moncousu, 44093, Nantes, France.
| |
Collapse
|
29
|
Stoeklé HC, Forster N, Turrini M, Charlier P, Hervé C, Deleuze JF, Vogt G. [The ownership of genetic data: from data to information]. Med Sci (Paris) 2019; 34:1100-1104. [PMID: 30623772 DOI: 10.1051/medsci/2018291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In France, genetic data are not covered by property laws. They are considered to be equivalent to a part of the human body, to be protected rather than as something of economic value. However, in this highly competitive world, France must find solutions to increase the scientific and economic values of its genetic data. One possibility would be to define genetic data as raw information with no value for use. The choice of such a value of use (clinical, scientific, economic, etc.), following various key analysis and treatment processes will thus transform genetic data into useful information. In this case, and under certain conditions, intellectual property law could consider this information to be an original creation with an economic value, whilst maintaining current levels of protection for genetic data. France thus faces a choice between changing its laws concerning the protection of genetic data, bringing them into line with the North American approach, according to which data are a form of capital that everyone has the right to increase or sell, and making the distinction between genetic data and information clearer.
Collapse
Affiliation(s)
- Henri-Corto Stoeklé
- Laboratoire de Génétique Humaine Négligée, CNRGH-CEA, Évry, France - Centre National de Recherche en Génomique Humaine (CNRGH), Direction de la recherche fondamentale, CEA, Institut de biologie François Jacob, Université Paris Saclay, Évry, France
| | - Ninon Forster
- Centre de Droit Européen, Université Paris II Panthéon-Assas, Paris, France
| | - Mauro Turrini
- Université de Nantes - Maison des Sciences de l'Homme (MSH), Nantes, France
| | - Philippe Charlier
- Département de la Recherche et de l'Enseignement, Musée du Quai Branly-Jacques Chirac, 222, rue de l'Université, 75007 Paris, France - UVSQ (Laboratoire DANTE - EA 4498), 2, avenue de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France
| | - Christian Hervé
- Académie Internationale Éthique, Médecine et Politiques Publiques, Université Paris Descartes, Paris, France
| | - Jean-François Deleuze
- Centre National de Recherche en Génomique Humaine (CNRGH), Direction de la recherche fondamentale, CEA, Institut de biologie François Jacob, Université Paris Saclay, Évry, France - LaBex GenMed, Fondation Jean Dausset, Paris, France - Centre d'études du polymorphisme humain (CEPH), Fondation Jean Dausset, Paris, France
| | - Guillaume Vogt
- Laboratoire de Génétique Humaine Négligée, CNRGH-CEA, Évry, France - Centre National de Recherche en Génomique Humaine (CNRGH), Direction de la recherche fondamentale, CEA, Institut de biologie François Jacob, Université Paris Saclay, Évry, France - Laboratoire de Génétique Humaine Négligée, Inserm, Université Paris Descartes, Paris, France
| |
Collapse
|
30
|
Abstract
Over the last three decades, various biotech companies, mostly in North America, have become experts in the production, processing and analysis of large volumes of genetic data. They have surpassed the performance of traditional academic platforms, by appropriating a new economic model: the two-sided market. Thus, by applying web 2.0 ideas, these biotech companies have made it possible for millions of users to produce and "share" data including genetic data, with each other and with third parties through a digital network rich in information and "free" services. However, in reality, data have become a means of payment for access to these networks and the use of these services. In the era of the digital economy, data sharing has become synonymous with commercial exchange and genetic data synonymous with capital.
Collapse
Affiliation(s)
- Henri-Corto Stoeklé
- Laboratoire de génétique humaine négligée, CNRGH-CEA, Évry, France - Centre national de recherche en génomique humaine (CNRGH), Direction de la recherche fondamentale, CEA, institut de biologie François Jacob, Évry, France
| | - Ninon Forster
- Centre de droit européen, université Paris II Panthéon-Assas, Paris, France
| | - Philippe Charlier
- Département de consultations et de santé publique / unité sanitaire (hôpital Max Fourestier / Maison d'arrêt des Hauts-de-Seine), Nanterre, France - Équipe d'anthropologie médicale et médico-légale (UVSQ)/laboratoire DANTE-EA 4498, Montigny-le-Bretonneux, France
| | - Oudy C Bloch
- Avocat aux barreaux de Paris et de New York, Paris, France - Institut Rafaël, Maison de l'après-cancer, Levallois-Perret, France
| | - Christian Hervé
- Académie Internationale Éthique, Médecine et Politiques Publiques, Université Paris Descartes, Paris, France
| | - Mauro Turrini
- Université de Nantes - Maison des sciences de l'homme (MSH), Nantes, France
| | - Guillaume Vogt
- Laboratoire de génétique humaine négligée, CNRGH-CEA, Évry, France - Centre national de recherche en génomique humaine (CNRGH), Direction de la recherche fondamentale, CEA, institut de biologie François Jacob, Évry, France - Laboratoire de génétique humaine négligée, Inserm, université Paris Descartes, Paris, France - Institut Rafaël, Maison de l'après-cancer, Levallois-Perret, France
| |
Collapse
|
31
|
Pungolino E, Rossi G, De Canal G, Trojani A, D'adda M, Perego A, Orlandi EM, Lunghi F, Turrini M, Borin L, Iurlo A, Latargia ML, Carraro MC, Spina F, Lodola M, Artale S, Anghilieri M, Spedini P, Cantoni S, Di Camillo B, Morra E, Cairoli R. Nilotinib induced bone marrow CD34+/lin-Ph+ cells early clearance in newly diagnosed CP-chronic myeloid leukemia. Am J Hematol 2018; 93:E162-E164. [PMID: 29633310 DOI: 10.1002/ajh.25106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Ester Pungolino
