1
|
Bassan R, Chiaretti S, Della Starza I, Spinelli O, Santoro A, Paoloni F, Messina M, Elia L, De Propris MS, Scattolin AM, Audisio E, Marbello L, Borlenghi E, Zappasodi P, Mauro E, Martinelli G, Mattei D, Fracchiolla N, Bocchia M, De Fabritiis P, Bonifacio M, Candoni A, Cassibba V, Di Bartolomeo P, Latte G, Trappolini S, Guarini A, Vitale A, Fazi P, Piciocchi A, Rambaldi A, Foà R. Pegaspargase-modified risk-oriented program for adult acute lymphoblastic leukemia: results of the GIMEMA LAL1913 trial. Blood Adv 2023; 7:4448-4461. [PMID: 37276451 PMCID: PMC10440455 DOI: 10.1182/bloodadvances.2022009596] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/17/2023] [Accepted: 05/21/2023] [Indexed: 06/07/2023] Open
Abstract
Pediatric-inspired chemotherapy is the standard of care for younger adults with Philadelphia chromosome-negative acute lymphoblastic leukemia/lymphoma (Ph- ALL/LL). In LAL1913 trial, the Gruppo Italiano Malattie EMatologiche dell'Adulto added pegaspargase 2000 IU/m2 to courses 1, 2, 5, and 6 of an 8-block protocol for patients aged from 18 to 65 years, with dose reductions in patients aged >55 years. Responders were risk stratified for allogeneic hematopoietic cell transplantation (HCT) or maintenance per clinical characteristics and minimal residual disease (MRD). Of 203 study patients (median age, 39.8 years), 91% achieved a complete remission. The 3-year overall survival, event-free, and disease-free survival (DFS) rates were 66.7%, 57.7%, and 63.3%, respectively, fulfilling the primary study end point of a 2-year DFS >55%. Although based on the intention-to-treat, the DFS being 74% and 50% in the chemotherapy (n = 94) and HCT (n = 91) assignment cohorts, respectively, a time-dependent analysis proved the value of HCT in patients who were eligible (DFS HCT 70% vs no HCT 26%; P <.0001). In multivariate analysis, age and MRD were independent factors predicting DFS rates of 86% (age ≤ 40 and MRD-negative), 64%-65% (MRD-positive or age > 40) and 25% (age > 40 and MRD-positive); P < .0001. Grade ≥2 pegaspargase toxicity was mainly observed at course 1, contributing to induction death in 2 patients but was rare thereafter. This program improved outcomes of patients with Ph- ALL/LL aged up to 65 years in a multicenter national setting. This trial was registered at www.clinicaltrials.gov as #NCT02067143.
Collapse
Affiliation(s)
- Renato Bassan
- Complex Operational Unit of Hematology, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Sabina Chiaretti
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Irene Della Starza
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
- Centro Dati Fondazione GIMEMA Franco Mandelli, Rome, Italy
| | - Orietta Spinelli
- Complex Structure of Hematology, AO Papa Giovanni XXIII, Bergamo; and Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Alessandra Santoro
- Division of Hematology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | - Monica Messina
- Centro Dati Fondazione GIMEMA Franco Mandelli, Rome, Italy
| | - Loredana Elia
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Maria Stefania De Propris
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Anna Maria Scattolin
- Complex Operational Unit of Hematology, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Ernesta Audisio
- Complex Structure of Hematology, AO Città della Salute e della Scienza, Torino, Italy
| | - Laura Marbello
- Complex Structure of Hematology, Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - Erika Borlenghi
- Operational Unit of Hematology, AO Spedali Civili, Brescia, Italy
| | - Patrizia Zappasodi
- Complex Structure of Hematology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Elisa Mauro
- Complex Operational Unit of Hematology, AOU Policlinico S. Marco, University of Catania, Catania, Italy
| | - Giovanni Martinelli
- Institute of Hematology "Seragnoli", Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Daniele Mattei
- Complex Structure of Hematology, ASO S. Croce e Carle, Cuneo, Italy
| | - Nicola Fracchiolla
- Complex Operational Unit of Onco-Hematology, Fondazione IRCCS Cà Granda Ospedale Maggiore, Milan, Italy
| | - Monica Bocchia
- Complex Operational Unit of Hematology, AO Senese Policlinico Le Scotte, Siena, Italy
| | - Paolo De Fabritiis
- Complex Operational Unit of Hematology, Ospedale S. Eugenio ASL Roma 2, University of Tor Vergata, Rome, Italy
| | - Massimiliano Bonifacio
- Department of Medicine, Complex Operational Unit of Hematology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Anna Candoni
- Department of Hematology, Azienda Ospedaliero-Universitaria, Udine, Italy
| | | | | | - Giancarlo Latte
- Section of Clinical Hematology, Ospedale S. Francesco, Nuoro, Italy
| | | | - Anna Guarini
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Antonella Vitale
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Paola Fazi
- Centro Dati Fondazione GIMEMA Franco Mandelli, Rome, Italy
| | | | - Alessandro Rambaldi
- Complex Structure of Hematology, AO Papa Giovanni XXIII, Bergamo; and Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Robin Foà
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
2
|
Dargenio M, Bonifacio M, Chiaretti S, Vitale A, Fracchiolla NS, Papayannidis C, Giglio F, Salutari P, Audisio E, Scappini B, Zappasodi P, Defina M, Forghieri F, Scattolin AM, Todisco E, Lunghi M, Guolo F, Del Principe MI, Annunziata M, Lazzarotto D, Cedrone M, Pasciolla C, Imovilli A, Tanasi I, Trappolini S, Cerrano M, La Starza R, Krampera M, Di Renzo N, Candoni A, Pizzolo G, Ferrara F, Foà R. Incidence, treatment and outcome of central nervous system relapse in adult acute lymphoblastic leukaemia patients treated front-line with paediatric-inspired regimens: A retrospective multicentre Campus ALL study. Br J Haematol 2023; 200:440-450. [PMID: 36335916 PMCID: PMC10098932 DOI: 10.1111/bjh.18537] [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: 08/08/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022]
Abstract
Within the Campus ALL network we analyzed the incidence, characteristics, treatment and outcome of a central nervous system (CNS) relapse in 1035 consecutive adult acute lymphoblastic leukemia (ALL) patients treated frontline with pediatric-inspired protocols between 2009 and 2020. Seventy-one patients (6.8%) experienced a CNS recurrence, more frequently in T- (28/278; 10%) than in B-ALL (43/757; 5.7%) (p = 0.017). An early CNS relapse-< 12 months from diagnosis-was observed in 41 patients. In multivariate analysis, risk factors for early CNS relapse included T-cell phenotype (p = <0.001), hyperleucocytosis >100 × 109 /L (p<0.001) and male gender (p = 0.015). Treatment was heterogeneous, including chemotherapy, radiotherapy, intrathecal therapy and novel agents. A complete remission (CR) was obtained in 39 patients (55%) with no differences among strategies. After CR, 26 patients underwent an allogenic transplant, with a significant overall survival benefit compared to non-transplanted patients (p = 0.012). After a median observation of 8 months from CNS relapse, 23 patients (32%) were alive. In multivariate analysis, the time to CNS relapse was the strongest predictor of a lower 2-year post-relapse survival (p<0.001). In conclusion, in adult ALL the outcome after a CNS relapse remains very poor. Effective CNS prophylaxis remains the best approach and allogenic transplant should be pursued when possible.
