Annalisa Peli

Incidence of bacterial and fungal infections in newly diagnosed acute myeloid leukaemia patients younger than 65 yr treated with induction regimens including fludarabine: retrospective analysis of 224 cases

Objectives:  Infections are the major cause of morbidity and mortality in patients with acute myeloid leukaemia (AML). They primarily occur during the first course of induction chemotherapy and may increase the risk of leukaemia relapse, due to a significant delay in consolidation therapy. The intensification of induction chemotherapy and the use of non‐conventional drugs such as fludarabine are considered responsible for the increased risk of infections.

Plasmablastic lymphoma among human immunodeficiency virus-positive patients: results of a single center's experience.

Plasmablastic lymphoma (PBL) is a recently introduced entity, with a particularly aggressive clinical behavior among human immunodefi ciency virus-positive (HIV-pos) patients [1], and with a predilection for the mucosa of the oral cavity [2,3]. Occasionally, PBL has also been reported among HIV-negative patients, with a similar unfavorable prognosis [4]. Markers of plasmacytic diff erentiation (CD38/CD138) and CD20 negativity are usually observed, together with a phenotypic pattern indicating a post-germinal center origin [5]. An etiological role of Epstein – Barr virus (EBV) has been suggested [6]. c-myc translocation has been observed in 49% of PBL, and may be associated with a worse prognosis [7]. Due to the rarity of this disease, data concerning its clinical characteristics and prognosis are limited to case reports and small series [8,9]. Recently, Castillo et al . [10] and Schommers et al . [11] reported the results of multicentric retrospective studies on HIV-pos patients aff ected by PBL, confi rming the aggressive behavior and a poor prognosis of PBL. In order to verify this clinical behavior among our patients, we evaluated clinical characteristics, response to treatment and outcome of all consecutive HIV-pos patients with PBL admitted to and treated at our institution. Data concerning patients aff ected by PBL were extracted from the institutional database, where all consecutive HIV-pos patients with a diagnosis of lymphoma have been prospectively registered since 1985. Diagnosis of PBL required plasmablastic morphology, CD20 negativity and the expression of at least one plasmacytic marker (CD138 and/or MUM1/IRF4). EBV expression and c-myc rearrangement were also evaluated. Detailed information on age, gender, immunological status, histopathological features, clinical characteristics of lymphoma, type of treatment, toxicity and outcome were retrieved from the clinical charts of all patients included in the study. Progression-free survival (PFS) was defi ned as the time between diagnosis and progression or death, whichever happened fi rst, or last follow-up visit. Overall survival (OS) was defi ned as the time between diagnosis and death or last follow-up visit [12]. OS and PFS were evaluated according to the Kaplan – Meier method, and diff erences among subgroups were assessed by the log-rank test. Between January 1985 and August 2013, 221 cases of HIV-pos aggressive non-Hodgkin lymphoma (NHL) were recorded in the database (98 in the pre-highly active antiretroviral therapy [HAART] and 123 in the HAART era) and 18 patients were found with a reported diagnosis of PBL. After histological revision, 17 patients with newly diagnosed PBL were retrieved. Four patients were diagnosed before 1997, when HAART was not available (pre-HAART era) and 13 after 1997 (HAART era). However, three patients were HAARTnaive at lymphoma diagnosis. A trend for a higher frequency of PBL was found in the HAART period (13/123, 10.6%) as compared to the pre-HAART period (4/98, 4.1%) ( p 0.08, Fisher ’ s exact test). Characteristics of the patients were as follows: median age 36 years (range 25 – 54); male/female ratio 14/3; median time from HIV diagnosis to lymphoma 29 months (0 – 299); median CD4 count at PBL diagnosis 241/ m L (13 – 727); six patients (35%) with less than 200/ m L CD4; advanced disease (stage III – IV) and B symptoms in 14 (87.5%) and fi ve (31.3%) out of 16 evaluable patients, respectively; and oral cavity involvement in seven cases, more frequently in the preHAART (75%) than in the HAART era (30.8%). Extranodal involvement other than the oral cavity was observed in 88% of patients (gastrointestinal tract four cases; bone marrow, liver and bone two cases each; breast, testis and lung one case each). EBV encoded small RNA (EBER) positivity was observed in all 13 evaluable cases (100%). c-myc translocation analysis was performed in eight patients and c-myc rearrangement was observed in fi ve (62.5%), at baseline. Two patients, in the HAART era, did not receive any treatment because of early death and refusal, respectively. All the remaining 15 patients were treated with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) or CHOP-like regimens. Involved fi eld irradiation L eu k L ym ph om a D ow nl oa de d fr om in fo rm ah ea lth ca re .c om b y N yu M ed ic al C en te r on 0 7/ 21 /1 5

A simple prognostic scoring system for newly diagnosed cytogenetically normal acute myeloid leukemia: retrospective analysis of 530 patients

Abstract We retrospectively analyzed the data of 337 patients with cytogenetically normal (CN) acute myeloid leukemia (AML), aged ≤ 65 years (training set). A prognostic index score (PIS) was calculated by totaling the score derived from the regression coefficients of each clinical variable, significantly associated with prognosis by multivariate analysis. The variables that were independent prognostic factors for event-free survival (EFS) and overall survival (OS) in the training set were: age ≥ 50 years, secondary AML and white blood cell count (WBC) ≥ 20 × 109/L. The patients of the training set were stratified into three groups: low-, intermediate- and high-risk. The median EFS was 25, 12 and 7 months in the low-, intermediate- and high-risk groups (p < 0.0001), respectively. The median OS was not reached in the low-risk group and was 19 and 10 months in the intermediate- and high-risk groups (p < 0.0001). This PIS was validated in a series of 193 patients with CN-AML. The median EFS was 66, 16, and 3 months (p < 0.0001) and the median OS was 66, 16, and 5 months in the three risk groups, respectively (p < 0.0001). This PIS may be useful for clinical decision-making in CN-AML and may be prospectively integrated with the newest biological markers which at present are not routinely assessed and need prognostic validation.

Romidepsin in relapsed/refractory T-cell lymphomas: Italian experience and results of a named patient program

Abstract Clinical trial results indicate that romidepsin, a histone deacetylase inhibitor, is a promising treatment in relapsed/refractory T-cell lymphomas (TCLs). This retrospective multicenter study was conducted in patients with relapsed/refractory TCL treated with romidepsin monotherapy through a Named Patient Program (NPP) in Italy. Principal endpoints were overall response rate (ORR), safety, and overall survival (OS). The ORR in 33 evaluable patients was 24.2% with an ORR in the cutaneous TCL of 35.7%. Global OS was 39.3% at 30 months. There were not any specific differences on hematological and extrahematological adverse events. Data from patients treated with romidepsin outside a controlled clinical trial give additional information about the clinical use, efficacy, and toxicity of the drug given to relapsed or refractory TCL patients in a real life context as TCLs are rare diseases and more information is needed. These findings suggest that romidepsin is effective and safe for heavily pretreated TCL patients.