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  • 1
    In: British Journal of Haematology, Wiley, Vol. 167, No. 1 ( 2014-10), p. 121-126
    Abstract: The risk of developing hepatocellular carcinoma ( HCC ) in patients with thalassaemia is increased by transfusion‐transmitted infections and haemosiderosis. All Italian Thalassaemia Centres use an ad hoc form to report all diagnoses of HCC to the Italian Registry. Since our last report, in 2002, up to December 2012, 62 new cases were identified, 52% of whom were affected by thalassaemia major ( TM ) and 45% by thalassaemia intermedia ( TI ). Two had sickle‐thalassaemia ( ST ). The incidence of the tumour is increasing, possibly because of the longer survival of patients and consequent longer exposure to the noxious effects of the hepatotropic viruses and iron. Three patients were hepatitis B surface antigen‐positive, 36 patients showed evidence of past infection with hepatitis B virus ( HBV ). Fifty‐four patients had antibodies against hepatitis C virus ( HCV ), 43 of whom were HCV RNA positive. Only 4 had no evidence of exposure either to HCV or HBV . The mean liver iron concentration was 8 mg/g dry weight. Therapy included chemoembolization, thermoablation with radiofrequency and surgical excision. Three patients underwent liver transplant, 21 received palliative therapy. As of December 2012, 41 patients had died. The average survival time from HCC detection to death was 11·5 months (1·4–107·2 months). Ultrasonography is recommended every 6 months to enable early diagnosis of HCC , which is crucial to decrease mortality.
    Type of Medium: Online Resource
    ISSN: 0007-1048 , 1365-2141
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    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 2
    In: Journal of Allergy and Clinical Immunology, Elsevier BV, Vol. 146, No. 2 ( 2020-08), p. 429-437
    Type of Medium: Online Resource
    ISSN: 0091-6749
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    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2006613-2
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  • 3
    In: Blood, American Society of Hematology, Vol. 112, No. 11 ( 2008-11-16), p. 3872-3872
    Abstract: Despite dramatic gains in life expectancy in the desferrioxamine era for thalassemia major patients, the leading cause of death for this young adult’s population remains iron-induced heart failure. For this reason, strategies to reduce heart disease by improving chelation regimens have the highest priority in this phase. These strategies include development of novel oral iron chelators to improve compliance. Oral deferipron was proved more effective than subcutaneous desferrioxamine in removing cardiac iron. The novel oral one-daily chelator deferasirox has been recently commercially available but its long-term efficacy on myocardial iron concentrations and cardiac function is unknown. Aim of this study was to compare in thalassemia major patients the effectiveness of deferasirox, deferipron, and desferrioxamine on myocardial and liver iron concentrations and bi-ventricular function by quantitative magnetic-resonance imaging (MRI). Among the 550 thalassemic subjects enrolled in the MIOT (Myocardial Iron Overload in Thalassemia) network between September 2006 and September 2007, we selected patients receiving one chelator alone for longer than one year. MIOT is an Italian network of six MR sites where the cardiac and liver iron status is assessed by validated and homogeneous standard procedures. We identified three groups of patients: 24 treated with deferasirox, 42 treated with deferipron and 89 treated with desferrioxamine. The three groups were matched for gender, Hb pre-transfusion levels, age of starting chelation, and good compliance to the treatment. The deferasirox group was significantly younger (26±7 years) than the deferipron (32±9 years) and desferioxamine group (33±8 years) (P=0.0001) and showed significantly higher mean serum ferritin levels (2516±2106 ng/ml) than the deferipron (1493±1651 ng/ml) and the desferrioxamine group (987±915 ng/ml) (P=0.0001). Myocardial iron concentrations and distribution were measured by MRI T2* multislice multiecho technique. Biventricular function parameters were quantitatively evaluated by cine-dynamic MRI images. Liver iron concentrations were measured by MR T2* multiecho