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Rossi G, Borlenghi E, Zappasodi P, Lussana F, Bernardi M, Basilico C, Molteni A, Lotesoriere I, Turrini M, Frigeni M, Fumagalli M, Cozzi P, Gigli F, Cattaneo C, Fracchiolla NS, Riva M, Martini G, Mancini V, Cairoli R, Todisco E. Adapting the Fitness Criteria for Non-Intensive Treatments in Older Patients with Acute Myeloid Leukemia to the Use of Venetoclax-Hypomethylating Agents Combination-Practical Considerations from the Real-Life Experience of the Hematologists of the Rete Ematologica Lombarda. Cancers (Basel) 2024; 16:386. [PMID: 38254875 PMCID: PMC10814062 DOI: 10.3390/cancers16020386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
A retrospective survey was conducted in hematologic centres of the Rete Ematologica Lombarda (REL) on 529 older AML patients seen between 2020-2022. Compared to 2008-2016, the use of intensive chemotherapy (ICT) decreased from 40% to 18.1% and of hypomethylating agents (HMAs) from 19.5% to 13%, whereas the combination of Venetoclax/HMA, initially not available, increased from 0% to 36.7%. Objective treatment-specific fitness criteria proposed by SIE/SIES/GITMO in 2013 allow an appropriate choice between ICT and HMAs by balancing their efficacy and toxicity. Venetoclax/HMA, registered for patients unfit to ICT, has a unique toxicity profile because of prolonged granulocytopenia and increased infectious risk. Aiming at defining specific fitness criteria for the safe use of Venetoclax/HMA, a preliminary investigation was conducted among expert REL hematologists, asking for modifications of SIE/SIES/GITMO criteria they used to select candidates for Venetoclax/HMA. While opinions among experts varied, a general consensus emerged on restricting SIE/SIES/GITMO criteria for ICT-unfit patients to an age limit of 80-85, cardiac function > 40%, and absence of recurrent lung infections, bronchiectasis, or exacerbating COPD. Also, the presence of an adequate caregiver was considered mandatory. Such expert opinions may be clinically useful and may be considered when treatment-specific fitness criteria are updated to include Venetoclax/HMA.
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Affiliation(s)
- Giuseppe Rossi
- Department of Hematology, ASST Spedali Civili of Brescia, 25100 Brescia, Italy; (E.B.); (C.C.)
| | - Erika Borlenghi
- Department of Hematology, ASST Spedali Civili of Brescia, 25100 Brescia, Italy; (E.B.); (C.C.)
| | - Patrizia Zappasodi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (P.Z.); (G.M.)
| | - Federico Lussana
- Department of Oncology and Hematology, University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, 24100 Bergamo, Italy; (F.L.); (M.F.)
| | - Massimo Bernardi
- Haematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, 20132 Milano, Italy;
| | - Claudia Basilico
- Division of Hematology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy;
| | - Alfredo Molteni
- Department of Hematology, ASST di Cremona, 26100 Cremona, Italy;
| | - Ivana Lotesoriere
- Department of Hematology, Ospedale Busto Arsizio, ASST Valle Olona, 21052 Busto Arsizio, Italy;
| | - Mauro Turrini
- Division of Hematology, Ospedale Valduce, 22100 Como, Italy; (M.T.); (E.T.)
| | - Marco Frigeni
- Department of Oncology and Hematology, University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, 24100 Bergamo, Italy; (F.L.); (M.F.)
| | - Monica Fumagalli
- Department of Hematology, Ospedale “San Gerardo” ASST di Monza, 20900 Monza, Italy;
| | - Paola Cozzi
- Unità Complessa di Ematologia, ASST Ovest Milanese, Ospedale Civile, 20025 Legnano, Italy;
| | - Federica Gigli
- Divisione di Emato-Oncologia, European Institute of Oncology, 20122 Milano, Italy;
| | - Chiara Cattaneo
- Department of Hematology, ASST Spedali Civili of Brescia, 25100 Brescia, Italy; (E.B.); (C.C.)
| | - Nicola Stefano Fracchiolla
- UOC Oncoematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and University of Milan, 20122 Milano, Italy;
| | - Marta Riva
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, 20162 Milano, Italy; (M.R.); (V.M.); (R.C.)
| | - Gianluca Martini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (P.Z.); (G.M.)
| | - Valentina Mancini
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, 20162 Milano, Italy; (M.R.); (V.M.); (R.C.)
| | - Roberto Cairoli
- Dipartimento di Ematologia ed Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano, 20162 Milano, Italy; (M.R.); (V.M.); (R.C.)
| | - Elisabetta Todisco
- Division of Hematology, Ospedale Valduce, 22100 Como, Italy; (M.T.); (E.T.)
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Oliva EN, Riva M, Niscola P, Santini V, Breccia M, Giai V, Poloni A, Patriarca A, Crisà E, Capodanno I, Salutari P, Reda G, Cascavilla N, Ferrero D, Guarini A, Tripepi G, Iannì G, Russo E, Castelli A, Fattizzo B, Beltrami G, Bocchia M, Molteni A, Fenaux P, Germing U, Ricco A, Palumbo GA, Impera S, Di Renzo N, Rivellini F, Buccisano F, Stamatoullas-Bastard A, Liberati AM, Candoni A, Delfino IM, Arcadi MT, Cufari P, Rizzo L, Bova I, D'Errigo MG, Zini G, Latagliata R. Eltrombopag for Low-Risk Myelodysplastic Syndromes With Thrombocytopenia: Interim Results of a Phase II, Randomized, Placebo-Controlled Clinical Trial (EQOL-MDS). J Clin Oncol 2023; 41:4486-4496. [PMID: 37294914 PMCID: PMC10552995 DOI: 10.1200/jco.22.02699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/16/2023] [Accepted: 05/01/2023] [Indexed: 06/11/2023] Open
Abstract
PURPOSE In myelodysplastic syndromes (MDS), severe thrombocytopenia is associated with poor prognosis. This multicenter trial presents the second-part long-term efficacy and safety results of eltrombopag in patients with low-risk MDS and severe thrombocytopenia. METHODS In this single-blind, randomized, placebo-controlled, phase-II trial of adult patients with International Prognostic Scoring System low- or intermediate-1-risk MDS, patients with a stable platelet (PLT) count (<30 × 103/mm3) received eltrombopag or placebo until disease progression. Primary end points were duration of PLT response (PLT-R; calculated from the time of PLT-R to date of loss of PLT-R, defined as bleeding/PLT count <30 × 103/mm3 or last date in observation) and long-term safety and tolerability. Secondary end points included incidence and severity of bleeding, PLT transfusions, quality of life, leukemia-free survival, progression-free survival, overall survival and pharmacokinetics. RESULTS From 2011 to 2021, of 325 patients screened, 169 patients were randomly assigned oral eltrombopag (N = 112) or placebo (N = 57) at a starting dose of 50 mg once daily to maximum of 300 mg. PLT-R, with 25-week follow-up (IQR, 14-68) occurred in 47/111 (42.3%) eltrombopag patients versus 6/54 (11.1%) in placebo (odds ratio, 5.9; 95% CI, 2.3 to 14.9; P < .001). In eltrombopag patients, 12/47 (25.5%) lost the PLT-R, with cumulative thrombocytopenia relapse-free survival at 60 months of 63.6% (95% CI, 46.0 to 81.2). Clinically significant bleeding (WHO bleeding score ≥ 2) occurred less frequently in the eltrombopag arm than in the placebo group (incidence rate ratio, 0.54; 95% CI, 0.38 to 0.75; P = .0002). Although no difference in the frequency of grade 1-2 adverse events (AEs) was observed, a higher proportion of eltrombopag patients experienced grade 3-4 AEs (χ2 = 9.5, P = .002). AML evolution and/or disease progression occurred in 17% (for both) of eltrombopag and placebo patients with no difference in survival times. CONCLUSION Eltrombopag was effective and relatively safe in low-risk MDS with severe thrombocytopenia. This trial is registered with ClinicalTrials.gov identifier: NCT02912208 and EU Clinical Trials Register: EudraCT No. 2010-022890-33.
