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1.
G Ital Nefrol ; 40(3)2023 Jun 29.
Article in Italian | MEDLINE | ID: mdl-37427907

ABSTRACT

There is a strong correlation between SARS-CoV-2 and the onset of autoimmune neurological disease with atypical clinical presentation, characterized by limited response to medical therapy, likely caused by the underlying mechanism of the virus itself. In situations like these, after the failure of pharmacological therapy, therapeutic apheresis, including immunoadsorption, can be pursued. Treatments with IMMUSORBA TR-350 columns have proven to be particularly effective in managing refractory forms of post-Covid-19 nephropathies, leading to complete recovery of disability and elimination of neurological signs and symptoms. We discuss the case of a patient with chronic inflammatory polyradiculopathy post-Covid-19, resistant to medical therapy, effectively treated with immunoadsorption.


Subject(s)
Blood Component Removal , COVID-19 , Kidney Diseases , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating , Humans , COVID-19/complications , COVID-19/therapy , SARS-CoV-2
2.
Ann Hematol ; 97(8): 1301-1315, 2018 Aug.
Article in English | MEDLINE | ID: mdl-29802458

ABSTRACT

The majority of Hodgkin lymphoma patients are now cured with conventional first-line therapy; however, 10-15% of early-stage disease and less than 30% of advanced-stage patients are refractory(rare) or relapsed. Salvage second-line therapy combined with high-dose therapy and autologous stem-cell transplantation can cure 40-50% of patients. Recently novel agents (Brentuximab Vedotin and Immune Checkpoint inhibitors) have demonstrated evidence of therapeutic activity and are potential bridge to an allogeneic stem-cell transplantation. The review is aimed to present not only salvage strategies; indeed, the paper contains paragraphs about therapy and new treatment options at diagnosis.


Subject(s)
Antineoplastic Agents, Immunological/therapeutic use , Hodgkin Disease/drug therapy , Immunoconjugates/therapeutic use , Immunomodulation/drug effects , Molecular Targeted Therapy , Antineoplastic Agents, Immunological/administration & dosage , Antineoplastic Agents, Immunological/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bleomycin/adverse effects , Bleomycin/therapeutic use , Brentuximab Vedotin , Combined Modality Therapy , Dacarbazine/adverse effects , Dacarbazine/therapeutic use , Doxorubicin/adverse effects , Doxorubicin/therapeutic use , Drug Resistance, Neoplasm , Hodgkin Disease/diagnosis , Hodgkin Disease/immunology , Hodgkin Disease/mortality , Humans , Immunoconjugates/administration & dosage , Immunoconjugates/adverse effects , Neoplasm Staging , Positron-Emission Tomography , Retreatment , Salvage Therapy , Treatment Outcome , Vinblastine/adverse effects , Vinblastine/therapeutic use
3.
Ann Oncol ; 28(7): 1547-1553, 2017 Jul 01.
Article in English | MEDLINE | ID: mdl-28368509

ABSTRACT

BACKGROUND: Allogeneic stem-cell transplantation (HSCT) is the only curative treatment in myelodysplastic syndromes (MDS). Azacitidine (AZA) is increasingly used prior to HSCT, however in Europe it is only approved for patients who are not eligible for HSCT. PATIENTS AND METHODS: We conducted a phase II multicenter study to prospectively evaluate the feasibility of HSCT after treatment with AZA in 70 patients with a myelodysplastic syndrome (MDS), 19 with acute myeloid leukemia (AML), and 8 with chronic myelomonocytic leukemia (CMML). After a median of four cycles (range 1-11): 24% of patients achieved complete remission, 14% partial remission, 8% hematologic improvement, 32% had stable and 22% progressive disease. Ten patients discontinued treatment before the planned four cycles, due to an adverse event in nine cases. RESULTS: A HSC donor was identified in 73 patients, and HSCT was performed in 54 patients (74% of patients with a donor). Main reasons for turning down HSCT were lack of a donor, an adverse event, or progressive disease (9, 12, and 16 patients, respectively). At a median follow-up of 20.5 months from enrolment, response to AZA was the only independent prognostic factor for survival. Compared to baseline assessment, AZA treatment did not affect patients' comorbidities at HSCT: the HCT-CI remained stable in 62% patients, and worsened or improved in 23% and 15% of patients, respectively. CONCLUSIONS: Our study shows that HSCT is feasible in the majority of patients with HR-MDS/AML/CMML-2 after AZA treatment. As matched unrelated donor was the most frequent source of donor cells, the time between diagnosis and HSCT needed for donor search could be 'bridged' using azacitidine. These data show that AZA prior to HSCT could be a better option than intensive chemotherapy in higher-risk MDS. The trial has been registered with the EudraCT number 2010-019673-1.