technique. Written informed consent was obtained from all subjects. The global heart T2* value was significantly higher in the deferipron group (34±11 ms) versus the deferasirox (21±12 ms) and the desferrioxamine group (27±11 ms) (P=0.0001), as showed in Figure A. The T2* in the mid ventricular septum was significantly higher in the deferipron (36 ± 12 ms) versus the deferasirox (20 ± 12 ms) and the desferrioxamine group (28 ± 13 ms) (P = 0.0001). The number of segments with normal T2* value was significantly higher in the deferipron and the desferrioxamine group versus the deferasirox group (14 ± 2 versus 11 ± 6 versus 7 ± 7 segments; P = 0.0001). Among the biventricular function parameters, we found higher left ventricular ejection fractions in the deferipron and the desferrioxamine group versus the deferasirox group (64 ± 7 versus 62 ± 6 versus 58 ± 7 %; P = 0.005), as showed in Figure B. Liver T2* values were significantly higher in the desferrioxamine group versus the deferipron and the deferasirox group (10 ± 9 versus 6 ± 6 versus 5 ± 5 segments; P = 0.002). In conclusion, Oral deferipron seems to be more effective than oral deferasirox and subcutaneous desferrioxamine in removal of myocardial iron with concordant positive effect on left global systolic function. Figure Figure
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2008
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  • 4
    In: Journal of Allergy and Clinical Immunology, Elsevier BV, Vol. 146, No. 5 ( 2020-11), p. 967-983
    Type of Medium: Online Resource
    ISSN: 0091-6749
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    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
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  • 5
    In: Journal of Clinical Immunology, Springer Science and Business Media LLC, Vol. 40, No. 7 ( 2020-10), p. 1026-1037
    Abstract: Primary immunodeficiencies (PIDs) are heterogeneous disorders, characterized by variable clinical and immunological features. National PID registries offer useful insights on the epidemiology, diagnosis, and natural history of these disorders. In 1999, the Italian network for primary immunodeficiencies (IPINet) was established. We report on data collected from the IPINet registry after 20 years of activity. A total of 3352 pediatric and adult patients affected with PIDs are registered in the database. In Italy, a regional distribution trend of PID diagnosis was observed. Based on the updated IUIS classification of 2019, PID distribution in Italy showed that predominantly antibody deficiencies account for the majority of cases (63%), followed by combined immunodeficiencies with associated or syndromic features (22.5%). The overall age at diagnosis was younger for male patients. The minimal prevalence of PIDs in Italy resulted in 5.1 per 100.000 habitants. Mortality was similar to other European registries (4.2%). Immunoglobulin replacement treatment was prescribed to less than one third of the patient cohort. Collectively, this is the first comprehensive description of the PID epidemiology in Italy.
    Type of Medium: Online Resource
    ISSN: 0271-9142 , 1573-2592
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    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2016755-6
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  • 6
    In: Blood, American Society of Hematology, Vol. 126, No. 23 ( 2015-12-03), p. 2788-2788
    Abstract: Reports in adults have shown that a BCR-ABL1 IS 〈 10% at 3 months after the start of imatinib (IM) can predict better clinical outcome in chronic myeloid leukemia (CML). Recently, early molecular response (EMR) at 3 months has also been reported to correlate with better progression-free survival (PFS) in children treated with IM at a standard dose (260 mg/m2/day) (Millot et al, 2014). In order to confirm the relevance of this cut-off in the pediatric population treated with high-dose IM, we investigated the impact a cohort of children and adolescents with CML in chronic phase (CP) followed at 11 Italian Centers. Forty-four of 53 CP-CML patients treated with IM at a dose of 340 mg/m2/day who had available BCR-ABL1 levels at 3 months and had been followed for at least 12 months were included in this analysis. Cytogenetics were planned on bone marrow (BM) cells before and during IM therapy as well as molecular analysis on peripheral