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Affiliation(s)
- Esther Natalie Oliva
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Marta Riva
- Dipartimento di Ematologia, Ospedale Niguarda Ca' Granda, Milano, Italy
| | | | - Valeria Santini
- U.O. di Ematologia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Massimo Breccia
- Dipartimento di Ematologia Policlinico Umberto I, Università La Sapienza, Roma, Italy
| | - Valentina Giai
- S.C. a Direzione Universitaria di Ematologia A.O., SS. Antonio e Biagio e Cesare Arrigo Alessandria, Alessandria, Italy
| | - Antonella Poloni
- Clinica di Ematologia Azienda Ospedaliera Universitaria—Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Elena Crisà
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Isabella Capodanno
- U.O. di Ematologia, A.U.S.L.-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Prassede Salutari
- Dipartimento Oncologico-Ematologico, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Gianluigi Reda
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Cascavilla
- U.O. Ematologia Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Dario Ferrero
- Dipartimento Biotecnologie Molecolari, Ematologia Universitaria A.O.U. Citta' della Salute e della Scienza di Torino, Turin, Italy
| | - Attilio Guarini
- U.O. Ematologia I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Giovanni Tripepi
- IFC-CNR Institute of Clinical Physiology, Reggio Calabria, Italy
| | | | - Emilio Russo
- Department of Pharmacology, University of Germaneto Catanzaro, Catanzaro, Italy
| | | | - Bruno Fattizzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
| | - Germana Beltrami
- U.O. Ematologia e terapie cellulari, IRCCS Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Monica Bocchia
- UOC Ematologia, Università di Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Pierre Fenaux
- Groupe Francais desmyélodysplasies (GFM), Paris, France
| | - Ulrich Germing
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Alessandra Ricco
- U.O. Ematologia con Trapianto, Azienda Ospedale Policlinicodi Bari, Bari, Italy
| | - Giuseppe A. Palumbo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Stefana Impera
- U.O. C. Ematologia, A. O.ad Alta Specializzazione Ospedale Garibaldi Nesima, Catania, Italy
| | | | - Flavia Rivellini
- Divisione Ematologia, P.O. A. Tortora di Pagani-ASL Salerno, Pagani, Italy
| | - Francesco Buccisano
- Divisione di Biopatologia e Diagnostica per Immagini, Policlinico Universitario Tor Vergata, Rome, Italy
| | | | - Anna Marina Liberati
- S.C. Oncoematologia, Università degli Studi di Perugia A.O. Santa Maria, Terni, Italy
| | - Anna Candoni
- Divisione Ematologia, P.O. Santa Maria della Misericordia, A.S.U.F.C di Udine, Udine, Italy
| | - Ilaria Maria Delfino
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Maria Teresa Arcadi
- U.O. Farmacia Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Patrizia Cufari
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Lorenzo Rizzo
- Dipartimento di Ematologia, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Irene Bova
- U.O.S. di Genetica Medica Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Maria Grazia D'Errigo
- U.O.S. di Genetica Medica Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Gina Zini
- Fondazione Policlinico, Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Lanino L, Restuccia F, Perego A, Ubezio M, Fattizzo B, Riva M, Consagra A, Musto P, Cilloni D, Oliva EN, Palmieri R, Poloni A, Califano C, Capodanno I, Itri F, Elena C, Fozza C, Pane F, Pelizzari AM, Breccia M, Di Bassiano F, Crisà E, Ferrero D, Giai V, Barraco D, Vaccarino A, Griguolo D, Minetto P, Quintini M, Paolini S, Sanpaolo G, Sessa M, Bocchia M, Di Renzo N, Diral E, Leuzzi L, Genua A, Guarini A, Molteni A, Nicolino B, Occhini U, Rivoli G, Bono R, Calvisi A, Castelli A, Di Bona E, Di Veroli A, Ferrara F, Fianchi L, Galimberti S, Grimaldi D, Marchetti M, Norata M, Frigeni M, Sancetta R, Selleri C, Tanasi I, Tosi P, Turrini M, Giordano L, Finelli C, Pasini P, Naldi I, Santini V, Della Porta MG. Real-world efficacy and safety of luspatercept and predictive factors of response in patients with lower risk myelodysplastic syndromes with ring sideroblasts. Am J Hematol 2023. [PMID: 37222267 DOI: 10.1002/ajh.26960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/25/2023]
Affiliation(s)
- Luca Lanino
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | - Marta Ubezio
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Bruno Fattizzo
- SC Ematologia, IRCCS Ca' Granda Ospedale Maggiore Policlinico & Dipartimento di Oncologia ed Emato-oncologia, University of Milan, Milan, Italy
| | - Marta Riva
- S.C. Ematologia, Dipartimento di Ematologia, Oncologia e Medicina Molecolare, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angela Consagra
- MDS Unit, Dipartimento Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Pellegrino Musto
- Dipartimento di Medicina di Precisione e Rigenerativa e Area Ionica, Università degli Studi "Aldo Moro", AOU Consorziale Policlinico, Bari, Italy
| | - Daniela Cilloni
- AO Ordine Mauriziano, Università degli Studi di Torino, Turin, Italy
| | - Esther Natalie Oliva
- UOC Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | | | - Antonella Poloni
- Università Politecnica Marche, UOC Ematologia, AOU Marche, Ancona, Italy
| | | | - Isabella Capodanno
- Azienda Unità Sanitaria Locale- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federico Itri
- AOU San Luigi Gonzaga, SCDU Medicina Interna ad Indirizzo Ematologico, Università degli Studi di Torino, Torino, Italy
| | - Chiara Elena
- UOC Ematologia1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Fozza
- Dipartimento di Medicina, Chirurgia e Farmacia, Università di Sassari, Sassari, Italy
| | - Fabrizio Pane
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | | | | | | | - Elena Crisà
- AOU Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy
| | - Dario Ferrero
- SC Ematologia, AOU Città della Salute e della Scienza, Torino, Italy
| | - Valentina Giai
- SC Ematologia, AOU Città della Salute e della Scienza, Torino, Italy
| | - Daniela Barraco
- SC Ematologia, Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
| | | | - Davide Griguolo
- UCO Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Ospedale Maggiore, Trieste, Italy
| | - Paola Minetto
- Clinica Ematologica, IRCCS-Policlinico San Martino, Genoa, Italy
| | - Martina Quintini
- Azienda Ospedaliera di Perugia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Stefania Paolini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Grazia Sanpaolo
- UOC Ematologia e Trapianto di Cellule Staminali Emopoietiche - Ospedale Casa Sollievo della Sofferenza, IRCCS San Giovanni Rotondo, San Giovanni Rotondo, Italy
| | - Mariarosaria Sessa
- Hematology Section, Department of Medical Sciences, Azienda Ospedaliero-Universitaria, Arcispedale S.Anna, University of Ferrara, Ferrara, Italy
| | - Monica Bocchia
- UOC Ematologia, Azienda Ospedaliero Universitaria Senese, Università di Siena, Siena, Italy
| | - Nicola Di Renzo
- UOC Ematologia e Trapianto di Cellule Staminali P.O. "Vito Fazzi" -ASL Lecce, Lecce, Italy
| | - Elisa Diral
- Unità di Ematologia e Trapianto di Midollo Osseo, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Livia Leuzzi
- SC Oncologia, SS Oncoematologia, PO Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | | | | | - Barbara Nicolino
- SSD Ematologia, ASLTO4 Presidio Ospedaliero di Ivrea, Ivrea, Italy
| | | | - Giulia Rivoli
- IRCCS Ospedale Policlinico San Martino, U.O Ematologia e terapie Cellulari, Genoa, Italy
| | - Roberto Bono
- A.O.O.R Villa Sofia - Cervello, U.O.S.D. Unità Trapianti di Midollo Osseo, Palermo, Italy
| | - Anna Calvisi
- U.O.C. Ematologia - CTMO Ospedale San Francesco, Nuoro, Italy
| | | | - Eros Di Bona
- Oncoematologia, AULSS 7 Pedemontana, Bassano del Grappa, Italy
| | | | | | - Luana Fianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Sara Galimberti
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | | | - Monia Marchetti
- Hematology Unit, AO Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marianna Norata
- Hematology Unit, IRCCS - Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Marco Frigeni
- Dipartimento di Oncologia ed Ematologia, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Carmine Selleri
- UOC Ematologia, AOU San Giovanni Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy
| | - Ilaria Tanasi
- U.O.C. di Ematologia Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Patrizia Tosi
- UO Ematologia Ospedale Infermi Rimini, Rimini, Italy
| | - Mauro Turrini
- Division of Hematology, Valduce Hospital, Como, Italy
| | - Laura Giordano
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Carlo Finelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Paolo Pasini
- AIPASIM (Associazione Italiana Pazienti con Sindrome Mielodisplastica), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ilaria Naldi
- MDS Unit, Dipartimento Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Valeria Santini
- MDS Unit, Dipartimento Medicina Sperimentale e Clinica, AOU Careggi, Università di Firenze, Firenze, Italy
| | - Matteo Giovanni Della Porta
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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4
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Todisco E, Papayannidis C, Fracchiolla N, Petracci E, Zingaretti C, Vetro C, Martelli MP, Zappasodi P, Di Renzo N, Gallo S, Audisio E, Griguolo D, Cerchione C, Selleri C, Mattei D, Bernardi M, Fumagalli M, Rizzuto G, Facchini L, Basilico CM, Manfra I, Borlenghi E, Cairoli R, Salutari P, Gottardi M, Molteni A, Martini V, Lunghi M, Fianchi L, Cilloni D, Lanza F, Abruzzese E, Cascavilla N, Rivellini F, Ferrara F, Maurillo L, Nanni J, Romano A, Cardinali V, Gigli F, Roncoroni E, Federico V, Marconi G, Volpi R, Sciumè M, Tarella C, Rossi G, Martinelli G. AVALON: The Italian cohort study on real-life efficacy of hypomethylating agents plus venetoclax in newly diagnosed or relapsed/refractory patients with acute myeloid leukemia. Cancer 2023; 129:992-1004. [PMID: 36692409 DOI: 10.1002/cncr.34608] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 07/19/2022] [Revised: 10/21/2022] [Accepted: 10/29/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Venetoclax in combination with hypomethylating agents (HMA) is revolutionizing the therapy of acute myeloid leukemia (AML). However, evidence on large sets of patients is lacking, especially in relapsed or refractory leukemia. METHODS AVALON is a multicentric cohort study that was conducted in Italy on patients with AML who received venetoclax-based therapies from 2015 to 2020. The study was approved by the ethics committee of the participating institution and was conducted in accordance with the Declaration of Helsinki. The effectiveness and toxicity of venetoclax + HMA in 190 (43 newly diagnosed, 68 refractory, and 79 relapsed) patients with AML are reported here. RESULTS In the newly diagnosed AML, the overall response rate and survival confirmed the brilliant results demonstrated in VIALE-A. In the relapsed or refractory AML, the combination demonstrated a surprisingly complete remission rate (44.1% in refractory and 39.7% in relapsed evaluable patients) and conferred to treated patients a good expectation of survival. Toxicities were overall manageable, and most incidents occurred in the first 60 days of therapy. Infections were confirmed as the most common nonhematologic adverse event. CONCLUSIONS Real-life data show that the combination of venetoclax and HMA offers an expectation of remission and long-term survival to elderly, newly diagnosed patients, and to relapsed or chemoresistant AML, increasing the chance of cure through a different mechanism of action. The venetoclax + HMA combination is expected to constitute the base for triplet combinations and integration of target therapies. Our data contribute to ameliorate the understanding of venetoclax + HMA effectiveness and toxicities in real life.