Subject(s)
Antimetabolites, Antineoplastic/administration & dosage , Azacitidine/administration & dosage , Hematopoietic Stem Cell Transplantation , Leukemia, Myeloid, Acute/therapy , Leukemia, Myelomonocytic, Chronic/therapy , Myelodysplastic Syndromes/therapy , Transplantation Conditioning/methods , Adult , Aged , Antimetabolites, Antineoplastic/adverse effects , Azacitidine/adverse effects , Disease Progression , Disease-Free Survival , Drug Administration Schedule , Feasibility Studies , Female , Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/mortality , Humans , Italy , Leukemia, Myeloid, Acute/mortality , Leukemia, Myeloid, Acute/pathology , Leukemia, Myelomonocytic, Chronic/mortality , Leukemia, Myelomonocytic, Chronic/pathology , Male , Middle Aged , Myelodysplastic Syndromes/mortality , Myelodysplastic Syndromes/pathology , Prospective Studies , Risk Factors , Survival Analysis , Time Factors , Transplantation Conditioning/adverse effects , Transplantation Conditioning/mortality , Transplantation, Homologous , Treatment Outcome , Young Adult
4.
Leukemia ; 31(8): 1727-1734, 2017 08.
Article in English | MEDLINE | ID: mdl-28008174

ABSTRACT

In newly diagnosed myeloma patients, upfront autologous transplant (ASCT) prolongs progression-free survival 1 (PFS1) compared with chemotherapy plus lenalidomide (CC+R). Salvage ASCT at first relapse may still effectively rescue patients who did not receive upfront ASCT. To evaluate the long-term benefit of upfront ASCT vs CC+R and the impact of salvage ASCT in patients who received upfront CC+R, we conducted a pooled analysis of 2 phase III trials (RV-MM-209 and EMN-441). Primary endpoints were PFS1, progression-free survival 2 (PFS2), overall survival (OS). A total of 268 patients were randomized to 2 courses of melphalan 200 mg/m2 and ASCT (MEL200-ASCT) and 261 to CC+R. Median follow-up was 46 months. MEL200-ASCT significantly improved PFS1 (median: 42 vs 24 months, HR 0.53; P<0.001), PFS2 (4 years: 71 vs 54%, HR 0.53, P<0.001) and OS (4 years: 84 vs 70%, HR 0.51, P<0.001) compared with CC+R. The advantage was noticed in good and bad prognosis patients. Only 53% of patients relapsing from CC+R received ASCT at first relapse. Upfront ASCT significantly reduced the risk of death (HR 0.51; P=0.007) in comparison with salvage ASCT. In conclusion, these data confirm the role of upfront ASCT as the standard approach for all young myeloma patients.


Subject(s)
Multiple Myeloma/therapy , Stem Cell Transplantation , Thalidomide/analogs & derivatives , Administration, Oral , Adult , Aged , Clinical Trials, Phase III as Topic , Humans , Lenalidomide , Middle Aged , Multiple Myeloma/mortality , Salvage Therapy , Thalidomide/therapeutic use , Transplantation, Autologous
5.
Leukemia ; 30(6): 1320-6, 2016 06.
Article in English | MEDLINE | ID: mdl-26898189

