105 results on '"Luca Cupelli"'
Search Results
2. P971: EFFECT OF DARATUMUMAB ON STEM CELL YIELDS IN PATIENTS WITH NEWLY DIAGNOSED MULTIPLE MYELOMA: REPORT FROM THE MULTIPLE MYELOMA LAZIO GROUP.
- Author
-
Francesca Fazio, Mauro Passucci, Chiara Lisi, Jacopo Micozzi, Luana Fianchi, Francesca DI Landro, Tommaso Za, Svitlana Gumenyuk, Silvia Ferraro, Barbara Anaclerico, Laura De Padue, Ombretta Annibali, Angela Rago, Alfonso Piciocchi, Velia Bongarzoni, Luca Cupelli, Andrea Mengarelli, Valerio De Stefano, Maurizio Martelli, and Maria-Teresa Petrucci
- Subjects
Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2023
- Full Text
- View/download PDF
3. Daratumumab combined with dexamethasone and lenalidomide or bortezomib in relapsed/refractory multiple myeloma (RRMM) patients: Report from the multiple myeloma GIMEMA Lazio group
- Author
-
Francesca Fazio, Luca Franceschini, Valeria Tomarchio, Angela Rago, Maria Grazia Garzia, Luca Cupelli, Velia Bongarzoni, Alessandro Andriani, Svitlana Gumenyuk, Agostino Tafuri, Agostina Siniscalchi, Alfonso Piciocchi, Paolo De Fabritiis, Luca De Rosa, Tommaso Caravita di Toritto, Ombretta Annibali, Maria Cantonetti, and Maria Teresa Petrucci
- Subjects
immunotherapy ,multiple myeloma ,relapsed refractory ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Abstract The multiple myeloma (MM) treatment has changed over the last years due to the introduction of novel drugs. Despite improvements in the MM outcome, MM remains an incurable disease. Daratumumab is a human IgGK monoclonal antibody targeting CD38 with tumor activity associated with immunomodulatory mechanism. In combination with standard of care regimens, including bortezomib (Vd) or lenalidomide (Rd), daratumumab prolonged progression‐free survival (PFS) in patients (pts) with relapsed/refractory multiple myeloma (RRMM) and in new diagnosis MM. We report the data of the MM GIMEMA Lazio group in 171 heavily treated pts who received daratumumab, lenalidomide and dexamethasone (DRd) or daratumumab, velcade and dexamethasone (DVd). The overall response rate was 80%, and the overall survival (OS) and PFS were 84% and 77%, respectively. In addition, pts treated with DRd showed a better median PFS compared to pts treated with DVd, at 12 and 24 months, respectively. The most common hematologic treatment‐emergent adverse events (TAEs) were neutropenia, thrombocytopenia, and anemia. The most common nonhematologic TAEs were peripheral sensory neuropathy and infections. Our data confirmed that DRd or DVd therapy is effective and safe in RRMM pts, and our real‐life analysis could support the physicians regarding the choice of optimal therapy in this setting of pts.
- Published
- 2022
- Full Text
- View/download PDF
4. Consensus for Flow Cytometry Clinical Report on Multiple Myeloma: A Multicenter Harmonization Process Merging Laboratory Experience and Clinical Needs
- Author
-
Iole Cordone, Rachele Amodeo, Silvia Bellesi, Fiorella Bottan, Francesco Buccisano, Maria Stefania De Propris, Serena Masi, Valentina Panichi, Maria Cristina Scerpa, Ombretta Annibali, Velia Bongarzoni, Tommaso Caravita di Toritto, Ugo Coppetelli, Luca Cupelli, Paolo de Fabritiis, Luca Franceschini, Mariagrazia Garzia, Alessia Fiorini, Giacinto Laverde, Andrea Mengarelli, Tommaso Za, and Maria Teresa Petrucci
- Subjects
multiple myeloma ,flow cytometry ,clinical report ,minimal residual disease ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Flow cytometry is a highly sensitive and specific approach for discriminating between normal and clonal plasma cells in multiple myeloma. Uniform response criteria after treatment have been established by the International Myeloma Working Group and the EuroFlow Group; however, the way in which flow cytometry data are reported has suffered from no collaborative or multicentre efforts. This study, involving 8 expert laboratories and 12 clinical hematology units of the Lazio region in Italy, aims to produce a uniform and shared report among the various Centres. From the pre-analytical phase to sample processing, data acquisition, analysis, and evaluation of the potential limitations and pitfalls of the entire process, the study reaches a final conclusion shared by laboratories and clinicians according to the most updated principles and recommendations. The aim was to identify the necessary data to be included in the clinical report by using multiple-choice questionnaires at every single stage of the process. An agreement of more than 75% of the laboratories was considered mandatory for the data to be included in the report. By ensuring the operational autonomy of each laboratory, this study provides a clear report that limits subjective interpretations and highlights possible bias in the process, better supporting clinical decision-making.
- Published
- 2023
- Full Text
- View/download PDF
5. Clinical complications in outpatient myelodysplastic syndromes
- Author
-
andrea tendas, pasquale niscola, luca cupelli, laura scaramucci, marco giovannini, daniela piccioni, teresa dentamaro, alessio pio perrotti, and paolo de fabritiis
- Subjects
Ambulatory Care ,Adverse Effects ,Complications ,Infection ,Myelodysplastic Syndromes ,Quality of Life ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
The outcome of myelodysplastic syndromes (MDS) depends on both progression to acute leukemia and complications development. During a 18-months observation period, non-toxic complications emerging in 48 outpatient MDS, of which 15 (31%) on active treatment and 33 (69%) receiving supportive measures alone, were recorded and analyzed. Out of 48 patients (median age of 72 years), 34 (71%) experienced complications; a total number of 92 events were recorded; most frequently observed events were infectious (38 events). Complications are a frequent issue in MDS; preventive measures should be increased and directed toward the most frequently observed complications.
- Published
- 2014
6. Allogeneic stem cell transplantation for advanced acute promyelocytic leukemia in the ATRA and ATO era
- Author
-
Safaa M. Ramadan, Ambra Di Veroli, Agnese Camboni, Massimo Breccia, Anna Paola Iori, Franco Aversa, Luca Cupelli, Cristina Papayannidis, Andrea Bacigalupo, William Arcese, and Francesco Lo-Coco
- Subjects
Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
The role of allogeneic stem cell transplant in advanced acute promyelocytic leukemia patients who received standard first- and second-line therapy is still unknown. We report the outcome of 31 acute promyelocytic leukemia patients (median age 39 years) who underwent allogeneic transplant in second remission (n=15) or beyond (n=16). Sixteen patients were real-time polymerase chain reaction positive and 15 negative for PML/RARA pre-transplant. The 4-year overall survival was 62% and 31% for patients transplanted in second remission and beyond, respectively (P=0.05), and 64% and 27% for patients with pre-transplant negative and positive real-time polymerase chain reaction, respectively (P=0.03). The 4-year cumulative incidence of relapse was 32% and 44% for patients transplanted in second remission and beyond, respectively (P=0.37), and 30% and 47% for patients transplanted with negative and positive real-time polymerase chain reaction, respectively (P=0.30). Transplant-related mortality was 19.6%. In conclusion, allogeneic transplant is effective in advanced acute promyelocytic leukemia in the all-trans-retinoic acid and arsenic trioxide era, and should be considered once relapse is diagnosed.
- Published
- 2012
- Full Text
- View/download PDF
7. Single versus double-unit transfusion policy in hematology
- Author
-
Andrea Tendas, Pasquale Niscola, Luca Cupelli, Laura Scaramucci, Marco Giovannini, and Paolo de Fabritiis
- Subjects
Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2012
- Full Text
- View/download PDF
8. Mucositis in patients with hematologic malignancies: an overview
- Author
-
Pasquale Niscola, Claudio Romani, Luca Cupelli, Laura Scaramucci, Andrea Tendas, Teresa Dentamaro, Sergio Amadori, and Paolo de Fabritiis
- Subjects
Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Mucosal barrier injury (mucositis) is a common complication of many treatments used in hematologic malignancies, affecting most patients whose neoplasms are treated with intensive chemotherapy, and virtually all those receiving myeloablative conditioning regimens prior to hematopoietic stem cell transplantation. Mucositis has been identified as a critical risk factor for infections and is a major driver of analgesic and total parenteral nutrition use. Patients with this complication require careful analgesic therapy, additional nursing care and longer hospitalization. To date, the measures to prevent and treat this potentially devastating complication are inadequate and limited to the control of pain, infections, bleeding and nutrition. Nevertheless, in the last decade, a better insight into the pathogenesis of the mucosal damage has led to the development of novel therapeutic options which potentially could allow a targeted approach to mucositis.
- Published
- 2007
- Full Text
- View/download PDF
9. Fever of unknown origin, anemia and thrombocytosis as early symptoms and signs of a late-onset polymialgia rheumatica: A diagnostic challenge
- Author
-
Pasquale Niscola, Laura Scaramucci, Marco Giovannini, Andrea Tendas, Luca Cupelli, Alessio Pio Perroti, and Paolo de Fabritiis
- Subjects
Medicine - Published
- 2012
- Full Text
- View/download PDF
10. IgA-induced autoimmune hemolytic anemia in a patient with antiphospholipid syndrome
- Author
-
Laura Scaramucci, Marco Giovannini, Pasquale Niscola, Massimiliano Palombi, Luca Cupelli, Andrea Tendas, Alessio Pio Perrotti, and Paolo de Fabritiis
- Subjects
Diseases of the blood and blood-forming organs ,RC633-647.5 - Published
- 2012
- Full Text
- View/download PDF
11. Elotuzumab plus lenalidomide and dexamethasone in relapsed/refractory multiple myeloma: Extended 3‐year follow‐up of a multicenter, retrospective clinical experience with 319 cases outside of controlled clinical trials
- Author
-
Antonella Bruzzese, Daniele Derudas, Monica Galli, Enrica Antonia Martino, Stefano Rocco, Concetta Conticello, Catello Califano, Nicola Giuliani, Silvia Mangiacavalli, Giuliana Farina, Alessandra Lombardo, Marino Brunori, Elena Rossi, Elisabetta Antonioli, Roberto Ria, Renato Zambello, Nicola Di Renzo, Giuseppe Mele, Gianpaolo Marcacci, Giuseppe Pietrantuono, Gaetano Palumbo, Nicola Cascavilla, Claudio Cerchione, Angelo Belotti, Clelia Criscuolo, Giuseppina Uccello, Paola Curci, Ernesto Vigna, Francesco Mendicino, Enrico Iaccino, Selena Mimmi, Cirino Botta, Donatella Vincelli, Nicola Sgherza, Angela Bonalumi, Luca Cupelli, Raffaella Stocchi, Massimo Martino, Stelvio Ballanti, Dominella Gangemi, Alfredo Gagliardi, Barbara Gamberi, Alessandra Pompa, Giovanni Tripepi, Ferdinando Frigeri, Ugo Consoli, Sara Bringhen, Elena Zamagni, Francesca Patriarca, Valerio De Stefano, Francesco Di Raimondo, Salvatore Palmieri, Maria Teresa Petrucci, Massimo Offidani, Pellegrino Musto, Mario Boccadoro, Michele Cavo, Antonino Neri, Fortunato Morabito, Massimo Gentile, Bruzzese, Antonella, Derudas, Daniele, Galli, Monica, Martino, Enrica Antonia, Rocco, Stefano, Conticello, Concetta, Califano, Catello, Giuliani, Nicola, Mangiacavalli, Silvia, Farina, Giuliana, Lombardo, Alessandra, Brunori, Marino, Rossi, Elena, Antonioli, Elisabetta, Ria, Roberto, Zambello, Renato, Di Renzo, Nicola, Mele, Giuseppe, Marcacci, Gianpaolo, Pietrantuono, Giuseppe, Palumbo, Gaetano, Cascavilla, Nicola, Cerchione, Claudio, Belotti, Angelo, Criscuolo, Clelia, Uccello, Giuseppina, Curci, Paola, Vigna, Ernesto, Mendicino, Francesco, Iaccino, Enrico, Mimmi, Selena, Botta, Cirino, Vincelli, Donatella, Sgherza, Nicola, Bonalumi, Angela, Cupelli, Luca, Stocchi, Raffaella, Martino, Massimo, Ballanti, Stelvio, Gangemi, Dominella, Gagliardi, Alfredo, Gamberi, Barbara, Pompa, Alessandra, Tripepi, Giovanni, Frigeri, Ferdinando, Consoli, Ugo, Bringhen, Sara, Zamagni, Elena, Patriarca, Francesca, De Stefano, Valerio, Di Raimondo, Francesco, Palmieri, Salvatore, Petrucci, Maria Teresa, Offidani, Massimo, Musto, Pellegrino, Boccadoro, Mario, Cavo, Michele, Neri, Antonino, Morabito, Fortunato, and Gentile, Massimo
- Subjects
Cancer Research ,lenalidomide ,dexamethasone ,elotuzumab ,multiple myeloma ,salvage therapy ,Hematology ,General Medicine ,Antibodies, Monoclonal, Humanized ,Thalidomide ,Oncology ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Settore MED/15 - Malattie del Sangue ,Follow-Up Studies ,Retrospective Studies - Abstract
The combination of elotuzumab, lenalidomide, and dexamethasone (EloRd) enhanced the clinical benefit over Rd with a manageable toxicity profile in the ELOQUENT-2 trial, leading to its approval in relapsed/refractory multiple myeloma (RRMM). The present study is a 3-year follow-up update of a previously published Italian real-life RRMM cohort of patients treated with EloRd. This revised analysis entered 319 RRMM patients accrued in 41 Italian centers. After a median follow-up of 36 months (range 6-55), 236 patients experienced disease progression or died. Median progression-free survival (PFS) and overall survival (OS) were 18.4 and 34 months, respectively. The updated multivariate analyses showed a significant reduction of PFS and OS benefit magnitude only in cases with ISS stage III. Major adverse events included grade 3/4 neutropenia (18.5%), anemia (15.4%), lymphocytopenia (12.5%), and thrombocytopenia (10.7%), while infection rates and pneumonia were 33.9% and 18.9%, respectively. No new safety signals with longer follow-up have been observed. Of 319 patients, 245 (76.7%) reached at least a partial remission. A significantly lower response rate was found in patients previously exposed to lenalidomide. In conclusion, our study confirms that EloRd is a safe and effective regimen for RRMM patients, maintaining benefits across multiple unfavorable subgroups. This article is protected by copyright. All rights reserved.