Collapse
Affiliation(s)
- Michelina Dargenio
- Ospedale Vito Fazzi, Unità Operativa di Ematologia e Trapianto, Lecce, Italy
| | - Massimiliano Bonifacio
- Dipartimento di Medicina, Sezione di Ematologia, Università e Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sabina Chiaretti
- Divisione di Ematologia, Dipartimento di Medicina Traslazionale e di Precisione, Università Sapienza, Rome, Italy
| | - Antonella Vitale
- Divisione di Ematologia, Dipartimento di Medicina Traslazionale e di Precisione, Università Sapienza, Rome, Italy
| | | | - Cristina Papayannidis
- IRCCS Azienda Ospedaliero-Universitaria, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Fabio Giglio
- Ospedale San Raffaele, Unità Operativa di Ematologia, Milan, Italy
| | - Prassede Salutari
- Unità Operativa Complessa di Ematologia, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Ernesta Audisio
- Dipartimento di Ematologia e Oncologia, AO Città della Salute e della Scienza, Torino, Italy
| | | | - Patrizia Zappasodi
- Unità Operativa di Ematologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marzia Defina
- Unità Operativa Complessa di Ematologia, AOUS, Università di Siena, Siena, Italy
| | - Fabio Forghieri
- Unità Operativa Complessa di Ematologia, AOU Policlinico, Modena, Italy
| | | | - Elisabetta Todisco
- Unità Operativa Ematologia, Istituto Europeo di Oncologia (IEO), Milan, Italy
| | - Monia Lunghi
- Divisione di Ematologia, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Fabio Guolo
- Clinica Ematologica, Dipartimento di Medicina Interna, Università degli Studi di Genova, Genoa, Italy.,Dipartimento di Oncologia e Ematologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Mario Annunziata
- Unità Operativa Complessa di Ematologia, AORN Cardarelli, Naples, Italy
| | - Davide Lazzarotto
- Clinica ematologica e centro trapianti, Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
| | - Michele Cedrone
- Unità Operativa Complessa di Ematologia, Ospedale San Giovanni Addolorata, Rome, Italy
| | - Crescenza Pasciolla
- Unità Operativa di Ematologia, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | | | - Ilaria Tanasi
- Dipartimento di Medicina, Sezione di Ematologia, Università e Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Marco Cerrano
- Unità Operativa di Ematologia, Presidio Molinette-AOU Città della Salute e della Scienza, Torino, Italy
| | - Roberta La Starza
- Sezione di Ematologia e Trapianto, Università degli Studi di Perugia, A.O. Perugia, Italy
| | - Mauro Krampera
- Dipartimento di Medicina, Sezione di Ematologia, Università e Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nicola Di Renzo
- Ospedale Vito Fazzi, Unità Operativa di Ematologia e Trapianto, Lecce, Italy
| | - Anna Candoni
- Unità Operativa Complessa di Ematologia, AORN Cardarelli, Naples, Italy
| | - Giovanni Pizzolo
- Dipartimento di Medicina, Sezione di Ematologia, Università e Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Felicetto Ferrara
- Dipartimento di Biomedicina e Prevenzione, Università degli studi Tor Vergata, Rome, Italy
| | - Robin Foà
- Divisione di Ematologia, Dipartimento di Medicina Traslazionale e di Precisione, Università Sapienza, Rome, Italy
| |
Collapse
|
3
|
Zappasodi P, Cattaneo C, Valeria Ferretti V, Mina R, José María Ferreri A, Merli F, Oberti M, Krampera M, Romano A, Zerbi C, Ferrari J, Cavo M, Salvini M, Bertù L, Stefano Fracchiolla N, Marchesi F, Massaia M, Marasco V, Cairoli R, Maria Scattolin A, Maria Vannucchi A, Gambacorti‐Passerini C, Musto P, Gherlinzoni F, Cuneo A, Pinto A, Trentin L, Bocchia M, Galimberti S, Coviello E, Chiara Tisi M, Morotti A, Falini B, Turrini M, Tafuri A, Billio A, Gentile M, Massimo Lemoli R, Venditti A, Giovanni Della Porta M, Lanza F, Rigacci L, Tosi P, Mohamed S, Corso A, Luppi M, Giuliani N, Busca A, Pagano L, Bruno R, Antonio Grossi P, Corradini P, Passamonti F, Arcaini L. Secondary infections worsen the outcome of COVID-19 in patients with hematological malignancies: A report from the ITA-HEMA-COV. Hematol Oncol 2022; 40:846-856. [PMID: 35854643 PMCID: PMC9349965 DOI: 10.1002/hon.3048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/13/2022]
Abstract
The impact of secondary infections (SI) on COVID-19 outcome in patients with hematological malignancies (HM) is scarcely documented. To evaluate incidence, clinical characteristics, and outcome of SI, we analyzed the microbiologically documented SI in a large multicenter cohort of adult HM patients with COVID-19. Among 1741 HM patients with COVID-19, 134 (7.7%) had 185 SI, with a 1-month cumulative incidence of 5%. Median time between COVID-19 diagnosis and SI was 16 days (IQR: 5-36). Acute myeloid leukemia (AML) and lymphoma/plasma cell neoplasms (PCN) were more frequent diagnoses in SI patients compared to patients without SI (AML: 14.9% vs. 7.1%; lymphoma/PCN 71.7% vs. 65.3%). Patients with SI were older (median age 70 vs. 66 years, p = 0.002), with more comorbidities (median Charlson Comorbidity Index 5 vs. 4, p < 0.001), higher frequency of critical COVID-19 (19.5% vs. 11.5%, p = 0.046), and more frequently not in complete remission (75% vs. 64.7% p = 0.024). Blood and bronchoalveolar lavage were the main sites of isolation for SI. Etiology of infections was bacterial in 80% (n = 148) of cases, mycotic in 9.7% (n = 18) and viral in 10.3% (n = 19); polymicrobial infections were observed in 24 patients (18%). Escherichia coli represented most of Gram-negative isolates (18.9%), while coagulase-negative Staphylococci were the most frequent among Gram-positive (14.2%). The 30-day mortality of patients with SI was higher when compared to patients without SI (69% vs. 15%, p < 0.001). The occurrence of SI worsened COVID-19 outcome in HM patients. Timely diagnosis and adequate management should be considered to improve their prognosis.
