Leda Leoncini

Ente Ospedaliero Cantonale, Bellinzona, Ticino, Switzerland

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Publications (6)14.22 Total impact

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    ABSTRACT: Abstract This phase II trial treated elderly or frail AML patients with single agent subcutaneous azacytidine at 100 mg/m(2), on 5 of 28 days for up to 6 cycles. Treatment was stopped for lack of response, or continued to progression in responders. Primary endpoint was response within 6 months. A response rate >34% was considered a positive trial outcome. From 9/2008-4/2010, 45 patients from 10 centres (median age 74 (55-86) years) were accrued. Patients received 4 (1-21) cycles. Best response was CR/CRi in 8 (18%; 95% CI: 8%-32%.), 0 (0%) PR, 7 (16%) hematologic improvement, 17 (38%) stable disease. Three nonresponding patients stopped treatment after 6 cycles, 31 patients had stopped early and 11 patients continued treatment for 8-21 cycles. Adverse events (grade >III) were infections (13), febrile neutropenia (14), thrombocytopenia (7), dyspnea (6), bleeding (5) and anemia (4 patients). Median overall survival was 6 months. Peripheral blood blast counts, grouped at 30% had a borderline significant association with response (p = 0.07). This modified azacytidine schedule is feasible for elderly or frail AML patients in an outpatient setting with moderate, mainly hematologic, toxicity and response in a proportion of patients, although the primary objective was not reached.
    Leukemia & lymphoma 04/2013; · 2.61 Impact Factor
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    ABSTRACT: BACKGROUND: The diagnosis of malignant hematologic diseases has become increasingly complex during the last decade. It is based on the interpretation of results from different laboratory analyses, which range from microscopy to gene expression profiling. Recently, a method for the analysis of RNA phenotypes has been developed, the nCounter technology (Nanostring® Technologies), which allows for simultaneous quantification of hundreds of RNA molecules in biological samples. We evaluated this technique in a Swiss multi-center study on eighty-six samples from acute leukemia patients. METHODS: mRNA and protein profiles were established for normal peripheral blood and bone marrow samples. Signal intensities of the various tested antigens with surface expression were similar to those found in previously performed Affymetrix microarray analyses. Acute leukemia samples were analyzed for a set of twenty-two validated antigens and the Pearson Correlation Coefficient for nCounter and flow cytometry results was calculated. RESULTS: Highly significant values between 0.40 and 0.97 were found for the twenty-two antigens tested. A second correlation analysis performed on a per sample basis resulted in concordant results between flow cytometry and nCounter in 44-100% of the antigens tested (mean = 76%), depending on the number of blasts present in a sample, the homogeneity of the blast population, and the type of leukemia (AML or ALL). CONCLUSIONS: The nCounter technology allows for fast and easy depiction of a mRNA profile from hematologic samples. This technology has the potential to become a valuable tool for the diagnosis of acute leukemias, in addition to multi-color flow cytometry.
    PLoS ONE 01/2012; 7(11):e49010. · 3.53 Impact Factor
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    ABSTRACT: Einführung Diagnosestellung, Staging und prognostische Faktoren der chronischen lymphatischen Leukämie (CLL) wur­ den im ersten Teil 1 dieser Übersichtsarbeit vorgestellt. Dieser zweite Teil behandelt Therapieindikationen, Therapiewahl, Beurteilung des Ansprechens und unter­ stützende Massnahmen bei Patienten mit CLL. Therapieindikationen Zum Zeitpunkt der Diagnose einer CLL ist es notwendig festzustellen, ob ein Patient bereits therapiebedürftig ist oder ob eine Beobachtung des weiteren Verlaufs möglich ist. Bis anhin gibt es keine Evidenz, dass eine Frühbehandlung von asymptomatischen Patienten das langfristige Überleben verlängert. Patienten mit neu diagnostizierter CLL in Frühstadien (Binet A, Rai 0) oder mit intermediärem Risiko (Binet B, Rai I oder II) sollen daher zunächst ohne Behandlung nach­ kontrolliert werden, ausser bei Symptomen oder Hin­ weisen für eine fortschreitende Erkrankung (Tab. 1 p). Die IWCLL veröffentlichte Leitlinien für eine progres­ sive und symptomatische Erkrankung als Kriterium für einen Behandlungsbedarf [1] (Tab. 2 p). Eine alleinige ausgeprägte Erhöhung der Lymphozyten­ zahl ist keine Indikationen für eine Therapieeinleitung, ebenso wenig wie eine alleinige Hypogammaglobulin­ ämie oder Paraproteinämie. Die Indikationsstellung für die Zweitlinienbehandlung und spätere Therapien folgt denselben Kriterien wie bei der Einleitung der Erstlinienbehandlung. Therapiemöglichkeiten bei CLL Keine der heutigen Therapien für die CLL ist kurativ mit der Ausnahme der allogenen Stammzelltrans­ plantation, welche jedoch für die meisten Patienten keine Behandlungsoption darstellt. Man kann daher annehmen, dass alle behandlungsbedürftigen Patienten nach der Erstlinienbehandlung einen Rückfall oder eine Krankheitsprogression zeigen und weitere Therapien erhalten werden. Bis vor kurzem konnte keine Thera­ piestrategie zeigen, dass sie das Gesamtüberleben ver­ längert. Es ist sinnvoll, sich zunächst mit der Entwick­ lung der Therapien der CLL vertraut zu machen, um unsere Empfehlungen für eine intensitätsabhängigeBe­ handlungsstrategie zu verstehen (Tab. 3 und 4 p).
    Schweiz Med Forum. 01/2011; 11:118-124.
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    ABSTRACT: Daily administration of 2-chlorodeoxyadenosine (Cladribine, CDA) is a standard treatment for hairy cell leukemia, but may cause severe neutropenia and neutropenic fever. This trial compared toxicity and efficacy of weekly versus daily CDA administration. One hundred patients were randomized to receive standard (CDA 0.14 mg/kg/day day 1-5 [Arm A]) or experimental treatment (CDA 0.14 mg/kg/day once weekly for 5 weeks [Arm B]). The primary endpoint was average leukocyte count within 6 weeks from randomization. Secondary endpoints included response rates, other acute hematotoxicity, acute infection rate, hospital admission, remission duration, event-free, and overall survival. There was no significant difference in average leukocyte count. Response rate (complete + partial remission) at week 10 was 78% (95% confidence interval (CI) 64-88%) in Arm A and 68% (95% CI 54-80%) in Arm B (p = 0.13). Best response rates during follow-up were identical (86%) in both arms. No significant difference was found in the rate of grade 3+4 leukocytopenia (94%vs. 84%), grade 3+4 neutropenia (90%vs. 80%), acute infection (44%vs. 40%), hospitalization (38%vs. 34%), and erythrocyte support (22%vs. 30%) within 10 weeks. Overall, these findings indicate that there are no apparent advantages in toxicity and efficacy by giving CDA weekly rather than daily.
    Leukemia & lymphoma 09/2009; 50(9):1501-11. · 2.61 Impact Factor
  • Leukemia & lymphoma 02/2009; 50(1):133-6. · 2.61 Impact Factor
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    ABSTRACT: Amyloidosis (AL) is a rapidly fatal plasma cell dyscrasia causing progressive multiorgan failure. Recently, substantial improvement of survival was reported following high-dose chemotherapy with peripheral blood stem cell (PBSC) rescue. We describe a patient with AL with severe cardiac and renal involvement who received high-dose melphalan followed by fractioned autologous PBSC transplantation (455 ml on day 1 and 350 ml on day 2). Immediately after the second infusion of the PBSCs, life-threatening cardiac arrhythmias occurred and, despite intensive treatment, the patient died less than 24 h later. The infusion of cryopreserved PBSCs may be associated with complications, including cardiac toxicity. Dimethyl sulfoxide (DMSO) is the most frequently used cryopreservation agent. In the present case, we suggest that DMSO could have played an important role in causing the fatal cardiac arrhythmias. The mechanisms of the cardiovascular effects of DMSO and the possible preventive measures are discussed. Given the poor prognosis of AL and the promising results of dose-intensive chemotherapy with autologous PBSC transplantation, careful patient selection and intensive monitoring are mandatory in order to further pursue this therapeutic approach.
    Annals of Hematology 10/2000; 79(9):523-6. · 2.87 Impact Factor