- Division of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milano Italy
| | - Giuseppe Rossi
- Department of Hematology; ASST Spedali Civili; Brescia Italy
| | - Gabriella De Canal
- Pathology Department; Cytogenetics, ASST Grande Ospedale Metropolitano Niguarda; Milano Italy
| | - Alessandra Trojani
- Division of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milano Italy
| | - Mariella D'adda
- Department of Hematology; ASST Spedali Civili; Brescia Italy
| | | | | | - Francesca Lunghi
- San Raffaele Hospital; Hematology and Bone Marrow Transplant Unit; Milano Italy
| | - Mauro Turrini
- Division of Hematology; Valduce Hospital; Como Italy
| | | | - Alessandra Iurlo
- Oncohematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, University of Milan; Milano Italy
| | | | | | - Francesco Spina
- Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori; Milan Italy
| | - Milena Lodola
- Division of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milano Italy
| | - Salvatore Artale
- Division of Oncology; Ospedale di Gallarate, ASST Valle Olona; Gallarate Italy
| | | | | | - Silvia Cantoni
- Division of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milano Italy
| | - Barbara Di Camillo
- Department of Information Engineering; University of Padova; Padova Italy
| | - Enrica Morra
- ASST Grande Ospedale Metropolitano Niguarda, Scientific Coordinator, Lombardy' Hematology Network; Milano Italy
| | - Roberto Cairoli
- Division of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milano Italy
| |
Collapse
|
32
|
Borlenghi E, Pagani C, Zappasodi P, Bernardi M, Basilico C, Todisco E, Fracchiolla N, Mancini V, Turrini M, Da Vià M, Sala E, Cattaneo C, Petullà M, Serana F, Ferrario A, Cairoli R, Cortelezzi A, Santoro A, Castagnola C, Rossi G. Secondary acute myeloid leukaemia in elderly patients: Patient's fitness criteria and ELN prognostic stratification can be applied to guide treatment decisions. An analysis of 280 patients by the network rete ematologica lombarda (REL). Am J Hematol 2018; 93:E54-E57. [PMID: 29164738 DOI: 10.1002/ajh.24977] [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: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Erika Borlenghi
- Department of Haematology; ASST Spedali Civili of Brescia; Brescia Italy
| | - Chiara Pagani
- Department of Haematology; ASST Spedali Civili of Brescia; Brescia Italy
| | - Patrizia Zappasodi
- Division of Haematology; Fondazione IRCCS Policlinico San Matteo, University of Pavia; Pavia Italy
| | - Massimo Bernardi
- San Raffaele Scientific Institute Haematology and Bone Marrow Transplantation Unit; Milano Italy
| | - Claudia Basilico
- Division of Haematology; ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Elisabetta Todisco
- Humanitas Cancer Center, Humanitas Clinical and Research Center; Rozzano-Milano Italy
| | - Nicola Fracchiolla
- U.O. Oncoematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milano Italy
| | - Valentina Mancini
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano Milano, Milano, Italy
| | - Mauro Turrini
- Division of Haematology Department of Medicine; Valduce Hospital; Como Italy
| | - Matteo Da Vià
- Division of Haematology; Fondazione IRCCS Policlinico San Matteo, University of Pavia; Pavia Italy
| | - Elisa Sala
- San Raffaele Scientific Institute Haematology and Bone Marrow Transplantation Unit; Milano Italy
| | - Chiara Cattaneo
- Department of Haematology; ASST Spedali Civili of Brescia; Brescia Italy
| | - Marta Petullà
- Department of Haematology; ASST Spedali Civili of Brescia; Brescia Italy
| | - Federico Serana
- CREA Laboratory, Diagnostics Department, Clinical Chemistry Laboratory, Diagnostics Department ASST Spedali Civili of Brescia; Brescia Italy
| | - Andrea Ferrario
- Division of Haematology; ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Roberto Cairoli
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano Milano, Milano, Italy
| | - Agostino Cortelezzi
- U.O. Oncoematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milano Italy
| | - Armando Santoro
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Humanitas University; Rozzano Milano Italy
| | - Carlo Castagnola
- Division of Haematology; Fondazione IRCCS Policlinico San Matteo, University of Pavia; Pavia Italy
| | - Giuseppe Rossi
- Department of Haematology; ASST Spedali Civili of Brescia; Brescia Italy
| |
Collapse
|
33
|
Trojani A, Pungolino E, Rossi G, D’Adda M, Lodola M, Camillo BD, Perego A, Turrini M, Orlandi E, Borin L, Iurlo A, Malato S, Spina F, Latargia ML, Lanza F, Artale S, Anghilieri M, Carraro MC, Canal GD, Morra E, Cairoli R. Wide-transcriptome analysis and cellularity of bone marrow CD34+/lin- cells of patients with chronic-phase chronic myeloid leukemia at diagnosis vs. 12 months of first-line nilotinib treatment. Cancer Biomark 2017; 21:41-53. [DOI: 10.3233/cbm-170209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Alessandra Trojani
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Ester Pungolino
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giuseppe Rossi
- Department of Hematology, ASST Spedali Civili, Brescia, Italy
| | - Mariella D’Adda
- Department of Hematology, ASST Spedali Civili, Brescia, Italy
| | - Milena Lodola
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Barbara Di Camillo
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Mauro Turrini
- Division of Hematology, Department of Internal Medicine, Valduce Hospital, Como, Italy
| | - Ester Orlandi
- Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenza Borin
- Hematology Division, San Gerardo Hospital, Monza, Italy
| | - Alessandra Iurlo
