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Ferrero S, Grimaldi D, Arrigoni E, Pironti M, Zaccaria GM, Alessandria B, Genuardi E, De Luca G, Ghislieri M, Tavarozzi R, Di Rocco A, Re A, Stefoni V, Cavallo F, Boccomini C, Balzarotti M, Zilioli VR, Moita F, Arcaini L, Lucchini E, Ballerini F, Ferreri AJM, Puccini B, Palumbo GA, Galimberti S, Cortelazzo S, Di Paolo A, Ladetto M. Candidate germline biomarkers of lenalidomide efficacy in mantle cell lymphoma: the FIL MCL0208 trial. Blood Adv 2023:495379. [PMID: 37058477 PMCID: PMC10368781 DOI: 10.1182/bloodadvances.2022009504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/15/2023] Open
Abstract
In the FIL MCL0208 phase III trial, lenalidomide maintenance (LEN) after transplantation (ASCT) in mantle cell lymphoma (MCL) improved progression-free survival (PFS) vs observation (OBS). The host pharmacogenetic background was analyzed to decipher whether single nucleotide polymorphisms (SNPs) of genes encoding transmembrane transporters, metabolic enzymes, or cell surface receptors might predict drug efficacy. Genotypes were obtained by real-time polymerase chain reaction (RT-PCR) in peripheral blood (PB) germ line DNA. Polymorphisms of either ABCB1 or VEGF were found in 69% and 79% of 278 patients and predicted favorable PFS vs homozygous wild type (WT) in the LEN arm: 3-year PFS 85% vs 70% (p < 0.05) and 85% vs 60% (p < 0.01), respectively. Patients carrying both ABCB1 and VEGF WT had the poorest 3-year PFS (46%) and overall survival (OS, 76%): in fact, in these patients LEN did not improve PFS vs OBS (3-year PFS 44% vs 60%, p = 0.62). Moreover, CRBN polymorphism (n = 28) was associated with lenalidomide dose reduction or discontinuation. Finally, ABCB1, NCF4, and GSTP1 polymorphisms predicted lower hematological toxicity during induction, while ABCB1 and CRBN polymorphisms predicted lower risk of grade ≥3 infections. This study demonstrates that specific SNPs represent candidate predictive biomarkers of immunochemotherapy toxicity and LEN efficacy after ASCT in MCL. This trial is registered at eudract.ema.europa.eu as 2009-012807-25.
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Affiliation(s)
- Simone Ferrero
- Hematology Division, AOU "Città della Salute e della Scienza di Torino", Torino, Italy;, Italy
| | - Daniele Grimaldi
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy, Italy
| | - Elena Arrigoni
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mariapia Pironti
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | | | - Beatrice Alessandria
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Elisa Genuardi
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Gabriele De Luca
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | | | - Rita Tavarozzi
- AO SS Antonio e Biagio E Cesare Arrigo, Alessandria, Italy, Italy
| | | | | | | | - Federica Cavallo
- Department of Molecular Biotechnologies and Health Sciences, University of Torino. Hematology 1U, Italy
| | | | | | | | - Filipa Moita
- 7. Instituto Português de Oncologia de Lisboa de Francisco Gentil, Lisbon, Portugal
| | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Italy
| | - Elisa Lucchini
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | | | | | | | | | | | | | | | - Marco Ladetto
- Università del Piemonte Orientale ed AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Ferrero S, Grimaldi D, Genuardi E, Drandi D, Zaccaria GM, Alessandria B, Ghislieri M, Ferrante M, Evangelista A, Mantoan B, De Luca G, Stefani PM, Benedetti F, Casaroli I, Zanni M, Castellino C, Pavone V, Petrini M, Re F, Hohaus S, Musuraca G, Cascavilla N, Ghiggi C, Liberati AM, Cortelazzo S, Ladetto M. Punctual and kinetic MRD analysis from the Fondazione Italiana Linfomi MCL0208 phase 3 trial in mantle cell lymphoma. Blood 2022; 140:1378-1389. [PMID: 35737911 PMCID: PMC9507010 DOI: 10.1182/blood.2021014270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/27/2022] [Indexed: 11/20/2022] Open
Abstract
Minimal residual disease (MRD) analysis is a known predictive tool in mantle cell lymphoma (MCL). We describe MRD results from the Fondazione Italiana Linfomi phase 3 MCL0208 prospective clinical trial assessing lenalidomide (LEN) maintenance vs observation after autologous stem cell transplantation (ASCT) in the first prospective comprehensive analysis of different techniques, molecular markers, and tissues (peripheral blood [PB] and bone marrow [BM]), taken at well-defined time points. Among the 300 patients enrolled, a molecular marker was identified in 250 (83%), allowing us to analyze 234 patients and 4351 analytical findings from 10 time points. ASCT induced high rates of molecular remission (91% in PB and 83% in BM, by quantitative real-time polymerase chain reaction [RQ-PCR]). Nevertheless, the number of patients with persistent clinical and molecular remission decreased over time in both arms (up to 30% after 36 months). MRD predicted early progression and long-term outcome, particularly from 6 months after ASCT (6-month time to progression [TTP] hazard ratio [HR], 3.83; P < .001). In single-timepoint analysis, BM outperformed PB, and RQ-PCR was more reliable, while nested PCR appeared applicable to a larger number of patients (234 vs 176). To improve MRD performance, we developed a time-varying kinetic model based on regularly updated MRD results and the MIPI (Mantle Cell Lymphoma International Prognostic Index), showing an area under the ROC (Receiver Operating Characteristic) curve (AUROC) of up to 0.87 using BM. Most notably, PB reached an AUROC of up to 0.81; with kinetic analysis, it was comparable to BM in performance. MRD is a powerful predictor over the entire natural history of MCL and is suitable for models with a continuous adaptation of patient risk. The study can be found in EudraCT N. 2009-012807-25 (https://eudract.ema.europa.eu/).
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Affiliation(s)
- Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
- AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Daniele Grimaldi
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
- Hematology Division, AO S.Croce e Carle, Cuneo, Italy
| | - Elisa Genuardi
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Daniela Drandi
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Gian Maria Zaccaria
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
- Hematology and Cell Therapy Unit, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Beatrice Alessandria
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Marco Ghislieri
- PoliToBIOMed Lab, Politecnico di Torino, Torino, Italy
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Martina Ferrante
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Andrea Evangelista
- Unit of Cancer Epidemiology, CPO, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Barbara Mantoan
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Gabriele De Luca
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | | | - Fabio Benedetti
- Department of Medicine, Section of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy
| | | | - Manuela Zanni
- Division of Hematology, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | | | | | - Francesca Re
- Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Stefan Hohaus
- Hematology Unit, Università Cattolica S.Cuore; Roma, Italy
| | - Gerardo Musuraca
- Department of Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS
| | - Nicola Cascavilla
- Hematology, Casa Sollievo della Sofferenza IRCCS Hospital, San Giovanni Rotondo, Italy
| | - Chiara Ghiggi
- Department of Hematology, San Martino Hospital and University, Genova, Italy
| | - Anna Marina Liberati
- Department of Hematology, A.O. Santa Maria Terni, University of Perugia, Perugia, Italy; and
| | | | - Marco Ladetto
- Division of Hematology, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
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3
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Zaccaria GM, Ferrero S, Hoster E, Passera R, Evangelista A, Genuardi E, Drandi D, Ghislieri M, Barbero D, Del Giudice I, Tani M, Moia R, Volpetti S, Cabras MG, Di Renzo N, Merli F, Vallisa D, Spina M, Pascarella A, Latte G, Patti C, Fabbri A, Guarini A, Vitolo U, Hermine O, Kluin-Nelemans HC, Cortelazzo S, Dreyling M, Ladetto M. A Clinical Prognostic Model Based on Machine Learning from the Fondazione Italiana Linfomi (FIL) MCL0208 Phase III Trial. Cancers (Basel) 2021; 14:cancers14010188. [PMID: 35008361 PMCID: PMC8750124 DOI: 10.3390/cancers14010188] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/26/2021] [Indexed: 12/05/2022] Open
Abstract
Simple Summary The interest in using Machine-Learning (ML) techniques in clinical research is growing. We applied ML to build up a novel prognostic model from patients affected with Mantle Cell Lymphoma (MCL) enrolled in a phase III open-labeled, randomized clinical trial from the Fondazione Italiana Linfomi (FIL)—MCL0208. This is the first application of ML in a prospective clinical trial on MCL lymphoma. We applied a novel ML pipeline to a large cohort of patients for which several clinical variables have been collected at baseline, and assessed their prognostic value based on overall survival. We validated it on two independent data series provided by European MCL Network. Due to its flexibility, we believe that ML would be of tremendous help in the development of a novel MCL prognostic score aimed at re-defining risk stratification. Abstract Background: Multicenter clinical trials are producing growing amounts of clinical data. Machine Learning (ML) might facilitate the discovery of novel tools for prognostication and disease-stratification. Taking advantage of a systematic collection of multiple variables, we developed a model derived from data collected on 300 patients with mantle cell lymphoma (MCL) from the Fondazione Italiana Linfomi-MCL0208 phase III trial (NCT02354313). Methods: We developed a score with a clustering algorithm applied to clinical variables. The candidate score was correlated to overall survival (OS) and validated in two independent data series from the European MCL Network (NCT00209222, NCT00209209); Results: Three groups of patients were significantly discriminated: Low, Intermediate (Int), and High risk (High). Seven discriminants were identified by a feature reduction approach: albumin, Ki-67, lactate dehydrogenase, lymphocytes, platelets, bone marrow infiltration, and B-symptoms. Accordingly, patients in the Int and High groups had shorter OS rates than those in the Low and Int groups, respectively (Int→Low, HR: 3.1, 95% CI: 1.0–9.6; High→Int, HR: 2.3, 95% CI: 1.5–4.7). Based on the 7 markers, we defined the engineered MCL international prognostic index (eMIPI), which was validated and confirmed in two independent cohorts; Conclusions: We developed and validated a ML-based prognostic model for MCL. Even when currently limited to baseline predictors, our approach has high scalability potential.
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Affiliation(s)
- Gian Maria Zaccaria
- Unit of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (S.F.); (E.G.); (D.D.); (D.B.)
- Unit of Hematology and Cell Therapy, IRCCS-Istituto Tumori ‘Giovanni Paolo II’, 70124 Bari, Italy;
- Correspondence: or ; Tel.: +39-(0)8-0555-5446; Fax: +39-(0)8-0555-5407
| | - Simone Ferrero
- Unit of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (S.F.); (E.G.); (D.D.); (D.B.)
| | - Eva Hoster
- Institute of Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-University of Munich, 81377 Munich, Germany;
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, 10126 Turin, Italy;
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, CPO Piemonte, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Elisa Genuardi
- Unit of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (S.F.); (E.G.); (D.D.); (D.B.)
| | - Daniela Drandi
- Unit of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (S.F.); (E.G.); (D.D.); (D.B.)
| | - Marco Ghislieri
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy;
- PoliToBIOMedLab of Politecnico di Torino, 10129 Turin, Italy
| | - Daniela Barbero
- Unit of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy; (S.F.); (E.G.); (D.D.); (D.B.)
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Monica Tani
- Hematology Unit, Santa Maria delle Croci Hospital, 48121 Ravenna, Italy;
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (R.M.); (M.L.)
| | - Stefano Volpetti
- Unit of Hematology, Presidio Ospedaliero Universitario “Santa Maria della Misericordia”, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy;
| | | | - Nicola Di Renzo
- Unit of Hematology and Bone Marrow Transplant, ‘V. Fazzi’ Hospital, 73100 Lecce, Italy;
| | | | - Daniele Vallisa
- Unit of Hematology, Department of Oncology and Hematology, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy;
| | - Michele Spina
- Division of Medical Oncology and Immune-Related Tumors, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy;
| | - Anna Pascarella
- Unit of Hematology, dell’ Angelo Mestre-Venezia Hospital, 30174 Mestre-Venezia, Italy;
| | - Giancarlo Latte
- Unit of Hematology and Bone Marrow Transplant, ‘San Francesco’ Hospital, 08100 Nuoro, Italy;
| | - Caterina Patti
- Unit of Hematology, Azienda Ospedali Riuniti Villa Sofia-Cervello, 90146 Palermo, Italy;
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy;
| | - Attilio Guarini
- Unit of Hematology and Cell Therapy, IRCCS-Istituto Tumori ‘Giovanni Paolo II’, 70124 Bari, Italy;
| | - Umberto Vitolo
- Division of Hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Olivier Hermine
- Service D’hématologie, Hôpital Universitaire Necker, Université René Descartes, Assistance Publique Hôpitaux de Paris, 75015 Paris, France;
| | - Hanneke C Kluin-Nelemans
- Department of Haematology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands;
| | | | - Martin Dreyling
- Department of Medicine III, University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Marco Ladetto
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (R.M.); (M.L.)