- Published
- 2022
12. Efficacy and safety of netupitant/palonosetron combination (NEPA) in preventing nausea and vomiting in non-Hodgkin’s lymphoma patients undergoing to chemomobilization before autologous stem cell transplantation
- Author
-
Alessandra Cupri, Attilio Guarini, Anna Rita Messa, Valentina Bozzoli, Andrea Mengarelli, Luca Cupelli, Giorgina Specchia, Tommasina Perrone, Maurizio Musso, Patrizio Mazza, Domenico Pastore, Saveria Capria, Paolo Codega, Vincenzo Federico, Davide Seripa, Rosanna Scimè, Rosella Matera, Clara De Risi, Nicola Di Renzo, Erminio Bonizzoni, P Chiusolo, and Fabio Benedetti
- Subjects
Oncology ,medicine.medical_specialty ,medicine.drug_class ,Nausea ,Vomiting ,CINV ,NEPA ,Antineoplastic Agents ,Transplantation, Autologous ,chemistry.chemical_compound ,Autologous stem-cell transplantation ,Internal medicine ,medicine ,Antiemetic ,Netupitant ,Multiday chemotherapy ,Humans ,Adverse effect ,ASCT ,business.industry ,Lymphoma, Non-Hodgkin ,Palonosetron ,Hematopoietic Stem Cell Transplantation ,medicine.disease ,Non-Hodgkin's lymphoma ,Treatment Outcome ,chemistry ,Antiemetics ,Original Article ,Drug Therapy, Combination ,medicine.symptom ,business ,medicine.drug - Abstract
Purpose Prevention of chemotherapy-induced nausea and vomiting (CINV) is particularly challenging for patients receiving highly emetogenic preparative regimens before autologous stem cell transplantation (ASCT) due to the daily and continuous emetogenic stimulus of the multiple day chemotherapy. While studies have shown effective prevention of CINV during the conditioning phase with NK1 receptor antagonist (NK1RA)-containing regimens, there have been no studies evaluating antiemetic use during chemomobilization prior to ASCT. Methods This multicenter, open-label, phase IIa study evaluated the efficacy of every-other-day dosing of NEPA administered during chemomobilization in patients with relapsed-refractory aggressive non-Hodgkin’s lymphoma. Eighty-one patients participated. Results Response rates were 77.8% for complete response (no emesis and no rescue use), 72.8% for complete control (complete response and no more than mild nausea), 86.4% for no emesis, and 82.7% for no rescue use during the overall phase (duration of chemomobilization through 48 h after). NEPA was well tolerated with no treatment-related adverse events reported. Conclusion NEPA, administered with a simplified every-other-day schedule, show to be very effective in preventing CINV in patients at high risk of CINV undergoing to chemomobilization of hematopoietic stem cells prior to ASCT.
- Published
- 2021
13. Autologous stem cell transplantation in multiple myeloma patients over 70 years: A GIMEMA Lazio Working Group experience in a retrospective case-control study
- Author
-
Angela Rago, Ombretta Annibali, Valeria Tomarchio, Ugo Coppetelli, Francesca Fazio, Luca Cupelli, Alessia Fiorini, Alfonso Piciocchi, Agostino Tafuri, and Tommaso Caravita di Toritto
- Subjects
Case-Control Studies ,Hematopoietic Stem Cell Transplantation ,Humans ,Hematology ,General Medicine ,Multiple Myeloma ,Transplantation, Autologous ,Disease-Free Survival ,Aged ,Retrospective Studies ,Stem Cell Transplantation - Abstract
High-dose chemotherapy followed by autologous stem cell transplantation (auto-SCT) is the standard treatment for young patient ≤65 years with multiple myeloma (MM). The role of auto-SCT in elderly patients older than 70 years remains controversial in the era of novel agents and especially since the recent introduction of monoclonal antibodies (AbMo). In this study, we evaluated 12 patients with MM over 70 years old undergoing auto-SCT (elderly graft cohort) in seven centers of GIMEMA Working Group Lazio. We compared the baseline characteristics, treatment and outcome with 97 MM elderly patients who did not receive auto-SCT (nontransplant patients) from the same registry who were ≥ 70 years old, but did not undergo auto-SCT. The median progression free survival (PFS) for graft versus no-graft cohort was 56.4 versus 26.1 months, respectively. There was a trend for better PFS among graft compared to nontransplant patient (p = .1). On the other hand, the median overall survival for transplant versus nontransplant cohort was 107.6 versus 49.5 months (p = .02). Despite the small number of patients aged ≥70 years and ≤74 years, it seems that auto-SCT is well tolerated, safe and effective. Therefore, we propose that it should be considered an important treatment option in the era of new drugs in elderly fit patients with MM.
- Published
- 2022
14. Matched-Pair Analysis of Transplant from Haploidentical, Unmanipulated Bone Marrow Donor versus HLA Identical Sibling for Patients with Hematologic Malignancies
- Author
-
Laura Cudillo, Maria Cristina Tirindelli, Ombretta Annibali, Gaspare Adorno, A Bruno, Michele Cedrone, Gottardo De Angelis, Andrea Mengarelli, Ilaria Mangione, Francesco Marchesi, William Arcese, Alessandra Picardi, Cristina Rapanotti, Loredana Sarmati, Barbara Anaclerico, Silvia Miccichè, Agostino Tafuri, Marco Andreani, Antonella Ferrari, Teresa Dentamaro, Luca Cupelli, Paolo de Fabritiis, Benedetta Mariotti, Massimo Andreoni, and Raffaella Cerretti
- Subjects
medicine.medical_specialty ,Basiliximab ,Matched-Pair Analysis ,Congenital cytomegalovirus infection ,Graft vs Host Disease ,Disease ,Human leukocyte antigen ,Haplo vs Identical Sibling ,Matched pair analysis ,hematological malignancies ,03 medical and health sciences ,0302 clinical medicine ,Bone Marrow ,Internal medicine ,medicine ,Humans ,Cumulative incidence ,Sibling ,Transplantation ,business.industry ,Siblings ,Hematology ,Settore MED/15 ,medicine.disease ,medicine.anatomical_structure ,Hematologic Neoplasms ,030220 oncology & carcinogenesis ,Methotrexate ,Bone marrow ,Neoplasm Recurrence, Local ,business ,haploidentical versus identical sibling ,hematologic malignancies ,matched-pair analysis ,030215 immunology ,medicine.drug - Abstract
A matched-pair analysis of transplant-related outcomes was carried out in 116 of 255 consecutive patients who received transplants from an HLA identical sibling (n = 58) or haploidentical related donor (n = 58). The 2 patient series were matched with 9 variables: period of transplant, patient and donor age, sex, diagnosis, disease phase, conditioning regimen, donor-recipient sex, and cytomegalovirus (CMV) status combinations. As graft-versus-host disease (GVHD) prophylaxis, all patients received the standard cyclosporine and methotrexate association with the addition of anti-thymocyte globulins, mycophenolate mofetil, and basiliximab in haploidentical, unmanipulated bone marrow recipients. Anti-infectious management, transfusion policy, and supportive care were identical for all patients. By comparing the 2 patient series, no statistically significant difference was observed for the cumulative incidence of advanced acute and extensive chronic GVHD, transplant-related mortality, and relapse. With a median follow-up of 3.5 years, the 5-year disease-free survival was 37% ± 6% and 36% ± 6% for HLA identical sibling and haploidentical recipients, respectively. The results of transplant from HLA identical siblings and haploidentical donors are comparable. Regardless of the HLA matching, other factors known to affect the transplant outcomes, such as donor-recipient age, sex, and CMV status combinations, might drive the search for the best donor.
- Published
- 2020
15. Efficacy and Safety of Nepa in Preventing Nausea and Vomiting Induced by Multiple-day Chemotherapy in Patients With Refractory/relapsed Aggressive Non-hodgkin’s Lymphoma Undergoing Stem Cell Mobilization Prior to Autologous Hematopoietic Stem Cell Transplantation
- Author
-
Attilio Guarini, Vincenzo Federico, Davide Seripa, Maurizio Musso, Domenico Pastore, Clara De Risi, Nicola Di Renzo, Paolo Codega, Fabio Benedetti, Alessandra Cupri, Saveria Capria, Valentina Bozzoli, Andrea Mengarelli, Luca Cupelli, Erminio Bonizzoni, P Chiusolo, Patrizio Mazza, Rosella Matera, Giorgina Specchia, Anna Rita Messa, Rosanna Scimè, and Tommasina Perrone
- Subjects
Oncology ,medicine.medical_specialty ,Stem cell mobilization ,Nausea ,business.industry ,medicine.medical_treatment ,Hematopoietic stem cell transplantation ,medicine.disease ,Non-Hodgkin's lymphoma ,Refractory ,Internal medicine ,medicine ,Vomiting ,Multiple day chemotherapy ,In patient ,medicine.symptom ,business - Abstract
PurposePrevention of chemotherapy-induced nausea and vomiting (CINV) is particularly challenging for patients receiving highly emetogenic preparative regimens before autologous stem cell transplantation (ASCT) due to the daily and continuous emetogenic stimulus of the multiple day chemotherapy (MD-CT). While studies have shown effective prevention of CINV during the conditioning phase with NK1 receptor antagonist (NK1RA)-containing regimens, there have been no studies evaluating antiemetic use with MD-CT administered for mobilization of hematopoietic stem cells prior to ASCT. MethodsThis multicenter, open-label, phase IIa study evaluated the efficacy of every-other-day dosing of NEPA administered during MD-CT being given for mobilization of stem cells prior to ASCT in patients with relapsed-refractory aggressive non-Hodgkin’s lymphoma. Eighty-one patients participated. ResultsResponse rates were 77.8% for complete response (no emesis and no rescue use), 72.8% for complete control (complete response and no more than mild nausea), 86.4% for no emesis, and 82.7% for no rescue use during the overall phase (duration of MD-CT through 48 hours after). NEPA was well tolerated with no treatment-related adverse events reported. ConclusionNEPA, administered with a simplified every-other-day schedule, show to be very effective in preventing CINV in patients at high risk of CINV undergoing MD-CT for mobilization of hematopoietic stem cells prior to ASCT.