- Oncohematology Division, IRCCS Ca’ Granda – Maggiore Policlinico Hospital Foundation, Milano, Italy
| | - Simona Malato
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy
| | - Francesco Spina
- Division of Hematology – Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | | | - Gabriella De Canal
- Pathology Department, Cytogenetics, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Enrica Morra
- Executive Committee, Rete Ematologia Lombarda, Italy
| | - Roberto Cairoli
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| |
Collapse
|
34
|
Lazzaroni F, Giacco LD, Biasci D, Turrini M, Prosperi L, Brusamolino R, Cairoli R, Beghini A. Corrigendum: Intronless WNT10B-short variant underlies new recurrent allele-specific rearrangement in acute myeloid leukaemia. Sci Rep 2017; 7:46788. [PMID: 28443613 PMCID: PMC5405405 DOI: 10.1038/srep46788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Scientific Reports 6: Article number: 37201; published online: 17 November 2016; updated: 26 April 2017 This Article contains typographical errors in the Methods section under subheading ‘WNT10B/WNT10B IVS1 Gene expression analysis’. “The WNT10B (P4-P2 primers) amplification was performed with following thermal conditions: 94 °C for 1 min, 33 cycles at 94° for 30 s, 58 °C for 30 s, 72 °C for 30 s and 72 °C for 5 min.
Collapse
|
35
|
Cereda E, Turrini M, Ciapanna D, Marbello L, Pietrobelli A, Corradi E. Assessing Energy Expenditure in Cancer Patients: A Pilot Validation of a New Wearable Device. JPEN J Parenter Enteral Nutr 2017; 31:502-7. [DOI: 10.1177/0148607107031006502] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Emanuele Cereda
- From the International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Italy; Division of Haematology, Department of Oncology, Niguarda Ca' Granda Hospital, Milano, Italy; Paediatric Unit, Verona University Medical School, Verona, Italy; and the Division of Clinical Nutrition, Department of Medical Area, Niguarda Ca' Granda Hospital, Milano, Italy
| | - Mauro Turrini
- From the International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Italy; Division of Haematology, Department of Oncology, Niguarda Ca' Granda Hospital, Milano, Italy; Paediatric Unit, Verona University Medical School, Verona, Italy; and the Division of Clinical Nutrition, Department of Medical Area, Niguarda Ca' Granda Hospital, Milano, Italy
| | - Denis Ciapanna
- From the International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Italy; Division of Haematology, Department of Oncology, Niguarda Ca' Granda Hospital, Milano, Italy; Paediatric Unit, Verona University Medical School, Verona, Italy; and the Division of Clinical Nutrition, Department of Medical Area, Niguarda Ca' Granda Hospital, Milano, Italy
| | - Laura Marbello
- From the International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Italy; Division of Haematology, Department of Oncology, Niguarda Ca' Granda Hospital, Milano, Italy; Paediatric Unit, Verona University Medical School, Verona, Italy; and the Division of Clinical Nutrition, Department of Medical Area, Niguarda Ca' Granda Hospital, Milano, Italy
| | - Angelo Pietrobelli
- From the International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Italy; Division of Haematology, Department of Oncology, Niguarda Ca' Granda Hospital, Milano, Italy; Paediatric Unit, Verona University Medical School, Verona, Italy; and the Division of Clinical Nutrition, Department of Medical Area, Niguarda Ca' Granda Hospital, Milano, Italy
| | - Ettore Corradi
- From the International Center for the Assessment of Nutritional Status (ICANS), University of Milan, Italy; Division of Haematology, Department of Oncology, Niguarda Ca' Granda Hospital, Milano, Italy; Paediatric Unit, Verona University Medical School, Verona, Italy; and the Division of Clinical Nutrition, Department of Medical Area, Niguarda Ca' Granda Hospital, Milano, Italy
| |
Collapse
|
36
|
Lazzaroni F, Del Giacco L, Biasci D, Turrini M, Prosperi L, Brusamolino R, Cairoli R, Beghini A. Intronless WNT10B-short variant underlies new recurrent allele-specific rearrangement in acute myeloid leukaemia. Sci Rep 2016; 6:37201. [PMID: 27853307 PMCID: PMC5112549 DOI: 10.1038/srep37201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/26/2016] [Indexed: 12/12/2022] Open
Abstract
Defects in the control of Wnt signaling have emerged as a recurrent mechanism involved in cancer pathogenesis and acute myeloid leukaemia (AML), including the hematopoietic regeneration-associated WNT10B in AC133bright leukaemia cells, although the existence of a specific mechanism remains unproven. We have obtained evidences for a recurrent rearrangement, which involved the WNT10B locus (WNT10BR) within intron 1 (IVS1) and flanked at the 5' by non-human sequences whose origin remains to be elucidated; it also expressed a transcript variant (WNT10BIVS1) which was mainly detected in a cohort of patients with intermediate/unfavorable risk AML. We also identified in two separate cases, affected by AML and breast cancer respectively, a genomic transposable short form of human WNT10B (ht-WNT10B). The intronless ht-WNT10B resembles a long non-coding RNA (lncRNA), which suggests its involvement in a non-random microhomology-mediated recombination generating the rearranged WNT10BR. Furthermore, our studies supports an autocrine activation primed by the formation of WNT10B-FZD4/5 complexes in the breast cancer MCF7 cells that express the WNT10BIVS1. Chemical interference of WNT-ligands production by the porcupine inhibitor IWP-2 achieved a dose-dependent suppression of the WNT10B-FZD4/5 interactions. These results present the first evidence for a recurrent rearrangement promoted by a mobile ht-WNT10B oncogene, as a relevant mechanism for Wnt involvement in human cancer.
