3 results on '"di Grazia, C."'
Search Results
2. Liposomal daunorubicin, fludarabine, and cytarabine (FLAD) as bridge therapy to stem cell transplant in relapsed and refractory acute leukemia.
- Author
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De Astis E, Clavio M, Raiola AM, Ghiso A, Guolo F, Minetto P, Galaverna F, Miglino M, Di Grazia C, Ballerini F, Marani C, Pastori G, Mitscheunig L, Cruciani F, Lovera D, Varaldo R, Ghiggi C, Lemoli RM, Bacigalupo A, and Gobbi M
- Subjects
- Adolescent, Adult, Aged, Antineoplastic Combined Chemotherapy Protocols adverse effects, Blood Component Transfusion, Combined Modality Therapy, Consolidation Chemotherapy, Cytarabine administration & dosage, Cytarabine adverse effects, Daunorubicin administration & dosage, Daunorubicin adverse effects, Diarrhea chemically induced, Drug Administration Schedule, Drug Evaluation, Female, Granulocyte Colony-Stimulating Factor therapeutic use, Humans, Kaplan-Meier Estimate, Leukemia, Myeloid, Acute therapy, Liposomes, Male, Middle Aged, Neutropenia chemically induced, Neutropenia drug therapy, Precursor Cell Lymphoblastic Leukemia-Lymphoma therapy, Proportional Hazards Models, Remission Induction, Retrospective Studies, Vidarabine administration & dosage, Vidarabine adverse effects, Vidarabine analogs & derivatives, Young Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Hematopoietic Stem Cell Transplantation, Leukemia, Myeloid, Acute drug therapy, Precursor Cell Lymphoblastic Leukemia-Lymphoma drug therapy, Salvage Therapy
- Abstract
Therapeutic options for patients with relapsed or refractory acute leukemia are still undefined and often unsatisfactory. We report the outcome of 79 patients with relapsed-refractory acute leukemia treated with fludarabine, cytarabine, and liposomal daunorubicin (FLAD regimen) followed by hematopoietic stem cell transplantation (HSCT), when clinically indicated, between May 2000 and January 2013. Forty-one patients had acute myeloid leukemia (AML), and 38 had acute lymphoblastic leukemia (ALL). Two patients with myeloid blast crises of CML and three with lymphoid blast crises were included in the AML and ALL subgroups, respectively. Median age was 48 years (range 13-77). FLAD was well tolerated with negligible, nonhematological toxicity. Six patients (7.5 %) died before response evaluation. Forty-seven patients achieved hematologic complete response (CR). Complete remission rate was 53 and 65 % among AML and ALL patients, respectively. No CR was recorded among 11 refractory AML patients. Twenty-four patients (30 %) underwent HSCT. Nine patients received stem cells from an HLA identical sibling, and 15 from an alternative donor (3 unrelated matched, 12 haploidentical sibling). Median overall survival in AML and ALL patients receiving FLAD therapy was 9 and 8 months, respectively. A 5-year projected OS for patients receiving the whole program (FLAD + HSCT) was 24 % for AML patients (median survival 43 months), 28 % for ALL patients treated in relapse (median survival 15 months), and 0 % for ALL patients treated for refractory disease. In this paper, we show that FLAD seems to be an effective bridge therapy to HSCT for a part of poor prognosis acute leukemia patients. However, prospective studies are needed to confirm our results.
- Published
- 2014
- Full Text
- View/download PDF
3. Epidemiology of viral respiratory tract infections in an outpatient haematology facility.
- Author
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Mikulska M, Del Bono V, Gandolfo N, Dini S, Dominietto A, Di Grazia C, Bregante S, Varaldo R, Orsi A, Ansaldi F, Bacigalupo A, and Viscoli C
- Subjects
- Cohort Studies, Cross Infection diagnosis, Cross Infection epidemiology, Cross Infection therapy, Female, Hematologic Neoplasms therapy, Humans, Influenza, Human therapy, Male, Prospective Studies, Respiratory Syncytial Viruses isolation & purification, Respiratory Tract Infections diagnosis, Respiratory Tract Infections epidemiology, Respiratory Tract Infections therapy, Rhinovirus isolation & purification, Ambulatory Care methods, Hematologic Neoplasms diagnosis, Hematologic Neoplasms epidemiology, Hematopoietic Stem Cell Transplantation adverse effects, Influenza, Human diagnosis, Influenza, Human epidemiology
- Abstract
Viral respiratory tract infections (VRTI) are an important cause of morbidity and mortality in haematology patients, particularly after haematopoietic stem cell transplantation (HSCT). The incidence, clinical presentation and outcome of symptomatic and asymptomatic VRTI in HSCT outpatient unit were prospectively evaluated during a single influenza season (January-March 2011). Pharyngeal swabs were performed at the first visit and if new symptoms were present. Molecular multiplex assay for 12 respiratory viruses was performed by the regional reference laboratory. Among 264 swabs from 193 outpatients, 58 (22 %) resulted positive for 61 viruses (influenza, n = 20; respiratory syncytial virus [RSV], n = 21; rhinovirus, n = 12; coronavirus, n = 4; adenovirus, n = 3; parainfluenza, n = 1). VRTI were detected more frequently in the presence of symptoms than in asymptomatic patients: 49 out of 162 (30 %) vs. 9 out of 102 (9 %), p < 0.001. Influenza-like illness syndrome (ILI) was significantly associated with a VRTI if compared to other presentations (42 %), while the European Centre for Disease Prevention and Control definition was not (30 %). Positive predictive value (PPV) of ILI for influenza was 17 %. Influenza and RSV peak periods were contemporary. Influenza prophylaxis was given to 25 patients following exposure. Low rate of progression from upper to lower respiratory tract infection (approximately 5 % for influenza and RSV), no nosocomial epidemics and no VRTI-related deaths were observed. VRTI are very frequent in high-risk haematology outpatients, but symptoms are aspecific and PPV of ILI is low. Symptoms of influenza and RSV overlap. Thus, microbiological diagnosis and contact preventive measures are crucial. Rather than universal influenza prophylaxis, prompt diagnosis and treatment of only documented infections could be pursued.
- Published
- 2014
- Full Text
- View/download PDF
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