ABSTRACT

This phase 2 trial evaluated three low-dose intensity subcutaneous bortezomib-based treatments in patients ⩾75 years with newly diagnosed multiple myeloma (MM). Patients received subcutaneous bortezomib plus oral prednisone (VP, N=51) or VP plus cyclophosphamide (VCP, N=51) or VP plus melphalan (VMP, N=50), followed by bortezomib maintenance, and half of the patients were frail. Response rate was 64% with VP, 67% with VCP and 86% with VMP, and very good partial response rate or better was 26%, 28.5% and 49%, respectively. Median progression-free survival was 14.0, 15.2 and 17.1 months, and 2-year OS was 60%, 70% and 76% in VP, VCP, VMP, respectively. At least one drug-related grade ⩾3 non-hematologic adverse event (AE) occurred in 22% of VP, 37% of VCP and 33% of VMP patients; the discontinuation rate for AEs was 12%, 14% and 20%, and the 6-month rate of toxicity-related deaths was 4%, 4% and 8%, respectively. The most common grade ⩾3 AEs included infections (8-20%), and constitutional (10-14%) and cardiovascular events (4-12%); peripheral neuropathy was limited (4-6%). Bortezomib maintenance was effective and feasible. VP, VCP and VMP regimens demonstrated no substantial difference. Yet, toxicity was higher with VMP, suggesting that a two-drug combination followed by maintenance should be preferred in frail patients.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bortezomib/administration & dosage , Multiple Myeloma/drug therapy , Aged , Aged, 80 and over , Cyclophosphamide , Disease-Free Survival , Female , Humans , Male , Melphalan/administration & dosage , Multiple Myeloma/mortality , Prednisone/administration & dosage , Survival Rate
6.
Leuk Res ; 39(8): 846-52, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26145790

ABSTRACT

BACKGROUND: Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal disorders, with very different prognosis in given individuals; age and comorbidities are emerging as relevant patient-related factors influencing clinical outcome in MDS. Our aim was to evaluate the impact of age, comorbidities and disease severity (IPSS and IPSS-R prognostic scores) in a "real-life" series of MDS patients. METHODS: 318 patients with available assessment of comorbidities at diagnosis and consecutively registered into the Registro Ligure delle Mielodisplasie were analyzed. Comorbidities were evaluated according to HCT-CI and MDS-CI comorbidity indexes. Overall survival (OS) and the probability of death among patients who did not develop acute myeloid leukemia (NLD cumulative incidence) were analyzed. RESULTS: Comorbidities were seen in 177 (55.7%) patients. An older age (>75 y) had a significant negative impact on OS (p=0.008). HCT-CI was not associated with OS. MDS-CI was of prognostic significance (p=0.001), but the association was limited to pts with IPSS or IPSS-R "lower-risk". In multivariate analysis, MDS-CI remained an independent factor associated with OS and with an increased risk of NLD both when controlling for IPSS (p=0.019 and p=0.001, respectively) and for IPSS-R (p=0.048 and p=0.002, respectively). CONCLUSIONS: Evaluation of age and comorbidities according to a tailored tool such is MDS-CI helps to predict survival in patients with MDS and should be incorporated to current prognostic scores.


Subject(s)
Myelodysplastic Syndromes/diagnosis , Myelodysplastic Syndromes/epidemiology , Adult , Age Factors , Aged , Aged, 80 and over , Comorbidity , Female , Humans , Male , Middle Aged , Myelodysplastic Syndromes/mortality , Prevalence , Prognosis , Retrospective Studies , Survival Analysis
7.
Bone Marrow Transplant ; 50(4): 505-10, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25621805

ABSTRACT

Previous studies have shown that obtaining complete hematologic remission (CR) in multiple myeloma is an important predictor of PFS and OS. This applies both to autologous and allogeneic transplantation. However, the importance of CR obtained before vs after second transplant or following allogeneic vs autologous transplantation is not clear. We investigated the role of CR analyzing data from the EBMT-NMAM2000 interventional prospective study comparing tandem autologous/reduced intensity conditioning allogeneic transplantation (auto/RICallo) to autologous transplantation-single or double (auto/auto). Allocation to treatment was performed according to availability of a matched sibling donor. Cox regression and multi-state models were applied. The long-term probability of survival in CR was superior in auto/RICallo, both comparing groups according to treatment allocated at start (28.8 vs 11.4% at 60 months, P=0.0004) and according to actual administration of second transplant (25.6 vs 9.6% at 60 months, P=0.008). CR achieved before the second transplant was predictive for PFS (hazard ratio (HR)=0.44, P= 0.003) and OS (HR 0.51, P=0.047) irrespective of the type of second transplant. CR achieved after auto/RICallo was more beneficial for PFS (HR=0.53, P=0.027) than CR after auto/auto (HR=0.81, P=0.390), indicating a better durability of CR obtained after an allotransplant procedure.