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Affiliation(s)
- Elisabetta Todisco
- Divisione di Oncoematologia, IRCCS Istituto Europeo di Oncologia, Milano, Italy.,SC Ematologia, Ospedale Busto Arsizio, ASST Valle Olona, Varese, Italy
| | - Cristina Papayannidis
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Nicola Fracchiolla
- UOC Oncoematologia, Fondazione IRCCS "Ca'Granda" Ospedale Maggiore Policlinico, Milano, Italy
| | - Elisabetta Petracci
- Unità di Biostatistica e Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (ISRT) "Dino Amadori", Meldola, Italy
| | - Chiara Zingaretti
- Unità di Biostatistica e Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (ISRT) "Dino Amadori", Meldola, Italy
| | - Calogero Vetro
- Divisione di Ematologia, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Maria Paola Martelli
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Ospedale "Santa Maria della Misericordia", Perugia, Italy
| | - Patrizia Zappasodi
- Dipartimento di Oncoematologia, Fondazione IRCCS Policlinico "San Matteo", Pavia, Italy
| | - Nicola Di Renzo
- Unità di Ematologia e TCS, Ospedale "Vito Fazzi", Lecce, Italy
| | - Susanna Gallo
- SCDU di Ematologia e Terapie Cellulari, AO Ordine Mauriziano, Torino, Italy
| | - Ernesta Audisio
- SC Ematologia 2, AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Claudio Cerchione
- Dipartimento di Oncologia ed Ematologia Clinica e Sperimentale, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Carmine Selleri
- UOC Ematologia, AOU "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Daniele Mattei
- SC di Ematologia, AO "Santa Croce e Carle", Cuneo, Italy
| | - Massimo Bernardi
- UO Ematologia e Centro Trapianto di Midollo Osseo, IRCCS Ospedale "San Raffaele", Milano, Italy
| | - Monica Fumagalli
- SC Ematologia, Ospedale "San Gerardo", ASST di Monza, Monza, Italy
| | - Giuliana Rizzuto
- UOC Ematologia e Centro Trapianto di Midollo Osseo, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Luca Facchini
- UOC Ematologia, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Ilenia Manfra
- UO Ematologia, Azienda Ospedaliera "S. G. Moscati", Avellino, Italy
| | - Erika Borlenghi
- UO Ematologia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Roberto Cairoli
- SC Ematologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Prassede Salutari
- UOC Ematologia Clinica, Ospedale Civile "Santo Spirito", Pescara, Italy
| | - Michele Gottardi
- Dipartimento di Oncologia, UOC Oncoematologia, Istituto Oncologico Veneto (IOV) IRCCS, Padova, Italy
| | | | | | - Monia Lunghi
- SCDU Ematologia, AOU "Maggiore della Carità", Novara, Italy
| | - Luana Fianchi
- UOC Ematologia e TCSE, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Daniela Cilloni
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Torino, Italy
| | - Francesco Lanza
- UO Ematologia, Ospedale "Santa Maria delle Croci", AUSL Romagna, Ravenna, Italy
| | - Elisabetta Abruzzese
- Dipartimento di Ematologia, Ospedale "S. Eugenio", Università Tor Vergata, Roma, Italy
| | - Nicola Cascavilla
- UO Ematologia, Ospedale "Casa Sollievo della Sofferenza" IRCCS, San Giovanni Rotondo, Italy
| | - Flavia Rivellini
- UOC Oncoematologia, Presidio Ospedaliero "A. Tortora", Pagani, Italy
| | | | - Luca Maurillo
- Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italy
| | - Jacopo Nanni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Alessandra Romano
- Divisione di Ematologia, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Valeria Cardinali
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Ospedale "Santa Maria della Misericordia", Perugia, Italy
| | - Federica Gigli
- Divisione di Oncoematologia, IRCCS Istituto Europeo di Oncologia, Milano, Italy
| | - Elisa Roncoroni
- Dipartimento di Oncoematologia, Fondazione IRCCS Policlinico "San Matteo", Pavia, Italy
| | | | - Giovanni Marconi
- Dipartimento di Oncologia ed Ematologia Clinica e Sperimentale, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Roberta Volpi
- Unità di Biostatistica e Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (ISRT) "Dino Amadori", Meldola, Italy
| | - Mariarita Sciumè
- UOC Oncoematologia, Fondazione IRCCS "Ca'Granda" Ospedale Maggiore Policlinico, Milano, Italy
| | - Corrado Tarella
- Divisione di Oncoematologia, IRCCS Istituto Europeo di Oncologia, Milano, Italy
| | - Giuseppe Rossi
- UO Ematologia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giovanni Martinelli
- Dipartimento di Oncologia ed Ematologia Clinica e Sperimentale, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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Riva M, Bosi A, Rizzo L, Mazzon F, Ferrari S, Lussana F, Borin L, Castelli A, Cairoli R, Barcellini W, Molteni A, Fattizzo B. Danazol Treatment for Thrombocytopenia in Myelodysplastic Syndromes: Can an “Old-fashioned” Drug be Effective? Hemasphere 2023; 7:e867. [PMID: 36999006 PMCID: PMC10047600 DOI: 10.1097/hs9.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/17/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
- Marta Riva
- Department of Haematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Bosi
- Haematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Haemato-oncology, University of Milan, Italy
| | - Lorenzo Rizzo
- Department of Haematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico Mazzon
- Department of Haematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Oncology and Haemato-oncology, University of Milan, Italy
| | - Silvia Ferrari
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Lussana
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lorenza Borin
- Department of Hematology, San Gerardo Hospital, Monza, Italy
| | | | - Roberto Cairoli
- Department of Haematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Wilma Barcellini
- Haematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Bruno Fattizzo
- Haematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Haemato-oncology, University of Milan, Italy
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6
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Gibson L, Mittal A, Qureshi F, Neerumpa S, Hamidpour S, Mateescu V, Salzman G, Molteni A, Monaghan NP, Poisner A. Distinct Responses in the Brain Compared to Lung in a Rat Model of Fat Embolism Syndrome. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r4079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lilian Gibson
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - A. Mittal
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - F. Qureshi
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - S. Neerumpa
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - S. Hamidpour
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - V. Mateescu
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - G. Salzman
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - A. Molteni
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | | | - A. Poisner
- University of Kansas Medical CenterKansas CityKS
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7
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Roviello G, Nardone V, Bonetta A, Correale P, Molteni A, Lazzari MC, Generali D. Effects of Whole Pelvic Radiotherapy on the Distribution of Lymphocyte Subpopulations in Prostate Cancer Patients. Am J Clin Oncol 2022; 45:105-111. [PMID: 35081052 DOI: 10.1097/coc.0000000000000894] [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: 11/25/2022]
Abstract
INTRODUCTION In the current study, we have investigated the effects of the different modalities of treatment (volume of radiotherapy [RT], previous surgery) as well as the Gleason score of prostate cancer (PC) on the lymphocyte composition of PC patients undergoing RT. METHODS This is a monoinstitutional study that prospectively included PC patients that underwent RT from January 2016 until December 2017. To compare the different evaluations, the Wilcoxon signed-rank test was used among 2 times (Timepoint 0 to Timepoint 1). Percentage variation was calculated for all the lymphocyte subpopulation and was correlated with clinical parameters (previous surgery, Gleason score, and pelvic irradiation) with the χ2 test. The statistical analysis was repeated also on the stratified dataset according to the above parameters (previous surgery, Gleason score, and whole pelvic radiotherapy [WPRT]). RESULTS One hundred and eleven patients were included in the present analysis. All the lymphocyte subpopulations resulted significantly lower after RT. The modifications of several lymphocyte subpopulations correlated with previous surgery, Gleason score, and WPRT, although stratified analysis demonstrated that WPRT showed the greatest correlation. CONCLUSION Our results could be used to design a prospective trial in order to study the use of WPRT on the lymphocyte subpopulations.
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Affiliation(s)
| | - Valerio Nardone
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples
| | | | - Pierpaolo Correale
- Unit of Medical Oncology, Grand Metropolitan Hospital "Bianchi Melacrino Morelli" Reggio Calabria
| | | | | | - Daniele Generali
- Breast Cancer Unit and Traslational Research Unit, ASST Cremona
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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8
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Ungari M, Ghiringhelli P, Marchi G, Fisogni S, Lavazza A, Molteni A, Malberti F, Bertoni R, Trombatore M, Ferrero G, Gusolfino MD, Varotti E, Tanzi G, Manotti L. Combined renal proximal tubulopathy and crystal storing histiocytosis in a patient with κ light chain multiple myeloma. Pathologica 2021; 113:285-293. [PMID: 34463673 DOI: 10.32074/1591-951x-154] [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: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022] Open
Abstract
Multiple myeloma accounts for 10-15% of all hematologic malignancies, and 20% of deaths related to cancers of the blood and bone marrow. Diagnosis is defined by the presence of a serum monoclonal spike (M-spike) of more than 3 g/dL or more than 10% clonal plasma cells in the bone marrow and at least one myeloma-defining event, such as hypercalcemia, anemia, bone lesions, or renal impairment. The kidney is a major target organ, and renal impairment is frequently the first manifestation of the disease. Renal damage occurs in up to 40% of patients and 10-20% will require dialysis. Monoclonal immunoglobulin light chains are the major causes of renal complications in multiple myeloma. Glomerular disease, with the deposition of monoclonal immunoglobulins or their components, includes monoclonal immunoglobulin deposition disease, AL or AH amyloidosis, type I cryoglobulinemia, proliferative glomerulonephritis with monoclonal IgG deposits, immunotactoid glomerulopathy, and fibrillary glomerulonephritis. In addition, tubulointerstitial diseases with the deposition of monoclonal immunoglobulins or their components, are constituted by light chain cast nephropathy, light chain proximal tubulopathy, and crystal-storing histiocytosis. We report the case of a 66-year-old woman who presented with albumin-predominant moderate proteinuria and renal failure. Serum and urine immunofixation electrophoresis showed monoclonal κ light chain in both. Renal biopsy confirmed κ-restricted crystal-storing renal disease involving proximal tubular epithelial cells and crystal storing histiocytosis. Multiple myeloma with crystal storing histiocytosis was discovered in bone marrow biopsy. Thus, we present an unusual case of a myeloma patient presenting light chain proximal tubulopathy and crystal-storing histiocytosis both in the kidney and in the bone marrow.
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Affiliation(s)
| | | | | | | | - Antonio Lavazza
- Virology Unit of IZSLER, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia- Romagna, Brescia, Italy
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9
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Passalacqua R, Ratti M, Pan A, Testa S, Molteni A, Tonoli S, Faliva A, Mainardi E, Saleri J, Gobbi A, Nanni N, Bacciocchini N, Donati G, Marchi R, Cattaneo M, Gnocchi N, Grizzi G, Brighenti M, Maglietta G, Caminiti C. 1646TiP Efficacy of SARS-CoV-2 vaccination in cancer patients during treatment: A prospective observational study (ANTICOV trial). Ann Oncol 2021. [PMCID: PMC8454316 DOI: 10.1016/j.annonc.2021.08.1639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Vannucchi AM, Mortara A, D’Alessio A, Morelli M, Tedeschi A, Festuccia MB, Monforte AD, Capochiani E, Selleri C, Simonetti F, Saracino A, Rapezzi D, Badagliacca MR, Falasca K, Molteni A, Palazzolo R, Schettino G, Bocchia M, Turrini M, Ascierto PA, Zuurman M, Paley C, Coco P, Saglio G. JAK Inhibition with Ruxolitinib in Patients with COVID-19 and Severe Pneumonia: Multicenter Clinical Experience from a Compassionate Use Program in Italy. J Clin Med 2021; 10:jcm10163752. [PMID: 34442045 PMCID: PMC8397012 DOI: 10.3390/jcm10163752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022] Open
Abstract
Jak inhibitors are potent anti-inflammatory drugs that have the potential to dampen the hyperactive inflammatory response associated with severe COVID-19. We reviewed the clinical outcomes of 218 patients with COVID-19 hospitalized for severe pneumonia and treated with ruxolitinib through a compassionate use program. Data on the duration of treatment; outcomes at 4, 7, 14, and 28 days; oxygen support requirements; clinical status; and laboratory parameters were retrospectively collected. Overall, according to the physician evaluation, 66.5% of patients showed improvement at follow-up; of these, 83.5% showed improvement by day 7. Oxygen support status also showed improvement, and by day 7, 21.6% of patients were on ambient air, compared with 1.4% at baseline, which increased to 48.2% by day 28. Significant decreases in C-reactive protein and increases in the lymphocyte total count were already observed by day 4, which seemed to correlate with a positive outcome. At the end of the observation period, 87.2% of patients were alive. No unexpected safety findings were observed, and grade 3/4 adverse events were reported in 6.9% of patients.
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Affiliation(s)
- Alessandro Maria Vannucchi
- Center Research Innovation of Myeloproliferative Neoplasms (CRIMM), SOD Hematology, University of Florence and AOU Careggi, 50134 Florence, Italy;
| | - Andrea Mortara
- Department of Clinical Cardiology, Policlinico di Monza, 28100 Monza, Italy;
| | - Andrea D’Alessio
- COVID Medical Department, Policlinico S. Marco, Gruppo San Donato University and Research Hospital, 24040 Zingonia, Italy;
| | - Mara Morelli
- Novartis Farma SpA, 21040 Origgio, Italy; (M.M.); (M.Z.); (P.C.)
| | - Alberto Tedeschi
- U.O.C. Medicina Generale, Ospedale Bolognini, ASST Bergamo Est, 24068 Seriate, Italy;
| | | | | | - Enrico Capochiani
- UOC Ematologia, Azienda USL Toscana Nord Ovest, 57124 Livorno, Italy;
| | - Carmine Selleri
- Hematology, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy;
| | | | - Annalisa Saracino
- Clinica Malattie Infettive, Dip. Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari, 70124 Bari, Italy;
| | - Davide Rapezzi
- S.C. Ematologia Ospedale S. Croce e Carle, 12100 Cuneo, Italy;
| | - Maria Rita Badagliacca
- UOS UFA UOC Farmacia Ospedaliera Distretto Ospedaliero CL1-P.O.S. Elia, Azienda Sanitaria Provinciale di Caltanissetta, 93100 Caltanissetta, Italy;
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University G. d’Annunzio, Chieti-Pescara, 66100 Chieti, Italy;
| | | | | | | | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy;
| | - Mauro Turrini
- Division of Hematology, Department of Medicine, Valduce Hospital, 22100 Como, Italy;
| | - Paolo A. Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale per lo Studio e la Cura dei Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy;
| | - Mike Zuurman
- Novartis Farma SpA, 21040 Origgio, Italy; (M.M.); (M.Z.); (P.C.)