- Division of Hematology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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4
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Ferrero S, Moia R, Cascione L, Zaccaria GM, Rinaldi A, Alessandria B, Grimaldi D, Favini C, Evangelista A, Schipani M, Narni F, Stelitano C, Stefani PM, Benedetti F, Mian M, Casaroli I, Zanni M, Castellino C, Pavone V, Galimberti S, Re F, Rossi D, Cortelazzo S, Gaidano G, Ladetto M, Bertoni F. A COMPLETELY GENETIC PROGNOSTIC MODEL OVERCOMES CLINICAL PROGNOSTICATORS IN MANTLE CELL LYMPHOMA: RESULTS FROM THE MCL0208 TRIAL FROM THE FONDAZIONE ITALIANA LINFOMI (FIL). Hematol Oncol 2021. [DOI: 10.1002/hon.59_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- S. Ferrero
- Hematology Department of Molecular Biotechnologies and Health Sciences University of Torino Hematology 1, AOU "Città della salute e della scienza di Torino" Torino Italy
| | - R. Moia
- Division of Hematology Department of Translational Medicine Università del Piemonte Orientale Novara Italy
| | - L. Cascione
- Institute of Oncology Research Faculty of Biomedical Sciences USI, Bellinzona SIB Swiss Institute of Bioinformatics Lausanne Switzerland
| | - G. M. Zaccaria
- Hematology and Cell Therapy Unit IRCCS Istituto Tumori 'Giovanni Paolo II' Bari Italy
| | - A. Rinaldi
- Institute of Oncology Research Faculty of Biomedical Sciences USI Bellinzona Switzerland
| | - B. Alessandria
- Hematology Department of Molecular Biotechnologies and Health Sciences University of Torino Torino Italy
| | - D. Grimaldi
- Hematology Department of Molecular Biotechnologies and Health Sciences University of Torino Torino Italy
| | - C. Favini
- Division of Hematology Department of Translational Medicine Università del Piemonte Orientale Novara Italy
| | - A. Evangelista
- Unit of Cancer Epidemiology CPO Piemonte A.O.U. Città della Salute e della Scienza di Torino Torino Italy
| | - M. Schipani
- Division of Hematology Department of Translational Medicine Università del Piemonte Orientale Novara Italy
| | - F. Narni
- Department of Medical and Surgical Sciences Section of Hematology University of Modena and Reggio Emilia Azienda Ospedaliero Universitaria Policlinico Modena Italy
| | - C. Stelitano
- Hematology Department AO "Bianchi‐Melacrino‐Morelli" Reggio Calabria Italy
| | - P. M. Stefani
- Hematology Unit General Hospital Ca' Foncello Treviso Italy
| | - F. Benedetti
- Hematology University Division Verona Hospital Verona Italy
| | - M. Mian
- Department of Haematology and CBMT Bolzano Hospital Bolzano Italy
| | - I. Casaroli
- Haematology Unit ASST Monza San Gerardo Monza Italy
| | - M. Zanni
- Hematology Unit Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo Alessandria Italy
| | - C. Castellino
- Department of Hematology S. Croce e Carle Hospital Cuneo Italy
| | - V. Pavone
- UOC Ematologia e Trapianto Az. Osp. C. Panico Tricase Italy
| | - S. Galimberti
- Section of Hematology Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - F. Re
- Haematology and Bone Marrow Transplant Unit Parma General Hospital Parma Italy
| | - D. Rossi
- Institute of Oncology Research Faculty of Biomedical Sciences USI, Bellinzona, Switzerland Oncology Institute of Southern Switzerland (IOSI) Bellinzona,Bellinzona Switzerland
| | - S. Cortelazzo
- Oncology Unit Italy Medical & Center Hospital Humanitas Gavazzeni and Castelli Bergamo Italy
| | - G. Gaidano
- Division of Hematology Department of Translational Medicine Università del Piemonte Orientale Novara Italy
| | - M. Ladetto
- Division of Hematology Department of Translational Medicine Università del Piemonte Orientale Novara, Division of Hematology Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo Alessandria Italy
| | - F. Bertoni
- Institute of Oncology Research Faculty of Biomedical Sciences USI, Bellinzona, Switzerland Oncology Institute of Southern Switzerland (IOSI) Bellinzona,Bellinzona Switzerland
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5
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Genuardi E, Romano G, Beccuti M, Alessandria B, Mannina D, Califano C, Rota Scalabrini D, Cortelazzo S, Ladetto M, Ferrero S, Calogero RA, Cordero F. Application of the Euro Clonality next-generation sequencing-based marker screening approach to detect immunoglobulin heavy chain rearrangements in mantle cell lymphoma patients: first data from the Fondazione Italiana Linfomi MCL0208 trial. Br J Haematol 2021; 194:378-381. [PMID: 34002365 PMCID: PMC8515379 DOI: 10.1111/bjh.17519] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/06/2021] [Indexed: 01/09/2023]
Abstract
Minimal residual disease (MRD) determined by classic polymerase chain reaction (PCR) methods is a powerful outcome predictor in mantle cell lymphoma (MCL). Nevertheless, some technical pitfalls can reduce the rate of of molecular markers. Therefore, we applied the EuroClonality‐NGS IGH (next‐generation sequencing immunoglobulin heavy chain) method (previously published in acute lymphoblastic leukaemia) to 20 MCL patients enrolled in an Italian phase III trial sponsored by Fondazione Italiana Linfomi. Results from this preliminary investigation show that EuroClonality‐NGS IGH method is feasible in the MCL context, detecting a molecular IGH target in 19/20 investigated cases, allowing MRD monitoring also in those patients lacking a molecular marker for classical screening approaches.
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Affiliation(s)
- Elisa Genuardi
- Department of Molecular Biotechnologies and Health Sciences - Hematology Division, University of Torino, Torino, Italy
| | - Greta Romano
- Department of Computer Sciences, University of Torino, Torino, Italy.,IIGM - Italian Institute for Genomic Medicine, c/o IRCCS, Candiolo (Torino), Italy.,Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - Marco Beccuti
- Department of Computer Sciences, University of Torino, Torino, Italy
| | - Beatrice Alessandria
- Department of Molecular Biotechnologies and Health Sciences - Hematology Division, University of Torino, Torino, Italy
| | - Donato Mannina
- Azienda Ospedaliera Papardo- UOC di Ematologia, Messina, Italy
| | | | | | | | - Marco Ladetto
- Division of Hematology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences - Hematology Division, University of Torino, Torino, Italy.,Hematology Division, AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Raffaele A Calogero
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Francesca Cordero
- Department of Computer Sciences, University of Torino, Torino, Italy
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6
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Genuardi E, Klous P, Mantoan B, Drandi D, Ferrante M, Cavallo F, Alessandria B, Dogliotti I, Grimaldi D, Ragaini S, Clerico M, Lo Schirico M, Saraci E, Yilmaz M, Zaccaria GM, Cortelazzo S, Vitolo U, Luminari S, Federico M, Boccadoro M, van Min M, Splinter E, Ladetto M, Ferrero S. Targeted locus amplification to detect molecular markers in mantle cell and follicular lymphoma. Hematol Oncol 2021; 39:293-303. [PMID: 33742718 PMCID: PMC8451873 DOI: 10.1002/hon.2864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/22/2021] [Accepted: 03/06/2021] [Indexed: 11/16/2022]
Abstract
Minimal residual disease (MRD) monitoring by PCR methods is a strong and standardized predictor of clinical outcome in mantle cell lymphoma (MCL) and follicular lymphoma (FL). However, about 20% of MCL and 40% of FL patients lack a reliable molecular marker, being thus not eligible for MRD studies. Recently, targeted locus amplification (TLA), a next‐generation sequencing (NGS) method based on the physical proximity of DNA sequences for target selection, identified novel gene rearrangements in leukemia. The aim of this study was to test TLA in MCL and FL diagnostic samples lacking a classical, PCR‐detectable, t(11; 14) MTC (BCL1/IGH), or t(14; 18) major breakpoint region and minor cluster region (BCL2/IGH) rearrangements. Overall, TLA was performed on 20 MCL bone marrow (BM) or peripheral blood (PB) primary samples and on 20 FL BM, identifying a novel BCL1 or BCL2/IGH breakpoint in 16 MCL and 8 FL patients (80% and 40%, respectively). These new breakpoints (named BCL1‐TLA and BCL2‐TLA) were validated by ASO primers design and compared as MRD markers to classical IGH rearrangements in eight MCL: overall, MRD results by BCL1‐TLA were superimposable (R Pearson = 0.76) to the standardized IGH‐based approach. Moreover, MRD by BCL2‐TLA reached good sensitivity levels also in FL and was predictive of a primary refractory case. In conclusion, this study offers the proof of principle that TLA is a promising and reliable NGS‐based technology for the identification of novel molecular markers, suitable for further MRD analysis in previously not traceable MCL and FL patients.
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Affiliation(s)
- Elisa Genuardi
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy
| | | | - Barbara Mantoan
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy
| | - Daniela Drandi
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy
| | - Martina Ferrante
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy
| | - Federica Cavallo
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Beatrice Alessandria
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy
| | - Irene Dogliotti
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Daniele Grimaldi
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Simone Ragaini
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Michele Clerico
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Mariella Lo Schirico
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy
| | | | | | - Gian Maria Zaccaria
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy
| | | | - Umberto Vitolo
- Department of Oncology, Division of Hematology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Modena, Italy.,Medical Oncology, CHIMOMO department, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Federico
- Medical Oncology, CHIMOMO department, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario Boccadoro
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | | | | | - Marco Ladetto
- Division of Hematology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Simone Ferrero
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy.,Division of Hematology 1, AOU "Città della Salute e della Scienza di Torino", Torino, Italy
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7
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Della Starza I, De Novi LA, Cavalli M, Novelli N, Soscia R, Genuardi E, Mantoan B, Drandi D, Ferrante M, Monitillo L, Barbero D, Ciabatti E, Grassi S, Bomben R, Degan M, Gattei V, Galimberti S, Di Rocco A, Martelli M, Cortelazzo S, Guarini A, Foà R, Ladetto M, Ferrero S, Del Giudice I. Immunoglobulin kappa deleting element rearrangements are candidate targets for minimal residual disease evaluation in mantle cell lymphoma. Hematol Oncol 2020; 38:698-704. [PMID: 32816326 DOI: 10.1002/hon.2792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 11/09/2022]
Abstract
Minimal residual disease (MRD) assessment is of high clinical relevance in patients with mantle cell lymphoma (MCL). In mature B-cell malignancies, the presence of somatic hypermutations (SHM) in Variable-Diversity-Joining Heavy chain (VDJH) rearrangements leads to frequent mismatches between primers, probes, and the target, thus impairing tumor cells quantification. Alternative targets, such as immunoglobulin kappa-deleting-element (IGK-Kde) rearrangements, might be suitable for MRD detection. We aimed at evaluating the applicability of IGK-Kde rearrangements for MRD quantification in MCL patients by real-time quantitative polymerase chain reaction (RQ-PCR)/digital-droplet-PCR (ddPCR). IGK screening was performed on bone marrow samples from two cohorts: the first from Turin (22 patients enrolled in the FIL-MCL0208 trial, NCT02354313) and the second from Rome (15 patients). IGK-Kde rearrangements were found in 76% (28/37) of cases, representing the sole molecular marker in 73% (8/11) of IGH-BCL1/IGH negative cases. MRD RQ-PCR monitoring was possible in 57% (16/28) of cases, showing a 100% concordance with the conventional targets. However, the frequent background amplification affected the sensitivity of the assay, that was lower in MCL compared to acute lymphoblastic leukemia and in line with multiple myeloma published results. ddPCR had a good concordance with RQ-PCR and it might help to identify false positive/negative results. From a clinical perspective, we suggest that IGK-Kde can be a candidate target for MRD monitoring and deserves a validation of its predictive value in prospective MCL series.
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Affiliation(s)
- Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Lucia Anna De Novi
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Marzia Cavalli
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Noemi Novelli
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Roberta Soscia
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Elisa Genuardi
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Barbara Mantoan
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Daniela Drandi
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Martina Ferrante
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Luigia Monitillo
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Daniela Barbero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Elena Ciabatti
- Division of Hematology, Department of Oncology, Santa Chiara Hospital, Pisa, Italy
| | - Susanna Grassi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano, Italy
| | - Massimo Degan
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Haematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano, Italy
| | - Sara Galimberti
- Division of Hematology, Department of Oncology, Santa Chiara Hospital, Pisa, Italy
| | - Alice Di Rocco
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Sergio Cortelazzo
- Hematology, Medical Oncology and Hematology Division, "Istituto Clinico Humanitas Gavazzeni", Bergamo, Italy
| | - Anna Guarini
- Department of Molecular Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Marco Ladetto
- Division of Hematology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy.,Division of Hematology, AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University of Roma, Rome, Italy
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8
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Abstract
MCL is a well-characterized generally aggressive lymphoma with a poor prognosis. However, patients with a more indolent disease have been reported in whom the initiation of therapy can be delayed without any consequence for the survival. In 2017 the World Health Organization updated the classification of MCL describing two main subtypes with specific molecular characteristics and clinical features, classical and indolent leukaemic nonnodal MCL. Recent research results suggested an improving outcome of this neoplasm. The addition of rituximab to conventional chemotherapy has increased overall response rates, but it did not improve overall survival compared to chemotherapy alone. The use of intensive frontline therapies including rituximab and consolidation with autologous stem cell transplantation ameliorated response rate and prolonged progression-free survival in young fit patients, but any impact on survival remains to be proven. Furthermore, the optimal timing, cytoreductive regimen and conditioning regimen, and the clinical implications of achieving a disease remission even at molecular level remain to be elucidated. The development of targeted therapies as the consequence of better understanding of pathogenetic pathways in MCL might improve the outcome of conventional chemotherapy and spare the toxicity of intense therapy in most patients. Cases not eligible for intensive regimens, may be considered for less demanding therapies, such as the combination of rituximab either with CHOP or with purine analogues, or bendamustine. Allogeneic SCT can be an effective option for relapsed disease in patients who are fit enough and have a compatible donor. Maintenance rituximab may be considered after response to immunochemotherapy as the first-line strategy in a wide range of patients. Finally, since the optimal approach to the management of MCL is still evolving, it is critical that these patients are enrolled in clinical trials to identify the better treatment options.
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Affiliation(s)
| | - Maurilio Ponzoni
- Pathology Unit, San Raffaele Scientific Institute, Milan, Italy; Unit of Lymphoid Malignancies, San Raffaele Scientific Institute, Milan, Italy
| | - Andrés J M Ferreri
- Unit of Lymphoid Malignancies, San Raffaele Scientific Institute, Milan, Italy; Medical Oncology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Martin Dreyling
- Medizinische Klinik III der Universität München-Grosshadern, München, Germany
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9
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Zaccaria GM, Ferrero S, Rosati S, Ghislieri M, Genuardi E, Evangelista A, Sandrone R, Castagneri C, Barbero D, Lo Schirico M, Arcaini L, Molinari AL, Ballerini F, Ferreri A, Omedè P, Zamò A, Balestra G, Boccadoro M, Cortelazzo S, Ladetto M. Applying Data Warehousing to a Phase III Clinical Trial From the Fondazione Italiana Linfomi Ensures Superior Data Quality and Improved Assessment of Clinical Outcomes. JCO Clin Cancer Inform 2020; 3:1-15. [PMID: 31633999 DOI: 10.1200/cci.19.00049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Data collection in clinical trials is becoming complex, with a huge number of variables that need to be recorded, verified, and analyzed to effectively measure clinical outcomes. In this study, we used data warehouse (DW) concepts to achieve this goal. A DW was developed to accommodate data from a large clinical trial, including all the characteristics collected. We present the results related to baseline variables with the following objectives: developing a data quality (DQ) control strategy and improving outcome analysis according to the clinical trial primary end points. METHODS Data were retrieved from the electronic case reporting forms (eCRFs) of the phase III, multicenter MCL0208 trial (ClinicalTrials.gov identifier: NCT02354313) of the Fondazione Italiana Linfomi for younger patients with untreated mantle cell lymphoma (MCL). The DW was created with a relational database management system. Recommended DQ dimensions were observed to monitor the activity of each site to handle DQ management during patient follow-up. The DQ management was applied to clinically relevant parameters that predicted progression-free survival to assess its impact. RESULTS The DW encompassed 16 tables, which included 226 variables for 300 patients and 199,500 items of data. The tool allowed cross-comparison analysis and detected some incongruities in eCRFs, prompting queries to clinical centers. This had an impact on clinical end points, as the DQ control strategy was able to improve the prognostic stratification according to single parameters, such as tumor infiltration by flow cytometry, and even using established prognosticators, such as the MCL International Prognostic Index. CONCLUSION The DW is a powerful tool to organize results from large phase III clinical trials and to effectively improve DQ through the application of effective engineered tools.
