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Linari S, Pieri L, Carulli C, Demartis F, Fjerza R, Prisco D, Castaman G. Is pharmacological thromboprophylaxis necessary in persons with haemophilia undergoing major orthopaedic surgery? Haemophilia 2024; 30:865-867. [PMID: 38575529 DOI: 10.1111/hae.15012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Silvia Linari
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Lisa Pieri
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Christian Carulli
- Orthopedic Clinic, Orthopedic Traumatologic Center, Careggi University Hospital, Florence, Italy
| | - Francesco Demartis
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Rajmonda Fjerza
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
| | - Domenico Prisco
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy
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Carulli C, Daniele G, Linari S, Pieri L, Littera M, Mazzetti M, Tamburini C, Prisco D, Castaman G. Major Orthopaedic Surgery in Persons with Haemophilia A with and without Inhibitors Treated by Emicizumab: A Mid-Term, Large, and Successful Series at a Single Center. J Clin Med 2024; 13:2646. [PMID: 38731175 PMCID: PMC11084841 DOI: 10.3390/jcm13092646] [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: 02/07/2024] [Revised: 04/01/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Introduction: Patients with Haemophilia (PWH) need orthopaedic treatments and often they undergo surgery. Classically, PWH with inhibitors have to face such procedures earlier than other patients. Major orthopaedic surgery is not easy and complications are frequent. Emicizumab is the first monoclonal antibody introduced for haematological prophylaxis for PWH with inhibitors, achieving an efficacious haemostasis also in patients with severe haemophilia A with inhibitors, later demonstrated for PWH without inhibitors. A few years ago, emicizumab was also proposed for PWH undergoing surgery, as it supports excellent bleeding control. The literature on orthopaedic surgery using an emicizumab protocol is scarce: only isolated case reports with short-term follow-ups are available. Aim: The purpose of this study is the assessment of the mid-term outcomes of major orthopaedic surgery performed in a population of patients with and without inhibitors and an emicizumab regimen. Methods: We reviewed the records of 13 PWH (eight with high-titre inhibitors, five without) with a mean age of 54.6 years, undergoing 15 orthopaedic surgical procedures between 2017 and 2022: primary knee and hip arthroplasty, revision, pseudotumor excision, or amputation. Their prophylaxis consisted of the combination of emicizumab and boluses of rFVIIa (PWH with inhibitors) or rFVIII (PWH without inhibitors). The clinical parameters of evaluation were: VAS, Haemophilic Joint Health Score (HJHS), and standard radiologic studies. Follow-up was conducted at 1, 3, 6 months, and then yearly. The survival rate of all implants was also assessed. Results: The mean follow-up was 38.8 months (range: 12-65). All patients were successfully treated without complications during surgery. During the postoperative period, a patient affected by a septic complication two months after his pseudotumor excision underwent an above-the-knee amputation. All patients were regularly discharged to the rehabilitative ward, reporting satisfaction for pain reduction and improved joint and global function at the VAS and HJHS scores. No revisions or implant failures were recorded. Conclusions: A prophylaxis regimen with emicizumab and factor replacement in PWH with or without inhibitors undergoing major orthopaedic surgery ensures effective bleeding control and good postoperative clinical outcomes at mid-term follow-up, and may be routinely adopted in dedicated high-volume hospitals. This series is the most consistent to date reported at a single Haemophilia centre.
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Affiliation(s)
| | - Giovanna Daniele
- Orthopaedic Clinic, University of Florence, 50121 Florence, Italy;
| | - Silvia Linari
- Center for Bleeding Disorders, Careggi University Hospital, 50139 Florence, Italy; (S.L.); (G.C.)
| | - Lisa Pieri
- Center for Bleeding Disorders, Careggi University Hospital, 50139 Florence, Italy; (S.L.); (G.C.)
| | - Mariastefania Littera
- Interdisciplinary Internal Medicine, Careggi University Hospital, 50139 Florence, Italy
| | - Matteo Mazzetti
- Interdisciplinary Internal Medicine, Careggi University Hospital, 50139 Florence, Italy
| | - Carlo Tamburini
- Interdisciplinary Internal Medicine, Careggi University Hospital, 50139 Florence, Italy
| | - Domenico Prisco
- Interdisciplinary Internal Medicine, Careggi University Hospital, 50139 Florence, Italy
| | - Giancarlo Castaman
- Center for Bleeding Disorders, Careggi University Hospital, 50139 Florence, Italy; (S.L.); (G.C.)
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Castaman G, Linari S, Pieri L, Carulli C, Prosperi P, Tonelli P, Demartis F, Fjerza R, Attanasio M, Coppo M, Salvianti F. Safe and Successful Surgical Outcome in Persons with Hemophilia A with and without Inhibitors Treated with Emicizumab: A Large, Single Center, Real-World Experience. J Clin Med 2023; 12:jcm12062317. [PMID: 36983317 PMCID: PMC10055920 DOI: 10.3390/jcm12062317] [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] [Received: 02/22/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Emicizumab is a humanized recombinant bispecific antibody, bridging together activated factor IX (FIXa) and factor X (FX), thus mimicking the activity of FVIII in vivo. Emicizumab is designed for long-term prophylaxis in patients with severe hemophilia A with and without inhibitors. This approach provides constant protection, with significant reduction in bleeding rate and improved quality of life. However, protection provided by emicizumab is not absolute, and clotting factor concentrates (FVIII, rFVIIa, aPCC) may be necessary for post-traumatic bleeding or surgery, with a potential thrombotic risk or difficulty in preventing bleeding. Real world evidence is still scanty, especially for managing major surgery. In this study, 75 surgeries were managed in 28 patients (27 major procedures in 15 patients and 48 minor procedures in 20 patients. In 17 patients without inhibitors, 30 minor surgeries were carried out by using FVIII in 5, with only a bleeding event, which was successfully treated with FVIII concentrate. Six major surgeries were uneventfully performed with FVIII concentrate. Eleven PWHA and high-titer inhibitors underwent 39 surgical procedures (18 minor and 21 major surgeries). Minor surgeries were mostly performed without prophylaxis with rFVIIa, with only a single bleeding complication. All 21 major surgeries were covered with a homogeneous protocol using rFVIIa. In four instances, bleeding complications occurred, treated with rFVIIa. Of them, a single patient only failed to respond and died because of an uncontrollable bleeding from a large ruptured retroperitoneal pseudotumor. Surgery in patients with emicizumab can be safely carried out with the use of appropriate replacement therapy protocols.
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Affiliation(s)
- Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
- Correspondence: ; Tel.: +39-55-7947587
| | - Silvia Linari
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
| | - Lisa Pieri
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
| | - Christian Carulli
- Department of Orthopedic Surgery, University Hospital of Florence, 50139 Florence, Italy
| | - Paolo Prosperi
- Emergency Surgery Department, Careggi University Hospital, 50134 Florence, Italy
| | - Paolo Tonelli
- Department of Surgery and Translational Medicine, University of Florence, 50121 Florence, Italy
| | - Francesco Demartis
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
| | - Rajmonda Fjerza
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
| | - Monica Attanasio
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
| | - Mirella Coppo
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
| | - Francesca Salvianti
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, 50134 Florence, Italy
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Sordi B, Vanderwert F, Crupi F, Gesullo F, Zanotti R, Bonadonna P, Crosera L, Elena C, Fiorelli N, Ferrari J, Grifoni F, Sciumè M, Parente R, Triggiani M, Palterer B, Mecheri V, Almerigogna F, Santi R, Di Medio L, Brandi ML, Iorno ML, Ciardetti I, Bencini S, Annunziato F, Mannarelli C, Pieri L, Guglielmelli P, Mannelli F, Vannucchi AM. Disease correlates and clinical relevance of hereditary α-tryptasemia in patients with systemic mastocytosis. J Allergy Clin Immunol 2023; 151:485-493.e11. [PMID: 36309122 DOI: 10.1016/j.jaci.2022.09.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/05/2022] [Accepted: 09/15/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Systemic mastocytosis (SM) encompasses a heterogeneous group of clonal disorders characterized by abnormal expansion of mast cells (MCs). Beyond KIT and other genes recurrently mutated in myeloid neoplasms, several genetic variants have been described as predisposing to the development of the disease and influencing its clinical phenotype. Increased copy number variants of the TPSAB1 gene were identified as a cause of nonclonal elevated tryptasemia and defined as hereditary α-tryptasemia (HαT). Moreover, HαT is enriched in patients with SM, where it can affect the incidence of mediator-related symptoms. OBJECTIVE In a multicenter data set of 444 patients with MC disorders, we aimed to investigate the clinical correlates of germline TPSAB1 copy number gains. METHODS Droplet digital PCR was performed in all cases to ascertain the presence of HαT. Clinical history along with blood values and bone marrow examination were analyzed. RESULTS We confirmed a higher incidence of HαT+ cases (n = 59, 13.3%) in patients diagnosed with mastocytosis with respect to the general population (approximately 5%). HαT+ patients were characterized by a lower MC-associated disease burden and higher levels of tryptase. Several disease variables were coherent with this pattern, from bone marrow MC infiltration to MC-related histopathologic traits, which also accounted for a significantly higher incidence of clonal MC activation syndrome in HαT+ (10.2%) compared to HαT- (3.4%, P = .029) patients. We also confirmed that HαT+ carriers had a significantly higher frequency of anaphylaxis, without relevant differences for other clinical manifestations. CONCLUSION These findings on a large patient series support and extend previous data, and suggest that knowledge of HαT status may be useful for personalized management of patients with SM.
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Affiliation(s)
- Benedetta Sordi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Fiorenza Vanderwert
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesca Crupi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesca Gesullo
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Roberta Zanotti
- UO Ematologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Patrizia Bonadonna
- UO Allergologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Lara Crosera
- UO Ematologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Chiara Elena
- Divisione di Ematologia, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
| | - Nicolas Fiorelli
- Dipartimento di Medicina Molecolare, Università di Pavia, Pavia, Italy
| | | | - Federica Grifoni
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Mariarita Sciumè
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Roberta Parente
- Dipartimento di Medicina, Divisione di Allergologia e Immunologia Clinica, Università di Salerno, Salerno, Italy
| | - Massimo Triggiani
- Dipartimento di Medicina, Divisione di Allergologia e Immunologia Clinica, Università di Salerno, Salerno, Italy
| | - Boaz Palterer
- Centro di Diagnostica Citofluorimetrica e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Valentina Mecheri
- SOD Immunoallergologia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Florence, Italy
| | - Fabio Almerigogna
- SOD Immunoallergologia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Florence, Italy
| | - Raffaella Santi
- Sezione di Patologia, Dipartimento di Scienze della Salute, Università di Florence, Florence, Italy
| | - Lisa Di Medio
- SOD Malattie del Metabolismo Minerale e Osseo, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Maria Luisa Brandi
- SOD Malattie del Metabolismo Minerale e Osseo, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; FirmoLab, Fondazione FIRMO, Florence, Italy
| | - Maria Loredana Iorno
- Allergologia e Immunologia Clinica Azienda Toscana Centro Ospedale S. Giovanni di Dio, Florence, Italy
| | - Isabella Ciardetti
- Dipartimento di Scienze della Salute, sezione Dermatologia, Università degli Studi di Florence, Florence, Italy
| | - Sara Bencini
- Centro di Diagnostica Citofluorimetrica e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Francesco Annunziato
- Centro di Diagnostica Citofluorimetrica e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Carmela Mannarelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Lisa Pieri
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Alessandro M Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy.
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Manzi P, Messina G, Falcone V, Cevenini G, Bernardini I, De Lio C, Pieri L, De Filippis G, Violi S. [Permanent environmental disinfection techniques in hospital settings with infectious risk]. Ig Sanita Pubbl 2021; 80:676-692. [PMID: 35119055] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
While the world's economies avoid the COVID-19 pandemic blockade, there is an urgent need for technologies aimed at reducing the transmission of COVID-19 in confined spaces such as hospital environments. Although the cleaning and disinfection procedures now have rather complex and sophisticated weapons, they do not seem to be sufficient to continuously maintain low levels of environmental microbiological contamination. This result can now be achieved through the cross-use, in space and time, of improved, more efficient and effective technologies. This result can now be achieved through the cross-use, in space and time, of improved technologies. This work highlights the possibility of crossing and cooperation of different disinfection techniques, such as to keep the microbial and viral load low over time.
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Affiliation(s)
- P Manzi
- SC Igiene e Organizzazione dei Servizi Ospedalieri Azienda Ospedaliera di Perugia
| | | | - V Falcone
- Dipartimento di Medicina Molecolare e dello Sviluppo, Scuola Post Laurea di Sanità Pubblica, Università di Siena
| | - G Cevenini
- Dipartimento di Biotecnologie Mediche Università di Siena
| | - I Bernardini
- SC Igiene e Organizzazione dei Servizi Ospedalieri Azienda Ospedaliera di Perugia
| | - C De Lio
- SC Igiene e Organizzazione dei Servizi Ospedalieri Azienda Ospedaliera di Perugia
| | - L Pieri
- SC Igiene e Organizzazione dei Servizi Ospedalieri Azienda Ospedaliera di Perugia
| | | | - S Violi
- Scuola di Specializzazione in Igiene Università di Perugia
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Linari S, Melchiorre D, Pieri L, Tofani L, Fanelli A, Brogi M, Castaman G. Low bone mass and hypovitaminosis D in haemophilia: A single-centre study in patients with severe and moderate haemophilia A and B. Haemophilia 2020; 26:898-906. [PMID: 32842167 DOI: 10.1111/hae.14127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/06/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Haemophilia (H) is frequently associated with a multifactorial reduction in bone mineral density (BDM), but little is known about possible differences between HA and HB according to their severity. AIM To evaluate the association between low bone mineral density (BMD), 25-hydroxyvitamin D [25(OH)D] concentrations and bone turnover markers in patients with HA and HB younger or older than 50 years. METHODS In 78 patients <50 years and 33 patients >50 years with severe (S) or moderate (M) HA and HB, BMD was measured by dual-energy X-ray absorptiometry at femoral neck (FN) and lumbar spine and then correlated to annual bleeding rate (ABR), World Federation of Haemophilia orthopaedic joint scale (WFH score), 25(OH)D concentrations, parathyroid hormone (PTH), amino-terminal telopeptide of type 1 collagen (NTx), urinary pyridinolines, osteocalcin and bone-specific alkaline phosphatase. RESULTS Overall, a high prevalence of hypovitaminosis D was diagnosed. In patients <50 years, low FN-BMD was significantly more frequent in HA than in HB, while PTH, pyridinolines, ABR and WFH score were associated with H type and severity. In patients >50 years, similarly low FN-BMD was observed in HA and HB, while ABR and WFH score were associated with H type and severity, being milder in HB. CONCLUSIONS Low bone mass is a frequent comorbidity in haemophilic patients of all ages, apart from those with MHB. Clinical and laboratory assessments confirm a higher bone impairment and faster bone resorption in HA compared with HB. Looking at H type and severity, MHB seems to have a normal bone metabolism and a less severe disease.