blood (PB) monthly and on BM every 3 months. Complete cytogenetic response (CCyR) was defined as the absence of Ph+ metaphases. Peripheral blood BCR-ABL1 levels were measured by quantitative RT-PCR assay expressed as International Scale (IS). Major molecular response (MMR) was defined as ≤0.1% BCR-ABL1 IS, while molecular response (MR) was considered as ≤0.01% BCR-ABL1 IS. Complete molecular response (CMR) was used to indicate levels of disease ≤0.0032% BCR-ABL1 IS or undetectable. BCR-ABL1 transcript levels 〈 10% 3 months after starting IM were considered as EMR and were used to assess the association between EMR and the rates of: a) BCR-ABL1 IS 〈 1% and CCyR after 6 months of IM treatment; b) MMR at 12 months; c) CCyR at 6 months; d) overall CCyR, MMR and CMR, as well as the association between EMR and PFS. Forty-four CP-CML patients - females: 17, males: 27; median age at diagnosis: 11.2 years (range: 3.1-15,8); median follow-up: 73.5 months (range:15-151.3) who had received IM at a median dose of 300 mg/m2/day (range: 140-380) were evaluable for molecular response. At 3 months of IM treatment, BCR-ABL1 transcript levels 〈 10% and ≥10% were found in 79.5% and 20.5% of patients, respectively. The median administered dose of IM was similar (300 mg/m2 and 314 mg/m2 in patients with BCR-ABL1 IS 〈 10% and ≥10%, respectively). At 6 months, 82% and 64% of evaluable patients showed CCyR and BCR-ABL1 transcript levels 〈 1%, respectively. BCR-ABL1 transcript levels 〈 0.1% were found in 63.5% of patients evaluable at 12 months. Overall, 92.5%, 85% and 39% of patients achieved CCyR, MMR and CMR, respectively. The correlations between BCR-ABL1 transcript levels 〈 10% and ≥10% at 3 months and the rates of BCR-ABL1 IS 〈 1% at 6 months and 〈 0.1% at 12 months, CCyR at 6 months, overall CCyR, MMR and CMR are detailed in Fig 1. At 6 months, patients with BCR-ABL1 IS 〈 10% after 3 months of IM had significantly higher response rates compared to those with BCR-ABL1 IS ≥10% (P = .031 and P.003 for CCyR and BCR-ABL1 IS 〈 1%, respectively). Patients with EMR achieved higher rates of BCR-ABL1 IS 〈 0.1% at 12 months as well as a better overall CCyR, MMR and CMR, though no statistically significant differences were found except for MMR (P =.041). With an overall PFS at 72 months of 91.4% (95% CI, 54.2-81.6), patients withBCR-ABL1 IS 〈 10% at 3 months had a PFS similar to that of those with higher transcript levels. This might in part be explained by the high proportion (80%) of children who achieved a BCR-ABL1 IS 〈 10% cut-off at 3 months. This response rate, higher than that (63%) reported by Millot in children treated with IM at a lower dose, is probably due to the higher dose of the drug utilized in our patients. In conclusion, the high-doses of IM used in our study allowed to achieve better short and long term results in childhood CP-CML than those reported with lower doses of IM (Millot et al, 2014). Using such doses, the prognostic impact of a BCR-ABL1 IS 〈 10% cut-off after 3 months of IM treatment as a surrogate marker of response at 1 year and PFS is not confirmed. Disclosures Saglio: BMS: Consultancy, Other: Fees for occasional speeches; Novartis: Consultancy, Other: Fees for occasional speeches; Pfizer: Consultancy, Other: Fees for occasional speeches ; ARIAD: Consultancy, Other: Fees for occasional speeches.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2015
    detail.hit.zdb_id: 1468538-3
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  • 7
    In: The Journal of Allergy and Clinical Immunology: In Practice, Elsevier BV, Vol. 7, No. 7 ( 2019-09), p. 2369-2376
    Type of Medium: Online Resource
    ISSN: 2213-2198
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
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  • 8
    In: Blood, American Society of Hematology, Vol. 126, No. 23 ( 2015-12-03), p. 2077-2077