Collapse
Affiliation(s)
| | - Luca Del Giacco
- Department of Biosciences, University of Milan, Milan, Italy
| | - Daniele Biasci
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Mauro Turrini
- Department of Internal Medicine, Valduce Hospital, Como, Italy
| | - Laura Prosperi
- Department of Biosciences, University of Milan, Milan, Italy
| | | | - Roberto Cairoli
- Department of Oncology, Hematology Unit, Niguarda Hospital, Milan, Italy
| | | |
Collapse
|
37
|
Abstract
One point of consensus in the otherwise very controversial discussion about the benefits and dangers of DTC genetics in the health domain is the lack of substantial clinical utility. At the same time, both the empirical and conceptual literature indicate that health-related DTC tests can have value and utility outside of the clinic. We argue that a broader and multi-faceted conceptualization of utility and value would enrich the ethical and social discussion of DTC testing in several ways: First, looking at ways in which DTC testing can have personal and social value for users – in the form of entertainment, learning, or a way to relate to others – can help to explain why people still take DTC tests, and will, further down the line, foster a more nuanced understanding of secondary and tertiary uses of DTC test results (which could very well unearth new ethical and regulatory challenges). Second, considering the economic value and broader utility of DTC testing foregrounds wider social and political aspects than have been dominant in the ethical and regulatory debates surrounding DTC genetics so far. These wider political aspects include the profound power asymmetries that characterize the collection and use of personal genetic data in many contexts.
Collapse
Affiliation(s)
- Mauro Turrini
- Centre for the Study of Techniques, Knowledge and Practices, University of Paris 1 "Panthéon Sorbonne", France
| | - Barbara Prainsack
- Department of Social Science, Health & Medicine, King's College London, United Kingdom
| |
Collapse
|
38
|
Cairoli R, Beghini A, Turrini M, Bertani G, Nadali G, Rodeghiero F, Castagnola C, Lazzaroni F, Nichelatti M, Ferrara F, Pizzolo G, Pogliani E, Rossi G, Martinelli G, Morra E. Old and new prognostic factors in acute myeloid leukemia with deranged core-binding factor beta. Am J Hematol 2013; 88:594-600. [PMID: 23619823 DOI: 10.1002/ajh.23461] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 04/04/2013] [Accepted: 04/08/2013] [Indexed: 02/06/2023]
Abstract
Acute myeloid leukemia (AML) with deranged core-binding factor beta (CBFβ) is usually associated with a favorable prognosis with 50-70% of patients cured using contemporary treatments. We analyzed the prognostic significance of clinical features on 58 patients with CBFβ-AML aged ≤60 years. Increasing age was the only predictor for survival (P <0.001), with an optimal cut-point at 43 years. White blood cells (WBCs) at diagnosis emerged as an independent risk factor for relapse incidence (P = 0.017), with 1.1% increase of hazard for each 1.0 × 10(9) /L WBC increment. KIT mutations lacked prognostic value for survival and showed only a trend for relapse incidence (P = 0.069).
Collapse
Affiliation(s)
- Roberto Cairoli
- Division of Haematology; Niguarda Hospital; Milan Italy
- Division of Haematology; Department of Internal Medicine; Valduce Hospital; Como Italy
| | - Alessandro Beghini
- Department of Medical Biotechnology and Translational Medicine; University of Milan; Milan Italy
| | - Mauro Turrini
- Division of Haematology; Niguarda Hospital; Milan Italy
| | | | - Gianpaolo Nadali
- Department of Clinical and Experimental Medicine; University of Verona; Verona Italy
| | | | - Carlo Castagnola
- Department of Haematology Oncology; University of Pavia & Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Francesca Lazzaroni
- Department of Medical Biotechnology and Translational Medicine; University of Milan; Milan Italy
| | | | - Felicetto Ferrara
- Division of Haematology and Stem Cell Transplantation Unit; Cardarelli General Hospital; Naples Italy
| | - Giovanni Pizzolo
- Department of Clinical and Experimental Medicine; University of Verona; Verona Italy
| | - Enrico Pogliani
- Division of Hematology and Bone Marrow Transplantation Unit; San Gerardo University Hospital; Monza Italy
| | - Giuseppe Rossi
- Department of Haematology; Spedali Civili; Brescia Italy
| | | | - Enrica Morra
- Division of Haematology; Niguarda Hospital; Milan Italy
| |
Collapse
|
39
|
Trojani A, Greco A, Tedeschi A, Lodola M, Di Camillo B, Ricci F, Turrini M, Varettoni M, Rattotti S, Morra E. Microarray demonstrates different gene expression profiling signatures between Waldenström macroglobulinemia and IgM monoclonal gammopathy of undetermined significance. Clin Lymphoma Myeloma Leuk 2013; 13:208-10. [PMID: 23477935 DOI: 10.1016/j.clml.2013.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Waldenström macroglobulinemia (WM) (symptomatic and indolent) and immunoglobulin M (IgM) monoclonal gammopathy of undetermined significance (IgMMGUS) can be identified based on the bone marrow (BM) infiltration and the existence of symptoms. The purpose of this study was to investigate the biological and genetic characteristics of both disorders comparing the molecular signature of WM versus IgMMGUS using microarray analysis. We investigated BM CD19(+) cells isolated from 21 WM patients and 10 IgMMGUS cases, and CD138(+) BM cells isolated from all of the WM patients and 4 of the IgMMGUS cases. Gene expression profiling of WM versus IgMMGUS CD19(+) cells highlighted 151 differently expressed genes and the comparison with CD138(+) cells demonstrated 43 differently expressed genes in WM versus IgMMGUS. Regulation of transcription, Janus kinase/signal transducer and activator of transcription, PI3K/Akt/mammalian target of rapamycin, mitogen-activated protein kinase signaling pathways are the relevant gene ontology biological processes occurring in CD19(+) cells, and immune response, cell activation, and signaling processes developing in CD138(+) cells mainly distinguish WM and IgMMGUS.