Collapse
Affiliation(s)
- Patrizia Zappasodi
- Division of Hematology, Fondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Chiara Cattaneo
- Division of HematologyAzienda Socio‐Sanitaria Territoriale‐Spedali CiviliBresciaItaly
| | | | - Roberto Mina
- SSD Clinical Trial in Oncoematologia e Mieloma MultiploDivision of HematologyUniversity of TorinoAzienda Ospedaliero‐Universitaria Città della Salute e della Scienza di TorinoTorinoItaly
| | - Andrés José María Ferreri
- Division of HematologyIstituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific InstituteMilanItaly
| | - Francesco Merli
- Division of Hematology, AUSL‐IRCCS Reggio EmiliaReggio EmiliaItaly
| | - Margherita Oberti
- Division of Hematology and Transplant UnitASST Spedali CiviliBresciaItaly
| | - Mauro Krampera
- Division of HematologyAzienda Ospedaliera Integrata di VeronaVeronaItaly
| | - Alessandra Romano
- Division of Hematology and Bone Marrow TransplantationAzienda Ospedaliera Universitaria Policlinico “G. Rodolico—San Marco”CataniaItaly
| | - Caterina Zerbi
- Department of Molecular MedicineUniversity of PaviaPaviaItaly
| | | | - Michele Cavo
- Division of HematologyAzienda Ospedaliero‐Universitaria Policlinico S. Orsola‐MalpighiBolognaItaly
| | - Marco Salvini
- UOC Ematologia, Azienda Socio‐Sanitaria Territoriale Sette Laghi, Ospedale di Circolo of VareseVareseItaly,Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - Lorenza Bertù
- UOC Ematologia, Azienda Socio‐Sanitaria Territoriale Sette Laghi, Ospedale di Circolo of VareseVareseItaly,Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | | | | | | | - Vincenzo Marasco
- Division of HematologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei TumoriUniversity of MilanMilanItaly
| | - Roberto Cairoli
- HematologyAzienda Socio‐Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Anna Maria Scattolin
- Division of HematologyAzienda Unità Locale Socio‐Sanitaria 3 SerenissimaOspedale dell'AngeloVenezia‐MestreVeniceItaly
| | | | | | - Pellegrino Musto
- Department of Emergency and Organ Transplantation“Aldo Moro” University School of Medicine and Unit of Hematology and Stem Cell Transplantation, AOUC PoliclinicoBariItaly
| | | | - Antonio Cuneo
- Division of HematologyAzienda Ospedaliero Universitaria Arcispedale S. AnnaFerraraItaly
| | - Antonello Pinto
- Hematology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico “Fondazione G Pascale,” NaplesNaplesItaly
| | - Livio Trentin
- Division of HematologyAzienda Ospedaliera di PadovaPadovaItaly
| | - Monica Bocchia
- Division of HematologyPoliclinico Santa Maria alle ScotteSienaItaly
| | - Sara Galimberti
- Division of HematologyAzienda Ospedaliera Universitaria Pisana‐ Santa ChiaraPisaItaly
| | - Elisa Coviello
- Ematologia e terapie cellulari. IRCCS Ospedale Policlinico San MartinoGenovaItaly
| | | | - Alessandro Morotti
- Department of Clinical and Biological SciencesUniversity of TorinoOrbassanoItaly
| | - Brunangelo Falini
- Division of Hematology and Transplant UnitAzienda Ospedaliera di PerugiaPerugiaItaly
| | | | - Agostino Tafuri
- Division of HematologyUniversity Hospital Sant'AndreaSapienzaRomeItaly
| | - Atto Billio
- Division of Hematology and Transplant UnitOspedale di BolzanoBolzanoItaly
| | - Massimo Gentile
- Division of HematologyAzienda Ospedaliera di CosenzaCosenzaItaly
| | - Roberto Massimo Lemoli
- Department of Internal Medicine (DiMI)Clinic of Hematology, University of GenoaGenoaItaly,IRCCS‐ San Martino HospitalGenoaItaly
| | - Adriano Venditti
- Department of Biomedicine and PreventionUniversity Tor Vergata RomeRomeItaly
| | - Matteo Giovanni Della Porta
- Division of Hematology, Humanitas Clinical and Research Hospital Istituto di Ricovero e Cura a Carattere Scientifico and Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Francesco Lanza
- Division of HematologyOspedale Santa Maria delle CrociRavennaItaly
| | - Luigi Rigacci
- Division of Hematology and Transplant Unit, Azienda Ospedaliera S. Camillo‐ForlaniniRomeItaly
| | - Patrizia Tosi
- Division of HematologyOspedale degli InfermiRiminiItaly
| | - Sara Mohamed
- SC EmatologiaAzienda Sanitaria Universitaria Giuliano IsontinaTriesteItaly
| | | | - Mario Luppi
- Department of Medical and Surgical SciencesUNIMORE. Division of Hematology Azienda Ospedaliero Universitaria ModenaModenaItaly
| | - Nicola Giuliani
- Division of Hematology and Transplant UnitAzienda Ospedaliero‐Universitaria di ParmaSItaly
| | - Alessandro Busca
- SSD Clinical Trial in Oncoematologia e Mieloma MultiploDivision of HematologyUniversity of TorinoAzienda Ospedaliero‐Universitaria Città della Salute e della Scienza di TorinoTorinoItaly
| | - Livio Pagano
- Division of HematologyFondazione Policlinico Universitario Agostino Gemelli ‐ Istituto di Ricovero e Cura a Carattere ScientificoRomeItaly,Hematology, Università Cattolica del Sacro CuoreRomeItaly
| | - Raffaele Bruno
- Division of Infectious and Tropical DiseasesFondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San MatteoPaviaItaly,Department of ClinicalSurgical, Diagnostic, and Paediatric SciencesUniversity of PaviaPaviaItaly
| | - Paolo Antonio Grossi
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly,Division of Infectious and Tropical DiseasesAzienda Socio‐Sanitaria Territoriale Sette Laghi, Ospedale di Circolo of VareseVareseItaly
| | - Paolo Corradini
- Division of HematologyFondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei TumoriUniversity of MilanMilanItaly
| | - Francesco Passamonti
- UOC Ematologia, Azienda Socio‐Sanitaria Territoriale Sette Laghi, Ospedale di Circolo of VareseVareseItaly,Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San MatteoPaviaItaly,Department of Molecular MedicineUniversity of PaviaPaviaItaly
| | | |
Collapse
|
4
|
Chiaretti S, Bonifacio M, Agrippino R, Giglio F, Annunziata M, Curti A, Principe MID, Salutari P, Sciumè M, Delia M, Armenio M, Mancini V, Mulè A, Grimaldi F, Rege-Cambrin G, Santoro L, Lussana F, Chiusolo P, Pasciolla C, Scattolin AM, Cerrano M, Ciccone M, Defina M, Forghieri F, Mazzone C, Piccini M, Ferrara F, Pizzolo G, Foà R. COVID-19 Infection in acute lymphoblastic leukemia over 15 months of the pandemic. A CAMPUS ALL report. Haematologica 2022; 107:1955-1959. [PMID: 35443561 PMCID: PMC9335088 DOI: 10.3324/haematol.2021.280289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/18/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sabina Chiaretti
- Department of Translational and Precision Medicine, Sapienza University.
| | | | - Roberta Agrippino
- Department of Translational and Precision Medicine, Sapienza University
| | - Fabio Giglio
- Haematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute
| | | | - Antonio Curti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia Seràgnoli
| | | | | | - Mariarita Sciumè
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | - Mario Delia
- Hematology and Stem Cell Transplantation Unit, AOUC Policlinico
| | - Marco Armenio
- Department of Clinical and Biological Sciences, Università di Torino
| | | | | | | | | | | | - Federico Lussana
- Hematology and Bone Marrow Transplantation Unit, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore
| | | | | | - Marco Cerrano
- Division of Hematology, Department of Oncology, A.O.U. Città della Salute e della Scienza di Torino
| | - Maria Ciccone
- UO Ematologia, Dipartimento di Medicine Specialistiche, Azienda Ospedaliero-Universitaria Arcispedale S Anna
| | - Marzia Defina
- UOC Ematologia, Azienda Ospedaliero Universitaria Senese
| | - Fabio Forghieri
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia
| | - Carla Mazzone
- Haematology, Department of Medical Area, St. Eugenio Hospital
| | - Matteo Piccini
- Azienda Ospedaliera Universitaria Careggi, SOD Ematologia, Florence
| | | | - Giovanni Pizzolo
- Department of Medicine, Section of Hematology, University of Verona
| | - Robin Foà
- Department of Translational and Precision Medicine, Sapienza University
| |
Collapse
|
5
|
Cerrano M, Bonifacio M, Olivi M, Curti A, Malagola M, Dargenio M, Scattolin AM, Papayannidis C, Forghieri F, Gurrieri C, Tanasi I, Zappasodi P, La Starza R, Fracchiolla NS, Chiusolo P, Giaccone L, Del Principe MI, Giglio F, Defina M, Favre C, Rizzari C, Castella B, Pizzolo G, Ferrara F, Chiaretti S, Foà R. Daratumumab with or without chemotherapy in relapsed and refractory acute lymphoblastic leukemia. A retrospective observational Campus Acute Lymphoblastic Leukemia study. Haematologica 2022; 107:996-999. [PMID: 35021604 PMCID: PMC8968887 DOI: 10.3324/haematol.2021.279851] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 09/06/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marco Cerrano
- Divisione di Ematologia, Dipartimento di Oncologia, AOU Città della Salute e della Scienza, Torino, Italy.
