19 results on '"R Rosamilio"'
Search Results
2. Mesenchymal Stem Cells from the Wharton’s Jelly of the Human Umbilical Cord: Biological Properties and Therapeutic Potential
- Author
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Carmine Selleri, Maria Antonietta Castaldi, Rosa Vitolo, Bianca Serio, R Rosamilio, Enrico Ragni, Maurizio Guida, Caterina Fulgione, Salvatore Giovanni Castaldi, Luigi Marino, and Rosario Bianco
- Subjects
Human leukocyte antigen ,Review Article ,Umbilical cord ,Regenerative medicine ,Immunomodulation ,03 medical and health sciences ,0302 clinical medicine ,Wharton's jelly ,medicine ,Human umbilical cord blood ,030304 developmental biology ,GvHD ,0303 health sciences ,business.industry ,Mesenchymal stem cell ,Cell Biology ,Embryonic stem cell ,Haematopoiesis ,medicine.anatomical_structure ,WJ-MSCs ,Immunology ,Mesenchymal stem cells ,Stem cell ,business ,030217 neurology & neurosurgery ,Developmental Biology - Abstract
Wharton's jelly mesenchymal stem cells (WJ-MSCs) are a class of stem cells with high differentiative potential, an immuno-privileged status and easy access for collection, which raise no legal or ethical issues. WJ-MSCs exhibit several features of embryonic stem cells, both in the phenotypic and genetic aspects, with only a few differences, such as a shorter doubling time and a more extensive ex vivo expansion capacity. WJ-MSCs have immunomodulatory properties, involving both innate and adaptive immune responses. This review focuses on the role of WJ-MSCs in the management of graft-versus-host disease (GvHD), a life-threatening complication of the allogenic transplantation of hematopoietic stem cells. Different studies documented the beneficial effect of the infusion of WJ-MSCs, even when not fully HLA identical, in patients with severe GvHD, refractory to standard treatment. Finally, we summarized current ongoing clinical trials with WJ-MSCs and their potential in regenerative medicine.
- Published
- 2019
3. PS1270 HIGH INCIDENCE OF CYTOMEGALOVIRUS (CMV) REACTIVATION IN HEMATOLOGICAL PATIENTS TREATED WITH BENDAMUSTINE BASED CHEMOTERAPY REGIMENS
- Author
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M.C. Martorelli, R. Fonatana, L. Pezzullo, R. Rosamilio, Carmine Selleri, R. bianco, B. serio, G. cassiodoro, E. Vaccaro, R. Guariglia, and A. Bruno
- Subjects
Bendamustine ,business.industry ,medicine ,Congenital cytomegalovirus infection ,Hematology ,High incidence ,medicine.disease ,Cmv reactivation ,business ,Virology ,medicine.drug - Published
- 2019
4. INCREASED CYTOMEGALOVIRUS (CMV) REACTIVATION IN PATIENTS TREATED WITH BENDAMUSTINE BASED REGIMEN IS CORRELATE WITH DRAMATICAL REDUCTION OF CD4+ T LYMPHOCITES
- Author
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M.C. Martorelli, R Rosamilio, R. bianco, R. Guariglia, E. Vaccaro, Carmine Selleri, A. Bruno, G Villani, R Fontana, Bianca Serio, L Pezzullo, and G. cassiodoro
- Subjects
Bendamustine ,Cancer Research ,medicine.medical_specialty ,business.industry ,Congenital cytomegalovirus infection ,Hematology ,General Medicine ,medicine.disease ,Cmv reactivation ,Gastroenterology ,Regimen ,Oncology ,Internal medicine ,medicine ,In patient ,business ,medicine.drug - Published
- 2019
5. Role of Laparoscopic Splenectomy in Elderly Immune Thrombocytopenia
- Author
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Vincenzo Pilone, Amato de Paulis, R Rosamilio, Carmine Selleri, Francesca Wanda Rossi, Valentina Giudice, Rosa Maria Di Crescenzo, Bianca Serio, Giudice, Valentina, Rosamilio, Rosa, Serio, Bianca, Di Crescenzo, Rosa Maria, Rossi, FRANCESCA WANDA, DE PAULIS, Amato, Pilone, Vincenzo, and Selleri, Carmine
- Subjects
Pediatrics ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Splenectomy ,Review Article ,Laparoscopic splenectomy ,03 medical and health sciences ,0302 clinical medicine ,Elderly ,medicine ,Laparoscopy ,medicine.diagnostic_test ,business.industry ,Immune thrombocytopenia ,General Medicine ,030220 oncology & carcinogenesis ,Concomitant ,Corticosteroid ,Medicine ,Rituximab ,business ,Complication ,030215 immunology ,medicine.drug - Abstract
The management of older patients with chronic primary immune thrombocytopenia (ITP) is still very challenging because of the fragility of older patients who frequently have severe comorbidities and/or disabilities. Corticosteroid-based first-line therapies fail in most of the cases and patients require a second-line treatment, choosing between rituximab, thrombopoietin-receptor agonists and splenectomy. The choice of the best treatment in elderly patients is a compromise between effectiveness and safety and laparoscopic splenectomy may be a good option with a complete remission rate of 67% at 60 months. But relapse and complication rates remain higher than in younger splenectomized ITP patients because elderly patients undergo splenectomy with unfavorable conditions (age >60 year-old, presence of comorbidities, or multiple previous treatments) which negatively influence the outcome, regardless the hematological response. For these reasons, a good management of concomitant diseases and the option to not use the splenectomy as the last possible treatment could improve the outcome of old splenectomized patients.
