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Mikulska M, Testi D, Russo C, Balletto E, Sepulcri C, Bussini L, Dentone C, Magne F, Policarpo S, Campoli C, Miselli F, Cilli A, Ghiggi C, Aquino S, Di Grazia C, Giannella M, Giacobbe DR, Vena A, Raiola AM, Bonifazi F, Zinzani P, Cavo M, Lemoli R, Angelucci E, Viale P, Bassetti M, Bartoletti M. Outcome of early treatment of SARS-CoV-2 infection in patients with haematological disorders. Br J Haematol 2023; 201:628-639. [PMID: 36806152 DOI: 10.1111/bjh.18690] [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: 12/02/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
Outcome of early treatment of COVID-19 with antivirals or anti-spike monoclonal antibodies (MABs) in patients with haematological malignancies (HM) is unknown. A retrospective study of HM patients treated for mild/moderate COVID-19 between March 2021 and July 2022 was performed. The main composite end-point was treatment failure (severe COVID-19 or COVID-19-related death). We included 328 consecutive patients who received MABs (n = 120, 37%; sotrovimab, n = 73) or antivirals (n = 208, 63%; nirmatrelvir/ritonavir, n = 116) over a median of two days after symptoms started; 111 (33.8%) had non-Hodgkin lymphoma (NHL); 89 (27%) were transplant/CAR-T (chimaeric antigen receptor T-cell therapy) recipients. Most infections (n = 309, 94%) occurred during the Omicron period. Failure developed in 31 patients (9.5%). Its independent predictors were older age, fewer vaccine doses, and treatment with MABs. Rate of failure was lower in the Omicron versus the pre-Omicron period (7.8% versus 36.8%, p < 0.001). During the Omicron period, predictors of failure were age, fewer vaccine doses and diagnosis of acute myeloid leukaemia/myelodysplastic syndrome (AML/MDS). Independent predictors of longer viral shedding were age, comorbidities, hospital admission at diagnosis, NHL/CLL, treatment with MABs. COVID-19-associated mortality was 3.4% (n = 11). The mortality in those who developed severe COVID-19 after early treatment was 26% in the Omicron period. Patients with HM had a significant risk of failure of early treatment, even during the Omicron period, with high mortality rate.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Diletta Testi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Chiara Russo
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Balletto
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Sepulcri
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Linda Bussini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Sílvia Policarpo
- Infectious Diseases Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Caterina Campoli
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Filippo Miselli
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandro Cilli
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Chiara Ghiggi
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Aquino
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carmen Di Grazia
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Daniele Roberto Giacobbe
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Bonifazi
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Institute of Hematology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - Pierluigi Zinzani
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Institute of Hematology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - Michele Cavo
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Institute of Hematology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - Roberto Lemoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Internal Medicine (DiMI), Clinic of Hematology, University of Genoa, Genoa, Italy
| | - Emanuele Angelucci
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Bartoletti
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Passamonti F, Romano A, Salvini M, Merli F, Porta MGD, Bruna R, Coviello E, Romano I, Cairoli R, Lemoli R, Farina F, Venditti A, Busca A, Ladetto M, Massaia M, Pinto A, Arcaini L, Tafuri A, Marchesi F, Fracchiolla N, Bocchia M, Armiento D, Candoni A, Krampera M, Luppi M, Cardinali V, Galimberti S, Cattaneo C, La Barbera EO, Mina R, Lanza F, Visani G, Musto P, Petrucci L, Zaja F, Grossi PA, Bertù L, Pagano L, Corradini P. COVID-19 elicits an impaired antibody response against SARS-CoV-2 in patients with haematological malignancies. Br J Haematol 2021; 195:371-377. [PMID: 34272724 PMCID: PMC8444788 DOI: 10.1111/bjh.17704] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 05/25/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022]
Abstract
COVID‐19 is associated with high mortality in patients with haematological malignancies (HM) and rate of seroconversion is unknown. The ITA‐HEMA‐COV project (NCT04352556) investigated patterns of seroconversion for SARS‐CoV‐2 IgG in patients with HMs. A total of 237 patients, SARS‐CoV‐2 PCR‐positive with at least one SARS‐CoV‐2 IgG test performed during their care, entered the analysis. Among these, 62 (26·2%) had myeloid, 121 (51·1%) lymphoid and 54 (22·8%) plasma cell neoplasms. Overall, 69% of patients (164 of 237) had detectable IgG SARS‐CoV‐2 serum antibodies. Serologically negative patients (31%, 73 of 237) were evenly distributed across patients with myeloid, lymphoid and plasma cell neoplasms. In the multivariable logistic regression, chemoimmunotherapy [odds ratio (OR), 3·42; 95% confidence interval (CI), 1·04–11·21; P = 0·04] was associated with a lower rate of seroconversion. This effect did not decline after 180 days from treatment withdrawal (OR, 0·35; 95% CI: 0·11–1·13; P = 0·08). This study demonstrates a low rate of seroconversion in HM patients and indicates that treatment‐mediated immune dysfunction is the main driver. As a consequence, we expect a low rate of seroconversion after vaccination and thus we suggest testing the efficacy of seroconversion in HM patients.
