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Angotzi F, Lessi F, Leoncin M, Filì C, Endri M, Lico A, Visentin A, Pravato S, Candoni A, Trentin L, Gurrieri C. Efficacy and safety of venetoclax plus hypomethylating agents in relapsed/refractory acute myeloid leukemia: a multicenter real-life experience. Front Oncol 2024; 14:1370405. [PMID: 38680863 PMCID: PMC11045980 DOI: 10.3389/fonc.2024.1370405] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Venetoclax (VEN) has been shown to play a synergistic effect in combination with hypomethylating agents (HMAs) in the frontline treatment of acute myeloid leukemia (AML). However, the potential role of this therapy in the relapsed/refractory (R/R) AML setting, still needs to be further unveiled. The aim of the current study was to retrospectively outline the safety profile, response and survival outcomes of R/R AML patients treated with VEN in association with HMAs. Clinical, biological, and molecular data were collected from 57 patients with R/R AML treated with VEN combined with azacitidine or decitabine between 2018 and 2023. The median age of patients was 63 years, 38 (66.7%) received treatment for relapsed disease while 19 (33.3%) for refractory disease, 5 (8.7%) were treated for molecular relapse. A consistent proportion of the cohort was represented by patients with unfavorable prognostic factors such as complex karyotype (36.8%), secondary AML (29.8%), previous exposure to HMAs (38.6%), and relapse after allogeneic stem cell transplant (22.8%). A total of 14 patients achieved CR (24.6%), 3 (5.3%) CRi, 3 (5.3%) MLFS, and 3 (5.3%) PR, accounting for an ORR of 40.4%. The CR/CRi rate was higher in the group treated with azacitidine than in the group treated with decitabine (37.8% vs. 15%). The median OS was 8.2 months, reaching 20.1 months among responding patients. VEN-HMAs treatment allowed to bridge to allogeneic stem cell transplantation 11 (23.9%) of eligible patients, for which a median OS of 19.8 months was shown. On multivariate analysis, ECOG performance status ≥2, complex karyotype and not proceeding to allogeneic stem cell transplantation after therapy with VEN-HMAs were the factors independently associated with shorter OS. Patients treated with the azacitidine rather than the decitabine containing regimen generally displayed a trend toward superior outcomes. The major toxicities were prolonged neutropenia and infections. In conclusion, this study showed how VEN-HMAs could represent an effective salvage therapy in patients with R/R AML, even among some of those patients harboring dismal prognostic features, with a good toxicity profile. Further prospective studies are thus warranted.
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Affiliation(s)
- Francesco Angotzi
- Hematology Unit, Azienda Ospedale-Università and University of Padova, Padua, Italy
| | - Federica Lessi
- Hematology Unit, Azienda Ospedale-Università and University of Padova, Padua, Italy
| | - Matteo Leoncin
- Hematology Unit, Azienda Ulss3 Serenissima, Ospedale dell’Angelo, Venice, Italy
| | - Carla Filì
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Integrata Friuli Centrale (ASUFC), Udine, Italy
| | - Mauro Endri
- Hematology Section, Dipartimento di Medicina Specialistica, Ca’ Foncello Hospital, Treviso, Italy
| | - Albana Lico
- Hematology and Cell Therapy Division, San Bortolo Hospital, Vicenza, Italy
| | - Andrea Visentin
- Hematology Unit, Azienda Ospedale-Università and University of Padova, Padua, Italy
| | - Stefano Pravato
- Hematology Unit, Azienda Ospedale-Università and University of Padova, Padua, Italy
| | - Anna Candoni
- Division of Hematology and Bone Marrow Transplantation, Azienda Sanitaria Universitaria Integrata Friuli Centrale (ASUFC), Udine, Italy
| | - Livio Trentin
- Hematology Unit, Azienda Ospedale-Università and University of Padova, Padua, Italy
| | - Carmela Gurrieri
- Hematology Unit, Azienda Ospedale-Università and University of Padova, Padua, Italy
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Breccia M, Luciano L, Latagliata R, Castagnetti F, Ferrero D, Cavazzini F, Trawinska MM, Annunziata M, Stagno F, Tiribelli M, Binotto G, Crisà E, Musto P, Gozzini A, Cavalli L, Montefusco E, Iurlo A, Russo S, Cedrone M, Rossi AR, Pregno P, Endri M, Spadea A, Molica M, Giglio G, Celesti F, Sorà F, Storti S, D'Addosio A, Cambrin GR, Isidori A, Sica S, Abruzzese E, Speccha G, Rosti G, Alimena G. Age influences initial dose and compliance to imatinib in chronic myeloid leukemia elderly patients but concomitant comorbidities appear to influence overall and event-free survival. Leuk Res 2014; 38:1173-6. [PMID: 25047978 DOI: 10.1016/j.leukres.2014.06.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 04/12/2014] [Revised: 06/15/2014] [Accepted: 06/28/2014] [Indexed: 11/28/2022]
Abstract