| | - Massimiliano Bonifacio
- UOC di Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; Dipartimento di Medicina, Sezione di Ematologia, Università di Verona, Italy
| | - Matteo Olivi
- Divisione di Ematologia, Dipartimento di Oncologia, AOU Città della Salute e della Scienza, Torino, Italy; Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, Torino, Italy
| | - Antonio Curti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Michele Malagola
- Università di Brescia, Unità Operativa di Ematologia e Centro Trapianti, ASST Spedali Civili di Brescia, Italy
| | - Michelina Dargenio
- Unità Operativa di Ematologia e Trapianto, Ospedale Vito Fazzi, Lecce, Italy
| | | | - Cristina Papayannidis
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Fabio Forghieri
- Unità Operativa Complessa di Ematologia, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Carmela Gurrieri
- UO Ematologia ed Immunologia Clinica, Azienda Ospedale-Università Padova, Italy
| | - Ilaria Tanasi
- UOC di Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; Dipartimento di Medicina, Sezione di Ematologia, Università di Verona, Italy
| | - Patrizia Zappasodi
- Unità Operativa di Ematologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta La Starza
- Unità Operativa di Ematologia e Trapianto, AOU-Ospedale S. Maria della Misericordia, Perugia, Italy
| | | | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luisa Giaccone
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, Università di Torino, Torino, Italy; Unità di Trapianto Allogenico di Cellule Staminali, Dipartimento di Oncologia, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | | | - Fabio Giglio
- Unità Operativa di Ematologia e Trapianto di Midollo Osseo, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Marzia Defina
- Unità Operativa Complessa di Ematologia, AOUS, Università di Siena, Siena, Italy
| | - Claudio Favre
- Unità Operativa di Oncologia ed Ematologia Pediatrica, Ospedale Pediatrico Meyer, Firenze, Italy
| | - Carmelo Rizzari
- Unità Operativa di Ematologia Pediatrica, Università di Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | | | - Giovanni Pizzolo
- UOC di Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy; Dipartimento di Medicina, Sezione di Ematologia, Università di Verona, Italy
| | | | - Sabina Chiaretti
- Ematologia, Dipartimento di Medicina Traslazionale e di Precisione, Università Sapienza, Roma, Italy
| | - Robin Foà
- Ematologia, Dipartimento di Medicina Traslazionale e di Precisione, Università Sapienza, Roma, Italy.
| |
Collapse
|
6
|
Caprioli C, Lussana F, Salmoiraghi S, Cavagna R, Buklijas K, Elidi L, Zanghi' P, Michelato A, Delaini F, Oldani E, Intermesoli T, Grassi A, Gianfaldoni G, Mannelli F, Ferrero D, Audisio E, Terruzzi E, De Paoli L, Cattaneo C, Borlenghi E, Cavattoni I, Tajana M, Scattolin AM, Mattei D, Corradini P, Campiotti L, Ciceri F, Bernardi M, Todisco E, Cortelezzi A, Falini B, Pavoni C, Bassan R, Spinelli O, Rambaldi A. Clinical significance of chromatin-spliceosome acute myeloid leukemia: a report from the Northern Italy Leukemia Group (NILG) randomized trial 02/06. Haematologica 2021; 106:2578-2587. [PMID: 32855275 PMCID: PMC8485674 DOI: 10.3324/haematol.2020.252825] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Indexed: 12/05/2022] Open
Abstract
Secondary acute myeloid leukemia (sAML) after myelodysplastic or myeloproliferative disorders is a high-risk category currently identified by the clinical history or specific morphological and cytogenetic abnormalities. However, in the absence of these features, uncertainties to identify the secondary nature of some cases, otherwise defined as de novo AML, remain. In order to test whether a chromatinspliceosome (CS) mutational signature might better define the de novo AML group, we analyzed a prospective cohort of 413 newly diagnosed AML patients who were enrolled in a randomized clinical trial (NILG AML 02/06) and who provided samples for accurate cytogenetic and molecular characterization. Among clinically defined de novo AML, 17.6% carried CS mutations (CS-AML) and showed clinical characteristics closer to sAML (older age, lower white blood cell counts and higher rate of multilineage dysplasia). Outcomes in this group were adverse, more similar to those of sAML as compared to de novo AML (overall survival, 30% in CS-AML and 17% in sAML vs. 61% in de novo AML, P<0.0001; disease-free survival, 26% in CS-AML and 22% in sAML vs. 54% of de novo AML, P<0.001) and independently confirmed by multivariable analysis. Allogeneic transplant in first complete remission improved survival in both sAML and CS-AML patients. In conclusion, these findings highlight the clinical significance of identifying CS-AML for improved prognostic prediction and potential therapeutic implications. (NILG AML 02/06; clinicaltrials gov. Identifier: NCT00495287).
Collapse
Affiliation(s)
| | | | - Silvia Salmoiraghi
- ASST Ospedale Papa Giovanni XXIII and FROM Research Foundation, Bergamo, Italy
| | | | | | - Lara Elidi
- ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | | | - Elena Oldani
- ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Anna Grassi
- ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Dario Ferrero
- AOU Città della Salute e della Scienza, Torino, Italy
| | | | | | - Lorella De Paoli
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Renato Bassan
- Ospedale dell'Angelo e SS. Giovanni e Paolo, Venezia Mestre, Italy
| | | | | |
Collapse
|
7
|
Guolo F, Fianchi L, Minetto P, Clavio M, Gottardi M, Galimberti S, Rizzuto G, Rondoni M, Bertani G, Dargenio M, Bilio A, Scappini B, Zappasodi P, Scattolin AM, Grimaldi F, Pietrantuono G, Musto P, Cerrano M, D'Ardia S, Audisio E, Cignetti A, Pasciolla C, Pavesi F, Candoni A, Gurreri C, Morselli M, Alati C, Fracchiolla N, Rossi G, Caizzi M, Carnevale-Schianca F, Tafuri A, Rossi G, Ferrara F, Pagano L, Lemoli RM. CPX-351 treatment in secondary acute myeloblastic leukemia is effective and improves the feasibility of allogeneic stem cell transplantation: results of the Italian compassionate use program. Blood Cancer J 2020; 10:96. [PMID: 33024084 PMCID: PMC7538937 DOI: 10.1038/s41408-020-00361-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023] Open
Abstract
Secondary acute myeloid leukemia (sAML) poorly responds to conventional treatments and allogeneic stem cell transplantation (HSCT). We evaluated toxicity and efficacy of CPX-351 in 71 elderly patients (median age 66 years) with sAML enrolled in the Italian Named (Compassionate) Use Program. Sixty days treatment-related mortality was 7% (5/71). The response rate at the end of treatment was: CR/CRi in 50/71 patients (70.4%), PR in 6/71 (8.5%), and NR in 10/71 (19.7%). After a median follow-up of 11 months relapse was observed in 10/50 patients (20%) and 12 months cumulative incidence of relapse (CIR) was 23.6%. Median duration of response was not reached. In competing risk analysis, CIR was reduced when HSCT was performed in first CR (12 months CIR of 5% and 37.4%, respectively, for patients receiving (=20) or not (=30) HSCT, p = 0.012). Twelve-months OS was 68.6% (median not reached). In landmark analysis, HSCT in CR1 was the only significant predictor of longer survival (12 months OS of 100 and 70.5%, for patients undergoing or not HSCT in CR1, respectively, p = 0.011). In conclusion, we extend to a real-life setting, the notion that CPX is an effective regimen for high risk AML patients and may improve the results of HSCT.
