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Zappaterra A, Civettini I, Cafro AM, Pezzetti L, Pierini S, Anghilieri M, Bellio L, Bertazzoni P, Grillo G, Minga P, Pioltelli ML, Ravano E, Sassone M, Viganò CV, Volpato EB, Gambacorti-Passerini C, Rossini S, Cairoli R, Crocchiolo R. Anti-CD38 monoclonal antibody impairs CD34+ mobilization and affects clonogenic potential in multiple myeloma patients. Blood Transfus 2024:BloodTransfus.667. [PMID: 38315530 DOI: 10.2450/bloodtransfus.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/26/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Induction with daratumumab-based regimens followed by autologous stem cell transplantation is the current standard for newly diagnosed multiple myeloma (NDMM) patients eligible for intensive chemotherapy. However, concerns emerged regarding potential negative effects following daratumumab-based treatment on CD34+ mobilization. We here compared CD34+ mobilization and clonogenic potential between daratumumab and non-daratumumab based therapy without upfront plerixafor administration among patients affected by NDMM. MATERIALS AND METHODS Clinical, mobilization and clonogenic data from 41 consecutively enrolled NDMM patients were analyzed. Patients underwent collection of autologous CD34+ by apheresis at the ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy, from January 2021 to March 2023. Clonogenicity analysis was performed on BFU-E and CFU-GM. RESULTS Seventy-five percent of daratumumab-treated patients underwent >1 apheresis, compared to 24% of non-daratumumab patients (p=0.0017). Daratumumab-treated patients had significantly lower CD34+ count (mean 38 vs 79/μL, respectively; p=0.0011), with a median CD34+ harvest of 3.98×106/kg (range 1.68-9.18) vs 6.87×106/kg (range 1.63-16.85) in non-daratumumab-treated (p=0.0006). In multivariate analysis the likelihood of undergoing >1 apheresis was significantly higher in older patients (OR 1.2, 95% CI 1-1.4, Z=2.10, p=0.03) and daratumumab-treated patients (OR 15, 95% CI 2.8-129, p=0.004). Moreover, daratumumab-based induction therapy demonstrated an independent negative association with BFU-E colony formation (p=0.0148), even when accounting for patient age and CD34+ levels. DISCUSSION Our findings underscore the impact of daratumumab-based treatment on CD34+ mobilization in a real-life, upfront plerixafor-free population of NDMM patients. Higher probability of requiring multiple apheresis occurred among daratumumab-treated patients. Interestingly, the observation that daratumumab might negatively impact BFU-E colony formation, independent of CD34+ cell count, offers novel biological perspectives. Appropriate strategies should be adopted by the Apheresis teams to mitigate these potential negative effects.
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Affiliation(s)
- Arianna Zappaterra
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Hematology Division, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, Italy
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Ivan Civettini
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Hematology Division, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, Italy
| | - Anna Maria Cafro
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Laura Pezzetti
- Cellular Therapy Laboratory, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Silvia Pierini
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Hematology Division, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, Italy
| | | | - Laura Bellio
- Immunohematology and Transfusion Medicine Service, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Paola Bertazzoni
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giovanni Grillo
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Periana Minga
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Maria L Pioltelli
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Emanuele Ravano
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Clara V Viganò
- Onco-hematology Division, Manzoni Hospital, Lecco, Italy
| | - Elisabetta B Volpato
- Immunohematology and Transfusion Medicine Service, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Carlo Gambacorti-Passerini
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Hematology Division, Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, Italy
| | - Silvano Rossini
- Immunohematology and Transfusion Medicine Service, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Roberto Cairoli
- Department of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Hematology Division, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Roberto Crocchiolo
- Immunohematology and Transfusion Medicine Service, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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Villa F, Corbetta C, Crippa A, Pelizzoni D, Vittimberga I, Sansi C, Arnoffi J, Guida F, Cuomo O, Tafuni M, Sassone M, Viganò C, Anghilieri M, Ardizzoia A. Breast cancer management with CDK4/6 inhibitors as first line treatment: a single institution retrospective review. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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3
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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.
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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
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4
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Maffioli M, Giorgino T, Mora B, Iurlo A, Elli E, Finazzi MC, Caramella M, Rumi E, Carraro MC, Polverelli N, D'Adda M, Malato S, Rossi M, Molteni A, Vismara A, Sissa C, Spina F, Anghilieri M, Cattaneo D, Renso R, Bellini M, Pioltelli ML, Cavalloni C, Barraco D, Accetta R, Bertù L, Della Porta MG, Passamonti F. Second primary malignancies in ruxolitinib-treated myelofibrosis: real-world evidence from 219 consecutive patients. Blood Adv 2019; 3:3196-3200. [PMID: 31698448 PMCID: PMC6855128 DOI: 10.1182/bloodadvances.2019000646] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/10/2019] [Indexed: 01/25/2023] Open
Abstract
We present real-world data on all ruxolitinib-treated myelofibrosis patients in a 10-million-resident region, with a follow-up of 2 years. We found no evidence of an increased risk of developing lymphomas.