- Published
- 2021
16. Prevention of chemotherapy-induced nausea and vomiting after high-dose melphalan and stem cell transplantation: review of the evidence and suggestions
- Author
-
Debora Saltarelli, Alessio Perrotti, William Arcese, Francesco Marchesi, Andrea Mengarelli, Luca Cupelli, Fabio Sollazzo, Mirko Di Venanzio, Valeria Tomarchio, A Bruno, Gottardo De Angelis, Anna Chierichini, Ombretta Annibali, Paolo de Fabritiis, Luciano Delbono, Monica Piedimonte, Andrea Tendas, and Pasquale Niscola
- Subjects
Oncology ,Melphalan ,Male ,Transplantation Conditioning ,Aprepitant ,Chemotherapy-induced nausea and vomiting ,High-dose melphalan ,Quality of life ,Stem cell transplantation ,Adult ,Antiemetics ,Antineoplastic Agents, Alkylating ,Dexamethasone ,Female ,Hematopoietic Stem Cell Transplantation ,Humans ,Induction Chemotherapy ,Multiple Myeloma ,Nausea ,Quality of Life ,Serotonin Antagonists ,Transplantation, Autologous ,Vomiting ,0302 clinical medicine ,Autologous stem-cell transplantation ,030212 general & internal medicine ,chemotherapy-induced nausea and vomiting ,stem cell transplantation ,high-dose melphalan ,aprepitant ,quality of life ,Chemotherapy regimen ,Alkylating ,humanities ,030220 oncology & carcinogenesis ,medicine.symptom ,Autologous ,medicine.drug ,medicine.medical_specialty ,Antineoplastic Agents ,03 medical and health sciences ,Internal medicine ,medicine ,Transplantation ,business.industry ,Settore MED/15 ,Regimen ,business - Abstract
High-dose melphalan (HDMel) is the most common conditioning chemotherapy regimen for autologous stem cell transplantation (SCT) in patients affected by multiple myeloma (MM). No consensus exists for the emetogenicity or prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in this regimen. Data on the incidence and efficacy/safety of CINV prophylaxis among patients affected by MM undergoing autologous SCT with the HDMel regimen was extracted from electronic databases and analyzed. Eleven studies involving multiple CINV prophylaxis regimens were identified and included. No consensus on HDMel emetogenicity was reached, but most studies summarized the emetogenicity as moderate-high risk. An aprepitant-based three-drug regimen (aprepitant + serotonin receptor antagonist (5HT3RA) + dexamethasone) showed better efficacy than a two-drug regimen (5HT3RA + dexamethasone) for CINV prevention without increasing the frequency in adverse events. The aprepitant-based three-drug regimen should be the regimen of choice for CINV prophylaxis for MM patients undergoing autologous SCT with HDMel conditioning.
- Published
- 2019
17. Multidimensional Vascular Evaluation in Patients Treated with Tyrosine Kinase Inhibitors (TKIs): From Plaque Formation to Evolution and Follow up on 150 Patients
- Author
-
Teresa Dentamaro, Luca Cupelli, Andrea Siani, Matteo Molica, Rossana Gloria, Paolo de Fabritiis, Malgorzata Monika Trawinska, Elisabetta Abruzzese, and Carla Mazzone
- Subjects
medicine.medical_specialty ,Heart disease ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Immunology ,Physical examination ,Cell Biology ,Hematology ,medicine.disease ,Revascularization ,Biochemistry ,Comorbidity ,Blood pressure ,Diabetes mellitus ,Internal medicine ,medicine ,Family history ,Adverse effect ,business - Abstract
Background Among the unresolved issues concerning management of chronic myeloid leukemia (CML) patients, the most feared are long-term adverse events due to TKI treatment. Although TKIs have revolutionized CML outcomes, their use has also been associated with severe side effects including cardiovascular events, of which peripheral arterial occlusive disease (PAOD) is the most frequently reported. In 2010 we began a long-term collaboration with local angiologists and vascular surgeons to investigate, screen and follow patients on TKI therapy. Placque formation, evolution and follow up of 150 patients were studied and are presented here. Methods We analyzed 143 CML and 7 Ph+ Acute Lymphoid leukemia (ALL) patients, all of whom were treated with TKIs. Careful assessment of cardiovascular risk factors (i.e., age, smoking, obesity, diabetes, high blood pressure, high LDL or low HDL cholesterol levels, family history of heart disease or other cardiovascular disease) were done according to the European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE) risk charts. A complete vascular screening, including physical examination, and a series of instrumental tests were performed for all patients. Tests included doppler echocardiography (US) of supra-aortic arteries with measurement of pre-bulbar IMT, abdominal arteries and inferior limbs arteries and veins (IL), ABI of the posterior tibial artery and digital photoplethysmography (FPG). Patients needing surgical intervention were referred to a surgeon. The team of hematologists, angiologists and surgeons met periodically to discuss results and intervention approaches. Results Patients included 76 males and 74 females with a median age of 53.7 yo (range 18-85). All patients were treated with a TKI at diagnosis, 87 (58%) with imatinib, 63 (42%) with other TKIs, including ponatinib (2 LLA), and all received TKI therapy for a minimum of 12 months since 2010. For analyses purposes, patients were divided in 7 different age groups at diagnosis (18-30, 31-40, 41-50, 51-60, 61-70, 71-80 and 81-85 years; patients incidence per group was 6%, 18%, 18.6%, 27.4%, 13.3%, 12.7% and 4%, respectively). Each patient in the study received yearly screening, and this increased to every 3-6 mo if abnormalities occurred. Of the 150 patients in the study, 10 (7%) developed severe PAOD (grade 3-4) requiring revascularization. Districts involved were: carotid (5), renal (2) and extremities (14 IL, 1 subclavian). Three patients were polyvascular requiring intervention in multiple regions. 18 patients with no malignancies requiring surgery were used as a control group and matched for sex, age, diabetes, smoking, district and intervention to compare patency rates, morbidity and mortality. At event, these 10 patients were taking imatinib (1), bosutinib (1), nilotinib (5) and ponatinib (3). None of them had a previous PAOD, but all had cardiovascular risk factors (100% were hypertensive). Median age was 66.8 yo (range 46-82) and the median number of PAOD risk factors (age >60, hypertension, diabetes, male gender, nicotine abuse and coronary heart disease) was 2 (range 1-5). Plaque was deemed significant when stenosis was >30%; at this point it developed very rapidly, with signs of arterial thrombosis within a year, requiring intervention. IMT scores (measuring thickness of carotid artery wall) and ABI followed by FPG and their variation over time proved predictive for plaque evolution. No patient died due to complications relating directly to surgical intervention or within 30 days post-surgery. One patient required a major limb amputation at 12 months. Patency rates were similar in the TKI and control group at 12 months (88.2% vs 80%), however the frequency of reintervention (endo or open) was 50% in TKI patients (n=5) and 11% in the control group (n=2; P Discussion Multidisciplinary evaluation, comorbidity analysis and cardiovascular risk assessment in CML patients are highly recommended, at diagnosis if possible, to implement a tailored treatment strategy and to identify patients who require strict monitoring of risk factors during treatment. Extensive and detailed information on the 150 patients in this study will be presented with a focus on the onset and characteristics of thrombotic arterial events, medical/surgical interventions, analysis of instrumental parameters (ABI, IMT, FPG) and correlation with clinical data. Disclosures Abruzzese: Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bms: Honoraria.
- Published
- 2020
18. Advanced chronic myelomonocytic leukemia in elderly and frail patients managed by azacitidine in the field of clinical practice
- Author
-
Paolo de Fabritiis, Agostina Siniscalchi, M. M. Trawinska, Luca Cupelli, Laura Scaramucci, Tommaso Caravita, Andrea Tendas, Marco Giovannini, Elisabetta Abruzzese, and Pasquale Niscola
- Subjects
Male ,Antimetabolites, Antineoplastic ,medicine.medical_specialty ,Frail Elderly ,Azacitidine ,Chronic myelomonocytic leukemia ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Aged ,Retrospective Studies ,Hematology ,business.industry ,Disease Management ,Leukemia, Myelomonocytic, Chronic ,General Medicine ,Middle Aged ,Settore MED/15 ,medicine.disease ,Survival Analysis ,Clinical Practice ,Treatment Outcome ,030220 oncology & carcinogenesis ,Physical therapy ,Female ,business ,Follow-Up Studies ,030215 immunology ,medicine.drug - Published
- 2017
19. Decitabine treatment of multiple extramedullary acute myeloid leukemia involvements after essential thrombocytemia transformation
- Author
-
Elisabetta Abruzzese, Paolo de Fabritiis, Malgorzata Monika Trawinska, Pasquale Niscola, Gianfranco Catalano, Andrea Tendas, Stefano Fratoni, Laura Scaramucci, Nélida I. Noguera, Luca Cupelli, Massimiliano Palombi, and Marco Giovannini
- Subjects
Myeloid ,business.industry ,Treatment outcome ,Decitabine ,Essential Thrombocytemia ,Myeloid leukemia ,Hematology ,General Medicine ,Settore MED/15 ,medicine.disease ,03 medical and health sciences ,Leukemia ,Transformation (genetics) ,0302 clinical medicine ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Cancer research ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,030215 immunology ,medicine.drug - Published
- 2017
20. Phase II Multicenter, Not Comparative, Study of Multiple Doses of NEPA (netupitant + palonosetron) in Preventing Chemotherapy-Induced Nausea and Vomiting (CINV) in Non-Hodgkin Lymphoma Patients Eligible for Autologous Hematopoietic Stem Cell Transplantation Receiving Multiple Days / High Dose Chemotherapy Regimens
- Author
-
Giorgina Specchia, Luca Cupelli, Valentina Bozzoli, Vincenzo Federico, Patrizio Mazza, Tommasina Perrone, Clara De Risi, Nicola Di Renzo, Domenico Pastore, P Chiusolo, Maurizio Musso, Attilio Guarini, Fabio Benedetti, Giuseppe Milone, Anna Rita Messa, Vera Capria, Rosanna Scimè, and Andrea Mengarelli
- Subjects
medicine.medical_specialty ,business.industry ,medicine.drug_class ,Nausea ,Immunology ,Palonosetron ,Cell Biology ,Hematology ,Biochemistry ,Chemotherapy regimen ,chemistry.chemical_compound ,Regimen ,chemistry ,Internal medicine ,Vomiting ,Netupitant ,Medicine ,Antiemetic ,medicine.symptom ,business ,Chemotherapy-induced nausea and vomiting ,medicine.drug - Abstract
Cancer chemotherapy may be associated with a high incidence of nausea and vomiting (CINV), which may occur acutely within 24 hours after the start of chemotherapy (acute phase) or in the following days (delayed phase). Despite the availability of several antiemetics, clinical findings show that control of nausea and vomiting continue to be a serious concern for hematological patients, mainly for those receiving multiple-day (MD) and high-dose (HD) chemotherapy (CT), for which no specific international recommendations have been formulated, due to the lack of a unanimous consensus between the main international guidelines. NEPA is the first antiemetic developed as an oral fixed dose combination of two drugs that are antagonists of two receptors involved in the control of nausea and vomiting: a new highly selective NK1-RA, netupitant, and a second generation 5HT3-RA, palonosetron, that simplify the antiemetic regimen allowing for a lower number of capsules and days of treatment. In clinical practice, NEPA is administered together with dexamethasone that contributes to CINV prophylaxis by its intrinsic antiemetic properties. However, dexamethasone also exhibits an important immunosuppressive activity, which could lead to several adverse events, such as increasing the risk of serious infections, especially in patients undergoing myeloablative treatment. The rational of this study was to explore the efficacy of multiple doses of NEPA given with an every-other-day regimen without dexamethasone in preventing CINV in patients with non-Hodgkin's lymphoma (NHL) eligible for autologous stem cell transplantation (ASCT) and treated with MD-HD-CT. The chemotherapy regimen (BEAM/FEAM) was administered for 6 days, NEPA was taken on day 1, 3 and 5, and nausea and vomiting were monitored up to day 15. No dexamethasone was given for antiemetic prophylaxis. The primary endpoint was the percentage of patients achieving a Complete Response (CR; no vomiting and no use of rescue medication) during the overall phase, defined as the period from day 1 (first day of chemotherapy) until 2 days after the last dose of chemotherapy. Seventy patients participated to the study. According to the adopted Fleming one-stage design, the primary endpoint of this study was achieved. Indeed, the number of complete responders for the overall phase was 60, which is greater than the predetermined cut-off of 42, representing the minimum frequency of responders for which the treatment is considered effective. In addition to the primary efficacy result, several additional endpoints were evaluated for the study period (Figure 1). The CR values were 87.1% (primary endpoint, overall phase: days 1-8), 88.6% (acute phase: days 1-6) and 98.6% (delayed phase: days 7-8), while the complete control (CR with no more than mild nausea) was 85.7% (overall phase), 88.6% (acute phase) and 95.7% (delayed phase) (Figure 1A). Moreover, the percentages of patients that did not have any emetic episodes were 88.6% (overall phase), 90% (acute phase) and 98.6% (delayed phase) and patients that did not require a rescue therapy for controlling CINV were 94.3% (overall phase), 94.3% (acute phase) and 100% (delayed phase). Daily records taken from day 1 to day 15 showed that values for all these categories were above 85% for all the days of observation (Figure 1B). Patients also documented the grade of their nausea according to the Likert scale. Moderate and severe episodes of nausea were reported by less than 10% for the overall phase and less than 5% in both acute and delayed phase and the daily values of no nausea were above 65% for each day of the treatment (Figure 1C and 1D). Indeed, the mean patient global satisfaction for the antiemetic prophylaxis for the study period was 9.13 ± 1.59 out of 10. Regarding safety, a total of 12 Treatment-Emergent Adverse Events (TEAEs) occurred in 6 (8.6%) subjects enrolled in the study. Among these, only 1 (8.3%, constipation) was evaluated as possibly related to NEPA administration. Moreover, the only two TEAEs classified as SAE (Serious Adverse Event) were two episodes of fever that have been evaluated as not-related to NEPA. Therefore, the safety profile of NEPA was confirmed also in this setting. In conclusion, our study demonstrated that multiple alternate dosing of NEPA without the addition of dexamethasone can effectively prevent nausea and vomiting in a difficult setting, such as MD/HD-CT with a good tolerability profile. Disclosures No relevant conflicts of interest to declare.