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Affiliation(s)
| | | | | | | | | | - Andrea Evangelista
- Unit of Clinical Epidemiology, Centro di Prevenzione Oncologica (CPO), Città della Salute e della Scienza di Torino, Hospital of Turin, Turin, Italy
| | | | | | | | | | - Luca Arcaini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Filippo Ballerini
- University of Genoa, Ospedale Policlinico San Martino, IRCCS per l'Oncologia, Genoa, Italy
| | | | | | | | | | | | | | - Marco Ladetto
- Division of Hematology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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10
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Peccatori J, Mastaglio S, Giglio F, Greco R, Crocchiolo R, Patriarca F, Forno B, Deola S, Assanelli A, Lupo Stanghellini MT, Marcatti M, Zecca M, Cortelazzo S, Fanin R, Fagioli F, Locatelli F, Ciceri F. Clofarabine and Treosulfan as Conditioning for Matched Related and Unrelated Hematopoietic Stem Cell Transplantation: Results from the Clo3o Phase II Trial. Biol Blood Marrow Transplant 2019; 26:316-322. [PMID: 31605823 DOI: 10.1016/j.bbmt.2019.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) can be curative for patients with hematologic malignancies. The ideal conditioning regimen before allo-HSCT has not been established. We conducted a Phase II study to evaluate the tolerability and efficacy of clofarabine and treosulfan as conditioning regimen before allo-HSCT. The primary objective was to evaluate the cumulative incidence of nonrelapse mortality (NRM) on day +100. Forty-four patients (36 with acute myelogenous leukemia, 5 with acute lymphoblastic leukemia, 3 with myelodysplastic syndromes) were enrolled. The median patient age was 47 years, and the median duration of follow-up was 27 months. The conditioning regimen was based on clofarabine 40 mg/m2 (days -6 to -2) and treosulfan 14 g/m2 (days -6 to -4). Allogeneic hematopoietic stem cells were derived from a sibling (n = 22) or a well-matched unrelated donor (n = 22). Graft-versus-host disease (GVHD) prophylaxis consisted of antithymocyte globulin, rituximab, cyclosporine, and a short-course of methotrexate. The regimen allowed for rapid engraftment and a 100-day NRM of 18%, due mainly to bacterial infections. The incidences of grade II-IV acute GVHD and chronic GVHD were 16% and 19%, respectively. The rates of overall survival (OS), progression-free survival, and relapse at 2 years were 51%, 31%, and 50%, respectively. Significantly different outcomes were observed between patients with low-intermediate and patients with high-very high Disease Risk Index (DRI) scores (1-year OS, 78% and 24%, respectively). Our findings show that the use of treosulfan and clofarabine as a conditioning regimen for allo-HSCT is feasible, with a 78% 1-year OS in patients with a low-intermediate DRI score. However, 1-year NRM was 18%, and despite the intensified conditioning regimen, relapse incidence remains a major issue in patients with poor prognostic risk factors.
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Affiliation(s)
- Jacopo Peccatori
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Mastaglio
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Giglio
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Greco
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Francesca Patriarca
- Carlo Melzi Hematology and Cellular Therapy Unit, Azienda Sanitaria Universitaria Integrata di Udine, Undine, Italy
| | - Barbara Forno
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Deola
- Department of Hematology, Ospedale Regionale, Bolzano, Italy
| | - Andrea Assanelli
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Magda Marcatti
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Renato Fanin
- Carlo Melzi Hematology and Cellular Therapy Unit, Azienda Sanitaria Universitaria Integrata di Udine, Undine, Italy
| | - Franca Fagioli
- Pediatric Onco-Hematology, University of Torino, Torino, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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11
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Ferrero S, Rossi D, Rinaldi A, Bruscaggin A, Spina V, Eskelund CW, Evangelista A, Moia R, Kwee I, Dahl C, Di Rocco A, Stefoni V, Diop F, Favini C, Ghione P, Mahmoud AM, Schipani M, Kolstad A, Barbero D, Novero D, Paulli M, Zamò A, Jerkeman M, da Silva MG, Santoro A, Molinari A, Ferreri A, Grønbæk K, Piccin A, Cortelazzo S, Bertoni F, Ladetto M, Gaidano G. KMT2D mutations and TP53 disruptions are poor prognostic biomarkers in mantle cell lymphoma receiving high-dose therapy: a FIL study. Haematologica 2019; 105:1604-1612. [PMID: 31537689 PMCID: PMC7271566 DOI: 10.3324/haematol.2018.214056] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [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: 12/24/2018] [Accepted: 09/19/2019] [Indexed: 11/16/2022] Open
Abstract
In recent years, the outcome of mantle cell lymphoma (MCL) has improved, especially in younger patients, receiving cytarabine-containing chemoimmunotherapy and autologous stem cell transplantation. Nevertheless, a proportion of MCL patients still experience early failure. To identify biomarkers anticipating failure of intensive chemotherapy in MCL, we performed target resequencing and DNA profiling of purified tumor samples collected from patients enrolled in the prospective FIL-MCL0208 phase 3 trial (high-dose chemoimmunotherapy followed by autologous transplantation and randomized lenalidomide maintenance). Mutations of KMT2D and disruption of TP53 by deletion or mutation associated with an increased risk of progression and death, both in univariate and multivariate analysis. By adding KMT2D mutations and TP53 disruption to the MIPI-c backbone, we derived a new prognostic index, the “MIPI-genetic” (“MIPI- g”). The “MIPI-g” improved the model discrimination ability compared to the MIPI-c alone, defining three risk groups: i) low-risk patients (4-year progression free survival and overall survival of 72.0% and 94.5%); ii) inter-mediate-risk patients (4-year progression free survival and overall survival of 42.2% and 65.8%) and iii) high-risk patients (4-year progression free survival and overall survival of 11.5% and 44.9%). Our results: i) confirm that TP53 disruption identifies a high-risk population characterized by poor sensitivity to conventional or intensified chemotherapy; ii) provide the pivotal evidence that patients harboring KMT2D mutations share the same poor outcome as patients harboring TP53 disruption; and iii) allow to develop a tool for the identification of high-risk MCL patients for whom novel therapeutic strategies need to be investigated. (Trial registered at clinicaltrials.gov identifier: NCT02354313).
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Affiliation(s)
- Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences - Hematology Division, Università di Torino, Torino, Italy .,Hematology Division, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Davide Rossi
- Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Universita' della Svizzera italiana, Institute of Oncology Research, Bellinzona, Switzerland
| | - Andrea Rinaldi
- Universita' della Svizzera italiana, Institute of Oncology Research, Bellinzona, Switzerland
| | - Alessio Bruscaggin
- Universita' della Svizzera italiana, Institute of Oncology Research, Bellinzona, Switzerland
| | - Valeria Spina
- Universita' della Svizzera italiana, Institute of Oncology Research, Bellinzona, Switzerland
| | - Christian W Eskelund
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.,Biotech Research and Innovation Centre, Copenhagen, Denmark
| | - Andrea Evangelista
- Clinical Epidemiology, Città della Salute e della Scienza and CPO Piemonte, Torino, Italy
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Ivo Kwee
- Universita' della Svizzera italiana, Institute of Oncology Research, Bellinzona, Switzerland.,Swiss Institute of Bioinformatics (SIB), Lausanne, Switzerland.,Dalle Molle Institute for Artificial Intelligence (IDSIA), Manno, Switzerland
| | - Christina Dahl
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Alice Di Rocco
- Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, "Sapienza" University of Rome, Roma, Italy
| | - Vittorio Stefoni
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Fary Diop
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Chiara Favini
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Paola Ghione
- Department of Molecular Biotechnologies and Health Sciences - Hematology Division, Università di Torino, Torino, Italy
| | - Abdurraouf Mokhtar Mahmoud
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Mattia Schipani
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Arne Kolstad
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Daniela Barbero
- Department of Molecular Biotechnologies and Health Sciences - Hematology Division, Università di Torino, Torino, Italy
| | - Domenico Novero
- First Unit of Pathology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Paulli
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and Università degli Studi di Pavia, Pavia, Italy
| | - Alberto Zamò
- Department of Oncology, Università di Torino, Torino, Italy.,Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Mats Jerkeman
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Maria Gomes da Silva
- Department of Hematology, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Armando Santoro
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - Andres Ferreri
- Lymphoma Unit, Department of Onco-Haematology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Kirsten Grønbæk
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.,Biotech Research and Innovation Centre, Copenhagen, Denmark
| | - Andrea Piccin
- Department of Hematology, Ospedale Generale, Bolzano, Italy
| | | | - Francesco Bertoni
- Universita' della Svizzera italiana, Institute of Oncology Research, Bellinzona, Switzerland
| | - Marco Ladetto
- SC Ematologia, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
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12
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Mian M, Pescosta N, Badiali S, Cappelletto PC, Marcheselli L, Luminari S, Patriarca F, Zambello R, Pascarella A, Tagariello G, Marabese A, Mondello P, Billio A, Cortelazzo S. Phase II trial to investigate efficacy and safety of bendamustine, dexamethasone and thalidomide in relapsed or refractory multiple myeloma patients after treatment with lenalidomide and bortezomib. Br J Haematol 2018; 185:944-947. [PMID: 30478966 DOI: 10.1111/bjh.15645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michael Mian
- Department of Haematology & CBMT, Hospital of Bolzano, Bolzano, Italy.,Internal Medicine V, Haematology & Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Norbert Pescosta
- Department of Haematology & CBMT, Hospital of Bolzano, Bolzano, Italy
| | | | | | | | - Stefano Luminari
- Haematology, Santa Maria Nuova Hospital, IRCCS, Reggio Emilia, Italy
| | - Francesca Patriarca
- ClinicaEmatologica e Unita' di TerapieCellulari "Carlo Melzi", Azienda Ospedaliera-Universitaria, Udine, Italy
| | | | | | - Giuseppe Tagariello
- Transfusion Service, Haemophilia Centre and Haematology, Laboratory Analysis, Castelfranco Veneto Hospital, Castelfranco Veneto, Italy
| | | | - Patrizia Mondello
- Department of Human Pathology, University of Messina, Messina, Italy.,Department of Biological and Environmental Sciences, University of Messina, Messina, Italy.,Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Atto Billio
- Department of Haematology & CBMT, Hospital of Bolzano, Bolzano, Italy
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13
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Cortelazzo S, Barbui T, Viero P, Bassan R, Dini E, Milone FF. Platelet Malonyldialdehyde and Spontaneous Aggregation During Ischaemic Attacks of Patients with Polycythaemia Vera. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Cortelazzo
- Divisioni di Ematologia e di Neurologia, Ospedale Generale Regionale, Vicenza (Italy)
| | - T Barbui
- Divisioni di Ematologia e di Neurologia, Ospedale Generale Regionale, Vicenza (Italy)
| | - P Viero
- Divisioni di Ematologia e di Neurologia, Ospedale Generale Regionale, Vicenza (Italy)
| | - R Bassan
- Divisioni di Ematologia e di Neurologia, Ospedale Generale Regionale, Vicenza (Italy)
| | - E Dini
- Divisioni di Ematologia e di Neurologia, Ospedale Generale Regionale, Vicenza (Italy)
| | - F Ferro Milone
- Divisioni di Ematologia e di Neurologia, Ospedale Generale Regionale, Vicenza (Italy)
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14
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Affiliation(s)
- P Viero
- Divisione di Ematologia, Vicenza, Ospedali Riunti di Bergamo e, Vicenza, Italy
| | | | - T Barbui
- Divisione di Ematologia, Vicenza, Ospedali Riunti di Bergamo e, Vicenza, Italy
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15
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D’Andrea G, Cananzi A, Toldo M, Cortelazzo S, Ferro-Milone F. Platelet Behavior in Classic Migraine: Responsiveness to Small Doses of Aspirin. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657349] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- G D’Andrea
- Divisione di Neurologia, Ospedale Regionale “S. Bortolo”, 36100 Vicenza, Italy
| | - A Cananzi
- Divisione di Neurologia, Ospedale Regionale “S. Bortolo”, 36100 Vicenza, Italy
| | - M Toldo
- Divisione di Neurologia, Ospedale Regionale “S. Bortolo”, 36100 Vicenza, Italy
| | - S Cortelazzo
- e di Ematologia, Ospedale Regionale “S. Bortolo”, 36100 Vicenza, Italy
| | - F Ferro-Milone
- Divisione di Neurologia, Ospedale Regionale “S. Bortolo”, 36100 Vicenza, Italy
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16
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Affiliation(s)
- Piera Viero
- Divisione di Ematologia, Ospedali Riuniti di Bergamo, Largo Barozzi, 1, 24100 Bergamo, Italy
| | - Sergio Cortelazzo
- Divisione di Ematologia, Ospedali Riuniti di Bergamo, Largo Barozzi, 1, 24100 Bergamo, Italy
| | - Tiziano Barbui
- Divisione di Ematologia, Ospedali Riuniti di Bergamo, Largo Barozzi, 1, 24100 Bergamo, Italy
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17
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Abstract
SummaryPlatelet aggregation is frequently impaired in myeloproliferative disorders (MPD). The presence of spontaneous platelet aggregation (SPA) or alterations of the aggregation pattern after ADP, epinephrine and collagen have been a frequent feature in the series of 52 patients here presented. The occurrence of SPA was not related to the findings obtained with the aggregating agents or to the number of circulating platelets. The aggregation results did not correlate with the number of megathrombocytes.The presence of platelet abnormalities, not completely corrected after busulfan therapy, and the increased size of platelets should aid in diagnosis of myeloproliferative disorders.
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Affiliation(s)
- Sergio Cortelazzo
- Divisione di Ematologia, Ospedale Generate Regionale, Vicenza, Italy
| | - Tiziano Barbui
- Divisione di Ematologia, Ospedale Generate Regionale, Vicenza, Italy
| | - Renato Bassan
- Divisione di Ematologia, Ospedale Generate Regionale, Vicenza, Italy
| | - Enrico Dim
- Divisione di Ematologia, Ospedale Generate Regionale, Vicenza, Italy
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18
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Viero P, Cortelazzo S, Bassan R, Barbui T. Effect of Aspirin on Platelet 5-Hydroxytryptamine and Beta-Thromboglobulin Plasma Levels in Patients with Myeloproliferative Diseases. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Summary14 patients with myeloproliferative diseases (MD) showed low 5-hydroxytryptamine (5-HT) platelet content and high beta-thromboglobulin (β-TG) plasma levels.This pattern could support the view that MD platelets undergo “in vivo“ degranulation.A single dose of aspirin was unable to induce modification of platelet 5-HT and plasma β-TG, whereas 6 out of 14 patientsNo modification of platelet 5-HT was obtained suggesting that the cause of dense bodies deficiency may lie in the production of abnormal platelets and not be related to “in vivo” degranulation.