Collapse
|
40
|
Neri B, Vannozzi L, Fulignati C, Pantaleo P, Pantalone D, Paoletti C, Perfetto F, Turrini M, Mazzanti R. Long-Term Survival in Metastatic Melanoma Patients Treated with Sequential Biochemotherapy: Report of a Phase II Study. Cancer Invest 2009; 24:474-8. [PMID: 16939954 DOI: 10.1080/07357900600817758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The overall survival for patients with metastatic melanoma is very poor, with a median survival of 8.5 months. In this Phase II trial, we assessed the efficacy, safety, and tolerability of a sequential biochemotherapy schedule, using dacarbazine as antiblastic agent and immunomodulant doses of interleukin-2 and interferon-alfa. Thirty-one eligible patients with metastatic melanoma received dacarbazine IV as antiblastic therapy and interluekin-2, plus interferon-alfa SC as sequential immunotherapy, for 6 months. Responding and nonprogressing patients were subsequently maintained on immunotherapy treatment for further 6 months. Twenty-nine patients had an adequate trial, and were assessable for both response and toxicities, with a median follow-up of 49 months. The overall response rate was 52 percent (3 CR and 12 PR), SD was 8 (27 percent) and PD were achieved in 6 patients (21 percent). The median survival duration of responders was 28 months, significantly longer (p < 0.001) than the 16 months of nonresponders. Therapy was well tolerated and produced a significant improvement in progressive-free survival. Further studies, thus, are recommended for larger groups of patients not only to confirm these results, but also to apply this biochemotherapy regimen as adjuvant postsurgical treatment in early stages of malignant melanoma.
Collapse
Affiliation(s)
- B Neri
- Department of Internal Medicine-Centre of Experimental and Clinical Oncology, Postgraduate School of Oncology, University of Florence, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Marbello L, Ricci F, Nosari AM, Turrini M, Nador G, Nichelatti M, Tedeschi A, Vismara E, Morra E. Outcome of hyperleukocytic adult acute myeloid leukaemia: A single-center retrospective study and review of literature. Leuk Res 2008; 32:1221-7. [DOI: 10.1016/j.leukres.2008.01.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 12/28/2007] [Accepted: 01/03/2008] [Indexed: 11/27/2022]
|
42
|
Neri B, Cipriani G, Fulignati C, Turrini M, Ponchietti R, Bartoletti R, Della Melina A, Di Cello V, Dominici A, Maleci D, Raugei A, Villari D, Nicita G. Weekly paclitaxel and epirubicin in the treatment of symptomatic hormone-refractory advanced prostate carcinoma: report of a phase II trial. Anticancer Drugs 2005; 16:63-6. [PMID: 15613906 DOI: 10.1097/00001813-200501000-00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/27/2022]
Abstract
The efficacy of weekly paclitaxel in androgen-independent prostate cancer and its addictive cytotoxicity with anthracycline derivatives led us to determine the safety and efficacy of a weekly schedule of paclitaxel and epirubicin. Between October 2000 and November 2002, 32 patients were enrolled in this study. Patients characteristics included a median age of 72 years (range 68-77), adequate hepatic, cardiac, renal and bone marrow functions, ECOG performance status of 1-2, and no prior chemotherapy. All patients had received hormonal manipulation and seven patients (22%) had received prior palliative radiation therapy. The regimen consisted of paclitaxel 70 mg/m2 i.v. infusion for 2 h and epirubicin 30 mg/m2 in bolus every week. Treatment was continued for 3 months or until disease progression or unacceptable toxicity were observed. During the study, prostate-specific antigen (PSA) was monitored and response was defined as a 50% reduction in PSA levels, to be confirmed 4 weeks later. Thirty-one patients were evaluable for toxicity and 21 for objective response. Seventeen patients (57%) had a decline above 50% in PSA level that lasted more than 4 weeks with a median time to PSA progression and a median duration of PSA response of approximately 5.5 months. Ten of the 21 patients with measurable disease (47%) had a confirmed objective response (one complete response and 20 partial responses). Thirteen of 25 symptomatic patients (56 %) had improvement in pain. The median time to disease progression was 7.6 months and the median survival was 12.9. The most prominent grade 3 toxicities were reversible myelosuppression and fatigue. Nausea, vomiting, diarrhea and peripheral edema were minimal. No evidence of cardiac toxicity was recorded. Alopecia was frequent, but reversible, in all patients. We conclude that despite the small sample size, this study demonstrates that the combination of weekly paclitaxel and epirubicin is a well-tolerated regimen for androgen-independent prostate cancer. The results imply that a combination of these agents in a weekly schedule may have clinical potential in prostate cancer treatment.
