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1.
Ann Hematol ; 101(8): 1727-1739, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35587825

RESUMO

We report herein a multicentre retrospective analysis of 192 consecutive patients with symptomatic refractory/relapsed multiple myeloma (RRMM) treated with daratumumab in combination with bortezomib or lenalidomide as salvage therapy at 9 haematological centres in Puglia. Choice of both regimens was based on previous treatment and/or physicians' preference. Considering the under-representation of older patients (very old patient ≥ 80 years) in clinical trials and the prognostic and predictive importance and value of frailty status, here, we further characterised the patient cohort by age. The overall response rate (ORR) was generally lower than what was previously reported in the CASTOR (ORR 72.6% vs 85%) and POLLUX (ORR 86.5% vs 93%) trials. The lower ORR in our analysis compared to the CASTOR and POLLUX trials could be related to a less selected population. Similarly, amongst very old patients, the ORR was encouraging: ORR to treatment with DVd (daratumumab + bortezomib + dexamethasone) was 66.7%, and ORR to treatment with DRd (daratumumab + lenalidomide + dexamethasone) was 92.3%. Median TTP (time to progression) was 10.8 months (1-year TTP: 44.7%; 2-year TTP: 25.3%) in the DVd group; median TTP was not reached in the DRd group (1-year TTP: 82.7%; 2-year TTP: 71.4%). Median OS (overall survival) was not reached either in the DRd group (1-year OS: 85.9%; 2-year OS: 73.7%) or the DVd group (1-year OS: 70.2%; 2-year OS: 58.9%).


Assuntos
Mieloma Múltiplo , Neoplasias de Plasmócitos , Anticorpos Monoclonais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bortezomib , Dexametasona , Seguimentos , Humanos , Lenalidomida , Mieloma Múltiplo/tratamento farmacológico , Estudos Retrospectivos , Terapia de Salvação
2.
Leuk Res ; 39(3): 279-83, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25636354

RESUMO

This current retrospective multicenter analysis represents, to our knowledge, the first Italian study evaluating the efficacy and toxicity profile of "lenalidomide plus dexamethasone" as salvage therapy in patients with recurrent-refractory MM in the real life contest. Our study included patients who are usually excluded from clinical trials because of unfavorable baseline characteristics. Median OS was significantly longer in patients receiving "lenalidomide plus dexamethasone" for more than 12 months compared with those who had received "lenalidomide plus dexamethasone" for a shorter interval (P<0.0001). Median OS was not affected by best response achieved (P 0.4) and age (P 0.3). Quality of response did not correlate with number of previous lines of therapy (P 0.77) and age. Higher ORRs were recorded in the patients group with relapsed MM compared to those with refractory disease, but this difference was not statistically significant (P 0.38).


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Mieloma Múltiplo/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Terapia de Salvação , Adulto , Idoso , Idoso de 80 Anos ou mais , Dexametasona/administração & dosagem , Feminino , Seguimentos , Humanos , Lenalidomida , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/patologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Talidomida/administração & dosagem , Talidomida/análogos & derivados
4.
Blood Cancer J ; 1(6): e27, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22829171

RESUMO

Wingless-type (Wnt) signaling through the secretion of Wnt inhibitors Dickkopf1, soluble frizzled-related protein-2 and -3 has a key role in the decreased osteoblast (OB) activity associated with multiple myeloma (MM) bone disease. We provide evidence that another Wnt antagonist, sclerostin, an osteocyte-expressed negative regulator of bone formation, is expressed by myeloma cells, that is, human myeloma cell lines (HMCLs) and plasma cells (CD138+ cells) obtained from the bone marrow (BM) of a large number of MM patients with bone disease. We demonstrated that BM stromal cells (BMSCs), differentiated into OBs and co-cultured with HMCLs showed, compared with BMSCs alone, reduced expression of major osteoblastic-specific proteins, decreased mineralized nodule formation and attenuated the expression of members of the activator protein 1 transcription factor family (Fra-1, Fra-2 and Jun-D). Moreover, in the same co-culture system, the addition of neutralizing anti-sclerostin antibodies restored OB functions by inducing nuclear accumulation of ß-catenin. We further demonstrated that the upregulation of receptor activator of nuclear factor κ-B ligand and the downregulation of osteoprotegerin in OBs were also sclerostin mediated. Our data indicated that sclerostin secretion by myeloma cells contribute to the suppression of bone formation in the osteolytic bone disease associated to MM.