Collapse
Affiliation(s)
- Fabio Guolo
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy. .,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy.
| | - Luana Fianchi
- Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Paola Minetto
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Marino Clavio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | | | - Sara Galimberti
- UO Ematologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | - Giuliana Rizzuto
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Rondoni
- U.O.C. di Ematologia, Azienda Unità Sanitaria Locale della Romagna, Ravenna, Italy
| | - Giambattista Bertani
- S.C. Ematologia, ASST Grande Ospedale Metropolitano, Niguarda Ca' Granda Milano, Milan, Italy
| | | | | | - Barbara Scappini
- Dipartimento di Oncologia-SODc Ematologia, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy
| | - Patrizia Zappasodi
- Clinica Ematologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Francesco Grimaldi
- Dipartimento di Medicina Clinica e Chirurgia, AOU Federico II di Napoli, Naples, Italy
| | | | - Pellegrino Musto
- IRCCS Centro Oncologico della Basilicata, Rionero in Vulture, Potenza, Italy.,Unit of Hematology and Stem Cell Transplantation, AOU Policlinico Consorziale, "Aldo Moro" University, Bari, Italy
| | - Marco Cerrano
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Stefano D'Ardia
- Institute for Cancer Research and Treatment, University of Turin-School of Medicine, Turin, Italy
| | - Ernesta Audisio
- S.C. Ematologia2, Dipartimento di Ematologia e Oncologia, AO Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandro Cignetti
- Divisione Universitaria di Ematologia e Terapie Cellulari, A.O. Ordine Mauriziano, Turin, Italy
| | | | - Francesca Pavesi
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Anna Candoni
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Carmela Gurreri
- U.O. Ematologia ed Immunologia Clinica, Azienda Ospedaliera di Padova, Padova, Italy
| | - Monica Morselli
- Department of Medical and Surgical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | | | - Nicola Fracchiolla
- Oncoematologia, IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Giovanni Rossi
- U.O. Ematologia, Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Manuela Caizzi
- S.C. Ematologia Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale Maggiore, Trieste, Italy
| | - Fabrizio Carnevale-Schianca
- Medical Oncology, Hematopoietic Stem Cells Unit, Turin Metropolitan Transplant Center, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Agostino Tafuri
- Department of Clinical and Molecular Medicine & Hematology, Sant'Andrea - University Hospital - Sapienza - University of Rome, Rome, Italy
| | - Giuseppe Rossi
- SC Ematologia e Dipartimento di Oncologia Clinica, A.O. Spedali Civili, Brescia, Italy
| | | | - Livio Pagano
- Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Roberto Massimo Lemoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| |
Collapse
|
8
|
Passamonti F, Cattaneo C, Arcaini L, Bruna R, Cavo M, Merli F, Angelucci E, Krampera M, Cairoli R, Della Porta MG, Fracchiolla N, Ladetto M, Gambacorti Passerini C, Salvini M, Marchetti M, Lemoli R, Molteni A, Busca A, Cuneo A, Romano A, Giuliani N, Galimberti S, Corso A, Morotti A, Falini B, Billio A, Gherlinzoni F, Visani G, Tisi MC, Tafuri A, Tosi P, Lanza F, Massaia M, Turrini M, Ferrara F, Gurrieri C, Vallisa D, Martelli M, Derenzini E, Guarini A, Conconi A, Cuccaro A, Cudillo L, Russo D, Ciambelli F, Scattolin AM, Luppi M, Selleri C, Ortu La Barbera E, Ferrandina C, Di Renzo N, Olivieri A, Bocchia M, Gentile M, Marchesi F, Musto P, Federici AB, Candoni A, Venditti A, Fava C, Pinto A, Galieni P, Rigacci L, Armiento D, Pane F, Oberti M, Zappasodi P, Visco C, Franchi M, Grossi PA, Bertù L, Corrao G, Pagano L, Corradini P. Clinical characteristics and risk factors associated with COVID-19 severity in patients with haematological malignancies in Italy: a retrospective, multicentre, cohort study. Lancet Haematol 2020; 7:e737-e745. [PMID: 32798473 PMCID: PMC7426107 DOI: 10.1016/s2352-3026(20)30251-9] [Citation(s) in RCA: 372] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several small studies on patients with COVID-19 and haematological malignancies are available showing a high mortality in this population. The Italian Hematology Alliance on COVID-19 aimed to collect data from adult patients with haematological malignancies who required hospitalisation for COVID-19. METHODS This multicentre, retrospective, cohort study included adult patients (aged ≥18 years) with diagnosis of a WHO-defined haematological malignancy admitted to 66 Italian hospitals between Feb 25 and May 18, 2020, with laboratory-confirmed and symptomatic COVID-19. Data cutoff for this analysis was June 22, 2020. The primary outcome was mortality and evaluation of potential predictive parameters of mortality. We calculated standardised mortality ratios between observed death in the study cohort and expected death by applying stratum-specific mortality rates of the Italian population with COVID-19 and an Italian cohort of 31 993 patients with haematological malignancies without COVID-19 (data up to March 1, 2019). Multivariable Cox proportional hazards model was used to identify factors associated with overall survival. This study is registered with ClinicalTrials.gov, NCT04352556, and the prospective part of the study is ongoing. FINDINGS We enrolled 536 patients with a median follow-up of 20 days (IQR 10-34) at data cutoff, 85 (16%) of whom were managed as outpatients. 440 (98%) of 451 hospitalised patients completed their hospital course (were either discharged alive or died). 198 (37%) of 536 patients died. When compared with the general Italian population with COVID-19, the standardised mortality ratio was 2·04 (95% CI 1·77-2·34) in our whole study cohort and 3·72 (2·86-4·64) in individuals younger than 70 years. When compared with the non-COVID-19 cohort with haematological malignancies, the standardised mortality ratio was 41·3 (38·1-44·9). Older age (hazard ratio 1·03, 95% CI 1·01-1·05); progressive disease status (2·10, 1·41-3·12); diagnosis of acute myeloid leukaemia (3·49, 1·56-7·81), indolent non-Hodgin lymphoma (2·19, 1·07-4·48), aggressive non-Hodgkin lymphoma (2·56, 1·34-4·89), or plasma cell neoplasms (2·48, 1·31-4·69), and severe or critical COVID-19 (4·08, 2·73-6·09) were associated with worse overall survival. INTERPRETATION This study adds to the evidence that patients with haematological malignancies have worse outcomes than both the general population with COVID-19 and patients with haematological malignancies without COVID-19. The high mortality among patients with haematological malignancies hospitalised with COVID-19 highlights the need for aggressive infection prevention strategies, at least until effective vaccination or treatment strategies are available. FUNDING Associazione italiana contro le leucemie, linfomi e mieloma-Varese Onlus.
Collapse
Affiliation(s)
- Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy.
| | | | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Bruna
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and Ospedale Maggiore della Carità, Novara, Italy
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, Bologna, Italy
| | - Francesco Merli
- Hematology, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Mauro Krampera
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Roberto Cairoli
- Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Giovanni Della Porta
- Humanitas Clinical and Research Hospital-IRCCS and Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Marco Ladetto
- Hematology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Marco Salvini
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Monia Marchetti
- Hematology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Roberto Lemoli
- Dipartimento di Medicina interna e Specialità mediche, University of Genoa, Genoa, Italy
| | | | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Antonio Cuneo
- Hematology, Azienda Ospedaliero Universitaria Sant'Anna, Ferrara, Italy
| | - Alessandra Romano
- Hematology, Dipartimento di Chirurgia e Specialità Medico Chirurgiche, Università degli Studi di Catania, Catania, Italy
| | - Nicola Giuliani
- Dipartimento di Medicina e Chirurgia, University of Parma, Parma, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Alessandro Morotti
- Department of Clinical and Biological Sciences, Università di Torino, Turin, Italy
| | | | | | | | - Giuseppe Visani
- Dipartimento di Onco- Ematologia, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Agostino Tafuri
- Hematology, University Hospital Sant'Andrea, Sapienza, Rome, Italy; Department of Clinical and Molecular Medicine, Sapienza, University of Rome, Rome, Italy
| | - Patrizia Tosi
- Hematology, Ospedale degli Infermi di Rimini, Rimini, Italy
| | | | | | | | | | - Carmela Gurrieri
- Dipartimento Strutturale Aziendale Medicina, University of Padova, Padova, Italy
| | | | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza, University of Rome, Rome, Italy
| | | | | | | | | | - Laura Cudillo
- Hematology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Domenico Russo
- Dipartimento di Scienze Cliniche e Sperimentali, University of Brescia, Brescia, Italy
| | | | | | - Mario Luppi
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, University of Modena and Reggio Emilia, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Carmine Selleri
- Hematology, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Elettra Ortu La Barbera
- UOC Ematologia con Trapianto, Ospedale Santa Maria Goretti, Latina, Italy; Hematology, Ospedale Santa Maria Goretti, Latina, Italy
| | - Celestino Ferrandina
- Hematology, Ospedali Riuniti Azienda Ospedaliera Universitaria di Foggia, Foggia, Italy
| | - Nicola Di Renzo
- Hematology and Transplant Unit, Ospedale Vito Fazzi, Lecce, Italy
| | | | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | | | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Pellegrino Musto
- Department of Emergency and Organ Transplantation, "Aldo Moro" University School of Medicine and Unit of Hematology and Stem Cell Transplantation, AOU Consorziale Policlinico, Bari, Italy
| | | | - Anna Candoni
- Dipartimento di Medicina Specialistica, University of Udine, Udine, Italy
| | | | - Carmen Fava
- Department of Clinical and Biological Sciences, Università di Torino, Turin, Italy
| | - Antonio Pinto
- Hematology, Istituto Nazionale Tumori IRCCS "Fondazione G Pascale", Naples, Italy
| | | | | | - Daniele Armiento
- Unit of Hematology, Stem Cell Transplantation, University Campus Bio-Medico, Rome, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Federico II Hospital, Naples, Italy
| | | | - Patrizia Zappasodi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Matteo Franchi
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Milan, Italy; National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Paolo Antonio Grossi
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Lorenza Bertù
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Giovanni Corrao
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Milan, Italy; National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Livio Pagano
- Dipartimento di Scienze Radiologiche ed Ematologiche, Fondazione Policlinico Universitario A Gemelli-IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Corradini
- Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano
| |
Collapse
|
9
|
Gianfaldoni G, Mannelli F, Intermesoli T, Bencini S, Giupponi D, Farina G, Cutini I, Bonetti MI, Masciulli A, Audisio E, Ferrero D, Pavoni C, Scattolin AM, Bosi A, Rambaldi A, Bassan R. Early peripheral clearance of leukemia-associated immunophenotypes in AML: centralized analysis of a randomized trial. Blood Adv 2020; 4:301-311. [PMID: 31978214 PMCID: PMC6988394 DOI: 10.1182/bloodadvances.2019000406] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/20/2019] [Indexed: 12/15/2022] Open
Abstract
Although genetics is a relevant risk factor in acute myeloid leukemia (AML), it can be minimally informative and/or not readily available for the early identification of patients at risk for treatment failure. In a randomized trial comparing standard vs high-dose induction (ClinicalTrials.gov #NCT00495287), we studied early peripheral blast cell clearance (PBC) as a rapid predictive assay of chemotherapy response to determine whether it correlates with the achievement of complete remission (CR), as well as postremission outcome, according to induction intensity. Individual leukemia-associated immunophenotypes (LAIPs) identified pretherapy by flow cytometry were validated and quantified centrally after 3 days of treatment, expressing PBC on a logarithmic scale as the ratio of absolute LAIP+ cells on day 1 and day 4. Of 178 patients, 151 (84.8%) were evaluable. Patients in CR exhibited significantly higher median PBC (2.3 log) compared with chemoresistant patients (1.0 log; P < .0001). PBC < 1.0 predicted the worst outcome (CR, 28%). With 1.5 log established as the most accurate cutoff predicting CR, 87.5% of patients with PBC >1.5 (PBChigh, n = 96) and 43.6% of patients with PBC ≤1.5 (PBClow, n = 55) achieved CR after single-course induction (P < .0001). CR and PBChigh rates were increased in patients randomized to the high-dose induction arm (P = .04) and correlated strongly with genetic/cytogenetic risk. In multivariate analysis, PBC retained significant predictive power for CR, relapse risk, and survival. Thus, PBC analysis can provide a very early prediction of outcome, correlates with treatment intensity and disease subset, and may support studies of customized AML therapy.
Collapse
Affiliation(s)
- Giacomo Gianfaldoni
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
| | - Francesco Mannelli
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
- Centro Ricerca e Innovazione Malattie Mieloproliferative, Azienda Ospedaliero-Universitaria (AOU) Careggi, Florence, Italy
| | - Tamara Intermesoli
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Bencini
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
- Centro Diagnostico di Citofluorimetria e Immunoterapia, AOU Careggi, Florence, Italy
| | - Damiano Giupponi
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Giorgio Farina
- Unità Operativa Laboratorio Analisi-Citofluorimetria, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Ilaria Cutini
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
- SOD Terapie Cellulari e Medicina Trasfusionale, AOU Careggi, Florence, Italy
| | - Maria Ida Bonetti
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
| | - Arianna Masciulli
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Ernesta Audisio
- Struttura Complessa di Ematologia, Ospedale Molinette, Turin, Italy
| | - Dario Ferrero
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy; and
| | - Chiara Pavoni
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alberto Bosi
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
| | - Alessandro Rambaldi
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Renato Bassan
- Unità Operativa di Ematologia, Ospedale dell'Angelo, Mestre-Venezia, Italy
| |
Collapse
|
10
|
Bassan R, Fumagalli M, Chiaretti S, Audisio E, Cascavilla N, Paolini S, Delia M, Cerqui E, Micò C, Fabbiano F, Canichella M, Scattolin AM, Perfetti P, Paoloni F, Iodice M, Vitale A, Della Starza I, Fazi P, Vignetti M, Foà R. Phase II trial with sequential clofarabine and cyclophosphamide for refractory and relapsed philadelphia-negative adult acute lymphoblastic leukemia. Results of the GIMEMA LAL 1610 protocol. Leuk Lymphoma 2019; 60:3482-3492. [PMID: 31298059 DOI: 10.1080/10428194.2019.1639170] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Clofarabine (CLO) and cyclophosphamide (CY) combinations were tested in late stage refractory/relapsed (R/R) acute lymphoblastic leukemia (ALL) with disappointing results and high-grade toxicity. We designed a sequential 5-day combination of CLO 40 mg/m2/d plus CY 400 mg/m2/d as first salvage for Philadelphia-negative ALL patients refractory or relapsed until 24 months from complete remission (CR). Primary endpoint was an overall response rate (ORR) ≥ 40%. Among 26 study patients (median age 40.5 years) ORR was 57.6% (CR with complete [n = 8] or incomplete [n = 7] hematologic recovery). Despite severe myelotoxicity, no dose-limiting toxicity suggested de-intensification of CLO schedule. With a median follow-up of 17.0 months, median and 1-year overall and disease-free survival were 6.5 months and 28.6%, and 3.7 months and 28.1%, respectively. This association was tolerable and more effective in patients younger than 40 years with B-precursor ALL, longer first CR, not previously transplanted and achieving CR with full hematological recovery.