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Affiliation(s)
- Francesco Passamonti
- Dipartimento di Medicina e Chirurgia, Università dell'Insubria, Varese, Italy.,ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | | | - Marco Salvini
- ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | | | - Matteo G Della Porta
- Department of Biomedical Sciences, Humanitas Clinical and Research Hospital - IRCCS, Humanitas University, Milano, Italy
| | - Riccardo Bruna
- Department of Translational Medicine, University of Eastern Piedmont and Ospedale Maggiore della Carità, Novara, Italy
| | | | - Ilaria Romano
- University of Florence and AOU Careggi, Firenze, Italy
| | | | | | | | - Adriano Venditti
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italy
| | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza of Torino, Torino, Italy
| | - Marco Ladetto
- Dip di Medicina Traslazionale, Università del Piemonte Orientale ed AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Antonio Pinto
- Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Luca Arcaini
- Division of Hematology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Agostino Tafuri
- Department of Clinical and Molecular Medicine, Sapienza, University Hospital Sant'Andrea, University of Rome, Roma, Italy
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Nicola Fracchiolla
- Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Bocchia
- Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Daniele Armiento
- Unit of Hematology, Stem Cell Transplantation, University Campus Bio-Medico, Rome, Italy
| | - Anna Candoni
- Division of Hematology, University Hospital of Udine -ASUFC, Udine, Italy
| | - Mauro Krampera
- Department of Medicine, University of Verona, Verona, Italy
| | - Mario Luppi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | | | - Roberto Mina
- Università di Torino, Azienda Ospedaliera Città della Salute e della Scienza, Alessandria, Italy
| | | | - Giuseppe Visani
- Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Pellegrino Musto
- Department of Emergency and Organ Transplantation, Unit of Hematology and Stem Cell Transplantation, "Aldo Moro" University School of Medicine, AOU Consorziale Policlinico, Bari, Italy
| | - Luigi Petrucci
- Division of Hematology, Department of Translational and Precison Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Paolo A Grossi
- Dipartimento di Medicina e Chirurgia, Università dell'Insubria, Varese, Italy.,ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Lorenza Bertù
- ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Livio Pagano
- University Cattolica del Sacro Cuore, Roma, Italy
| | - Paolo Corradini
- University of Milan, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Vagge S, Guolo F, Ballerini F, Agostinelli S, Tramontano D, Chiola I, Olivetta E, Corvò R, Angelucci E, Lemoli R. PO-0911: Volumetric total lymphoid hypofractionated irradiation and stem cell transplantation in lymphomas. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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4
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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.