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Affiliation(s)
- P Viero
- The Division of Haematology, Ospedali Riuniti, Bergamo
| | - S Cortelazzo
- The Division of Haematology, Ospedale Generale Regionale, Vicenza, Italy
| | - R Bassan
- The Division of Haematology, Ospedali Riuniti, Bergamo
| | - T Barbui
- The Division of Haematology, Ospedali Riuniti, Bergamo
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19
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Affiliation(s)
- P Viero
- Divisione di Ematologia, Ospedale Riuniti di Bergamo, Italy
| | - M Buelli
- Divisione di Ematologia, Ospedale Riuniti di Bergamo, Italy
| | - B Comotti
- Divisione di Ematologia, Ospedale Riuniti di Bergamo, Italy
| | - B Minetti
- Divisione di Ematologia, Ospedale Riuniti di Bergamo, Italy
| | - S Cortelazzo
- Divisione di Ematologia, Ospedale Riuniti di Bergamo, Italy
| | - T Barbui
- Divisione di Ematologia, Ospedale Riuniti di Bergamo, Italy
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20
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Rocca B, Ciabattoni G, Tartaglione R, Cortelazzo S, Barbui T, Patrono C, Landolfi R. Increased Thromboxane Biosynthesis in Essential Thrombocythemia. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1649916] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIn order to investigate the in vivo thromboxane (TX) biosynthesis in essential thromboeythemia (ET), we measured the urinary exeretion of the major enzymatic metabolites of TXB2, 11-dehydro-TXB2 and 2,3-dinor-TXB2 in 40 ET patients as well as in 26 gender- and age-matched controls. Urinary 11-dehydro-TXB2 was significantly higher (p <0.001) in thrombocythemic patients (4,063 ± 3,408 pg/mg creatinine; mean ± SD) than in controls (504 ± 267 pg/mg creatinine), with 34 patients (85%) having 11-dehydro-TXB2 >2 SD above the control mean. Patients with platelet number <1,000 × 109/1 (n = 25) had significantly higher (p <0.05) 11 -dehydro-TXB2 excretion than patients with higher platelet count (4,765 ± 3,870 pg/mg creatinine, n = 25, versus 2,279 ± 1,874 pg/mg creatinine, n = 15). Average excretion values of patients aging >55 was significantly higher than in the younger group (4,784 ± 3,948 pg/mg creatinine, n = 24, versus 2,405 ± 1,885 pg/mg creatinine, n = 16, p <0.05). Low-dose aspirin (50 mg/d for 7 days) largely suppressed 11-dehydro-TXB2 excretion in 7 thrombocythemic patients, thus suggesting that platelets were the main source of enhanced TXA2 biosynthesis. The platelet count-corrected 11-dehydro-TXB2 excretion was positively correlated with age (r = 0.325, n = 40, p <0.05) and inversely correlated with platelet count (r = -0.381, n = 40, p <0.05). In addition 11 out of 13 (85%) patients having increased count-corrected 11-dehydro-TXB2 excretion, belonged to the subgroup with age >55 and platelet count <1,000 × 1099/1. We conclude that in essential thrombocythemia: 1) enhanced 11-dehydro-TXB2 excretion largely reflects platelet activation in vivo;2) age as well as platelet count appear to influence the determinants of platelet activation in this setting, and can help in assessing the thrombotic risk and therapeutic strategy in individual patients.
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Affiliation(s)
- Bianca Rocca
- The Department of Medicine, Catholic University School of Medicine, Rome, Italy
| | - Giovanni Ciabattoni
- The Department of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | | | - Sergio Cortelazzo
- The Division of Hematology, Bergamo’;s Civil Hospital, Bergamo, Italy
| | - Tiziano Barbui
- The Division of Hematology, Bergamo’;s Civil Hospital, Bergamo, Italy
| | - Carlo Patrono
- The Department of Pharmacology, University of Chieti “G. D’Annunzio” School of Medicine, Chieti, Italy
| | - Raffaele Landolfi
- The Department of Medicine, Catholic University School of Medicine, Rome, Italy
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21
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Finazzi G, Falanga A, Galli M, Cortelazzo S, Remuzzi A, Barbui T. Recombinant Versus High-sensitivity Conventional Thromboplastin: A Randomized Clinical Study in Patients on Oral Anticoagulation. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryA prospective, randomized, double-blind clinical trial was carried out in a single center to compare the clinical and laboratory quality of oral anticoagulant therapy monitored with recombinant tissue factor (RTF) or with a sensitive, human-derived, conventional thromboplastin (CT) in the PT test. Seven hundred and fifty-seven consecutive patients receiving oral anticoagulation for various indications were randomized to RTF (n = 379) or CT (n = 368) for 6 months. Total follow-up was 167 and 153 patient-years for RTF and TP groups respectively. Fifty-six bleeding events were observed: 31 in the RTF group and 25 in the TP group. The incidence of bleeding was 18.5 and 16.5% pt-yrs for RTF and TP patients respectively (n.s.). The event-free follow-up curves were not significantly different between the two groups. The laboratory quality of oral anticoagulation was evaluated with the “last check in file” method: therapeutic INR was found in the same propor-tipn of RTF and TP patients (70.2% vs 68.8%). Our study shows that RTF is as effective as a sensitive, conventional thromboplastin for monitoring oral anticoagulation.
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Affiliation(s)
- Guido Finazzi
- The Department of Hematology, Ospedali Riuniti and the “Mario Negri” Institute, Bergamo, Italy
| | - Anna Falanga
- The Department of Hematology, Ospedali Riuniti and the “Mario Negri” Institute, Bergamo, Italy
| | - Monica Galli
- The Department of Hematology, Ospedali Riuniti and the “Mario Negri” Institute, Bergamo, Italy
| | - Sergio Cortelazzo
- The Department of Hematology, Ospedali Riuniti and the “Mario Negri” Institute, Bergamo, Italy
| | | | - Tiziano Barbui
- The Department of Hematology, Ospedali Riuniti and the “Mario Negri” Institute, Bergamo, Italy
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22
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Abstract
SummaryBeta-thromboglobulin (beta-TG) and platelet factor four (PF4) are specific platelet proteins released when a process of platelet activation occurs.The present study was undertaken in order to measure beta-TG and PF4 both as absolute plasma value and ratio to platelet number in 69 patients with myeloproliferative disorders (MD). The aim was to establish whether the increase of the two proteins could depend on platelet number or indicated an “in vivo” platelet activation.In 74% of patients beta-TG was found elevated and PF4 was high in 68% of cases. However in 34.7% and in 31.9% of cases respectively, the elevation of the two platelet markers was correlated to platelet number and the ratio was normal. Only in about one third of cases an “in vivo” platelet activation could be admitted and this finding provides a more rational use of antiaggregating agents.
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Affiliation(s)
- S Cortelazzo
- The Divisione di Ematologia, Ospedale Generale Regionale, Vicenza, Italy
| | - P Viero
- The Divisione di Ematologia, Ospedale Generale Regionale, Vicenza, Italy
| | - T Barbui
- The Divisione di Ematologia, Ospedale Generale Regionale, Vicenza, Italy
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23
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Cortelazzo S, Finazzi G, Viero P, Galli M, Remuzzi A, Parenzan L, Barbui T. Thrombotic and Hemorrhagic Complications in Patients with Mechanical Heart Valve Prosthesis Attending an Anticoagulation Clinic. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1651604] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThis study evaluated the advantage of an anticoagulation clinic in terms of the improvement of the clinical quality of oral anticoagulation (i.e. prevention of thromboembolism and low rate of hemorrhagic complications). The incidence of thromboembolic events and major hemorrhagic complications was assessed in a series of 271 patients on oral anticoagulation for mechanical heart valve prosthesis before and after their enrollment in our anticoagulation clinic from January 1987 to December 1990. Risk factors for hemostatic events were also analyzed. The incidence of major hemostatic complications was significantly lower when patients attended the clinic: 1.0 vs 4.9%/pt-yr for hemorrhage and 0.6 vs 6.6%/pt-yr for thrombosis. This depended on three main factors: better dose regulation of warfarin, continuous patient education and early identification of clinical conditions potentially at risk for thrombosis and hemorrhage. Only previous hemorrhagic or thromboembolic events were recognized as major risk factors for hemostatic complications.In conclusion, our study shows that an anticoagulation clinic offers a real advantage to patients with mechanical heart valve prosthesis in terms of prevention of thromboembolic events and hemorrhagic complications.
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Affiliation(s)
- S Cortelazzo
- The Division of Hematology, Ospedali Riuniti, Bergamo, Italy
| | - G Finazzi
- The Division of Hematology, Ospedali Riuniti, Bergamo, Italy
| | - P Viero
- The Division of Hematology, Ospedali Riuniti, Bergamo, Italy
| | - M Galli
- The Division of Hematology, Ospedali Riuniti, Bergamo, Italy
| | - A Remuzzi
- The “Mario Negri” Institute for Pharmacological Research, Bergamo, Italy
| | - L Parenzan
- The Division of Cardiovascular Surgery, Ospedali Riuniti, Bergamo, Italy
| | - T Barbui
- The Division of Hematology, Ospedali Riuniti, Bergamo, Italy
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24
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Abstract
SummaryPlatelet adhesion to collagen under flow conditions was studied in 18 patients with lupus anticoagulant, seven of which showed a prolonged bleeding time in the presence of a normal platelet count. The effect of patient plasma, IgG and purified anticardiolipin antibodies on platelet adhesion was also examined. We found a significant reduction of platelet adhesion in patients with lupus anticoagulant, which was more evident in patients with prolonged bleeding time. This platelet adhesion defect could be attributed to a plasma factor. In fact, patients' platelets regained normal adhesion when mixed with normal plasma, whereas controls' platelets showed abnormal adhesion in the presence of patient plasma. A causative role of antiphospholipid antibodies was demonstrated in experiments using purified immunoglobulins and anticardiolipin antibodies.
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Affiliation(s)
- E Orlando
- The Department of Hematology, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - S Cortelazzo
- The Department of Hematology, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - M Marchetti
- The Department of Hematology, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - R Sanfratello
- The Department of Hematology, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - T Barbui
- The Department of Hematology, Ospedali Riuniti di Bergamo, Bergamo, Italy
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25
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Affiliation(s)
- M Galli
- Department of Haematology, Ospedali Riuniti, Bergamo, Italy
| | - S Cortelazzo
- Department of Haematology, Ospedali Riuniti, Bergamo, Italy
| | - M Daldossi
- Department of Haematology, Ospedali Riuniti, Bergamo, Italy
| | - T Barbui
- Department of Haematology, Ospedali Riuniti, Bergamo, Italy
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26
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Affiliation(s)
- Guido Finazzi
- Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy
| | | | - Piera Viero
- Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - Monica Galli
- Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - Tiziano Barbui
- Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy
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27
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Cortelazzo S, Galli M, Castagna D, Viero P, Gaetano GD, Barbui T. Increased Response to Arachidonic Acid and U-46619 and Resistance to Inhibitory Prostaglandins in Patients with Chronic Myeloproliferative Disorders. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryIn patients with myeloproliferative disorders (MPD) a group of related diseases of the bone marrow stem cell and recurrent haemorrhagic and/or thrombotic complications, the production of aggregating prostaglandins (PGs) may be normal or slightly reduced, while PGI2 production is normal. However, MPD platelet sensitivity to antiaggregatory PGs is still unknown.We studied the potency of PGD2, PGI2 and PGEi as inhibitors of platelet aggregation induced by threshold aggregating concentrations of arachidonic acid and U-46619-analogue of the cyclic endoperoxide PGH2 in 20 patients with MPD in comparison with healthy controls, with the aim of evaluating the sensitivity of MPD platelets to antiaggregatory PGs. In these patients platelet prostanoid metabolism was normal. However, the functional response of platelets to aggregating and antiaggregating prostanoids was shifted towards potentially increased platelet aggregation response. These findings could have a clinical relevance in view of the haemostatic and thrombotic complications so frequent in MPD.
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Affiliation(s)
| | - Monica Galli
- The Reparto di Ematologia, Ospedali Riuniti di Bergamo, Italy
| | | | - Piera Viero
- The Reparto di Ematologia, Ospedali Riuniti di Bergamo, Italy
| | - Giovanni de Gaetano
- The Reparto di Ematologia, Ospedali Riuniti di Bergamo and Istituto di Ricerche Farmacologiche “Mario Negri“, Centro di Ricerche del Consorzio “Mario Negri Sud”, S. Maria Imbaro, Chieti, Italy
| | - Tiziano Barbui
- The Reparto di Ematologia, Ospedali Riuniti di Bergamo, Italy
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28
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Bomben R, Ferrero S, D'Agaro T, Dal Bo M, Re A, Evangelista A, Carella AM, Zamò A, Vitolo U, Omedè P, Rusconi C, Arcaini L, Rigacci L, Luminari S, Piccin A, Liu D, Wiestner A, Gaidano G, Cortelazzo S, Ladetto M, Gattei V. A B-cell receptor-related gene signature predicts survival in mantle cell lymphoma: results from the Fondazione Italiana Linfomi MCL-0208 trial. Haematologica 2018; 103:849-856. [PMID: 29472356 PMCID: PMC5927985 DOI: 10.3324/haematol.2017.184325] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/14/2018] [Indexed: 12/22/2022] Open
Abstract
Mantle cell lymphoma patients have variable clinical courses, ranging from indolent cases that do not require immediate treatment to aggressive, rapidly progressing diseases. Thus, diagnostic tools capable of stratifying patients according to their risk of relapse and death are needed. This study included 83 samples from the Fondazione Italiana Linfomi MCL-0208 clinical trial. Through gene expression profiling and quantitative real-time PCR we analyzed 46 peripheral blood and 43 formalin-fixed paraffin-embedded lymph node samples. A prediction model to classify patients was developed. By analyzing the transcriptome of 27 peripheral blood samples, two subgroups characterized by a differential expression of genes from the B-cell receptor pathway (B-cell receptorlow and B-cell receptorhigh) were identified. The prediction model based on the quantitative real-time PCR values of six representative genes (AKT3, BCL2, BTK, CD79B, PIK3CD, and SYK), was used to classify the 83 cases (43 B-cell receptorlow and 40 B-cell receptorhigh). The B-cell receptorhigh signature associated with shorter progression-free survival (P=0.0074), selected the mantle cell lymphoma subgroup with the shortest progression-free survival and overall survival (P=0.0014 and P=0.029, respectively) in combination with high (>30%) Ki-67 staining, and was an independent predictor of short progression- free survival along with the Mantle Cell Lymphoma International Prognostic Index-combined score. Moreover, the clinical impact of the 6- gene signature related to the B-cell receptor pathway identified a mantle cell lymphoma subset with shorter progression-free survival intervals also in an external independent mantle cell lymphoma cohort homogenously treated with different schedules. In conclusion, this 6-gene signature associates with a poor clinical response in the context of the MCL- 0208 clinical trial. (clinicaltrials.gov identifier: 02354313).