- Published
- 2016
6. Reproductive issues in patients undergoing Hematopoietic Stem Cell Transplantation: an update
- Author
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Maurizio Guida, Francesco Orio, R Rosamilio, Maria Antonietta Castaldi, Carmine Selleri, Valentina Giudice, Guida, Maurizio, Castaldi Maria, Antonietta, Rosamilio, Rosa, Giudice, Valentina, Orio, Francesco, and Selleri, Carmine
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Reproductive medicine ,Graft vs Host Disease ,Hematopoietic stem cell transplantation ,Review ,Malignancy ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,immune system diseases ,Pregnancy ,hemic and lymphatic diseases ,Obstetrics and Gynaecology ,Medicine ,Humans ,Fertility preservation ,Intensive care medicine ,Reproductive health ,030219 obstetrics & reproductive medicine ,business.industry ,Hematopoietic Stem Cell Transplantation ,Obstetrics and Gynecology ,Disease Management ,Fertility Preservation ,Neoplasms, Second Primary ,medicine.disease ,Female Urogenital Diseases ,Premature ovarian failure ,Surgery ,surgical procedures, operative ,Fertility ,Oncology ,030220 oncology & carcinogenesis ,Osteoporosis ,Female ,business ,Immunosuppressive Agents - Abstract
In 1963 George Mathe announced to the world that he had cured a patient of leukaemia by means of a bone-marrow transplant. Since than much progress has been made and nowadays Hematopoietic Stem Cell Transplantation (HSCT) is considered the most effective treatment of numerous severe haematological diseases. Gynaecological complications in HSCT women represent a serious concern for these patients, but often underestimated by clinicians in the view of Overall Survival. The main gynaecological complications of HSCT are represented by: premature ovarian failure (POF), thrombocytopenia-associated menorrhagia, genital symptoms or sexual problems in course of chronic GVHD (cGVHD), osteoporosis, secondary solid tumours due to immunosuppressive drugs to treat cGVHD and severity of cGVHD, and fertility and pregnancy issues. In particular fertility-related issues are always more relevant for patients, whose life expectation is constantly growing up after HSCT. Thus, taking care of a patient undergoing HSCT should primarily include gynaecological evaluation, even before conditioning regimen or chemotherapy for the underlying malignancy, as, in our opinion, it is of great importance to ensure a complete diagnostic work-up and intervention options to guarantee maximum reproductive health and a better quality of life in HSCT women. The present review aims at describing principal features of the aforementioned gynaecological complications of HSCT, and to define, on the basis of current international literature, a specific protocol for the prevention, diagnosis, management and follow-up of gynaecological complications of both autologous and heterologous transplantation, before and after the procedure.
