Research Interests:
Research Interests: Survival Analysis, Treatment Outcome, Medicine, Transplantation, Lymphoma, and 14 moreHumans, Female, Male, Clinical Sciences, Middle Aged, Adult, Retrospective Studies, Health surveys, Disease Progression, MANTLE CELL LYMPHOMA, Life tables, Hematopoietic Stem Cell Transplantation, Combined Modality Therapy, and Disease Free Survival
Ninety-five patients undergoing an allogeneic bone marrow transplant (BMT) and developing acute graft-versus-host disease (aGvHD) were randomized to receive low-dose intravenous 6-methylprednisolone (6MPred; 2 mg/kg /d; n = 47) or... more
Ninety-five patients undergoing an allogeneic bone marrow transplant (BMT) and developing acute graft-versus-host disease (aGvHD) were randomized to receive low-dose intravenous 6-methylprednisolone (6MPred; 2 mg/kg /d; n = 47) or high-dose 6MPred (10 mg/kg/d; n = 48) for 5 days, with subsequent tapering doses. On day 5 patients not responding or progressing on low-dose 6MPred could be switched to high-dose 6MPred. All patients, aged 1 to 55 years, were recipients of unmanipulated BMT from HLA identical sibling donors. Patients were stratified at randomization for age (/= 20 years), disease (acute leukemia, chronic myeloid leukemia [CML], nonneoplastic disease), disease status (early/advanced), and GvHD prophylaxis (cyclosporin/cyclosporin + methotrexate). Primary endpoints were response to treatment and evolution of aGvHD to grade III-IV. Secondary endpoints were cytomegalovirus (CMV) infections, transplant-related mortality (TRM), and relapse. The median interval between BMT and t...
Research Interests: Gastroenterology, Adolescent, Humans, Child, Hyperglycemia, and 15 moreHypertension, Female, Blood, Infection, Infant, Clinical Sciences, Bone Marrow Transplantation, Adult, Cytomegalovirus Infections, Acute Disease, Child preschool, Immunosuppressive Agents, Cause of death, Cardiovascular medicine and haematology, and Hematologic neoplasms
Idiopathic hypereosinophilic syndrome (HES) is a rare, chronic hematological disease mainly characterized by unexplained prolonged eosinophilia, with frequent evidence of secondary organ damage. Treatment with steroids, chemotherapy,... more
Idiopathic hypereosinophilic syndrome (HES) is a rare, chronic hematological disease mainly characterized by unexplained prolonged eosinophilia, with frequent evidence of secondary organ damage. Treatment with steroids, chemotherapy, interferon-alpha (IFN-α), or imatinib-mesylate may improve the prognosis. Here we describe the case of a young male patient with a six-year history of HES and severe heart involvement who, after unsuccessful treatment attempts with steroids, hydroxyurea and IFN-α, had a prompt, clinical and hematological complete remission following administration of imatinib. As his cardiac function also markedly improved, he was considered for heart transplant. However, seven years after the onset of the disease and four months after the termination of imatinib treatment the patient died of a cerebral hemorrhage that occurred during an episode of acute respiratory sepsis. Imatinib has been previously reported to be effective in some hematological conditions with no ev...
Research Interests: Treatment Outcome, Enzyme Inhibitors, Medicine, Humans, Internal Medicine, and 14 moreMale, Imatinib, Clinical Sciences, Adult, Eosinophilia, Antineoplastic Agents, Benzamides, Heart Diseases, Severity of Illness Index, Imatinib Mesylate, Tumori, hypereosinophilic syndrome, Protein tyrosine kinases, and Fatal outcome
Circulating progenitor cells (CPC), when infused in large numbers, rapidly repopulate the marrow after myeloablation with high-dose therapy. In multiple myeloma (MM), as in other disorders, different chemotherapy regimens, including... more
Circulating progenitor cells (CPC), when infused in large numbers, rapidly repopulate the marrow after myeloablation with high-dose therapy. In multiple myeloma (MM), as in other disorders, different chemotherapy regimens, including single-as well as multiple-agent chemotherapy, with or without hemopoietic growth factors, have been proposed to mobilize these progenitor cells into the blood. Here we report our experience with a drug combination called VCAD and compare the results to those obtained by adding rhG-CSF to the same combination. Fourteen MM patients were given one course of VCAD, a chemotherapy association of vincristine 2 mg, cyclophosphamide 4 x 0.5 g/m2, adriamycin 2 x 50 mg/m2 and dexamethasone 4 x 40 mg, before undergoing apheresis to collect CPC for autografting. Seven also received rhG-CSF (filgrastim) 5 mcg/kg/day over the period of apheresis. These latter were allocated to rhG-CSF treatment sequentially from the time the drug became available for clinical use. Fol...
