Esmeralda Conte

Low absolute lymphocyte count is a poor prognostic factor in diffuse-large-B-cell-lymphoma

The prognostic value of absolute lymphocytic count (ALC), has been a recent matter of debate in non-Hodgkin-lymphoma (NHL). We assessed prospectively the value of ALC at diagnosis and also after the completion of immuno-chemotherapy in 101 diffuse-large-B-cell-lymphoma (DLBCL). Analysis of prognostic factors with respect to overall survival (OS), event free survival (EFS) and progression free survival (PFS) was done by two-tailed log-rank test. The ALC cut-off value was calculated as <0.84 × 109/L at diagnosis: this was a strong negative prognostic factor for OS (p = 0.0004), EFS (p < 0.00001) and PFS (p < 0.00001) and in multivariate analysis was independent from the revised-international-prognostic-index (R-IPI). ALC after chemo-immunotherapy was not of prognostic value. As R-IPI and ALC < 0.84 × 109/L, were the factors better discriminating poor prognosis, a new trichotomous score (ALC/R-IPI) was built up: (1) low risk: R-IPI = very good or good and ALC < 0.84 × 109/L; (2) intermediate risk: patients with at least one risk factor (R-IPI = poor or ALC < 0.84 × 109/L). (3) high risk: patients with both risk factors. This new prognostic score was highly significant in univariate analysis for OS (p = 0.0002), EFS (p < 0.00001) and PFS (p < 0.00001). In multivariate analysis ALC/R-IPI was the most predictive factor for OS (OR = 2.954; p = 0.002) and EFS (OR = 2.381; p < 0.00001) and the only predictive factor for PFS (OR = 4.018; p < 0.00001).Our data, show that ALC at diagnosis has a strong prognostic relevance and is independent from the R-IPI. The new score including both values proved the most powerful predictor at multivariate analysis.

Identification of a potential “hotspot” DNA region in the RUNX1 gene targeted by mitoxantrone in therapy‐related acute myeloid leukemia with t(16;21) translocation

The translocation t(16;21) involving RUNX1 (AML1) and resulting in the RUNX1‐CBFA2T3 fusion is a rare but recurrent abnormality mostly found in therapy‐related acute myeloid leukemia (t‐AML) associated with agents targeting topoisomerase II (topo II). We characterized, at the genomic level, the t(16;21) translocation in a patient who developed t‐AML after treatment of multiple sclerosis with mitoxantrone (MTZ). Long template nested PCR of genomic DNA followed by direct sequencing enabled the localization of RUNX1 and CBFA2T3 (ETO2) breakpoints in introns 5 and 3, respectively. Sequencing of the cDNA with specific primers showed the presence of the expected RUNX1‐CBFA2T3 fusion transcript in leukemic cells. The RUNX1 intron 5 breakpoint was located at nucleotide position 24,785. This region contained an ATGCCCCAG nucleotide sequence showing ∼90% homology to a “hotspot” DNA region ATGCCCTAG present in intron 6 of PML previously identified in therapy‐related acute promyelocytic leukemia cases arising following treatment with MTZ. This study suggests a wider distribution in the human genome, and particularly at genes involved in chromosome translocations observed in t‐AML, of DNA regions (hotspot) targeted by specific topo II drugs.

Primary Pancreatic Burkitt Lymphoma Presenting as Acute Pancreatitis

Primary pancreatic lymphoma (PPL) is an uncommon primary extra-nodal malignant non-Hodgkin’s lymphoma (NHL) of the pancreatic gland. More than 50 % of NHL arises in extranodal sites, frequently with the involvement of the gastrointestinal tract, in particular, the stomach and small bowel [1, 2]. Only 0.2–2 % of patients with NHL have pancreatic involvement at presentation, diffuse large B-cell lymphoma being the predominant type [3, 4]. PPL is an uncommon disease, less frequent than secondary involvement of the pancreas by NHL. Pancreatic lymphoma presenting as acute pancreatitis is rare [1, 2]. We report a case of a primary pancreatic lymphoma, Burkitt type, presenting as acute pancreatitis in an adult female.

Bone marrow aspiration and biopsy-related pain management

Fabio Sollazzo & Andrea Tendas & Esmeralda Conte & Maria Paola Bianchi & Pasquale Niscola & Luca Cupelli & Maria Rita Mauroni & Veronica Molinari & Antonella D’Apolito & Vittoria Pilozzi & Stella Cacciaraichi & Caterina Viggiani & Adriana Concetta Pignatelli & Ombretta Annibali & Andrea Mengarelli & Teresa Dentamaro & Paolo de Fabritiis & Antonella Ferrari & Enrico Montefusco & William Arcese & on behalf of Rome Transplant & Network Quality of Life Working Party

Patient‐reported outcomes and quality of life assessment: New targets for new targeted therapy?

We read with great interest the article by Wood et al, which demonstrated that patient-reported physical component impairment reported before hematopoietic cell transplantation (HCT) independently predicted poor overall survival after allogeneic HCT. Prompted by their article, we would like to provide some interesting observations. First, the physical component scale of the Medical Outcomes Study Short Form-36 Health Survey (SF-36) questionnaire enumerates 4 components: physical functioning, role functioning, bodily pain, and general health. The patient-perceived component impairment could be related to coexisting illness (hematological disease burden, therapy-related complications, or comorbid illness), as stated by the authors. It also could be considered as a causal factor for complications, with a subsequent effect on morbidity and overall survival. In our opinion, among the 4 components, physical functioning retains a major role in the prognosticate patient trajectory during all the phases of disease and treatment, from initial treatment to transplant, and from diagnosis to advanced-phase disease. Second, the article by Wood et al strengthens our opinion in favor of both the baseline and prospective use of quality of life assessment with the aim of producing a “dashboard” with indicators and alarms that may both ameliorate the capacity of prognosticate HCT risk prior to the procedure and help to monitor the development of complications after HCT. However, several points should be discussed concerning this issue, such as which symptoms should be evaluated (predefined symptoms, patienttailored symptoms) and how often (daily, weekly, monthly), but suggestions could be drafted. Finally, patient-reported outcomes assessment could be interlaced with prearranged patient-reported outcomesdriven procedures of supportive care, such as prehabilitation/rehabilitation or pain control. It is our firm opinion that those targeted interventions should be initiated promptly to prevent and treat physical component impairment, not only at the time of transplantation but immediately after disease diagnosis and during induction therapy. Effects on both the patients’ quality of life and caregivers’ workload are strongly expected, whereas a positive impact on morbidity and mortality could only be hypothesized and addressed with dedicated clinical trials.

Protection during haempoietic stem cell transplantation: a survey from the quality of life working party of the Rome Transplant Network

Hospitalisation in protected/isolated rooms is a measure, frequently, adopted for hematological patients undergoing to intensive treatment, such as allogeneic (allo) or autologous (auto) stem cell transplantation (SCT), due to a high risk of infections.1 However, the level of evidence about the efficacy of isolation measure during SCT is poor, thus resulting in discrepancy between different centres.1 Prolonged isolation affects quality of life, due to restriction of socio-familiar role and lack of psychological relieve of patients, thus increasing the high burden of symptoms reported by transplanted patients during the first weeks after SCT.2–6 Moreover, isolation could affect psychological status of patient relatives, such as children, frequently not allowed to visit their parent during hospitalisation. Isolation effects on patient undergoing to SCT could …

Rehabilitation need and referrals in hematopoietic stem cell transplantation: the experience of Quality of Life Working Party of the Rome Transplant Network.

Rehabilitation need and referrals in hematopoietic stem cell transplantation: the experience of Quality of Life Working Party of the Rome Transplant Network