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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
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5
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Loges S, Heuser M, Chromik J, Vigil CE, Paschka P, RE F, Di Renzo N, Lemoli R, Mattei D, Ben Batalla I, Hellesøy M, Micklem D, Holt RJ, Lorens K, Lorens JB, Shoaib M, Aly H, Fiedler WM, Cortes JE, Gjertsen BT. First-in class selective AXL inhibitor bemcentinib (BGB324) in combination with LDAC or decitabine exerts anti-leukaemic activity in AML patients unfit for intensive chemotherapy: Phase II open-label study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7043 Background: The RTK AXL represents a therapeutic target promoting AML cell proliferation and survival by pleiotropic mechanisms and is a negative regulator of anti-tumour immunity. Bemcentinib is a first-in-class, highly selective, oral AXL inhibitor that has previously shown encouraging anti-leukaemic activity as a monotherapy in r/r AML and hr-MDS. Methods: A monotherapy dose-escalation and expansion part of this trial is complete. In this second, phase II part of the study, 11 and 15 AML pts unfit for intensive chemotherapy received bemcentinib at RP2D (200 mg po/d) in combination with low-dose cytarabine (LDAC) and decitabine, respectively. Median age was 77 yr (range: 50-83), median screen myeloblast count 39% (3-95%) and 2/19 (11%) of pts evaluable for FLT3 were FLT3+. Plasma protein biomarker levels were measured using the DiscoveryMap v3.3 panel (Myriad RBM) at screen and following treatment. Results: The most common TRAEs (≥ 15% of pts) were ECG QT prolongation (35%) and diarrhoea (15%). Among these, 3 were Grade 3, and none 4 or 5. All TRAEs were manageable and/or reversible. As of Feb ‘19, 9 pts (2 de novo, 1 secondary, 6 r/r) in the bemcentinib + LDAC group were evaluable for response and 4 (44%; 2 de novo + 2 relapsed) achieved rapid CRi at C2D1. Responses were durable (range: 7 – 11 cycles) in 3 of the 4 responders. A further 2 pts (22%, 1 secondary + 1 relapsed) achieved durable SD (5 and 6 cycles). mPFS among the 5 pts with durable CRi or SD was 5 months (range: 3.5-7.7). Further, at the time of writing, 11 pts (8 de novo, 3 r/r) in the bemcentinib + decitabine group were evaluable for response of which 4 (36%, all de novo) achieved CRi after ≥ 4 cycles. One additional de novo pt achieved durable SD lasting for 5 cycles. Conclusions: Bemcentinib in combination with LDAC exerted early durable responses in patients with both de novo and relapsed AML whilst the combination of bemcentinib + decitabine exerted comparably fewer and later responses in de novo AML. Soluble biomarker correlations will be presented at the meeting. Both combinations were generally well-tolerated and further exploration is warranted. Clinical trial information: NCT02488408.
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Affiliation(s)
- Sonja Loges
- Department of Oncology, Hematology, BMT with Section Pneumology and Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jörg Chromik
- University Hospital Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | | | - Isabel Ben Batalla
- Medical Clinic and Institute of Tumor Biology, Campus Forschung, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | - James B. Lorens
- Centre for Cancer Biomarkers, University of Bergen, Bergen, Norway
| | | | | | - Walter M. Fiedler
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
| | - Jorge E. Cortes
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bjorn T. Gjertsen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
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6
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Balleari E, Salvetti C, Filiberti R, Allione B, Angelucci E, Cavalieri M, Cavalleri M, Cilloni D, Clavio M, Crisa’ E, Da Col A, Danise P, Di Tucci A, Finelli C, Lemoli R, Miglino M, Oliva E, Pellegrino M, Poloni A, Santini V. Different Repo Doses (High vs Standard) for Treatment of Anemia in MDS Patients: A Survey from the Italian MDS Registry. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30204-7] [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: 11/16/2022]
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7
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Balleari E, Salvetti C, Del Corso L, Filiberti R, Bacigalupo A, Bellodi A, Beltrami G, Bergamaschi M, Berisso G, Calzamiglia T, Carella A, Cavalleri M, Da Col A, Favorini S, Forni G, Goretti R, Miglino M, Mitscheuning L, Molinari E, Racchi O, Scudeletti M, Tassara R, Gobbi M, Lemoli R, Clavio M. Age and comorbidities deeply impact on clinical outcome of patients with myelodysplastic syndromes. Leuk Res 2015; 39:846-52. [DOI: 10.1016/j.leukres.2015.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 05/11/2015] [Accepted: 05/17/2015] [Indexed: 11/16/2022]