- Novartis Pharma BV, 1101 Amsterdam, The Netherlands
| | | | - Paola Coco
- Novartis Farma SpA, 21040 Origgio, Italy; (M.M.); (M.Z.); (P.C.)
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences of the University of Turin, San Luigi University Hospital, 10143 Orbassano, Italy
- Correspondence:
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Schettini F, Corona SP, Giudici F, Strina C, Sirico M, Bernocchi O, Milani M, Ziglioli N, Aguggini S, Azzini C, Barbieri G, Cervoni V, Cappelletti MR, Molteni A, Lazzari MC, Ferrero G, Ungari M, Marasco E, Bruson A, Xumerle L, Zago E, Cerra D, Loddo M, Williams GH, Paris I, Scambia G, Generali D. Clinical, Radiometabolic and Immunologic Effects of Olaparib in Locally Advanced Triple Negative Breast Cancer: The OLTRE Window of Opportunity Trial. Front Oncol 2021; 11:686776. [PMID: 34262869 PMCID: PMC8273330 DOI: 10.3389/fonc.2021.686776] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/27/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Olaparib is effective in metastatic triple negative breast cancer (TNBC) carrying germline mutations in DNA damage repair (DDR) genes BRCA1/2 (gBRCA-mut). The OLTRE window-of-opportunity trial preliminarily investigated potential pathologic, radiometabolic and immune biomarkers of early-response to olaparib in gBRCA-wild-type (wt) TNBC and, as proof-of-concept in gBRCA-mut HER2-negative BC. METHODS Patients received olaparib for 3 weeks (3w) before standard neoadjuvant chemotherapy and underwent multiple FDG18-PET/CT scan (basal, after olaparib), clinical assessments (basal, every 3w), tumor biopsies and blood samplings (baseline, after olaparib). Clinical and radiometabolic responses were evaluated according to RECIST1.1 and PERCIST criteria. RESULTS 27 patients with gBRCA-wt TNBC and 8 with gBRCA-mut BC (6 TNBC, 2 HR+/HER2-negative) were enrolled. Three (11.1%) patients showed mutations in non-BRCA1/2 DDR genes and 4 (14.8%) in other genes. 3w olaparib induced 16/35 and 15/27 partial clinical and radiometabolic responses, including in 40.7% and 50.0% gBRCA-wt patients. gBRCA-mut tumors presented numerically higher tumor-infiltrating lymphocytes (TILs) levels and PD-L1 positive tumors. Clinical responders experienced a reduction in T-regs/T-eff ratio (p=0.05), B and NK lymphocytes (p=0.003 both), with an average increase in T-helpers rate (p<0.001) and CD4/CD8 ratio (p=0.02). Ki67% and TILs did not vary significantly (p=0.67 and p=0.77). A numerical increase in PD-L1 positive cases after olaparib was observed, though non-significant (p=0.134). No differences were observed according to gBRCA status and type of response. CONCLUSIONS Early-stage TNBC might be a target population for olaparib, irrespective of gBRCA mutations. Future trials should combine TILs, PD-L1 and gBRCA status to better identify candidates for escalated/de-escalated treatment strategies including olaparib.
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Affiliation(s)
- Francesco Schettini
- Translational genomics and targeted therapies in solid tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Silvia Paola Corona
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Fabiola Giudici
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carla Strina
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Marianna Sirico
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Ottavia Bernocchi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Manuela Milani
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Nicoletta Ziglioli
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Sergio Aguggini
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Carlo Azzini
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Giuseppina Barbieri
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Valeria Cervoni
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Maria Rosa Cappelletti
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Alfredo Molteni
- Unitá Operativa Ematologia e CTMO, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Maria Chiara Lazzari
- Unitá Operativa Ematologia e CTMO, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | | | - Marco Ungari
- UO Anatomia Patologica ASST di Cremona, Cremona, Italy
| | | | | | | | | | | | - Marco Loddo
- Oncologica UK Ltd, Cambridge, United Kingdom
| | | | - Ida Paris
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giovanni Scambia
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Daniele Generali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
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12
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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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13
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Generali D, Bosio G, Malberti F, Cuzzoli A, Testa S, Romanini L, Fioravanti A, Morandini A, Pianta L, Giannotti G, Viola EM, Giorgi-Pierfranceschi M, Foramitti M, Tira RA, Zangrandi I, Chiodelli G, Machiavelli A, Cappelletti MR, Giossi A, De Giuli V, Costanzi C, Campana C, Bernocchi O, Sirico M, Zoncada A, Molteni A, Venturini S, Giudici F, Scaltriti M, Pan A. Canakinumab as treatment for COVID-19-related pneumonia: A prospective case-control study. Int J Infect Dis 2021; 104:433-440. [PMID: 33385581 PMCID: PMC7771302 DOI: 10.1016/j.ijid.2020.12.073] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Canakinumab is an IL-1β antibody that neutralises the activity of IL-1β. This study examined the efficacy and safety of canakinumab in patients with moderate COVID-19-related pneumonia. DESIGN This study aimed to evaluate the reduction in duration of hospitalisation with adequate oxygen status. Forty-eight patients with moderate COVID-19-related pneumonia were asked to participate in the prospective case-control study: 33 patients (cases) signed informed consent and received canakinumab (Cohort 1) and 15 patients (Controls) refused to receive the experimental drug and received institutional standard of care (Cohort 2). RESULTS Hospital discharge within 21 days was seen in 63% of patients in Cohort 1 vs. 0% in Cohort 2 (median 14 vs. 26 days, respectively; p < 0.001). There was significant clinical improvement in ventilation regimes following administration of canakinumab compared with Cohort 2 (Stuart-Maxwell test for paired data, p < 0.001). Patients treated with canakinumab experienced a significant increase in PaO2:FiO2 (p < 0.001) and reduction in lung damage by CT (p = 0.01), along with significant decreases in immune/inflammation markers that were not observed in Cohort 2. Only mild side-effects were seen in patients treated with canakinumab; survival at 60 days was 90.0% (95% CI 71.9-96.7) in patients treated with canakinumab and 73.3% (95% CI 43.6-89.1) for Cohort 2. CONCLUSIONS Treatment with canakinumab in patients with COVID-19-related pneumonia rapidly restored normal oxygen status, decreased the need for invasive mechanical ventilation, and was associated with earlier hospital discharge and favourable prognosis versus standard of care.
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Affiliation(s)
- Daniele Generali
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
| | - Giancarlo Bosio
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Fabio Malberti
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Antonio Cuzzoli
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Sophie Testa
- Haemostasis and Thrombosis Center, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Laura Romanini
- Radiology Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Antonio Fioravanti
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | | | - Luca Pianta
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | | | - Erika Maria Viola
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | | | - Marina Foramitti
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Rosa Angela Tira
- Radiology Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Ilaria Zangrandi
- Radiology Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Giulia Chiodelli
- Pharmacy Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Andrea Machiavelli
- Pharmacy Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Maria Rosa Cappelletti
- Haemostasis and Thrombosis Center, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Alessia Giossi
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Valeria De Giuli
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Chiara Costanzi
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Chiara Campana
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Ottavia Bernocchi
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Marianna Sirico
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Alessia Zoncada
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Alfredo Molteni
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Sergio Venturini
- Department of Management, University of Turin, Turin, Italy; Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Fabiola Giudici
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Maurizio Scaltriti
- Department of Pathology and Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Angelo Pan
- COVID Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
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14
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Fomasi L, Foini P, Marchi G, Ghiringhelli P, Molteni A, Ungari M, Fisogni S, Malberti F. [Kidney involvement in Waldenström's disease - case report]. G Ital Nefrol 2021; 38:38-1-2021-05. [PMID: 33599424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Waldenström's disease is a rare haematological neoplasm involving B lymphocytes, characterized by medullary infiltrated lymphoplasmacytic lymphoma and by the presence of a monoclonal M paraprotein. Although rarely, this condition may lead to heterogeneous renal involvement and cause severe renal failure. We report the clinical case of a patient with overt nephrotic syndrome in Waldenström's disease treated with a combination chemotherapy (rituximab, cyclophosphamide, dexamethasone) until complete renal and haematological remission.
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Affiliation(s)
- Luigi Fomasi
- UO Nefrologia e Dialisi ASST Spedali civili di Brescia - Scuola di specializzazione in Nefrologia di Brescia, Italia
| | - Paolo Foini
- UO Nefrologia e Dialisi ASST Cremona, Italia
| | | | | | | | | | - Simona Fisogni
- UO Anatomia Patologica ASST Spedali Civili di Brescia, Italia
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15
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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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16
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Schettini F, Sobhani N, Ianza A, Triulzi T, Molteni A, Lazzari MC, Strina C, Milani M, Corona SP, Sirico M, Bernocchi O, Giudici F, Cappelletti MR, Ciruelos E, Jerusalem G, Loi S, Fox SB, Generali D. Immune system and angiogenesis-related potential surrogate biomarkers of response to everolimus-based treatment in hormone receptor-positive breast cancer: an exploratory study. Breast Cancer Res Treat 2020; 184:421-431. [PMID: 32770287 PMCID: PMC7599144 DOI: 10.1007/s10549-020-05856-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/31/2020] [Indexed: 01/08/2023]
Abstract
Purpose mTOR inhibitor everolimus is used for hormone receptor-positive (HR+)/HER2-negative metastatic breast cancer (mBC). No reliable predictive biomarker of response is available. Following evidences from other solid tumors, we aimed to assess the association between treatment-associated immune system features and everolimus activity. Methods We retrospectively explored a correlation with the therapeutic activity of everolimus and tumor-associated immune pathways with ingenuity pathway analysis (IPA), neutrophil-to-lymphocyte ratio (NLR), circulating lymphocytes, and endothelial cells (CECs) in 3 different HR+ mBC studies, including the BALLET phase IIIb study. Results The circulating levels of CD3+/CD8+, CD3+/CD4+, and overall T lymphocytes were higher in responders versus non-responders at baseline (p = 0.017, p < 0.001, p = 0.034) and after treatment (p = 0.01, p = 0.003, p = 0.023). Reduced CECs, a tumor neoangiogenesis marker, were observed in responders after treatment (p < 0.001). Patients with low NLR (≤ 4.4) showed a better progression-free survival compared to patients with high NLR (> 4.4) (p = 0.01). IPA showed that the majority of immunity-related genes were found upregulated in responders compared to non-responders before treatment, but not after. Conclusions Lymphocytes subpopulations, CECs and NLR could be interesting biomarkers predictive of response to everolimus-based regimens, potentially useful in daily clinical practice to select/monitor everolimus-based treatment in mBC. Further studies to confirm such hypotheses are warranted.