    Abstract: Background: In thalassemia major (TM) three iron chelators are available to treat chronic iron overload due to blood transfusions: subcutaneous desferrioxamine (DFO), oral deferiprone (DFP) and oral deferasirox (DFX). Aims: This study evaluated the relative cost effectiveness of the three chelators in monotherapy. Methods: The cost-effectiveness model used is an Italian adaptation within the MIOT (Myocardial Iron Overload in Thalassemia) project of the previously built and published UK model (Bentley A et al. Pharmacoeconomics 2013;31:807-22). Based on literature and MIOT data, it was assumed that all the monotherapies had a comparable effect on and liver iron. Data about adverse events (AE) and cardiac morbidity were taken from the MIOT Network. Four different efficacy-based scenarios were explored in respect to cardiac morbidity and mortality using Markov-type models. Cost data were updated to reflect the Italian market: the tariffs applied in Veneto Region in the year 2014 were considered for the drugs, the administration of desferrioxamine and the monitoring. In Italy Veneto Region was proved to be one of the most upright region in the health costs management. Incremental costs and quality-adjusted life-years (QALYs) were calculated for each treatment, with cost effectiveness expressed as incremental cost per QALY. Results: Within the MIOT project, none of the AE considered in the UK model (neutropenia, agranulocytosis, Franconi syndrome, hepatitis) were detected for the 193 TM patients who had been received the same chelator for at least 18 months and were considered as reference group. The table shows costs and QALYs in the different modelled scenarios. For the first three scenarios a 5-year period was considered per patient while for the last scenario a 1-year time horizon was used and the discount rate of 3% was not applied. DFP was the dominant strategy in all scenarios, providing greater QALY at a lower cost. There was a higher QALY gain with DFX compared with DFO, but at a greater cost. Conclusions: The results of this analysis indicate that, from an Italian perspective, DFP is the most cost-effective treatment available for managing chronic iron overload in β-thalassaemia patients. Use of DFP in these patients could therefore result in substantial cost savings. Table 1. Drug cost Administration costs Monitoring costs AE costs Total costs QALYs Scenario 1: iron chelators impact cardiac morbidity and mortality. Time horizon: 5 years. DFP €14,815 (€15,704) €0 (€0) €1,277 (€1,354) 0 €16,092 (€17,058) 3.962 (4.200) DFX €158,122 (€167,508) €0 (€0) €1,495 (€1,583) 0 €159,618 (€169,091) 3.876 (4.106) DFO €55,009 (€58,274) €12,034 (€12,748) €788 (€835) 0 €67,831 (€71,857) 3.285 (3.479) Scenario 2: iron chelators impact only cardiac mortality. Time horizon: 5 years. DFP €14,815 (€15,704) €0 (€0) €1,277 (€1,354) 0 €16,092 (€17,058) 3.962 (4.200) DFX €158,122 (€167,508) €0 (€0) €1,495 (€1,583) 0 €159,618 (€169,091) 3.888 (4.119) DFO €55,009 (€58,274) €12,034 (€12,748) €788 (€835) 0 €67,831 (€71,857) 3.294 (3.490) Scenario 3: iron chelators impact only cardiac morbidity. Time horizon: 5 years. DFP €14,815 (€15,704) €0 (€0) €1,277 (€1,354) 0 €16,092 (€17,058) 3.962 (4.200) DFX €161,155 (€170,820) €0 (€0) €1,524 (€1,615) 0 €162,679 (€172,435) 3.951 (4.187) DFO €56,064 (€59,427) €12,264 (€13,000) €803 (€851) 0 €69,132 (€73,278) 3.348 (3.548) Scenario 4: iron chelators are all equivalent. Time horizon: 1 year. No discount. DFP €3,141 €0 €271 0 €3,412 0.840 DFX €34,164 €0 €334 0 €34,498 0.840 DFO €11,885 €2,600 €170 0 €14,656 0.712 Discounted valuea (Undiscounted value) Disclosures Pepe: ApoPharma Inc: Speakers Bureau; Novartis: Speakers Bureau; Chiesi: Speakers Bureau.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2015
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  • 9
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 1812-1812
    Abstract: Imatinib (IM) is an established first-line treatment for children with chronic myeloid leukemia (CML). However, the most effective dosage of IM and overall management of newly-diagnosed childhood CML in chronic phase (CP) are not well defined. This study was designed to evaluate (a) the response to IM at a dosage equivalent in terms of drug exposure to the 600 mg daily utilized in adults and (b) the long-term outcome in newly-diagnosed children and adolescents with CML. Patients aged 〈 18 years with a diagnosis of CML in CP were treated with IM at a dosage of 340 mg/m2/day. Cytogenetic analyses were planned on bone marrow (BM) cells before and during IM therapy as well as quantitative RT-PCR on peripheral blood (PB) monthly and on BM every 3 months. Partial cytogenetic response (PCyR) was considered as the presence of Ph+ cells between 0 and 35%. Molecular response (MR) was considered as 〈 0.01% BCR-ABL1 IS, while major MR (MMR) was defined as 