Research Interests: Chemotherapy, Medicine, Hematopoietic Stem Cells, Dexamethasone, Humans, and 15 moreFemale, Multiple Myeloma, Male, Middle Aged, Doxorubicin, Bone Marrow Transplantation, Adult, Fever, Apheresis, Growth Factor, Cyclophosphamide, Filgrastim, Hematopoietic Stem Cell Transplantation, Agranulocytosis, and Cardiovascular medicine and haematology
Research Interests:
Here we report the results of a randomised multicenter phase III clinical trial which assesses the therapeutic efficacy and tolerability of a chemotherapy protocol CEMP (cyclophosphamide, etoposide, mitoxantrone and prednisone) in adult... more
Here we report the results of a randomised multicenter phase III clinical trial which assesses the therapeutic efficacy and tolerability of a chemotherapy protocol CEMP (cyclophosphamide, etoposide, mitoxantrone and prednisone) in adult and elderly patients with advanced intermediate and high-grade NHL. Between October 1991 and October 1995, 139 patients, aged 55 to 79 years, with diffuse intermediate and high-grade lymphoma, were enrolled. A considerable percentage of patients had clinically aggressive disease: 32.4% had systemic symptoms, 79% had stage III or IV disease, 33.8% had bone marrow involvement, 46% had splenic involvement and 42.5% had increased values of serum lactate dehydrogenate. Complete remission was achieved in 70 of the 139 patients (51.9%) and PR in 12 (16.6%) with an overall response of 68.5%. The overall response survival rate at 6 years was 39%, whereas DFS rate was 48.7% and PFS rate was 28.5%. At four years 49% of the patients were still in CR. Dividing the patients in two groups, under and over 65 years of age, we obtained the same results as far as overall response is concerned. No toxic deaths occurred, neither cardiac, renal nor liver complications happened. CEMP regimen is an effective and safe protocol with good results in elderly people, well comparable to those achieved in younger ones.
Research Interests:
Primary cardiac lymphomas (PCLs), involving solely heart and/or pericardium at presentation, are rare events. They are frequently recognized at autopsy and generally carry a poor prognosis due either to a delay in the diagnosis or to... more
Primary cardiac lymphomas (PCLs), involving solely heart and/or pericardium at presentation, are rare events. They are frequently recognized at autopsy and generally carry a poor prognosis due either to a delay in the diagnosis or to infiltration of heart structures. We report here on two patients with large B-cell PCL. One is a 52-year-old man who presented with multiple cardiac tumors infiltrating mainly the right atrium and the inter-atrial septum. Diagnosis was established by ultrasound-assisted transesophageal biopsy of the intra-atrial multilobated tumor mass. He was treated with Rituximab-implemented high-dose sequential (R-HDS) chemotherapy followed by autologous peripheral blood stem cell transplantation, attaining complete response. He had no evidence of disease 24 months from onset. The second patient was a 70-year-old woman who presented with pericardial tamponade and low-output cardiac failure. Despite prompt pericadiocentesis and chemotherapy with cyclophosphamide and vincristine, she died 2 weeks later. Postmortem examination revealed large B-cell lymphoma proliferation confined to the heart. Whether primitive heart localizations represent an independent prognostic factor, and what specific measures should be adopted in patients with this rare presentation is the subject of the present report and review of the literature.
