Drugs and Cell Therapies in Hematology

Journal Information
ISSN / EISSN : 2281-4884 / 2281-4876
Published by: PAGEPress Publications (10.4081)
Total articles ≅ 91
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, Ettore Sabadini, Paola Stefanoni, Federica Delaini, Elena Oldani, Alessandro Rambaldi
Drugs and Cell Therapies in Hematology, Volume 3; https://doi.org/10.4081/dcth.2014.58

The major determinants of treatment response were analyzed in 71 newly diagnosed stage B multiple myeloma (MM) patients, whose treatment allocation was based on age and performance status but not on serum creatinine. Forty-one patients entered programs of high-dose therapy (HDT) with autotransplantation (autoTx), while the other 30 received non-autoTx-based therapies. At the end of the treatment program, serum creatinine returned below 2 mg/dl in 65% of patients. The median overall survival (OS) and event-free survival (EFS) of the 41 patients who entered programs of HDT were 32 and 26 months, respectively, which increased to 41 and 32 months for the 28 patients who received at least one autoTx. The other 30 patients allocated to non autoTx-based therapies had median OS and EFS of 17 and 14 months. Overall, 60% of patients reached at least a partial response. Requirement of dialysis at diagnosis was the strongest independent predictor of worse OS and EFS. Anemia, hypercalcemia and Bence Jones positive proteinuria were adverse predictors of EFS. In conclusion, an appropriate treatment of stage B-MM patients allows restoring a normal renal function in the majority of the cases. When feasible, HDT and autoTx represent an important treatment option also for these patients.
Deborah Patti, Paola Iudicone,
Drugs and Cell Therapies in Hematology, Volume 3; https://doi.org/10.4081/dcth.2014.57

The storage of hemopoietic progenitor cells (HPC) is a current practice to allow autologous transplantation or, in very rare cases, to collect enough HPC from donors with documented suboptimal characteristics as referred to a given recipient (e.g. high weight disparity) or not endowed with proper vascular accesses (i.e. in case of peripheral HPC collection). In the autologous setting, HPC storage may last several years at very low temperature in tank containing liquid nitrogen, albeit most units are re-infused within the first year of storage. In this review, some issues relative to the quality and safety of HPC storage are discussed with a particular focus on microbiology testing policies, protection of frozen units by secondary packages and use of liquid nitrogen produced as medical device (MD). On the basis of knowledge and technologies currently available, a proposal has been made for an improvement in the quality and safety of storage which includes the use of liquid nitrogen MD (limited to the vapor phase in a dedicated tank for units coming from patients with documented infections), two distinct options for a safe and complete screening for blood-borne agents and the universal use of cryogenic secondary bags.
, Stefano Volpetti, Marianna Chiozzotto, Simona Puglisi, Maddalena Mazzucco, Giulia Perali, Renato Fanin
Drugs and Cell Therapies in Hematology, Volume 3; https://doi.org/10.4081/dcth.2014.61

Treatment of relapsed/refractory T-cell lymphomas represents an unmet medical need. We here analyze the results of two studies, one prospective and one retrospective, recently published in order to evaluate the therapeutic impact of bendamustine in this setting of diseases. Overall 80 adult patients, the majority with a diagnosis of systemic nodal peripheral T-cell lymphoma were treated with bendamustine monotherapy. Overall response rate was achieved in nearly 50% of patients with some complete responses; angioimmunoblastic T-cell lymphoma appeared the hystotype most responsive to bendamustine, which however showed activity also in some cases of cutaneous T-cell lymphomas and prolymphocytic leukemia. Patients’ compliance to treatment was generally good. Bendamustine deserves further investigation in patients with T-cell lymphomas.
Drugs and Cell Therapies in Hematology, Volume 3; https://doi.org/10.4081/dcth.2014.59

Mantle cell lymphoma (MCL) is generally considered incurable and has the worst overall survival among B-cell lymphoma subtypes. The disease usually responds well to initial therapy but most patients relapse and then respond only briefly to salvage therapy. Nevertheless, the median overall survival of MCL patients has dramatically improved from 2 to 3 years of the 90’s to more than 5 years at present. This improvement was due either to the introduction of dose-intensive strategies and/or high-dose therapy upfront in younger patients, and to the availability of novel agents in older patients or in the relapsed/refractory setting. Bendamustine, mostly in combination with rituximab, has been recently introduced in the armamentarium for treating patients with MCL with surprising results. Its efficacy and tolerability compare favorably with any other cytotoxic drug or drug combinations for treating patients with MCL, as summarized in this review. Due to its favorable toxicity profile, bendamustine is now increasingly combined with other active compounds. Cytosine arabinoside, which is well known for its striking activity in younger patients with MCL, has been combined with bendamustine in the rituximab, bendamustine and cytarabine (R-BAC) regimen with promising results. Other novel agents, that are approved in Europe or in the United States for the treatment of MCL, like bortezomib, lenalidomide, temsirolimus, and drugs targeting the B-cell receptor pathway (idelalisib, ibrutinib), are under investigation in combination with bendamustine. These molecules provide an opportunity to build up on the regimens used in MCL either in combination with bendamustine upfront, or as maintenance, and will open new frontiers in the treatment of patients with MCL.
Drugs and Cell Therapies in Hematology, Volume 3; https://doi.org/10.4081/dcth.2014.60

Elderly patients with diffuse large B cell lymphoma often are no suitable of standard treatment due to comorbidities. Therefore to have the opportunity to use less toxic regimens and of similar efficacy represents a medical need. The combination of rituximab and bendamustine has shown a significant reduction in terms of both hematological and extra-hematological toxicity and a surprising activity both in front line and in relapsing/ refractory setting.
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