- Published
- 2016
7. The Role of B Regulatory Cells in the Immunological Escape of Tumor Cells in Hodgkin Lymphoma
- Author
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M Rocco, G Villani, Valentina Giudice, Carmine Selleri, R Rosamilio, L Pezzullo, Bianca Serio, and Idalucia Ferrara
- Subjects
biology ,business.industry ,T cell ,Dacarbazine ,Immunology ,Cell Biology ,Hematology ,Biochemistry ,CD19 ,Vinblastine ,Interleukin 10 ,medicine.anatomical_structure ,biology.protein ,Medicine ,Cytotoxic T cell ,IL-2 receptor ,business ,CD8 ,medicine.drug - Abstract
Hodgkin and Reed-Sternberg (HRS) cells in classical Hodgkin Lymphoma (HL) are surrounded by a rich inflammatory infiltrate which aids in their survival and escape from cytotoxic CD8+ T cells (CTLs) and Natural Killer cells (NKs). Within HL environment, T regulatory cells (Tregs) directly suppress the activity of CTLs and NKs, enhancing the tolerance against HRS cells. B regulatory cells (Bregs) have been shown to support the differentiation of Tregs through IL-10 production; thus, we hypothesized that they could have a role in the pathophysiology of HL. We evaluated 30 classic HL patients (M/F: 18/12; median age, 31 years, range 15-62) and 5 healthy controls (HC) for circulating peripheral blood (PB) Bregs, Tregs, CTLs, NKs, and NKTs. Twenty-four of them were new-diagnosed patients (NwHL) and 6 received a previous diagnosis of HL but were in complete remission (CR) for more than 12 months (PvHL). NwHL patients were divided according to the International Prognostic Score (IPS) and the Ann-Arbor Staging System. All subjects were treated following the ABVD protocol (doxorubicin 25 mg/m2, bleomycin 10 U/m2, vinblastine 6 mg/m2, and dacarbazine 375 mg/m2). Flow cytometry was performed on heparinized PB samples with a 5-color Beckman Coulter Cytomics FC500 flow cytometer. Breg (CD19+CD24+), Treg (CD3+CD4+CD25+), CTL (CD3+CD8+), NK (CD3-CD56+), and NKT (CD3+CD56+) levels were measured simultaneously with the PET/CT evaluations, ie at diagnosis, at the end of the second ABVD administration, at the end of treatment, and at 6 and/or 12 months off-therapy. Moreover, Breg levels were compared to IPS and Ann-Arbor staging groups, and also were correlated to the erythrocyte sedimentation rate (ESR) and to the absolute lymphocyte count (ALC). We found decreased circulating Bregs in NwHL and PvHL patients compared to controls (0.39% vs 0.875% vs 1.813%, respectively, p Our preliminary data suggest involvement of Bregs in the escape and survival of HRS cells during active disease. Peripheral blood may mirror disease activity in lymphoid tissues. Thus, the decrease of circulating Bregs may be related to the recruitment of these cells to the tumor site; amplification of the Bregs/Tregs ratio may result in a greater Breg-dependent Treg activation with subsequent inhibition of CTL and NK function. Additionally, the normalization of Bregs and the Bregs/Tregs ratio after chemotherapy could be used to predict disease remission. While larger prospective studies are required to validate these results, we present intriguing evidence of the involvement of Bregs in the pathophysiology of HL. Disclosures No relevant conflicts of interest to declare.
- Published
- 2016
8. How to Improve the Definition of Chronic Lymphocytic Leukemia Outcome Using a Simple Flow Cytometric Score Based on CD49d and Homing Marker Expression
- Author
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Bianca Serio, G Villani, Luigi Marino, Valentina Giudice, S Annunziata, Carmine Selleri, Idalucia Ferrara, R Rosamilio, L Pezzullo, R Fontana, and M Rocco
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,Chronic lymphocytic leukemia ,Immunology ,Cell Biology ,Hematology ,CD49d ,medicine.disease ,Biochemistry ,Chemotherapy regimen ,Immunophenotyping ,immune system diseases ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Platelet Count measurement ,Hemoglobin measurement ,business ,Homing (hematopoietic) - Abstract
The identification of new molecular markers in Chronic Lymphocytic Leukemia (CLL) allowed to better define prognosis and clinical outcome. The actual staging systems could estimate the prognosis, but not the rapidity of disease evolution. Neither the identification of new molecular markers did allow to foresee the evolution and clinical response, because discordant findings were mostly reported. The aim of the present study was (1) to confirm the independent prognostic role of CD49d as a single marker in CLL patients, (2) to investigate the relationship between CD49d and other well-established CLL-membrane predictor markers (CD5, CD11c, CD20 and CD38) or clinical staging systems and (3) to evaluate the role of an immunophenotypic score based on the flow-cytometric detection of CD5, CD11c, CD20, CD38 and CD49d in the work up of CLL staging. Heparinized whole blood was collected from 68 CLL patients for immunophenotyping using the following antibodies: anti kappa, anti-lambda, CD5, CD11c, CD19, CD20, CD23, CD38, CD45, CD49d. A scoring system was elaborated combining 