Subject(s)
Multiple Myeloma/mortality , Multiple Myeloma/therapy , Stem Cell Transplantation , Allografts , Autografts , Disease-Free Survival , Female , Humans , Male , Middle Aged , Prospective Studies , Remission Induction , Survival Rate
9.
Ann Oncol ; 25(2): 442-7, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24412823

ABSTRACT

BACKGROUND: [18F]fluorodeoxyglucose-positron emission tomography (PET) is emerging as a strong diagnostic and prognostic tool in follicular lymphoma (FL) patients. PATIENTS AND METHODS: In a subset analysis of the FOLL05 trial (NCT00774826), we investigated the prognostic role of post-induction PET (PI-PET) scan. Patients were eligible to this study if they had a PI-PET scan carried out within 3 months from the end of induction immunochemotherapy. Progression-free survival (PFS) was the primary study end point. RESULTS: A total of 202 patients were eligible and analysed for this study. The median age was 55 years (range 33-75). Overall, PI-PET was defined as positive in 49 (24%) patients. Conventional response assessment with CT scan was substantially modified by PET: 15% (22/145) of patients considered as having a complete response (CR) after CT were considered as having partial response (PR) after PI-PET and 53% (30/57) patients considered as having a PR after CT were considered as a CR after PI-PET. With a median follow-up of 34 months, the 3-year PFS was 66% and 35%, respectively, for patients with negative and positive PI-PET (P<0.001). At multivariate analysis, PI-PET (hazard ratio 2.57, 95% confidence interval 1.52-4.34, P<0.001) was independent of conventional response, FLIPI and treatment arm. Also, the prognostic role of PI-PET was maintained within each FLIPI risk group. CONCLUSIONS: In FL patients, PI-PET substantially modifies response assessment and is strongly predictive for the risk of progression. PET should be considered in further updates of response criteria.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Fluorodeoxyglucose F18 , Lymphoma, Follicular/diagnostic imaging , Radiopharmaceuticals , Disease-Free Survival , Female , Humans , Induction Chemotherapy , Kaplan-Meier Estimate , Lymphoma, Follicular/drug therapy , Lymphoma, Follicular/mortality , Male , Middle Aged , Multivariate Analysis , Positron-Emission Tomography , Prognosis , Proportional Hazards Models , Retrospective Studies , Treatment Outcome
10.
Ann Oncol ; 24(8): 2108-12, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23585513

ABSTRACT

BACKGROUND: The role of [¹8F] fluorodeoxyglucose (FDG)-positron emission tomography (PET) in follicular lymphoma (FL) staging is not yet determined. PATIENTS AND METHODS: The aim of the present study was to investigate the role of PET in the initial staging of FL patients enrolled in the FOLL05-phase-III trial that compared first-line regimens (R-CVP, R-CHOP and R-FM). Patients should have undergone conventional staging and have available PET baseline to be included. RESULTS: A total of 142 patients were analysed. PET identified a higher number of nodal areas in 32% (46 of 142) of patients and more extranodal (EN) sites than computed tomography (CT) scan. Also, the Follicular Lymphoma International Prognostic Index (FLIPI) score increased in 18% (26 of 142) and decreased in 6% (9 of 142) of patients. Overall, the impact of PET on modifying the stage was highest in patients with limited stage. Actually, 62% (15 of 24) of cases with limited disease were upstaged with PET. CONCLUSIONS: The inclusion of PET among staging procedures makes the evaluation of patients with FL more accurate and has the potential to modify therapy decision and prognosis in a moderate proportion of patients. Further prospective clinical trials on FL should incorporate PET at different moments, and the therapeutic criteria to start therapy should be re-visited in the views of this new tool.