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Affiliation(s)
| | - Toni Giorgino
- Biophysics Institute (IBF-CNR), National Research Council of Italy, Milan, Italy
- Department of Biosciences, University of Milan, Milan, Italy
| | - Barbara Mora
- Hematology Unit, Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Elli
- Hematology Division and Bone Marrow Unit, Ospedale San Gerardo, Monza, Italy
| | | | - Marianna Caramella
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elisa Rumi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Nicola Polverelli
- Unit of Blood Diseases and Stem Cell Transplantation, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Mariella D'Adda
- Department of Hematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Simona Malato
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marianna Rossi
- Department of Hematology, Cancer Center, IRCCS Humanitas Research Hospital/Humanitas University, Rozzano, Italy
| | | | | | - Cinzia Sissa
- Department of Hematology and Transfusion Medicine, ASST Mantova, Mantova, Italy
| | - Francesco Spina
- Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Daniele Cattaneo
- Hematology Division, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rossella Renso
- Hematology Division and Bone Marrow Unit, Ospedale San Gerardo, Monza, Italy
| | - Marta Bellini
- Department of Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Chiara Cavalloni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Daniela Barraco
- Hematology Unit, Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
| | - Raffaella Accetta
- Cytogenetics and Genetics Laboratory, Ospedale di Circolo, ASST Sette Laghi, Varese, Italy; and
| | - Lorenza Bertù
- Department of Medicine and Surgery, University of Insubria, ASST Sette Laghi-Ospedale di Circolo, Varese, Italy
| | - Matteo Giovanni Della Porta
- Department of Hematology, Cancer Center, IRCCS Humanitas Research Hospital/Humanitas University, Rozzano, Italy
| | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria, ASST Sette Laghi-Ospedale di Circolo, Varese, Italy
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5
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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.
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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
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6
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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
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7
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Nosari A, Nichelatti M, De Gasperi A, Nador G, Anghilieri M, Mazza E, Cozzi P, Mancini V, Miqueleiz S, Bettinelli L, Lucchesini C, Baraté C, Ricci F, Ciapanna D, Ravelli E, Morra E. Incidence of Sepsis in Central Venous Catheter-Bearing Patients with Hematologic Malignancies: Preliminary Results. J Vasc Access 2018; 5:168-73. [PMID: 16596561 DOI: 10.1177/112972980400500406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Indwelling central venous catheters (CVCs) are essential devices in the management of patients with hematological disorders treated with chemotherapy. However, their nature predisposes patients to unwanted complications. Methods CVC-related complications were retrospectively analyzed in 227 hematologic patients who were consecutively admitted to our hematology department between May 2002 and April 2004. Patients’ diagnoses comprised acute myeloid leukemia (36.8%), acute lymphoid leukemia (7.3%), lymphoproliferative disorders (28.3%), multiple myeloma (19.5%), myeloproliferative syndromes (5%) and others (3.1%). The CVCs used were polyurethane three lumen 7-Fr (111 patients) for chemotherapy and 12-Fr (114 patients) for chemotherapy and peripheral blood stem cell apheresis, plus two tunneled catheters. Results The pathological events were: bacteriaemias (n=46); occlusions (n=10); exit tunnel infections (n=8); thrombosis (n=6); lung emboli (n=2). Among febrile patients the bacteriemia frequency was 20%, of which 13.6% were CVC-related (with a higher incidence in leukemia patients (p=0.027). Among the isolates, gram-positive bacteria were found in 29 cases (23 CVC-related cases), and gram-negative bacteria in 16 cases (8 CVC-related cases). Only one patient had Candida albicans sepsis. At univariate and multivariate analysis significant risk factors for infection (p<0.0001) were only the number of days/catheters and neutropenia duration. Conclusions In our hematologic patients, the CVC complications were mainly septic, with only 10.1% of CVC-related bacteriemias, despite prolonged catheterization duration. Acute leukemia patients were at major risk for sepsis, probably due to a more severe neutropenia and prolonged catheterization duration.