We applied Charlson comorbidity index (CCI) stratification on a large cohort of chronic myeloid leukemia (CML) very elderly patients (>75 years) treated with imatinib, in order to observe the impact of concomitant diseases on both compliance and outcome. One hundred and eighty-one patients were recruited by 21 Italian centers. There were 95 males and 86 females, median age 78.6 years (range 75-93.6). According to Sokal score, 106 patients were classified as intermediate risk and 55 as high risk (not available in 20 patients). According to CCI stratification, 71 patients had score 0 and 110 a score ≥ 1. Imatinib standard dose was reduced at start of therapy (200-300 mg/day) in 68 patients independently from the evaluation of baseline comorbidities, but based only on physician judgement: 43.6% of these patients had score 0 compared to 34% of patients who had score ≥ 1. Significant differences were found in terms of subsequent dose reduction (39% of patients with score 0 compared to 53% of patients with score ≥ 1) and in terms of drug discontinuation due to toxicity (35% of patients with score 0 vs 65% of patients with score ≥ 1). We did not find significant differences as regards occurrence of hematologic side effects, probably as a consequence of the initial dose reduction: 39% of patients with score 0 experienced grade 3/4 hematologic toxicity (most commonly anemia) compared to 42% of patients with score ≥ 1. Independently from the initial dose, comorbidities again did not have an impact on development of grade 3/4 non-hematologic side effects (most commonly skin rash, muscle cramps and fluid retention): 62% of patients with score 0 compared to 52.5% of patients with score ≥ 1. Notwithstanding the reduced dose and the weight of comorbidities we did not find significant differences but only a trend in terms of efficacy: 66% of patients with score 0 achieved a CCyR compared to 54% of patients with score ≥ 1. Comorbidities appeared to have an impact on median OS (40.8 months for patients with score 0 vs 20.16 months for patients with score ≥ 1) on EFS and on non-CML death rate. Our results suggest that treatment of very elderly CML patients might be influenced by personal physician perception: evaluation at baseline of comorbidities according to CCI should improve initial decision-making in this subset of patients.
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Affiliation(s)
- Massimo Breccia
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Via Benevento 6, Roma 00161, Italy.
| | | | - Roberto Latagliata
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Via Benevento 6, Roma 00161, Italy
| | | | | | | | | | | | | | | | | | - Elena Crisà
- Ematologia, Università di Torino, Torino, Italy
| | - Pellegrino Musto
- Dipartimento Onco-Ematologico, IRCCS-CROB, Rionero in Vulture, Italy
| | | | | | | | - Alessandra Iurlo
- UOC Oncoematologia, Fondazione IRCSS Cà Granda Policlinico Milano, Milan, Italy
| | - Sabina Russo
- Ematologia, Università di Messina, Messina, Italy
| | | | | | | | - Mauro Endri
- Ematologia, Centro Trapianti Cremona, Cremona, Italy
| | | | - Matteo Molica
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Via Benevento 6, Roma 00161, Italy
| | | | | | - Federica Sorà
- Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sergio Storti
- Onco-Ematologia, Università Cattolica Giovanni Paolo II, Campobasso, Italy
| | | | | | | | - Simona Sica
- Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | | | - Giuliana Alimena
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Via Benevento 6, Roma 00161, Italy
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Endri M, Cartei G, Zustovich F, Serino FS, Fassina A. Differential diagnosis of lung nodules: breast cancer metastases and lung tuberculosis. Infez Med 2010; 18:39-42. [PMID: 20424525] [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: 05/29/2023]
Abstract
In a follow-up a 74-year-old woman with breast cancer (clinical stage T4N1M0 at onset, treatment by surgical resection and tamoxifen) presented a combination of two distinct diseases in the lung: breast cancer metastasis and tuberculosis. A CT scan showed multiple pulmonary nodular lesions and in only one lesion fine needle aspiration cytology (FNAC) diagnosed tuberculosis. After specific antibiotic therapy, isoniazide and rifampin, a CT scan highlighted disappearance of tubercular lesion. Because occurrence of tuberculosis during chemo or hormone therapy for metastatic breast cancer is rare, the present case is noteworthy. Indeed, it is worth pointing out the differential diagnosis of pulmonary nodular lesions in patients with cancer and the possible reactivation of tuberculosis even in patients without specific symptoms, without typical tubercular radiological features.
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MESH Headings
- Aged
- Androstadienes/therapeutic use
- Antineoplastic Agents, Hormonal/therapeutic use
- Breast Neoplasms/complications
- Breast Neoplasms/drug therapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/complications
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Diagnosis, Differential
- Estrogens
- Female
- Humans
- Lung Neoplasms/drug therapy
- Lung Neoplasms/secondary
- Lymphatic Metastasis
- Neoplasms, Hormone-Dependent/drug therapy
- Neoplasms, Hormone-Dependent/secondary
- Neoplasms, Hormone-Dependent/surgery
- Progesterone
- Recurrence
- Tamoxifen/therapeutic use
- Tomography, X-Ray Computed
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/diagnosis
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Affiliation(s)
- Mauro Endri
- Department of Medicine, Operative Unit of Medicine 2, Azienda Ospedaliera Santa Maria degli Angeli, Pordenone City Hospital, Pordenone, Italy
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