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Affiliation(s)
- Silvia Linari
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze, Italy
| | - Daniela Melchiorre
- Department of Experimental, Clinical Medicine and Rheumatology, Careggi University Hospital, Firenze, Italy
| | - Lisa Pieri
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze, Italy
| | - Lorenzo Tofani
- Department of Experimental, Clinical Medicine and Rheumatology, Careggi University Hospital, Firenze, Italy
| | | | - Marco Brogi
- Central Laboratory, Careggi University Hospital, Firenze, Italy
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze, Italy
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7
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Sant'Antonio E, Guglielmelli P, Pieri L, Primignani M, Randi ML, Santarossa C, Rumi E, Cervantes F, Delaini F, Carobbio A, Betti S, Rossi E, Lavi N, Harrison CN, Curto‐Garcia N, Gisslinger H, Gisslinger B, Specchia G, Ricco A, Vianelli N, Polverelli N, Koren‐Michowitz M, Ruggeri M, Girodon F, Ellis M, Iurlo A, Mannelli F, Mannelli L, Sordi B, Loscocco GG, Cazzola M, De Stefano V, Barbui T, Tefferi A, Vannucchi AM. Splanchnic vein thromboses associated with myeloproliferative neoplasms: An international, retrospective study on 518 cases. Am J Hematol 2020; 95:156-166. [PMID: 31721282 DOI: 10.1002/ajh.25677] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022]
Abstract
Myeloproliferative Neoplasms (MPN) course can be complicated by thrombosis involving unusual sites as the splanchnic veins (SVT). Their management is challenging, given their composite vascular risk. We performed a retrospective, cohort study in the framework of the International Working Group for MPN Research and Treatment (IWG-MRT), and AIRC-Gruppo Italiano Malattie Mieloproliferative (AGIMM). A total of 518 MPN-SVT cases were collected and compared with 1628 unselected, control MPN population, matched for disease subtype. Those with MPN-SVT were younger (median 44 years) and enriched in females compared to controls; PV (37.1%) and ET (34.4%) were the most frequent diagnoses. JAK2V617F mutation was highly prevalent (90.2%), and 38.6% of cases had an additional hypercoagulable disorder. SVT recurrence rate was 1.6 per 100 patient-years. Vitamin K-antagonists (VKA) halved the incidence of recurrence (OR 0.48), unlike cytoreduction (OR 0.96), and were not associated with overall or gastrointestinal bleeding in multivariable analysis. Esophageal varices were the only independent predictor for major bleeding (OR 17.4). Among MPN-SVT, risk of subsequent vascular events was skewed towards venous thromboses compared to controls. However, MPN-SVT clinical course was overall benign: SVT were enriched in PMF with lower IPSS, resulting in significantly longer survival than controls; survival was not affected in PV and slightly reduced in ET. MPN-U with SVT (n = 55) showed a particularly indolent phenotype, with no signs of disease evolution. In the to-date largest, contemporary cohort of MPN-SVT, VKA were confirmed effective in preventing recurrence, unlike cytoreduction, and safe; the major risk factor for bleeding was esophageal varices that therefore represent a major therapeutic target.
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Affiliation(s)
- Emanuela Sant'Antonio
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
- Medical Genetics, University of Siena Siena Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
| | - Lisa Pieri
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
| | - Massimo Primignani
- CRC "A. M. e A. Migliavacca" Center for Liver Disease, Division of Gastroenterology and Hepatology, Foundation IRCCS Cà Granda Maggiore Policlinico Hospital, University of Milan Milan Italy
| | - Maria Luigia Randi
- Department of Medicine – DIMEDUniversity of Padova Medical School Padova Italy
| | - Claudia Santarossa
- Department of Medicine – DIMEDUniversity of Padova Medical School Padova Italy
| | - Elisa Rumi
- Department of Hematology OncologyIRCCS Policlinico S. Matteo Foundation and University of Pavia Pavia Italy
| | | | - Federica Delaini
- Hematology and Bone Marrow Transplant UnitAzienda Ospedaliera Papa Giovanni XXIII Bergamo Italy
| | - Alessandra Carobbio
- Hematology and Bone Marrow Transplant UnitAzienda Ospedaliera Papa Giovanni XXIII Bergamo Italy
| | - Silvia Betti
- Institute of HematologyCatholic University, Fondazione Policlinico A. Gemelli IRCCS Rome Italy
| | - Elena Rossi
- Institute of HematologyCatholic University, Fondazione Policlinico A. Gemelli IRCCS Rome Italy
| | - Noa Lavi
- Department of Hematology and Bone Marrow TransplantationRambam Health Care Campus Haifa Israel
| | - Claire N. Harrison
- Department of HaematologyGuy's and St. Thomas NHS Foundation Trust London UK
| | | | - Heinz Gisslinger
- Department of Internal Medicine I, Division of Hematology and Blood CoagulationMedical University of Vienna Vienna Austria
| | - Bettina Gisslinger
- Department of Internal Medicine I, Division of Hematology and Blood CoagulationMedical University of Vienna Vienna Austria
| | - Giorgina Specchia
- Department of Emergency and Organ TransplantationSection of Hematology with Transplantation, Medical School, University of Bari Bari Italy
| | - Alessandra Ricco
- Department of Emergency and Organ TransplantationSection of Hematology with Transplantation, Medical School, University of Bari Bari Italy
| | - Nicola Vianelli
- Department of Hematology and Clinical Oncology “L. and A. Seràgnoli” S. Orsola‐Malpighi Hospital Bologna Italy
| | - Nicola Polverelli
- Department of Hematology and Clinical Oncology “L. and A. Seràgnoli” S. Orsola‐Malpighi Hospital Bologna Italy
| | - Maya Koren‐Michowitz
- Department of HematologyShamir Medical Center (Assaf Harofeh), Zerifin, Israel and Sackler school of Medicine, Tel Aviv University Tel Aviv Israel
| | | | | | - Martin Ellis
- The Hematology Institute and Blood Bank and Translational Hemato‐Oncology, Meir Hospital Kfar‐Saba Israel
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda‐Ospedale Maggiore Policlinico Milan Italy
| | - Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
| | - Lara Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
- Medical Genetics, University of Siena Siena Italy
| | - Benedetta Sordi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
| | - Giuseppe Gaetano Loscocco
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
| | - Mario Cazzola
- Department of Hematology OncologyIRCCS Policlinico S. Matteo Foundation and University of Pavia Pavia Italy
| | - Valerio De Stefano
- Institute of HematologyCatholic University, Fondazione Policlinico A. Gemelli IRCCS Rome Italy
| | - Tiziano Barbui
- Research Foundation, Azienda Ospedaliera Papa Giovanni XXIII Bergamo Italy
| | | | - Alessandro Maria Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie MieloproliferativeAzienda Ospedaliera Universitaria Careggi Florence Italy
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi, Firenze, DENOTHE Excellence Center Florence Italy
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8
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Mannelli F, Gesullo F, Rotunno G, Pacilli A, Bencini S, Annunziato F, Zanotti R, Scaffidi L, Giona F, Santopietro M, Grifoni F, Pieri L, Guglielmelli P, Vannucchi AM. Myelodysplasia as assessed by multiparameter flow cytometry refines prognostic stratification provided by genotypic risk in systemic mastocytosis. Am J Hematol 2019; 94:845-852. [PMID: 31056768 DOI: 10.1002/ajh.25506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
Systemic mastocytosis (SM) is characterized by extreme heterogeneity of manifestations and prognosis. Several disease-related biomarkers, including clinical, hematological and molecular variables, have been correlated with prognosis. Although relevant, the mutation profile closely reflects the WHO classification that has per se prognostic value. High-risk mutations (HRM) are largely confined to advanced forms, and thus fail in providing information regarding progression and outcome in the not-advanced variants. In this work, we studied hematopoietic cells by multi-parameter flow cytometry (MFC) in order to highlight dysplastic traits that might provide insights into outcome. A score previously validated for myelodysplastic syndromes, with high reproducibility in standard diagnostics, was used. The application of an MFC score to a cohort of 71 SM cases, concurrently genotyped for configuring a HRM category, resulted in the identification of two separate patients' categories (MFC+ and MFC-) characterized by significantly different clinical and laboratory features at presentation. The extent of dysplasia by MFC tended to parallel WHO-category and genotype-related stratification. MFC+ patients had shorter survival compared to MFC- ones, for whom the incidence of progression and/or death was virtually null. Of note, MFC score remained prognostically informative in unadvanced subsets. Furthermore, the integration of MFC and HRM was an independent predictor for outcome, also overcoming WHO-categories in multivariate analysis for EFS. Our results support the use of MFC analysis in the evaluation of patients with SM, alone and in combination with HRM, for refinement of prognosis assessment.
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Affiliation(s)
- Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Francesca Gesullo
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Giada Rotunno
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Annalisa Pacilli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Sara Bencini
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e ClinicaDenothe Excellence Center Firenze Italy
| | - Francesco Annunziato
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e ClinicaDenothe Excellence Center Firenze Italy
| | - Roberta Zanotti
- Multidisplinary Outpatients Clinic for Mastocytosis (GISM)Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
- Department of Medicine, Haematology UnitAzienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Luigi Scaffidi
- Multidisplinary Outpatients Clinic for Mastocytosis (GISM)Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
- Department of Medicine, Haematology UnitAzienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Fiorina Giona
- EmatologiaDipartimento di Medicina Traslazionale e di Precisione, Università Sapienza Roma Italy
| | - Michelina Santopietro
- EmatologiaDipartimento di Medicina Traslazionale e di Precisione, Università Sapienza Roma Italy
| | - Federica Grifoni
- UOC EmatologiaFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Lisa Pieri
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Alessandro M. Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
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9
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Merante S, Ferretti VV, Elena C, Brazzelli V, Zanotti R, Neri I, Magliacane D, Belloni Fortina A, Ingeborg F, Pastorello EA, Pieri L, Papayannidis C, Mauro M, Grifoni F, Minelli R, Guggiari E, Difonzo E, Bocchia M, Caroppo F, Di Nuzzo S, Elli EM, Rondoni M, Ciccocioppo R, Di Stefano M, Bossi G, Boveri E, Bonadonna P, Giona F, Valent P, Triggiani M. The Italian Mastocytosis Registry: 6-year experience from a hospital-based registry. Future Oncol 2018; 14:2713-2723. [DOI: 10.2217/fon-2018-0291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: We collected ‘real-life’ data on the management of patients with mastocytosis in the Italian Mastocytosis Registry. Methods: Six hundred patients diagnosed with mastocytosis between 1974 and 2014 were included from 19 centers. Results: Among adults (n = 401); 156 (38.9%) patients were diagnosed with systemic mastocytosis. In 212 adults, no bone marrow studies were performed resulting in a provisional diagnosis of mastocytosis of the skin. This diagnosis was most frequently established in nonhematologic centers. In total, 182/184 pediatric patients had cutaneous mastocytosis. We confirmed that in the most patients with systemic mastocytosis, serum tryptase levels were >20 ng/ml and KIT D816V was detectable. Conclusion: The Italian Mastocytosis Registry revealed some center-specific approaches for diagnosis and therapy. Epidemiological evidence on this condition is provided.
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Affiliation(s)
- Serena Merante
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Hematology Department, James Cook University Hospital, South Tees Trust (NHS), Middlesbrough, UK
| | | | - Chiara Elena
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Iria Neri
- Dermatology, Department of Experimental, Diagnostic & Specialty Medicine, University of Bologna, Bologna, Italy
| | | | | | | | | | - Lisa Pieri
- Center of Research & Innovation of Myeloproliferative Neoplasms (CRIMM), Careggi University Hospital/University of Florence, Florence, Italy
| | | | | | - Federica Grifoni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | | | - Elisa Difonzo
- Dermatology, University of Florence, Florence, Italy
| | | | | | | | - Elena Maria Elli
- Divisione di Ematologia, Ospedale San Gerardo, ASST Monza, Italy
| | | | - Rachele Ciccocioppo
- Gastroenterology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Grazia Bossi
- Pediatric Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuela Boveri
- Pathology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Italy
| | | | - Fiorina Giona
- Ematologia, Sapienza Università di Roma, Azienda Policlinico Umberto I Roma, Italy
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
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10
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Dominici S, Visvikis A, Pieri L, Paolicchi A, Valentini MA, Comporti M, Pompella A. Redox Modulation of NF-κB Nuclear Translocation and DNA Binding in Metastatic Melanoma. The Role of Endogenous and γ-Glutamyl Transferase-Dependent Oxidative Stress. Tumori 2018; 89:426-33. [PMID: 14606649 DOI: 10.1177/030089160308900416] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 11/15/2022]
Abstract
Aims and background The transcription factor NF-κB is implicated in the expression of genes involved in cell proliferation, apoptosis and metastasis. In melanoma, high constitutive levels of NF-κB activation are usually observed. NF-κB is regulated by oxidation/reduction (redox) processes, and the occurrence of constitutive oxidative stress in melanoma cells has been documented. Recent studies of our laboratories showed that the membrane-bound gamma-glutamyl transferase (GGT) enzyme activity – expressed by a number of malignancies, including melanoma – can act as a basal source of superoxide, hydrogen peroxide and other prooxidants. Methods In the present study we utilized the 2/60 clone of Me665/2 human metastatic melanoma, which displays high levels of GGT activity, in order to verify if the presence of this enzyme - through the promotion of redox processes - may influence the activation status of NF-κB. The latter was evaluated by determining the nuclear translocation of the p65 subunit (by immunoblot), the DNA binding of NF-kB (by elec-trophoretic mobility shift assay) and its transcriptional activity (by gene transactivation studies). Results Me665/2/60 cells displayed a basal production of hydrogen peroxide. Stimulation of GGT activity by its substrates glutathione and glycyl-glycine caused additional production of hydrogen peroxide, up to levels approx. double the basal levels. Nuclear translocation of the NF-κB p65 subunit, DNA-binding and gene transactivation were thus investigated in Me665/2/60 cells whose GGT activity was modulated by means of substrates or inhibitors. Stimulation of GGT activity resulted in increased nuclear translocation of p65, while on the other hand NF-κB DNA binding and gene transactivation were paradoxically decreased. NF-κB DNA binding could be restored by treating cell lysates with the thiol-re-ducing agent dithiothreitol (DTT). Treatment of cells with exogenous hydrogen peroxide did not affect NF-κB activation status. Conclusions Altogether, the data obtained indicate that GGT activity may impair the redox status of thiols that is critical for NF-κB DNA binding and gene transactivation, through the production of prooxidant species allegedly distinct from hydrogen peroxide. GGT activity therefore appears to be an additional factor in modulation of NF-κB transcriptional activity in melanoma, capable of hindering NF-κB DNA binding even in conditions where continuous oxidative stress would favor NF-κB nuclear translocation.