5 membrane markers: CD5, CD11c, CD20, CD38 and CD49d. Antigens were divided in two groups, favorable (CD5 and CD20) and unfavorable (CD11c, CD38 and CD49d) prognostic markers, and the cut-off of positivity was chosen according to the literature (30% for CD5, CD11c, CD20 and CD38, and 45% for CD49d). A value of "0" or "1" ("2" only for CD49d positivity) was assigned according to antigen expression. Finally, we defined a favorable phenotype when the sum of all the cytometric features was equal or less than 2, conversely the unfavorable phenotype was defined for a sum equal or greater than 3 (between 3 and 6). Flow cytometric analysis showed high CD49d expression in CD19+ cells in 47% of patients (n=32), and high CD38 expression in 44% of subjects (n=30), simultaneously expressed in 28% of patients (n=19). The 19% (n=13) of all CLL patients were CD5-, and interestingly the 85% of them showed higher expression of CD49d. Linear correlation was found between CD49d and CD38 (r2=0.08772, p=0.0142), and between CD49d and CD20 expression (r2=0.2490, p45% of CD49d positive cells. Four patients with Unfavorable Phenotype received chemotherapy with an ORR of 25%. Furthermore, a small population (n=16) of our CLL cohort was also studied for genetic abnormalities using FISH technique. According to FISH analysis, 25% of studied patients were classifies as very low-risk and, interestingly, no one of them showed an Unfavorable Phenotype (only one patient carried CD49d as unique negative marker). In our cohort, 50% of patients were low-risk with no genetic abnormalities or +12, but 63% of them showed an Unfavorable Phenotype with high CD49d and CD38 expression in 100% and 60% of cases, respectively. Our data confirm the independent negative prognostic role of CD49d and suggest a stronger prognostic power compared to CD38 in the definition of CLL outcome, because of its complex activity as homing marker, signaling receptor and anti-apoptotic molecule. Thus, the prognostic significance of CD49d may be enhanced when considered in comparison with other established markers, as CD11c and CD38. In conclusion, our results propose the use of the CD49d marker in combination with other B-cell membrane antigens as an additional tool for routine diagnosis and risk-stratification of CLL patients. Identification of high-risk phenotype with a simple scoring method could improve the treatment of these patients, who could take advantage of the most recent molecular targeting therapies. Disclosures No relevant conflicts of interest to declare.
- Published
- 2016
9. Cytomegalovirus reactivation prophylaxis with low dose valgancyclovir after hematopoietic stem cell transplantation
- Author
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Ciro De Luca, R Fontana, Carmine Selleri, M Rocco, Valentina Giudice, S Annunziata, Mariarosaria Sessa, R Rosamilio, L Pezzullo, Bianca Serio, and Idalucia Ferrara
- Subjects
medicine.medical_specialty ,Acute leukemia ,business.industry ,medicine.medical_treatment ,Immunology ,Cell Biology ,Hematology ,Hematopoietic stem cell transplantation ,medicine.disease ,Biochemistry ,Asymptomatic ,Gastroenterology ,Surgery ,Cyclosporin a ,Internal medicine ,medicine ,Methotrexate ,medicine.symptom ,Complication ,business ,Viral load ,Multiple myeloma ,medicine.drug - Abstract
Cytomegalovirus (CMV) reactivation is one of the most frequent complication after hematopoietic stem cell transplantation (HSCT). Pre-transplant CMV-positive recipient serostatus is the most significant independent variable for viral reactivation. Oral valgancyclovir (VGCV) is a prodrug of intravenous gancyclovir (GCV) and is an effective and safety alternative for the management of CMV reactivation prophylaxis and preemptive therapy. However, VGCV at standard dose (900 mg twice a day) increases risk of myelosuppression in HSCT recipients. The efficacy of low dose (LD, 450 mg daily) oral VGCV was retrospectively evaluated in 30 allogeneic HLA-matched related patients and 2 unrelated, with a median age of 40 years (range, 18-59) and a median follow-up of 30 months (range, 3-56). Primary diseases were acute myeloid leukemia (AML, n=19), acute lymphoblastic leukemia (n=4), non-Hodgkin’s lymphoma (n=3), multiple myeloma (n=3) and myelodysplastic syndrome (n=3). Seventeen of twenty-three acute leukemia (AL) patients were transplanted in first complete remission (CR), while the remaining (n=6) were transplanted in 2nd CR. Five patients suffered from AML secondary to long-lasting MDS (n=3) or Hodgkin disease and breast cancer (n=2). Based upon CMV serostatus (D/R, donor/recipient), thirty (94%) of HSCT recipients were classified as high risk (D-/R+ = 3 and D+/R+ = 27) for CMV reactivation and only 6% as low risk (D-/R- = 2); none of the patients was in the intermediate risk group (D+/R-). Fifteen and 17 patients received a myeloablative and RIC regimens, respectively. Twenty-one patients received GvHD prophylaxis with cyclosporin A (CsA, 1 mg/kg intravenously from day -1 to +21, then 8 mg/kg orally for at least 6 months) and short-course