Subject(s)
Fluorodeoxyglucose F18 , Lymphoma, Follicular/diagnostic imaging , Neoplasm Staging/methods , Positron-Emission Tomography , Tomography, X-Ray Computed , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Female , Humans , Italy , Male , Middle Aged , Neoplasm Metastasis/diagnosis , Prednisone/therapeutic use , Prognosis , Radiopharmaceuticals , Retrospective Studies , Vincristine/therapeutic use
11.
Leukemia ; 27(3): 695-701, 2013 Mar.
Article in English | MEDLINE | ID: mdl-22996335

ABSTRACT

This multicenter phase II trial evaluated the safety and efficacy of lenalidomide-prednisone (RP) induction, followed by lenalidomide-melphalan-prednisone (MPR) consolidation and RP maintenance in elderly unfit newly diagnosed myeloma patients. Patients received four 28-day RP induction courses (lenalidomide 25 mg/day on days 1-21 and prednisone 50 mg three times/week), followed by six 28-day MPR consolidation cycles (melphalan 2 mg, prednisone 50 mg three times/week and lenalidomide 10-15 mg/day on days 1-21), and maintenance with lenalidomide (10 mg/day on days 1-21 every 28 days) plus prednisone (25 mg three times/week). Forty-six patients were enrolled. Median age was 75 years, 59% of patients had at least one comorbidity and 35% at least two. Partial response rate was 80%, including 29% very good partial response. Median time to progression was 19.6 months, median progression-free survival was 18.4 months and 2-year overall survival was 80%. At the tolerated consolidation dose (melphalan 25 mg/month and lenalidomide 10 mg/day), the most frequent grade 3 adverse events were neutropenia (36.4%), anemia (12.1%), cutaneous reactions (18.2%) and infections (12.1%). Grade 4 neutropenia occurred in 12.1% of patients. In conclusion, RP induction followed by MPR consolidation and RP maintenance showed a manageable safety profile, and reduced the risk of severe hematological toxicity in unfit elderly myeloma patients.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Multiple Myeloma/drug therapy , Aged , Aged, 80 and over , Female , Humans , Lenalidomide , Male , Melphalan/administration & dosage , Multiple Myeloma/mortality , Multiple Myeloma/pathology , Neoplasm Staging , Prednisone/administration & dosage , Prognosis , Survival Rate , Thalidomide/administration & dosage , Thalidomide/analogs & derivatives
12.
Leuk Suppl ; 1(Suppl 2): S49-50, 2012 Aug.
Article in English | MEDLINE | ID: mdl-27175249

ABSTRACT

Autophagy inhibition has been shown to sensitize tumor cells to cell death induced by tyrosine kinase inhibitors (TKIs). The remarkable responses obtained in seven patients with the combination of clarithromycin and TKIs support the hypothesis that the inhibition of autophagy may make chronic myeloid leukemia cells sensitive to killing by TKIs.

13.
Leukemia ; 25(10): 1627-31, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21637283

ABSTRACT

Lenalidomide has raised concerns regarding its potential impact on the ability to collect stem cells for autologous stem cell transplantation, especially after prolonged exposure. The use of cyclophosphamide plus granulocyte colony-stimulating factor (G-CSF) to mobilize peripheral blood stem cells may overcome this concern. In newly diagnosed multiple myeloma (MM) patients, we investigated the influence of lenalidomide on stem cell collection. In a prospective study, 346 patients received four cycles of lenalidomide-dexamethasone (Rd). Stem cells were mobilized with cyclophosphamide and G-CSF. Patients failing to collect a minimum of 4 × 10(6) CD34(+)/kg cells received a second mobilization course. After mobilization, a median yield of 8.7 × 10(6) CD34(+)/kg was obtained from patients receiving Rd induction. After first mobilization, inadequate yield was observed in 21% of patients, whereas only 9% of patients failed to collect the target yield after the second mobilization attempt. In conclusion, we confirm that a short induction with lenalidomide allowed sufficient stem cells collection to perform autologous transplantation in 91% of newly diagnosed patients.


Subject(s)
Hematopoietic Stem Cell Mobilization , Thalidomide/analogs & derivatives , Transplantation Conditioning , Antineoplastic Agents , Female , Humans , Lenalidomide , Male , Middle Aged , Thalidomide/therapeutic use
14.
Mini Rev Med Chem ; 11(6): 473-9, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21561410

ABSTRACT

To date, Graft-versus-host disease (GVHD) represents one of the most important complications of allogeneic hematopoietic stem cell transplantation (HSCT). GVHD is one of the major determinants of transplant-related mortality and it also may be an additional cause that affects patients late outcome. Despite of the development of new and advanced Human Leukocyte Antigens (HLA) matching techniques, this complication occurs in approximately 50-80% of patients who underwent allogeneic hematopoietic stem cell transplantation, and it is responsible for one-third of deaths after transplantation. Moreover, GVHD occurrence, if moderate, may strongly contribute to the eradication of residual malignant cells which survived after myeloablative conditioning regimen, allowing the patients to have a reduced risk of relapse so that the presence of this complication may have a determinant role for the allogeneic transplantation outcome through the so-called graft-versus-tumor (GVT) effect.