Collapse
Affiliation(s)
- Renato Bassan
- U.O. di Ematologia - Ospedale dell'Angelo, Mestre Venezia, Italy
| | - Monica Fumagalli
- U.O. Centro Trapianto Midollo Adulti Azienda Ospedaliera "S.Gerardo", Monza, Italy
| | - Sabina Chiaretti
- Ematologia, Dipartimento di Medicina Traslazionale e di Precisione, Università "Sapienza" Roma, Italy
| | - Ernesta Audisio
- Dipartimento di Oncologia ed Ematologia S.C. Ematologia 2, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Nicola Cascavilla
- Dipartimento di Onco-Ematologia, IRCCS Ospedale "Casa Sollievo della Sofferenza", S. G. Rotondo, Italy
| | - Stefania Paolini
- U.O.C. Ematologia Università degli Studi di Bologna - Policlinico S. Orsola, Bologna, Italy
| | - Mario Delia
- U.O. Ematologia Con Trapianto Universitaria, A.O.- Universitaria cons. Policlinico, Bari, Italy
| | | | - Caterina Micò
- Dipartimento di Oncologia ed Ematologia, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Fabbiano
- Dipartimento di Ematologia e Oncologia, Ospedali Riuniti "Villa Sofia-Cervello", Palermo, Italy
| | - Martina Canichella
- Ematologia, Dipartimento di Medicina Traslazionale e di Precisione, Università "Sapienza" Roma, Italy
| | | | - Paola Perfetti
- U.O. Centro Trapianto Midollo Adulti Azienda Ospedaliera "S.Gerardo", Monza, Italy
| | | | | | - Antonella Vitale
- Ematologia, Dipartimento di Medicina Traslazionale e di Precisione, Università "Sapienza" Roma, Italy
| | - Irene Della Starza
- Ematologia, Dipartimento di Medicina Traslazionale e di Precisione, Università "Sapienza" Roma, Italy.,Fondazione GIMEMA "Franco Mandelli" ONLUS, Roma, Italy
| | - Paola Fazi
- Fondazione GIMEMA "Franco Mandelli" ONLUS, Roma, Italy
| | - Marco Vignetti
- Ematologia, Dipartimento di Medicina Traslazionale e di Precisione, Università "Sapienza" Roma, Italy.,Fondazione GIMEMA "Franco Mandelli" ONLUS, Roma, Italy
| | - Robin Foà
- Ematologia, Dipartimento di Medicina Traslazionale e di Precisione, Università "Sapienza" Roma, Italy
| |
Collapse
|
11
|
|
12
|
Bassan R, Masciulli A, Intermesoli T, Audisio E, Rossi G, Pogliani EM, Cassibba V, Mattei D, Romani C, Cortelezzi A, Corti C, Scattolin AM, Spinelli O, Tosi M, Parolini M, Marmont F, Borlenghi E, Fumagalli M, Cortelazzo S, Gallamini A, Marfisi RM, Oldani E, Rambaldi A. Randomized trial of radiation-free central nervous system prophylaxis comparing intrathecal triple therapy with liposomal cytarabine in acute lymphoblastic leukemia. Haematologica 2015; 100:786-93. [PMID: 25749825 DOI: 10.3324/haematol.2014.123273] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/26/2015] [Indexed: 01/31/2023] Open
Abstract
Developing optimal radiation-free central nervous system prophylaxis is a desirable goal in acute lymphoblastic leukemia, to avoid the long-term toxicity associated with cranial irradiation. In a randomized, phase II trial enrolling 145 adult patients, we compared intrathecal liposomal cytarabine (50 mg: 6/8 injections in B-/T-cell subsets, respectively) with intrathecal triple therapy (methotrexate/cytarabine/prednisone: 12 injections). Systemic therapy included methotrexate plus cytarabine or L-asparaginase courses, with methotrexate augmented to 2.5 and 5 g/m(2) in Philadelphia-negative B- and T-cell disease, respectively. The primary study objective was the comparative assessment of the risk/benefit ratio, combining the analysis of feasibility, toxicity and efficacy. In the liposomal cytarabine arm 17/71 patients (24%) developed grade 3-4 neurotoxicity compared to 2/74 (3%) in the triple therapy arm (P=0.0002), the median number of episodes of neurotoxicity of any grade was one per patient compared to zero, respectively (P=0.0001), and even though no permanent disabilities or deaths were registered, four patients (6%) discontinued intrathecal prophylaxis on account of these toxic side effects (P=0.06). Neurotoxicity worsened with liposomal cytarabine every 14 days (T-cell disease), and was improved by the adjunct of intrathecal dexamethasone. Two patients in the liposomal cytarabine arm suffered from a meningeal relapse (none with T-cell disease, only one after high-dose chemotherapy) compared to four in the triple therapy arm (1 with T-cell disease). While intrathecal liposomal cytarabine could contribute to improved, radiation-free central nervous system prophylaxis, the toxicity reported in this trial does not support its use at 50 mg and prompts the investigation of a lower dosage. (clinicaltrials.gov identifier: NCT-00795756).
Collapse
Affiliation(s)
- Renato Bassan
- U.O.C. Ematologia, Ospedale dell'Angelo e Ospedale SS. Giovanni e Paolo, Mestre-Venezia
| | - Arianna Masciulli
- Laboratorio di Epidemiologia Clinica delle Malattie Cardiovascolari, Fondazione Mario Negri Sud, S.Maria Imbaro, Chieti
| | | | - Ernesta Audisio
- Ematologia 2, Presidio Ospedaliero Molinette, A.O.U. Città della Salute e della Scienza, Torino
| | | | | | | | - Daniele Mattei
- S.C. Ematologia, Azienda Ospedaliera S. Croce e Carle, Cuneo
| | - Claudio Romani
- U.O. Ematologia e Centro TMO, Ospedale Armando Businco, Cagliari
| | - Agostino Cortelezzi
- U.O. Ematologia e TMO, Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, Milano
| | | | - Anna Maria Scattolin
- U.O.C. Ematologia, Ospedale dell'Angelo e Ospedale SS. Giovanni e Paolo, Mestre-Venezia
| | - Orietta Spinelli
- U. O. C. Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
| | - Manuela Tosi
- U. O. C. Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
| | | | - Filippo Marmont
- Ematologia 2, Presidio Ospedaliero Molinette, A.O.U. Città della Salute e della Scienza, Torino
| | | | | | | | | | - Rosa Maria Marfisi
- Laboratorio di Epidemiologia Clinica delle Malattie Cardiovascolari, Fondazione Mario Negri Sud, S.Maria Imbaro, Chieti
| | - Elena Oldani
- U. O. C. Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
| | | |
Collapse
|
13
|
Maino E, Scattolin AM, Viero P, Sancetta R, Pascarella A, Vespignani M, Bassan R. Modern immunotherapy of adult B-lineage acute lymphoblastic leukemia with monoclonal antibodies and chimeric antigen receptor modified T cells. Mediterr J Hematol Infect Dis 2015; 7:e2015001. [PMID: 25574360 PMCID: PMC4283921 DOI: 10.4084/mjhid.2015.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 11/20/2014] [Indexed: 11/08/2022] Open
Abstract
The introduction of newer cytotoxic monoclonal antibodies and chimeric antigen receptor modified T cells is opening a new age in the management of B-lineage adult acute lymphoblastic leukemia. This therapeutic change must be very positively acknowledged because of the limits of intensive chemotherapy programs and allogeneic stem cell transplantation. In fact, with these traditional therapeutic tools the cure can be achieved in only 40-50% of the patients. The failure rates are particularly high in the elderly, in patients with post-induction persistence of minimal residual disease and especially in refractory/relapsed disease. The place of the novel immunotherapeutics in improving the outcome of adult patients with B-lineage acute lymphoblastic leukemia is reviewed.
Collapse
Affiliation(s)
- Elena Maino
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - Anna Maria Scattolin
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - Piera Viero
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - Rosaria Sancetta
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - Anna Pascarella
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - Michele Vespignani
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | - Renato Bassan
- Hematology and Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Mestre-Venezia, Italy
| |
Collapse
|
14
|
Spinelli O, Tosi M, Guinea Montalvo ML, Peruta B, Parolini M, Scattolin AM, Maino E, Viero P, Rambaldi A, Bassan R. Prognostic impact of minimal residual disease in adult acute lymphoblastic leukemia. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.14.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY While adult acute lymphoblastic leukemia (ALL) is curable in 40–50% of the patients, the individual prognosis is rather unpredictable due to associated biological and clinical risk factors. In both B- and T-precursor ALL, minimal residual disease (MRD) represents the most sensitive prognostic marker, useful to support critical treatment decisions, ranging from allogeneic stem cell transplantation in patients with inadequate MRD response to chemotherapy only in MRD responsive ones. This optimized risk-adapted strategy allows to spare transplant-associated morbidity and mortality in patients curable by chemotherapy. Further progress is expected from the integration of the MRD-based strategy with improved pediatric-type regimens and novel targeting agents for discrete ALL subsets. These changes are increasing the cure rate to above 50%.
