Pietro R Di Ciaccio's research while affiliated with Australian National University and other places
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Publications (33)
Lymphoma in pregnancy (LIP) presents unique clinical, social and ethical challenges; however, the evidence regarding this clinical scenario is limited. We conducted a multicentre retrospective observational study reporting on the features, management, and outcomes of LIP in patients diagnosed between January 2009 and December 2020 at 16 sites in Au...
Antiretroviral therapy (ART) has improved outcomes for human immunodeficiency virus-associated non-Hodgkin lymphoma (HIV-NHL). This is an analysis of 44 patients with HIV with Burkitt lymphoma (HIV-BL) and diffuse large B-cell lymphoma (HIV-DLBCL) treated in Australia over a 10-year period (2009-2019) during the ART and rituximab era. At HIV-NHL di...
Background:
There is no standard front-line therapy for older patients with classical Hodgkin lymphoma (cHL). We analyzed the clinical presentation and front-line management of older Australian patients with cHL and explored factors associated with unplanned hospital admission and survival.
Methods:
Patients aged ≥ 61 years and diagnosed between...
Lymphoma in pregnancy is a rare and challenging diagnosis that complicates ∼1:6000 pregnancies; posing a series of unique therapeutic, social, and ethical challenges to the patient, her family, and the medical professionals involved. These difficulties are compounded by the paucity of real-world data on the management of LIP, and a lack of relevant...
Introduction
Lymphoma complicates approximately 1/6000 pregnancies (Pereg, Haematologica 2007), and presents challenges for the patient, her family, and medical professionals. This rare event raises unique therapeutic, social and ethical issues, with the welfare of both mother and unborn child to consider. There are challenges regarding symptom obf...
Background: Pregnant or breastfeeding women are routinely excluded from clinical trials due to fear of teratogenicity and toxicity of therapeutic agents, despite a paucity of evidence to support this practice. In response to the diethylstilbesterol (DES) and thalidomide-induced embryopathy in the mid-20 th century, the US Food and Drug Administrati...
Background: Lymphoma in pregnancy is a rare and challenging diagnosis that complicates approximately 1:6000 pregnancies. Diagnostic delay occurs frequently, as lymphoma-related symptoms may be mistakenly attributed to the pregnancy itself, and diagnostic investigations postponed or omitted. Lymphoma in pregnancy poses a series of unique therapeutic...
Background: Chemotherapy is potentially harmful to the developing foetus and there is limited data on the foetal impact of immunotherapy except for rituximab. Therefore determining pregnancy status prior to initiation of chemo- and or immuno-therapy (CIT) should be standard of care. Repeat screening or testing during and after chemotherapy should b...
Background
Transformation of Chronic Lymphocytic Leukaemia (CLL) or Small Lymphocytic Lymphoma (SLL) to high-grade disease (Richter's Transformation; RT) carries a poor prognosis. Despite the advent of novel therapies, published data indicates that chemoimmunotherapy remains the standard of care for RT. This project evaluated real-world outcomes in...
Background
Modern antiretroviral therapy (ART) has reduced HIV associated morbidity and mortality, and allowed a similar treatment approach of aggressive lymphomas in PLWH to that of their HIV negative counterparts. Australia is an ethnically diverse country with a low HIV prevalence and an excellent population-wide ART coverage and adherence in PL...
Aim:
Primary Central Nervous System Lymphoma (PCNSL) [i.e. diffuse large B-cell lymphoma of the CNS] is a rare and poor-prognosis disease occurring predominantly in older patients (median age >60 years old). Prospective studies of two commonly used chemoimmunotherapy (CIT) protocols, MATRix and MPV/Ara-C (± rituximab), have reported 2-year PFS and...
Staging using positron emission tomography/computed tomography (PET/CT) is standard of care in many cancers that occur most frequently in pregnancy, particularly lymphoma. While expert guidelines generally recommend against PET/CT in pregnant women, there is emerging evidence that likely absorbed foetal doses in pregnancy are relatively low, and as...
Australia and New Zealand have achieved excellent community control of COVID‐19 infection. In light of the imminent COVID‐19 vaccination roll out in both countries, representatives from the Haematology Society of Australia and New Zealand and infectious diseases specialists have collaborated on this consensus position statement regarding COVID‐19 v...
Background
The absence of the red cell antigens P, P1 and Pk, known as ‘p’, represents an extremely rare red cell phenotype. Individuals with this phenotype spontaneously form anti‐PP1Pk isoantibodies, associated with severe haemolytic transfusion reactions, recurrent spontaneous abortion and haemolytic disease of the fetus and newborn (HDFN).
Met...
Viral infections, principally cytomegalovirus, Epstein Barr virus (EBV) and adenovirus, are a leading cause of morbidity and mortality after allogeneic stem cell transplantation. The use of systemic antivirals is limited by limited efficacy and organ toxicities. Inability to clear infection is exacerbated by transplant‐related immunosuppression and...
An Australasian Bone Marrow Transplant Registry (ABMTR) Study of the Trends and Outcomes of Allogeneic Haematopoietic Stem Cell Transplantation (HSCT) in Hodgkin Lymphoma between 2009-2019: Relapse remains the most common cause of death post transplantation
Introduction:
Hodgkin Lymphoma (HL) is an eminently curable disease, with 80% of cases achie...
Background
Despite combination antiretroviral therapy (cART), the incidence of lymphomas remains elevated in persons with HIV/AIDS (PWHA).
While the risk of subsequent primary cancers (SPCs) in the general population is well understood, these data are lacking for PWHA. Underlying aetiologic factors in PWHA, including oncogenic viruses and immunodef...
