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L Potenza,
P Barozzi,
M Masetti,
M Pecorari,
P Bresciani,
A Gautheret-Dejean,
G Riva,
D Vallerini,
S Tagliazucchi,
M Codeluppi,
F Di Benedetto,
G E Gerunda,
F Narni, G Torelli,
M Luppi
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ABSTRACT: The unique phenomenon of human herpesvirus-6 (HHV-6) chromosomal integration (CIHHV-6) may account for clinical drawbacks in transplant setting, being misinterpreted as active infection and leading to unnecessary and potentially harmful treatments. We have investigated the prevalence of CIHHV-6 in 205 consecutive solid organ (SO) and allogeneic stem cell transplant (alloSCT) Italian patients. Fifty-two (38.5%) of 135 solid organ transplant (SOT) and 16 (22.8%) of 70 alloSCT patients resulted positive for plasma HHV-6 DNA by real-time polymerase chain reaction. Seven SOT and three alloSCT patients presented HHV-6-related diseases, requiring antivirals. Two further patients (0.9%) were identified, presenting high HHV-6 loads. The quantification of HHV-6 on hair follicles disclosed the integrated state, allowing the discontinuation of antivirals. Before starting specific treatments, CIHHV-6 should be excluded in transplant patients with HHV-6 viremia by the comparison of HHV-6 loads on different fluids and tissues. Pretransplantation screening of donors and recipients may further prevent the misdiagnosis of CIHHV-6.
American Journal of Transplantation 07/2009; 9(7):1690-7. · 6.39 Impact Factor
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Haematologica 11/2008; 93(10):e63. · 6.42 Impact Factor
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F Forghieri,
M Luppi,
F Narni,
M Morselli,
L Potenza,
P Bresciani,
F Volzone,
G Rossi,
A Rossi,
L Trenti,
P Barozzi, G Torelli
Bone marrow transplantation 09/2008; 42(10):701-3. · 3.00 Impact Factor
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European Journal Of Haematology 06/2008; 81(3):244-5. · 2.61 Impact Factor
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R Maffei,
R Marasca,
S Martinelli,
I Castelli,
R Santachiara,
E Morandi,
P Zucchini,
M Fontana,
F Giacobbi,
P Silingardi,
G Bonacorsi,
P Temperani,
L Masini,
A M Colacci,
R Serra, G Torelli
Leukemia 07/2007; 21(6):1312-5. · 9.56 Impact Factor
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A Re,
F Facchetti,
E Borlenghi,
C Cattaneo,
M A Capucci,
M Ungari,
P Barozzi,
D Vallerini,
L Potenza, G Torelli,
G Rossi,
M Luppi
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ABSTRACT: Hemophagocytic syndrome (HS) may occur as a consequence of herpes viral infections. Human herpesvirus 8 (HHV-8)/Kaposi sarcoma-associated herpesvirus has so far been recognized as a trigger of HS only in immunosuppressed subjects or in patients with Kaposi sarcoma and/or HHV-8-related lymphoproliferative diseases. We report two Italian human immunodeficiency virus (HIV)-negative elderly men who developed an HS with a rapidly fatal course, following treatment with corticosteroids for autoimmune hemolytic anemia. An overwhelming active infection with HHV-8 was unequivocally documented by molecular and immunohistochemical methods, in the absence of HHV-8-related tumors. The occurrence of HHV-8-associated HS, although rare, may be considered, even out of the HIV or the transplantation settings, at least in areas endemic for HHV-8 infection.
European Journal Of Haematology 05/2007; 78(4):361-4. · 2.61 Impact Factor
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ABSTRACT: Intracerebral haemorrhage (ICH) is the deadliest form of stroke, carrying a mortality rate between 30% and 55%, increasing to 67% in patients on oral anticoagulant therapy (OAT). Despite its relevant incidence, the treatment of ICH has been until recently a largely neglected item, addressed by only a few trials. Early treatment of ICH in non-anticoagulated patients with recombinant activated factor VII (rFVII) has been demonstrated to be able to limit the growth of the haematoma, but such a promising result requires further confirmations. In ICH patients receiving OAT a prompt reversal of the anticoagulant effect should be warranted in order to reduce the consequences of this dreadful adverse event. In clinical practice, however, just a small proportion of anticoagulated patients receive this treatment, probably because of the fear of thromboembolic complications. It is now time to check our way of thinking about ICH, regarding and treating it as a compelling medical emergency.