- Published
- 2019
21. Voriconazole treatment in adults and children with hematological diseases: Can it be used without measurement of plasma concentration?
- Author
-
Maria Iris Cassetta, Luciana Annino, Michela Ribersani, Rosa Fanci, Alice Bertaina, Corrado Girmenia, Andrea Novelli, Antonella Ferrari, Adriano Venditti, Katia Girardi, Alessandra Carotti, Francesco Arcioni, Claudio Cartoni, Luca Cupelli, Désirée Caselli, Francesco Marchesi, Stefania Fallani, Benedetta Mariotti, Walter Barberi, Elisabetta Cerchiara, and Anna Proia
- Subjects
0301 basic medicine ,Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Antifungal Agents ,Adolescent ,medicine.medical_treatment ,030106 microbiology ,Body weight ,03 medical and health sciences ,Young Adult ,Medicine ,Humans ,Child ,Aged ,Voriconazole ,medicine.diagnostic_test ,business.industry ,Body Weight ,Age Factors ,Infant ,General Medicine ,Middle Aged ,Hematologic Diseases ,Infectious Diseases ,Hematological Diseases ,Treatment Outcome ,Mycoses ,Therapeutic drug monitoring ,Intravenous therapy ,Child, Preschool ,Toxicity ,Plasma concentration ,Female ,business ,Settore MED/15 - Malattie del Sangue ,medicine.drug - Abstract
Indication and timing of trough plasma-voriconazole (VCZ)-concentration (t-PVC) measurement during VCZ treatment is a debated issue. Patterns of t-PVC were prospectively evaluated in pediatric (50 courses) and adult (95 courses) hematologic patients. Efficacy patterns were defined: adequate, t-PVC always ≥1 mcg/ml; borderline, at least one t-PVC measurement1 mcg/ml but median value of the measurements ≥1 mcg/ml; inadequate, median value of the measurements1 mcg/ml. Toxicity patterns were defined: favorable, t-PVC always ≤5 mcg/ml; borderline, one or more t-PVC measurements5 mcg/ml but median value of the measurements ≤5 mcg/ml; unfavorable, median value of the measurements5 mcg/ml. In children and adults the mean t-PVCs were higher during intravenous treatments. The t-PVC efficacy pattern was adequate, borderline and inadequate in 48%, 12%, and 40% of courses, respectively, in children, and in 66.3%, 16.8%, and 16.8% of courses, respectively, in adults. Adequate efficacy pattern was more frequent in children with body weight above the median (≥25 kg) (OR 4.8; P = .011) and in adults with active hematological disease receiving intravenous therapy (OR 3.93; P = .006). Favorable toxicity pattern was more frequent in children receiving VCZ daily dosage below the median (14 mg/kg) (OR 4.18; P = .027) and in adults with body weight below the median (68 kg) (OR 0.22; P = .004). T-PVC measurement is generally needed, however, a non t-PVC guided approach may be considered in heavier adults receiving intravenous VCZ. The risk of supratherapeutic levels does not seem an absolute indication for t-PVC monitoring.
- Published
- 2018
22. Haploidentical, G-CSF-primed, unmanipulated bone marrow transplantation for patients with high-risk hematological malignancies: an update
- Author
-
Manuela Testi, P. Di Bartolomeo, Teresa Dentamaro, M.C. Tirindelli, Luca Cupelli, William Arcese, Raffaella Cerretti, G De Angelis, Stella Santarone, Andrea Mengarelli, F Di Piazza, Elsa Pennese, Antonella Ferrari, P Bavaro, Anna Chierichini, Laura Cudillo, P Olioso, and Alessandra Picardi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Transplantation Conditioning ,Adolescent ,Basiliximab ,Graft vs Host Disease ,ThioTEPA ,Gastroenterology ,Disease-Free Survival ,Internal medicine ,Granulocyte Colony-Stimulating Factor ,medicine ,Humans ,Cumulative incidence ,Child ,Survival rate ,Aged ,Bone Marrow Transplantation ,Transplantation ,Neutrophil Engraftment ,business.industry ,Hematology ,Middle Aged ,Myeloablative Agonists ,Settore MED/15 ,Fludarabine ,Surgery ,Survival Rate ,Child, Preschool ,Hematologic Neoplasms ,Female ,business ,Follow-Up Studies ,medicine.drug - Abstract
Ninety-seven patients affected by high-risk hematological malignancies underwent G-CSF primed, unmanipulated bone marrow (BM) transplantation from a related, haploidentical donor. All patients were prepared with an identical conditioning regimen including Thiotepa, Busilvex, Fludarabine (TBF) and antithymocyte globulin given at myeloablative (MAC = 68) or reduced (reduced intensity conditioning (RIC) = 29) dose intensity and received the same GvHD prophylaxis consisting of the combination of methotrexate, cyclosporine, mycofenolate-mofetil and basiliximab. Patients were transplanted in 1st or 2nd CR (early phase: n = 60) or in > 2nd CR or active disease (advanced phase: n = 37). With a median time of 21 days (range 12-38 days), the cumulative incidence (CI) of neutrophil engraftment was 94 ± 3%. The 100-day CI of III-IV grade acute GvHD and the 2-year CI of extensive chronic GvHD were 9 ± 3% and 12 ± 4%, respectively. Overall, at a median follow-up of 2.2 years (range 0.3-5.6), 44 out of 97 (45%) patients are alive in CR. The 5-year probability of overall survival (OS) and disease-free survival (DFS) for patients in early and advanced phase was 53 ± 7 vs 24 ± 8% (P = 0.006) and 48 ± 7 vs 22 ± 8% (P = 0.01), respectively. By comparing MAC with RIC patient groups, the transplant-related mortality was equivalent (36 ± 6 vs 28 ± 9%) while the relapse risk was lower for the MAC patients (22 ± 6 vs 45 ± 11%), who showed higher OS (48 ± 7 vs 29 ± 10%) and DFS (43 ± 7 vs 26 ± 10%). However, all these differences did not reach a statistical significance. In multivariate analysis, diagnosis and recipient age were significant factors for OS and DFS. In conclusion, this analysis confirms, on a longer follow-up and higher number of patients, our previous encouraging results obtained by using MAC and RIC TBF regimen as conditioning for G-CSF primed, unmanipulated BM transplantation from related, haploidentical donor in patients with high-risk hematological malignancies, lacking an HLA-identical sibling or unrelated donor and in need to be urgently transplanted.
- Published
- 2015
23. An unusual case of follicular dendritic cell sarcoma of the omentum with pleomorphous morphology and aberrant cytokeratin expression
- Author
-
Pasquale Niscola, Luciana Morino, Laura Scaramucci, Teresa Dentamaro, Luca Cupelli, Giuseppe Santeusanio, Stefano Fratoni, Paolo de Fabritiis, and Andrea Tendas
- Subjects
Pathology ,medicine.medical_specialty ,Histology ,CD30 ,biology ,Follicular dendritic cells ,Clone (cell biology) ,CD23 ,Hematology ,medicine.disease ,Pathology and Forensic Medicine ,Cytokeratin ,Follicular dendritic cell sarcoma ,biology.protein ,medicine ,Histiocyte ,Fascin - Abstract
Follicular dendritic cell sarcoma (FDCS) is an uncommon tumor arising from follicular dendritic cells (FDCs) in the lymph nodes or in extranodal sites. We herein report an unusual case of a 30-year-old man who presented with a FDCS of the omentum and massive liver involvement. The tumor proliferation was a diffuse growth composed by large and highly pleomorphic cells. On immunostaining, B and T cell markers; CD30, myeloid, and histiocytic markers; and S100 were negative whereas CD21, CD23, CD35, clusterin, and fascin were positive. Unexpectedly, large spectrum cytokeratin clone AE1/AE3 was focally and variably expressed. Despite the latter atypical finding and the misleading morphology, immunohistochemistry allowed for a conclusive diagnosis of FDCS.
- Published
- 2014
24. The Management of Membranous Glomerulopathy in Allogeneic Stem Cells Transplantation: Updated Literature
- Author
-
Pasquale Niscola, Xiao-dan Luo, Daniela Piccioni, Roberto Palumbo, Laura Scaramucci, Paolo de Fabritiis, Marco Giovannini, Alessio Perrotti, Qi-fa Liu, Andrea Tendas, Michele Ferrannini, Teresa Dentamaro, Luca Cupelli, Gianfranco Catalano, and Francesco Bondanini
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Renal function ,Hematopoietic stem cell transplantation ,Glomerulonephritis, Membranous ,Gastroenterology ,Risk Factors ,Internal medicine ,medicine ,Humans ,Transplantation, Homologous ,Pharmacology ,business.industry ,Hematopoietic Stem Cell Transplantation ,Glomerulonephritis ,Hematology ,Settore MED/15 ,medicine.disease ,Discontinuation ,Surgery ,Transplantation ,Graft-versus-host disease ,Rituximab ,Cardiology and Cardiovascular Medicine ,business ,Nephrotic syndrome ,medicine.drug - Abstract
Background: membranous glomerulopathy (MG) is an immunomediated disorder which accounts for the most common cause of nephrotic syndrome (NS) following allogeneic hematopoietic stem cell transplantation (HSCT). Objective and Methods: to provide an update on the issue by reviewing pertinent literature on the MEDLINE database. Results: sixty-nine post allogenic HSCT patients (42 male) with MG were identified. The median age was 43 (5 to 68) years. Time interval from allogenic HSCT to MG diagnosis ranged from 3 to 134 months (median 17). Most MG patients had a history of acute (70%) or chronic (84%) graft versus host disease (GVHD). Corticosteroids and cyclosporine were the most common therapeutic agents used in this setting; alternative therapies, including rituximab, were given to a lower number of patients. Outcome data were available in 64 out of 69 MG patients; 38 (59%) and 18 (28%) patients achieved a complete and a partial response respectively, whereas treatment failure was recorded in the remaining 8 (13%). Conclusion: MG after allogenic HSCT appears to be associated with a sub clinical or overt cGVHD, which follows the discontinuation of immunosuppressive prophylaxis. Although a standard therapeutic approach has not been established, the application of available measures can induce favorable response in more than 80% of affected patients, but treatmentfailure and progressive deterioration of the renal function may occur in about one fifth of cases.