5.
Bone Marrow Transplant ; 29(4): 285-90, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11896424

RESUMO

Our study analyzes the mobilization of hematopoietic stem cells after two chemotherapeutic regimens in non-Hodgkin's lymphoma (NHL) patients. The study included 72 patients with NHL (42 follicular and 30 large cells). The mean age was 37 years (range 17-60). Sixty-four patients (88.9%) had stage III-IV disease. Forty-eight patients (66.7%) had bone marrow involvement. Systemic B symptoms were present in 42 patients (58.3%). Mobilization chemotherapy regimens were randomly assigned as DHAP in 38 patients (52.7%) or cyclophosphamide (CPM) (5 g/m(2)) in 34 (47.2%) and the results of 132 procedures were analyzed. At the time of PBSC mobilization, 46 patients (63.9%) were considered to be responsive (complete remission, partial remission or sensitive relapse) and 26 (36.1%) not responsive (refractory relapse or refractory to therapy). Pre-apheresis CD34+ blood cell count and number of previous chemotherapy treatments were used to predict the total number of CD34+ cells in the apheresis product. The mobilizing regimens (CPM or DHAP) were similar in achieving the threshold CD34+ cell yield, for optimal engraftment. Since DHAP was very effective as salvage treatment, we suggest using DHAP as a mobilizing regimen in patients with active residual lymphoma at the time of stem cell collection.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Cisplatino , Ciclofosfamida/administração & dosagem , Citarabina , Dexametasona , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Mobilização de Células-Tronco Hematopoéticas/métodos , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/terapia , Adolescente , Adulto , Feminino , Mobilização de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas , Humanos , Contagem de Leucócitos , Linfoma não Hodgkin/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transplante Autólogo
6.
Psychother Psychosom ; 45(2): 91-6, 1986.
Artigo em Inglês | MEDLINE | ID: mdl-2947258

RESUMO

The authors deal with the psychological and psychopathological implications connected with cervicobrachial neuralgia and low-back pain. In particular they propose a classification of the various pathologies pertaining to cervicobrachial neuralgia and low-back pain of nonneoplastic organic etiology. In the last part of the present paper the authors touch on the broader issues of patient handling and the role of psychiatric consultation.


Assuntos
Dor nas Costas/psicologia , Neurite do Plexo Braquial/psicologia , Dor nas Costas/etiologia , Dor nas Costas/terapia , Neurite do Plexo Braquial/etiologia , Neurite do Plexo Braquial/terapia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Equipe de Assistência ao Paciente , Prognóstico , Psiquiatria , Psicopatologia
7.
Psychother Psychosom ; 33(1-2): 1-6, 1980.
Artigo em Inglês | MEDLINE | ID: mdl-7375622

RESUMO

The authors present some of their experiences concerning psychiatric consultation in a 1,800-bed university hospital. Particular evidence is given to the development which the physician-psychiatrist relationship has had in the long run. The experiences refer to the consultation work carried out in the Department of Medicine, in the Division of Cardiology and in the Hemodialysis Unit.


Assuntos
Hospitais de Ensino , Hospitais Universitários , Psiquiatria , Encaminhamento e Consulta , Adulto , Humanos , Relações Interprofissionais , Itália , Masculino , Relações Médico-Paciente , Testes Psicológicos , Transtornos Psicofisiológicos/psicologia , Psicoterapia
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