methotrexate (MTX, 10 mg/kg on days +1, +3, +6 and +11). The others (n=11) received CsA with MTX and antithymocyte globulin (ATG, as a part of the conditioning regimen at 10 mg/kg at days -3, -2 and -1). According to the Glucksberg scoring system, thirteen patients experienced grade I-II and two grade III-IV acute GvHD, while 7 patients developed limited (n=6, 18%) and extensive (n=3, 10%) chronic GvHD. Starting from time of engraftment, LD oral VGCV was given prophylactically for at least 6 months. CMV infection was monitored weekly using polymerase chain reaction (PCR) in high risk seropositive recipients and we started preemptive therapy when the peak viral load exceeding 1000 copies/mL in two consecutive plasma samples. Six patients (4 early and 2 late) developed a positive PCR after a mean of 59 days post-HSCT successfully treated with 900 mg of VGCV twice a day for at least when PCR negative (in a median of 12 days). Only one patient developed late fatal gastrointestinal CMV disease. Indeed, asymptomatic early and late CMV-DNA PCR reactivation occurred only in 17% (n=5) of high risk seropositive HSCT recipients, in contrast to 37% and 18% of early and late CMV reactivation observed in matched gender, disease phase, graft source and CMV serostatus cohort of 32 HSCT recipients treated prophylactically with oral acyclovir (ACV, 15 mg/kg daily) and high dose intravenous immunoglobulins (IVIG, 0.4 gr/kg weekly for at least 6 months) . Seven patients presented hematological toxicity do not requiring drug discontinuation. The rate of non CMV-related infections was 25% and was similar in both groups with and without CMV reactivation. At the end of the follow-up, 18 of 32 (56%) patients were alive with a median follow-up of 31 months (range, 2-56). Relapsed-related mortality was 20%, transplant-related mortality was 9% and did not differ between group with and without CMV reactivation. Our data provide evidence that LD-VGCV is safe and effective as CMV reactivation prophylaxis in allogeneic HSCT recipients. These results require further validation in randomized studies. Disclosures: No relevant conflicts of interest to declare.
- Published
- 2013
10. Mesenchymal Stem Cells from the Wharton's Jelly of the Human Umbilical Cord: Biological Properties and Therapeutic Potential.
- Author
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Marino L, Castaldi MA, Rosamilio R, Ragni E, Vitolo R, Fulgione C, Castaldi SG, Serio B, Bianco R, Guida M, and Selleri C
- Abstract
Wharton's jelly mesenchymal stem cells (WJ-MSCs) are a class of stem cells with high differentiative potential, an immuno-privileged status and easy access for collection, which raise no legal or ethical issues. WJ-MSCs exhibit several features of embryonic stem cells, both in the phenotypic and genetic aspects, with only a few differences, such as a shorter doubling time and a more extensive ex vivo expansion capacity. WJ-MSCs have immunomodulatory properties, involving both innate and adaptive immune responses. This review focuses on the role of WJ-MSCs in the management of graft-versus-host disease (GvHD), a life-threatening complication of the allogenic transplantation of hematopoietic stem cells. Different studies documented the beneficial effect of the infusion of WJ-MSCs, even when not fully HLA identical, in patients with severe GvHD, refractory to standard treatment. Finally, we summarized current ongoing clinical trials with WJ-MSCs and their potential in regenerative medicine.
- Published
- 2019
- Full Text
- View/download PDF
11. Role of Laparoscopic Splenectomy in Elderly Immune Thrombocytopenia.
- Author
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Giudice V, Rosamilio R, Serio B, Di Crescenzo RM, Rossi F, De Paulis A, Pilone V, and Selleri C
- Abstract
The management of older patients with chronic primary immune thrombocytopenia (ITP) is still very challenging because of the fragility of older patients who frequently have severe comorbidities and/or disabilities. Corticosteroid-based first-line therapies fail in most of the cases and patients require a second-line treatment, choosing between rituximab, thrombopoietin-receptor agonists and splenectomy. The choice of the best treatment in elderly patients is a compromise between effectiveness and safety and laparoscopic splenectomy may be a good option with a complete remission rate of 67% at 60 months. But relapse and complication rates remain higher than in younger splenectomized ITP patients because elderly patients undergo splenectomy with unfavorable conditions (age >60 year-old, presence of comorbidities, or multiple previous treatments) which negatively influence the outcome, regardless the hematological response. For these reasons, a good management of concomitant diseases and the option to not use the splenectomy as the last possible treatment could improve the outcome of old splenectomized patients., Competing Interests: Conflict of interest statement: Authors state no conflict of interest. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