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Affiliation(s)
- Francesco Schettini
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Navid Sobhani
- Department of Medical, Surgery & Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy
| | - Anna Ianza
- Department of Medical, Surgery & Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy
| | - Tiziana Triulzi
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alfredo Molteni
- UO Ematologia e CTMO, ASST di Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | | | - Carla Strina
- UO Multidisciplinare di Patologia Mammaria e Ricerca Traslazionale, ASST di Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - Manuela Milani
- UO Multidisciplinare di Patologia Mammaria e Ricerca Traslazionale, ASST di Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - Silvia Paola Corona
- Department of Medical, Surgery & Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy
| | - Marianna Sirico
- UO Multidisciplinare di Patologia Mammaria e Ricerca Traslazionale, ASST di Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - Ottavia Bernocchi
- Department of Medical, Surgery & Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy.,UO Multidisciplinare di Patologia Mammaria e Ricerca Traslazionale, ASST di Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - Fabiola Giudici
- Department of Medical, Surgery & Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy
| | - Maria Rosaria Cappelletti
- UO Multidisciplinare di Patologia Mammaria e Ricerca Traslazionale, ASST di Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - Eva Ciruelos
- SOLTI Breast Cancer Research Group, Barcelona, Spain.,Department of Medical Oncology, Breast Cancer Unit, University Hospital, 12 de Octubre, Avda de Córdoba s/n, Madrid, Spain
| | - Guy Jerusalem
- Department of Medical Oncology, Centre Hospitalier Universitaire de Liège and Liège University, Avenue de L'Hòpital 1, 4000, Liège, Belgium
| | - Sherine Loi
- Peter MacCallum Cancer Center, 305 Grattan Street, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - Stephen B Fox
- Peter MacCallum Cancer Center, 305 Grattan Street, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | - Daniele Generali
- Department of Medical, Surgery & Health Sciences, University of Trieste, Piazza Ospitale 1, 34129, Trieste, Italy. .,UO Multidisciplinare di Patologia Mammaria e Ricerca Traslazionale, ASST di Cremona, Viale Concordia 1, 26100, Cremona, Italy.
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17
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Reda G, Noto A, Cassin R, Zamprogna G, Borella C, Scarfò L, Farina L, Molteni A, Ghia P, Tedeschi A, Montillo M. Reply to "CLL and COVID-19 at the Hospital Clinic of Barcelona: an interim report" Analysis of six hematological centers in Lombardy : On behalf of CLL commission of Lombardy Hematology Network (REL). Leukemia 2020; 34:2531-2532. [PMID: 32753689 PMCID: PMC7401467 DOI: 10.1038/s41375-020-0966-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Gianluigi Reda
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy.
| | - Alessandro Noto
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | - Ramona Cassin
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | - Giulia Zamprogna
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Borella
- Hematology Department, San Gerardo Hospital, ASST Monza (MB), Monza, Italy
| | - Lydia Scarfò
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Lucia Farina
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Paolo Ghia
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Alessandra Tedeschi
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Montillo
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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18
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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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19
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Bocchia M, Candoni A, Borlenghi E, Defina M, Filì C, Cattaneo C, Sammartano V, Fanin R, Sciumè M, Sicuranza A, Imbergamo S, Riva M, Fracchiolla N, Latagliata R, Caizzi E, Mazziotta F, Alunni G, Di Bona E, Crugnola M, Rossi M, Consoli U, Fontanelli G, Greco G, Nadali G, Rotondo F, Todisco E, Bigazzi C, Capochiani E, Molteni A, Bernardi M, Fumagalli M, Rondoni M, Scappini B, Ermacora A, Simonetti F, Gottardi M, Lambertenghi Deliliers D, Michieli M, Basilico C, Galeone C, Pelucchi C, Rossi G. Real‐world experience with decitabine as a first‐line treatment in 306 elderly acute myeloid leukaemia patients unfit for intensive chemotherapy. Hematol Oncol 2019; 37:447-455. [DOI: 10.1002/hon.2663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Monica Bocchia
- Unità di Ematologia Azienda Ospedaliera Universitaria Senese e Università di Siena Siena Italy
| | - Anna Candoni
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari Azienda Sanitaria Universitaria Integrata Udine Italy
| | | | - Marzia Defina
- Unità di Ematologia Azienda Ospedaliera Universitaria Senese e Università di Siena Siena Italy
| | - Carla Filì
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari Azienda Sanitaria Universitaria Integrata Udine Italy
| | | | - Vincenzo Sammartano
- Unità di Ematologia Azienda Ospedaliera Universitaria Senese e Università di Siena Siena Italy
| | - Renato Fanin
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari Azienda Sanitaria Universitaria Integrata Udine Italy
| | | | - Anna Sicuranza
- Unità di Ematologia Azienda Ospedaliera Universitaria Senese e Università di Siena Siena Italy
| | - Silvia Imbergamo
- Ematologia ed Immunologia Clinica Azienda Ospedaliero‐Universitaria Padua Italy
| | - Marta Riva
- S.C. Ematologia, Dipartimento di Ematologia e Oncologia, Niguarda Cancer Center ASST Grande Ospedale Metropolitano Niguarda Milan Italy
| | | | - Roberto Latagliata
- Ematologia‐Dipartimento di Biotecnologie Cellulari ed Ematologia Università Sapienza Rome Italy
| | - Emanuela Caizzi
- S. C. Ematologia Clinica, Ospedale Maggiore Azienda Sanitaria Universitaria Integrata Trieste Italy
| | - Francesco Mazziotta
- Dipartimento di Oncologia, dei Trapianti e delle Nuove Tecnologie, Sezione di Ematologia Università di Pisa Pisa Italy
| | - Giulia Alunni
- S.C. Oncoematologia con Autotrapianto, Dipartimento di Medicina e Specialità Mediche University of Perugia Perugia Italy
| | - Eros Di Bona
- Unità Operativa Ematologia Ospedale S. Bortolo Vicenza Italy
| | - Monica Crugnola
- Divisione di Ematologia Azienda Ospedaliero‐Universitaria di Parma Parma Italy
| | - Marianna Rossi
- S.O.S. Terapia Cellulare e Chemioterapia Alte Dosi Centro Riferimento Oncologico IRCCS Aviano Italy
| | - Ugo Consoli
- UOC Ematologia ARNAS Garibaldi Catania Italy
| | | | | | - Gianpaolo Nadali
- UOC Ematologia Azienda Ospedaliera Universitaria Integrata Verona Italy
| | | | - Elisabetta Todisco
- Divisione di Onco‐Ematologia IEO Istituto Europeo di Oncologia IRCCS Milan Italy
| | - Catia Bigazzi
- UOC Ematologia e Terapia Cellulare Ospedale C. e G. Mazzoni Ascoli Piceno Italy
| | | | | | - Massimo Bernardi
- UO Ematologia e Trapianto Midollo Osseo IRCCS Istituto Scientifico Universitario San Raffaele Milan Italy
| | - Monica Fumagalli
- UO Ematologia e CTA, ASST Monza Ospedale San Gerardo Monza Italy
| | - Michela Rondoni
- UOC Ematologia Azienda Unità Sanitaria Locale della Romagna Ravenna Italy
| | | | - Anna Ermacora
- UOC Medicina Interna Azienda Ospedaliera S. Maria Angeli Pordenone Italy
| | - Federico Simonetti
- UOC Ematologia Aziendale, Ospedale Versilia Azienda Toscana Nord‐Ovest Lucca Italy
| | - Michele Gottardi
- UOC Ematologia, Azienda ULSS9 Ospedale Ca' Foncello Treviso Italy
| | | | - Mariagrazia Michieli
- S.O.S. Terapia Cellulare e Chemioterapia Alte Dosi Centro Riferimento Oncologico IRCCS Aviano Italy
| | | | - Carlotta Galeone
- Dipartimento di Scienze Cliniche e di Comunità Università di Milano Milan Italy
| | - Claudio Pelucchi
- Dipartimento di Scienze Cliniche e di Comunità Università di Milano Milan Italy
| | - Giuseppe Rossi
- UO Ematologia ASST Spedali Civili di Brescia Brescia Italy
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20
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Fabiani E, Calabrese C, Niscola P, Balleari E, Molteni A, Finelli C, Falconi G, Fenu S, Fianchi L, Criscuolo M, Salvi F, Lavorgna S, Buccisano F, Maurillo L, Lo Coco F, Cilloni D, Voso MT. Mutational profile and haematological response to iron chelation in myelodysplastic syndromes (
MDS
). Br J Haematol 2018; 185:954-957. [DOI: 10.1111/bjh.15655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Emiliano Fabiani
- Department of Biomedicine and Prevention Universita’ Tor Vergata RomeItaly
| | - Chiara Calabrese
- Department of Clinical and Biological Sciences University of Turin OrbassanoItaly
| | | | - Enrico Balleari
- Department of Haematology and Oncology IRCCS AOU San Martino ‐ IST GenovaItaly
| | - Alfredo Molteni
- Haematology ASST Grande Ospedale Metropolitano Niguarda MilanItaly
| | - Carlo Finelli
- Department of Haematology S. Orsola‐Malpighi Hospital BolognaItaly
| | - Giulia Falconi
- Department of Biomedicine and Prevention Universita’ Tor Vergata RomeItaly
| | - Susanna Fenu
- Haematology Department Az. Osp. San Giovanni‐Addolorata RomeItaly
| | - Luana Fianchi
- Dipartimento Scienze Radiologiche Radioterapiche ed Ematologiche Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Marianna Criscuolo
- Dipartimento Scienze Radiologiche Radioterapiche ed Ematologiche Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Flavia Salvi
- Department of Haematology AO SS Antonio e Biagio e C. Arrigo Alessandria Italy
| | - Serena Lavorgna
- Department of Biomedicine and Prevention Universita’ Tor Vergata RomeItaly
| | | | - Luca Maurillo
- Department of Biomedicine and Prevention Universita’ Tor Vergata RomeItaly
| | - Francesco Lo Coco
- Department of Biomedicine and Prevention Universita’ Tor Vergata RomeItaly
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences University of Turin OrbassanoItaly
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention Universita’ Tor Vergata RomeItaly
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21
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Girmenia C, Candoni A, Delia M, Latagliata R, Molteni A, Oliva EN, Palumbo GA, Poloni A, Salutari P, Santini V, Voso MT, Musto P. Infection control in patients with myelodysplastic syndromes who are candidates for active treatment: Expert panel consensus-based recommendations. Blood Rev 2018; 34:16-25. [PMID: 30448050 DOI: 10.1016/j.blre.2018.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 06/25/2018] [Revised: 09/05/2018] [Accepted: 10/26/2018] [Indexed: 12/15/2022]
Abstract
The improvement in supportive care and the introduction of new therapeutic agents, including lenalidomide and hypomethylating agents, in myelodysplastic syndromes have improved patients' outcomes; however, at the same time, the frequency and epidemiology of infections have changed. Therefore, the great strides in the indications and use of new treatment strategies for myelodysplastic syndromes need a parallel progress in the best approach to prophylaxis and supportive therapy for infections. Based on the recognition that the above issues represent an unmet clinical need in myelodysplastic syndromes, an Italian expert panel performed a review of the literature and composed a framework of the best recommendations for optimal infection control in patient candidates to receive active treatment for myelodysplastic syndromes. In this consensus document we report the outcomes of that review and of the consensus meetings held during 2017. The issues tackled in the project dealt with: information to be collected from candidates for active treatment for myelodysplastic syndromes; how to monitor the risk of infection; antimicrobial prophylaxis; the role of iron chelation and antiviral/antibacterial vaccinations. For each of these issues, practice recommendations are provided.