- Published
- 2013
25. Primary acquired chronic pure red cell aplasia refractory to standard treatments: remission with rituximab
- Author
-
Pasquale Niscola, Alessio Perrotti, Paolo de Fabritiis, Laura Scaramucci, Andrea Tendas, and Luca Cupelli
- Subjects
medicine.medical_specialty ,Pediatrics ,Anemia ,business.industry ,Pure red cell aplasia ,Azathioprine ,Hematology ,medicine.disease ,Settore MED/15 ,Surgery ,Transplantation ,03 medical and health sciences ,0302 clinical medicine ,Leukocytopenia ,030220 oncology & carcinogenesis ,medicine ,Rituximab ,Autoimmune hemolytic anemia ,Packed red blood cells ,business ,Letter to the Editor ,030215 immunology ,medicine.drug - Abstract
TO THE EDITOR: Pure red cell aplasia (PRCA) is a rare syndrome caused by erythropoietic hypoplasia in the absence of leukocytopenia and thrombocytopenia. It is characterized by severe normocytic and reticulocytopenic anemia, with a normally cellular bone marrow (BM) but devoid of erythroblasts [1]. The acquired form of PRCA is a chronic illness that is often diagnosed in conjunction with a variety of diseases [1], such as lymphoproliferative disorders [2], viral infections, autoimmune hemolytic anemia (AIHA) [3], rheumatologic disorders [4], and allogeneic stem cell transplantation [5]. However, this disorder is rarely diagnosed as an idiopathic condition. Acquired PRCA is managed as an immunologically mediated disease, using immunosuppressive therapy (IST) with corticosteroids and cyclosporine A (CSA) as the treatments of first choice [1]. As alternative and salvage treatment, rituximab has been reported to be highly effective [2,3,4,5]; however, to the best of our knowledge, no case of idiopathic PRCA managed with this agent has been reported. A 63-year-old woman was diagnosed in June 2003 as having PRCA after the discovery of isolated normocytic and reticulocytopenic anemia, the course of which had been insidious and progressive. All other possible underlying causes of erythroblastopenia were ruled out by appropriate investigations (Table 1); other laboratory and radiological evaluations revealed no abnormal findings. The patient had required transfusions of almost 2 units of packed red blood cells (RBC) every 2 to 3 weeks. Once the diagnosis was made, she was started on CSA plus corticosteroids, and soon achieved full recovery from BM erythropoiesis and attained normalization of peripheral blood counts. The patient no longer required transfusions. This was considered complete remission (CR) of PRCA. Therefore, the dosage of CSA was gradually reduced and discontinued. However, there was a progressive loss of response, and CSA was resumed in February 2007 due to a full relapse. The patient achieved a second CR, and the dosage of CSA was carefully tapered. However, the patient experienced progressive chronic renal failure (CRF) in January 2011, which fully resolved after discontinuation of CSA. PRCA recurred soon after, and the patient again required frequent RBC transfusions. When she required approximately 4 RBC units per month, steroids were retried, but without any benefit. Azathioprine was tried without any response. By May 2013, the need for transfusions had reached about 6 RBC units/month, and direct and indirect Coombs blood compatibility tests became positive with the appearance of anti-IgG autoantibody; therefore, the availability of required transfusions became a concern due the difficulty of finding compatible RBC units. In view of this life-threatening complication and a severe hematological condition refractory to all standard treatments for PRCA [1], rituximab was started as a salvage measure at a dose of 375 mg/m2/week for a total of 4 cycles, after the patient gave properly informed consent. Given the lack of experience with rituximab in the setting of primary PRCA, this treatment schedule was derived from that reported as safe and effective in patients with PRCA secondary to lymphoproliferative disorders [2]. After the second dose of rituximab, she exhibited a striking rise in her reticulocyte count and an increase in hemoglobin level. Thus, a third CR was achieved and was maintained during the subsequent 24 months (Fig. 1). In conclusion, the present letter describes a case of acquired chronic primary PRCA of idiopathic origin, refractory to standard measures, with remission on rituximab salvage treatment. To the best of our knowledge, this is the first report of idiopathic PRCA managed with rituximab. In our experience, this agent provided important clinical benefits in an elderly patient with a 12-year PRCA history, during which she had become intolerant/unresponsive to the majority of immunosuppressive agents used in this difficult-to-treat disorder. The course of disease and repeated responses to IST pointed to a possible underlying autoimmune pathogenesis. Although this hypothesis has not been proven by extensive clinical and laboratory evaluations; for this case, rituximab was highly effective in inducing long-lasting remission without any adverse effects.
- Published
- 2016
26. Patient-reported outcomes and quality of life assessment: New targets for new targeted therapy?
- Author
-
Andrea, Tendas, Luca, Cupelli, Maria Rita, Mauroni, Fabio, Sollazzo, Fabio, Di Piazza, Debora, Saltarelli, Ilaria, Carli, Anna, Chierichini, Chiara, Melfa, Maria Antonietta, Surano, Ombretta, Annibali, Monica, Piedimonte, Esmeralda, Conte, Francesco, Marchesi, Caterina, Viggiani, Adriana Concetta, Pignatelli, Teresa, Dentamaro, Paolo, de Fabritiis, Alessio Pio, Perrotti, and William, Arcese
- Subjects
Outcome Assessment, Health Care ,Quality of Life ,Humans ,Patient Reported Outcome Measures ,Article - Published
- 2016
27. Rehabilitation need and referrals in hematopoietic stem cell transplantation. the experience of Quality of Life Working Party of the Rome Transplant Network
- Author
-
Monica Piedimonte, M Surano, Andrea Tendas, I Carli, Caterina Viggiani, Debora Saltarelli, P. De Fabritiis, Teresa Dentamaro, Alessio Perrotti, F Di Piazza, Francesco Marchesi, C Melfa, Luca Cupelli, Esmeralda Conte, Fabio Sollazzo, Adriana Concetta Pignatelli, Ombretta Annibali, William Arcese, Pasquale Niscola, Anna Chierichini, and Maria Rita Mauroni
- Subjects
medicine.medical_specialty ,Transplantation Conditioning ,medicine.medical_treatment ,Transplants ,Hematopoietic stem cell transplantation ,behavioral disciplines and activities ,Article ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,medicine ,Humans ,030212 general & internal medicine ,Progenitor cell ,Intensive care medicine ,Referral and Consultation ,Transplantation ,Rehabilitation ,business.industry ,digestive, oral, and skin physiology ,Hematopoietic Stem Cell Transplantation ,Hematology ,Settore MED/15 ,medicine.disease ,humanities ,not available ,surgical procedures, operative ,Graft-versus-host disease ,030220 oncology & carcinogenesis ,Quality of Life ,Physical therapy ,Stem cell ,business - Abstract
In a cohort of inpatient hematopoietic cell transplantation (HCT) recipients, we assessed patterns of referral to rehabilitation treatment, functional performance and short-term outcomes in patients who received post-transplant rehabilitation in comparison with those who did not. Among 201 first-time HCT recipients, 53 (26%) were referred to an inpatient rehabilitation provider, had an assessment of functional performance using the Functional Independence Measure scale and underwent rehabilitation treatments to address functional needs. Patients who received rehabilitation therapy were more likely to be females (P = 0.02), older than 60 years of age (P = 0.0146), employed (P = 0.01), have hypertension (P = 0.02), peripheral vascular disease (P = 0.01) and pre-transplant Karnofsky Performance Score (KPS)
- Published
- 2016
28. Posaconazole oral suspension primary prophylaxis in acute leukemia and allogeneic stem cell transplant patients. can it be used without measurement of plasma concentration?
- Author
-
Antonio Spadea, Andrea Mengarelli, Massimo Di Gioia, Francesco Arcioni, Vincenzo Perriello, Alessandra Carotti, Corrado Girmenia, Andrea Novelli, Luca Cupelli, Anna Proia, Maria Iris Cassetta, Benedetta Mariotti, Clara Minotti, Giovanni Fernando Torelli, Elisabetta Cerchiara, Alice Bertaina, Michela Ribersani, Luciana Annino, Désirée Caselli, Rosa Fanci, Maria Ilaria Del Principe, Anna Chierichini, Stefania Fallani, and Monica Piedimonte
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Posaconazole ,Antifungal Agents ,genetic structures ,Adolescent ,Settore MED/06 - Oncologia Medica ,Posaconazole Oral Suspension ,030106 microbiology ,diarrhea ,Administration, Oral ,03 medical and health sciences ,Immunocompromised Host ,Plasma ,Young Adult ,Pharmacotherapy ,Internal medicine ,Blood plasma ,Medicine ,Humans ,Transplantation, Homologous ,Prospective Studies ,Child ,plasma level ,Aged ,allogeneic stem cell transplant ,Acute leukemia ,Leukemia ,business.industry ,General Medicine ,Middle Aged ,Triazoles ,Chemotherapy regimen ,posaconazole ,Diarrhea ,Infectious Diseases ,Mycoses ,Child, Preschool ,Immunology ,Female ,medicine.symptom ,Stem cell ,business ,medicine.drug ,Stem Cell Transplantation - Abstract
Posaconazole oral suspension (PCZ-susp) can display a variable degree of inter and intra-individual absorption. However, there is no agreement on the need of plasma-posaconazole-concentration (PPC) monitoring as a routine practice in patients receiving PCZ-susp. In this prospective, multicenter study we evaluated the variability of PPCs in hematologic patients receiving PCZ-susp prophylaxis with the aim to define conditions at different risk of subtherapeutic PPCs. Overall, 103 acute leukemia (AL) patients submitted to intensive chemotherapy (115 courses) and 46 allogeneic stem cell transplant (allo-SCT) recipients (47 courses) receiving PCZ-susp prophylaxis were considered. The adequacy of PPC pattern after the steady state (≥day 7 of treatment) in courses with two or more PPC measurements was defined as follows: inadequate pattern: PPC
- Published
- 2016
29. Pain Management in Hematological Patients with Major Organ Dysfunctions and Comorbid Illnesses
- Author
-
Luca Cupelli, Francesco Bondanini, Roberto Palumbo, Claudio Romani, Claudio Cartoni, Fabio Efficace, Marco Giovannini, Gregorio Antonio Brunetti, Alessio Perrotti, Paolo de Fabritiis, Michele Ferrannini, Andrea Tendas, Laura Scaramucci, and Pasquale Niscola
- Subjects
medicine.medical_specialty ,MEDLINE ,Pain ,Comorbidity ,medicine ,Humans ,Pain Management ,Intensive care medicine ,Adverse effect ,Adjuvants, Pharmaceutic ,Pharmacology ,Analgesics ,business.industry ,Liver Diseases ,Anti-Inflammatory Agents, Non-Steroidal ,Hematology ,Pain management ,Settore MED/15 ,medicine.disease ,Hematologic Diseases ,Analgesics, Opioid ,Physical therapy ,Kidney Diseases ,Cardiology and Cardiovascular Medicine ,business ,Systematic search - Abstract
Background: Organ dysfunctions and medical complications, such as renal failure, liver impairment, coagulation disorders, cardiovascular and respiratory illnesses, may hamper an adequate pain management in haematological patients. Aim: To summarize current knowledge on pain management in hematological patients presenting major organ dysfunctions and comorbidity. We also attempted to provide recommendations to optimize analgesia and to minimize side effects in the setting of medically compromised and frail haematological patients. Methods: A systematic search of the literature, using relevant key words, was conducted in PubMed. Results and conclusions: Pain in hematological patients is a common symptom and is often multi-factorial. Most pharmacotherapeutic measures, including causal therapies, analgesics and adjuvant agents routinely applied in pain management, may also be used in the setting of clinical frailty and medical comorbidities; however, comprehensive clinical and functional patient’s evaluations and a careful consideration of expected benefits and potential adverse events are required.