Research Interests: Treatment Outcome, Medicine, Electrocardiography, Lymphoma, Humans, and 15 moreFemale, Male, Monoclonal Antibodies, Clinical Sciences, Middle Aged, Autopsy, Rituximab, Diffuse Large B-Cell Lymphoma, Pericardium, Cyclophosphamide, Immunocompetence, cardiac tamponade, Diffuse large B cell lymphoma, Vincristine, and Heart neoplasms
Research Interests: Gastroenterology, Chemotherapy, Leukemia, Adolescent, Humans, and 15 moreInternal Medicine, Female, Feasibility Studies, Clinical Sciences, Cisplatin, Adult, Cyclophosphamide, Germinal Center, Hematopoietic Stem Cell, Combined Modality Therapy, Etoposide, Disease Free Survival, Diffuse large B cell lymphoma, High risk, and B cell
Purpose To investigate the impact of adding rituximab to intensive chemotherapy with peripheral-blood progenitor cell (PBPC) autograft for high-risk diffuse large B-cell lymphoma (DLB-CL) and follicular lymphoma (FL). Patients and Methods... more
Purpose To investigate the impact of adding rituximab to intensive chemotherapy with peripheral-blood progenitor cell (PBPC) autograft for high-risk diffuse large B-cell lymphoma (DLB-CL) and follicular lymphoma (FL). Patients and Methods Data were collected from 10 centers associated with Gruppo Italiano Terapie Innnovative nei Linfomi for 522 patients with DLB-CL and 223 patients with FL (median age, 47 years) who received the original or a modified high-dose sequential (HDS) chemotherapy regimen. HDS was delivered to 396 patients without (R−) and to 349 patients with (R+) rituximab; 154 (39%) and 178 patients (51%) in the R− and R+ subsets, respectively, underwent HDS for relapsed/refractory disease. Results A total of 355 R− (90%) and 309 R+ patients (88%) completed the final PBPC autograft. Early treatment-related mortality was 3.3% for R− and 2.8% for R+ (P = not significant). Two parameters significantly influenced the outcome: disease status at HDS, with 5-year overall survi...
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Research Interests: Hematology, Breast Cancer, Chemotherapy, Hematopoiesis, Humans, and 15 moreFemale, Cytomegalovirus, Fungal Infection, Antibiotic Prophylaxis, CD, Cisplatin, Aged, Adult, Herpes Zoster, Bacterial Infection, Cyclophosphamide, Combined Modality Therapy, Etoposide, Breast Neoplasms, and Cardiovascular medicine and haematology
A retrospective study was undertaken to evaluate the efficacy of autologous blood stem cell transplantation (ABSCT) in terms of haemopoietic reconstitution after ablative chemotherapy or chemo-radiotherapy. 55 patients with malignancies,... more
A retrospective study was undertaken to evaluate the efficacy of autologous blood stem cell transplantation (ABSCT) in terms of haemopoietic reconstitution after ablative chemotherapy or chemo-radiotherapy. 55 patients with malignancies, observed in four Italian institutions from January 1987 to June 1991, were eligible for evaluation. This series included 19 non-Hodgkin's lymphoma, 11 multiple myeloma, nine ovarian cancer, seven Hodgkin's disease, seven non-lymphocytic leukaemia, one acute lymphoblastic leukaemia, one neuroblastoma. 522 PBSC collections were performed on 55 patients. Following ABSCT, the rate of engraftment was positively related to the dose of CFU-GM infused and negatively to the presence of bone marrow involvement at conditioning. 48 patients out of 55 transplanted (87%) had rapid, complete and sustained engraftment. Three patients (5%) died of transplant-related complications. Considering that 60% of the patients in this series were in partial remission or in progressive disease at the time of ABSCT, we conclude that ABSCT is a safe approach for the use of ablative conditioning therapy in patients with a wide scope of malignancies, provided that a large number of CFU-GM have been collected after mobilizing treatment.