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Affiliation(s)
- Corrado Girmenia
- Dipartimento di Ematologia, Oncologia e Dermatologia, Policlinico Umberto I, Sapienza University of Rome, Italy.
| | - Anna Candoni
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Mario Delia
- Hematology and BMT Unit, Policlinic of Bari, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Roberto Latagliata
- Dipartimento di Ematologia, Oncologia e Dermatologia, Policlinico Umberto I, Sapienza University of Rome, Italy
| | | | - Esther N Oliva
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Giuseppe A Palumbo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F.Ingrassia", Università degli Studi di Catania, Catania, Italy
| | - Antonella Poloni
- Clinica di Ematologia, AOU Ospedali Riuniti, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Prassede Salutari
- Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Ospedale Spirito Santo, Pescara, Italy
| | - Valeria Santini
- MDS UNIT, Hematology, AOU-Careggi University Hospital, Department of Experimental and Clinical Medicine, Università degli Studi di Firenze, Florence, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, PZ, Italy
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22
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Falconi G, Fabiani E, Piciocchi A, Criscuolo M, Fianchi L, Lindfors Rossi EL, Finelli C, Cerqui E, Ottone T, Molteni A, Parma M, Santarone S, Candoni A, Sica S, Leone G, Lo-Coco F, Voso MT. Somatic mutations as markers of outcome after azacitidine and allogeneic stem cell transplantation in higher-risk myelodysplastic syndromes. Leukemia 2018; 33:785-790. [PMID: 30291338 PMCID: PMC6462855 DOI: 10.1038/s41375-018-0284-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/05/2018] [Accepted: 09/12/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Giulia Falconi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | - Emiliano Fabiani
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | | | - Marianna Criscuolo
- Dipartimento Scienze Radiologiche Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Luana Fianchi
- Dipartimento Scienze Radiologiche Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | | | - Carlo Finelli
- Department of Hematology, Ospedale Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - Elisa Cerqui
- Department of Hematology, A.O. Spedali Civili, Brescia, Italy
| | - Tiziana Ottone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | | | - Matteo Parma
- Department of Hematology, HSCT Adult Unit, San Gerardo Hospital, Monza, Italy
| | - Stella Santarone
- Department of Hematology, Centro Trapianti Midollo Osseo, Pescara, Italy
| | - Anna Candoni
- Division of Hematology and BMT, Department of Experimental and Clinical Medical Sciences, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Simona Sica
- Dipartimento Scienze Radiologiche Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Giuseppe Leone
- Dipartimento Scienze Radiologiche Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Francesco Lo-Coco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy.,Fondazione Santa Lucia, Laboratorio di Neuro-Oncoematologia, Roma, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy.
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23
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Reda G, Riva M, Fattizzo B, Cassin R, Giannarelli D, Pennisi M, Freyrie A, Cairoli R, Molteni A, Cortelezzi A. Bone Marrow Fibrosis and Early Hematological Response as Predictors of Poor Outcome in Azacitidine Treated High Risk-Patients With Myelodysplastic Syndromes or Acute Myeloid Leukemia. Semin Hematol 2018; 55:202-208. [DOI: 10.1053/j.seminhematol.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/29/2017] [Accepted: 02/16/2018] [Indexed: 12/12/2022]
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24
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Voso MT, Leone G, Piciocchi A, Fianchi L, Santarone S, Candoni A, Criscuolo M, Masciulli A, Cerqui E, Molteni A, Finelli C, Parma M, Poloni A, Carella AM, Spina F, Cortelezzi A, Salvi F, Alessandrino EP, Rambaldi A, Sica S. Feasibility of allogeneic stem-cell transplantation after azacitidine bridge in higher-risk myelodysplastic syndromes and low blast count acute myeloid leukemia: results of the BMT-AZA prospective study. Ann Oncol 2018; 28:1547-1553. [PMID: 28368509 DOI: 10.1093/annonc/mdx154] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Indexed: 12/25/2022] Open
Abstract
Background Allogeneic stem-cell transplantation (HSCT) is the only curative treatment in myelodysplastic syndromes (MDS). Azacitidine (AZA) is increasingly used prior to HSCT, however in Europe it is only approved for patients who are not eligible for HSCT. Patients and methods We conducted a phase II multicenter study to prospectively evaluate the feasibility of HSCT after treatment with AZA in 70 patients with a myelodysplastic syndrome (MDS), 19 with acute myeloid leukemia (AML), and 8 with chronic myelomonocytic leukemia (CMML). After a median of four cycles (range 1-11): 24% of patients achieved complete remission, 14% partial remission, 8% hematologic improvement, 32% had stable and 22% progressive disease. Ten patients discontinued treatment before the planned four cycles, due to an adverse event in nine cases. Results A HSC donor was identified in 73 patients, and HSCT was performed in 54 patients (74% of patients with a donor). Main reasons for turning down HSCT were lack of a donor, an adverse event, or progressive disease (9, 12, and 16 patients, respectively). At a median follow-up of 20.5 months from enrolment, response to AZA was the only independent prognostic factor for survival. Compared to baseline assessment, AZA treatment did not affect patients' comorbidities at HSCT: the HCT-CI remained stable in 62% patients, and worsened or improved in 23% and 15% of patients, respectively. Conclusions Our study shows that HSCT is feasible in the majority of patients with HR-MDS/AML/CMML-2 after AZA treatment. As matched unrelated donor was the most frequent source of donor cells, the time between diagnosis and HSCT needed for donor search could be 'bridged' using azacitidine. These data show that AZA prior to HSCT could be a better option than intensive chemotherapy in higher-risk MDS. The trial has been registered with the EudraCT number 2010-019673-1.
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Affiliation(s)
- M T Voso
- Division of Hematology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome
| | - G Leone
- Department of Hematology, Università Cattolica del Sacro Cuore, Rome
| | - A Piciocchi
- Department of Statistical Sciences, La Sapienza University, Rome
| | - L Fianchi
- Department of Hematology, Università Cattolica del Sacro Cuore, Rome
| | - S Santarone
- Department of Hematology, Centro Trapianti Midollo Osseo, Pescara
| | - A Candoni
- Division of Hematology and BMT, Department of Experimental and Clinical Medical Sciences, Azienda Ospedaliero-Universitaria di Udine, Udine
| | - M Criscuolo
- Department of Hematology, Università Cattolica del Sacro Cuore, Rome
| | - A Masciulli
- Department of Hematology, ASST Papa Giovanni XXIII, Bergamo
| | - E Cerqui
- Department of Hematology, A.O. Spedali Civili, Brescia
| | - A Molteni
- Department of Hematology, Ospedale Niguarda, Milano
| | - C Finelli
- Department of Hematology, Ospedale Sant'Orsola Malpighi, University of Bologna, Bologna
| | - M Parma
- Department of Hematology, HSCT Adult Unit, San Gerardo Hospital, Monza
| | - A Poloni
- Department of Hematology, Azienda Ospedaliera Universitaria - Ospedali Riuniti di Ancona, Ancona
| | - A M Carella
- Department of Hematology, Ospedale Opera Padre Pio, San Giovanni Rotondo
| | - F Spina
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - A Cortelezzi
- Department of Hematology Oncology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milano
| | - F Salvi
- Department of Hematology, "SS Antonio e Biagio" Hospital, Alessandria
| | - E P Alessandrino
- Department of Hematology, Policlinico San Matteo and Pavia University, Pavia, Italy
| | - A Rambaldi
- Department of Hematology, ASST Papa Giovanni XXIII, Bergamo
| | - S Sica
- Department of Hematology, Università Cattolica del Sacro Cuore, Rome
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25
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Cattaneo M, Molteni A, Cesana B, Mannucci PM, Tripodi A. Changes of Prothrombin Fragment 1+2 (F 1+2) as a Function of Increasing Intensity of Oral Anticoagulation. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614947] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryPlasma F 1+2 levels, the activation peptide originating from the factor Xa-mediated activation of prothrombin, increase in many clinical conditions associated with hypercoagulability and decrease in patients on oral anticoagulant treatment (OAT). However, the usefulness of F 1+2 measurement to monitor OAT has not yet been investigated in clinical studies. Before those studies are attempted, the plausibility of its implementation in the laboratory control of OAT should be evaluated. In this respect, a thorough investigation of the pattern of changes of F 1+2 as a function of increased intensity of anticoagulation expressed as International Normalized Ratio is essential. One hundred and thirty-two patients on long-term warfarin treatment were recruited to cover 8 ranges of anticoagulation from <1.5 to 9.0 INR. F 1+2 was measured in batch on frozen plasma and INR was determined on fresh plasma. The relationship of F 1+2 vs. INR showed a hyperbolic pattern with F 1+2 levels decreasing progressively and significantly as a function of increasing INR up to 3.0. A further decrease in F 1+2 levels observed at INR up to 4.0 was not statistically significant. At INR greater than 4.0, F 1+2 reached a plateau, with mean levels not significantly different for patients at increasing INR up to 9.0. Since the risk of bleeding increases at INR greater than 4.5, our results suggest that F 1+2 is of little value to assess the hemorrhagic risk in patients on OAT.
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26
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Oliva EN, Alati C, Santini V, Poloni A, Molteni A, Niscola P, Salvi F, Sanpaolo G, Balleari E, Germing U, Fenaux P, Stamatoullas A, Palumbo GA, Salutari P, Impera S, Avanzini P, Cortelezzi A, Liberati AM, Carluccio P, Buccisano F, Voso MT, Mancini S, Kulasekararaj A, Morabito F, Bocchia M, Cufari P, Spiriti MAA, Santacaterina I, D'Errigo MG, Bova I, Zini G, Latagliata R. Eltrombopag versus placebo for low-risk myelodysplastic syndromes with thrombocytopenia (EQoL-MDS): phase 1 results of a single-blind, randomised, controlled, phase 2 superiority trial. The Lancet Haematology 2017; 4:e127-e136. [DOI: 10.1016/s2352-3026(17)30012-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/30/2016] [Accepted: 01/02/2017] [Indexed: 12/28/2022]
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27
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Molteni A, Riva M, Ravano E, Marbello L, Mancini V, Grillo G, Zucchetti E, Greco R, Cairoli R. Clofarabine-based chemotherapy as a bridge to transplant in the setting of refractory or relapsed acute myeloid leukemia, after at least one previous unsuccessful salvage treatment containing fludarabine: a single institution experience. Int J Hematol 2017; 105:769-776. [PMID: 28220349 DOI: 10.1007/s12185-017-2198-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 11/25/2022]
Abstract
For refractory or relapsed acute myeloid leukemia patients, allogeneic hematopoietic stem cell transplantation is the only curative treatment option, but the disease must be in remission before this can be attempted. "Salvage" therapy regimens containing high-dose cytarabine plus fludarabine or cladribine with or without anthracyclines or plus mitoxantrone and etoposide fail in 30-50% of cases. We report the outcome of 14 patients treated with a clofarabine-based treatment administered after at least one failed fludarabine-based "salvage" attempt in a "real life" (outside a clinical trial) context. No death related to the clofarabine-based treatment was observed. Four of the 14 patients (29%) reached complete remission and one (7%) achieved a reduction of marrow blasts to fewer than 10%. Three of these five patients were successfully transplanted and have shown a long-term survival. The small number of this group of patients does not permit the identification of clinical features clearly related to a favorable outcome, but we note that all the three long-term survivals were FLT3 wild type. Clofarabine-based "salvage therapy" in patients with very poor expectancy is feasible even after a fludarabine-based salvage attempt, albeit with success only in a small percentage of cases (3/14 = 21%).