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Affiliation(s)
- Silvia Dominici
- Department of Experimental Pathology, University of Pisa Medical School, Pisa, Italy
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11
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Castaman G, Pieri L. Management of thrombocytopenia in cancer. Thromb Res 2018; 164 Suppl 1:S89-S93. [DOI: 10.1016/j.thromres.2018.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 12/13/2022]
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12
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Abdi A, Linari S, Pieri L, Voorberg J, Fijnvandraat K, Castaman G. Inhibitors in Nonsevere Hemophilia A: What Is Known and Searching for the Unknown. Semin Thromb Hemost 2018; 44:568-577. [DOI: 10.1055/s-0037-1621717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractNonsevere hemophilia A (NSHA) is an inherited X-linked bleeding disorder, caused by mutations of the F8 gene, leading to decreases of clotting factor VIII (FVIII) levels to 1 to 40 IU/dL. Desmopressin is the first therapeutic option for NSHA, but 40 to 50% of patients fail to attain adequate postinfusion FVIII levels. Thus, in these cases, FVIII concentrates remain the mainstay of treatment. The development of neutralizing FVIII antibodies (inhibitors) is a major challenge with replacement therapy. In contrast to severe disease, NSHA patients have a lifelong risk of inhibitor development. Recent data indicate that inhibitors are associated with a deterioration of clinical outcome, illustrated by an increase in bleeding and mortality rate. F8 genotype is an important risk factor for inhibitor occurrence together with surgical interventions and a high dose of FVIII concentrate. Adequate prevention and treatment of inhibitors in NSHA patients is limited by a lack of understanding of the underlying immunological mechanisms. Elucidation of the immunology driving inhibitor development is required to identify high-risk patients, to understand the association between clinical risk factors and inhibitor occurrence, and to provide the opportunity to develop new preventive and therapeutic strategies.
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Affiliation(s)
- Amal Abdi
- Department of Pediatric Hematology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Silvia Linari
- Department of Oncology, Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze, Italy
| | - Lisa Pieri
- Department of Oncology, Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze, Italy
| | | | - Karin Fijnvandraat
- Department of Pediatric Hematology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Giancarlo Castaman
- Department of Oncology, Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze, Italy
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13
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Loscocco G, Vannucchi M, Paoli C, Franci A, Pieri L, Annunziato F, Massi D, Vannucchi A. Kaposi sarcoma in a patient treated with ruxolitinib. Ann Oncol 2017; 28:1670-1671. [DOI: 10.1093/annonc/mdx188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Indexed: 01/22/2023] Open
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14
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Pieri L, Paoli C, Arena U, Marra F, Mori F, Zucchini M, Colagrande S, Castellani A, Masciulli A, Rosti V, De Stefano V, Betti S, Finazzi G, Ferrari ML, Rumi E, Ruggeri M, Nichele I, Guglielmelli P, Fjerza R, Mannarelli C, Fanelli T, Merli L, Corbizi Fattori G, Massa M, Cimino G, Rambaldi A, Barosi G, Cazzola M, Barbui T, Vannucchi AM. Safety and efficacy of ruxolitinib in splanchnic vein thrombosis associated with myeloproliferative neoplasms. Am J Hematol 2017; 92:187-195. [PMID: 27880982 DOI: 10.1002/ajh.24614] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/19/2016] [Accepted: 11/21/2016] [Indexed: 12/19/2022]
Abstract
Splanchnic vein thrombosis (SVT) is one of the vascular complications of myeloproliferative neoplasms (MPN). We designed a phase 2 clinical trial to evaluate safety and efficacy of ruxolitinib in reducing splenomegaly and improving disease-related symptoms in patients with MPN-associated SVT. Patients diagnosed with myelofibrosis (12 cases), polycythemia vera (5 cases) and essential thrombocythemia (4 cases) received ruxolitinib for 24 weeks in the core study period. Spleen volume was assessed by magnetic resonance imaging (MRI) and splanchnic vein circulation by echo-Doppler analysis. Nineteen patients carried JAK2V617F, one had MPLW515L, and one CALRL367fs*46 mutation. Eighteen patients had spleno-portal-mesenteric thrombosis, two had Budd-Chiari syndrome, and one had both sites involved; 16 patients had esophageal varices. Ruxolitinib was well tolerated with hematological toxicities consistent with those of patients without SVT and no hemorrhagic adverse events were recorded. After 24 weeks of treatment, spleen volume reduction ≥35% by MRI was achieved by 6/21 (29%) patients, and a ≥50% spleen length reduction by palpation at any time up to week 24 was obtained by 13/21 (62%) patients. At week 72, 8 of the 13 (62%) patients maintained the spleen response by palpation. No significant effect of treatment on esophageal varices or in splanchnic circulation was observed. MPN-related symptoms, evaluated by MPN-symptom assessment form (SAF) TSS questionnaire, improved significantly during the first 4 weeks and remained stable up to week 24. In conclusion, this trial shows that ruxolitinib is safe in patients with MPN-associated SVT, and effective in reducing spleen size and disease-related symptoms.
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Affiliation(s)
- Lisa Pieri
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Chiara Paoli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Umberto Arena
- Internal Medicine and Hepatology; Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Fabio Mori
- Department of Cardiology; Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Mery Zucchini
- Department of Cardiology; Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences; University of Florence - Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Alessandro Castellani
- Department of Experimental and Clinical Biomedical Sciences; University of Florence - Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Arianna Masciulli
- Department of Hematology; Hospital Papa Giovanni XXIII; Bergamo Italy
| | - Vittorio Rosti
- IRCCS Policlinico San Matteo Foundation; Center for the Study of Myelofibrosis, Biotechnology Research Area; Pavia Italy
| | | | - Silvia Betti
- Institute of Hematology, Catholic University; Rome Italy
| | - Guido Finazzi
- Department of Hematology; Hospital Papa Giovanni XXIII; Bergamo Italy
| | | | - Elisa Rumi
- Department of Hematology Oncology; IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Marco Ruggeri
- Department of Hematology; San Bortolo Hospital; Vicenza Italy
| | - Ilaria Nichele
- Department of Hematology; San Bortolo Hospital; Vicenza Italy
| | - Paola Guglielmelli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Rajmonda Fjerza
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Carmela Mannarelli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Tiziana Fanelli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
- University of Siena; Siena Italy
| | - Lucia Merli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Giuditta Corbizi Fattori
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
- University of Siena; Siena Italy
| | - Margherita Massa
- IRCCS Policlinico San Matteo Foundation; Biotechnology Research Area; Pavia Italy
| | - Giuseppe Cimino
- Department of Cellular Biotechnology and Hematology; University “La Sapienza”; Rome Italy
| | | | - Giovanni Barosi
- IRCCS Policlinico San Matteo Foundation; Center for the Study of Myelofibrosis, Biotechnology Research Area; Pavia Italy
| | - Mario Cazzola
- Department of Hematology Oncology; IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Tiziano Barbui
- Hospital Papa Giovanni XXIII and Research Foundation; Bergamo Italy
| | - Alessandro M. Vannucchi
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
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15
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Barbui T, Vannucchi AM, Carobbio A, Rumi E, Finazzi G, Gisslinger H, Ruggeri M, Randi ML, Cazzola M, Rambaldi A, Gisslinger B, Pieri L, Thiele J, Pardanani A, Tefferi A. The effect of arterial hypertension on thrombosis in low-risk polycythemia vera. Am J Hematol 2017; 92:E5-E6. [PMID: 27737508 DOI: 10.1002/ajh.24583] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Tiziano Barbui
- FROM Research Foundation; Papa Giovanni XXIII hospital; Bergamo Italy
| | | | | | - Elisa Rumi
- Department of Hematology; University of Pavia, IRCCS Policlinico San Matteo; Pavia Italy
| | - Guido Finazzi
- Division of Hematology; Papa Giovanni XXIII hospital; Bergamo Italy
| | - Heinz Gisslinger
- Division of Hematology; Medical University of Vienna; Vienna Austria
| | - Marco Ruggeri
- Division of Hematology; S. Bortolo Hospital; Vicenza Italy
| | | | - Mario Cazzola
- Department of Hematology; University of Pavia, IRCCS Policlinico San Matteo; Pavia Italy
| | | | | | - Lisa Pieri
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Juergen Thiele
- Institute of Pathology University of Cologne; Cologne Germany
| | - Animesh Pardanani
- Division of Hematology Department of Medicine; Mayo Clinic; Rochester Minnesota
| | - Ayalew Tefferi
- Division of Hematology Department of Medicine; Mayo Clinic; Rochester Minnesota
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16
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Passamonti F, Mora B, Giorgino T, Guglielmelli P, Cazzola M, Maffioli M, Rambaldi A, Caramella M, Komrokji R, Gotlib J, Kiladjian JJ, Cervantes F, Devos T, Palandri F, De Stefano V, Ruggeri M, Silver R, Benevolo G, Albano F, Caramazza D, Rumi E, Merli M, Pietra D, Casalone R, Barbui T, Pieri L, Vannucchi AM. Driver mutations’ effect in secondary myelofibrosis: an international multicenter study based on 781 patients. Leukemia 2016; 31:970-973. [DOI: 10.1038/leu.2016.351] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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17
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De Stefano V, Vannucchi AM, Ruggeri M, Cervantes F, Alvarez-Larrán A, Iurlo A, Randi ML, Pieri L, Rossi E, Guglielmelli P, Betti S, Elli E, Finazzi MC, Finazzi G, Zetterberg E, Vianelli N, Gaidano G, Nichele I, Cattaneo D, Palova M, Ellis MH, Cacciola E, Tieghi A, Hernandez-Boluda JC, Pungolino E, Specchia G, Rapezzi D, Forcina A, Musolino C, Carobbio A, Griesshammer M, Barbui T. Splanchnic vein thrombosis in myeloproliferative neoplasms: risk factors for recurrences in a cohort of 181 patients. Blood Cancer J 2016; 6:e493. [PMID: 27813534 PMCID: PMC5148051 DOI: 10.1038/bcj.2016.103] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/16/2016] [Indexed: 12/13/2022] Open
Abstract
We retrospectively studied 181 patients with polycythaemia vera (n=67), essential thrombocythaemia (n=67) or primary myelofibrosis (n=47), who presented a first episode of splanchnic vein thrombosis (SVT). Budd–Chiari syndrome (BCS) and portal vein thrombosis were diagnosed in 31 (17.1%) and 109 (60.3%) patients, respectively; isolated thrombosis of the mesenteric or splenic veins was detected in 18 and 23 cases, respectively. After this index event, the patients were followed for 735 patient years (pt-years) and experienced 31 recurrences corresponding to an incidence rate of 4.2 per 100 pt-years. Factors associated with a significantly higher risk of recurrence were BCS (hazard ratio (HR): 3.03), history of previous thrombosis (HR: 3.62), splenomegaly (HR: 2.66) and leukocytosis (HR: 2.8). Vitamin K-antagonists (VKA) were prescribed in 85% of patients and the recurrence rate was 3.9 per 100 pt-years, whereas in the small fraction (15%) not receiving VKA more recurrences (7.2 per 100 pt-years) were reported. Intracranial and extracranial major bleeding was recorded mainly in patients on VKA and the corresponding rate was 2.0 per 100 pt-years. In conclusion, despite anticoagulation treatment, the recurrence rate after SVT in myeloproliferative neoplasms is high and suggests the exploration of new avenues of secondary prophylaxis with new antithrombotic drugs and JAK-2 inhibitors.