Subject(s)
Antibodies, Monoclonal/therapeutic use , Graft vs Host Disease/drug therapy , Immunologic Factors/therapeutic use , Alemtuzumab , Antibodies, Monoclonal, Humanized , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antibodies, Neoplasm/therapeutic use , Clinical Trials as Topic , Hematopoietic Stem Cell Transplantation , Humans , Infliximab , Rituximab , Transplantation, Homologous
15.
Mini Rev Med Chem ; 11(6): 480-5, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21561409

ABSTRACT

Regulatory T-cells (Tregs) comprise a group of either thymically derived or peripherally induced suppressor CD4+ cells involved in the control of effector T-cells against both self- and foreign-antigens. They are found increased in tumor tissues and are thought to be involved in pathogenesis of cancer by providing tumors with a mechanism to evade immune detection and destruction. Despite the fact that mechanisms of Tregs regulation are still in progress, efforts are made aiming to develop approaches to deplete or inhibit tumor-associated Tregs function. This could lead to restore antitumor immunity and emerging strategies for therapeutic vaccination, and immunotherapeutic targeting of Tregs with specific drugs are underway.


Subject(s)
Neoplasms/therapy , T-Lymphocytes, Regulatory/immunology , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Antigens, Neoplasm/immunology , Antigens, Neoplasm/metabolism , Humans , Immunologic Factors/therapeutic use , Immunosuppression Therapy , Ipilimumab , Neoplasms/immunology , T-Lymphocytes, Regulatory/metabolism
16.
Interv Neuroradiol ; 16(4): 442-6, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21162775

ABSTRACT

Intrasphenoid rupture of a non-traumatic aneurysm of the cavernous carotid artery is rare. We describe a patient in whom this condition manifested with epistaxis and led to the formation of a pseudoaneurysm occupying the right sphenoid sinus. The lesion recurred after repeated attempts at conservative endovascular therapy. Eventually the patient was treated with endovascular occlusion of the right internal carotid artery. Our report emphasizes the relapsing behaviour of a non-traumatic aneurysm of the cavernous portion of the internal carotid artery ruptured into the sphenoid sinus.


Subject(s)
Carotid Artery Injuries/etiology , Carotid Artery, Internal, Dissection/complications , Carotid Artery, Internal, Dissection/therapy , Embolization, Therapeutic/adverse effects , Foreign-Body Migration/diagnostic imaging , Aged , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/therapy , Carotid Artery Injuries/diagnostic imaging , Carotid Artery, Internal, Dissection/diagnostic imaging , Cavernous Sinus/diagnostic imaging , Cerebral Angiography , Epistaxis/diagnostic imaging , Epistaxis/etiology , Humans , Male , Recurrence
17.
Ann Hematol ; 89(6): 531-3, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20165848

ABSTRACT

A sequential treatment approach is the rule in CML and Ph(+) ALL with imatinib failure being followed by second-line tyrosine kinase inhibitors. The sequential strategy may be vulnerable to compound mutations. An alternative and fascinating hypothesis discussed in this paper is the upfront use, at least in very high-risk Ph(+) leukemias, of ABL kinase inhibitor combinations, either simultaneously or sequentially to target a wider range of mutations-based drug resistance. The main questions are: will TKI cocktails be able to eliminate the leukemic compartment? Which are the correct doses? Which are the long-term effects? Clinical trials have been recently initiated, and the future will give us the answer to all these questions.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Protein Kinase Inhibitors/administration & dosage , Proto-Oncogene Proteins c-abl/antagonists & inhibitors , Drug Administration Schedule , Humans , Models, Theoretical , Neoadjuvant Therapy , Risk Factors
18.
Bone Marrow Transplant ; 45(4): 640-6, 2010 Apr.
Article in English | MEDLINE | ID: mdl-19802019