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Affiliation(s)
- Alfredo Molteni
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Marta Riva
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Emanuele Ravano
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Laura Marbello
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Valentina Mancini
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Giovanni Grillo
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Elisa Zucchetti
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Rosa Greco
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Roberto Cairoli
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
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Fletcher A, Raza F, Buursma J, Livingston S, Kearn D, Herndon B, Vanden Heauvel G, Baybutt R, Molteni A. Pathological Changes in the Heart of the Strain CUX1 Transgenic Mice. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.lb432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A Fletcher
- PathologyUniversity of Missouri Kansas City School of MedicineKansas CityMissouriUnited States
| | - F Raza
- PathologyUniversity of Missouri Kansas City School of MedicineKansas CityMissouriUnited States
| | - J Buursma
- Nutrition and Health Sciences Wheaton CollegeWheatonIllinoisUnited States
| | - S Livingston
- Nutrition and Health Sciences Wheaton CollegeWheatonIllinoisUnited States
| | - D Kearn
- Nutrition and Health Sciences Wheaton CollegeWheatonIllinoisUnited States
| | - B Herndon
- PathologyUniversity of Missouri Kansas City School of MedicineKansas CityMissouriUnited States
| | - G Vanden Heauvel
- MedicineWestern Michigan University School of MedicineKalamazooMichiganUnited States
| | - R Baybutt
- Nutrition and Health Sciences Wheaton CollegeWheatonIllinoisUnited States
| | - A Molteni
- PathologyUniversity of Missouri Kansas City School of MedicineKansas CityMissouriUnited States
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Pelizzari A, Ferrero D, Molteni A, Allione B, Mezzabotta M, Clavio M, Borlenghi E, Rossi G, Masiera E, Santini V. 110 BIOSIMILAR EPOETIN ZETA FOR THE TREATMENT OF ANEMIA IN MYELODYSPLASTIC SYNDROMES (MDS). Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30111-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Molteni A, Riva M, Cesana C, Speziale V, Nichelatti M, Scarpati B, Greco R, Ravano E, Cairoli R, Rossini S, Morra E. Prognostic relevance of the flow cytometric count of medullar blasts in myelodysplastic syndromes. Eur J Haematol 2014; 94:519-25. [PMID: 25307971 DOI: 10.1111/ejh.12465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The medullar blast count is a milestone in the prognostic assessment in myelodysplastic syndromes (MDS). The optical microscopy (OM) may sometimes be inaccurate in this disease. The aim of this work is to test the flow immunocytometric (FCM) determinations of medullar immature cells (CD45(±) ) and the expression, among them, of CD33, CD34, and CD117 markers, for their prognostic relevance. METHODS In a retrospective analysis of 98 patients affected by MDS, the IPSS was re-calculated by means of the FCM determination of blasts. Survival of patients at low or intermediate-1 IPSS risk was compared with the survival of patients at intermediate-2 or high IPSS risk. In the 64 cases with OM blast count lower than 5%, the survival of patients with the FCM count of medullar blasts ≤2% was compared with that of patients with FCM count >2%. RESULTS Each single marker had a prognostic weight comparable to the optical blast count. The FCM blast count was particularly efficient in distinguishing the risk of having up to 2% or more than 2% of blasts in patients without OM excess of blasts. CONCLUSION This method is interesting as prognostic tool, especially in patients without excess of blast.
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Affiliation(s)
- Alfredo Molteni
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Marta Riva
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Clara Cesana
- Immuno-Hematology and Transfusional Unit, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Valentina Speziale
- Department of General Medicine, AO Ospedale Civile di Legnano, Legnano, Italy
| | - Michele Nichelatti
- Service of Biostatistics Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Barbara Scarpati
- Immuno-Hematology and Transfusional Unit, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Rosa Greco
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Emanuele Ravano
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Roberto Cairoli
- Department of General Medicine, Oncology and Hematology, Ospedale Valduce, Como, Italy
| | - Silvano Rossini
- Immuno-Hematology and Transfusional Unit, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Enrica Morra
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
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Efficace F, Santini V, La Nasa G, Cottone F, Finelli C, Borin L, Quaresmini G, Di Tucci AA, Volpe A, Cilloni D, Quarta G, Sanpaolo G, Rivellini F, Salvi F, Molteni A, Voso MT, Alimena G, Fenu S, Mandelli F, Angelucci E. Health-related quality of life in transfusion-dependent patients with myelodysplastic syndromes: a prospective study to assess the impact of iron chelation therapy. BMJ Support Palliat Care 2014; 6:80-8. [DOI: 10.1136/bmjspcare-2014-000726] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/24/2014] [Indexed: 01/19/2023]
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Centis E, Trento M, Dei Cas A, Pontiroli AE, De Feo P, Bruno A, Sasdelli AS, Arturi F, Strollo F, Vigili De' Kreutzenberg S, Invitti C, Di Bonito P, Di Mauro M, Pugliese G, Molteni A, Marchesini G. Stage of change and motivation to healthy diet and habitual physical activity in type 2 diabetes. Acta Diabetol 2014; 51:559-66. [PMID: 24442514 DOI: 10.1007/s00592-013-0551-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
Abstract
Lifestyle changes to healthy diet (HD) and habitual physical activity (HPA) are recommended in type 2 diabetes mellitus (T2DM). Yet, for most people with diabetes, it may be difficult to start changing. We investigated the stage of change toward healthier lifestyles according to Prochaska's model, and the associated psychological factors in T2DM patients, as a prerequisite to improve strategies to implement behavior changes in the population. A total of 1,353 consecutive outpatients with T2DM attending 14 tertiary centers for diabetes treatment completed the validated EMME-3 questionnaire, consisting of two parallel sets of instruments to define the stage of change for HD and HPA, respectively. Logistic regression was used to determine the factors associated with stages that may hinder behavioral changes. A stage of change favoring progress to healthier behaviors was more common in the area of HD than in HPA, with higher scores in action and maintenance. Differences were observed in relation to gender, age and duration of disease. After adjustment for confounders, resistance to change toward HD was associated with higher body mass index (BMI) (odds ratio (OR) 1.05; 95 % confidence interval (CI) 1.02-1.08). Resistance to improve HPA also increased with BMI (OR 1.06; 95 % CI 1.03-1.10) and decreased with education level (OR 0.74; 95 % CI 0.64-0.92). Changing lifestyle, particularly in the area of HPA, is not perceived as an essential part of treatment by many subjects with T2DM. This evidence must be considered when planning behavioral programs, and specific interventions are needed to promote adherence to HPA.
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Affiliation(s)
- E Centis
- Unit of Metabolic Diseases and Clinical Dietetics, Alma Mater University of Bologna, Policlinico S. Orsola, Via Massarenti, 9, 40138, Bologna, Italy
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Angelucci E, Santini V, Di Tucci AA, Quaresmini G, Finelli C, Volpe A, Quarta G, Rivellini F, Sanpaolo G, Cilloni D, Salvi F, Caocci G, Molteni A, Vallisa D, Voso MT, Fenu S, Borin L, Latte G, Alimena G, Storti S, Piciocchi A, Fazi P, Vignetti M, Tura S. Deferasirox for transfusion-dependent patients with myelodysplastic syndromes: safety, efficacy, and beyond (GIMEMA MDS0306 Trial). Eur J Haematol 2014; 92:527-36. [DOI: 10.1111/ejh.12300] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Emanuele Angelucci
- Hematology and Bone Marrow Transplantation Unit; Ospedale Oncologico di Riferimento Regionale “Armando Businco”; Cagliari Italy
| | - Valeria Santini
- Division of Hematology; University of Florence; Florence Italy
| | - Anna Angela Di Tucci
- Hematology and Bone Marrow Transplantation Unit; Ospedale Oncologico di Riferimento Regionale “Armando Businco”; Cagliari Italy
| | - Giulia Quaresmini
- Hematology and Bone Marrow Transplant Unit; Azienda Ospedaliera Papa Giovanni XXIII; Bergamo Italy
| | - Carlo Finelli
- Division of Hematology; Policlinico S. Orsola-Malpighi; Bologna Italy
| | - Antonio Volpe
- Division of Hematology; San Giuseppe Moscati Hospital; Avellino Italy
| | | | - Flavia Rivellini
- UO Medicina Interna e Onco-Ematologica P.O. “Umberto I”; Nocera Inferiore Italy
| | - Grazia Sanpaolo
- Division of Hematology; IRCCS “Casa Sollievo della Sofferenza”; San Giovanni Rotondo Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences; University of Turin; Turin Italy
| | - Flavia Salvi
- Division of Hematology; A.O. Nazionale Santi Antonio e Biagio e C. Arrigo; Alessandria Italy
| | - Giovanni Caocci
- Bone Marrow Transplantation Center; R. Binaghi Hospital; Cagliari Italy
| | - Alfredo Molteni
- Division of Hematology; Niguarda Ca’ Granda Hospital; Milan Italy
| | - Daniele Vallisa
- Division of Medical Oncology and Hematology; Hospital of Piacenza; Piacenza Italy
| | - Maria Teresa Voso
- Division of Hematology; Università Cattolica del Sacro Cuore; Rome Italy
| | - Susanna Fenu
- Division of Hematology; San Giovanni Hospital; Rome Italy
| | | | | | - Giuliana Alimena
- Division of Hematology; “Sapienza”University of Rome; Rome Italy
| | - Sergio Storti
- Division of Hematology and Medical Oncology; Campobasso University; Campobasso Italy
| | | | - Paola Fazi
- GIMEMA Data Center; GIMEMA Foundation; Rome Italy
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Nosari AM, Pioltelli ML, Riva M, Marbello L, Nichelatti M, Greco A, Molteni A, Vismara E, Gabutti C, Volonterio A, Lombardi P, Morra E. Invasive fungal infections in lymphoproliferative disorders: a monocentric retrospective experience. Leuk Lymphoma 2014; 55:1844-8. [PMID: 24138328 DOI: 10.3109/10428194.2013.853299] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Invasive fungal infections (IFIs) seem to be a relevant cause of morbidity and mortality in patients with chronic lymphoproliferative disorders. We studied retrospectively the epidemiology, clinical manifestations and outcome of invasive fungal infections in 42 patients with lymphoproliferative diseases, treated between January 2004 and February 2012 for probable or proven IFI. In our entire population (1355 patients) of chronic lymphoproliferative malignancies, the incidence of probable/proven IFI was 3% (molds 2.3%, yeasts 0.5%, mixed infections 0.2%). Eight patients developed a yeast infection documented by blood cultures in seven cases and by the microscopic observation of Candida spp. in the vitreum after vitrectomy in one case. Among molds we diagnosed three proven infections by histologic evidence of Aspergillus spp. (n = 2) and Mucor (n = 1) in the lung and 28 probable mycoses. Three mixed infections from both molds and yeasts were also observed. Twenty-two cases showed positivity of galactomannan antigen in the serum (n = 16), in bronchoalveolar lavage (BAL) fluid (n = 4) or in both (n = 2). Cultures were positive in 11 cases. The overall rate of response to therapy was 64%. Fungal-attributable mortality rate was 17%, with a significant difference between molds and yeasts (16% vs. 25%, p = 0.03). At univariate analysis, the only risk factors related to mortality were severe and prolonged neutropenia (p = 0.003) and age (p = 0.03). Among molds, the rapid start of antifungals was probably partially responsible, together with new drugs, for the reduction of mortality, despite the severe immunosuppression of these patients.
