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ABSTRACT: Despite the impressive results obtained with standard chemotherapy, approximately 20% of acute promyelocytic leukemia (APL) patients undergo disease relapse thereby requiring salvage therapy. Few data is available on long-term prognosis in relation to time to complete remission (CR): we reviewed 142 patients treated with AIDA protocols and we found that 42 out of 142 (29.6%) patients achieved CR after 35 days (median time, 42 days). No significant differences in presenting features, including FAB subtype, type of PML/RARA transcript and relapse risk at presentation between the two patient groups achieving CR > or <35 days were revealed, except for male sex and older age that were significantly associated with delayed CR. Rate of relapse was 31% in patients with delayed CR compared to 17% in the group of patients who achieved CR<35 days (p=0.001), with a 5-year CIR of 29.6% compared to 12% (p=0.03). APL patients with delayed CR should be more closely monitored during follow-up for early identification of relapse and prompt administration of pre-emptive salvage therapy.
Leukemia research 12/2012; · 2.36 Impact Factor
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Federico De Angelis,
Alice Di Rocco, Clara Minotti,
Guido Valesini,
Claudio Cartoni,
Mara Riminucci,
Fabrizio Conti,
Erica Finolezzi,
Daniele Armiento,
Sara Grammatico,
Laura Massaro,
Angelo Fama,
Gioia Colafigli,
Catrine Viccarone,
Robin Foà,
Maurizio Martelli
Leukemia research 06/2012; 36(9):e199-201. · 2.36 Impact Factor
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Saveria Capria,
Silvia Maria Trisolini, Clara Minotti,
Caterina Stefanizzi,
Luisa Cardarelli,
Claudio Cartoni,
Daniela Diverio,
Maria Stefania De Propris,
Marco Mancini,
Alessandra Micozzi,
Robin Foà,
Giovanna Meloni
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ABSTRACT: Long-term survival of relapsed/refractory acute myeloid leukemia (AML) remains a major problem, particularly in patients not eligible for transplantation.We hereby evaluated the feasibility and efficacy of adding Gemtuzumab Ozogamicin to salvage chemotherapy (Ara-C, Idarubicine, Peg-Filgrastim) in relapsed/refractory AML. The main endpoints were: the rate of complete remissions (CR) and the proportion of patients capable of undergoing a stem cell transplant.Fourty-two patients were enrolled. The overall CR rate was 76% and no induction deaths were reported. In 56% of patients, a transplant procedure could be performed. The treatment schedule proved feasible and well tolerated, providing a high CR rate and a useful bridge to transplant.
Mediterranean Journal of Hematology and Infectious Diseases 01/2012; 4(1):e2012072.
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Corrado Girmenia,
Anna Maria Frustaci,
Giuseppe Gentile, Clara Minotti,
Claudio Cartoni,
Saveria Capria,
Silvia Maria Trisolini,
Angela Matturro,
Giuseppina Loglisci,
Roberto Latagliata,
Massimo Breccia,
Giovanna Meloni,
Giuliana Alimena,
Robin Foà,
Alessandra Micozzi
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ABSTRACT: Posaconazole is effective as primary antifungal prophylaxis of invasive fungal diseases in patients with acute myeloid leukemia.
The impact of primary antifungal prophylaxis administered during front-line chemotherapy for acute myeloid leukemia was evaluated by comparing 58 patients who received oral amphotericin B (control group) to 99 patients who received oral posaconazole (posaconazole group). The primary endpoint was the incidence of proven/probable invasive fungal diseases. Secondary endpoints included incidence of invasive aspergillosis, survival at 4 and 12 months after the diagnosis of acute myeloid leukemia and costs.
Proven/probable invasive fungal diseases were documented in 51.7% of patients in the control group and in 23.2% in the posaconazole group (P=0.0002). Invasive aspergillosis was documented in 43% of patients in the control group and in 15% in the posaconazole group (P=0.002). No survival difference was observed in patients aged over 60 years. In patients aged 60 years or less, a statistically significant survival advantage was observed at 4 months, but no longer at 12 months, in the posaconazole group (P=0.03). It was calculated that in the posaconazole group there was a mean 50% cost reduction for the antifungal drugs.
Primary antifungal prophylaxis with posaconazole during front-line chemotherapy was effective in preventing invasive fungal diseases in a "real-life" scenario of patients with acute myeloid leukemia, resulted in an early but transitory survival advantage in younger patients and was economically advantageous.