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Affiliation(s)
- V De Stefano
- Institute of Hematology, Catholic University, Roma, Italy
| | - A M Vannucchi
- Center for Research and Innovation of Myeloproliferative Neoplasms, A.O.U. Careggi, University of Florence, Florence, Italy
| | - M Ruggeri
- Ospedale San Bortolo, Vicenza, Italy
| | | | - A Alvarez-Larrán
- Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain
| | - A Iurlo
- Oncohematology Division, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - M L Randi
- Clinica Medica 1, Università di Padova, Padova, Italy
| | - L Pieri
- Center for Research and Innovation of Myeloproliferative Neoplasms, A.O.U. Careggi, University of Florence, Florence, Italy
| | - E Rossi
- Institute of Hematology, Catholic University, Roma, Italy
| | - P Guglielmelli
- Center for Research and Innovation of Myeloproliferative Neoplasms, A.O.U. Careggi, University of Florence, Florence, Italy
| | - S Betti
- Institute of Hematology, Catholic University, Roma, Italy
| | - E Elli
- Divisione di Ematologia, Ospedale San Gerardo, ASST Monza, Italy
| | - M C Finazzi
- Hematology Division, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - G Finazzi
- Hematology Division, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - N Vianelli
- Institute of Hematology and Medical Oncology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Gaidano
- Department of Translational Medicine, Università del Piemonte Orientale, Vercelli, Italy
| | - I Nichele
- Ospedale San Bortolo, Vicenza, Italy
| | - D Cattaneo
- Oncohematology Division, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - M Palova
- University Hospital of Olomouc, Olomouc, Czech Republic
| | - M H Ellis
- Department of Hematology, Institute Meir Medical Center, Kfar Saba, Israel
| | - E Cacciola
- Haemostasis Unit, Department of Medical, Surgical and Advanced Technologies Sciences 'G.F. Ingrassia', University of Catania, Catania, Italy
| | - A Tieghi
- Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - E Pungolino
- A.O. Ospedale Niguarda Ca' Granda, Milano, Italy
| | - G Specchia
- A.O. Universitaria, Policlinico di Bari, Italy
| | - D Rapezzi
- A.O. Santa Croce e Carle, Cuneo, Italy
| | - A Forcina
- IRCCS Ospedale San Raffaele, Milano, Italy
| | | | - A Carobbio
- FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - M Griesshammer
- Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - T Barbui
- FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
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Calistri L, Pieri L, Santi R, Nardi C, Vannucchi AM, Colagrande S. MR Imaging in non-hepatosplenic extramedullary hematopoiesis in primary myelofibrosis. Am J Hematol 2016; 91:1062-3. [PMID: 27197653 DOI: 10.1002/ajh.24425] [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] [Received: 04/26/2016] [Revised: 05/14/2016] [Accepted: 05/17/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences; Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi; Largo Brambilla 3 Florence 50134 Italy
| | - Lisa Pieri
- Department of Experimental and Clinical Medicine; DENOTHE Excellence Center, University of Florence, CRIMM Center for Research and Innovation for Myeloproliferative Neoplasms, Azienda Ospedaliero Universitaria Careggi; Largo Brambilla 3 Firenze 50134 Italia
| | - Raffaella Santi
- Division of Pathological Anatomy; Department of Surgery and Translational Medicine, University of Florence - Azienda Ospedaliero-Universitaria Careggi; Largo Brambilla, 3, 50134 Florence 50134 Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences; Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi; Largo Brambilla 3 Florence 50134 Italy
| | - Alessandro Maria Vannucchi
- Department of Experimental and Clinical Medicine; DENOTHE Excellence Center, University of Florence, CRIMM Center for Research and Innovation for Myeloproliferative Neoplasms, Azienda Ospedaliero Universitaria Careggi; Largo Brambilla 3 Firenze 50134 Italia
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences; Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi; Largo Brambilla 3 Florence 50134 Italy
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19
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Guglielmelli P, Rotunno G, Pacilli A, Rumi E, Rosti V, Delaini F, Maffioli M, Fanelli T, Pancrazzi A, Pieri L, Fjerza R, Pietra D, Cilloni D, Sant'Antonio E, Salmoiraghi S, Passamonti F, Rambaldi A, Barosi G, Barbui T, Cazzola M, Vannucchi AM. Prognostic impact of bone marrow fibrosis in primary myelofibrosis. A study of the AGIMM group on 490 patients. Am J Hematol 2016; 91:918-22. [PMID: 27264006 DOI: 10.1002/ajh.24442] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 01/24/2023]
Abstract
The prognostic significance of bone marrow (BM) fibrosis grade in patients with primary myelofibrosis (PMF) is still debated. A fibrosis grade greater than 1 was shown to associate with higher risk of death, and addition of fibrosis grade to IPSS score resulted in a more accurate prediction of survival. The aim of this study was to analyze the prognostic impact of BM fibrosis in 490 patients with PMF, evaluated at diagnosis, molecularly annotated and with extensive follow-up information. We found that fibrosis grade 2 and greater on a 0-3 scale was associated with clinical characteristics indicative of a more advanced disease, such as anemia, leukopenia, thrombocytopenia, constitutional symptoms, larger splenomegaly and a higher IPSS risk category. Patients with higher grade of fibrosis were also more likely to have additional somatic mutations in ASXL1 and EZH2, that are prognostically adverse. Median survival was significantly reduced in patients with grade 2 and 3 fibrosis as compared with grade 1; this effect was maintained when analysis was restricted to younger patients. In multivariate analysis, fibrosis grade independently predicted for survival regardless of IPSS variables and mutational status; the adverse impact of fibrosis was noticeable especially in lower IPSS risk categories. Overall, results indicate that higher grades of fibrosis correlate with unique clinical and molecular aspects and represent an independent adverse variable in patients with PMF; these observations deserve confirmation in prospectively designed series of patients. Am. J. Hematol. 91:918-922, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Paola Guglielmelli
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center; CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence; Florence Italy
| | - Giada Rotunno
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center; CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence; Florence Italy
| | - Annalisa Pacilli
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center; CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence; Florence Italy
| | - Elisa Rumi
- Department of Hematology Oncology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
- Department of Molecular Medicine; University of Pavia; Pavia Italy
| | - Vittorio Rosti
- Center for the Study of Myelofibrosis, Research Lab of Biotechnology, IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Federica Delaini
- Hematology and BMT Unit; ASST Papa Giovanni XXIII; Bergamo Italy
| | - Margherita Maffioli
- Ospedale Di Circolo; Fondazione Macchi Università Degli Studi Dell'Insubria; Varese Viale Borri 57 Varese Italia
| | - Tiziana Fanelli
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center; CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence; Florence Italy
- University of Siena; Italy
| | - Alessandro Pancrazzi
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center; CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence; Florence Italy
| | - Lisa Pieri
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center; CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence; Florence Italy
| | - Rajmonda Fjerza
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center; CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence; Florence Italy
| | - Daniela Pietra
- Department of Hematology Oncology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences University of Turin; San Luigi Hospital Turin; Italy
| | - Emanuela Sant'Antonio
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center; CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence; Florence Italy
| | | | - Francesco Passamonti
- Ospedale Di Circolo; Fondazione Macchi Università Degli Studi Dell'Insubria; Varese Viale Borri 57 Varese Italia
| | | | - Giovanni Barosi
- Center for the Study of Myelofibrosis, Research Lab of Biotechnology, IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Tiziano Barbui
- Research Foundation; Ospedale Papa Giovanni XXIII; Bergamo Italy
| | - Mario Cazzola
- Department of Hematology Oncology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
- Department of Molecular Medicine; University of Pavia; Pavia Italy
| | - Alessandro M. Vannucchi
- Department of Experimental and Clinical Medicine and DENOTHE Excellence Center; CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence; Florence Italy
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20
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Pieri L, Vannucchi AM. Improving prognostic tools in systemic mastocytosis: Insights from mutations. Am J Hematol 2016; 91:867-8. [PMID: 27397606 DOI: 10.1002/ajh.24472] [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: 07/01/2016] [Accepted: 07/07/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Lisa Pieri
- CRIMM-Centro Ricerca e Innovazione delle Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence, DenoThe Excellence Center; Florence Italy
| | - Alessandro M. Vannucchi
- CRIMM-Centro Ricerca e Innovazione delle Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence, DenoThe Excellence Center; Florence Italy
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21
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Pieri L, Bonadonna P, Elena C, Papayannidis C, Grifoni FI, Rondoni M, Girlanda S, Mauro M, Magliacane D, Elli EM, Iorno ML, Almerigogna F, Scarfì F, Salerno R, Fanelli T, Gesullo F, Corbizi Fattori G, Bonifacio M, Perbellini O, Artuso A, Soverini S, De Benedittis C, Muratori S, Pravettoni V, Cova V, Cortellini G, Ciceri F, Cortelezzi A, Martinelli G, Triggiani M, Merante S, Vannucchi AM, Zanotti R. Clinical presentation and management practice of systemic mastocytosis. A survey on 460 Italian patients. Am J Hematol 2016; 91:692-9. [PMID: 27060898 DOI: 10.1002/ajh.24382] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 04/05/2016] [Indexed: 01/18/2023]
Abstract
Systemic mastocytosis is a rare heterogeneous myeloproliferative neoplasm characterized by abnormal proliferation and activation of mast cells. We describe a large multicentre series of 460 adult patients with systemic mastocytosis, with a diagnosis based on WHO 2008 criteria, in a "real-life" setting of ten Italian centers with dedicated multidisciplinary programs. We included indolent forms with (n = 255) and without (n = 165) skin lesions, smouldering (n = 20), aggressive (n = 28), associated with other hematological diseases mastocytosis (n = 21) and mast cell leukemia (n = 1). This series was uniquely characterized by a substantial proportion of patients with low burden of neoplastic mast cells; notably, 38% of cases were diagnosed using only minor diagnostic criteria according to WHO 2008 classification, underlying the feasibility of early diagnosis where all diagnostic approaches are made available. This has particular clinical relevance for prevention of anaphylaxis manifestations, that were typically associated with indolent forms. In multivariate analysis, the most important features associated with shortened overall survival were disease subtype and age at diagnosis >60 years. Disease progression was correlated with mastocytosis subtype and thrombocytopenia. As many as 32% of patients with aggressive mastocytosis suffered from early evolution into acute leukemia. Overall, this study provides novel information about diagnostic approaches and current presentation of patients with SM and underlines the importance of networks and specialized centers to facilitate early diagnosis and prevent disease-associated manifestations. Am. J. Hematol. 91:692-699, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Lisa Pieri
- CRIMM Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Medicine; DENOTHE Excellence Center, University of Florence; Florence Italy
| | - Patrizia Bonadonna
- Allergy Unit, Azienda Ospedaliera Universitaria Integrata of Verona; Verona Italy
| | - Chiara Elena
- Department of Molecular Medicine; University of Pavia
- Department of Hematology Oncology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | | | - Federica Irene Grifoni
- Fondazione IRCCS Ca‘Granda Ospedale Maggiore Policlinico; UOC Di Oncoematologia; Milano Italy
| | - Michela Rondoni
- Clinical Pathology Department; Azienda Unità Sanitaria Locale Della Romagna; Cesena Italy
| | | | | | - Diomira Magliacane
- Clinical Immunology and Allergoloy; University of Salerno; Salerno Italy
| | | | | | - Fabio Almerigogna
- Internal Medicine Section, Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Federica Scarfì
- Dermatology Sect, Department of Translational Medicine and Surgery; University of Florence; Florence Italy
| | - Roberto Salerno
- Endocrinology Unit, Azienda Ospedaliera Universitaria Careggi; Florence Italy
| | - Tiziana Fanelli
- CRIMM Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Medicine; DENOTHE Excellence Center, University of Florence; Florence Italy
- University of Siena, Doctorate in genetic, oncology and clinical medicine
| | - Francesca Gesullo
- CRIMM Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Medicine; DENOTHE Excellence Center, University of Florence; Florence Italy
| | - Giuditta Corbizi Fattori
- CRIMM Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Medicine; DENOTHE Excellence Center, University of Florence; Florence Italy
- University of Siena, Doctorate in genetic, oncology and clinical medicine
| | - Massimiliano Bonifacio
- Department of Medicine, Haematology Section; Azienda Ospedaliera Universitaria Integrata Di Verona; Verona Italy
| | - Omar Perbellini
- Department of Medicine, Haematology Section; Azienda Ospedaliera Universitaria Integrata Di Verona; Verona Italy
| | - Anna Artuso
- Department of Medicine, Haematology Section; Azienda Ospedaliera Universitaria Integrata Di Verona; Verona Italy
| | - Simona Soverini
- Institute of Hematology Seragnoli DIMES, University of Bologna; Bologna Italy
| | | | - Simona Muratori
- Department of Medical and Surgical Physiopathology; Physiopathology of Transplant, Milano, Italy, University of Milano
| | - Valerio Pravettoni
- Internal Medicine, Clinic Allergology and Immunology; Ospedale Maggiore Policlinico, IRCCS Ca' Granda Foundation; Milano Italy
| | - Vittoria Cova
- Clinical Pathology Department; Azienda Unità Sanitaria Locale Della Romagna; Cesena Italy
| | | | - Fabio Ciceri
- Department of Hematology; San Raffaele Hospital; Milano Italy
| | - Agostino Cortelezzi
- Hematology and Transplantation Unit, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico and University of Milan; Milano Italy
| | - Giovanni Martinelli
- Institute of Hematology Seragnoli DIMES, University of Bologna; Bologna Italy
| | - Massimo Triggiani
- Clinical Immunology and Allergoloy; University of Salerno; Salerno Italy
| | - Serena Merante
- Department of Molecular Medicine; University of Pavia
- Department of Hematology Oncology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Alessandro Maria Vannucchi
- CRIMM Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero Universitaria Careggi, Department of Experimental and Clinical Medicine; DENOTHE Excellence Center, University of Florence; Florence Italy
| | - Roberta Zanotti
- Department of Medicine, Haematology Section; Azienda Ospedaliera Universitaria Integrata Di Verona; Verona Italy
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22
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Rotunno G, Pacilli A, Artusi V, Rumi E, Maffioli M, Delaini F, Brogi G, Fanelli T, Pancrazzi A, Pietra D, Bernardis I, Belotti C, Pieri L, Sant'Antonio E, Salmoiraghi S, Cilloni D, Rambaldi A, Passamonti F, Barbui T, Manfredini R, Cazzola M, Tagliafico E, Vannucchi AM, Guglielmelli P. Epidemiology and clinical relevance of mutations in postpolycythemia vera and postessential thrombocythemia myelofibrosis: A study on 359 patients of the AGIMM group. Am J Hematol 2016; 91:681-6. [PMID: 27037840 DOI: 10.1002/ajh.24377] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 03/28/2016] [Indexed: 12/14/2022]
Abstract
Transformation to secondary myelofibrosis (MF) occurs as part of the natural history of polycythemia vera (PPV-MF) and essential thrombocythemia (PET-MF). Although primary (PMF) and secondary MF are considered similar diseases and managed similarly, there are few studies specifically focused on the latter. The aim of this study was to characterize the mutation landscape, and describe the main clinical correlates and prognostic implications of mutations, in a series of 359 patients with PPV-MF and PET-MF. Compared with PV and ET, the JAK2V617F and CALR mutated allele burden was significantly higher in PPV-MF and/or PET-MF, indicating a role for accumulation of mutated alleles in the process of transformation to MF. However, neither the allele burden nor the type of driver mutation influenced overall survival (OS), while absence of any driver mutation (triple negativity) was associated with significant reduction of OS in PET-MF, similar to PMF. Of the five interrogated subclonal mutations (ASXL1, EZH2, SRSF2, IDH1, and IDH2), that comprise a prognostically detrimental high molecular risk (HMR) category in PMF, only SRSF2 mutations were associated with reduced survival in PET-MF, and no additional mutation profile with prognostic relevance was highlighted. Overall, these data indicate that the molecular landscape of secondary forms of MF is different from PMF, suggesting that unknown mutational events might contribute to the progression from chronic phase disease to myelofibrosis. These findings also support more extended genotyping approaches aimed at identifying novel molecular abnormalities with prognostic relevance for patients with PPV-MF and PET-MF. Am. J. Hematol. 91:681-686, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Giada Rotunno
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, DENOTHE Excellence Center; University of Florence; Florence Italy
| | - Annalisa Pacilli
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, DENOTHE Excellence Center; University of Florence; Florence Italy
| | - Valentina Artusi
- Center for Genome Research, and Department of Medical and Surgical Sciences; University of Modena and Reggio Emilia; Modena, Italy
| | - Elisa Rumi
- Department of Hematology Oncology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
- Department of Molecular Medicine; University of Pavia; Pavia Italy
| | - Margherita Maffioli
- Ospedale Di Circolo - Fondazione Macchi; University of Insubria; Varese Italy
| | - Federica Delaini
- Hematology and BMT Unit; ASST Papa Giovanni XXIII; Bergamo Italy
| | - Giada Brogi
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, DENOTHE Excellence Center; University of Florence; Florence Italy
| | - Tiziana Fanelli
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, DENOTHE Excellence Center; University of Florence; Florence Italy
- University of Siena; Siena Italy
| | - Alessandro Pancrazzi
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, DENOTHE Excellence Center; University of Florence; Florence Italy
| | - Daniela Pietra
- Department of Hematology Oncology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Isabella Bernardis
- Center for Genome Research, and Department of Medical and Surgical Sciences; University of Modena and Reggio Emilia; Modena, Italy
| | - Clara Belotti
- Hematology and BMT Unit; ASST Papa Giovanni XXIII; Bergamo Italy
| | - Lisa Pieri
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, DENOTHE Excellence Center; University of Florence; Florence Italy
| | - Emanuela Sant'Antonio
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, DENOTHE Excellence Center; University of Florence; Florence Italy
| | | | - Daniela Cilloni
- Department of Clinical and Biological Sciences University of Turin; San Luigi Hospital Turin; Turin Italy
| | | | | | - Tiziano Barbui
- FROM Research Foundation; Ospedale Papa Giovanni XXIII; Bergamo Italy
| | - Rossella Manfredini
- Department of Life Sciences, Centre for Regenerative Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - Mario Cazzola
- Department of Hematology Oncology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Enrico Tagliafico
- Center for Genome Research, and Department of Medical and Surgical Sciences; University of Modena and Reggio Emilia; Modena, Italy
| | - Alessandro M. Vannucchi
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, DENOTHE Excellence Center; University of Florence; Florence Italy
| | - Paola Guglielmelli
- CRIMM-Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, DENOTHE Excellence Center; University of Florence; Florence Italy
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23
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Martinaud C, Desterke C, Konopacki J, Vannucchi AM, Pieri L, Guglielmelli P, Dupriez B, Ianotto JC, Boutin L, Lataillade JJ, Le Bousse-Kerdilès MC. Transcriptome analysis of bone marrow mesenchymal stromal cells from patients with primary myelofibrosis. Genom Data 2015; 5:1-2. [PMID: 26484208 PMCID: PMC4583614 DOI: 10.1016/j.gdata.2015.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/13/2015] [Accepted: 04/20/2015] [Indexed: 10/27/2022]
Abstract
Primary myelofibrosis (PMF) is a clonal myeloproliferative neoplasm whose severity and treatment complexity are attributed to the presence of bone marrow (BM) fibrosis and alterations of stroma impairing the production of normal blood cells. Despite the recently discovered mutations including the JAK2V617F mutation in about half of patients, the primitive event responsible for the clonal proliferation is still unknown. In the highly inflammatory context of PMF, the presence of fibrosis associated with a neoangiogenesis and an osteosclerosis concomitant to the myeloproliferation and to the increase number of circulating hematopoietic progenitors suggests that the crosstalk between hematopoietic and stromal cells is deregulated in the PMF BM microenvironmental niches. Within these niches, mesenchymal stromal cells (BM-MSC) play a hematopoietic supportive role in the production of growth factors and extracellular matrix which regulate the proliferation, differentiation, adhesion and migration of hematopoietic stem/progenitor cells. A transcriptome analysis of BM-MSC in PMF patients will help to characterize their molecular alterations and to understand their involvement in the hematopoietic stem/progenitor cell deregulation that features PMF.