- Published
- 2016
- Full Text
- View/download PDF
12. Efficacy and safety of splenectomy in adult autoimmune hemolytic anemia.
- Author
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Giudice V, Rosamilio R, Ferrara I, Seneca E, Serio B, and Selleri C
- Abstract
Autoimmune hemolytic anemia (AIHA) is a rare hematologic disease, primarily affecting adults or children with immunodeficiency disease. First-line therapy consists of long course of steroids administration, with an early complete response rate (CRr) of 75-80%, but up to 20-30% of patients requires a second-line therapy. Rituximab is the first choice in refractory old AIHA patients, because of its safety and efficacy (early CRr at 80-90% and at 68% at 2-3 years). For this reason, splenectomy is even less chosen as second-line therapy in elderly, even though laparoscopic technique decreased complication and mortality rates. However, splenectomy can be still considered a good therapeutic option with a CRr of 81% at 35.6 months in patients older than 60 year-old, when rituximab administration cannot be performed., Competing Interests: Conflict of interest statement: Authors state no conflict of interest Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
- Published
- 2016
- Full Text
- View/download PDF
13. Prolonged complete hematologic response in relapsed/refractory T-large granular lymphocyte leukemia after bendamustine treatment.
- Author
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Rosamilio R, Giudice V, Ferrara I, Annunziata S, Pezzullo L, Villani G, Baldi C, Guariglia R, Rocco M, and Selleri C
- Abstract
T-large granular lymphocyte leukemia (T-LGLL) is a chronic clonal proliferation of effector memory cytotoxic CD3
+ CD57+ CD56- T cells and the current guidelines suggest immunosuppressive therapy as first-line therapy, but the treatment of refractory/relapsed patients is still challenging due to the lack of prospective studies. We describe a series of two refractory/relapsed T-LGLL patients successfully treated with bendamustine, a chemotherapeutic agent largely used for B-cell neoplasms, but poorly investigated for the treatment of T-cell diseases. Complete remission (CR) was achieved in 3 and 6 months, respectively, and maintained for at least 20 months. One patient relapsed after a 20-month CR, but she was responsive to bendamustine therapy again, obtaining a further prolonged CR. Bendamustine as single agent or in combination could be a feasible therapeutic option in refractory/relapsed T-LGLL, especially for elderly patients because of its safety profile.- Published
- 2016
14. Reproductive issues in patients undergoing Hematopoietic Stem Cell Transplantation: an update.
- Author
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Guida M, Castaldi MA, Rosamilio R, Giudice V, Orio F, and Selleri C
- Subjects
- Disease Management, Female, Fertility, Fertility Preservation, Graft vs Host Disease diagnosis, Graft vs Host Disease etiology, Graft vs Host Disease therapy, Humans, Immunosuppressive Agents adverse effects, Immunosuppressive Agents therapeutic use, Neoplasms, Second Primary diagnosis, Neoplasms, Second Primary etiology, Neoplasms, Second Primary therapy, Osteoporosis diagnosis, Osteoporosis etiology, Osteoporosis therapy, Pregnancy, Female Urogenital Diseases diagnosis, Female Urogenital Diseases etiology, Female Urogenital Diseases therapy, Hematopoietic Stem Cell Transplantation adverse effects
- Abstract
In 1963 George Mathé announced to the world that he had cured a patient of leukaemia by means of a bone-marrow transplant. Since than much progress has been made and nowadays Hematopoietic Stem Cell Transplantation (HSCT) is considered the most effective treatment of numerous severe haematological diseases. Gynaecological complications in HSCT women represent a serious concern for these patients, but often underestimated by clinicians in the view of Overall Survival. The main gynaecological complications of HSCT are represented by: premature ovarian failure (POF), thrombocytopenia-associated menorrhagia, genital symptoms or sexual problems in course of chronic GVHD (cGVHD), osteoporosis, secondary solid tumours due to immunosuppressive drugs to treat cGVHD and severity of cGVHD, and fertility and pregnancy issues. In particular fertility-related issues are always more relevant for patients, whose life expectation is constantly growing up after HSCT.Thus, taking care of a patient undergoing HSCT should primarily include gynaecological evaluation, even before conditioning regimen or chemotherapy for the underlying malignancy, as, in our opinion, it is of great importance to ensure a complete diagnostic work-up and intervention options to guarantee maximum reproductive health and a better quality of life in HSCT women.The present review aims at describing principal features of the aforementioned gynaecological complications of HSCT, and to define, on the basis of current international literature, a specific protocol for the prevention, diagnosis, management and follow-up of gynaecological complications of both autologous and heterologous transplantation, before and after the procedure.
