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Casale M, Forni GL, Cassinerio E, Pasquali D, Origa R, Serra M, Campisi S, Peluso A, Renni R, Cattoni A, De Michele E, Allò M, Poggi M, Ferrara F, Di Concilio R, Sportelli F, Quarta A, Putti MC, Notarangelo LD, Sau A, Ladogana S, Tartaglione I, Picariello S, Marcon A, Sturiale P, Roberti D, Lazzarino AI, Perrotta S. Risk factors for endocrine complications in transfusion-dependent thalassemia patients on chelation therapy with deferasirox: a risk assessment study from a multicentre nation-wide cohort. Haematologica 2021; 107:467-477. [PMID: 33406815 PMCID: PMC8804575 DOI: 10.3324/haematol.2020.272419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Indexed: 01/19/2023] Open
Abstract
Transfusion-dependent patients typically develop iron-induced cardiomyopathy, liver disease, and endocrine complications. We aimed to estimate the incidence of endocrine disorders in transfusiondependent thalassemia (TDT) patients during long-term iron-chelation therapy with deferasirox (DFX). We developed a multi-center follow-up study of 426 TDT patients treated with once-daily DFX for a median duration of 8 years, up to 18.5 years. At baseline, 118, 121, and 187 patients had 0, 1, or ≥2 endocrine diseases respectively. 104 additional endocrine diseases were developed during the follow-up. The overall risk of developing a new endocrine complication within 5 years was 9.7% (95% Confidence Interval [CI]: 6.3–13.1). Multiple Cox regression analysis identified three key predictors: age showed a positive log-linear effect (adjusted hazard ratio [HR] for 50% increase 1.2, 95% CI: 1.1–1.3, P=0.005), the serum concentration of thyrotropin showed a positive linear effect (adjusted HR for 1 mIU/L increase 1.3, 95% CI: 1.1–1.4, P<0.001) regardless the kind of disease incident, while the number of previous endocrine diseases showed a negative linear effect: the higher the number of diseases at baseline the lower the chance of developing further diseasess (adjusted HR for unit increase 0.5, 95% CI: 0.4–0.7, P<0.001). Age and thyrotropin had similar effect sizes across the categories of baseline diseases. The administration of levothyroxine as a covariate did not change the estimates. Although in DFX-treated TDT patients the risk of developing an endocrine complication is generally lower than the previously reported risk, there is considerable risk variation and the burden of these complications remains high. We developed a simple risk score chart enabling clinicians to estimate their patients’ risk. Future research will look at increasing the amount of variation explained from our model and testing further clinical and laboratory predictors, including the assessment of direct endocrine magnetic resonance imaging.
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Affiliation(s)
- Maddalena Casale
- Department of Women, Child and General and Specialized Surgery, University " Luigi Vanvitelli", via Luigi De Crecchio n. 4, 80138, Naples.
| | - Gian Luca Forni
- Center of Microcitemia and Congenital Anemias, Galliera Hospital, Mura delle Cappuccine 14 16128, Genoa
| | - Elena Cassinerio
- Rare Diseases Center, General Medicine Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Daniela Pasquali
- Endocrinology, Department of Advanced Medical and Surgical Sciences, University " Luigi Vanvitelli", Naples
| | - Raffaella Origa
- Thalassemia Centre, Pediatric Hospital A CAO, AOG Brotzu, Cagliari
| | - Marilena Serra
- Thalassemia Centre, Department of Internal Medicine, Hospital "V. Fazzi", Lecce
| | | | - Angelo Peluso
- Centre of Microcitemia, POC SS.Annunziata - ASL TA, Taranto
| | - Roberta Renni
- Thalassemia Centre, Department of Internal Medicine, Hospital F.Ferrari, Casarano
| | - Alessandro Cattoni
- Department of Pediatrics, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Azienda Ospedaliera San Gerardo, Monza
| | - Elisa De Michele
- Immunotransfusion Medicine Unit, AOU OO.RR. S. Giovanni di Dio e Ruggi d'Aragona, Salerno
| | | | | | | | | | | | - Antonella Quarta
- Center for Microcythemia, Iron Metabolism disorders, Gaucher disease-Hematology and Transplantation Unit, "A. Perrino" Hospital, Brindisi
| | | | | | - Antonella Sau
- Department of Pediatric Hematology and Oncology, Hospital "Spirito Santo", Pescara
| | - Saverio Ladogana
- Pediatric Oncohematology Unit, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo
| | - Immacolata Tartaglione