Collapse
Affiliation(s)
- B Neri
- Department of Internal Medicine-Experimental and Clinical Oncology Center, University of Florence, Florence, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Neri B, Doni L, Gemelli MT, Fulignati C, Turrini M, Di Cello V, Dominici A, Maleci M, Mottola A, Ponchietti R, Raugei A, Valsuani G, Cini G. Phase II trial of weekly intravenous gemcitabine administration with interferon and interleukin-2 immunotherapy for metastatic renal cell cancer. J Urol 2002; 168:956-8. [PMID: 12187198 DOI: 10.1016/s0022-5347(05)64550-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Since metastatic renal cell carcinoma has a poor prognosis and treatment strategies, including hormone therapy, chemotherapy and immunotherapy, have little impact on the quality of life and global survival statistics, new interest has recently focused on the combination of immuno-chemotherapy using pyrimidine analogues, such as gemcitabine. MATERIALS AND METHODS In a phase II study 16 patients with metastatic renal cell carcinoma were treated with 1,000 mg./m. gemcitabine intravenously on days 1, 8, 15 and 28 for 6 months, 3 MU (1 MU = 1 x 10(6) IU) interferon (IFN)-alpha intramuscularly 3 times a week and 4.5 million IU interleukin (IL)-2 subcutaneously daily for 5 days a week for 2 consecutive weeks every month for 6 months. Responding and nonprogressing cases were maintained on immunotherapy consisting of IFN-alpha and IL-2 for further 6 months. RESULTS In 15 evaluable patients overall response rate (1 complete response plus 3 partial response) was 28% while stable disease was achieved in 7 (47%). Median survival duration was 20 months (range, 9 to 26+) and median time to tumor progression was 14 months (6 to 26+). The complete response lasted 24+ months and partial response lasted 16 months. The regimen was well tolerated with only 1 case of neutropenia (WHO grade 3), while anorexia, fatigue and flu-like symptoms were the most common toxicity problems but were never greater than grade 2. CONCLUSIONS Despite the small sample size, this study demonstrates that gemcitabine combined with standard doses of IFN-alpha and low doses of IL-2 is effective treatment for metastatic renal cell carcinoma. This biotherapy was well tolerated and resulted in an optimum objective response and relatively long-term survival.
Collapse
Affiliation(s)
- B Neri
- Department of Internal Medicine, Oncological Day Hospital, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Neri B, Doni L, Gemelli MT, Fulignati C, Turrini M, Di Cello V, Dominici A, Maleci M, Mottola A, Ponchietti R, Raugei A, Valsuani G, Cini G. Phase II trial of weekly intravenous gemcitabine administration with interferon and interleukin-2 immunotherapy for metastatic renal cell cancer. J Urol 2002; 168:956-8. [PMID: 12187198 DOI: 10.1097/01.ju.0000024680.77882.8b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Since metastatic renal cell carcinoma has a poor prognosis and treatment strategies, including hormone therapy, chemotherapy and immunotherapy, have little impact on the quality of life and global survival statistics, new interest has recently focused on the combination of immuno-chemotherapy using pyrimidine analogues, such as gemcitabine. MATERIALS AND METHODS In a phase II study 16 patients with metastatic renal cell carcinoma were treated with 1,000 mg./m. gemcitabine intravenously on days 1, 8, 15 and 28 for 6 months, 3 MU (1 MU = 1 x 10(6) IU) interferon (IFN)-alpha intramuscularly 3 times a week and 4.5 million IU interleukin (IL)-2 subcutaneously daily for 5 days a week for 2 consecutive weeks every month for 6 months. Responding and nonprogressing cases were maintained on immunotherapy consisting of IFN-alpha and IL-2 for further 6 months. RESULTS In 15 evaluable patients overall response rate (1 complete response plus 3 partial response) was 28% while stable disease was achieved in 7 (47%). Median survival duration was 20 months (range, 9 to 26+) and median time to tumor progression was 14 months (6 to 26+). The complete response lasted 24+ months and partial response lasted 16 months. The regimen was well tolerated with only 1 case of neutropenia (WHO grade 3), while anorexia, fatigue and flu-like symptoms were the most common toxicity problems but were never greater than grade 2. CONCLUSIONS Despite the small sample size, this study demonstrates that gemcitabine combined with standard doses of IFN-alpha and low doses of IL-2 is effective treatment for metastatic renal cell carcinoma. This biotherapy was well tolerated and resulted in an optimum objective response and relatively long-term survival.