- Published
- 2016
- Full Text
- View/download PDF
15. OPSI threat in hematological patients.
- Author
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Serio B, Pezzullo L, Giudice V, Fontana R, Annunziata S, Ferrara I, Rosamilio R, De Luca C, Rocco M, Montuori N, and Selleri C
- Abstract
Overwhelming post-splenectomy infection (OPSI) is a rare medical emergency, mainly caused by encapsulated bacteria, shortly progressing from a mild flu-like syndrome to a fulminant, potentially fatal, sepsis. The risk of OPSI is higher in children and in patients with underlying benign or malignant hematological disorders. We retrospectively assessed OPSI magnitude in a high risk cohort of 162 adult splenectomized patients with malignant (19%) and non malignant (81%) hematological diseases, over a 25-year period: 59 of them splenectomized after immunization against encapsulated bacteria, and 103, splenectomized in the previous 12-year study, receiving only life-long oral penicillin prophylaxis. The influence of splenectomy on the immune system, as well as the incidence, diagnosis, risk factors, preventive measures and management of OPSI are also outlined. OPSI occurred in 7 patients (4%) with a median age of 37 years at time interval from splenectomy ranging from 10 days to 12 years. All OPSIs occurred in non immunized patients, except one fatal Staphylococcus aureus -mediated OPSI in a patient adequately immunized before splenectomy. Our analysis further provides evidence that OPSI is a lifelong risk and that current immune prophylaxis significantly decreases OPSI development. Improvement in patients' education about long-term risk of OPSI and increased physician awareness to face a potentially lethal medical emergency, according to the current surviving sepsis guidelines, represent mandatory strategies for preventing and managing OPSI appropriately.
- Published
- 2013
16. Fine needle aspiration biopsy of intraparotid spindle cell lipoma: a case report.
- Author
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D'Antonio A, Baldi C, Memoli D, Caleo A, Rosamilio R, and Zeppa P
- Subjects
- Actins analysis, Adipocytes pathology, Adult, Antigens, CD34 analysis, Biopsy, Fine-Needle, Humans, Lipoma diagnosis, Lipoma diagnostic imaging, Male, Parotid Gland diagnostic imaging, Parotid Neoplasms diagnosis, Parotid Neoplasms diagnostic imaging, S100 Proteins analysis, Ultrasonography, Lipoma pathology, Parotid Neoplasms pathology
- Abstract
Intraparotid spindle cell lipoma (SCL) of the salivary gland is a rare entity. Review of the literature revealed only two previous reports describing its cytological features. We report a case of a 44-year-old man who complained for a slowly growing, asymptomatic mass in the left parotid gland that since 12 months. Fine needle aspiration biopsy (FNAB) showed a loose collections of bland-appearing spindle cells in a myxoid background admixed with capillary fragments and some mature fat cells suggesting a diagnosis of SCL. A cytological diagnosis of mesenchymal myxoid spindle cell tumor with lipomatous differentiation, possibly an intraparotideal SCL was performed. Histological examination of the mass and the positive immunostaining for CD34 and negativity for S-100, CK-cocktail, and actin confirmed the diagnosis of SCL. The diagnosis of intraparotid SCL can be made by examining cytologic material containing mature fat with bland spindle cells in a myxoid background. FNAB diagnosis on SCL also allows to rule out other primary salivary gland tumors that may be clinically and instrumentally indistinguishable and thereby permits an appropriate surgical procedure to ensue., (Copyright © 2011 Wiley Periodicals, Inc.)
- Published
- 2013
- Full Text
- View/download PDF
17. Accelerated bone mass senescence after hematopoietic stem cell transplantation.
- Author
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Serio B, Pezzullo L, Fontana R, Annunziata S, Rosamilio R, Sessa M, Giudice V, Ferrara I, Rocco M, De Rosa G, Ricci P, Tauchmanovà L, Montuori N, and Selleri C
- Abstract
Osteoporosis and avascular necrosis (AVN) are long-lasting and debilitating complications of hematopoietic stem cell transplantation (HSCT). We describe the magnitude of bone loss, AVN and impairment in osteogenic cell compartment following autologous (auto) and allogeneic (allo) HSCT, through the retrospective bone damage revaluation of 100 (50 auto- and 50 allo-HSCT) long-term survivors up to 15 years after transplant. Current treatment options for the management of these complications are also outlined. We found that auto- and allo-HSCT recipients show accelerated bone mineral loss and micro-architectural deterioration during the first years after transplant. Bone mass density (BMD) at the lumbar spine, but not at the femur neck, may improve in some patients after HSCT, suggesting more prolonged bone damage in cortical bone. Phalangeal BMD values remained low for even more years, suggesting persistent bone micro-architectural alterations after transplant. The incidence of AVN was higher in allo-HSCT recipients compared to auto-HSCT recipients. Steroid treatment length, but not its cumulative dose was associated with a higher incidence of bone loss. Allo-HSCT recipients affected by chronic graft versus host disease seem to be at greater risk of continuous bone loss and AVN development. Reduced BMD and higher incidence of AVN was partly related to a reduced regenerating capacity of the normal marrow osteogenic cell compartment. Our results suggest that all patients after auto-HSCT and allo-HSCT should be evaluated for their bone status and treated with anti-resorptive therapy as soon as abnormalities are detected.