- Department of Women, Child and General and Specialized Surgery, University " Luigi Vanvitelli", via Luigi De Crecchio n. 4, 80138, Naples
| | - Stefania Picariello
- Department of Women, Child and General and Specialized Surgery, University " Luigi Vanvitelli", via Luigi De Crecchio n. 4, 80138, Naples
| | - Alessia Marcon
- Rare Diseases Center, General Medicine Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | | | - Domenico Roberti
- Department of Women, Child and General and Specialized Surgery, University " Luigi Vanvitelli", via Luigi De Crecchio n. 4, 80138, Naples
| | - Antonio Ivan Lazzarino
- EPISTATA - Agency for Clinical Research and Medical Statistics, London E8 3SY, United Kingdom
| | - Silverio Perrotta
- Department of Women, Child and General and Specialized Surgery, University " Luigi Vanvitelli", via Luigi De Crecchio n. 4, 80138, Naples
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Quarta A, Sgherza N, Pasanisi A, Solfrizzi MP, Serra M, Vitucci A, Dello Iacono N, Renni R, Daprile C, Mosna F, Palma A, Frappampina R, Visceglie D, Pastore D. Switching from dispersible to film coated tablet formulation of deferasirox improves hemoglobin levels and transfusional interval in patients with transfusion-dependent-thalassemia. Br J Haematol 2020; 189:e60-e63. [PMID: 32119115 DOI: 10.1111/bjh.16468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Antonella Quarta
- U.O.C. di Ematologia - Centro Trapianti di Midollo Osseo - Centro della Microcitemia - P.O. "A.Perrino", Brindisi, Italy
| | - Nicola Sgherza
- U.O.C. di Ematologia - Centro Trapianti di Midollo Osseo - Centro della Microcitemia - P.O. "A.Perrino", Brindisi, Italy
| | - Annamaria Pasanisi
- U.O.C. di Ematologia - Centro Trapianti di Midollo Osseo - Centro della Microcitemia - P.O. "A.Perrino", Brindisi, Italy
| | - Maria P Solfrizzi
- U.O.C. di Ematologia - Centro Trapianti di Midollo Osseo - Centro della Microcitemia - P.O. "A.Perrino", Brindisi, Italy
| | - Marilena Serra
- D.H. Talassemia - U.O. Medicina Interna- Osp. "V. Fazzi", Lecce, Italy
| | - Angelantonio Vitucci
- U.O. Ematologia con Trapianto -Azienda Ospedaliero-Universitaria- Policlinico, Bari, Italy
| | - Nicola Dello Iacono
- D.H. Talassemia, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Roberta Renni
- D.H. Talassemia-U.O. Medicina Interna - Osp. Civile "F.Ferrari", Casarano, Italy
| | - Carmela Daprile
- Servizio di Immunoematologia e Medicina Trasfusionale - Day Hospital Talassemie, Ospedale "Di Venere", Bari, Italy
| | - Federico Mosna
- Ematologia e CTMO - Ospedale Regionale "S. Maurizio", Comprensorio Sanitario di Bolzano, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Antonio Palma
- U.O. Ematologia con Trapianto -Azienda Ospedaliero-Universitaria- Policlinico, Bari, Italy
| | - Roberta Frappampina
- U.O. Ematologia con Trapianto -Azienda Ospedaliero-Universitaria- Policlinico, Bari, Italy
| | - Domenico Visceglie
- Servizio di Immunoematologia e Medicina Trasfusionale - Day Hospital Talassemie, Ospedale "Di Venere", Bari, Italy
| | - Domenico Pastore
- U.O.C. di Ematologia - Centro Trapianti di Midollo Osseo - Centro della Microcitemia - P.O. "A.Perrino", Brindisi, Italy
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Giuliano P, Meloni A, Pistoia L, Giunta N, Peritore G, Caccamo G, Salli A, Miciotto F, Cuccia L, Campisi S, Paci C, Renni R, Pepe A. P3329Long term prospective predictors for vascular events and cardiac complications in thalassemia major patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3329] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pietrapertosa AC, Minenna G, Colella SM, Santeramo TM, Renni R, D'Amore M. Osteoprotegerin and RANKL in the pathogenesis of osteoporosis in patients with thalassaemia major. Panminerva Med 2009; 51:17-23. [PMID: 19352306] [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: 05/27/2023]
Abstract
Osteoporosis represents an important cause of morbidity in thalassaemia major patients; the etiopathogenesis is multifactorial and includes expansion of the bone marrow, endocrine disorders, iron overload and genetic factors. Two cytokines, osteoprotegerin (OPG) and receptor activator of nuclear factor kappa B ligand (RANKL), have recently been identified as important mediators in the pathogenesis of osteoporosis. In this study, the possible role of the OPG-RANKL system in the pathogenesis of osteoporosis in thalassemia major is assessed, as well as any correlations between the serum levels of OPG and RANKL and bone mineral density (BMD), 17 beta-estradiol and free testosterone and the relationship