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8
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Del Corso L, Salvetti C, Filiberti R, Clavio M, Lemoli R, Carella A, Forni G, Scudeletti M, Tassara R, Berisso G, Calzamiglia T, Arboscello E, Bellodi A, Beltrami G, Bergamaschi M, Cavalleri M, Dominietto A, Favorini S, Ghiso A, Goretti R, Miglino M, Mitscheunig L, Racchi O, Molinari E, Vignolo L, Gobbi M, Balleari E. 202 BOTH AGE AND COMORBIDITIES NEGATIVELY IMPACT ON CLINICAL OUTCOME OF PATIENTS WITH MYELODYSPLASTIC SYNDROMES: RESULTS FROM A REAL-LIFE REGIONAL SURVEY. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30203-4] [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: 11/17/2022]
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9
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Rossi L, Forte D, Migliardi G, Buzzi M, Salvestrini V, Catani L, Lemoli R, Curti A. Declined Presentation. Exp Hematol 2014. [DOI: 10.1016/j.exphem.2014.07.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Rossi L, Stifani F, Migliardi G, Lemoli R. Hematopoiesis and inflammation: the role of TIMP-1 in human HSPCs. Exp Hematol 2013. [DOI: 10.1016/j.exphem.2013.05.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Worel N, Apperley JF, Basak GW, Douglas KW, Gabriel IH, Geraldes C, Hübel K, Jaksic O, Koristek Z, Lanza F, Lemoli R, Mikala G, Selleslag D, Duarte RF, Mohty M. European data on stem cell mobilization with plerixafor in patients with nonhematologic diseases: an analysis of the European consortium of stem cell mobilization. Transfusion 2012; 52:2395-400. [PMID: 22414093 DOI: 10.1111/j.1537-2995.2012.03603.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Plerixafor with granulocyte-colony-stimulating factor (G-CSF) has been shown to enhance stem cell mobilization in patients with multiple myeloma and lymphoma with previous mobilization failure. In this European named patient program we report the experience in insufficiently mobilizing patients diagnosed with nonhematologic diseases. STUDY DESIGN AND METHODS Thirty-three patients with germ cell tumor (n=11), Ewing sarcoma (n=6), Wiscott-Aldrich disease (n=5), neuroblastoma (n=4), and other nonhematologic diseases (n=7) were included in the study. Plerixafor was limited to patients with previous or current stem cell mobilization failure and given after 4 days of G-CSF (n=21) or after chemotherapy and G-CSF (n=12) in patients who mobilized poorly. RESULTS Overall, 28 (85%) patients succeeded in collecting at least 2×10(6)/kg body weight (b.w.) CD34+ cells (median, 5.0×10(6)/kg b.w. CD34+ cells; range, 2.0×10(6)-29.5×10(6)/kg b.w. CD34+ cells), and five (15%) patients collected a median of 1.5×10(6)/kg b.w. CD34+ cells (range, 0.9×10(6)-1.8×10(6)/kg b.w. CD34+ cells). Nineteen patients proceeded to transplantation. The median dose of CD34+ cells infused was 3.3×10(6)/kg b.w. (range, 2.3×10(6)-6.7×10(6)/kg b.w. CD34+ cells). The median numbers of days to neutrophil and platelet engraftment were 11 (range, 9-12) and 15 (range, 10-25) days, respectively. CONCLUSION These data emphasize the role of plerixafor in combination with G-CSF or chemotherapy and G-CSF as an effective mobilization regimen with the potential of successful stem cell collection. Accordingly, plerixafor seems to be safe and effective in patients with nonhematologic diseases. Larger prospective studies are warranted to further assess its use in these patients.
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Affiliation(s)
- Nina Worel
- Department of Bloodgroup Serology and Transfusion Medicine, Medical University of Vienna, Viena, Austria.
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Malard F, Kröger N, Gabriel IH, Hübel K, Apperley JF, Basak GW, Douglas KW, Geraldes C, Jaksic O, Koristek Z, Lanza F, Lemoli R, Mikala G, Selleslag D, Worel N, Mohty M, Duarte RF. Plerixafor for Autologous Peripheral Blood Stem Cell Mobilization in Patients Previously Treated with Fludarabine or Lenalidomide. Biol Blood Marrow Transplant 2012; 18:314-7. [DOI: 10.1016/j.bbmt.2011.10.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/01/2011] [Indexed: 10/16/2022]
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13
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Lemoli R. Zoledronic acid modulates function and differentiation of myeloid cells. Haematologica 2006; 91:1153A. [PMID: 16956803] [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: 05/11/2023] Open
Affiliation(s)
- Roberto Lemoli
- Istituto di Ematologia e Oncologia Medica Seragnoli Bologna, Italy.