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Affiliation(s)
- Christophe Martinaud
- INSERM Unit 1197 and UMS33, Paul Brousse Hospital, Andre Lwoff Institute, France
| | - Christophe Desterke
- INSERM Unit 1197 and UMS33, Paul Brousse Hospital, Andre Lwoff Institute, France
| | - Johanna Konopacki
- INSERM Unit 1197 and UMS33, Paul Brousse Hospital, Andre Lwoff Institute, France
| | | | - Lisa Pieri
- INSERM Unit 1197 and UMS33, Paul Brousse Hospital, Andre Lwoff Institute, France
| | - Paola Guglielmelli
- INSERM Unit 1197 and UMS33, Paul Brousse Hospital, Andre Lwoff Institute, France
| | - Brigitte Dupriez
- INSERM Unit 1197 and UMS33, Paul Brousse Hospital, Andre Lwoff Institute, France
| | | | - Laetitia Boutin
- INSERM Unit 1197 and UMS33, Paul Brousse Hospital, Andre Lwoff Institute, France
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Ruiz-Arlandis G, Pieri L, Bousset L, Melki R. Binding, internalization and fate of Huntingtin Exon1 fibrillar assemblies in mitotic and nonmitotic neuroblastoma cells. Neuropathol Appl Neurobiol 2015; 42:137-52. [PMID: 26111612 DOI: 10.1111/nan.12258] [Citation(s) in RCA: 15] [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] [Received: 02/02/2015] [Accepted: 06/21/2015] [Indexed: 01/02/2023]
Abstract
AIMS The aggregation of Huntingtin (HTT) protein and of its moiety encoded by its Exon1 (HTTExon1) into fibrillar structures inside neurons is the molecular hallmark of Huntington's disease. Prion-like transmission of these aggregates between cells has been demonstrated. The cell-to-cell transmission mechanisms of these protein aggregates and the susceptibility of different kinds of neuronal cells to these toxic assemblies still need assessment. METHODS Here, we documented the binding to and internalization by differentiated and undifferentiated neuroblastoma cells of exogenous fibrillar HTTExon1 and polyglutamine (polyQ) polypeptides containing the same number of glutamines. We assessed the contribution of endocytosis to fibrillar HTTExon1 uptake, their intracellular localization and fate. RESULTS We observed that undifferentiated neuroblastoma cells were more susceptible to fibrillar HTTExon1 and polyQ than their differentiated counterparts. Furthermore, we demonstrated that exogenous HTTExon1 aggregates are mainly taken up by endocytosis and directed to lysosomal compartments in both mitotic and quiescent cells. CONCLUSIONS These data suggest that the rates of endocytic processes that differ in mitotic and quiescent cells strongly impact the uptake of exogenous HTTExon1 and polyQ fibrils. This may be either the consequence of distinct metabolisms or distributions of specific protein partners for amyloid-like assemblies at the surface of highly dividing versus quiescent cells. Our results highlight the importance of endocytic processes in the internalization of exogenous HTTExon1 fibrils and suggest that a proportion of those assemblies reach the cytosol where they can amplify by recruiting the endogenous protein after escaping, by yet an unknown process, from the endo-lysosomal compartments.
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Affiliation(s)
- G Ruiz-Arlandis
- Paris-Saclay Institute of Neuroscience, CNRS, Gif-sur-Yvette, France
| | - L Pieri
- Paris-Saclay Institute of Neuroscience, CNRS, Gif-sur-Yvette, France
| | - L Bousset
- Paris-Saclay Institute of Neuroscience, CNRS, Gif-sur-Yvette, France
| | - R Melki
- Paris-Saclay Institute of Neuroscience, CNRS, Gif-sur-Yvette, France
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Barbui T, Vannucchi AM, Carobbio A, Thiele J, Rumi E, Gisslinger H, Rodeghiero F, Randi ML, Rambaldi A, Pieri L, Pardanani A, Passamonti F, Finazzi G, Tefferi A. Patterns of presentation and thrombosis outcome in patients with polycythemia vera strictly defined by WHO-criteria and stratified by calendar period of diagnosis. Am J Hematol 2015; 90:434-7. [PMID: 25683038 DOI: 10.1002/ajh.23970] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/08/2015] [Indexed: 01/08/2023]
Abstract
Most studies in polycythemia vera (PV) include patients with both remote and most recent diagnostic periods and are therefore vulnerable to inaccurate interpretation of time-dependent data. We addressed the particular issue by analyzing presenting characteristics and outcome data among 1,545 patients with WHO-defined PV stratified by a diagnosis period of before or after 2005, which coincides with the first description of JAK2V617F as the molecular marker of PV. Patients diagnosed after 2005 displayed lower hemoglobin values (P < 0.0001) and older age (P = 0.007) at diagnosis; we suggest ease of diagnosis offered by a molecular marker enabled earlier diagnosis and broader application across older age groups that is further enhanced by recent trends in increased attention and health monitoring for the elderly. Post-2005 diagnosed patients were also more or less likely to receive aspirin and cytoreductive therapy, respectively, and, despite their older age distribution, displayed significantly lower risk of thrombosis in high risk disease. Regardless of the contributing factors to the latter phenomenon, our observations underscore the need to reassess current demographics and frequencies of thrombosis in clinical trial designs including thrombosis prevention in PV.
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Affiliation(s)
- Tiziano Barbui
- Research Foundation Papa Giovanni XXIII Hospital; Bergamo Italy
| | | | | | - Jurgen Thiele
- Institute of Pathology; University of Cologne; Cologne Germany
| | - Elisa Rumi
- Division of Hematology; University of Pavia, I.R.C.C.S. Policlinico San Matteo; Pavia Italy
| | - Heinz Gisslinger
- Division of Hematology; Medical University of Vienna; Vienna Austria
| | | | | | | | - Lisa Pieri
- Division of Hematology; University of Padua; Padua Italy
| | | | | | - Guido Finazzi
- Division of Hematology; Papa Giovanni XXIII Hospital; Bergamo Italy
| | - Ayalew Tefferi
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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26
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Tapper W, Jones AV, Kralovics R, Harutyunyan AS, Zoi K, Leung W, Godfrey AL, Guglielmelli P, Callaway A, Ward D, Aranaz P, White HE, Waghorn K, Lin F, Chase A, Joanna Baxter E, Maclean C, Nangalia J, Chen E, Evans P, Short M, Jack A, Wallis L, Oscier D, Duncombe AS, Schuh A, Mead AJ, Griffiths M, Ewing J, Gale RE, Schnittger S, Haferlach T, Stegelmann F, Döhner K, Grallert H, Strauch K, Tanaka T, Bandinelli S, Giannopoulos A, Pieri L, Mannarelli C, Gisslinger H, Barosi G, Cazzola M, Reiter A, Harrison C, Campbell P, Green AR, Vannucchi A, Cross NC. Genetic variation at MECOM, TERT, JAK2 and HBS1L-MYB predisposes to myeloproliferative neoplasms. Nat Commun 2015; 6:6691. [PMID: 25849990 PMCID: PMC4396373 DOI: 10.1038/ncomms7691] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 02/20/2015] [Indexed: 12/21/2022] Open
Abstract
Clonal proliferation in myeloproliferative neoplasms (MPN) is driven by somatic mutations in JAK2, CALR or MPL, but the contribution of inherited factors is poorly characterized. Using a three-stage genome-wide association study of 3,437 MPN cases and 10,083 controls, we identify two SNPs with genome-wide significance in JAK2(V617F)-negative MPN: rs12339666 (JAK2; meta-analysis P=1.27 × 10(-10)) and rs2201862 (MECOM; meta-analysis P=1.96 × 10(-9)). Two additional SNPs, rs2736100 (TERT) and rs9376092 (HBS1L/MYB), achieve genome-wide significance when including JAK2(V617F)-positive cases. rs9376092 has a stronger effect in JAK2(V617F)-negative cases with CALR and/or MPL mutations (Breslow-Day P=4.5 × 10(-7)), whereas in JAK2(V617F)-positive cases rs9376092 associates with essential thrombocythemia (ET) rather than polycythemia vera (allelic χ(2) P=7.3 × 10(-7)). Reduced MYB expression, previously linked to development of an ET-like disease in model systems, associates with rs9376092 in normal myeloid cells. These findings demonstrate that multiple germline variants predispose to MPN and link constitutional differences in MYB expression to disease phenotype.
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Affiliation(s)
- William Tapper
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Amy V. Jones
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Robert Kralovics
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Ashot S. Harutyunyan
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Katerina Zoi
- Haematology Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens 11527, Greece
| | - William Leung
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Anna L. Godfrey
- Department of Haematology, Addenbrooke’s Hospital, Cambridge CB2 0XY, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK
| | - Paola Guglielmelli
- Laboratorio Congiunto MMPC, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Alison Callaway
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Daniel Ward
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Paula Aranaz
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Helen E. White
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Katherine Waghorn
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Feng Lin
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - Andrew Chase
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
| | - E. Joanna Baxter
- Department of Haematology, Addenbrooke’s Hospital, Cambridge CB2 0XY, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK
| | - Cathy Maclean
- Department of Haematology, Addenbrooke’s Hospital, Cambridge CB2 0XY, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK
| | - Jyoti Nangalia
- Department of Haematology, Addenbrooke’s Hospital, Cambridge CB2 0XY, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK
| | - Edwin Chen
- Department of Haematology, Addenbrooke’s Hospital, Cambridge CB2 0XY, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK
| | - Paul Evans
- Haematological Malignancy Diagnostic Service, St James's Institute of Oncology, Bexley Wing, St James's University Hospital, Leeds LS9 7TF, UK
| | - Michael Short
- Haematological Malignancy Diagnostic Service, St James's Institute of Oncology, Bexley Wing, St James's University Hospital, Leeds LS9 7TF, UK
| | - Andrew Jack
- Haematological Malignancy Diagnostic Service, St James's Institute of Oncology, Bexley Wing, St James's University Hospital, Leeds LS9 7TF, UK
| | - Louise Wallis
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK
| | - David Oscier
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK
| | - Andrew S. Duncombe
- Department of Haematology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Anna Schuh
- Oxford Biomedical Research Centre, Molecular Diagnostic Laboratory, Oxford University Hospitals NHS Trust, Oxford OX3 7LE, UK
| | - Adam J. Mead
- Haematopoietic Stem Cell Biology Laboratory, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, UK
| | - Michael Griffiths
- School of Cancer Sciences, University of Birmingham,, Birmingham B15 2TT, UK
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham B15 2TG, UK
| | - Joanne Ewing
- Birmingham Heartlands Hospital, Birmingham B9 5SS, UK
| | - Rosemary E. Gale
- Department of Haematology, UCL Cancer Institute, London WC1 E6BT, UK
| | | | | | - Frank Stegelmann
- Department of Internal Medicine III, University Hospital of Ulm, Ulm 89081, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm 89081, Germany
| | - Harald Grallert
- Institute of Epidemiology II, Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg 85764, Germany
- German Center for Diabetes Research, Neuherberg 85764, Germany
| | - Konstantin Strauch
- Institute of Epidemiology II, Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg 85764, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, 80539 Munich, Germany
| | - Toshiko Tanaka
- Longitudinal Study Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland 21224-6825, USA
| | | | - Andreas Giannopoulos
- Haematology Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens 11527, Greece
| | - Lisa Pieri
- Laboratorio Congiunto MMPC, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Carmela Mannarelli
- Laboratorio Congiunto MMPC, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Heinz Gisslinger
- Medical University of Vienna, Department of Internal Medicine I, Division of Hematology and Blood Coagulation, Vienna 1090, Austria
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico San Matteo Foundation, Pavia 27100, Italy
| | - Mario Cazzola
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy
| | - Andreas Reiter
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim 68167, Germany
| | - Claire Harrison
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London SE1 9RT, UK
| | - Peter Campbell
- Cancer Genome Project, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, UK
| | - Anthony R. Green
- Department of Haematology, Addenbrooke’s Hospital, Cambridge CB2 0XY, UK
- Department of Haematology, University of Cambridge, Cambridge CB2 0XY, UK
| | - Alessandro Vannucchi
- Laboratorio Congiunto MMPC, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Nicholas C.P. Cross
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury SP2 8BJ, UK
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27
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Desterke C, Martinaud C, Guerton B, Pieri L, Bogani C, Clay D, Torossian F, Lataillade JJ, Hasselbach HC, Gisslinger H, Demory JL, Dupriez B, Boucheix C, Rubinstein E, Amsellem S, Vannucchi AM, Le Bousse-Kerdilès MC. Tetraspanin CD9 participates in dysmegakaryopoiesis and stromal interactions in primary myelofibrosis. Haematologica 2015; 100:757-67. [PMID: 25840601 DOI: 10.3324/haematol.2014.118497] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 03/23/2015] [Indexed: 12/11/2022] Open
Abstract
Primary myelofibrosis is characterized by clonal myeloproliferation, dysmegakaryopoiesis, extramedullary hematopoiesis associated with myelofibrosis and altered stroma in the bone marrow and spleen. The expression of CD9, a tetraspanin known to participate in megakaryopoiesis, platelet formation, cell migration and interaction with stroma, is deregulated in patients with primary myelofibrosis and is correlated with stage of myelofibrosis. We investigated whether CD9 participates in the dysmegakaryopoiesis observed in patients and whether it is involved in the altered interplay between megakaryocytes and stromal cells. We found that CD9 expression was modulated during megakaryocyte differentiation in primary myelofibrosis and that cell surface CD9 engagement by antibody ligation improved the dysmegakaryopoiesis by restoring the balance of MAPK and PI3K signaling. When co-cultured on bone marrow mesenchymal stromal cells from patients, megakaryocytes from patients with primary myelofibrosis displayed modified behaviors in terms of adhesion, cell survival and proliferation as compared to megakaryocytes from healthy donors. These modifications were reversed after antibody ligation of cell surface CD9, suggesting the participation of CD9 in the abnormal interplay between primary myelofibrosis megakaryocytes and stroma. Furthermore, silencing of CD9 reduced CXCL12 and CXCR4 expression in primary myelofibrosis megakaryocytes as well as their CXCL12-dependent migration. Collectively, our results indicate that CD9 plays a role in the dysmegakaryopoiesis that occurs in primary myelofibrosis and affects interactions between megakaryocytes and bone marrow stromal cells. These results strengthen the "bad seed in bad soil" hypothesis that we have previously proposed, in which alterations of reciprocal interactions between hematopoietic and stromal cells participate in the pathogenesis of primary myelofibrosis.