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Affiliation(s)
- A Nosari
- Division of Hematology, Niguarda Ca' Granda Hospital, Milan, Italy
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8
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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
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9
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Villa F, Colombo I, Crippa A, De Martini G, Lafranconi M, Dell'Oro S, Vittimberga I, Arnoffi J, Guida F, Villa S, Anghilieri M, Viganò C, Ferrando P, De Nittis G, Valsecchi V, Ardizzoia A. Sharing long term follow-up of breast cancer survivors with family physician: a province of Lecco experience. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nosari A, Anghilieri M, Carrafiello G, Guffanti C, Marbello L, Montillo M, Muti G, Ribera S, Vanzulli A, Nichelatti M, Morra E. Utility of percutaneous lung biopsy for diagnosing filamentous fungal infections in hematologic malignancies. Haematologica 2003; 88:1405-9. [PMID: 14687995] [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: 04/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The incidence of invasive filamentous fungal infections in hematologic patients is increasing as a consequence of high dose chemotherapy and bone marrow transplant procedures. Mortality is usually very high. The diagnosis is often difficult and yet a fast, accurate diagnosis is of fundamental importance for treating the infection and planning subsequent management of the hematologic disease. We evaluated the sensitivity of computed tomography (CT)-guided percutaneous biopsy in diagnosing pulmonary fungal infections. DESIGN AND METHODS Between 1997 and 2002 we performed 17 CT-guided percutaneous transthoracic lung biopsies in 17 hematologic patients with suspected filamentous fungi infection with negative BAL, to obtain a certain diagnosis and to know what species of fungi was responsible for infection. In all cases suspected mycosis began during the post-chemotherapy aplastic period. Patients were receiving antifungal therapy at the time of all biopsies. When the platelet count rose above 50 x 10(9)/L, CT-guided percutaneous lung biopsy with fine-needle aspiration for cytology was performed. RESULTS Twelve of 17 patients had histologic confirmation of the fungal infection (70.5%), 8 with Aspergillus spp. 4 with Mucorales spp. Biopsies provided non-specific results in 4 cases; in 2 of these cases, clinical course and response to therapy confirmed the diagnosis of mycosis; in the last case bronchoalveolar carcinoma was found as a new diagnosis. Cultures were positive in only 6 cases, all for Aspergillus spp. The sensitivity of CT-guided percutaneous lung biopsy was 70.6% and its positive predictive value (PPV) was 100%. This procedure provided an immediate diagnosis and only one side-effect (1 pneumothorax, without complications). INTERPRETATION AND CONCLUSIONS Histologic discrimination between aspergillosis and mucormycosis is very important for deciding secondary prophylaxis during transplant procedures, because Mucor is usually resistant to azoles.
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MESH Headings
- Adenocarcinoma, Bronchiolo-Alveolar/diagnosis
- Adenocarcinoma, Bronchiolo-Alveolar/pathology
- Adult
- Antifungal Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Aspergillosis/diagnosis
- Aspergillosis/drug therapy
- Aspergillosis/etiology
- Aspergillosis/microbiology
- Aspergillosis/pathology
- Aspergillus/isolation & purification
- Biopsy, Needle/methods
- Bronchoalveolar Lavage Fluid/microbiology
- Disease Susceptibility
- Female
- Hematologic Neoplasms/complications
- Hematologic Neoplasms/drug therapy
- Humans
- Lung/diagnostic imaging
- Lung/microbiology
- Lung/pathology
- Lung Diseases, Fungal/diagnosis
- Lung Diseases, Fungal/drug therapy
- Lung Diseases, Fungal/etiology
- Lung Diseases, Fungal/microbiology
- Lung Diseases, Fungal/pathology
- Lung Neoplasms/diagnosis
- Lung Neoplasms/pathology
- Male
- Middle Aged
- Mucorales/isolation & purification
- Mucormycosis/diagnosis
- Mucormycosis/drug therapy
- Mucormycosis/etiology
- Mucormycosis/microbiology
- Mucormycosis/pathology
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/pathology
- Predictive Value of Tests
- Radiography, Interventional
- Retrospective Studies
- Sensitivity and Specificity
- Tomography, X-Ray Computed
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Affiliation(s)
- Annamaria Nosari
- Division of Haematology, Dept. of Hematology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
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Marbello L, Nosari A, Carrafiello G, Anghilieri M, Cesana C, Cafro AM, D'Avanzo G, Morra E. Successful treatment with voriconazole of cerebral aspergillosis in an hematologic patient. Haematologica 2003; 88:ECR05. [PMID: 12651283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Affiliation(s)
- Laura Marbello
- Department of Hematology, Niguarda Ca'Granda Hospital, Piazza Ospedale Maggiore no. 3, 20162 Milan, Italy.
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