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Affiliation(s)
- Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano (PN), Italy
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division 1, University of Torino, Italy.,Hematology Division 1, AOU "Città della Salute e della Scienza di Torino" University-Hospital, Italy
| | - Tiziana D'Agaro
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano (PN), Italy
| | - Michele Dal Bo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano (PN), Italy
| | | | - Andrea Evangelista
- Unit of Cancer Epidemiology, AOU "Città della Salute e della Scienza di Torino" University-Hospital, Italy
| | | | - Alberto Zamò
- Department of Diagnostics and Public Health, University of Verona, Italy
| | - Umberto Vitolo
- Hematology Division 1, AOU "Città della Salute e della Scienza di Torino" University-Hospital, Italy
| | - Paola Omedè
- Hematology Division 1, AOU "Città della Salute e della Scienza di Torino" University-Hospital, Italy
| | - Chiara Rusconi
- Hematology Division, "Niguarda Ca' Granda" Hospital, Milano, Italy
| | - Luca Arcaini
- Hematology Division, Department of Molecular Medicine, IRCCS Fondazione San Matteo, Pavia, Italy
| | - Luigi Rigacci
- Hematology Division, AOU "Careggi", University of Firenze, Italy
| | - Stefano Luminari
- Hematology, Azienda Sanitaria Locale IRCCS, Reggio Emilia, Italy.,Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Piccin
- Department of Hematology and BMT Unit, Bolzano/Bozen Regional Hospital, Italy
| | - Delong Liu
- Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Adrian Wiestner
- Hematology Branch, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine -University of Eastern Piedmont, Novara, Italy
| | - Sergio Cortelazzo
- Hematology, Medical Oncology and Hematology Division, "Istituto Clinico Humanitas Gavazzeni", Bergamo, Italy
| | - Marco Ladetto
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division 1, University of Torino, Italy.,SC Ematologia Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano (PN), Italy
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29
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Dreyling M, Aurer I, Cortelazzo S, Hermine O, Hess G, Jerkeman M, Le Gouill S, Ribrag V, Trněný M, Visco C, Walewski J, Zaja F, Zinzani PL. Treatment for patients with relapsed/refractory mantle cell lymphoma: European-based recommendations. Leuk Lymphoma 2017; 59:1814-1828. [DOI: 10.1080/10428194.2017.1403602] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Martin Dreyling
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München, LMU München, Germany
| | - Igor Aurer
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Olivier Hermine
- Department of Adult Haematology, Paris Descartes University, Paris, France
| | - Georg Hess
- University Medical School of the Johannes Gutenberg-University, Mainz, Germany
| | - Mats Jerkeman
- Department of Oncology, Lund University, Lund, Sweden
| | | | | | - Marek Trněný
- General Hospital, Charles University, Praha, Czech Republic
| | | | - Jan Walewski
- Maria Sklodowska-Curie Institute Oncology Centre, Warszawa, Poland
| | - Francesco Zaja
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari “Carlo Melzi,” University of Udine, Udine, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology “Seràgnoli,” University of Bologna, Bologna, Italy
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30
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Ferrero S, Rossi D, Bruscaggin A, Evangelista A, Di Rocco A, Spina V, Stefoni V, Ghione P, Barbero D, Monitillo L, Gomes Da Silva M, Santoro A, Molinari A, Ferreri A, Piccin A, Cortelazzo S, Ladetto M, Gaidano G. KMT2D AND TP53 MUTATIONS PREDICT POOR PFS AND OS IN MANTLE CELL LYMPHOMA RECEIVING HIGH-DOSE THERAPY AND ASCT: THE FONDAZIONE ITALIANA LINFOMI (FIL) MCL0208 PHASE III TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Ferrero
- Molecular Biotechnologies and Health Sciences - Hematology Division; Università di Torino; Torino Italy
| | - D. Rossi
- Hematology, Oncology; Institute of Southern Switzerland and Institute of Oncology Research; Bellinzona Switzerland
| | - A. Bruscaggin
- Hematology; Institute of Oncology Research; Bellinzona Switzerland
| | - A. Evangelista
- Clinical Epidemiology; Città della Salute e della Scienza and CPO Piemonte; Torino Italy
| | - A. Di Rocco
- Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I; "Sapienza" University of Rome; Rome Italy
| | - V. Spina
- Hematology; Institute of Oncology Research; Bellinzona Switzerland
| | - V. Stefoni
- University of Bologna; Institute of Hematology "L. e A. Seràgnoli; Bologna Italy
| | - P. Ghione
- Molecular Biotechnologies and Health Sciences - Hematology Division; Università di Torino; Torino Italy
| | - D. Barbero
- Molecular Biotechnologies and Health Sciences - Hematology Division; Università di Torino; Torino Italy
| | - L. Monitillo
- Molecular Biotechnologies and Health Sciences - Hematology Division; Università di Torino; Torino Italy
| | - M. Gomes Da Silva
- Department of Hematology; Instituto Português de Oncologia de Lisboa; Lisbona Portugal
| | - A. Santoro
- Humanitas Clinical and Research Center; Humanitas Cancer Center; Rozzano Italy
| | - A. Molinari
- Hematology; Ospedale degli Infermi; Rimini Italy
| | - A. Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Haematology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - A. Piccin
- Department of Hematology; Ospedale Generale; Bolzano Italy
| | | | - M. Ladetto
- Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, SC Ematologia; Alessandria Italy
| | - G. Gaidano
- Department of Translational Medicine; University of Eastern Piedmont, Division of Hematology; Novara Italy
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31
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Ferrero S, Genuardi E, Klous P, Drandi D, Mantoan B, Monitillo L, Barbero D, Yilmaz M, Cattellino F, Vasta M, Cavallo F, Cortelazzo S, Vitolo U, Luminari S, Federico M, Boccadoro M, Splinter E, Ladetto M. NOVEL MOLECULAR MARKERS FOR MINIMAL RESIDUAL DISEASE (MRD) MONITORING IN MANTLE CELL AND FOLLICULAR LYMPHOMA: THE TARGETED LOCUS AMPLIFICATION (TLA) NGS STRATEGY. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Ferrero
- Department of Molecular Biotechnology and Health Sciences; University of Torino; Torino Italy
| | - E. Genuardi
- Department of Molecular Biotechnology and Health Sciences; University of Torino; Torino Italy
| | - P. Klous
- B.V., Cergentis B.V.; Utrecht Netherlands
| | - D. Drandi
- Department of Molecular Biotechnology and Health Sciences; University of Torino; Torino Italy
| | - B. Mantoan
- Department of Molecular Biotechnology and Health Sciences; University of Torino; Torino Italy
| | - L. Monitillo
- Department of Molecular Biotechnology and Health Sciences; University of Torino; Torino Italy
| | - D. Barbero
- Department of Molecular Biotechnology and Health Sciences; University of Torino; Torino Italy
| | - M. Yilmaz
- B.V., Cergentis B.V.; Utrecht Netherlands
| | - F. Cattellino
- Department of Molecular Biotechnology and Health Sciences; University of Torino; Torino Italy
| | - M. Vasta
- Department of Molecular Biotechnology and Health Sciences; University of Torino; Torino Italy
| | - F. Cavallo
- Department of Molecular Biotechnology and Health Sciences; University of Torino; Torino Italy
| | - S. Cortelazzo
- Oncology Unit; Humanitas/Gavazzeni Clinic; Bergamo Italy
| | - U. Vitolo
- Department of Oncology, Division of Hematology; AOU Città della Salute e della Scienza di Torino; Torino Italy
| | - S. Luminari
- Clinics and Public Health, “Arcispedale S.Maria Nuova”; University of Modena e Reggio Emilia, Hematology Division, Department of Diagnostic Medicine; Reggio Emilia Italy
| | - M. Federico
- Department of Diagnostic, Clinical and Public Health Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - M. Boccadoro
- Department of Molecular Biotechnology and Health Sciences; University of Torino; Torino Italy
| | | | - M. Ladetto
- Division of Hematology; Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo; Alessandria Italy
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Cortelazzo S, Ferreri A, Hoelzer D, Ponzoni M. Lymphoblastic lymphoma. Crit Rev Oncol Hematol 2017; 113:304-317. [DOI: 10.1016/j.critrevonc.2017.03.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/12/2017] [Accepted: 03/15/2017] [Indexed: 12/15/2022] Open
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Santi RM, Ceccarelli M, Bernocco E, Monagheddu C, Evangelista A, Valeri F, Monaco F, Vitolo U, Cortelazzo S, Cabras MG, Spina M, Baldini L, Boccomini C, Chiappella A, Bari A, Luminari S, Visco C, Calabrese M, Limberti G, Levis A, Contino L, Ciccone G, Ladetto M. Khorana score and histotype predicts incidence of early venous thromboembolism in non-Hodgkin lymphomas. A pooled-data analysis of 12 clinical trials of Fondazione Italiana Linfomi (FIL). Thromb Haemost 2017; 117:16-11-0895. [PMID: 28447710 DOI: 10.1160/th16-11-0895] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/10/2017] [Indexed: 12/21/2022]
Abstract
Current data suggests that the risk of venous thromboembolism (VTE) in patients with non-Hodgkin lymphoma (NHL) is comparable to that observed in patients with solid tumours, although more robust confirmatory analyses are required. With that in mind, we investigated the occurrence of VTE in a pooled analysis of 12 "Fondazione Italiana Linfomi" (FIL) prospective clinical studies. Specifically, we wished to assess the cumulative incidence of VTE in NHL patients, evaluate the predictive value of the Khorana Score (KS), and identify other potential risk factors for VTEs. Data for VTE occurrence were retrieved from study databases and pharmacovigilance reports. Our analysis includes 1717 patients from 12 prospective phase II and III trials, including newly diagnosed NHL. We observed 53 VTEs (any grade) in 46 patients, with 20 severe VTEs in 17 patients. The cumulative incidences for "all-grade" or grade ≥3 VTEs were 2.9 % (95 % CI: 2.1-3.8) and 1.1 % (95 % CI: 0.6-1.6), respectively. KS categories were positively associated with the risk of VTE of any grade, and with severe events (i. e. grade ≥3; Gray's test p-values = 0.048 and 0.012, respectively). Among NHL patients, those with diffuse large B-cell lymphoma (DLBCL) showed a greater risk of (any grade) VTE (HR: 3.42, 95 % CI: 1.32-8.84, p-value = 0.011). Our study indicates that 1) VTE is a relevant complication for NHL patients, 2) KS is predictive of VTE events and 3) DLBCL histotype is an independent risk factor for VTE incidence, for which preventative interventions could be considered.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Giulia Limberti
- Giulia Limberti, AO SS Antonio e Biagio e C. Arrigo - SC Ematolgoia, Via Venezia 16, 15121 Alessandria, Italy, Tel.: +39 0131206930, Fax: +39 0131261029, E-mail:
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Orlando E, Cortelazzo S, Barbui T. Red blood cell deformability in polycythaemia vera does not depend on hypochromic microcytosis. Clin Hemorheol Microcirc 2016. [DOI: 10.3233/ch-1988-8204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- E. Orlando
- Department of Haematology, Ospedali Riuniti di Bergamo, Italy
| | - S. Cortelazzo
- Department of Haematology, Ospedali Riuniti di Bergamo, Italy
| | - T. Barbui
- Department of Haematology, Ospedali Riuniti di Bergamo, Italy
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Cortelazzo S, Tarella C, Gianni AM, Ladetto M, Barbui AM, Rossi A, Gritti G, Corradini P, Di Nicola M, Patti C, Mulé A, Zanni M, Zoli V, Billio A, Piccin A, Negri G, Castellino C, Di Raimondo F, Ferreri AJM, Benedetti F, La Nasa G, Gini G, Trentin L, Frezzato M, Flenghi L, Falorio S, Chilosi M, Bruna R, Tabanelli V, Pileri S, Masciulli A, Delaini F, Boschini C, Rambaldi A. Randomized Trial Comparing R-CHOP Versus High-Dose Sequential Chemotherapy in High-Risk Patients With Diffuse Large B-Cell Lymphomas. J Clin Oncol 2016; 34:4015-4022. [PMID: 28199143 DOI: 10.1200/jco.2016.67.2980] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The benefit of high-dose chemotherapy with autologous stem-cell transplantation (ASCT) as first-line treatment in patients with diffuse large B-cell lymphomas is still a matter of debate. To address this point, we designed a randomized phase III trial to compare rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)-14 (eight cycles) with rituximab plus high-dose sequential chemotherapy (R-HDS) with ASCT. Patients and Methods From June 2005 to June 2011, 246 high-risk patients with a high-intermediate (56%) or high (44%) International Prognostic Index score were randomly assigned to the R-CHOP or R-HDS arm, and 235 were analyzed by intent to treat. The primary efficacy end point of the study was 3-year event-free survival, and results were analyzed on an intent-to-treat basis. Results Clinical response (complete response, 78% v 76%; partial response, 5% v 9%) and failures (no response, 15% v 11%; and early treatment-related mortality, 2% v 3%) were similar after R-CHOP versus R-HDS, respectively. After a median follow-up of 5 years, the 3-year event-free survival was 62% versus 65% ( P = .83). At 3 years, compared with the R-CHOP arm, the R-HDS arm had better disease-free survival (79% v 91%, respectively; P = .034), but this subsequently vanished because of late-occurring treatment-related deaths. No difference was detected in terms of progression-free survival (65% v 75%, respectively; P = .12), or overall survival (74% v 77%, respectively; P = .64). Significantly higher hematologic toxicity ( P < .001) and more infectious complications ( P < .001) were observed in the R-HDS arm. Conclusion In this study, front-line intensive R-HDS chemotherapy with ASCT did not improve the outcome of high-risk patients with diffuse large B-cell lymphomas.