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Affiliation(s)
- Christophe Desterke
- INSERM UMR-S1197, Paul Brousse Hospital, Paris-Sud University, Villejuif, France INSERM UMS33, Paul Brousse Hospital, Paris-Sud University, Villejuif, France
| | - Christophe Martinaud
- INSERM UMR-S1197, Paul Brousse Hospital, Paris-Sud University, Villejuif, France CTS of Army, Percy Hospital, Clamart, France
| | - Bernadette Guerton
- INSERM UMR-S1197, Paul Brousse Hospital, Paris-Sud University, Villejuif, France
| | - Lisa Pieri
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Costanza Bogani
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Denis Clay
- INSERM UMR-S1197, Paul Brousse Hospital, Paris-Sud University, Villejuif, France INSERM UMS33, Paul Brousse Hospital, Paris-Sud University, Villejuif, France
| | - Frederic Torossian
- INSERM UMR-S1197, Paul Brousse Hospital, Paris-Sud University, Villejuif, France INSERM UMS33, Paul Brousse Hospital, Paris-Sud University, Villejuif, France
| | - Jean-Jacques Lataillade
- INSERM UMR-S1197, Paul Brousse Hospital, Paris-Sud University, Villejuif, France Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Hans C Hasselbach
- Department of Hematology, Herlev University Hospital, Copenhagen, Denmark
| | - Heinz Gisslinger
- Department of Hematology, University Klinik Fur Innere Medizin, Vienna, Austria
| | - Jean-Loup Demory
- Université Catholique de Lille, France French Intergroup on Myeloproliferative Neoplasms (FIM), France
| | - Brigitte Dupriez
- French Intergroup on Myeloproliferative Neoplasms (FIM), France Department of Hematology, Dr Schaffner Hospital, Lens, France
| | - Claude Boucheix
- INSERM UMS33, Paul Brousse Hospital, Paris-Sud University, Villejuif, France Inserm U935, Paul Brousse Hospital, Paris-Sud University, Villejuif, France
| | - Eric Rubinstein
- INSERM UMS33, Paul Brousse Hospital, Paris-Sud University, Villejuif, France Inserm U935, Paul Brousse Hospital, Paris-Sud University, Villejuif, France
| | - Sophie Amsellem
- Department of Hematology, Gustave Roussy Institute, Villejuif, France
| | | | - Marie-Caroline Le Bousse-Kerdilès
- INSERM UMR-S1197, Paul Brousse Hospital, Paris-Sud University, Villejuif, France INSERM UMS33, Paul Brousse Hospital, Paris-Sud University, Villejuif, France French Intergroup on Myeloproliferative Neoplasms (FIM), France
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28
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Pieri L, Guglielmelli P, Vannucchi AM. Ruxolitinib-induced reversal of alopecia universalis in a patient with essential thrombocythemia. Am J Hematol 2015; 90:82-3. [PMID: 25307179 DOI: 10.1002/ajh.23871] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/09/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Lisa Pieri
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
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29
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Martinelli I, De Stefano V, Carobbio A, Randi ML, Santarossa C, Rambaldi A, Finazzi MC, Cervantes F, Arellano-Rodrigo E, Rupoli S, Canafoglia L, Tieghi A, Facchini L, Betti S, Vannucchi AM, Pieri L, Cacciola R, Cacciola E, Cortelezzi A, Iurlo A, Pogliani EM, Elli EM, Spadea A, Barbui T. Cerebral vein thrombosis in patients with Philadelphia-negative myeloproliferative neoplasms. An European Leukemia Net study. Am J Hematol 2014; 89:E200-5. [PMID: 25042466 DOI: 10.1002/ajh.23809] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 01/23/2023]
Abstract
To investigate the characteristics and clinical course of cerebral vein thrombosis (CVT) in patients with myeloproliferative neoplasms (MPN) we compared 48 patients with MPN and CVT (group MPN-CVT) to 87 with MPN and other venous thrombosis (group MPN-VT) and 178 with MPN and no thrombosis (group MPN-NoT) matched by sex, age at diagnosis of MPN (±5 years) and type of MPN. The study population was identified among 5,500 patients with MPN, from January 1982 to June 2013. Thrombophilia abnormalities were significantly more prevalent in the MPN-CVT and MPN-VT than in MPN-NoT group (P = 0.015), as well as the JAK2 V617F mutation in patients with essential thrombocythemia (P = 0.059). Compared to MPN-VT, MPN-CVT patients had a higher rate of recurrent thrombosis (42% vs. 25%, P = 0.049) despite a shorter median follow-up period (6.1 vs. 10.3 years, P = 0.019), a higher long-term antithrombotic (94% vs. 84%, P = 0.099) and a similar cytoreductive treatment (79% vs. 70%, P = 0.311). The incidence of recurrent thrombosis was double in MPN-CVT than in MPN-VT group (8.8% and 4.2% patient-years, P = 0.022), and CVT and unprovoked event were the only predictive variables in a multivariate model including also sex, blood count, thrombophilia, cytoreductive, and antithrombotic treatment (HR 1.97, 95%CI 1.05-3.72 and 2.09, 1.09-4.00, respectively).
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Affiliation(s)
- Ida Martinelli
- Angelo Bianchi Bonomi Hemophilia and Thrombosis; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan; Italy
| | | | | | | | | | | | | | | | | | | | | | - Alessia Tieghi
- Hematology Oncology Department; AO Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia; Italy
| | - Luca Facchini
- Hematology Oncology Department; AO Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia; Italy
| | - Silvia Betti
- Institute of Hematology; Catholic University; Rome Italy
| | | | - Lisa Pieri
- Department of Experimental and Clinical Medicine; University of Florence; Italy
| | - Rossella Cacciola
- Haemostasis Unit, Department of Clinical and Molecular Biology; AOU Policlinico Vittorio Emanuele; Catania Italy
| | - Emma Cacciola
- Haemostasis Unit, Department of Clinical and Molecular Biology; AOU Policlinico Vittorio Emanuele; Catania Italy
| | - Agostino Cortelezzi
- Hematology and Transplantation Unit; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan; Italy
| | - Alessandra Iurlo
- Hematology and Transplantation Unit; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan; Italy
| | - Enrico M. Pogliani
- Hematology Division and BMT Unit; San Gerardo Hospital, Milan Bicocca University; Monza Italy
| | - Elena M. Elli
- Hematology Division and BMT Unit; San Gerardo Hospital, Milan Bicocca University; Monza Italy
| | - Antonio Spadea
- Unit of Hematology; Regina Elena National Cancer Institute; Rome Italy
| | - Tiziano Barbui
- Research Foundation; AO Papa Giovanni XXIII; Bergamo Italy
- Hematology Division; AO Papa Giovanni XXIII; Bergamo Italy
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30
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Bacci S, Defraia B, Cinci L, Calosi L, Guasti D, Pieri L, Lotti V, Bonelli A, Romagnoli P. Immunohistochemical analysis of dendritic cells in skin lesions: Correlations with survival time. Forensic Sci Int 2014; 244:179-85. [DOI: 10.1016/j.forsciint.2014.08.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/14/2014] [Accepted: 08/24/2014] [Indexed: 12/25/2022]
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31
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Lussana F, Carobbio A, Randi ML, Elena C, Rumi E, Finazzi G, Bertozzi I, Pieri L, Ruggeri M, Palandri F, Polverelli N, Elli E, Tieghi A, Iurlo A, Ruella M, Cazzola M, Rambaldi A, Vannucchi AM, Barbui T. A lower intensity of treatment may underlie the increased risk of thrombosis in young patients with masked polycythaemia vera. Br J Haematol 2014; 167:541-6. [PMID: 25130523 DOI: 10.1111/bjh.13080] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 05/24/2014] [Accepted: 07/10/2014] [Indexed: 01/22/2023]
Abstract
In patients who do not meet the World Health Organization (WHO) criteria for overt polycythaemia vera (PV), a diagnosis of masked PV (mPV) can be determined. A fraction of mPV patients may display thrombocytosis, thus mimicking essential thrombocythaemia (ET). No previous studies have examined clinical outcomes of mPV among young JAK2-mutated patients. We analysed a retrospective cohort of 538 JAK2-mutated patients younger than 40 years, after a re-assessment of the diagnosis according to the haemoglobin threshold for mPV. In this cohort of patients, 97 (18%) met the WHO criteria for PV, 66 patients (12%) were classified as mPV and 375 (70%) as JAK2-mutated ET. Surprisingly, a significant difference in the incidence of thrombosis was found when comparing mPV versus overt PV patients (P = 0·04). In multivariate analysis, the only factor accounting for the difference in the risk of thrombosis was the less frequent use of phlebotomies and cytoreduction in mPV patients compared to those with overt PV. Thus, we emphasize the need for the identification of mPV in young JAK2-mutated patients in order to optimize their treatments.
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Affiliation(s)
- Federico Lussana
- Haematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
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Verstovsek S, Passamonti F, Rambaldi A, Barosi G, Rosen PJ, Rumi E, Gattoni E, Pieri L, Guglielmelli P, Elena C, He S, Contel N, Mookerjee B, Sandor V, Cazzola M, Kantarjian HM, Barbui T, Vannucchi AM. A phase 2 study of ruxolitinib, an oral JAK1 and JAK2 Inhibitor, in patients with advanced polycythemia vera who are refractory or intolerant to hydroxyurea. Cancer 2014; 120:513-20. [PMID: 24258498 PMCID: PMC4231215 DOI: 10.1002/cncr.28441] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/04/2013] [Accepted: 09/17/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Polycythemia vera (PV) is a myeloproliferative neoplasm associated with somatic gain-of-function mutations of Januskinase-2 (JAK2). Therapeutic options are limited in patients with advanced disease. Ruxolitinib, an oral JAK1/JAK2 inhibitor, is active in preclinical models of PV. The long-term efficacy and safety of ruxolitinib in patients with advanced PV who are refractory or intolerant to hydroxyurea were studied in a phase 2 trial. METHODS Response was assessed using modified European LeukemiaNet criteria, which included a reduction in hematocrit to < 45% without phlebotomy, resolution of palpable splenomegaly, normalization of white blood cell and platelet counts, and reduction in PV-associated symptoms. RESULTS Thirty-four patients received ruxolitinib for a median of 152 weeks (range, 31 weeks-177 weeks) or 35.0 months (range, 7.1 months-40.7 months). Hematocrit < 45% without phlebotomy was achieved in 97% of patients by week 24. Only 1 patient required a phlebotomy after week 4. Among patients with palpable splenomegaly at baseline, 44% and 63%, respectively, achieved nonpalpable spleen measurements at weeks 24 and 144. Clinically meaningful improvements in pruritus, night sweats, and bone pain were observed within 4 weeks of the initiation of therapy and maintained with continued treatment. Ruxolitinib treatment also reduced elevated levels of inflammatory cytokines and granulocyte activation. Thrombocytopenia and anemia were the most common adverse events. Thrombocytopenia of ≥ grade 3 or anemia of ≥ grade 3 (according to National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0) occurred in 3 patients each (9%) (1 patient had both) and were managed with dose modification. CONCLUSIONS Ruxolitinib was generally well tolerated and provided rapid and durable clinical benefits in patients with advanced PV who were refractory or intolerant to hydroxyurea. Cancer 2014;120:513–20. © 2013 The Authors published by Wiley Periodicals, Inc. on behalf of American Cancer Society. In the current study, patients with polycythemia vera who were refractory or intolerant to hydroxyurea achieved clinically meaningful and durable benefit from treatment with ruxolitinib with respect to reductions in hematocrit, platelet and white blood cell counts, splenomegaly, and symptoms. Given the limited therapeutic options for patients with advanced polycythemia vera, these results suggest that ruxolitinib has the potential to address an important unmet medical need in this patient population.