Internal and Emergency Medicine 04/2007; 2(1):38-45. · 2.06 Impact Factor
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L Potenza,
P Barozzi,
D Vallerini,
R Bosco,
C Quadrelli,
L Mediani,
M Morselli,
F Forghieri,
F Volzone,
M Codeluppi,
G Rossi,
G Tazzioli,
C Venturelli, G Torelli,
M Luppi
Leukemia 04/2007; 21(3):578-81. · 9.56 Impact Factor
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Annals of the New York Academy of Sciences 12/2006; 663(1):202 - 214. · 3.15 Impact Factor
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ABSTRACT: Bleeding is a major surgical complication. Although mortality rates of 0.1% are observed for surgical procedures, it may be 5% to 8% for elective vascular surgery, and increase to 20% in the presence of severe bleeding. In major surgery for liver diseases, as well as in cardiac surgery, excessive blood loss is associated with increased mortality, morbidity, and intensive care stay. Approximately 75% to 90% of intraoperative and early postoperative bleeding is due to technical factors. However, in some cases either acquired or congenital coagulopathies may favor, if not directly cause, surgical hemorrhage. Uncontrolled bleeding leads to a combination of hemodilution, hypothermia, consumption of clotting factors, and acidosis, which in turn worsen the clotting process, further exacerbating the problem in a vicious bloody circle. At present, the standard treatment for surgical bleeding is the rapid control of the source of bleeding by either surgical or radiological techniques. Blood-derived products as well as hemostatic agents, such as aprotinin, tranexamic acid, and DDAVP, are widely used to improve hemostatic balance in bleeding patients. Recombinant activated factor VII (rFVIIa) has been reported to be effective for the treatment of surgical or traumatic massive bleeding unresponsive to conventional therapy. Although most reports are anecdotal, and therefore exposed to a "positive" selection bias, the number of cases is impressive, strongly suggesting that in such patients rFVIIa may afford a hemostatic advantage beyond that of conventional replacement therapy.
Transplantation Proceedings 05/2006; 38(3):812-4. · 1.00 Impact Factor
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L Richeldi,
M Luppi,
M Losi,
F Luppi,
L Potenza,
P Roversi,
S Cerri,
K A Millington,
K Ewer,
L M Fabbri, G Torelli,
A Lalvani
Leukemia 03/2006; 20(2):379-81. · 9.56 Impact Factor
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Journal of Thrombosis and Haemostasis 02/2006; 4(1):288. · 5.73 Impact Factor
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ABSTRACT: Acute promyelocytic leukaemia (APL) is a well-defined disease characterized by a typical morphology of leukaemic cells, the presence of t(15;17) translocation and the unique sensitivity to the differentiating effect of all-trans retinoic acid. Nevertheless, some aspects are variable among APL patients, with differences substantially related to morphological variants, peripheral leukocytes count, the presence of a disseminated intravascular coagulopathy, different PML/RARalpha isoforms (long, variable or short) and Fms-like tyrosine kinase 3 (Flt3) mutations. In order to better define this variability, we investigated the gene expression profiles of 18 APL cases revealing, besides a high uniformity in gene expression pattern, the presence of few robust differences among patients able to identify, by an unsupervised analysis, two major clusters of patients characterized by different phenotypes (hypogranular M3v vs classical M3) and by the presence or absence of Flt3 internal tandem duplications (ITDs). Further supervised analysis confirmed that Flt3 status was the APL parameter best associated with these two subgroups. We identified, between Flt3 wild-type and Flt3-ITDs subsets, 147 differentially expressed genes that were involved in the cytoskeleton organization, in the cell adhesion and migration, in the proliferation and the coagulation/inflammation pathways as well as in differentiation and myeloid granules constitution suggesting a role of Flt3 mutations in the pathogenesis and clinical manifestations of APL.
Leukemia 02/2006; 20(1):103-14. · 9.56 Impact Factor
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A Ferrari,
M Luppi,
L Potenza,
G Riva,
M Morselli,
A Imovilli,
F Volzone,
G Rossi,
M Codeluppi,
G Guaraldi, G Torelli
Leukemia 12/2005; 19(11):2019-21. · 9.56 Impact Factor
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M Luppi,
R Trovato,
P Barozzi,
D Vallisa,
G Rossi,
A Re,
L Ravazzini,
L Potenza,
G Riva,
M Morselli,
G Longo,
L Cavanna,
R Roncaglia, G Torelli
Leukemia 04/2005; 19(3):473-6. · 9.56 Impact Factor
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Leukemia 11/2004; 18(10):1572-5. · 9.56 Impact Factor
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ABSTRACT: Severe cutaneous infections in leukaemic patients are difficult to treat and can rapidly become fatal. We report on a case of essential thrombocythemia evolved to a myelodysplastic syndrome and finally, to an overt myeloid leukaemia, refractory to chemotherapy. In the presence of a marked neutropenia, the patients developed a wide Staphylococcus epidermidis necrotising dermatitis. The diagnosis was made possible only by a skin biopsy culture and the antibiotic treatment, based on antimicrobial susceptibility tests, rapidly resolved the infection. In neutropenic patients, appropriate laboratory tests and treatment, can lead to recovery of life-threatening infections.