Collapse
Affiliation(s)
- B Neri
- Department of Internal Medicine, Oncological Day Hospital, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Neri B, Doni L, Fulignati C, Gemelli MT, Turrini M, Di Cello V, Dominici A, Mottola A, Raugei A, Ponchietti R, Cini G. Gemcitabine plus Epi-doxorubicin as first-line chemotherapy for bladder cancer in advanced or metastatic stage: a phase II. Anticancer Res 2002; 22:2981-4. [PMID: 12530029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Combination chemotherapy with newer, more active drugs in patients with advanced and/or metastatic bladder cancer might show improved response rate and survival. Gemcitabine (GEM) and Epidoxorubicin (EPI) have demonstrated activity in this disease. In addition, experimental studies in vitro have shown that the two agents have additive-synergistic effects when used in combination. Our prior phase I dose-finding study in previously untreated patients with advanced or metastatic bladder cancer defined recommended doses for further trials of GEM 1000 mg/m2 and EPI 25 mg/m2 on days 1, 8 and 15 every 28 days. A phase II trial at this dose level was initiated in previously untreated patients to assess efficacy and toxicity. Eligible patients had measurable disease; Karnofsky performance status (PS) of > 40; no prior chemotherapy; and adequate bone marrow reserve, cardiac, hepatic and renal function. Thirty- one patients (22 males, 9 females) with median age of 64 (range 44-75) and median PS of 80 were accrued, and all were eligible. Twelve patients had T4N1-2 M0, 8 had lymph node only metastases, while 11 had visceral metastases (liver, bone, lung). A total of 181 cycles was administered (range 3-7 per patient). Major toxicities (WHO grade > or = 3) were: neutropenia in 5 patients, thrombocytopenia in 2 patients, and anemia in 2 patients. Three patients had febrile neutropenic episodes and only 3 patients required dose reduction. Grade 1-2 non-hematological toxicities included nausea/vomiting, stomatitis and alopecia. No cardiac toxicity was observed. Of the 30 response evaluable patients, 17 (57%) demonstrated a major response (3 complete and 14 partial) (95% CI: 39%-75%), 7 had stable disease (23%) and 6 progressed (20%). These preliminary results confirm the phase I observation that the combination of GEM--EPI is highly active in the treatment of advanced and metastatic bladder cancer with a favourable toxicity profile.
Collapse
Affiliation(s)
- B Neri
- Department of Internal Medicine, Oncological Day Hospital, Viale Pieraccini 18, 50139 Florence, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Neri B, Cini G, Doni L, Fulignati C, Turrini M, Pantalone D, Mini E, De Luca Cardillo C, Fioretto LM, Ribecco AS, Moretti R, Scatizzi M, Zocchi G, Quattrone A. Weekly gemcitabine plus Epirubicin as effective chemotherapy for advanced pancreatic cancer: a multicenter phase II study. Br J Cancer 2002; 87:497-501. [PMID: 12189543 PMCID: PMC2376146 DOI: 10.1038/sj.bjc.6600482] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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: 09/17/2001] [Revised: 05/30/2002] [Accepted: 06/06/2002] [Indexed: 12/20/2022] Open
Abstract
The current role of chemotherapy in pancreatic carcinoma is limited, and progress in the treatment of this disease represents a significant challenge to medical oncology. The most promising drug under study is gemcitabine, a relatively new antimetabolite that represents an attractive candidate for combination chemotherapy because of its excellent side-effect profile and the absence of overlapping toxicities with other chemotherapeutic agents. Combined administration of gemcitabine and anthracyclines could result in the induction of DNA breaks that are not easily repaired by the cell's machinery, thus enhancing the apoptotic signals triggered by these lesions. Forty-four patients with locally advanced and/or metastatic pancreatic adenocarcinoma were enrolled in this multicenter study. Patients received Epirubicin 20 mg m(-2) for 3 weeks followed by 1 week of rest (1 cycle) and gemcitabine 1000 mg m(-2) after Epirubicin on the same day. All were assessable for toxicity and response, 11 patients responded to treatment with one complete response and 10 partial responses, for an overall response rate of 25%. Median survival was 10.9 months (range, 2-26 months). Therapy was well tolerated, with a low incidence of haematologic grade >2 toxicity. A total of 12 of 27 (44.4%) eligible patients attained a clinical benefit response. Our findings suggest that the gemcitabine-epirubicin schedule is active and well tolerated in patients with advanced pancreatic cancer.
Collapse
Affiliation(s)
- B Neri
- Department of Internal Medicine, Oncological Day Hospital, University of Florence, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Neri B, Doni L, Fulignati C, Perfetto F, Turrini M, Andreoli F, Pantalone D, Pernice LM, Taruffi F, Martini V, Poma A, Valeri A, Bacci G, Sancez L, Moretti R. Raltitrexed plus oxaliplatin as first-line chemotherapy in metastatic colorectal carcinoma: a multicentric phase II trial. Anticancer Drugs 2002; 13:719-24. [PMID: 12187328 DOI: 10.1097/00001813-200208000-00006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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: 11/26/2022]
Abstract
For advanced colorectal carcinoma, two new drugs, raltitrexed (TOM) and oxaliplatin (L-OHP), have recently shown interesting results. Preclinical and clinical studies suggest that this combination, because of its favorable toxicity profile, high response rate and convenient schedule of administration, can be administered successfully in this disease. In our phase II study, 37 non pre-treated patients with metastatic colorectal carcinoma were treated with TOM (3 mg/m(2)) and L-OHP (130 mg/m(2)) every 3 weeks. In total, 222 cycles were administered; all patients received at least 2 cycles (median 6, range 2-8). There were two complete and 14 partial responses for an overall response rate of 43% (95% CI 27-69%). The median time to response was 2.5 months (range 2-4) and the median duration was 10.3 months (range 5-18). Twelve of the 23 (52%) patients with symptomatic colorectal cancer were classified as clinical benefit responders for at least 4 weeks during the study period. Treatment was well tolerated, and both acute, essentially hematologic, and cumulative hepatic and neurologic toxicities were manageable and reversible. Response rate and toxic effects observed during this study warrant additional studies comparing this TOM-L-OHP regimen with CPT-11 and/or capacitebine-containing regimens in metastatic colorectal carcinoma.