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Martinelli G, Terragna C, Zamagni E, Ronconi S, Tosi P, Lemoli R, Bandini G, Testoni N, Amabile M, Ottaviani E, Buonamici S, Soverini S, Montefusco V, de Vivo A, Bonifazi F, Tura S, Cavo M. Polymerase chain reaction-based detection of minimal residual disease in multiple myeloma patients receiving allogeneic stem cell transplantation. Haematologica 2000; 85:930-4. [PMID: 10980631] [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: 02/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recent advances in the treatment of multiple myeloma (MM) include use of high-dose chemoradiotherapy followed by allografting. Although allografting with bone marrow (BM) or peripheral blood stem cells (PBSC) seems to improve clinical outcome and lengthen survival, only about 50% of patients reach stringently defined complete remission (CR), and most subsequently relapse. We assessed the clinical relevance of minimal residual disease (MRD) in 14 MM patients in CR after allografting with PBSC (6 patients) or BM (8 patients). DESIGN AND METHODS Among the 30 out of 72 MM patients in our Institute who achieved CR after allografting, 14 had a molecular marker suitable for allo-specific polymerase chain reaction (PCR) analysis. Stringent molecular monitoring was done using clonal markers based upon rearranged immunoglobulin heavy-chain genes. Molecular remission (MCR) was defined as two consecutive negative PCR results. RESULTS Seven of 14 (50%) molecularly monitored patients, achieved MCR and did not relapse after a median molecular follow-up of 60 months (range 36-120). Median time to obtain first PCR negativity was 12 (BM group) and 6 months (PBSC group), respectively. Of the seven patients (50%) who never achieved MCR, one relapsed. INTERPRETATION AND CONCLUSIONS In conclusion, 50% of the MM patients in CR studied by us also achieved stringently-defined MCR. MCR was associated with a very low rate of clinical relapse.
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Affiliation(s)
- G Martinelli
- Molecular Biology Unit, Institute of Hematology and Medical Oncology "Seràgnoli", University of Bologna, via Massarenti 9, 40138 Bologna, Italy.
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15
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Visani G, Lemoli R, Tosi P, Martinelli G, Testoni N, Ricci P, Motta M, Gherlinzoni F, Leopardi G, Pastano R, Rizzi S, Piccaluga P, Isidori A, Tura S. Use of peripheral blood stem cells for autologous transplantation in acute myeloid leukemia patients allows faster engraftment and equivalent disease-free survival compared with bone marrow cells. Bone Marrow Transplant 1999; 24:467-72. [PMID: 10482929 DOI: 10.1038/sj.bmt.1701920] [Citation(s) in RCA: 35] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We compared the feasibility and efficacy of autologous bone marrow (ABMT) and peripheral blood progenitor cell transplantation (PBSCT) performed after an identical induction/consolidation in adults with acute myeloid leukemia (AML). From January 1993 to June 1996 91 consecutive AML patients were enrolled in a program consisting of anthracycline-based induction and high-dose cytarabine consolidation (NOVIA). Until May 1994 ABMT was performed; from June 1994, if PBSC collection was adequate, PBSCT was performed. Out of 88 evaluable patients, 73 obtained a complete remission (CR) and 15 were resistant. Allogeneic bone marrow transplantation was performed in 16 patients. Forty-four (50%) were given autologous stem cell transplantation. ABMT was performed in 21 cases; twenty-nine patients were given G-CSF mobilization after NOVIA administration. An adequate number of PBSC was obtained in 23/29 (79%) cases, which were then re-infused. Median times to both neutrophil and platelet recovery from transplant were significantly shorter for the PBSC group (17 vs 36 days to 500 PMN/microl, P < 0.01; 20 vs 150 days to 20000 platelets/microl, P < 0.02; 37 vs 279 days to 50000 platelets/microl, P < 0.03), as were days of hospitalization after the reinfusion (18 vs 33, P < 0.03) and median days to transfusion independence. Toxicity was not significant in either group. After a minimum follow-up for live patients of 24 months (longer than the mean time for relapse observed for the PBSC series - 14 months) the percentage of relapses was similar: 11 of 21 (52.4%) and 12 of 23 (52.1%) in the ABMT and PBSC groups, respectively. Our results indicate that autologous PBSC transplantation, performed after an intensive chemotherapy regimen, is not inferior to ABMT in terms of disease-free survival and allows faster recovery times and reduced need for transfusion support.