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Affiliation(s)
- Sergio Cortelazzo
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Corrado Tarella
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Alessandro Massimo Gianni
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Marco Ladetto
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Anna Maria Barbui
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Andrea Rossi
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Giuseppe Gritti
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Paolo Corradini
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Massimo Di Nicola
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Caterina Patti
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Antonino Mulé
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Manuela Zanni
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Valerio Zoli
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Atto Billio
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Andrea Piccin
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Giovanni Negri
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Claudia Castellino
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Francesco Di Raimondo
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Andrés J M Ferreri
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Fabio Benedetti
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Giorgio La Nasa
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Guido Gini
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Livio Trentin
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Maurizio Frezzato
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Leonardo Flenghi
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Simona Falorio
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Marco Chilosi
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Riccardo Bruna
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Valentina Tabanelli
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Stefano Pileri
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Arianna Masciulli
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Federica Delaini
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Cristina Boschini
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Alessandro Rambaldi
- Sergio Cortelazzo, Atto Billio, Andrea Piccin, and Giovanni Negri, Ospedale Centrale di Bolzano, Bolzano; Corrado Tarella and Riccardo Bruna, Azienda Ospedaliera Ordine Mauriziano and University of Turin; Marco Ladetto and Manuela Zanni, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin; Alessandro Massimo Gianni, Paolo Corradini, and Massimo Di Nicola, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, University of Milano; Andrés J.M. Ferreri, IRCCS San Raffaele Scientific Institute; Valentina Tabanelli and Stefano Pileri, Istituto Europeo di Oncologia; Alessandro Rambaldi, University of Milano, Milan; Anna Maria Barbui, Andrea Rossi, Giuseppe Gritti, Arianna Masciulli, Federica Delaini, Cristina Boschini, and Alessandro Rambaldi, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo; Caterina Patti and Antonino Mulé, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo; Valerio Zoli, Ospedale San Camillo Forlanini, Rome; Claudia Castellino, Ospedale S. Croce e Carle, Cuneo; Francesco Di Raimondo, AOU Policlinico Vittorio Emanuele University of Catania, Catania; Fabio Benedetti, University of Verona; Marco Chilosi, Azienda Ospedaliera Universitaria Integrata Verona, Verona; Giorgio La Nasa, Ospedale Binaghi, Cagliari; Guido Gini, Ospedali Riuniti, Ancona; Livio Trentin, Azienda Ospedaliera-Università di Padova, Padua; Maurizio Frezzato, Ospedale San Bortolo, Vicenza; Leonardo Flenghi, Azienda Ospedaliera di Perugia, Perugia; and Simona Falorio, Ospedale Civile Spirito Santo, Pescara, Italy
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Santi RM, Ceccarelli M, Catania G, Monagheddu C, Evangelista A, Bernocco E, Monaco F, Federico M, Vitolo U, Cortelazzo S, Cabras MG, Spina M, Baldini L, Boccomini C, Chiappella A, Bari A, Luminari S, Calabrese M, Levis A, Visco C, Contino L, Ciccone G, Ladetto M. PO-03 - Khorana score and histotype predict the incidence of early venous thromboembolism (VTE) in Non Hodgkin Lymphoma (NHL). A pooled data analysis of twelve clinical trials of Fondazione Italiana Linfomi (FIL). Thromb Res 2016; 140 Suppl 1:S177. [PMID: 27161692 DOI: 10.1016/s0049-3848(16)30136-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent studies show that the risk of VTE in NHL pts is similar to that observed in high risk solid tumors (i.e. pancreatic, ovarian cancer). VTE in NHL occurs in most cases within three months from diagnosis and can have substantial impact on treatment delivery and outcome as well as on quality of life. However few data are available on potential predictors. AIMS To better clarify the epidemiology of early (within six months from treatment start) VTE in NHL we conducted a pooled data analysis of 12 clinical trials from FIL. Our analysis included basic demographic features, lymphoma-related characteristics as well the Khorana score (based on histology, BMI, platelets WBC and HB counts) which is extensively used in solid tumors to predict VTE risk. PATIENTS AND METHODS From Jan. 2010 to Dec. 2014, all pts with B-cell NHL enrolled in prospective clinical trials from FIL for frontline treatment were included. For 9 studies study period included the entire trial population was included. The analyses were conducted based on CRFs as well as pharmacovigilance reports. VTE definition and grading was stated according to standard criteria of toxicity (CTCAE V4.0). Cumulative incidence of VTE from the study enrollment was estimated using the method described by Gooley et al. accounting for death from any causes as a competing risk. The Fine & Gray survival model was used to identify predictors of VTE among NHL pts. Factors predicting the grade of VTE were investigated using an ordinal logistic regression model. This pooled data analysis was approved by local IRB. RESULTS Overall, 1,717 patients belonging to 12 studies were evaluated. Eight were phase I/II or II (25% of pts) and 4 phase III (75% of pts). M/F ratio was 1.41, Median age was 57, (IQ range (IQR) 49-66). Histologies were: DLCL-B 34%, FL 41%, MCL 18%, other 6%. Median BMI was 25 (IQR 22-28). Median Hb, WBC and platelets counts were 13g/dl) (IQR 11.5-14.2), 7.1*10^(9)/l (IQR 5.6-10.3), 224*10^(9)/l (IQR 169-298), respectively. 1189 pts were evaluable Khorana score: 58% low risk, 30% intermediate risk, 12% were high risk. Human erythropoetin support was given to 9% of patients. All pts received Rituximab. Planned therapeutic programs included ASCT in 27% of pts, conventional chemotherapy in 67% a conventional chemotherapy plus lenalidomide in 6%. Overall 59 any grade VTE episodes occurred in 51 pts (2.9%), including 21 grade III-IV VTE (18 pts). None was fatal. Median time from study enrolment to VTE was 63 days (IQR: 35-110). Considering death as a competitive event the 6 months cumulative incidence of VTE was 2,2% in low risk Khorana score, 4.5% (95%IC: 2.3-6.7) in intermediate and 6.6% (95%IC: 2.4-10.8) in high risk (p=0.012) (figure 1). Khorana score was predictive also for grade III-IV events as they were 0,7% (95% CI:0.1-1.4) in low risk and 2.0% (95% CI:0.8-3.3) in intermediate-high risk (p=0.048). The results were similar also after excluding lenalidomide containing studies. The Fine and Gray multivariate analyses, adjusted for age and stage, showed that Khorana score (intermediate risk adjHR=1.96; 95%IC: 0.84-4.56 and high risk adjHR=3.81; 95%IC: 1.51-9.58) and DLCL-B histotype (adjHR=2.58; 95% CI: 1.01-6.55) were independently associated to an increased risk of VTE. Moreover an ordinal logistical regression model indicated that the increase of one point in the Khorana score resulted in an increased risk of VTE (OR=1.85; 95% CI: 1.23-2.79). CONCLUSIONS Our results suggest that DLCL-B histotype and Khorana score are predictors of VTE in NHL. The latter might become a simple and effective tool to assess the risk of VTE in NHL. Prospective validation including also patients not eligible for clinical trials is needed.
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Affiliation(s)
| | - M Ceccarelli
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Torino
| | - G Catania
- Division of Hematology, Az Osp SS Antinio e Biagio e Cesare Arrigo, Alessandria
| | - C Monagheddu
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Torino
| | - A Evangelista
- Unit of Cancer Epidemiology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino
| | - E Bernocco
- Division of Haematology - SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandrio
| | - F Monaco
- Division of Hematology, AZ Osp SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M Federico
- Oncologia Medica, Università di Modena e Reggio Emilia, Modena
| | - U Vitolo
- Hematology II, Azienda Ospedaliera Città della Salute, Torino
| | - S Cortelazzo
- Department of Haematology and Bone Marrow Transplantation, Regional Hospital, S. Maurizio, Bolzano/Bozen
| | - M G Cabras
- Division of Hematology, Ospedale Businco, Cagliari
| | - M Spina
- Division of Hematology, IRCCS CRO Aviano
| | - L Baldini
- Division of Hematology, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano
| | - C Boccomini
- Division of Hematology II, AOU Citta della Salute e della Scienza, Torino
| | - A Chiappella
- Department of Hematology, Azienda Ospedaliera Città della Salute e della Scienza, Torino
| | - A Bari
- Program of Innovative Therapy in Oncology and Hematology, Department of Diagnostic, Clinical and Public Health Medicine University of Modena and Reggio Emilia, Modena
| | - S Luminari
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena
| | - M Calabrese
- Fondazione Italiana Linfomi Onlus, Alessandria
| | - A Levis
- Italian Lymphoma Foundation (FIL), Alessandria
| | | | | | - G Ciccone
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Az Osp Citta della salute e della Scienza, Torino
| | - M Ladetto
- Division of Hematology, Az Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria; Italy
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Mian M, Tinelli M, DE March E, Turri G, Meneghini V, Pescosta N, Berno T, Marabese A, Mondello P, Patriarca F, Pizzolo G, Semenzato G, Cortelazzo S, Zambello R. Bortezomib, Thalidomide and Lenalidomide: Have They Really Changed the Outcome of Multiple Myeloma? Anticancer Res 2016; 36:1059-1065. [PMID: 26976998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Treatment of multiple myeloma (MM) has significantly improved, although the disease remains incurable. Prospective clinical trials evaluating the impact on outcome of new drugs such as proteasome inhibitors or immunomodulating agents are limited since they are not able to reflect the clinical routine and available retrospective data are not detailed enough to directly evaluate the value of new drugs. To address these information gaps, we performed a retrospective real-life analysis. We retrospectively assessed 949 patients treated for multiple myeloma or plasma cell leukemia at three Italian cancer centers in the years 1979-2014. Clinical features at the time of diagnosis were consistent with what was observed in clinical routine. A total of 39% of patients underwent high-dose chemotherapy followed by autologous stem cell transplantation (ASCT). The median overall survival (OS) of the whole group was 5.4 years and ranged from 3.4 years for patients who did not receive at least one of the new drugs compared to 5.9 years in the other patients (p<0.001). The improvement in OS due to administration of new drugs was also observed among different prognostic sub-groups such as age, Durie and Salmon stage, international staging system and renal impairment. Availability of new drugs significantly improved survival of patients who underwent ASCT and also those who did not. In conclusion, we provided evidence that the advent of the new drugs drastically improved the outcome of patients with MM, also in cases with poor risk at the time of diagnosis. ASCT is still of major importance in the treatment of this disease. Nevertheless, MM remains incurable and new therapeutic approaches are warranted.
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Affiliation(s)
- Michael Mian
- Department of Hematology & Center of Bone Marrow Transplantation, Ospedale di Bolzano, Bolzano, Italy Department of Internal Medicine V (Haematology and Oncology), Medical University of Innsbruck, Innsbruck, Austria
| | - Martina Tinelli
- Department of Medicine, Section of Hematology, University Hospital of Verona, Verona, Italy
| | - Elena DE March
- Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy
| | - Gloria Turri
- Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy
| | - Vittorio Meneghini
- Department of Medicine, Section of Hematology, University Hospital of Verona, Verona, Italy
| | - Norbert Pescosta
- Department of Hematology & Center of Bone Marrow Transplantation, Ospedale di Bolzano, Bolzano, Italy
| | - Tamara Berno
- Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy
| | - Alessandra Marabese
- Department of Hematology & Center of Bone Marrow Transplantation, Ospedale di Bolzano, Bolzano, Italy
| | - Patrizia Mondello
- Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Giovanni Pizzolo
- Department of Medicine, Section of Hematology, University Hospital of Verona, Verona, Italy
| | - Gianpietro Semenzato
- Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy
| | - Sergio Cortelazzo
- Unit of Medical Oncology and Hematology, Clinical Institute Humanitas-Gavazzeni, Bergamo, Italy
| | - Renato Zambello
- Department of Medicine, Hematology and Clinical Immunology, Padua University School of Medicine, Padua, Italy
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38
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Bassan R, Maino E, Cortelazzo S. Lymphoblastic lymphoma: an updated review on biology, diagnosis, and treatment. Eur J Haematol 2016; 96:447-60. [DOI: 10.1111/ejh.12722] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Renato Bassan
- Unità Operativa Complessa di Ematologia; Ospedale dell'Angelo & Ospedale SS. Giovanni e Paolo; Mestre-Venezia Italy
| | - Elena Maino
- Unità Operativa Complessa di Ematologia; Ospedale dell'Angelo & Ospedale SS. Giovanni e Paolo; Mestre-Venezia Italy
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39
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Jackson AE, Mian M, Kalpadakis C, Pangalis GA, Stathis A, Porro E, Conconi A, Cortelazzo S, Gaidano G, Lopez Guillermo A, Johnson PW, Martelli M, Martinelli G, Thieblemont C, McPhail ED, Copie-Bergman C, Pileri SA, Jack A, Campo E, Mazzucchelli L, Ristow K, Habermann TM, Cavalli F, Nowakowski GS, Zucca E. Extranodal Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue of the Salivary Glands: A Multicenter, International Experience of 248 Patients (IELSG 41). Oncologist 2015; 20:1149-53. [PMID: 26268740 DOI: 10.1634/theoncologist.2015-0180] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 04/30/2015] [Accepted: 06/09/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The salivary gland is one of the most common sites involved by nongastric, extranodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT). A large series of patients with long-term follow-up has not been documented. This multicenter, international study sought to characterize the clinical characteristics, treatment, and natural history of salivary gland MALT lymphoma. METHODS Patients with biopsy-confirmed salivary gland MALT lymphoma were identified from multiple international sites. Risk factors, treatment, and long-term outcomes were evaluated. RESULTS A total of 247 patients were evaluated; 76% presented with limited-stage disease. There was a history of autoimmune disorder in 41%, with Sjögren disease being the most common (83%). Fifty-seven percent of patients were initially treated with local therapy with surgery, radiation, or both; 37 of patients were treated with systemic therapy initially, with 47% of those receiving rituximab; and 6% of patients were observed. The median overall survival (OS) was 18.3 years. The median progression-free survival (PFS) following primary therapy was 9.3 years. There was no difference in the outcomes between patients receiving local or systemic therapy in first-line management. On multivariate analysis, age <60 years and low to intermediate international prognostic index were associated with improved OS and PFS; Sjögren disease was associated with improved OS. CONCLUSION Salivary gland MALT lymphoma has an excellent prognosis regardless of initial treatment, and patients with Sjögren disease have improved survival. Risks for long-term complications must be weighed when determining initial therapy.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Chemotherapy, Adjuvant
- Disease-Free Survival
- Female
- Humans
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/mortality
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Male
- Middle Aged
- Prognosis
- Rituximab/therapeutic use
- Salivary Gland Neoplasms/mortality
- Salivary Gland Neoplasms/pathology
- Salivary Gland Neoplasms/therapy
- Sjogren's Syndrome/complications
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Amie E Jackson
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Michael Mian
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Christina Kalpadakis
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Gerassimos A Pangalis
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Anastasios Stathis
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Elena Porro
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Annarita Conconi
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Sergio Cortelazzo
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Gianluca Gaidano
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | | | - Peter W Johnson
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Maurizio Martelli
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Giovanni Martinelli
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Catherine Thieblemont
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Ellen D McPhail
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Christiane Copie-Bergman
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Stefano A Pileri
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Andrew Jack
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Elias Campo
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Luca Mazzucchelli
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Kay Ristow
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Thomas M Habermann
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Franco Cavalli
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Grzegorz S Nowakowski
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
| | - Emanuele Zucca
- Divisions of Hematology and Hematopathology, Mayo Clinic, Rochester, Minnesota USA; Hospital of Bolzano, Department of Hematology & Center of Bone Marrow Transplantation, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria; University Hospital of Crete, Heraklion, Greece; Athens Medical Center-Psychikon Branch, Athens, Greece; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Hematology Unit, Department of Internal Medicine, Ospedale degli Infermi, Biella, Italy; Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; Hospital Clínic, Hematology, Barcelona, Spain; Cancer Research UK Centre, Southampton, United Kingdom; Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy; European Institute of Oncology, Division of Clinical Haemato-Oncology, Milan, Italy; APHP, Saint-Louis Hospital, Hemato-Oncology, and Diderot University-Sorbonne Paris Cité, Paris, France; Département de Pathologie, Groupe Henri Mondor-Albert Chenevier, AP-HP, Creteil, France; Diagnostic Haematopathology, European Institute of Oncology, Milan, Bologna University School of Medicine, Bologna, Italy; St. James's University Hospital, Leeds, United Kingdom; Hospital Clinic, Anatomia Patologica, IDIBAPS, Barcelona, Spain; ICP Locarno, Locarno, Switzerland
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Piccin A, Steurer M, Mitterer M, Blöchl EM, Marcheselli L, Pusceddu I, Marabese A, Bertozzi I, Corvetta D, Randi ML, Elli E, Pogliani EM, Veneri D, Perbellini O, Krampera M, Pacquola E, Gottardi M, Tiribelli M, Guella A, Innella B, Vivaldi P, De Biasi E, Sancetta R, Rocconi R, Bassan R, Gherlinzoni F, Pizzolo G, Gastl G, Cortelazzo S. Role of blood cells dynamism on hemostatic complications in low-risk patients with essential thrombocythemia. Intern Emerg Med 2015; 10:451-60. [PMID: 25585678 DOI: 10.1007/s11739-015-1186-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
Abstract
Patients with essential thrombocythemia (ET) aged less than 60 years, who have not suffered a previous vascular event (low-risk patients), may develop thrombotic or hemorrhagic events. So far, it has not been possible to identify useful markers capable of predicting which of these patients are more likely to develop an event and therefore who needs to be treated. In the present study, we analysed the relationship between vascular complications and longitudinal blood counts of 136 low-risk ET patients taken over a sustained period of time (blood cells dynamism). After a median follow-up of 60 months, 45 out of 136 patients (33%) suffered 40 major thrombotic and 5 severe hemorrhagic complications. A total number of 5,781 blood counts were collected longitudinally. Thrombotic and hemorrhagic events were studied together (primary endpoint) but also separately (thrombotic alone = secondary endpoint; hemorrhagic alone = tertiary endpoint). The primary endpoint showed no significant association between platelet and WBC count at diagnosis and risk of any event (platelet, p = 0.797; WBC, p = 0.178), while Hb at baseline did show an association (p = 0.024). In the dynamic analysis with Cox regression model, where the blood count values were studied by time of follow-up, we observed that the risk for Hb was 1.49 (95% CI 1.13-1.97) for every increase of 1 g/dL, and that this risk then marginally decreased during follow-up. WBC was associated with an increased risk at baseline for every increase of 1 × 10(9)/L (hazard ratio (HR) 1.07, 95% CI 1.01-1.13, p = 0.034), the risk was stable during follow-up (HR 0.95, p = 0.187 at 60 months). Also, for each increment at baseline of 100 × 10(9) platelets/L, HR was increased by 1.08 (95% CI 0.97-1.22, p = 0.159) and decreases during follow-up. In conclusion, this study is the first to evaluate in ET low-risk patients, the risk of developing a thrombotic/hemorrhagic event considering blood counts over time. Overall our study shows that the risk changes over time. For example, the risk associated with WCC is not linear as previously reported. An interesting new finding is that PLT and even Hb contribute to the risk of developing vascular events. Future treatments should take into consideration these findings and aim to control all parameters over time. We believe this early study may help develop a dynamic analysis model to predict thrombosis in the single patient. Further studies are now warranted to further validate our findings.