〈 0.1% BCR-ABL1 IS. This study was approved by the Istitutional Review Boards of each participating Institution. Between December 2002 and February 2014, 41 CML patients in CP (females: 13, males: 28; age 〈 10 years: 13 patients) were recorded from 9 Italian pediatric centers. Twenty-seven patients (66%) have a follow-up 〉 24 months. IM was started in all patients, including 16 with an HLA-matched sibling. The dosage of IM was modulated according to the occurrence of 〉 2 WHO side-effects or response, mainly during the first 6 months of treatment. Forty patients are evaluable for treatment results. Median administered dosage of IM was 309 mg/m2/day, higher in males than in females (326 mg/m2vs 245 mg/m2, p .015) and in those younger than 10 years (314 mg/m2vs 262 mg/m2). Twenty-four patients (60%) experienced isolated or combined side effects: hematologic toxicity (medullary hypoplasia [n=1], neutropenia [n=7] and/or thrombocytopenia [n=6], anemia [n=1] ) and/or extra-hematologic toxicity (arthralgia/myalgia [n=8] , nausea [n=1], vomiting [n=1] , diarrhea [n=1], abdominal pain [n=2] , hepatitis [n=1], skin rash [n=2] . Persistent 〉 3 WHO adverse events led to IM discontinuation in 6 patients (15%). At 3 months of IM treatment, hematologic response and PCyR rates were 91% and 54%, respectively; BCR-ABL1 transcript levels 〈 10% were found in 69% and 75% of patients on BM and on PB cells, respectively. At 6 months, 77% of patients was in CCyR; 56% and 66% of patients showed BCR-ABL1 transcript levels 〈 1% on BM and on PB cells, respectively. At 12 months, MMR was detected in 66.4% and 71.4% of patients on BM and on PB cells, respectively; BCR-ABL1 IS 〈 0.0032% was found in 21% and 14% of patients on BM and on PB cells, respectively. All but 1 patient achieved a response. Overall, 94% obtained a CCyR at a median time of 6.4 months. Fourteen of 25 (56%) and 13/17 (76%) evaluable patients obtained a MR on BM and on PB cells at a median time of 13 and 15 months, respectively. Intermittent therapy (IM at the same daily dosage for 3 weeks a month) was started in 6 patients with a sustained MR; thereafter, 2 adolescents with 〈 0.0032% BCR-ABL IS lasting 〉 7years successfully discontinued IM and 2 patients resumed continuous IM because of an increased BCR-ABL transcript. IM was interrupted in 8/33 (24%) responder patients, 4 of them in BCR-ABL1 IS 〈 0.1%, after a median time of 7 months because they underwent an allogeneic stem cell transplant (SCT). Treatment was also discontinued in 6 patients in continuous IM because of a disease recurrence (median response duration: 37 months; range, 21-115). Overall, 12 patients (30%) underwent a SCT after a median of 7.7 months: 8 from an identical sibling (BCR-ABL1 IS 〈 0.1% in 3), 3 from a MUD and 1 from an umbilical cord blood. Three patients, transplanted from an identical sibling, had disease recurrence after 24, 36 and 83 months, respectively. Estimated probabilities of failure-free survival was 50% at 8 years for patients submitted to an SCT and 60% at 10 years for those still receiving IM. At the last follow-up, all patients are alive at a median of 44.6 months. In our experience, IM at a daily dose of 340 mg/m2 is effective in newly-diagnosed CML children with responses rates higher than those reported in children treated with IM at lower dosage. Considering the long-term follow-up, high-dose IM allowed to safely discontinue treatment in some patients with a deep MR; furthermore, it did not worsen the outcome both in patients submitted to a SCT and in those with disease progression or side-effects. Disclosures Saglio: BMS: Consultancy, Fees for occasional speeches Other; Novartis: Consultancy, Fees for occasional speeches, Fees for occasional speeches Other; Pfizer: Consultancy, Fees for occasional speeches, Fees for occasional speeches Other; ARIAD: Consultancy, Fees for occasional speeches, Fees for occasional speeches Other.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
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  • 10
    In: British Journal of Haematology, Wiley, Vol. 180, No. 6 ( 2018-03), p. 895-898
    Type of Medium: Online Resource
    ISSN: 0007-1048 , 1365-2141
    URL: Issue
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    Language: English
    Publisher: Wiley
    Publication Date: 2018
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