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Affiliation(s)
- G Visani
- Institute of Haematology and Medical Oncology, 'Seragnoli', Bologna University, Bologna, Italy
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16
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Manfredini R, Trevisan F, Grande A, Tagliafico E, Montanari M, Lemoli R, Visani G, Tura S, Ferrari S, Ferrari S. Induction of a functional vitamin D receptor in all-trans-retinoic acid-induced monocytic differentiation of M2-type leukemic blast cells. Cancer Res 1999; 59:3803-11. [PMID: 10446999] [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: 02/13/2023]
Abstract
Different types of acute myeloid leukemia blast cells were induced to differentiate in vitro with all-trans-retinoic acid (ATRA) and vitamin D3 (VD). M0/M1 leukemic cells are not sensitive to differentiating agents, whereas M3 leukemic cells are induced to undergo granulocytic differentiation after ATRA treatment but are not sensitive to VD. M2 leukemic blast cells behave differently because they undergo monocytic differentiation with both the differentiation inducers. To gain some insight into the maturation of M2-type leukemic cells, we studied the molecular mechanisms underlying monocytic differentiation induced by ATRA and VD in spontaneous M2 blast cells as well as in Kasumi-1 cells (an acute myeloid leukemia M2-type cell line). Our results indicate that ATRA as well as VD efficiently increases the nuclear abundance of VD receptor (VDR) and promotes monocytic differentiation. VDR is functionally active in ATRA-treated Kasumi-1 cells because it efficiently heterodimerizes with retinoid X receptor, binds to a DR3-type vitamin D-responsive element, and activates the transcription of a vitamin D-responsive element-regulated reporter gene. Consistent with these findings, VD-responsive genes are induced by ATRA treatment of Kasumi-1 cells, suggesting that the genetic program underlying monocytic differentiation is activated. The molecular mechanism by which ATRA increases the nuclear abundance of a functional VDR is still unknown, but our data clearly indicate that the M2 leukemic cell context is only permissive of monocytic differentiation.
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MESH Headings
- Acute Disease
- Calcitriol/pharmacology
- Cell Differentiation/drug effects
- Cell Lineage
- Cell Nucleus/metabolism
- DNA/metabolism
- Dimerization
- Gene Expression Regulation, Leukemic/drug effects
- HL-60 Cells/metabolism
- Humans
- Leukemia, Myeloid/pathology
- Leukemia, Myeloid, Acute/pathology
- Monocytes/cytology
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- Neoplastic Stem Cells/metabolism
- Neoplastic Stem Cells/pathology
- Promoter Regions, Genetic/drug effects
- Protein Multimerization
- Receptors, Calcitriol/genetics
- Receptors, Calcitriol/physiology
- Receptors, Retinoic Acid/metabolism
- Recombinant Fusion Proteins/physiology
- Regulatory Sequences, Nucleic Acid
- Retinoic Acid Receptor alpha
- Retinoid X Receptors
- Transcription Factors/metabolism
- Transcription, Genetic
- Tretinoin/pharmacology
- Tumor Cells, Cultured
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Affiliation(s)
- R Manfredini
- Dipartimento di Scienze Biomediche, Sezione di Chimica Biologica, Università di Modena e di Reggio Emilia, Italy
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17
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Bolognesi A, Tazzari PL, Olivieri F, Polito L, Lemoli R, Terenzi A, Pasqualucci L, Falini B, Stirpe F. Evaluation of immunotoxins containing single-chain ribosome-inactivating proteins and an anti-CD22 monoclonal antibody (OM124): in vitro and in vivo studies. Br J Haematol 1998; 101:179-88. [PMID: 9576199 DOI: 10.1046/j.1365-2141.1998.00665.x] [Citation(s) in RCA: 31] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Immunotoxins were prepared with three ribosome-inactivating proteins (RIP), momordin, pokeweed antiviral protein from seeds (PAP-S) and saporin-S6, linked to the anti-CD22 monoclonal antibody OM124. These immunotoxins inhibited protein synthesis by CD22-expressing cell lines Daudi, EHM, BJAB, Raji and BM21 with IC50 (concentration causing 50% inhibition) ranging from < 5 x 10(-15) to 7.6 x 10(-11) M as RIP, and IC90 (concentration causing 90% inhibition) ranging from 5 x 10(-14) to 5 x 10(-8)M, with no effect on a CD22-negative HL60 cell line at the highest concentration tested (5 x 10[-8] M). Apoptosis was induced in sensitive cells. The formation of bone marrow colonies was inhibited by no more than 40% by the immunotoxins at concentrations up to 10(-9) M. Treatment with the immunotoxins, alone or in combination, significantly extended the survival time of mice bearing transplanted Daudi cells. A treatment with cyclophosphamide and OM124/saporin immunotoxin was particularly effective in SCID mice transplanted with a low number of cells (3 x 10[-6]), when 60% of the animals remained tumour-free.