- Published
- 2013
18. Low-dose valgancyclovir as cytomegalovirus reactivation prophylaxis in allogeneic haematopoietic stem cell transplantation.
- Author
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Serio B, Rosamilio R, Giudice V, Pepe S, Zeppa P, Esposiito S, Pezzullo L, Rocco M, Montuori N, and Selleri C
- Subjects
- Adolescent, Adult, Antiviral Agents pharmacology, Female, Ganciclovir administration & dosage, Ganciclovir pharmacology, Humans, Male, Middle Aged, Prospective Studies, Valganciclovir, Young Adult, Antiviral Agents administration & dosage, Cytomegalovirus drug effects, Cytomegalovirus physiology, Cytomegalovirus Infections etiology, Cytomegalovirus Infections prevention & control, Ganciclovir analogs & derivatives, Hematopoietic Stem Cell Transplantation adverse effects, Virus Activation drug effects
- Abstract
The efficacy and safety of low dose oral valgancyclovir (VGCV) as cytomegalovirus (CMV) reactivation prophylaxis was retrospectively evaluated in 32 consecutive patients which underwent allogeneic HLA-matched related and unrelated hematopoietic stem cell transplantation (HSCT). Thirty HSCT recipients showed pretransplant CMV seropositivity. Fifteen received a myeloablative conditioning regimen, while seventeen patients received a reduced-intensity conditioning regimen. Twenty-one patients received graft-versus-host disease (GVHD) prophylaxis with cyclosporin A (CsA) and methotrexate (MTX), and the others CsA with MTX and anti-thymocyte globulin. CMV infection was monitored weekly using polymerase chain reaction (PCR). VGCV was administered orally at a dose of 450 mg daily for six months. Six patients developed a positive CMV-PCR on average 56 days after HSCT successfully treated with VGCV at 1800 mg/day, except one who developed fatal gastrointestinal CMV disease. At the time of CMV reactivation, four patients had been affected by grade II-IV acute GVHD and two by an extensive chronic GVHD. No significant specific VGCV-related toxicity was encountered. Seven patients presented hematological toxicity which did not require drug discontinuation. Our data suggest that low dose VGCV is safe and effective as CMV reactivation prophylaxis in allogeneic HSCT recipients. These results require further validation in prospective randomized studies.
- Published
- 2012
19. Successful management of pulmonary mucormycosis with liposomal amphotericin B and surgery treatment: a case report.
- Author
-
Serio B, Rosamilio R, Giudice V, Zeppa P, Esposito S, Fontana R, Annunziata S, and Selleri C
- Subjects
- Adult, Combined Modality Therapy, Humans, Male, Remission Induction, Amphotericin B therapeutic use, Antifungal Agents therapeutic use, Lung Diseases, Fungal drug therapy, Lung Diseases, Fungal surgery, Mucormycosis drug therapy, Mucormycosis surgery
- Abstract
Mucormycosis is an increasingly recognized invasive fungal infection (IFI) in patients with acute myeloid leukemia (AML) and after allogeneic (allo) stem cell transplantation (HSCT); it is mainly due to the severe and prolonged neutropenia related to high-dose chemotherapy. In such patients, the lung is the most frequently involved site in mucormycosis. Since rapidly progressive dissemination may occur after pulmonary mucormycosis in hematologic malignancies, early diagnosis and prompt initiation of an effective antifungal therapy is mandatory for a successful outcome. We report the case of a young AML patient who developed, early after the onset of neutropenia in the first induction phase of chemotherapy, a rapidly progressive pulmonary IFI, successfully treated with liposomal Amphotericin-B (LAmB) and then with a limited open toracothomy biopsy, clearly establishing diagnosis of mucormycosis and removing lung infiltrate. Secondary prophylaxis with LamB, applied during both consolidation therapy and myeloablative sibling allogeneic HSCT, was effective to prevent IFI recurrence despite the development of grade I acute graft-versus-host disease (GVHD) and limited chronic GVHD requiring immunosuppressive treatment. Our case report further provide evidence that the combined surgical and LAmB therapy is an effective and safe choice for the management of pulmonary mucormycosis in hematological immunocompromised patients.
- Published
- 2012
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