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Molteni A, Riva M, Pellizzari A, Borin L, Freyrie A, Greco R, Ubezio M, Bernardi M, Fariciotti A, Nador G, Nichelatti M, Ravano E, Morra E. Corrigendum to ‘Hematological improvement during iron-chelation therapy in myelodysplastic syndromes: The experience of the “Rete Ematologica Lombarda”’ [Leuk Res 37 (2013) 1233–1240]. Leuk Res 2014. [DOI: 10.1016/j.leukres.2013.11.018] [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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36
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Molteni A, Riva M, Pellizzari A, Borin L, Freyre A, Greco R, Ubezio M, Bernardi M, Fariciotti A, Nador G, Nichelatti M, Ravano E, Morra E. Hematological improvement during iron-chelation therapy in myelodysplastic syndromes: The experience of the “Rete Ematologica Lombarda”. Leuk Res 2013; 37:1233-40. [DOI: 10.1016/j.leukres.2013.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/01/2013] [Indexed: 12/16/2022]
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Oliva E, Santini V, Zini G, Palumbo G, Poloni A, Cortelezzi A, Rodeghiero F, Voso M, Molteni A, Sanpaolo G, Liberati M, Morabito F, Balleari E, Impera S, Salvi F, Spiriti MA, Marino A, Rodà F, Alati C, Ronco F, Di Raimondo F, Leoni P, Alimena G, Latagliata R, Nobile F. P-310 Eltrombopag for the treatment of thrombocytopenia of low and intermediate-1 IPSS risk myelodysplastic syndromes: Results of a prospective, randomized trial. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70357-6] [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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Molteni A, Riva M, Ravano E, Greco R, Cesana C, Scarpati B, Morra E. P-099 The prognostic significance of the immunocytometric blast counts in MDS patients with medullar blasts <5% at the optical evaluation. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70147-4] [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: 10/26/2022]
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Herndon B, Quinn T, Wasson N, Nzabi M, Molteni A. Urease and Helicobacter spp. antigens in pulmonary granuloma. J Comp Pathol 2012; 148:266-77. [PMID: 22901429 DOI: 10.1016/j.jcpa.2012.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 06/07/2012] [Accepted: 06/29/2012] [Indexed: 12/11/2022]
Abstract
Pulmonary sarcoidosis, a human disease of unknown cause, has no animal model. Sarcoidosis patients have serum antibodies specific for Helicobacter pylori and its surface enzyme urease. H. pylori do not survive in the high-oxygen pulmonary atmosphere, but urease may access the lung by oesophageal reflux. A model was established in rats to study gastro-oesophageal reflux of urease into the airways. Pathology in tissues from human sarcoidosis patients was compared with that in the rat model. Changes observed in the rat model included prominent peribronchial lymphocytic infiltration, which is seen occasionally in human sarcoidosis. Granulomas, pathognomonic for human sarcoidosis, occurred occasionally in the lungs of rats given urease protein intratracheally, but were widespread when urease was coupled to microbeads and administered intravenously. Biomarkers associated with human sarcoidosis (interleukin1-β and platelet-activating factor) were up-regulated acutely in the rat model. Further investigations with this model may provide significant insights into the origin and pathogenesis of pulmonary diseases in man and other species that carry gastric Helicobacter spp. and its associated enzyme.
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Affiliation(s)
- B Herndon
- Pulmonary Research Laboratory, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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Nosari A, Caimi TM, Zilioli V, Molteni A, Mancini V, Morra E. Cerebral hemorrhage treated with NovoSeven in acute promyelocytic leukemia. Leuk Lymphoma 2011; 53:160-1. [DOI: 10.3109/10428194.2011.605189] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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42
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Soriani S, Fedeli F, Molteni A, Grillo G, Tedeschi A, Scarpati B, Campidelli C, Leszl A, Farioli R, De Canal G, Mura MA, Cesana C. Three copies of isochromosome 8q in Ph+ B-cell acute lymphoblastic leukemia. Leuk Res 2011; 35:e217-9. [PMID: 21767878 DOI: 10.1016/j.leukres.2011.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 06/02/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
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Nachnani JS, Bulchandani DG, Nookala A, Herndon B, Molteni A, Pandya P, Taylor R, Quinn T, Weide L, Alba LM. Biochemical and histological effects of exendin-4 (exenatide) on the rat pancreas. Diabetologia 2010; 53:153-9. [PMID: 19756486 DOI: 10.1007/s00125-009-1515-4] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 07/28/2009] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS Exendin-4 is a 39 amino acid agonist of the glucagon-like peptide receptor and has been approved for treatment of type 2 diabetes. Many reports describe an increased incidence of acute pancreatitis in humans treated with exendin-4 (exenatide). Previous studies have evaluated the effect of exendin-4 on beta cells and beta cell function. We evaluated the histological and biochemical effects of exendin-4 on the pancreas in rats. METHODS We studied 20 Sprague-Dawley male rats, ten of which were treated with exendin-4 and ten of which were used as controls. The study period was 75 days. Serum and pancreatic tissue were removed for biochemical and histological study. Blood glucose, amylase, lipase, insulin and adipocytokines were compared between the two groups. RESULTS Animals treated with exendin-4 had more pancreatic acinar inflammation, more pyknotic nuclei and weighed significantly less than control rats. They also had higher serum lipase than control animals. Exendin-4 treatment was associated with lower insulin and leptin levels as well as lower HOMA values than in the untreated control group. CONCLUSIONS/INTERPRETATION Although the use of exendin-4 in rats is associated with decreased weight gain, lower insulin resistance and lower leptin levels than in control animals, extended use of exendin-4 in rats leads to pancreatic acinar inflammation and pyknosis. This raises important concerns about the likelihood of inducing acute pancreatitis in humans receiving incretin mimetic therapy.
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Affiliation(s)
- J S Nachnani
- Division of Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, MO 64108, USA
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Patel S, Adler F, McIff T, Poisner A, Herndon B, Quinn T, Molteni A. Triolein‐induced renal arterial vasoconstriction and its reversal in a rat model. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.lb148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - B. Herndon
- Univ. MO‐KC School of MedicineKansas CityMO
| | - T. Quinn
- Univ. MO‐KC School of MedicineKansas CityMO
| | - A. Molteni
- Univ. MO‐KC School of MedicineKansas CityMO
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Cesana C, Klersy C, Brando B, Nosari A, Scarpati B, Scampini L, Molteni A, Nador G, Santoleri L, Formenti M, Valentini M, Mazzone A, Morra E, Cairoli R. Prognostic value of circulating CD34+ cells in myelodysplastic syndromes. Leuk Res 2008; 32:1715-23. [DOI: 10.1016/j.leukres.2008.03.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2007] [Revised: 03/27/2008] [Accepted: 03/27/2008] [Indexed: 10/22/2022]
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Yacoub WG, Waghela N, Herndon B, Quinn T, Molteni A. PULMONARY UREASE INCREASES CELLULAR RESPONSE TO H PYLORI PROTEIN. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.586b] [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: 11/01/2022] Open
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Kamal R, Molteni A, Zoubine M, Norkin M, Reppert S, Xue Y, Baybutt R, Herndon B, Shnyra A. Cytokine and Chemokine Responses of Type II Alveolar Epithelial Cells (AEC) in Monocrotaline-Induced Pulmonary Fibrosis. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.12.401] [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: 10/23/2022]
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Arcaini L, Burcheri S, Rossi A, Paulli M, Bruno R, Passamonti F, Brusamolino E, Molteni A, Pulsoni A, Cox MC, Orsucci L, Fabbri A, Frezzato M, Voso MT, Zaja F, Montanari F, Merli M, Pascutto C, Morra E, Cortelazzo S, Lazzarino M. Prevalence of HCV infection in nongastric marginal zone B-cell lymphoma of MALT. Ann Oncol 2006; 18:346-50. [PMID: 17071937 DOI: 10.1093/annonc/mdl388] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [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: 12/25/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is frequently associated with B-cell non-Hodgkin's lymphomas. We investigated the prevalence of HCV infection in nongastric marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT) in order to define the relationship between the viral infection and the presenting features, treatment, and outcome. METHODS We retrospectively studied 172 patients with a histological diagnosis of marginal zone B-cell lymphoma of MALT, except for stomach, and with available HCV serology, among a series of 208 patients. RESULTS HCV infection was documented in 60 patients (35%). Most HCV-positive patients (97%) showed a single MALT organ involvement. HCV-positive patients showed a more frequent involvement of skin (35%), salivary glands (25%), and orbit (15%). The majority of stage IV HCV-positive patients (71%) had a single MALT site with bone marrow involvement. The overall response rate was similar in HCV-positive (93%) and HCV-negative patients (87%). Overall survival (OS) and event-free survival (EFS) did not differ according to HCV infection. In multivariate analysis, advanced disease (stage III-IV) was associated with a poorer OS (P = 0.0001), irrespective of HCV serostatus. CONCLUSIONS This study shows that nongastric marginal zone lymphomas are characterized by a high prevalence of HCV infection. Patients with involvement of a single MALT site have the highest prevalence of HCV. HCV-positive nongastric lymphomas of MALT show an indolent course similar to HCV-negative patients and seem an ideal target for exploiting the antilymphoma activity of antiviral treatments.
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Affiliation(s)
- L Arcaini
- Division of Hematology, IRCCS Policlinico San Matteo, University of Pavia, Italy.
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Assaad B, Kakaji H, Quinn T, Molteni A, Wang W, Xie L, Vasques D, Ouyang P, Doan H, Herndon B. 8 ADIPOSITY AND INSULIN GROWTH FACTOR-DEPENDENT SIGNALING IN TPA-INDUCED MOUSE MODELS. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0015.7] [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: 11/18/2022]
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Assaad B, Kakaji H, Quinn T, Molteni A, Wang W, Xie L, Vasques D, Ouyang P, Doan H, Herndon B. Adiposity and Insulin Growth Factor-Dependent Signaling in Tpa-Induced Mouse Models. J Investig Med 2006. [DOI: 10.1177/108155890605402s08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- B. Assaad
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - H. Kakaji
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - T. Quinn
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - A. Molteni
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - W. Wang
- Kansas State University, Manhattan, KS
| | - L. Xie
- Kansas State University, Manhattan, KS
| | | | - P. Ouyang
- Kansas State University, Manhattan, KS
| | - H. Doan
- Kansas State University, Manhattan, KS
| | - B. Herndon
- University of Missouri-Kansas City School of Medicine, Kansas City, MO
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