Introduction
Plasmablastic lymphoma (PBL) is a rare, aggressive large cell lymphoma, first described in 1997. PBL is strongly associated with immunodeficient states, such as HIV infection and solid organ transplantation, but up to one third of cases are reported to occur in immunocompetent patients. The pathogenesis of PBL is incompletely understoo...
Introduction
Mantle cell lymphoma (MCL) is a mature B lymphoproliferative disorder with a frequently aggressive clinical course. Although the response rates in patients eligible for conventional chemoimmunotherapy are high, relapses are virtually inevitable, with a median overall survival (OS) of three to five years.
For some patients allogeneic st...
Background:
Bendamustine +/- anti-CD20 antibody is a highly effective regimen for iNHL. Though initially favoured for its toxicity profile, subsequent analyses demonstrate profound and prolonged lymphopenia and the landmark phase III GALLIUM study showed a grade 3-5 infection rate of 20-26% in the bendamustine arms (Hiddemann JCO 2018). The relatio...
Background
The treatment landscape for chronic lymphocytic leukaemia (CLL) has significantly changed over the past decade with the advent of targeted therapies. Subsequent improvement in remission rates has been seen in all patient groups, however patients with high-risk genetic features (del17p, TP53 mutation) continue to have poorer outcomes. In...
Introduction
A majority of patients with diffuse large B cell lymphoma (DLBCL) will be cured with frontline chemoimmunotherapy, however a significant number of patients will relapse. Although autologous haematopoietic stem cell transplantation (autoHCT) may lead to sustained survival in some relapsing patients, long term survival with relapsed DLBC...
The COVID‐19 pandemic poses a unique challenge to the care of patients with haematological malignancies. Viral pneumonia is known to cause disproportionately severe disease in patients with cancer, and patients with lymphoma, myeloma and chronic lymphocytic leukaemia are likely to be at particular risk of severe disease related to COVID‐19. This st...
Citations
... Health care experiences of women diagnosed with LIP (during pregnancy or within 12 months postpartum) were analyzed through qualitative analysis of semistructured interviews. This study was a qualitative substudy of an Australasian Lymphoma Alliance (ALA) project on lymphoma in pregnancy in Australasia [13] and was approved by the St Vincent's Health Human Research Ethics Committee, Sydney (2020/ETH00489). The study adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist (Supplementary Appendix 1) [14]. ...
... Furthermore, there is limited evidence defining reference ranges in pregnant women for laboratory markers relevant to the recognition, diagnosis, and prognostication of cancers [35]. Finally, physicians may be hesitant to request investigations (e.g., imaging investigations) that may potentially impact the fetus [36][37][38]. ...
... The initial diagnosis of cancer during pregnancy can be challenging as signs and symptoms of cancer can be incorrectly attributed to the pregnancy [3]. Furthermore, there is limited evidence defining reference ranges in pregnant women for laboratory markers relevant to the recognition, diagnosis, and prognostication of cancers [35]. Finally, physicians may be hesitant to request investigations (e.g., imaging investigations) that may potentially impact the fetus [36][37][38]. ...
... Patients with suspected or confirmed prior COVID-19 infection should be vaccinated according to international guidelines, as immunity may decrease over time [108]. ...
... Whereas these retrospective data only describe incidences of clinical reactivations of herpesviridae, introducing oral acyclovir (400 mg QID given from the start of therapy until four weeks after the last therapy cycle) together with cotrimoxazol (2 double strength doses twice a week) in addition to oral ciprofloxacin (500 mg BID) as anti-infective prophylaxis in the OPTIMAL > 60-trial significantly reduced grade 3/4 infections of all kind (from 28 to 18% per patient, p = 0.004) and treatment-related mortality (from 7 to 2%, p = 0.003) in elderly patients with DLBCL compared to a historical control [91]. Antiviral prophylaxis was also shown to reduce the risk of clinical reactivations of VZV and HSV in patients with indolent lymphomas treated with bendamustine ± anti-CD20 monoclonal antibody [92]. This evidence supports the use of pharmacological prophylaxis to reduce particularly VZV disease in non-Hodgkin lymphoma patients treated with (immuno-)chemotherapy (BIIu) ( Table 7). ...
... Extraoral disease has been reported in 43% of cases in a review of 248 patients (110) including the gastrointestinal tract, bone and skin. It is now seen outside of HIV-positive cohorts (111). Malignant cells have plasmablastic morphology and express a plasma cell-like immunophenotype (expression of CD38, CD138, MUM1, the antigen detected by the VS38c antibody, frequently CD79a, variably CD30, with a loss of CD20) and high Ki-67, usually above 90% (112). ...
... Anti-PP1P k can cause hemolytic transfusion reactions, and has the potential to cause severe, even fatal, hemolytic disease of the fetus and newborn. 4 Women with anti-PP1P k are at a higher risk for miscarriage, 5 likely due to the high expression of P1PK system antigens on the placenta with only low levels on fetal RBCs. We investigated the samples of two Bangladeshi sisters (S1 and S2), both obstetrics patients, referred with anti-PP1P k and a history of spontaneous abortion. ...
... Our study failed to demonstrate a reduction in cancer-related presentations; however, it did show that up to 76.1% of patients referred to the CUAC service potentially avoided an ED presentation. The avoidance of the ED by patients with cancer during the COVID-19 pandemic is a strategy recommended by expert groups through the application of screening algorithms or questionnaires [29,30]. Whilst the CUAC model of care was initially implemented to reduce the risk of exposure to COVID-19 in the ED of patients with cancer, the evaluation demonstrates that the CUAC model is feasible and an efficient model of care for the management of disease and treatment-related concerns in general. ...