between T-score of BMD and OPG/RANKL ratio. In 31 thalassaemia major patients and a control group, the serum values of OPG and RANKL were assayed and correlated with BMD, as well as with the sex hormones values. All the thalassemic patients had reduced BMD and 35.5% presented osteoporosis. The thalassemic patients had significantly higher serum levels of OPG than the controls, while their higher RANKL levels, were at the threshold of significance. The OPG/RANKL ratio showed higher level respect to the controls. No statistically significant correlation was observed between the T-score and RANKL neither between the T-score and OPG nor between T-score and OPG/RANKL ratio. Instead, a statistically significant correlation was found between the T-score and free testosterone and between the T-score and 17 beta-estradiol. There was no correlation between the sex hormones and OPG and RANKL. The increased OPG values in thalassemic patients could be considered to compensate the increased bone turnover. The authors confirm hypogonadism as a primary etiopathogenetic factor in the reduced BMD observed in thalassaemia major patients.
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Abstract
Hereditary hemochromatosis (HH) is an autosomal recessive trait regarding iron metabolism frequently found in Caucasian populations. The C282Y mutation of the HFE gene, held responsible for HH, has been identified as the major genetic basis for the phenotypic expression of HH whereas two additional mutations of the HFE H63D and S65C gene appear to be associated with a milder form of HH. A high allele frequency of C282Y and H63D has been reported in Northern European populations. In Italy, the overall allele frequency was 0.5% for the C282Y mutation, 12.6% for the H63D mutation and 1.1% for the S65C mutation. In this study, we evaluated the allele frequency of the three principal HFE mutations (C282Y, H63D, S65C) together with eight additional mutations (V53M, H63H, Q127H, E168Q, E168stop, W169stop, V59M, Q238P) in 500 healthy Apulian subjects. No subject homozygous for the C282Y mutation was found while 3% of subjects were heterozygous for this mutation. Heterozygosity and homozygosity for the H63D mutation were 26 and 1%, respectively. Only five subjects were heterozygous for the S65C mutation. Overall, the allele frequency was 1.5% for C282Y, 14% for H63D, 0.5% for S65C and 0% for the other mutations. The transferrin saturation (TS) was significantly higher in subjects heterozygous for the H63D mutations with respect to subjects with a normal genotype, though all were within the normal range. No statistically significant difference in the allele frequency was noted in the Apulian population compared to that in Northern and Southern Italy.
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Pietrapertosa A, Campanale D, Palma A, Renni R, D'Addario V, Tannoia N, Vitucci A. Analysis of HLA-DRB1*-A* and -B* alleles in prenatal diagnosis for determination of maternal contamination in fetal DNA. Mol Hum Reprod 2002; 8:586-8. [PMID: 12029078 DOI: 10.1093/molehr/8.6.586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/12/2022] Open
Abstract
During chorionic villi sampling for prenatal diagnosis with molecular biology techniques, contamination by maternal decidua frequently occurs and can lead to misinterpretation of the test results. To avoid such problems, we present a new method for appraising maternal contamination of fetal DNA, based on genomic typing of the highly variable human leukocyte antigen (HLA) locus-DRB1*, locus A* and locus B* regions by genetic amplification with sequence-specific primers and PCR. Fetal DNA samples obtained for beta-thalassemia diagnosis were analysed after artificial contamination with increasing maternal DNA concentrations ranging from 0.5 to 10% (0.5, 1, 3, 5 and 10%). The approach was found to be rapid, specific, reproducible and highly sensitive and permits recognition of 1-3% contamination by maternal DNA concentrations. The system currently used for detecting maternal DNA contamination in fetal samples is the analysis of polymorphic loci by variable number of tandem repeats and/or short tandem repeats. We propose that the analysis of HLA alleles may provide a valid alternative or complement to this system.
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Affiliation(s)
- A Pietrapertosa
- Division of Hematology II, University of Bari, Piazza Giulio Cesare 11, 70124, Italy.
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