Collapse
Affiliation(s)
- Orietta Spinelli
- Hematology & Bone Marrow Transplant Unit of Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Manuela Tosi
- Hematology & Bone Marrow Transplant Unit of Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - Barbara Peruta
- Hematology & Bone Marrow Transplant Unit of Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Margherita Parolini
- Hematology & Bone Marrow Transplant Unit of Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Maria Scattolin
- Hematology & Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Via Paccagnella 11, 30174 Mestre-Venezia, Mestre-Venezia, Italy
| | - Elena Maino
- Hematology & Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Via Paccagnella 11, 30174 Mestre-Venezia, Mestre-Venezia, Italy
| | - Piera Viero
- Hematology & Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Via Paccagnella 11, 30174 Mestre-Venezia, Mestre-Venezia, Italy
| | - Alessandro Rambaldi
- Hematology & Bone Marrow Transplant Unit of Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Renato Bassan
- Hematology & Bone Marrow Transplant Unit, Ospedale dell'Angelo e SS. Giovanni e Paolo, Via Paccagnella 11, 30174 Mestre-Venezia, Mestre-Venezia, Italy
| |
Collapse
|
15
|
Bassan R, Spinelli O, Oldani E, Intermesoli T, Tosi M, Peruta B, Borlenghi E, Pogliani EM, Di Bona E, Cassibba V, Scattolin AM, Romani C, Ciceri F, Cortelezzi A, Gianfaldoni G, Mattei D, Audisio E, Rambaldi A. Different molecular levels of post-induction minimal residual disease may predict hematopoietic stem cell transplantation outcome in adult Philadelphia-negative acute lymphoblastic leukemia. Blood Cancer J 2014; 4:e225. [PMID: 25014772 PMCID: PMC4219445 DOI: 10.1038/bcj.2014.48] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- R Bassan
- 1] UOC Ematologia, Ospedale dell'Angelo, Mestre-Venezia, Italy [2] USC Ematologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - O Spinelli
- USC Ematologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - E Oldani
- USC Ematologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - T Intermesoli
- USC Ematologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Tosi
- USC Ematologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - B Peruta
- USC Ematologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - E Borlenghi
- Divisione di Ematologia, Spedali Civili, Brescia, Italy
| | - E M Pogliani
- Clinica Ematologica, Ospedale San Gerardo, Monza, Italy
| | - E Di Bona
- UOC Ematologia, Ospedale S. Bortolo, Vicenza, Italy
| | - V Cassibba
- Divisione di Ematologia, Ospedale Civile, Bolzano, Italy
| | - A M Scattolin
- UOC Ematologia, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - C Romani
- UO Ematologia, Ospedale Oncologico di Riferimento Regionale, Cagliari, Italy
| | - F Ciceri
- UO Ematologia, Istituto Scientifico H.S. Raffaele, Milano, Italy
| | - A Cortelezzi
- UO Ematologia I, IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi, Milano, Italy
| | - G Gianfaldoni
- Ematologia, Università di Firenze, AOU Careggi, Firenze, Italy
| | - D Mattei
- SC Ematologia, ASO S. Croce e Carle, Cuneo, Italy
| | - E Audisio
- Ematologia 2, Ospedale San Giovanni Battista/Università, Torino, Italy
| | - A Rambaldi
- USC Ematologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
16
|
Maino E, Sancetta R, Viero P, Imbergamo S, Scattolin AM, Vespignani M, Bassan R. Current and future management of Ph/BCR-ABL positive ALL. Expert Rev Anticancer Ther 2014; 14:723-40. [PMID: 24611626 DOI: 10.1586/14737140.2014.895669] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Following the introduction of targeted therapy with tyrosine kinase inhibitors (TKI) at the beginning of the past decade, the outcome of patients with Philadelphia-chromosome positive acute lymphoblastic leukemia (Ph+ ALL) has dramatically improved. Presently, the use of refined programs with first/second generation TKI's and chemotherapy together with allogeneic stem cell transplantation allow up to 50% of all patients to be cured. Further progress is expected with the new TKI ponatinib, overcoming resistance caused by T315I point mutation, other targeted therapies, autologous transplantation in molecularly negative patients, therapeutic monoclonal antibodies like inotuzumab ozogamicin and blinatumomab, and chimeric antigen receptor-modified T cells. Ph+ ALL could become curable in the near future even without allogeneic stem cell transplantation, minimizing the risk of therapy-related death and improving greatly the quality of patients' life.
Collapse
Affiliation(s)
- Elena Maino
- Hematology/Bone Marrow Transplantation Unit, Ospedale dell'Angelo and Ospedale SS. Giovanni e Paolo, Via Paccagnella 11, 30174 Venezia-Mestre, Italy
| | | | | | | | | | | | | |
Collapse
|
17
|
Intermesoli T, Rambaldi A, Rossi G, Delaini F, Romani C, Pogliani EM, Pagani C, Angelucci E, Terruzzi E, Levis A, Cassibba V, Mattei D, Gianfaldoni G, Scattolin AM, Di Bona E, Oldani E, Parolini M, Gökbuget N, Bassan R. High cure rates in Burkitt lymphoma and leukemia: a Northern Italy Leukemia Group study of the German short intensive rituximab-chemotherapy program. Haematologica 2013; 98:1718-25. [PMID: 23753030 DOI: 10.3324/haematol.2013.086827] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We evaluate the long-term results of a prospective clinical study enrolling more than 100 adult patients with Burkitt lymphoma/leukemia. Depending on extent of disease, treatment consisted of six to eight rituximab infusions and four to six courses of intensive chemotherapy (attenuated in patients aged >55 years) with high-dose methotrexate, fractionated ifosfamide/cyclophosphamide, other drugs in rotation, and intrathecal chemoprophylaxis. One-hundred five patients were treated (median age 47 years, range 17-78 years); 48% had Burkitt leukemia, 25% were older than 60 years, 37% had an Eastern Cooperative Oncology Group performance score >1, and 14% were positive for human immunodeficiency virus. The complete response rate and 3-year overall and disease-free survival rates were 79%, 67% and 75%, respectively, ranging from 100% to 45% for survival (P=0.000) and from 100% to 60% for disease-free survival (P=0.01) in patients with low, intermediate and high adapted International Prognostic Index scores. In multivariate analysis, only age (≤ versus >60 years) and performance status (0-1 versus >1) retained prognostic significance, identifying three risk groups with overall and disease-free survival probabilities of 88% and 87.5%, 57% and 70.5%, 20% and 28.5% (P=0.0000 and P=0.0001), respectively. The relapse rate was only 7% in patients treated with an intercycle interval ≤ 25 days. This regimen achieved 100% curability in patients with low adapted International Prognostic Index scores (21% of total), and very close to 90% in patients aged ≤ 60 years with performance score 0-1 (48% of total). Rapid diagnosis of Burkitt lymphoma/leukemia with prompt referral of patients to prevent clinical deterioration, and careful supervision of treatment without chemotherapy delay can achieve outstanding therapeutic results. ClinicalTrials.gov ID, NCT01290120.
Collapse
|
18
|
Polacco A, Chiozzini G, Scattolin AM, Oliboni E, Veronesi M, Cristina P. [Current problems of infectious endocarditis. Clinico-diagnostic considerations on 17 cases]. Recenti Prog Med 1989; 80:67-71. [PMID: 2711018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Seventeen cases of Infective Endocarditis diagnosed over a seven-year period by clinical-echocardiographic criteria in a Division of General Medicine are reviewed. More significant aspects regard the observation of the disease in some subjects at risk (elderly persons, patients with normal native valves affected by cirrhosis, by intravenous drugs abuse, by haematological neoplasms), the diagnostic difficulties in cases with oligosymptomatic or atypical beginning, and the frequent negative blood cultures. The value and the limitations of echocardiography and some aspects of therapy are discussed.
Collapse
|