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Affiliation(s)
- Andrea Piccin
- Department of Haematology, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy,
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Tortorella G, Piccin A, Tieghi A, Marcheselli L, Steurer M, Gastl G, Codeluppi K, Fama A, Santoro U, Birtolo C, Gugliotta G, Cortelazzo S, Gugliotta L. Anagrelide treatment and cardiovascular monitoring in essential thrombocythemia. A prospective observational study. Leuk Res 2015; 39:592-8. [PMID: 25850727 DOI: 10.1016/j.leukres.2015.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
In this prospective observational single-center study, 55 patients with essential thrombocythemia who were candidates for second line treatment with anagrelide (ANA) received a preliminary cardiovascular (CV) clinical, instrumental and biochemical evaluation (CV history and symptoms, CV risk factors, blood pressure, heart rate, ECG and ECHO-cardio parameters, Troponin I, NT-proBNP). After this in-depth CV screening, 54 out of 55 patients were deemed to be fit for ANA treatment. Thirty-eight of the 55 patients received ANA treatment for a median of 36 months (range 3-48), and were monitored using the same CV evaluation. Fourteen of these 38 patients manifested CV adverse events (10 palpitation, 4 edema, 2 arterial hypertension, 2 acute myocardial infarction) that were not predicted by the in-depth CV evaluation, and that led to ANA withdrawal in only one case (non-cardiac refractory edema). In conclusion, the planned in-depth CV evaluation did not appear to be necessary in ET patients to evaluate their suitability for ANA treatment, and, moreover, was not able to predict the occurrence of CV adverse events during ANA treatment. Nevertheless, the CV adverse events (mostly palpitations and edema) were easily managed by the hematologists, and required the cardiologist involvement in very few selected cases.
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Affiliation(s)
- Giovanni Tortorella
- Cardiology Unit, Azienda Ospedaliera Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Andrea Piccin
- Hematology Department, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy
| | - Alessia Tieghi
- Hematology Department, Azienda Ospedaliera Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Luigi Marcheselli
- Clinical and Public Health Medicine Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Michael Steurer
- Hematology and Oncology Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Günther Gastl
- Hematology and Oncology Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Katia Codeluppi
- Hematology Department, Azienda Ospedaliera Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Angelo Fama
- Hematology Department, Azienda Ospedaliera Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Umberto Santoro
- Statistics Department, University of Bologna, Bologna, Italy
| | - Chiara Birtolo
- Internal Medicine Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Gabriele Gugliotta
- Hematology Institute "L. e A. Seragnoli", S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Sergio Cortelazzo
- Hemato-Oncology Department, Institute Humanitas Gavazzeni, Bergamo, Italy
| | - Luigi Gugliotta
- Hematology Institute "L. e A. Seragnoli", S. Orsola-Malpighi University Hospital, Bologna, Italy.
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Bassan R, Masciulli A, Intermesoli T, Audisio E, Rossi G, Pogliani EM, Cassibba V, Mattei D, Romani C, Cortelezzi A, Corti C, Scattolin AM, Spinelli O, Tosi M, Parolini M, Marmont F, Borlenghi E, Fumagalli M, Cortelazzo S, Gallamini A, Marfisi RM, Oldani E, Rambaldi A. Randomized trial of radiation-free central nervous system prophylaxis comparing intrathecal triple therapy with liposomal cytarabine in acute lymphoblastic leukemia. Haematologica 2015; 100:786-93. [PMID: 25749825 DOI: 10.3324/haematol.2014.123273] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/26/2015] [Indexed: 01/31/2023] Open
Abstract
Developing optimal radiation-free central nervous system prophylaxis is a desirable goal in acute lymphoblastic leukemia, to avoid the long-term toxicity associated with cranial irradiation. In a randomized, phase II trial enrolling 145 adult patients, we compared intrathecal liposomal cytarabine (50 mg: 6/8 injections in B-/T-cell subsets, respectively) with intrathecal triple therapy (methotrexate/cytarabine/prednisone: 12 injections). Systemic therapy included methotrexate plus cytarabine or L-asparaginase courses, with methotrexate augmented to 2.5 and 5 g/m(2) in Philadelphia-negative B- and T-cell disease, respectively. The primary study objective was the comparative assessment of the risk/benefit ratio, combining the analysis of feasibility, toxicity and efficacy. In the liposomal cytarabine arm 17/71 patients (24%) developed grade 3-4 neurotoxicity compared to 2/74 (3%) in the triple therapy arm (P=0.0002), the median number of episodes of neurotoxicity of any grade was one per patient compared to zero, respectively (P=0.0001), and even though no permanent disabilities or deaths were registered, four patients (6%) discontinued intrathecal prophylaxis on account of these toxic side effects (P=0.06). Neurotoxicity worsened with liposomal cytarabine every 14 days (T-cell disease), and was improved by the adjunct of intrathecal dexamethasone. Two patients in the liposomal cytarabine arm suffered from a meningeal relapse (none with T-cell disease, only one after high-dose chemotherapy) compared to four in the triple therapy arm (1 with T-cell disease). While intrathecal liposomal cytarabine could contribute to improved, radiation-free central nervous system prophylaxis, the toxicity reported in this trial does not support its use at 50 mg and prompts the investigation of a lower dosage. (clinicaltrials.gov identifier: NCT-00795756).
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Affiliation(s)
- Renato Bassan
- U.O.C. Ematologia, Ospedale dell'Angelo e Ospedale SS. Giovanni e Paolo, Mestre-Venezia
| | - Arianna Masciulli
- Laboratorio di Epidemiologia Clinica delle Malattie Cardiovascolari, Fondazione Mario Negri Sud, S.Maria Imbaro, Chieti
| | | | - Ernesta Audisio
- Ematologia 2, Presidio Ospedaliero Molinette, A.O.U. Città della Salute e della Scienza, Torino
| | | | | | | | - Daniele Mattei
- S.C. Ematologia, Azienda Ospedaliera S. Croce e Carle, Cuneo
| | - Claudio Romani
- U.O. Ematologia e Centro TMO, Ospedale Armando Businco, Cagliari
| | - Agostino Cortelezzi
- U.O. Ematologia e TMO, Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, Milano
| | | | - Anna Maria Scattolin
- U.O.C. Ematologia, Ospedale dell'Angelo e Ospedale SS. Giovanni e Paolo, Mestre-Venezia
| | - Orietta Spinelli
- U. O. C. Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
| | - Manuela Tosi
- U. O. C. Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
| | | | - Filippo Marmont
- Ematologia 2, Presidio Ospedaliero Molinette, A.O.U. Città della Salute e della Scienza, Torino
| | | | | | | | | | - Rosa Maria Marfisi
- Laboratorio di Epidemiologia Clinica delle Malattie Cardiovascolari, Fondazione Mario Negri Sud, S.Maria Imbaro, Chieti
| | - Elena Oldani
- U. O. C. Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
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Mian M, Marcheselli L, Rossi A, Visco C, Chiappella A, Volpetti S, Zaja F, Mondello P, Fiegl M, Billio A, Federico M, Luminari S, Rambaldi A, Cortelazzo S. A diachronic-comparative analysis for the identification of the most powerful prognostic index for localized diffuse large B-cell lymphoma. Ann Oncol 2014; 25:2398-2404. [PMID: 25274614 DOI: 10.1093/annonc/mdu462] [Citation(s) in RCA: 10] [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] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In the rituximab era, the conventional International Prognostic index (IPI) lost at least in part its predictive power, while the National Comprehensive Cancer Network-IPI (NCCN-IPI) seems to be a new and valid prognosticator. However, it has not yet been evaluated in patients with localized disease and it has not been compared with the modified IPI (mIPI) of the pre-rituximab era. In order to evaluate the different prognosticators and to assess the importance of rituximab and radiotherapy (RT), we carried out the so far largest retrospective analysis of patients with localized diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS We retrospectively assessed clinical and therapeutical data of 1405 patients treated in from 1987 to 2012 in 10 cancer centers in Italy and 1 in Austria. RESULTS All patients underwent an anthracycline containing polychemotherapy and 254 additional rituximab. The median follow-up was 5.7 years (range 0.1-23 years). The 5-year overall survival (OS) was 75%, being significantly superior in those who underwent additional rituximab, while RT consolidation did not improve the outcome of those who received immunochemotherapy. Patients with extranodal disease benefited from the addition of rituximab, while RT did not improve OS of the immunochemotherapy subgroup. In the pre-rituximab era, the mIPI showed a better performance than the others. In rituximab-treated patients, the NCCN-IPI had the highest discriminant value and the 5-years OS varied significantly (P < 0.001) between the three risk groups and was 98% in low-risk patients, 82% in those with a low-intermediate risk and 57% among high-intermediate and high-risk cases. CONCLUSIONS The NCCN-IPI is so far the best prognosticator for patients with localized DLBCL who underwent R-CHOP(-like). The addition of rituximab is indispensable regardless of the risk category and site of involvement, while the addition of RT should be reserved to those cases who are ineligible to rituximab.
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Affiliation(s)
- M Mian
- Division of Hematology, Hospital of Bolzano, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Austria.
| | - L Marcheselli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena
| | - A Rossi
- USC Hematology, A.O. Papa Giovanni XXIII, Bergamo
| | - C Visco
- Department of Hematology, Ospedale San Bortolo, Vicenza
| | - A Chiappella
- Division of Hematology 2, Azienda Ospedaliera Città Della Salute e Della Scienza, Turin
| | - S Volpetti
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria Udine, Udine
| | - F Zaja
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria Udine, Udine
| | - P Mondello
- Department of Medical Oncology, University of Messina, Messina
| | - M Fiegl
- Department of Hematology and Oncology, University Hospital Innsbruck, Austria
| | - A Billio
- Division of Hematology, Hospital of Bolzano, Bolzano, Italy
| | - M Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena
| | - S Luminari
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena
| | - A Rambaldi
- USC Hematology, A.O. Papa Giovanni XXIII, Bergamo
| | - S Cortelazzo
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Bergamo, Italy
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Introna M, Lucchini G, Dander E, Galimberti S, Rovelli A, Balduzzi A, Longoni D, Pavan F, Masciocchi F, Algarotti A, Micò C, Grassi A, Deola S, Cavattoni I, Gaipa G, Belotti D, Perseghin P, Parma M, Pogliani E, Golay J, Pedrini O, Capelli C, Cortelazzo S, D'Amico G, Biondi A, Rambaldi A, Biagi E. Treatment of graft versus host disease with mesenchymal stromal cells: a phase I study on 40 adult and pediatric patients. Biol Blood Marrow Transplant 2013; 20:375-81. [PMID: 24321746 DOI: 10.1016/j.bbmt.2013.11.033] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/30/2013] [Indexed: 02/07/2023]
Abstract
This phase I multicenter study was aimed at assessing the feasibility and safety of intravenous administration of third party bone marrow-derived mesenchymal stromal cells (MSC) expanded in platelet lysate in 40 patients (15 children and 25 adults), experiencing steroid-resistant grade II to IV graft-versus-host disease (GVHD). Patients received a median of 3 MSC infusions after having failed conventional immunosuppressive therapy. A median cell dose of 1.5 × 10(6)/kg per infusion was administered. No acute toxicity was reported. Overall, 86 adverse events and serious adverse events were reported in the study, most of which (72.1%) were of infectious nature. Overall response rate, measured at 28 days after the last MSC injection, was 67.5%, with 27.5% complete response. The latter was significantly more frequent in patients exhibiting grade II GVHD as compared with higher grades (61.5% versus 11.1%, P = .002) and was borderline significant in children as compared with adults (46.7 versus 16.0%, P = .065). Overall survival at 1 and 2 years from the first MSC administration was 50.0% and 38.6%, with a median survival time of 1.1 years. In conclusion, MSC can be safely administered on top of conventional immunosuppression for steroid resistant GVHD treatment. Eudract Number 2008-007869-23, NCT01764100.