Research Interests: British, Adolescent, Medicine, Hematopoiesis, Transplantation, and 15 moreLymphoma, Humans, Child, Female, Multiple Myeloma, Male, Middle Aged, Adult, Neoplasms, Retrospective Studies, Retrospective Study, Hematopoietic Stem Cell Transplantation, Combined Modality Therapy, Cardiovascular medicine and haematology, and leukocyte Count
Research Interests: British, Survival Analysis, Treatment Outcome, Medicine, Transplantation, and 15 moreAcute Myeloid Leukemia, Humans, Internal Medicine, Chronic Disease, Female, Male, Recurrence, Adult, Survival Rate, Platelet Count, Hematopoietic Stem Cell Transplantation, Acute Disease, Disease Free Survival, Cardiovascular medicine and haematology, and Peripheral blood
Research Interests: Surgery, Medicine, Transplantation, Humans, Internal Medicine, and 15 moreFemale, Multiple Myeloma, Male, Cyclosporine, Clinical Sciences, Middle Aged, Bone Marrow Transplantation, Adult, Methotrexate, Growth Factor, Cyclophosphamide, Hematopoietic Stem Cell Transplantation, Immunosuppressive Agents, Peripheral Blood Stem Cell, and Busulfan
Research Interests: Surgery, Leukemia, Medicine, Acute Myeloid Leukemia, Humans, and 15 moreFemale, Multiple Myeloma, Male, Disease Severity, Bone marrow, Recurrence, Clinical Sciences, Middle Aged, Bone Marrow Transplantation, Adult, Recombinant Proteins, Acute Lymphoblastic Leukemia, Hematopoietic Stem Cell Transplantation, Peripheral blood, and Acute Leukemia
We assessed efficacy, safety, and reversal of renal impairment (RI) in untreated patients with multiple myeloma given bortezomib-melphalan-prednisone-thalidomide followed by bortezomib-thalidomide (VMPT-VT) maintenance or... more
We assessed efficacy, safety, and reversal of renal impairment (RI) in untreated patients with multiple myeloma given bortezomib-melphalan-prednisone-thalidomide followed by bortezomib-thalidomide (VMPT-VT) maintenance or bortezomib-melphalan-prednisone (VMP). Exclusion criteria included serum creatinine ≥ 2.5 mg/dL. In the VMPT-VT/VMP arms, severe RI (estimated glomerular filtration rate [eGFR] ≤ 30 mL/min), moderate RI (eGFR 31-50 mL/min), and normal renal function (eGFR > 50 mL/min), were 6%/7.9%, 24.1%/24.9%, and 69.8%/67.2%, respectively. Statistically significant improvements in overall response rates and progression-free survival were observed in VMPT-VT versus VMP arms across renal cohorts, except in severe RI patients. In the VMPT group, severe RI reduced overall survival (OS). RI was reversed in 16/63 (25.4%) patients receiving VMPT-VT versus 31/77 (40.3%) receiving VMP. Multivariate analysis showed male sex (P = .022) and moderate RI (P = .003) significantly predicted ...
Research Interests: Kidney diseases, Medicine, Humans, Internal Medicine, Female, and 15 moreBlood, Renal Impairment, Multiple Myeloma, Male, Renal Function, Clinical Sciences, Aged, Boronic Acids, Creatinine, Bortezomib, Glomerular Filtration Rate, neoadjuvant therapy, Prednisone, Cardiovascular medicine and haematology, and Paediatrics and reproductive medicine
In this randomized multicenter study of 136 patients, 6 courses of CHOP (cyclo-phosphamide/doxorubicin/vincristine/prednisone) followed by rituximab (CHOP-R) were compared with rituximab-supplemented high-dose sequential chemotherapy with... more
In this randomized multicenter study of 136 patients, 6 courses of CHOP (cyclo-phosphamide/doxorubicin/vincristine/prednisone) followed by rituximab (CHOP-R) were compared with rituximab-supplemented high-dose sequential chemotherapy with autografting (R-HDS) to assess the value of intensified chemo-therapy as a first-line treatment for high-risk follicular lymphoma (FL) after the introduction of monoclonal antibodies. The analysis was intention to treat with event-free survival (EFS) as the primary endpoint. Complete remission (CR) was 62% with CHOP-R and 85% with R-HDS (P < .001). At a median follow-up (MFU) of 51 months, the 4-year EFS was 28% and 61%, respectively (P < .001), with no difference in overall survival (OS). Molecular remission (MR) was achieved in 44% of CHOP-R and 80% of R-HDS patients (P < .001), and was the strongest independent outcome predictor. Patients relapsing after CHOP-R underwent salvage R-HDS in 71% of cases. Salvage R-HDS had an 85% CR rate an...