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Affiliation(s)
- Srdan Verstovsek
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer CenterHouston, Texas
| | - Francesco Passamonti
- Division of Hematology, Department of Internal Medicine, Ospedali di Circolo e Fondazione MacchiVarese, Italy
| | - Alessandro Rambaldi
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIIIBergamo, Italy
| | - Giovanni Barosi
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San MatteoPavia, Italy
| | - Peter J Rosen
- Tower Cancer Research FoundationBeverly Hills, California
| | - Elisa Rumi
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San MatteoPavia, Italy
| | | | - Lisa Pieri
- Department of Experimental and Clinical Medicine, University of FlorenceFlorence, Italy
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine, University of FlorenceFlorence, Italy
| | - Chiara Elena
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San MatteoPavia, Italy
| | - Shui He
- Incyte CorporationWilmington, Delaware
| | | | | | | | - Mario Cazzola
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San MatteoPavia, Italy
- Department of Molecular Medicine, University of PaviaPavia, Italy
| | - Hagop M Kantarjian
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer CenterHouston, Texas
| | - Tiziano Barbui
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIIIBergamo, Italy
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Tiziana Storlazzi C, Pieri L, Paoli C, Daniele G, Lasho T, Tefferi A, Vannucchi AM. Complex karyotype in a polycythemia vera patient with a novel SETD1B/GTF2H3 fusion gene. Am J Hematol 2014; 89:438-42. [PMID: 24382738 DOI: 10.1002/ajh.23659] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 12/24/2013] [Accepted: 12/28/2013] [Indexed: 11/07/2022]
Abstract
The patient had been diagnosed with polycythemia vera (PV) in 1999, at the age of 61, according to the criteria of the Polycythemia Vera Study Group (PVSG) on the basis of the increased red cell mass by isotope determination, normal oxygen saturation, low plasma erythropoietin level, presence of endogenous erythroid colonies (EEC), and splenomegaly. Histopathology of bone marrow biopsy was also consistent with polycythemia vera with no evidence of increased reticulin fibrosis. A karyotype analysis was not performed at that time. He had been treated initially with phlebotomies and then with hydroxyurea with the aim to obtain a better control of hematocrit; he was under low-dose aspirin. In 2009, 10 years after the diagnosis, while the patient was still being treated with hydroxyurea and phlebotomies, he noticed worsening of general conditions and fatigue, and the appearance of night sweats; he also reported that his spleen volume had increased rapidly in the past few months. He complained of severe pruritus especially after (but not limited to) a shower. He was referred to our center for further evaluation. At presentation, his blood counts were as follows: hemoglobin 157 g/L, hematocrit 54.7%, leukocytes 13.1 × 10⁹ /L, platelets 238 × 10⁹ /L, LDH 856 U/L (normal upper limit, 250 U/L). Blood film examination showed neutrophilia (8.9 × 10⁹ /L) but immature myeloid cells and nucleated erythroblasts were absent. The spleen was 14 cm below the left costal margin, the liver was at 4 cm below the right costal margin. He was found to harbor the JAK2V617F mutation with an allele burden of 85% and the circulating CD34⁺ cell count was 14 × 10⁶ /L. A bone marrow biopsy showed the presence of hyperplasia of myeloid and erythroid lineages, increased number of scattered megakarocytes without overt morphologic abnormalities; reticulin fibrosis was grade 1 according to the European classification. On these basis, we considered the patient as presenting the features of PV according to the 2008 WHO classification of myeloid neoplasms associated with grade 1 reticulin fibrosis.
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Affiliation(s)
- Clelia Tiziana Storlazzi
- Department of Experimental and Clinical Medicine; University of Florence; Largo Brambilla 3 50134 Florence Italy
| | - Lisa Pieri
- Department of Experimental and Clinical Medicine; University of Florence; Largo Brambilla 3 50134 Florence Italy
| | - Chiara Paoli
- Department of Experimental and Clinical Medicine; University of Florence; Largo Brambilla 3 50134 Florence Italy
| | - Giulia Daniele
- Department of Experimental and Clinical Medicine; University of Florence; Largo Brambilla 3 50134 Florence Italy
| | - Terra Lasho
- Department of Experimental and Clinical Medicine; University of Florence; Largo Brambilla 3 50134 Florence Italy
| | - Ayalew Tefferi
- Department of Experimental and Clinical Medicine; University of Florence; Largo Brambilla 3 50134 Florence Italy
| | - Alessandro M. Vannucchi
- Department of Experimental and Clinical Medicine; University of Florence; Largo Brambilla 3 50134 Florence Italy
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Vannucchi AM, Rotunno G, Bartalucci N, Raugei G, Carrai V, Balliu M, Mannarelli C, Pacilli A, Calabresi L, Fjerza R, Pieri L, Bosi A, Manfredini R, Guglielmelli P. Calreticulin mutation-specific immunostaining in myeloproliferative neoplasms: pathogenetic insight and diagnostic value. Leukemia 2014; 28:1811-8. [PMID: 24618731 PMCID: PMC4158831 DOI: 10.1038/leu.2014.100] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [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: 02/07/2014] [Revised: 02/20/2014] [Accepted: 02/28/2014] [Indexed: 01/01/2023]
Abstract
Mutations in the gene calreticulin (CALR) occur in the majority of JAK2- and MPL-unmutated patients with essential thrombocythemia (ET) and primary myelofibrosis (PMF); identifying CALR mutations contributes to the diagnostic pathway of ET and PMF. CALR mutations are heterogeneous spanning over the exon 9, but all result in a novel common protein C terminus. We developed a polyclonal antibody against a 17-amino-acid peptide derived from mutated calreticulin that was used for immunostaining of bone marrow biopsies. We show that this antibody specifically recognized patients harboring different types of CALR mutation with no staining in healthy controls and JAK2- or MPL-mutated ET and PMF. The labeling was mostly localized in megakaryocytes, whereas myeloid and erythroid cells showed faint staining, suggesting a preferential expression of calreticulin in megakaryocytes. Megakaryocytic-restricted expression of calreticulin was also demonstrated using an antibody against wild-type calreticulin and by measuring the levels of calreticulin RNA by gene expression analysis. Immunostaining using an antibody specific for mutated calreticulin may become a rapid, simple and cost-effective method for identifying CALR-mutated patients complementing molecular analysis; furthermore, the labeling pattern supports the preferential expansion of megakaryocytic cell lineage as a result of CALR mutation in an immature hematopoietic stem cell.
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Affiliation(s)
- A M Vannucchi
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - G Rotunno
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - N Bartalucci
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - G Raugei
- Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - V Carrai
- Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - M Balliu
- Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - C Mannarelli
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - A Pacilli
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - L Calabresi
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - R Fjerza
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - L Pieri
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - A Bosi
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - R Manfredini
- Centre for Regenerative Medicine 'Stefano Ferrari', Department of Life Science, University of Modena and Reggio Emilia, Modena, Italy
| | - P Guglielmelli
- 1] Department of Experimental and Clinical Medicine, Laboratorio Congiunto MMPC, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence, Italy [2] Hematology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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Vannucchi AM, Guglielmelli P, Pieri L, Antonioli E, Bosi A. Treatment options for essential thrombocythemia and polycythemia vera. Expert Rev Hematol 2014; 2:41-55. [DOI: 10.1586/17474086.2.1.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Barbui T, Thiele J, Gisslinger H, Finazzi G, Carobbio A, Rumi E, Luigia Randi M, Betozzi I, Vannucchi AM, Pieri L, Carrai V, Gisslinger B, Müllauer L, Ruggeri M, Rambaldi A, Tefferi A. Masked polycythemia vera (mPV): results of an international study. Am J Hematol 2014; 89:52-4. [PMID: 23996471 DOI: 10.1002/ajh.23585] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 08/27/2013] [Indexed: 01/30/2023]
Abstract
We examined the baseline features and clinical outcomes of 140 patients presenting with JAK2V617F positivity and a bone marrow morphology conforming with WHO criteria of polycythemia vera (PV), but a hemoglobin level of <18.5 g/dL in males (range 16.0-18.4) and <16.5 g/dL in females (range 15.0-16.4). This cohort operationally referred to as masked PV (mPV) was compared with 257 patients with overt PV and displayed male predominance, a more frequent history of arterial thrombosis and thrombocytosis. Incidence of thrombosis was similar between the two groups but mPV displayed significantly higher rates of progression to myelofibrosis and acute leukemia and inferior survival. In multivariable analysis mPV diagnosis was an independent predictor of poor survival along with age >65 years and leukocyte count >10 × 10(9) /L. Our data suggest that mPV is a heterogeneous myeloproliferative neoplasia and not necessarily an early/ pre-polycythemic form of classical PV that at onset in a small fraction of patients clinically may mimic essential thrombocythemia. On the other hand, the majority mPV may have a longer prodrome of undiagnosed PV or a disease biology akin to primary myelofibrosis-post PV myelofibrosis that could explain the worsening of outcome in comparison to overt/classical manifestations.
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Affiliation(s)
| | | | | | | | | | - Elisa Rumi
- University of Pavia; I.R.C.C.S. Policlinico San Matteo Pavia Italy
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Klampfl T, Milosevic JD, Puda A, Schönegger A, Bagienski K, Berg T, Harutyunyan AS, Gisslinger B, Rumi E, Malcovati L, Pietra D, Elena C, Della Porta MG, Pieri L, Guglielmelli P, Bock C, Doubek M, Dvorakova D, Suvajdzic N, Tomin D, Tosic N, Racil Z, Steurer M, Pavlovic S, Vannucchi AM, Cazzola M, Gisslinger H, Kralovics R. Complex patterns of chromosome 11 aberrations in myeloid malignancies target CBL, MLL, DDB1 and LMO2. PLoS One 2013; 8:e77819. [PMID: 24147083 PMCID: PMC3797696 DOI: 10.1371/journal.pone.0077819] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/04/2013] [Indexed: 11/19/2022] Open
Abstract
Exome sequencing of primary tumors identifies complex somatic mutation patterns. Assignment of relevance of individual somatic mutations is difficult and poses the next challenge for interpretation of next generation sequencing data. Here we present an approach how exome sequencing in combination with SNP microarray data may identify targets of chromosomal aberrations in myeloid malignancies. The rationale of this approach is that hotspots of chromosomal aberrations might also harbor point mutations in the target genes of deletions, gains or uniparental disomies (UPDs). Chromosome 11 is a frequent target of lesions in myeloid malignancies. Therefore, we studied chromosome 11 in a total of 813 samples from 773 individual patients with different myeloid malignancies by SNP microarrays and complemented the data with exome sequencing in selected cases exhibiting chromosome 11 defects. We found gains, losses and UPDs of chromosome 11 in 52 of the 813 samples (6.4%). Chromosome 11q UPDs frequently associated with mutations of CBL. In one patient the 11qUPD amplified somatic mutations in both CBL and the DNA repair gene DDB1. A duplication within MLL exon 3 was detected in another patient with 11qUPD. We identified several common deleted regions (CDR) on chromosome 11. One of the CDRs associated with de novo acute myeloid leukemia (P=0.013). One patient with a deletion at the LMO2 locus harbored an additional point mutation on the other allele indicating that LMO2 might be a tumor suppressor frequently targeted by 11p deletions. Our chromosome-centered analysis indicates that chromosome 11 contains a number of tumor suppressor genes and that the role of this chromosome in myeloid malignancies is more complex than previously recognized.
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Affiliation(s)
- Thorsten Klampfl
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Jelena D. Milosevic
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Ana Puda
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Andreas Schönegger
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Klaudia Bagienski
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Tiina Berg
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Ashot S. Harutyunyan
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Bettina Gisslinger
- Division of Hematology and Blood Coagulation, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Elisa Rumi
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Malcovati
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Pietra
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Elena
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Giovanni Della Porta
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Lisa Pieri
- Section of Hematology, University of Florence, Florence, Italy
| | | | - Christoph Bock
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Michael Doubek
- Department of Internal Medicine Hematology and Oncology, University Hospital Brno, Masaryk University Brno, Brno, Czech Republic, Czech Republic
- CEITEC - Central European Institute of Technology, Masaryk University Brno, Brno, Czech Republic
| | - Dana Dvorakova
- Department of Internal Medicine Hematology and Oncology, University Hospital Brno, Masaryk University Brno, Brno, Czech Republic, Czech Republic
- CEITEC - Central European Institute of Technology, Masaryk University Brno, Brno, Czech Republic
| | - Nada Suvajdzic
- Clinic of Hematology, Clinical Center of Serbia, University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Dragica Tomin
- Clinic of Hematology, Clinical Center of Serbia, University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Natasa Tosic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Zdenek Racil
- Department of Internal Medicine Hematology and Oncology, University Hospital Brno, Masaryk University Brno, Brno, Czech Republic, Czech Republic
- CEITEC - Central European Institute of Technology, Masaryk University Brno, Brno, Czech Republic
| | - Michael Steurer
- Division of Hematology and Oncology, Innsbruck University Hospital, Innsbruck, Austria
| | - Sonja Pavlovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | | | - Mario Cazzola
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Heinz Gisslinger
- Division of Hematology and Blood Coagulation, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Robert Kralovics
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Division of Hematology and Blood Coagulation, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Tefferi A, Rumi E, Finazzi G, Gisslinger H, Vannucchi AM, Rodeghiero F, Randi ML, Vaidya R, Cazzola M, Rambaldi A, Gisslinger B, Pieri L, Ruggeri M, Bertozzi I, Sulai NH, Casetti I, Carobbio A, Jeryczynski G, Larson DR, Müllauer L, Pardanani A, Thiele J, Passamonti F, Barbui T. Survival and prognosis among 1545 patients with contemporary polycythemia vera: an international study. Leukemia 2013; 27:1874-81. [PMID: 23739289 PMCID: PMC3768558 DOI: 10.1038/leu.2013.163] [Citation(s) in RCA: 454] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 05/17/2013] [Indexed: 01/07/2023]
Abstract
Under the auspices of an International Working Group, seven centers submitted diagnostic and follow-up information on 1545 patients with World Health Organization-defined polycythemia vera (PV). At diagnosis, median age was 61 years (51% females); thrombocytosis and venous thrombosis were more frequent in women and arterial thrombosis and abnormal karyotype in men. Considering patients from the center with the most mature follow-up information (n=337 with 44% of patients followed to death), median survival (14.1 years) was significantly worse than that of the age- and sex-matched US population (P<0.001). In multivariable analysis, survival for the entire study cohort (n=1545) was adversely affected by older age, leukocytosis, venous thrombosis and abnormal karyotype; a prognostic model that included the first three parameters delineated risk groups with median survivals of 10.9-27.8 years (hazard ratio (HR), 10.7; 95% confidence interval (CI): 7.7-15.0). Pruritus was identified as a favorable risk factor for survival. Cumulative hazard of leukemic transformation, with death as a competing risk, was 2.3% at 10 years and 5.5% at 15 years; risk factors included older age, abnormal karyotype and leukocytes ≥15 × 10(9)/l. Leukemic transformation was associated with treatment exposure to pipobroman or P32/chlorambucil. We found no association between leukemic transformation and hydroxyurea or busulfan use.