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Affiliation(s)
- A Bolognesi
- Dipartimento di Patologia Sperimentale, Università di Bologna, Italy
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18
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Gulati S, Lemoli R, Fraig M. Newer approaches in treating chronic myelogenous leukemia. Stem Cells 1993; 11 Suppl 3:14-9. [PMID: 7905321 DOI: 10.1002/stem.5530110906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Allogeneic bone marrow transplantation (BMT) is a useful approach for treating patients with chronic myelogenous leukemia (CML). In patients who lack a suitable donor, various approaches to utilize the patient's own hematopoietic stem cells obtained from bone marrow and/or peripheral blood have been developed. Preferential recovery of normal human hematopoietic progenitors over CML clone in long-term bone marrow culture (LTBMC) has been observed for a long time. LTBMC initiated in tissue culture (TC) flasks to that in "Lifecell" bags, which are gas-permeable plastic bags in which feeder-layer cells cannot adhere, has been investigated for several years. In our laboratory, cells were incubated in the presence of various growth factors to develop improved methods for stem cell expansion. Sustained hematopoietic stem cell growth in the absence of a feeder layer in plastic gas-permeable bags has been observed. Growth of marrow from patients with CML is being investigated extensively. Combining effective drugs to decrease the Philadelphia (Ph) clone prior to bone marrow harvest and the use of cultured bone marrow may provide a useful method for treating patients with CML. Results of various international studies are also discussed below.
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Affiliation(s)
- S Gulati
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York 10021
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19
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Gulati SC, Lemoli R, Van Poznak C. Newer approaches in treating chronic myelogenous leukemia. Leuk Lymphoma 1993; 11 Suppl 1:293-6. [PMID: 8251910 DOI: 10.3109/10428199309047901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We evaluated the recovery of human hematopoietic progenitors in long-term bone marrow culture (LTBMC) initiated in tissue culture (TC) flasks to that in "Lifecell" bags, which are gas-permeable plastic bags in which feeder-layer cells cannot adhere. Cells were incubated in presence of IL-1 and IL-3. Our experiments reveal sustained hematopoietic stem cell growth in the absence of a feeder layer in plastic gas-permeable bags. Evaluations of marrow from patients with chronic myelogenous leukemia suggests enrichment of normal hematopoietic precursors. Combining effective drugs to decrease Ph(+) clone prior to bone marrow harvest and use of cultured bone marrow may provide a useful method for treating patients with chronic myelogenous leukemia.
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Affiliation(s)
- S C Gulati
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021
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20
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Gulati S, Yahalom J, Acaba L, Reich L, Motzer R, Crown J, Toia M, Igarashi T, Lemoli R, Hanninen E. Treatment of patients with relapsed and resistant non-Hodgkin's lymphoma using total body irradiation, etoposide, and cyclophosphamide and autologous bone marrow transplantation. J Clin Oncol 1992; 10:936-41. [PMID: 1588372 DOI: 10.1200/jco.1992.10.6.936] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Patients with non-Hodgkin's lymphoma (NHL) who do not achieve a complete response (CR) after induction chemotherapy or who relapse after achieving a CR are rarely cured of their disease by the usual salvage therapy. Success of high-dose cytotoxic therapy with an autologous bone marrow transplant (AuBMT) is limited. We describe the results of a prospective single-institution study using a new conditioning regimen for patients with relapsed or resistant NHL who underwent AuBMT. PATIENTS AND METHODS Forty-four patients were reinduced with cytotoxic therapy and then evaluated for response. All patients received the conditioning regimen of hyperfractionated total body irradiation (TBI), etoposide (VP-16), and cyclophosphamide (CTX) followed by autologous bone marrow reinfusion. RESULTS The disease-free survival (DFS) rate was 57% with a median follow-up of 42+ months. The only variable significantly associated with DFS was the patient's remission status at AuBMT. Patients who underwent AuBMT in CR had a DFS of 80%, whereas patients who underwent AuBMT in partial response (PR) or with progressive disease (PD) had a DFS of 60% and 11%, respectively (P = .002). The major toxicity was hemorrhage at the site of bulky disease, especially in patients with residual mediastinal and/or pulmonary disease. CONCLUSION Planned reinduction cytotoxic therapy followed by TBI, VP-16, and CTX with AuBMT is an effective treatment for patients with relapsed and resistant NHL.
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Affiliation(s)
- S Gulati
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021
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