ABSTRACT

AML patients (total 129; median age =50 years; range 16-72) in first CR received BU and melphalan (BU/Mel) as conditioning regimen before auto-SCT. In all, 82 patients (63.6%) received PBSCs and 47 patients (36.4%) received BM cells. The distribution of cytogenetic categories was conventionally defined as favorable (15.5%), intermediate (60.1%) and unfavorable (24.3%). With a median follow-up of 31 months, the 8-year projected OS and disease-free survival (DFS) was 62 and 56% for the whole population, respectively. The relapse rate was 46% and the non-relapse mortality was 4.65%. Although PBSC transplantation led to a faster hematological recovery than BM transplantation, in univariate analysis the stem cell source, cytogenetics and different BU formulations did not significantly affect OS and DFS, whereas age and the number of post-remission chemotherapy cycles did have a significant effect on the clinical outcome. Multivariate analysis identified age <55 years as the only important independent predictor for OS and DFS. Our data suggest that BU/Mel, being associated with a low toxicity profile (mainly mucositis) and mortality, is an effective conditioning regimen even for high-risk AML patients in first CR undergoing auto-SCT.


Subject(s)
Busulfan/therapeutic use , Hematopoietic Stem Cell Transplantation , Immunosuppressive Agents/therapeutic use , Leukemia, Myeloid, Acute/therapy , Melphalan/therapeutic use , Transplantation Conditioning/methods , Adolescent , Adult , Age Factors , Aged , Bone Marrow Transplantation , Disease-Free Survival , Drug Therapy, Combination , Female , Humans , Italy , Kaplan-Meier Estimate , Male , Middle Aged , Peripheral Blood Stem Cell Transplantation , Retrospective Studies , Transplantation, Autologous , Young Adult
19.
Interv Neuroradiol ; 15(2): 175-8, 2009 Jul 29.
Article in English | MEDLINE | ID: mdl-20465895

ABSTRACT

SUMMARY: We describe a 22-year-old woman admitted to hospital in emergency with nuchal headache and vomiting. CT scan disclosed subarachnoid hemorrhage. Digital subtraction angiography with three-dimensional rotational acquisitions showed a ruptured aneurysm of a right persistent primitive hypoglossal artery as the cause of symptoms and hemorrhage. The patient was successfully treated with endovascular coiling of the aneurysm. This is the second literature report describing endovascular treatment in this unusual condition.

20.
Radiol Med ; 113(4): 547-66, 2008 Jun.
Article in English, Italian | MEDLINE | ID: mdl-18478187

ABSTRACT

Hereditary haemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber disease, is an autosomal-dominant vascular disease characterised by mucocutaneous or visceral angiodysplastic lesions. Its diagnosis is exclusively based on clinical criteria. The brain, lungs and liver, in growing order of prevalence, are the most frequently involved organs. Diagnostic imaging based on ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) has a fundamental role in detecting visceral involvement in HHT patients and is therefore crucial for the prognostic assessment and therapeutic approach. Arteriovenous shunts are the most common cerebrovascular malformations (CVMs). MRI and CT angiography are the methods of choice for diagnosing cerebral involvement, and it is debated whether MRI could be considered as a screening examination on account of its noninvasiveness. Pulmonary arteriovenous malformations, diffuse telangiectases or high-flow, low-pressure shunts between pulmonary arteries and veins can be studied with contrast-enhanced US, but multidetector CT seems to provide the most comprehensive evaluation of their angioarchitecture, whereas angiography has a predominant role in treatment. Liver involvement is frequent and characterised by the presence of intrahepatic shunts, disseminated intraparenchymal telangiectases and other vascular lesions. US is useful for detecting hepatic lesions but should be completed by more accurate imaging methods such as multidetector CT and MRI.


Subject(s)
Arteriovenous Malformations/diagnosis , Arteriovenous Malformations/etiology , Telangiectasia, Hereditary Hemorrhagic/complications , Telangiectasia, Hereditary Hemorrhagic/diagnosis , Angiography, Digital Subtraction , Arteriovenous Malformations/diagnostic imaging , Diagnostic Imaging/methods , Humans , Intracranial Arteriovenous Malformations/diagnosis , Liver Circulation , Magnetic Resonance Imaging , Pulmonary Circulation , Sensitivity and Specificity , Telangiectasia, Hereditary Hemorrhagic/diagnostic imaging , Tomography, X-Ray Computed , Ultrasonography, Doppler, Color
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