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Affiliation(s)
- A Tefferi
- Division of Hematology, Department of
Medicine, Clinic, Rochester, MN, USA
| | - E Rumi
- Department of Hematology, University of
Pavia, IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Finazzi
- Ospedali Riuniti di Bergamo,
Bergamo, Italy
| | | | - A M Vannucchi
- Department of Hematology, University of
Florence, Florence, Italy
| | | | - M L Randi
- Department of Hematology, University of
Padua, Padua, Italy
| | - R Vaidya
- Division of Hematology, Department of
Medicine, Clinic, Rochester, MN, USA
| | - M Cazzola
- Department of Hematology, University of
Pavia, IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Rambaldi
- Ospedali Riuniti di Bergamo,
Bergamo, Italy
| | | | - L Pieri
- Department of Hematology, University of
Florence, Florence, Italy
| | | | - I Bertozzi
- Department of Hematology, University of
Padua, Padua, Italy
| | - N H Sulai
- Division of Hematology, Department of
Medicine, Clinic, Rochester, MN, USA
| | - I Casetti
- Department of Hematology, University of
Pavia, IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Carobbio
- Ospedali Riuniti di Bergamo,
Bergamo, Italy
| | | | - D R Larson
- Division of Hematology, Department of
Medicine, Clinic, Rochester, MN, USA
| | - L Müllauer
- Medical University of Vienna,
Vienna, Austria
| | - A Pardanani
- Division of Hematology, Department of
Medicine, Clinic, Rochester, MN, USA
| | - J Thiele
- Department of Pathology, University of
Cologne, Cologne, Germany
| | | | - T Barbui
- Ospedali Riuniti di Bergamo,
Bergamo, Italy
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40
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Spolverini A, Pieri L, Guglielmelli P, Pancrazzi A, Fanelli T, Paoli C, Bosi A, Nichele I, Ruggeri M, Vannucchi AM. Infrequent occurrence of mutations in the PH domain of LNK in patients with JAK2 mutation-negative 'idiopathic' erythrocytosis. Haematologica 2013; 98:e101-2. [PMID: 23812944 DOI: 10.3324/haematol.2013.090175] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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41
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Vannucchi AM, Lasho TL, Guglielmelli P, Biamonte F, Pardanani A, Pereira A, Finke C, Score J, Gangat N, Mannarelli C, Ketterling RP, Rotunno G, Knudson RA, Susini MC, Laborde RR, Spolverini A, Pancrazzi A, Pieri L, Manfredini R, Tagliafico E, Zini R, Jones A, Zoi K, Reiter A, Duncombe A, Pietra D, Rumi E, Cervantes F, Barosi G, Cazzola M, Cross NCP, Tefferi A. Mutations and prognosis in primary myelofibrosis. Leukemia 2013; 27:1861-9. [PMID: 23619563 DOI: 10.1038/leu.2013.119] [Citation(s) in RCA: 559] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 04/11/2013] [Accepted: 04/12/2013] [Indexed: 11/09/2022]
Abstract
Patient outcome in primary myelofibrosis (PMF) is significantly influenced by karyotype. We studied 879 PMF patients to determine the individual and combinatorial prognostic relevance of somatic mutations. Analysis was performed in 483 European patients and the seminal observations were validated in 396 Mayo Clinic patients. Samples from the European cohort, collected at time of diagnosis, were analyzed for mutations in ASXL1, SRSF2, EZH2, TET2, DNMT3A, CBL, IDH1, IDH2, MPL and JAK2. Of these, ASXL1, SRSF2 and EZH2 mutations inter-independently predicted shortened survival. However, only ASXL1 mutations (HR: 2.02; P<0.001) remained significant in the context of the International Prognostic Scoring System (IPSS). These observations were validated in the Mayo Clinic cohort where mutation and survival analyses were performed from time of referral. ASXL1, SRSF2 and EZH2 mutations were independently associated with poor survival, but only ASXL1 mutations held their prognostic relevance (HR: 1.4; P=0.04) independent of the Dynamic IPSS (DIPSS)-plus model, which incorporates cytogenetic risk. In the European cohort, leukemia-free survival was negatively affected by IDH1/2, SRSF2 and ASXL1 mutations and in the Mayo cohort by IDH1 and SRSF2 mutations. Mutational profiling for ASXL1, EZH2, SRSF2 and IDH identifies PMF patients who are at risk for premature death or leukemic transformation.
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Affiliation(s)
- A M Vannucchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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Vannucchi AM, Pieri L, Guglielmelli P. JAK2 Allele Burden in the Myeloproliferative Neoplasms: Effects on Phenotype, Prognosis and Change with Treatment. Ther Adv Hematol 2013; 2:21-32. [PMID: 23556073 DOI: 10.1177/2040620710394474] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [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] Open
Abstract
The field of Philadelphia-chromosome-negative chronic myeloproliferative neoplasms (MPNs) has recently witnessed tremendous advances in the basic knowledge of disease pathophysiology that followed the identification of mutations in JAK2 and MPL. These discoveries led to a revision of the criteria employed for diagnosis by the World Health Organization. The prognostic role of the JAK2V617F mutation and of its allelic burden has been the objective of intensive research using a variety of cellular and animal models as well as in large series of patients. While a definitive position cannot yet been taken on all of the issues, there is a consensus that the presence of higher V617F allele burden, that is on the basis of a stronger activation of intracellular signalling pathways, is associated with the clinical phenotype of polycythemia vera and with defined haematological and clinical markers indicative of a more aggressive phenotype. On the other hand, a low allele burden in myelofibrosis is associated with reduced survival. Finally, a significant reduction of JAK2 V617F allele burden has been demonstrated in patients treated with interferon, while the effects of novel JAK1 and JAK2 inhibitors have not yet been fully ascertained.
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Affiliation(s)
- Alessandro M Vannucchi
- Department of Medical and Surgical Care, Section of Hematology, University of Florence and Istituto Toscano Tumori, Florence, Italy
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Vannucchi AM, Pieri L, Susini MC, Guglielmelli P. BCR-ABL1-negative chronic myeloid neoplasms: an update on management techniques. Future Oncol 2012; 8:575-93. [PMID: 22646772 DOI: 10.2217/fon.12.50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Recent discoveries concerning mutations associated with chronic myeloproliferative neoplasms have modified our understanding of the biology of these incurable diseases and guided us to the development of inhibitors active on the constitutively activated JAK-STAT pathway. Concurrently, numerous studies dealt with clinical issues; it led to a revised WHO classification; clarified the role of mutated JAK2 and leukocytosis in the pathogenesis of cardiovascular events; allowed the development of risk prognostic scores and tools for monitoring response to therapy; and resulted in completion of Phase III trials with JAK2 inhibitor in myelofibrosis. All these results hold the promise of improving patient prognostication and therapeutic approach, with the aim of efficiently preventing disease-associated complications and, hopefully, to improve the dismal survival associated with myelofibrosis. This review discusses how to manage, according to current clinical practice, the steps of diagnosis, prognostication and therapeutic choices in myeloproliferative neoplasm patients.
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Affiliation(s)
- Alessandro M Vannucchi
- Section of Hematology, Department of Critical Care, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
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Antonioli E, Guglielmelli P, Pieri L, Finazzi M, Rumi E, Martinelli V, Vianelli N, Luigia Randi M, Bertozzi I, De Stefano V, Za T, Rossi E, Ruggeri M, Elli E, Cacciola R, Cacciola E, Pogliani E, Rodeghiero F, Baccarani M, Passamonti F, Finazzi G, Rambaldi A, Bosi A, Cazzola M, Barbui T, Vannucchi AM. Hydroxyurea-related toxicity in 3,411 patients with Ph'-negative MPN. Am J Hematol 2012; 87:552-4. [PMID: 22473827 DOI: 10.1002/ajh.23160] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [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: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 11/11/2022]
Abstract
Hydroxyurea (Hydroxycarbamide; HU) is commonly used for the long-term treatment of patients with Philadelphia-chromosome negative chronic myeloproliferative neoplasms (MPNs). It is considered a first-choice agent for the treatment of these disorders as underlined by the European Leukemia Net Consensus Conference [1], although it is formally approved for this indication in some countries only. The drug is reportedly well tolerated in the large majority of subjects, although systemic and/or localized toxicities have been reported. Consensus criteria for definition of "intolerance" to HU have been described;patients who develop intolerance are candidate for second-line therapy and, more recently, for investigational drugs. However, no epidemiologic information about the occurrence of the most clinically significant HU-associated adverse events is yet available. In this study, the authors report on a multicenter series of 3,411 patients who were treated with HU among which 184, accounting for 5% of total, developed significant drug-related toxicities. These data provide an estimate of the frequency and a detailed characterization of clinically significant HU-related toxicities; these information have relevance for the management of MPN patients who require second-line therapy after developing HU-related intolerance.
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Barbui T, Thiele J, Passamonti F, Rumi E, Boveri E, Randi ML, Bertozzi I, Marino F, Vannucchi AM, Pieri L, Rotunno G, Gisslinger H, Gisslinger B, Müllauer L, Finazzi G, Carobbio A, Gianatti A, Ruggeri M, Nichele I, D'Amore E, Rambaldi A, Tefferi A. Initial bone marrow reticulin fibrosis in polycythemia vera exerts an impact on clinical outcome. Blood 2012. [PMID: 22246040 DOI: 10.1182/blood-2011-11393819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
We examined the prevalence and prognostic relevance of bone marrow reticulin fibrosis in 526 patients with World Health Organization-defined polycythemia vera evaluated at the time of initial diagnosis. Seventy-four patients (14%) displayed mostly grade 1 reticulin fibrosis, with only 2 cases showing higher-grade fibrosis. Presenting clinical and laboratory characteristics, including JAK2V617F allele burden, between patients with and without fibrosis were similar for the most part, with the exception of a higher prevalence of palpable splenomegaly in patients with fibrosis (P < .01). Patients with fibrosis were less prone to experience thrombosis during their clinical course (1.1 vs 2.7 per 100 patient-years; P = .03) and more prone to develop post-polycythemia vera myelofibrosis (2.2 vs 0.8 per 100 patient-years; P = .01). There was no significant difference between the 2 groups in terms of overall or leukemia-free survival. The present study clarifies the incidence, degree, and prognostic relevance of bone marrow fibrosis obtained at time of initial diagnosis of polycythemia vera.
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Puda A, Milosevic JD, Berg T, Klampfl T, Harutyunyan AS, Gisslinger B, Rumi E, Pietra D, Malcovati L, Elena C, Doubek M, Steurer M, Tosic N, Pavlovic S, Guglielmelli P, Pieri L, Vannucchi AM, Gisslinger H, Cazzola M, Kralovics R. Frequent deletions of JARID2 in leukemic transformation of chronic myeloid malignancies. Am J Hematol 2012; 87:245-50. [PMID: 22190018 DOI: 10.1002/ajh.22257] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 11/15/2011] [Indexed: 11/06/2022]
Abstract
Chronic myeloproliferative neoplasms (MPN) and myelodysplastic syndromes (MDS) have an inherent tendency to progress to acute myeloid leukemia (AML). Using high-resolution SNP microarrays, we studied a total of 517 MPN and MDS patients in different disease stages, including 77 AML cases with previous history of MPN (N = 46) or MDS (N = 31). Frequent chromosomal deletions of variable sizes were detected, allowing the mapping of putative tumor suppressor genes involved in the leukemic transformation process. We detected frequent deletions on the short arm of chromosome 6 (del6p). The common deleted region on 6p mapped to a 1.1-Mb region and contained only the JARID2 gene--member of the polycomb repressive complex 2 (PRC2). When we compared the frequency of del6p between chronic and leukemic phase, we observed a strong association of del6p with leukemic transformation (P = 0.0033). Subsequently, analysis of deletion profiles of other PRC2 members revealed frequent losses of genes such as EZH2, AEBP2, and SUZ12; however, the deletions targeting these genes were large. We also identified two patients with homozygous losses of JARID2 and AEBP2. We observed frequent codeletion of AEBP2 and ETV6, and similarly, SUZ12 and NF1. Using next generation exome sequencing of 40 patients, we identified only one somatic mutation in the PRC2 complex member SUZ12. As the frequency of point mutations in PRC2 members was found to be low, deletions were the main type of lesions targeting PRC2 complex members. Our study suggests an essential role of the PRC2 complex in the leukemic transformation of chronic myeloid disorders.
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Affiliation(s)
- Ana Puda
- Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
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Affiliation(s)
- L Pieri
- Medical Research Department, F. Hoffmann-La Roche & Co. Ltd., Basle, Switzerland
| | - M da Prada
- Medical Research Department, F. Hoffmann-La Roche & Co. Ltd., Basle, Switzerland
| | - E Theiss
- Medical Research Department, F. Hoffmann-La Roche & Co. Ltd., Basle, Switzerland
| | - A Pletscher
- Medical Research Department, F. Hoffmann-La Roche & Co. Ltd., Basle, Switzerland
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Tefferi A, Lasho TL, Abdel-Wahab O, Guglielmelli P, Patel J, Caramazza D, Pieri L, Finke CM, Kilpivaara O, Wadleigh M, Mai M, McClure RF, Gilliland DG, Levine RL, Pardanani A, Vannucchi AM. IDH1 and IDH2 mutation studies in 1473 patients with chronic-, fibrotic- or blast-phase essential thrombocythemia, polycythemia vera or myelofibrosis. Leukemia 2010; 24:1302-9. [PMID: 20508616 PMCID: PMC3035975 DOI: 10.1038/leu.2010.113] [Citation(s) in RCA: 264] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 04/23/2010] [Indexed: 11/29/2022]
Abstract
In a multi-institutional collaborative project, 1473 patients with myeloproliferative neoplasms (MPN) were screened for isocitrate dehydrogenase 1 (IDH1)/IDH2 mutations: 594 essential thrombocythemia (ET), 421 polycythemia vera (PV), 312 primary myelofibrosis (PMF), 95 post-PV/ET MF and 51 blast-phase MPN. A total of 38 IDH mutations (18 IDH1-R132, 19 IDH2-R140 and 1 IDH2-R172) were detected: 5 (0.8%) ET, 8 (1.9%) PV, 13 (4.2%) PMF, 1 (1%) post-PV/ET MF and 11 (21.6%) blast-phase MPN (P<0.01). Mutant IDH was documented in the presence or absence of JAK2, MPL and TET2 mutations, with similar mutational frequencies. However, IDH-mutated patients were more likely to be nullizygous for JAK2 46/1 haplotype, especially in PMF (P=0.04), and less likely to display complex karyotype, in blast-phase disease (P<0.01). In chronic-phase PMF, JAK2 46/1 haplotype nullizygosity (P<0.01; hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.7-5.2), but not IDH mutational status (P=0.55; HR 1.3, 95% CI 0.5-3.4), had an adverse effect on survival. This was confirmed by multivariable analysis. In contrast, in both blast-phase PMF (P=0.04) and blast-phase MPN (P=0.01), the presence of an IDH mutation predicted worse survival. The current study clarifies disease- and stage-specific IDH mutation incidence and prognostic relevance in MPN and provides additional evidence for the biological effect of distinct JAK2 haplotypes.
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Affiliation(s)
- A Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Spolverini A, Jones AV, Hochhaus A, Pieri L, Cross NCP, Vannucchi AM. The myeloproliferative neoplasm-associated JAK2 46/1 haplotype is not overrepresented in chronic myelogenous leukemia. Ann Hematol 2010; 90:365-6. [DOI: 10.1007/s00277-010-1009-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 06/06/2010] [Indexed: 10/19/2022]
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