- Published
- 2012
30. Protection during haempoietic stem cell transplantation: a survey from the quality of life working party of the Rome Transplant Network
- Author
-
M.C. Tirindelli, Luca Cupelli, William Arcese, Debora Saltarelli, M Surano, Monica Piedimonte, R Mauroni, Francesco Marchesi, Esmeralda Conte, I Carli, Ombretta Annibali, A Inzeo, Adriana Concetta Pignatelli, Caterina Viggiani, Andrea Tendas, F Di Piazza, Fabio Sollazzo, Valeria Tomarchio, and Anna Chierichini
- Subjects
medicine.medical_specialty ,Pediatrics ,Isolation (health care) ,Medicine (miscellaneous) ,030204 cardiovascular system & hematology ,stem cell transplantation ,Patient Isolation ,isolation ,03 medical and health sciences ,0302 clinical medicine ,Psychological status ,Quality of life ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Oncology (nursing) ,business.industry ,Intensive treatment ,Hematopoietic Stem Cell Transplantation ,General Medicine ,Evidence-based medicine ,Transplantation ,Medical–Surgical Nursing ,surgical procedures, operative ,Italy ,Quality of Life ,Stem cell ,business ,Hospital Units - Abstract
Hospitalisation in protected/isolated rooms is a measure, frequently, adopted for hematological patients undergoing to intensive treatment, such as allogeneic (allo) or autologous (auto) stem cell transplantation (SCT), due to a high risk of infections.1 However, the level of evidence about the efficacy of isolation measure during SCT is poor, thus resulting in discrepancy between different centres.1 Prolonged isolation affects quality of life, due to restriction of socio-familiar role and lack of psychological relieve of patients, thus increasing the high burden of symptoms reported by transplanted patients during the first weeks after SCT.2–6 Moreover, isolation could affect psychological status of patient relatives, such as children, frequently not allowed to visit their parent during hospitalisation. Isolation effects on patient undergoing to SCT could …
- Published
- 2017
31. Management of hematological malignancies in patients affected by renal failure
- Author
-
Roberto Palumbo, Claudio Romani, Pasquale Niscola, Claudio Cartoni, Marco Giovannini, Luca Cupelli, Gisella Vischini, Giovanni Del Poeta, Paolo de Fabritiis, Laura Scaramucci, Gregorio Antonio Brunetti, Francesco Bondanini, Alessio Perrotti, Andrea Tendas, and Michele Ferrannini
- Subjects
medicine.medical_specialty ,Chemotherapy ,Kidney ,business.industry ,medicine.medical_treatment ,Antineoplastic Agents ,Clinical trial ,Therapeutic index ,medicine.anatomical_structure ,Oncology ,Dose adjustment ,Hematologic Neoplasms ,medicine ,Antineoplastic Drugs ,Humans ,Pharmacology (medical) ,In patient ,Renal Insufficiency ,business ,Intensive care medicine ,Settore MED/15 - Malattie del Sangue ,Dialysis - Abstract
The management of hematological malignancies (HM) in renally impaired patients may be a difficult task. Indeed, the kidney represents a major elimination pathway for many chemotherapeutic agents and their metabolites, whose serum levels are not usually measured in daily clinical practice. In addition, many antineoplastic drugs have a narrow therapeutic index for which they require dose adjustment when administered to patients with renal failure. Only limited data regarding the use of chemotherapy in patients with renal impairment and in those on dialysis are available. Indeed, renal patients with HM are often excluded from most clinical trials. Thus far, in order to provide recommendations, we have reviewed the pertinent literature, gathering information from published guidelines regarding chemotherapy in patients with kidney dysfunction and from articles describing the use of individual agents in renal patients with HM.
- Published
- 2011
32. Dismal Outcome of Acute Myeloid Leukemia Secondary to Myelodysplastic Syndrome and Chronic Myelomonocytic Leukemia after Azacitidine Failure in a Daily-Life Setting
- Author
-
Paolo de Fabritiis, Pasquale Niscola, Laura Scaramucci, Giovanni Del Poeta, Andrea Tendas, Daniela Piccioni, Marco Giovannini, Teresa Dentamaro, and Luca Cupelli
- Subjects
Adult ,Male ,Oncology ,Antimetabolites, Antineoplastic ,medicine.medical_specialty ,Azacitidine ,Chronic myelomonocytic leukemia ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Transplantation, Homologous ,Treatment Failure ,Aged ,Aged, 80 and over ,business.industry ,Hematopoietic Stem Cell Transplantation ,Myeloid leukemia ,Leukemia, Myelomonocytic, Chronic ,Hematology ,General Medicine ,Middle Aged ,medicine.disease ,Leukemia, Myeloid, Acute ,Myelodysplastic Syndromes ,Disease Progression ,Female ,business ,Settore MED/15 - Malattie del Sangue ,medicine.drug - Published
- 2014
33. Antifungal Drugs in the Management of Hematological Diseases in a Home Care Program
- Author
-
Laura Scaramucci, Pasquale Niscola, Marco Giovannini, Paolo de Fabritiis, Luca Cupelli, Malgorzata Monika Trawinska, Alessio Perrotti, Raffaello Lentini, and Andrea Tendas
- Subjects
Community and Home Care ,Voriconazole ,medicine.medical_specialty ,Posaconazole ,Leadership and Management ,Itraconazole ,business.industry ,Public Health, Environmental and Occupational Health ,Pharmacoepidemiology ,chemistry.chemical_compound ,Nystatin ,chemistry ,Internal medicine ,Amphotericin B ,medicine ,Caspofungin ,Intensive care medicine ,business ,Fluconazole ,medicine.drug - Abstract
Antifungal drugs are frequently used in hematology due to relatively high frequency of infections. Electronic health records of home care patients were retrospectively scanned, looking for antifungal drugs, nystatin, fluconazole, amphotericin B, caspofungin, itraconazole, voriconazole, and posaconazole; we extrapolated frequency, type, indication for use, and duration of each identified antifungal treatment. From September 15, 2011 to September 15, 2012, among 106 patients, median age 83 years, affected by cancer in 82 and other diagnosis in 24 patients, 18 were treated with antifungals, 12 with systemic antifungal (fluconazole 6, itraconazole 5, sequential voriconazole, and itraconazole 1) and 6 with local antifungal. According to our results, the use of antifungals in home care hematological patients is frequent, but limited to certain molecules.
- Published
- 2013
34. Hemorrhagic complications in patients with advanced hematological malignancies followed at home: an Italian experience
- Author
-
Andrea Tendas, Paolo de Fabritiis, Laura Scaramucci, Pasquale Niscola, Gianna Maria D'Elia, Massimo Breccia, Claudio Cartoni, Marco Giovannini, Claudio Romani, Robin Foà, Franco Mandelli, Luca Cupelli, and Gregorio Antonio Brunetti
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Palliative care ,Adolescent ,thrombocytopenia ,Young Adult ,Melena ,Cause of Death ,Internal medicine ,medicine ,Humans ,Young adult ,Child ,Survival rate ,Aged ,Cause of death ,Aged, 80 and over ,Acute leukemia ,palliative care ,business.industry ,Incidence ,Incidence (epidemiology) ,Disease Management ,bleeding ,hemorrhage ,home care ,Hematology ,Middle Aged ,Home Care Services ,Surgery ,Survival Rate ,Treatment Outcome ,Italy ,Oncology ,Child, Preschool ,Hematologic Neoplasms ,Female ,medicine.symptom ,business ,Packed red blood cells - Abstract
Patients with advanced hematological malignancies may experience many troublesome hemorrhagic complications requiring hospitalisation during a palliative home care (HC) program. We report on the feasibility of the management of bleeding at home in patients with haematological malignancies admitted in a domiciliary HC program. The occurrence of a major hemorrhage episode (>1 WHO grade) was registered among 469 patients with hematological malignancies in the terminal phase of their disease followed at home. Number, sites, domiciliary treatment (local hemostatic measures, platelet units, hemostatic drugs, packed red blood cells) and outcome of hemorrhagic complications were evaluated. Out of 469 patients, 123 (26%) experienced a bleeding complication; the overall number of hemorrhagic episodes was 232 (49%) with a median number of 2 episodes per patient. Patients with a platelet count lower than 20 x 10(9)/L (P < 0.00005) or with a diagnosis of acute leukemia or in blast crisis of myeloprolypherative disorders (P < 0.00005) showed a significant higher incidence of hemorrhages than other patients. Resolution of bleeding at home was obtained in 206 (88%) of the 232 episodes; platelet units were transfused at home in 188 (81%) cases. Bleeding was the cause of hospitalisation in four cases. Death occurred in 447 of 469 patients: in 26 of them (6%), it was caused by bleeding complications (11 brain hemorrhage, 2 hematemesis, 3 hemoptysis and 10 melena). In this group of patients, bleeding was a relevant clinical problem However, by implementing a domiciliary palliative care program, home management of hemorrhages proved to be a safe and effective choice.
- Published
- 2009
35. Epidemiology, features and outcome of pain in patients with advanced hematological malignancies followed in a home care program: an Italian survey
- Author
-
Franco Mandelli, Claudio Romani, Paolo de Fabritiis, Pasquale Niscola, Claudio Cartoni, Gianna Maria D'Elia, Andrea Tendas, Robin Foà, Gregorio Antonio Brunetti, and Luca Cupelli
- Subjects
Adult ,Male ,medicine.medical_specialty ,Osteolysis ,Adolescent ,Pain ,hematological malignancies ,home care ,pain ,Internal medicine ,Epidemiology ,medicine ,Mucositis ,Humans ,Pain Management ,Child ,Lymph node ,Aged ,Pain Measurement ,Aged, 80 and over ,Analgesics ,Hematology ,business.industry ,Data Collection ,Visceral pain ,General Medicine ,Middle Aged ,medicine.disease ,Home Care Services ,Lymphoma ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Italy ,Child, Preschool ,Hematologic Neoplasms ,Female ,Bone marrow ,medicine.symptom ,business - Abstract
We report on epidemiology, features, outcome, and domiciliary management of pain in patients with advanced hematological malignancies followed by an experienced hospital-based home care (HC) team. Out of 469 patients, 244 (52%) experienced a total of 284 pain syndromes. Pain intensity was rated from mild to moderate in 31% and from moderate to severe in 69% of them. The diagnosed pain mechanisms were deep somatic in 56%, superficial somatic in 15%, visceral 14%, mixed 8%, and neuropathic in 7% of pain syndromes, respectively. Incident pain was observed in 38% of all pain syndromes. In every diagnostic group, deep somatic pain was prevalent. Moreover, 85% of visceral pain syndromes were observed in patients affected by non-Hodgkin's lymphoma (NHL). In addition, out of 284 pain syndromes, 150 (51%) were caused by bone involvement. The most frequent recognized pain provocative mechanisms were bone marrow expansions, osteolysis, lymph node enlargement, and mucositis. In our experience, an approach based on the association of causal therapies and analgesics allows optimal control of most pain syndromes. Therefore, pain is a major problem in patients affected by advanced hematological malignancies, and its management can be effective and feasible when carried out by a skilled HC team.