Research Interests: Gastroenterology, Adolescent, Medicine, Humans, Internal Medicine, and 15 moreFemale, Feasibility Studies, Blood, Male, Immunotherapy, Monoclonal Antibodies, Disease Control, Clinical Sciences, Middle Aged, Adult, Overall Survival, Follicular lymphoma, Chemoimmunotherapy, High risk, and Cardiovascular medicine and haematology
Research Interests: Incidence Geometry, Adolescent, Medicine, Italy, Transplantation, and 15 moreProspective studies, Humans, Child, Internal Medicine, Infant, Incidence, Clinical Sciences, Aged, Middle Aged, Adult, Cumulative Incidence, Hematopoietic Stem Cell Transplantation, Child preschool, Mycoses, and Cardiovascular medicine and haematology
Research Interests: Medicine, Multivariate Analysis, Humans, Internal Medicine, Female, and 15 moreMale, Monoclonal Antibodies, Middle Aged, In Vivo, Doxorubicin, Adult, Disease Progression, Bleomycin, Anthracyclines, Cyclophosphamide, Follicular lymphoma, Combined Modality Therapy, Etoposide, Immunosuppressive Agents, and Disease Free Survival
A case-controlled analysis was performed to assess the effect of stem-cell source on autograft in a group of patients with malignant lymphoma reported to the European Bone Marrow Transplant Group (EBMT). The study was performed matching... more
A case-controlled analysis was performed to assess the effect of stem-cell source on autograft in a group of patients with malignant lymphoma reported to the European Bone Marrow Transplant Group (EBMT). The study was performed matching 83 patients autografted with peripheral blood stem cells (PBSC) with 83 autologous bone marrow transplantation (ABMT) patients. The case-matching was carried out following selection of the main prognostic factors for progression-free survival by multivariate analysis. The progression-free survival was similar in both types of transplants (38.5% PBSCT vs. 36.4% ABMT). The overall relapse and progression rate for the PBSCT was 51.2% compared with 50.1% for the ABMT patients. The differences were not significant statistically. The transplant-related mortality was 6% for both groups. The neutrophil and leucocyte recovery occurred faster in the peripheral blood stem-cell transplantation (PBSCT); the platelet recovery was not significant. A higher number of interstitial pneumonitis and fungal infection episodes were observed in the ABMT group. In conclusion, in these closely matched groups, there is no difference in PFS between patients undergoing PBSCT and those undergoing ABMT. However, the patients autografted with PBSC have a more rapid engraftment and a lower toxicity.
Research Interests: Adolescent, Medicine, Lymphoma, Humans, Child, and 15 moreEurope, Female, Male, Bone marrow, Registries, Middle Aged, Bone Marrow Transplantation, Adult, Prognosis, Annals, Proportional Hazards Models, Case Control Studies, Hematopoietic Stem Cell Transplantation, Combined Modality Therapy, and Blood component transfusion
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In the present study we assess the antitumor effect and circulating stem cells (CSC) mobilizing capacity of high-dose cyclophosphamide (5 to 7 gr/m2, HDCY). This treatment was given to 21 patients with various hematologic malignancies (8... more
In the present study we assess the antitumor effect and circulating stem cells (CSC) mobilizing capacity of high-dose cyclophosphamide (5 to 7 gr/m2, HDCY). This treatment was given to 21 patients with various hematologic malignancies (8 NHL, 5 MM, 4 HD, 3 CML) excluding 1 with neuroblastoma. All were eligible for later autologous blood stem cell transplantation (ABSCT). To reduce the hematologic toxicity of HDCY, GM CSF was simultaneously administered in 5 patients. HDCY produced a response (as defined by a &gt; 50% reduction of previous tumor mass) in 3 out of 12 HD/NHL and 1 out of 3 MM. Patients with CML were not considered to be evaluable for tumor response. Cell collection yields after HDCY varied widely with a range of 1.5 to 169.9 x 10(4)/Kg (median 13.1) CFU-GM and 1.7 to 18.4 x 10(8)/Kg (median 5.8) MNC collected per patient. Hematologic recovery was rapid and sustained with a median of 16 (12-18) days to PMN &gt; 0.5 x 10(9)/L and 14 (11-18) days to Plt &gt; 100.0 x 10(9)/L. Granulocyte recovery was significantly faster after GM-CSF (13 vs 16 days to PMN &gt; 0.5, p = 0.0008). Non hematologic toxicity consisted mainly of nausea and vomiting, but fatal complications occurred in 2 patients, from pulmonary infection in one and from tumor-lysis syndrome in the other. HDCY represents a useful means of increasing collection of CSC, but toxicity is not irrelevant. Whether a similar anti-tumor effect and mobilizing capacity would be offered by single lower intermediate doses of the drug is still to be ascertained.