Haematologica 11/2011; 97(4):560-7. · 6.42 Impact Factor
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Massimo Breccia,
Luca Mazzarella,
Vincenzo Bagnardi,
Davide Disalvatore,
Giuseppina Loglisci,
Giuseppe Cimino,
Anna Maria Testi,
Giuseppe Avvisati,
Maria Concetta Petti, Clara Minotti,
Roberto Latagliata,
Robin Foà,
Pier Giuseppe Pelicci,
Francesco Lo-Coco
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ABSTRACT: We investigated whether body mass index (BMI) correlates with distinct outcomes in newly diagnosed acute promyelocytic leukemia (APL). The study population included 144 patients with newly diagnosed and genetically confirmed APL consecutively treated at a single institution. All patients received All-trans retinoic acid and idarubicin according to the GIMEMA protocols AIDA-0493 and AIDA-2000. Outcome estimates according to the BMI were carried out together with multivariable analysis for the risk of relapse and differentiation syndrome. Fifty-four (37.5%) were under/normal weight (BMI < 25), whereas 90 (62.5%) patients were overweight/obese (BMI ≥ 25). An increased BMI was associated with older age (P < .0001) and male sex (P = .02). BMI was the most powerful predictor of differentiation syndrome in multivariable analysis (odds ratio = 7.24; 95% CI, 1.50-34; P = .014). After a median follow-up of 6 years, the estimated cumulative incidence of relapse at 5 years was 31.6% (95% CI, 22.7%-43.8%) in overweight/obese and 11.2% (95% CI, 5.3%-23.8%) in underweight/normal weight patients (P = .029). Multivariable analysis showed that BMI was an independent predictor of relapse (hazard ratio = 2.45, 95% CI, 1.00-5.99, in overweight/obese vs under/normal weight patients, P = .049). An increased BMI at diagnosis is associated with a higher risk of developing differentiation syndrome and disease relapse in APL patients treated with AIDA protocols.
Blood 11/2011; 119(1):49-54. · 9.90 Impact Factor
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ABSTRACT: Front-line treatment combining All-trans retinoic acid (ATRA) and chemotherapy is curative in approximately 80% of patients with acute promyelocytic leukaemia (APL). As for patients who relapse after this approach, current guidelines recommend the administration of arsenic trioxide (ATO) with or without ATRA ....
Haematologica 06/2011; 96(9):1390-1. · 6.42 Impact Factor
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Haematologica 12/2009; 95(5):853-4. · 6.42 Impact Factor
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Corrado Girmenia,
Alessandra Micozzi,
Giuseppe Gentile,
Stefania Santilli,
Eva Arleo,
Luisa Cardarelli,
Saveria Capria, Clara Minotti,
Claudio Cartoni,
Simonetta Brocchieri,
Vito Guerrisi,
Giovanna Meloni,
Robin Foà,
Pietro Martino
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ABSTRACT: Preemptive strategies in neutropenic patients based on serum galactomannan (GM) -guided triggering of diagnostic work-up may be time-consuming and expensive when applied to the entire population. We have assessed the feasibility of a clinically driven diagnostic strategy without GM screening.
Patients with neutropenic fever underwent a baseline diagnostic work-up (BDWU; three blood cultures and other examinations as indicated). An intensive diagnostic work-up (IDWU; GM for 3 days, chest computed tomography and other examinations as indicated) was reserved for patients with 4 days of persisting or relapsing fever or with other clinical findings possibly related to an invasive fungal diseaser (IFD). Antifungal therapy was administered to patients diagnosed with IFD and empirically (negative IDWU) only to those with persisting neutropenic fever and worsening clinical conditions.
Of 220 neutropenia episodes, fever occurred in 159 cases and recurred in 28 cases. Overall, 49 IFDs were diagnosed (two by BDWU and 47 by IDWU) during 48 episodes (21.8%). Diagnostic-driven therapy was administered to 48 patients with IFDs; one patient with zygomycosis died without treatment. Only one patient received empirical therapy. IDWU was required in 40% of neutropenia episodes, and only 1.4 mean blood samples per neutropenia episode were tested for GM. Our strategy allowed a 43% reduction in antifungal treatments compared with a standard empirical approach. At 3-month follow-up, 63% of patients with IFD survived, and no undetected IFDs were found.
A clinically driven diagnostic approach in selected neutropenia episodes offered effective antifungal control and reduced the exposure to unnecessary antifungal treatment.
Journal of Clinical Oncology 10/2009; 28(4):667-74. · 18.37 Impact Factor
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British Journal of Haematology 07/2008; 142(5):854-6. · 4.94 Impact Factor
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Annals of Hematology 05/2007; 86(4):295-7. · 2.62 Impact Factor