- Published
- 2007
36. Sustained resolution of anemia without any treatment after excessive therapeutic response to human recombinant erythropoietin in three patients with myelodysplastic syndromes
- Author
-
Pasquale Niscola, Luca Cupelli, Gianfranco Catalano, Alessio Perrotti, Paolo de Fabritiis, Marco Giovannini, Andrea Tendas, and Laura Scaramucci
- Subjects
Aged, 80 and over ,Male ,medicine.medical_specialty ,business.industry ,Anemia ,Myelodysplastic syndromes ,Erythropoietin ,Recombinant Proteins ,Humans ,Myelodysplastic Syndromes ,Aged ,Female ,Settore MED/15 ,medicine.disease ,Gastroenterology ,Oncology ,Internal medicine ,Immunology ,80 and over ,Medicine ,business ,Recombinant erythropoietin ,Settore MED/15 - Malattie del Sangue - Published
- 2013
37. Patient-reported outcomes and quality of life assessment: New targets for new targeted therapy?
- Author
-
Fabio Sollazzo, William Arcese, Ombretta Annibali, Maria Antonietta Surano, Caterina Viggiani, Maria Rita Mauroni, Monica Piedimonte, Chiara Melfa, Teresa Dentamaro, Alessio Perrotti, Andrea Tendas, Ilaria Carli, Fabio Di Piazza, Adriana Concetta Pignatelli, Paolo de Fabritiis, Luca Cupelli, Esmeralda Conte, Francesco Marchesi, Anna Chierichini, and Debora Saltarelli
- Subjects
Cancer Research ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Alternative medicine ,Targeted therapy ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Intensive care medicine ,business ,030215 immunology - Published
- 2016
38. Homecare-based Motor Rehabilitation in Musculoskeletal Chronic Graft Versus Host Disease
- Author
-
William Arcese, E Caiazza, Claudio Cartoni, C Boschetto, P. De Fabritiis, M. M. Trawinska, Laura Scaramucci, Luciana Morino, R. Lentini, Marco Giovannini, Franco Mandelli, Pasquale Niscola, Teresa Dentamaro, L Baraldi, Luca Cupelli, Micaela Ales, Massimiliano Palombi, and Andrea Tendas
- Subjects
Reflective practice ,Malignant pleural effusion ,medicine.medical_treatment ,Case Report ,Disease ,Neuropathic pain ,Cervix ,South Africa ,Hemopoietic stem cells transplantation ,Breast cancer ,Quality of life ,Lymphedema ,Cancer pain ,Challenges ,Fatigue ,Pleurodesis ,Breast self-examination ,Implementation evaluation ,lcsh:R5-920 ,Rehabilitation ,Health Policy ,Mechanism-based classification ,cGVHD ,Tube thoracostomy ,Awareness ,Motor rehabilitation ,Management ,Oral morphine ,Knowledge ,Oncology ,Talc ,Palliative care ,Caregiving ,HIV/AIDS ,Neonatal intensive care ,lcsh:Medicine (General) ,Brief Pain Inventory ,medicine.medical_specialty ,Case-reflection ,Pain measurement tools ,Pain ,Outcome measurement ,Cancer research ,Hypnotherapy ,Home care ,Palliative oncology ,medicine ,Community home-based care ,business.industry ,Heparin ,Disease progression ,Public Health, Environmental and Occupational Health ,Multidimensional approach ,medicine.disease ,Pain pathomechanisms ,Transplantation ,Graft-versus-host disease ,Pleurodesant ,Attitudes ,Physical therapy ,Health professionals ,Complication ,business ,Basic issues ,New practice ,Settore MED/15 - Malattie del Sangue ,Pain rehabilitation - Abstract
Chronic graft versus host disease (cGVHD) is a frequent complication of allogeneic stem cell transplantation. Extensive musculoskeletal and skin involvement may induce severe functional impairment, disability and quality of life deterioration. Physical rehabilitation is recommended as ancillary therapy in these forms, but experiences are sparse. A 39-year-old man affected by musculoskeletal and skin chronic graft versus host disease (cGVHD) was treated with a homecare-based motor rehabilitation program during palliation for disease progression. Significant functional improvement was obtained. Motor rehabilitation should be strongly considered for patients with musculoskeletal cGVHD, both in the palliative and in the curative phase of disease.
- Published
- 2011
39. Anticoagulant and Anti-thrombotic Treatments in the Management of Hematological Malignancies in a Home Care Program
- Author
-
Andrea Tendas, Paolo de Fabritiis, Massimiliano Palombi, Pasquale Niscola, Claudio Cartoni, Marco Giovannini, Laura Scaramucci, Malgorzata Monika Trawinska, Francesco Bondanini, Luca Cupelli, and Gregorio Antonio Brunetti
- Subjects
Nurses ,Palliative care in HIV/AIDS ,Not for resuscitation ,Hematological malignancies ,Palliative sedation ,Training effectiveness ,Professional training ,Hospice ,PPC units ,Pain control ,education.field_of_study ,Practice ,lcsh:R5-920 ,Low molecular weight heparin ,Health Policy ,Anticoagulant ,Palliative caregivers ,Knowledge ,Medical interns ,Palliative care giving ,Cohort ,Palliative care ,Original Article ,lcsh:Medicine (General) ,medicine.drug ,medicine.medical_specialty ,Structured intervention ,People living with HIV/AIDS ,medicine.drug_class ,Population ,India ,Documentation ,Program evaluation ,Internal medicine ,Physicians ,medicine ,Community home-based care program ,Curriculum development ,Adverse effect ,education ,business.industry ,Home care service ,Bleeding ,Public Health, Environmental and Occupational Health ,Warfarin ,Neighborhood network in palliative care ,Audit ,Acenocumarine ,Educational intervention ,Support groups ,Friedman repeated measures analysis of variance on ranks ,Surgery ,Attitude ,Attitudes ,Care program ,business - Abstract
Aim: Anticoagulants (AC) and anti-platelet (AP) agents are widely administered to patients with hematological malignancies (HM). However, HM patients may be at high risk of bleeding and hemorrhagic complications, because of different form of coagulopathies and several degrees of thrombocytopenia. Materials and Methods: A prospective evaluation of the use of anticoagulant and anti-thrombotic agents as well as of bleeding and thrombotic complications in a consecutive cohort of patients, which were followed during the first semester of 2010 by our home care service, was performed. In this regard, three pharmacological class of agents, such as oral anticoagulants (warfarin and acenocumarine), low molecular weight heparin (LMWH) and anti-platelet (AP) drugs were considered. Results: Out of 129 patients, 26 (20%) were treated with AC/AP drugs. Warfarin, acenocumarine, LMWH as well as AP were used in 7, 11 and 12 patients, respectively. Adverse events (bleeding) were observed in 3 patients (11.5%), 2 cases being on warfarin (replaced by LMWH) and 1 being AP (suspension without replacement); out of the 3 patients with bleeding, none presented thrombocytopenia. Conclusions: Despite the frequent findings of hemostatic disorders in a population of frail patients managed in a home care setting, our experience demonstrated that the use of AC/AP drugs has been very rarely responsible for significant complications.
- Published
- 2011
40. Bone marrow aspiration and biopsy-related pain management
- Author
-
William Arcese, Pasquale Niscola, Andrea Mengarelli, Caterina Viggiani, Andrea Tendas, Fabio Sollazzo, Teresa Dentamaro, Paolo de Fabritiis, Stella Cacciaraichi, Maria Rita Mauroni, Luca Cupelli, Esmeralda Conte, Antonella D’Apolito, Adriana Concetta Pignatelli, Ombretta Annibali, Maria Paola Bianchi, Antonella Ferrari, Veronica Molinari, Vittoria Pilozzi, and Enrico Montefusco
- Subjects
medicine.medical_specialty ,Biopsy ,MEDLINE ,Biopsy, Needle ,Bone Marrow Examination ,Humans ,Pain ,Pain Management ,Review Article ,Internal medicine ,medicine ,Needle ,Bone marrow ,Hematology ,medicine.diagnostic_test ,business.industry ,General Medicine ,Pain management ,Settore MED/15 ,Surgery ,Aspiration ,medicine.anatomical_structure ,business - Abstract
Examination of the bone marrow biopsy and aspirate allows diagnosis and assessment of various conditions such as primary hematologic and metastatic neoplasms, as well as nonmalignant disorders. Despite being performed for many years, according to many different protocols, the procedure still remains painful for the majority of patients. This paper summarizes the current knowledge of pain reduction measures in the bone marrow biopsy and aspiration.
- Published
- 2014
41. 274 SUCCESSFUL RE-TREATMENT WITH AZACITIDINE IN A PATIENT WITH MYELODYSPLASTIC SYNDROME (MDS) EVOLUTED INTO ACUTE MYELOID LEUKEMIA (AML) AFTER THE SUSPENSION OF THIS AGENT
- Author
-
Pasquale Niscola, Laura Scaramucci, P. De Fabritiis, Luca Cupelli, Stefano Fratoni, Marco Giovannini, and Andrea Tendas
- Subjects
Cancer Research ,Oncology ,business.industry ,Azacitidine ,Cancer research ,medicine ,Myeloid leukemia ,Hematology ,Suspension (vehicle) ,business ,medicine.drug - Published
- 2015
42. Azacitidine in chronic myelomonocytic leukemia: an effective and manageable approach
- Author
-
Andrea, Tendas, Luca, Cupelli, Agostina, Siniscalchi, Laura, Scaramucci, Marco, Giovannini, Teresa, Dentamaro, Alessio, Perrotti, Tommaso, Caravita, Paolo, de Fabritiis, and Pasquale, Niscola
- Subjects
Pediatrics ,medicine.medical_specialty ,lcsh:RC633-647.5 ,business.industry ,chronic myelomonocytic leukemia, azacitidine, myelodysplastic syndrome ,Azacitidine ,Chronic myelomonocytic leukemia ,Myeloid leukemia ,lcsh:Diseases of the blood and blood-forming organs ,Hematology ,medicine.disease ,Infectious Diseases ,Overall response rate ,hemic and lymphatic diseases ,Clinical heterogeneity ,Medicine ,Original Article ,Approaches of management ,business ,Median survival ,medicine.drug - Abstract
Chronic myelomonocytic leukemia (CMML) is an uncommon neoplastic hematological disorder, typically affecting the elderly and characterized by a marked clinical heterogeneity and a remarkable propensity for transformation into acute myeloid leukemia. Hypomethylating agents represent the most innovative management approach in this difficult setting. At our institution, between 2010 and 2012, we have treated with azacitidine 10 CMML patients with a median age of (62–86) 75 years. An overall response rate of 70% was achieved without remarkable toxicities; in particular, most therapy-induced side effects were managed on outpatient basis. With a median follow-up of 22 (11 – 44) months, 6 patients are alive and 4 of them continue to receive the treatment; the median survival from the start of therapy was 22 months. In conclusion, also in the light of our encouraging experience, azacitidine can offer new chances of treatment also in the difficult setting of elderly CMLL.