Collapse
Affiliation(s)
- B Neri
- Center of Experimental and Clinical Oncology, Department of Internal Medicine, Oncological Day Hospital, University of Florence, 50139 Florence, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Turrini M, Orzan E, Gabana M, Genovese E, Arslan E, Fisch U. Cochlear implantation in a bilateral Mondini dysplasia. Scand Audiol Suppl 1997; 46:78-81. [PMID: 9309843] [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: 02/05/2023]
Abstract
We report the speech perception progress and programming procedures of a case of congenital profound deafness and bilateral Mondini dysplasia implanted with a Nucleus 20 + 2 cochlear implant at the age of six. Unclear relations between electrodes array and cochlear partition made implant programming difficult and non-standard procedures were set. Cochlear implantation may give excellent rehabilitative results also in cochleae with malformation.
Collapse
Affiliation(s)
- M Turrini
- Audiology and Phoniatric Department, University of Padova, Italy
| | | | | | | | | | | |
Collapse
|
49
|
Arslan E, Turrini M, Lupi G, Genovese E, Orzan E. Hearing threshold assessment with auditory brainstem response (ABR) and ElectroCochleoGraphy (ECochG) in uncooperative children. Scand Audiol Suppl 1997; 46:32-7. [PMID: 9309836] [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: 02/05/2023]
Abstract
Two-hundred-and-sixty uncooperative children (442 ears) performed auditory brainstem response (ABR) and Electrocochleography (ECochG) in the same diagnostic session under general anaesthesia, and the results obtained with the two different methods were compared. A difference > or = 20 dB between the two methods was found in 134 ears (30.3%). The presence of middle ear effusion and symptoms of a possible central nervous system pathology were considered in order to verify the evidence of a correlation between the difference in ABR-ECochG results and these clinical parameters. The presence of middle ear effusion was not significantly correlated with differences > or = 20 dB (p = 0.1347). On the contrary, the presence of symptoms indicative of a possible central nervous system (CNS) involvement was significantly correlated with differences > or = 20 dB (p = 0.0000). ABR has to be considered the first choice in hearing assessment strategy, either for screening or diagnosis. However, the diagnosis of hearing loss only on the basis of the presence or absence of wave V requires some care in case of suspected central auditory pathway lesions. In these cases, ECochG may be the only reliable diagnostic tool for hearing assessment in uncooperative subjects.
Collapse
Affiliation(s)
- E Arslan
- Audiology and Phoniatrics Department, University of Padova, Italy
| | | | | | | | | |
Collapse
|
50
|
Genovese E, Orzan E, Turrini M, Babighian G, Arslan E. [Speech perception test in Italian language for profoundly deaf children]. Acta Otorhinolaryngol Ital 1995; 15:383-90. [PMID: 8721729] [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: 02/01/2023]
Abstract
Speech perception tests are an important part of procedures for diagnosing pre-verbal hearing loss. Merely establishing a child's hearing threshold with and without a hearing aid is not sufficient to ensure an adequate evaluation with a view to selecting cases suitable for cochlear implants because it fails to indicate the real benefit obtained from using a conventional hearing aid reliably. Speech perception tests have proved useful not only for patient selection, but also for subsequent evaluation of the efficacy of new hearing aids, such as tactile devices and cochlear implants. In clinical practice, the tests most commonly adopted with small children are: The Auditory Comprehension Test (ACT), Discrimination after Training (DAT), Monosyllable, Trochee, Spondee tests (MTS), Glendonald Auditory Screening Priocedure (GASP), Early Speech Perception Test (ESP), Rather than considering specific results achieved in individual cases, reference is generally made to the four speech perception classes proposed by Moog and Geers of the CID of St. Louis. The purpose of this classification, made on the results obtained with suitably differentiated tests according to the child's age and language ability, is to detect differences in perception of a spoken message in ideal listening conditions. To date, no italian language speech perception test has been designed to establish the assessment of speech perception level in children with profound hearing impairment. We attempted, therefore, to adapt the existing English tests to the Italian language taking into consideration the differences between the two languages. Our attention focused on the ESP test since it can be applied to even very small children (2 years old). The ESP is proposed in a standard version for hearing-impaired children over the age of 6 years and in a simplified version for younger children. The rationale we used for selecting Italian words reflect the rationale established for the original version, but the choice of single words follows different criteria from the original version. In fact, the two languages differ in important linguistic features so that the test can not be not adapted to the Italian language by simply translating the words involved. As currently there is no children's language dictionary in Italian arranged according to age bracket, we chose words used in children and in pre-school reading material.
Collapse
Affiliation(s)
- E Genovese
- Istituto di Clinica O.R.L., Università di Padova
| | | | | | | | | |
Collapse
|