European Journal Of Haematology 01/2004; 71(6):464-5. · 2.61 Impact Factor
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ABSTRACT: Inherited and acquired thrombophilia have been found to be associated with recurrent pregnancy loss. This paper examines whether or not elevated factor (F)VIII:C plasma levels, which have been demonstrated to be an independent risk factor for venous thromboembolism, are a risk factor for early recurrent miscarriages also.
Consecutive women referred to our clinic with a history of early recurrent abortion (at least three pregnancy losses before week 13 of gestation) were eligible for the study. Exclusion criteria were endocrine, immunological, anatomical and genetic causes of embryo demise, as well as any thrombophilic abnormality, either congenital or acquired, or a personal or familial history of venous thromboembolism. FVIII:C plasma levels were determined in 51 cases and in 51 controls matched for age, ethnicity and blood group.
The mean FVIII:C level in the control subjects was 106.8 IU dL-1, compared with 128.2 IU dL-1 in the patients group (P = 0.0002). Thirteen (25.5%) of the 51 patients had FVIII:C values exceeding the 90th centile of the control population (145 IU dL-1), compared with four subjects in the control group (chi2 = 4.52; P = 0.033; odds ratio = 4.02, 95% confidence interval 1.09, 16.05). No cases with increase in FVIII:C levels attributable to an acute-phase reaction, as assessed by C-reactive protein plasma concentration, were found.
We found FVIII:C levels significantly higher in women with early recurrent miscarriage compared with controls. This finding suggests a possible association between this thrombophilic condition and early reproductive failures.
Journal of Thrombosis and Haemostasis 01/2004; 1(12):2536-9. · 5.73 Impact Factor
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ABSTRACT: In 80 consecutive, anticoagulated patients scheduled for minor surgery, we reduced warfarin daily dosage by 50% on days 4, 3 and 2 before the surgery, restoring the original dose the day immediately before surgery. The evening after surgery, patients took a double warfarin dose, and then the usual maintenance dose was reintroduced. The mean International Normalized Ratio (INR) value assessed 1 week before surgery was 2.63 (range 1.88-3.87); it decreased at the moment of performing surgery to 1.68 (range 1.42-2.20; P < 0.05 with respect to the preoperative value), and returned to 2.43 7 days after (range 1.96-3.51, P = ns with respect to the preoperative value). No significant difference was found comparing prothrombin fragment 1.2 (F1.2) levels 1 week before surgery and on the morning of surgery (0.49 ng/ml vs 0.67 ng/ml, P = ns), suggesting that no activation of blood coagulation had taken place following the reduction of anticoagulant therapy. Patients developed neither major nor minor bleeding, nor thromboembolism during the procedures or up to 1 month after surgery. In our experience, this method for the management of anticoagulation before minor surgery has been shown to be safe and useful, avoiding the cumbersome shift to either intravenous or subcutaneous heparin.
Clinical & Laboratory Haematology 04/2003; 25(2):127-30. · 1.11 Impact Factor
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S Galimberti,
R Marasca,
F Caracciolo,
R Fazzi,
F Papineschi,
E Benedetti,
F Guerrini,
F Morabito,
E Oliva,
N Di Renzo,
M Federico,
M Petrini, G Torelli
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ABSTRACT: Seventy-two patients with non-Hodgkin's lymphoma were evaluated for the presence of molecular markers (IgH, bcl-1, bcl-2 rearrangement) on bone marrow, at diagnosis and after PBSCT, and on harvests in order to find a possible predictive role of minimal residual disease on treatment outcome. At diagnosis, 41 (59%) out of 69 available bone marrows showed molecular involvement. Fifty-six percent of leukaphereses were involved, mainly indolent lymphoma (P = 0.001) or advanced disease (P = 0.01). Ex vivo purging cleared only one stem collection out of 31 PCR-positive leukaphereses. Aggressive lymphomas showed both a longer overall survival (OS) (P = 0.03) and relapse-free survival RFS (P = 0.02) when transplanted with unpurged stem cells, whereas indolent NHL survival was not influenced by ex vivo purging. Twenty out of 26 samples taken during follow-up had bone marrow involvement at diagnosis. Of these, 15 cleared their bone marrow; both OS and RFS were significantly longer in the PCR-negative cases (P = 0.05 and P = 0.005). At 1 year after PBSCT, 75% of patients were PCR negative, with 50% molecular remissions; the relapse rate was 55% for patients still PCR positive vs 29% for those who were PCR negative. Thus, after high-dose chemotherapy, close molecular monitoring of MRD using qualitative PCR techniques seems to represent a reliable prognostic indicator.
Bone Marrow Transplantation 05/2002; 29(7):581-7. · 3.75 Impact Factor