- Published
- 2013
43. Accidental falls in home care hematological patients
- Author
-
Pasquale Niscola, Laura Scaramucci, Gregorio Antonio Brunetti, M. M. Trawinska, L. Lentini, Andrea Tendas, Luca Cupelli, Claudio Cartoni, P. De Fabritiis, Massimiliano Palombi, Franco Mandelli, and Marco Giovannini
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Anemia ,Population ,Poison control ,Physical examination ,Injury prevention ,medicine ,Humans ,Accidental fall ,education ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Incidence ,Middle Aged ,medicine.disease ,Settore MED/15 ,Home Care Services ,Oncology ,Hematologic Neoplasms ,Accidental ,Accidental Falls ,Female ,Medical emergency ,business - Abstract
Dear Editor, Accidental falls are a major concern in patients with both medical and surgical illness for twomain reasons: (1) potential complications, such as bone fractures, leading to hospitalization requirement and direct or indirect cost increase; (2) medico-legal and insurance implications of a fall and its complications, above all in controlled environments, such as hospital wards, nursing homes, and home care (HC). HC management is a special area of application in advancedterminal onco-hematological and older hematological patients, which is concerned with several factors, such as difficulty with access to a hospital and obtaining considerable benefits from HC, when compared with inpatient management. HC management allows the assistance of hematological patients at home, furnishing the health services that usually would be supplied in a hospital to treat hematological diseases and their complications (e.g., medical examinations, blood tests, transfusions, chemotherapy, etc.) [1–3]. Hematological patients, due to the underlying disease, their treatment, or associated comorbidities, are faced with several pathological processes, which may increase the risk of accidental falls in comparison to the general population. Risk factors for accidental falls have been extensively analyzed, both in the general population (children [4], elderly [5]) and in certain diseases (dialysis [6], stroke [7], cancer [8]), as well as in various settings (such as hospitals [9] and nursing homes [10]). An extensive literature search was conducted through database scanning, revealing lack of evidence regarding falls and injury in hematological HC patients. HC hematological patients could be considered at high risk both for accidental falls (due to age [8] and clinical features, such as anemia [11], fatigue, disability [12–16], cognitive impairment [17], and drugs [18, 19]), and for subsequent complications, such as fractures (due to osteolysis, treatment-induced/enhanced osteoporosis [20]), bleeding (due to hemostasis disorders), and infection. The aim of the present study was to retrospectively evaluate fall frequency and fall injury in hematological HCmanaged patients. Clinical data of 193 patients admitted in our HC service from January 2010 to June 2011 (median follow-up, 74 days (range, 15–500)) were retrospectively reviewed. Among these, 133 patients, with properly recorded clinical data, were considered evaluable for further analysis; 60 patients were excluded due to incomplete data recording (e.g., lack of registration of physical examination data). Accidental fall events (defined as “unexpected descent to the floor”) were extracted and analyzed, as well as complications and their outcome. Evaluable patient data were the following: 54 males (41 %), 79 females (59 %); diagnosis and disease stage are shown in Table 1. Median age was 83 years (20–98); age range details are shown in Table 2. Twenty-six fall events were identified in 23/133 pts (17 %). A total of 18,886 days A. Tendas : L. Cupelli :M. M. Trawinska : L. Lentini Hematology Unit, S. Eugenio Hospital, Home Care Service of the Rome Section of the Italian Association Against Leukemias (RomAIL), Rome, Italy
- Published
- 2013
44. Dysgeusia in patients with hematological malignancies: a reminder for hematologist
- Author
-
Paolo de Fabritiis, Malgorzata Monika Trawinska, Elisabetta Abruzzese, Pasquale Niscola, Massimiliano Palombi, Andrea Tendas, Alessio Perrotti, Tommaso Caravita, Marco Giovannini, Laura Scaramucci, Agostina Siniscalchi, Teresa Dentamaro, and Luca Cupelli
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,business.industry ,Settore MED/15 ,Dysgeusia ,Dermatology ,Pathology and Forensic Medicine ,Otorhinolaryngology ,Head and Neck Neoplasms ,Quality of Life ,Periodontics ,Medicine ,Humans ,In patient ,Female ,Oral Surgery ,Hematologist ,medicine.symptom ,Cranial Irradiation ,business - Published
- 2013
45. Single versus double-unit transfusion policy in hematology
- Author
-
Paolo de Fabritiis, Pasquale Niscola, Marco Giovannini, Andrea Tendas, Laura Scaramucci, and Luca Cupelli
- Subjects
medicine.medical_specialty ,Erythrocyte transfusion ,Hematology ,business.industry ,Red Blood Cell Transfusion ,Intensive chemotherapy ,Settore MED/15 ,Transplantation ,Internal medicine ,medicine ,In patient ,Intensive care medicine ,business - Abstract
We have read with great interest the article by Berger et al . entitled “Significant reduction of red blood cell transfusion requirements by changing from a double-unit to a single-unit transfusion policy in patients receiving intensive chemotherapy or stem cell transplantation”.[1][1] We
- Published
- 2012
46. The prevention of oral mucositis in patients with blood cancers: current concepts and emerging landscapes
- Author
-
Paolo de Fabritiis, Atul Sharma, Alessio Perrotti, Teresa Dentamaro, Gianfranco Catalano, Laura Scaramucci, Dorothy M. K. Keefe, Fabio Efficace, Luca Cupelli, Claudio Cartoni, Marco Giovannini, Daniela Piccioni, Pasquale Niscola, Vito Trinchieri, and Andrea Tendas
- Subjects
medicine.medical_specialty ,Fibroblast Growth Factor 7 ,Transplantation Conditioning ,medicine.medical_treatment ,Psychological intervention ,MEDLINE ,Hematopoietic stem cell transplantation ,Quality of life ,prevention ,oral mucositis ,blood cancer ,Mucositis ,Medicine ,Humans ,Intensive care medicine ,Pharmacology ,Stomatitis ,business.industry ,Hematopoietic Stem Cell Transplantation ,Mouth Mucosa ,Hematology ,medicine.disease ,Clinical trial ,Palifermin ,Hematologic Neoplasms ,Immunology ,Cardiology and Cardiovascular Medicine ,business ,Settore MED/15 - Malattie del Sangue ,medicine.drug - Abstract
Background. The prevention of oral mucositis (OM) in the management of hematological malignancies continues to represent an unmet clinical need. Addressing this issue has major clinical implications as OM can also greatly impair patient’s quality of life. Objectives. To review currently available measures and investigational agents to prevent OM in hematological patients. Methods: we searched for OM and related issues using Medline; the abstract books of the most important hematological and oncological meetings were also reviewed. Results/Conclusions. Many agents targeting different mechanisms of mucosal damage have been applied in order to prevent OM; most of them have failed or its efficacy has not been fully demonstrated. Palifermin is the first pharmaceutical/biological agent approved for the prevention of OM; its use is currently restricted to patients who have received radiotherapy-containing conditioning regimens prior to autologous hematopoietic stem cell transplantation. No clear benefit by this agent has been demonstrated outside of this specific setting and its application should be limited to clinical trials. Other interventions, such as other growth factors and non mitogenic measures are under investigation or in development and their application in the hematological setting is expected in the short term.
- Published
- 2012
47. Obstacles to managing chemotherapy-induced nausea and vomiting in high-dose chemotherapy with stem cell transplant
- Author
-
Andrea Tendas, Fabio Sollazzo, Adriana Concetta Pignatelli, Paolo de Fabritiis, Antonio Bruno, William Arcese, Teresa Dentamaro, Luca Cupelli, and Pasquale Niscola
- Subjects
medicine.medical_specialty ,Vomiting ,medicine.drug_class ,Nausea ,medicine.medical_treatment ,Antineoplastic Agents ,Internal medicine ,Humans ,Medicine ,Antiemetic ,Intensive care medicine ,Aprepitant ,Chemotherapy ,Hematology ,business.industry ,Regimen ,Oncology ,Anesthesia ,Antiemetics ,medicine.symptom ,business ,Settore MED/15 - Malattie del Sangue ,Chemotherapy-induced nausea and vomiting ,medicine.drug - Abstract
Dear Editor, We have read with great interest the paper by Einhorn et al. [1], entitled “Antiemetic therapy for multiple-day chemotherapy and additional topics consisting of rescue antiemetics and high-dose chemotherapy with stem cell transplant: review and consensus statement,” in particular the “High-dose chemotherapy” section, in which the authors rightly point out the difficulty in defining evidence based guidelines in the setting of high-dose chemotherapy and hemopoietic stem cell transplant (HSCT); in this regard however, we think we can provide a contribution, examining, with some valuable clarification, aspects which we feel may be responsible for the current difficulties of chemotherapy-induced nausea and vomiting (CINV) management in this setting. Variations in ages, gender and diagnosis are certainly barriers to adequate epidemiological analysis and evaluation of therapeutic and prophylactic measures effectiveness, as stated by authors. Conversely, conditioning regimens for the different diseases vary less, when compared to first-line treatments, often being the same for groups of diseases, both in autologous (e.g., BEAM in lymphoma), and perhaps evenmore in allogeneic transplant, where treatment — having mostly myeloablative and immunosuppressive function — is often identical for different disease groups. On the other hand, the predominantly inpatient management of HSCT also facilitates monitoring and assessment of CINV in these patients. Multiple days and often multiple daily doses regimen, commonly used as condition for HSCT, not doubtfully represents the biggest barrier both to categorization of emetogenic risk (lack of evaluation methodologies for emesis from multiple drugs administration) and possibility to deduce a CINV prophylactic guidelines for such a regimens. However, not all condition regimens include multiple days’ administrations. Indeed, one of the most commonly used regimens, MEL200, provides for a single-day administration of high dose melphalan alone, therefore representing as an ideal test-bed for the study of high-dose therapy effects, whose CINV prophylaxis, should be, in our opinion, the encoded three drugs schedule for HEC regimens (aprepitant, dexamethasone and 5-HT3 receptor antagonist) [2]. Stem cell infusion is one of the least studied and reported confounding factors. Actually, nausea and vomiting are reported among the side effects of the cryopreservation mean dimethyl sulfoxide (DMSO), and cytokine release from infused non-viable cells may also potentially induce similar effects [3]. Supportive A. Tendas (*) :A. Bruno : L. Cupelli : P. Niscola : T. Dentamaro : P. de Fabritiis Hematology, S. Eugenio Hospital, Piazzale dell’Umanesimo 10, Rome 00144, Italy e-mail: tendas.andrea@aslrmc.it
- Published
- 2012
48. Anticoagulants and Anti-platelet Agents in Palliative Home Healthcare
- Author
-
Andrea, Tendas, Luca, Cupelli, Laura, Scaramucci, Massimiliano, Palombi, Malgorzata Monika, Trawinska, Marco, Giovannini, Gregorio Antonio, Brunetti, Claudio, Cartoni, Francesco, Bondanini, Paolo, de Fabritiis, and Pasquale, Niscola
- Subjects
Letters to Editor - Published
- 2012
49. Allogeneic stem cell transplantation for advanced acute promyelocytic leukemia in the ATRA and ATO era
- Author
-
Ambra Di Veroli, Luca Cupelli, Anna Paola Iori, Francesco Lo-Coco, Franco Aversa, Cristina Papayannidis, Andrea Bacigalupo, William Arcese, Safaa M. Ramadan, Massimo Breccia, Agnese Camboni, Ramadan, Safaa M., Veroli, Ambra Di, Camboni, Agnese, Breccia, Massimo, Iori, Anna Paola, Aversa, Franco, Cupelli, Luca, Papayannidis, Cristina, Bacigalupo, Andrea, Arcese, William, and Lo-Coco, Francesco
- Subjects
Male ,Oncogene Proteins, Fusion ,Gastroenterology ,Arsenicals ,Antineoplastic Agent ,chemistry.chemical_compound ,Leukemia, Promyelocytic, Acute ,Acute promyelocytic leukemia ,Retrospective Studie ,Arsenical ,Cumulative incidence ,Arsenic trioxide ,Transplantation, Homologou ,Oxides ,Hematology ,Middle Aged ,Allogeneic stem cell transplant ,Survival Rate ,Leukemia ,Alltrans retinoic acid ,Female ,Stem cell ,medicine.drug ,Human ,Adult ,medicine.medical_specialty ,Adolescent ,Antineoplastic Agents ,Acute promyelocytic leukemia relapse ,Tretinoin ,Disease-Free Survival ,Follow-Up Studie ,Internal medicine ,medicine ,Humans ,Transplantation, Homologous ,Survival rate ,Retrospective Studies ,business.industry ,Oxide ,medicine.disease ,Transplantation ,chemistry ,Immunology ,Original Articles and Brief Reports ,business ,Settore MED/15 - Malattie del Sangue ,Follow-Up Studies ,Stem Cell Transplantation - Abstract
The role of allogeneic stem cell transplant in advanced acute promyelocytic leukemia patients who received standard first- and second-line therapy is still unknown. We report the outcome of 31 acute promyelocytic leukemia patients (median age 39 years) who underwent allogeneic transplant in second remission (n=15) or beyond (n=16). Sixteen patients were real-time polymerase chain reaction positive and 15 negative for PML/RARA pre-transplant. The 4-year overall survival was 62% and 31% for patients transplanted in second remission and beyond, respectively (P=0.05), and 64% and 27% for patients with pre-transplant negative and positive real-time polymerase chain reaction, respectively (P=0.03). The 4-year cumulative incidence of relapse was 32% and 44% for patients transplanted in second remission and beyond, respectively (P=0.37), and 30% and 47% for patients transplanted with negative and positive real-time polymerase chain reaction, respectively (P=0.30). Transplantrelated mortality was 19.6%. In conclusion, allogeneic transplant is effective in advanced acute promyelocytic leukemia in the all-trans-retinoic acid and arsenic trioxide era, and should be considered once relapse is diagnosed. ©2012 Ferrata Storti Foundation.
- Published
- 2012
50. Fever of unknown origin, anemia and thrombocytosis as early symptoms and signs of a late-onset polymialgia rheumatica: a diagnostic challenge
- Author
-
Laura Scaramucci, Paolo de Fabritiis, Marco Giovannini, Luca Cupelli, Alessio Pio Perroti, Pasquale Niscola, and Andrea Tendas
- Subjects
Pediatrics ,medicine.medical_specialty ,Thrombocytosis ,Anemia ,business.industry ,lcsh:R ,MEDLINE ,lcsh:Medicine ,Late onset ,General Medicine ,medicine.disease ,Settore MED/15 ,medicine ,Fever of unknown origin ,Age of onset ,business - Published
- 2012
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.