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Affiliation(s)
- Martino Introna
- Division of Hematology and Laboratory of Cell Therapy "G. Lanzani", Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
| | - Giovanna Lucchini
- HSCT Pediatric Unit and Laboratory of Cell Therapy "S. Verri", San Gerardo Hospital, Monza, Italy
| | - Erica Dander
- HSCT Pediatric Unit, "M. Tettamanti" Research Centre, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Stefania Galimberti
- Department of Health Sciences, Center of Biostatistics for Clinical Epidemiology, University of Milan-Bicocca, Monza, Italy
| | - Attilio Rovelli
- HSCT Pediatric Unit and Laboratory of Cell Therapy "S. Verri", San Gerardo Hospital, Monza, Italy
| | - Adriana Balduzzi
- HSCT Pediatric Unit and Laboratory of Cell Therapy "S. Verri", San Gerardo Hospital, Monza, Italy
| | - Daniela Longoni
- HSCT Pediatric Unit and Laboratory of Cell Therapy "S. Verri", San Gerardo Hospital, Monza, Italy
| | - Fabio Pavan
- HSCT Pediatric Unit and Laboratory of Cell Therapy "S. Verri", San Gerardo Hospital, Monza, Italy
| | - Francesca Masciocchi
- HSCT Pediatric Unit and Laboratory of Cell Therapy "S. Verri", San Gerardo Hospital, Monza, Italy
| | - Alessandra Algarotti
- Division of Hematology and Laboratory of Cell Therapy "G. Lanzani", Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Caterina Micò
- Division of Hematology and Laboratory of Cell Therapy "G. Lanzani", Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Grassi
- Division of Hematology and Laboratory of Cell Therapy "G. Lanzani", Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Deola
- Divisione di Ematologia e TMO, Ospedale Generale di Bolzano, Bolzano, Italy
| | - Irene Cavattoni
- Divisione di Ematologia e TMO, Ospedale Generale di Bolzano, Bolzano, Italy
| | - Giuseppe Gaipa
- HSCT Pediatric Unit and Laboratory of Cell Therapy "S. Verri", San Gerardo Hospital, Monza, Italy
| | - Daniela Belotti
- HSCT Pediatric Unit and Laboratory of Cell Therapy "S. Verri", San Gerardo Hospital, Monza, Italy
| | | | - Matteo Parma
- HSCT Adult Unit, San Gerardo Hospital, Monza, Italy
| | | | - Josee Golay
- Division of Hematology and Laboratory of Cell Therapy "G. Lanzani", Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Olga Pedrini
- Division of Hematology and Laboratory of Cell Therapy "G. Lanzani", Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Capelli
- Division of Hematology and Laboratory of Cell Therapy "G. Lanzani", Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Sergio Cortelazzo
- Divisione di Ematologia e TMO, Ospedale Generale di Bolzano, Bolzano, Italy
| | - Giovanna D'Amico
- HSCT Pediatric Unit, "M. Tettamanti" Research Centre, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Andrea Biondi
- HSCT Pediatric Unit and Laboratory of Cell Therapy "S. Verri", San Gerardo Hospital, Monza, Italy
| | - Alessandro Rambaldi
- Division of Hematology and Laboratory of Cell Therapy "G. Lanzani", Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Ettore Biagi
- HSCT Pediatric Unit and Laboratory of Cell Therapy "S. Verri", San Gerardo Hospital, Monza, Italy
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Piccin A, Corvetta D, Rovigatti U, Mazzoleni G, Pusceddu I, Svaldi M, Steurer M, Gastl G, Cortelazzo S. Essential thrombocytemia progressing to Ph+ chronic myeloid leukemia with megakaryoblastic blasts, following anagrelide withdrawal. Platelets 2013; 25:646-7. [PMID: 24205832 DOI: 10.3109/09537104.2013.858112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Andrea Piccin
- Haematology Department, San Maurizio Regional Hospital , Bolzano, South Tyrol , Italy
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46
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Piccin A, Eisendle K, Rovigatti U, Steurer M, Tauber M, Corvetta D, Mazzoleni G, Svaldi M, Gastl G, Cortelazzo S. Transition of idiopathic CD4 + lymphocytopenia into mycosis fungoides? Leuk Lymphoma 2013; 55:1649-51. [PMID: 24033108 DOI: 10.3109/10428194.2013.840779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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47
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Zaja F, Mian M, Volpetti S, Visco C, Sissa C, Nichele I, Castelli M, Ambrosetti A, Puglisi S, Fanin R, Cortelazzo S, Pizzolo G, Trentin L, Rodeghiero F, Paolini R, Vivaldi P, Sancetta R, Isola M, Semenzato G. Bendamustine in chronic lymphocytic leukemia: outcome according to different clinical and biological prognostic factors in the everyday clinical practice. Am J Hematol 2013; 88:955-60. [PMID: 23861234 DOI: 10.1002/ajh.23546] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/04/2013] [Accepted: 07/09/2013] [Indexed: 11/10/2022]
Abstract
Bendamustine proved to be effective for the treatment of chronic lymphocytic leukemia (CLL). However, the relationship between its activity with clinico-biological prognosticators has been addressed only in few studies. We retrospectively evaluated the efficacy of bendamustine, in a real-life contest, on 142 patients, median age 70 years, median number of previous regimens 2 (0-8, 13% previously untreated). Bendamustine was administered for a median number of 4 cycles, in 84% of cases with rituximab. Overall (ORR) and complete response (CRR) rates were 68 and 16.5%, respectively. Multivariate analysis demonstrated a relationship between ORR and number of prior treatments (OR 0.25, 95% CI 0.08-0.71; P = 0.009), del(17p) (OR 0.10, 95% CI 0.03-0.32; P < 0.001) and concomitant rituximab (OR 4.37, 95% CI 1.12-17.04; P = 0.033). The estimated 1- and 2-years overall survival (OS) and progression free survival (PFS) rates were 76, 61, 51, and 26%, respectively. Previous sensitivity to fludarabine (HR 0.36, 95% CI 0.16-0.82), response to bendamustine (HR 0.21, 95% CI 0.10-0.45), and del(17p) (HR 2.18, 95% CI 1.002-4.74) had a prognostic significance in multivariate analysis for PFS, while the number of previous therapies (HR 3.48, 95% CI 1.29-9.38; P = 0.014), concomitant use of rituximab (HR 0.32, 95% CI 0.11-0.93) and response to bendamustine (HR 0.22, 95% CI 0.07-0.66) were significant for OS. Side effects included grade 3-4 neutropenia, infections, thrombocytopenia and anemia which occurred in 40, 14, 14, and 10% of patients, respectively. These results confirm the activity and safety of bendamustine and rituximab combination even in patients with unfavorable clinical and biological features excluding del(17p).
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Affiliation(s)
- Francesco Zaja
- Clinica Ematologica; DISM, Azienda Ospedaliero Universitaria S. M. Misericordia; Udine Italy
| | - Michael Mian
- Divisione di Ematologia and CTMO; Ospedale di Bolzano; Italy
- Department of Hematology and Oncology; Medical University of Innsbruck; Austria
| | - Stefano Volpetti
- Clinica Ematologica; DISM, Azienda Ospedaliero Universitaria S. M. Misericordia; Udine Italy
| | - Carlo Visco
- Dipartimento di Terapie Cellulari ed Ematologia; Ospedale S. Bortolo; Vicenza Italy
| | - Cinzia Sissa
- Clinica Ematologica, Dipartimento di Medicina, Sezione di Ematologia; Università di Verona; Italy
| | - Ilaria Nichele
- Dipartimento di Terapie Cellulari ed Ematologia; Ospedale S. Bortolo; Vicenza Italy
| | | | - Achille Ambrosetti
- Clinica Ematologica, Dipartimento di Medicina, Sezione di Ematologia; Università di Verona; Italy
| | - Simona Puglisi
- Clinica Ematologica; DISM, Azienda Ospedaliero Universitaria S. M. Misericordia; Udine Italy
| | - Renato Fanin
- Clinica Ematologica; DISM, Azienda Ospedaliero Universitaria S. M. Misericordia; Udine Italy
| | | | - Giovanni Pizzolo
- Clinica Ematologica, Dipartimento di Medicina, Sezione di Ematologia; Università di Verona; Italy
| | - Livio Trentin
- Clinica Ematologica; Dipartimento di Medicina; Padova Italy
| | - Francesco Rodeghiero
- Dipartimento di Terapie Cellulari ed Ematologia; Ospedale S. Bortolo; Vicenza Italy
| | - Rossella Paolini
- SOS Oncoematologia; Ospedale S. Maria della Misericordia; Rovigo Italy
| | | | | | - Miriam Isola
- Instituto di Statistica, Università degli Studi; Udine Italy
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Mian M, Capello D, Ventre MB, Grazio D, Svaldi M, Rossi A, Tsang R, Gospodarowicz MK, Oldani E, Federico M, Luminari S, Marcheselli L, Pogliani EM, Rossini F, Cabrera ME, Martelli M, Gutierrez-Garcia G, Busetto M, Visco C, Fiegl M, Rossi D, Gaidano G, Cavalli F, Zucca E, Rambaldi A, Cortelazzo S. Early-stage diffuse large B cell lymphoma of the head and neck: clinico-biological characterization and 18 year follow-up of 488 patients (IELSG 23 study). Ann Hematol 2013; 93:221-231. [PMID: 23959436 DOI: 10.1007/s00277-013-1856-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 07/18/2013] [Indexed: 11/30/2022]
Abstract
It is known that extranodal head and neck diffuse large B cell lymphomas (eHN-DLBCL) can affect various anatomical structures what is not well-known, however, is whether they differ in terms of clinical presentation and outcome. Clinical data of the multi-institutional series, the largest of its kind as yet, has been analysed with the aim of answering these open questions and providing long-term follow-up information. Data from 488 patients affected by stage I/II eHN-DLBCL was collected: 300 of the Waldeyer's Ring (WR), 38 of the parotid and salivary glands (PSG), 48 of the thyroid gland (TG), 53 of the nasal cavity and paranasal sinuses (NPS), 24 of the palate and oral cavity (POC) and 25 with more than one involved site. Different eHN-DLBCL arising have distinct characteristics at presentation. The intermediate high risk-modified IPI was 67 % in TG, 44 % in WR, 38 % in PSG and POC and 20 % in MS. The worst 5-year survival rate had TG-DLBCL (61 %) due to the 61 % of patients with a mIPI >1. The addition of radiotherapy (cRT) to remitters did not translate into a survival advantage (5-year disease-free survival of 67 % in the cRT group vs. 70 % in the other). Three of four central nervous system recurrences occurred in NPS-DLBCL. Survival of HN-DLBCL was inferior to nodal DLBCL. This study showed that eHN-DLBCL remitters have an inferior survival when compared to nodal DLBCL, and that the addition of cRT does not provide a survival advantage. Since the standard of care nowadays is chemo-immunotherapy, survival of these patients might have been improved.
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Affiliation(s)
- M Mian
- Division of Hematology, Azienda Ospedaliera S. Maurizio, Bolzano/Bozen, Italy,
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49
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Mian M, Gaidano G, Rossi A, Cabrera ME, Federico M, Martelli M, Gomez H, Lopez-Guillermo A, Tsang R, Zucca E, Cavalli F, Cortelazzo S. High response rate and improvement of long-term survival with combined treatment modalities in patients with poor-risk primary thyroid diffuse large B-cell lymphoma: an International Extranodal Lymphoma Study Group and Intergruppo Italiano Linfomi study. Pneumologie 2013. [DOI: 10.1055/s-0033-1345067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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50
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Mian M, Franz I, Wasle I, Herold M, Griesmacher A, Prokop W, Cortelazzo S, Gastl G, Willenbacher W, Gunsilius E, Fiegl M. "Idiopathic Bence-Jones proteinuria": a new characterization of an old entity. Ann Hematol 2013; 92:1263-70. [PMID: 23580149 DOI: 10.1007/s00277-013-1739-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/15/2013] [Indexed: 10/27/2022]
Abstract
Idiopathic Bence-Jones proteinuria (BJP) is a rare plasma cell dyscrasia, of which the clinical and biological characteristics are yet unclear. Historical data suggested that they are at higher risk of progression to multiple myeloma or other related neoplasms, while recent findings are contradictory. To address these open questions, we evaluated a series of both BJP and monoclonal gammopathy of undetermined significance (MGUS) with production of an intact immunoglobulin plus Bence-Jones proteinuria (MGUS+BJP) with long-term follow-up, regarding their clinical characteristics and progression to multiple myeloma, amyloidosis or other related B cell lymphoproliferative disorders. Two hundred and twenty-nine persons fulfilling the 2004 criteria of MGUS were included in the final analyses: 31 had BJP and 198 had MGUS+BJP. At the time of diagnosis, significantly more persons in the BJP group had renal impairment, anaemia and polyneuropathy. A more detailed analysis revealed discrepancies between the serum and urine light chain type in nine cases, reflecting clonal heterogeneity. The number of disease progressions was higher in MGUS+BJP (n = 30) when compared to BJP (n = 1), with a rate of 1.6 and 0.4 progressions per 100 person-years, respectively. In conclusion, BJP has distinct clinical characteristics and a lower risk of progression when compared to MGUS+BJP. Our data suggest that MGUS+BJP being closer to malignant transformation may be due to the higher portion of genetically heterogeneous, pre-malignant plasma cell subclones.
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Affiliation(s)
- Michael Mian
- Department of Hematology and Oncology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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