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Sant'Ambrogio di Torino, Italy

Tedeschi A.,Ospedale Niguarda Ca Granda Milan | Ricci F.,Ospedale Niguarda Ca Granda Milan | Goldaniga M.C.,University of Milan | Benevolo G.,Azienda Ospedaliera San Giovanni Battista | And 11 more authors.
Clinical Lymphoma, Myeloma and Leukemia | Year: 2013

The combination FCR (fludarabine, cyclophosphamide, and rituximab) proved to be active in Waldenström's macroglobulinemia in a mixed population of untreated and previously treated patients. Prolonged myelosuppression and concerns about purine analogue treatment led to the conclusion that this regimen should be avoided in younger patients in first-line treatment. In this retrospective study on 40 patients we observed a response rate of 80% (32) after FCR salvage treatment with 32.5% (13) of patients reaching at least a very good partial remission. None of the prognostic variables had a significant effect on response or good quality of response achievement. Median event-free survival was reached at 77 months; median progression-free survival was not reached after a median follow-up of 51 months with any difference when categorizing patients according to quality of response. The results of this study suggest that the FCR regimen might overcome poor prognostic features and should be taken into account as salvage treatment. Tardive immunosuppression and myelosuppression warrant accurate patient follow-up. © 2013 Elsevier Inc. Source

Galassi C.,Azienda Ospedaliera San Giovanni Battista | Baldini M.,Osservatorio Epidemiologico Ambientale della Regione Marche | Serinelli M.,Centro Regionale Aria | Pandolfi P.,UOC Epidemiologia | And 18 more authors.
Epidemiologia e Prevenzione | Year: 2013

OBJECTIVE: to evaluate the relationship between air pollution and hospital admissions in 25 Italian cities that took part in the EpiAir (Epidemiological surveillance of air pollution effects among Italian cities) project. DESIGN: study of time series with case-crossover methodology, with adjustment for meteorological and time-dependent variables. The association air pollution-hospitalisation was analyzed in each of the 25 cities involved in the study; the overall estimates of effect were obtained subsequently by means of a meta-analy-sis. The pollutants considered were PM10, PM2.5 (in 13 cities only), NO2 and ozone (O3); this last pollutant restricted to the summer season (April-September). SETTING AND PARTICIPANTS: the study has analyzed 2,246,448 urgent hospital admissions for non-accidental diseases in 25 Italian cities during the period 2006-2010; 10 out of 25 cities took part also in the first phase of the project (2001-2005). MAIN OUTCOMEMEASURES: urgent hospital admissions for cardiac, cerebrovascular and respiratory diseases, for all age groups, were considered. The respiratory hospital admissions were analysed also for the 0-14-year subgroup. Percentage increases risk of hospitalization associated with increments of 10 μg/m 3 and interquartile range (IQR) of the concentration of each pollutant were calculated. RESULTS: reported results were related to an increment of 10 μg/m3 of air pollutant. The percent increase for PM10 for cardiac causes was 0.34% at lag 0 (95%CI 0.04-0.63), for respiratory causes 0.75% at lag 0-5 (95%CI 0.25-1.25). For PM2.5, the percent increase for respiratory causes was 1.23% at lag 0-5 (95%CI 0.58-1.88). For NO2, the percent increase for cardiac causes was 0.57%atlag 0 (95%CI 0.13-1.02); 1.29% at lag 0-5 (95%CI 0.52-2.06) for respiratory causes. Ozone (O3) did not turned out to be positively associated neither with cardiac nor with respiratory causes as noted in the previous period (2001-2005). CONCLUSION: the results of the study confirm an association between PM10, PM2.5, and NO2 on hospital admissions among 25 Italian cities. No positive associations for ozone was noted in this period. Source

Zinzani P.L.,University of Bologna | Marchetti M.,Unita di Ematologia | Billio A.,Unita di Ematologia | Carella A.M.,Azienda Ospedaliera Universitaria San Martino | And 7 more authors.
American Journal of Hematology | Year: 2013

By using the GRADE system, we updated the guidelines for management of follicular cell lymphoma issued in 2006 from SIE, SIES, and GITMO group. We confirmed our recommendation to frontline chemoimmunotherapy in patients with Stage III-IV disease and/or high tumor burden. Maintenance rituximab was also recommended in responding patients. In patients relapsing after an interval longer than 12 months from frontline therapy, we recommended chemoimmunotherapy with non cross-resistant regimens followed by rituximab maintenance. High dose chemotherapy followed by hematopoietic stem cell transplant was recommended for young fit patients who achieve a response after salvage chemoimmunotherapy. © 2012 Wiley Periodicals, Inc. Source

Piovesan L.,University of Turin | Molino G.,Azienda Ospedaliera San Giovanni Battista | Terenziani P.,University of Piemonte Orientale
HEALTHINF 2015 - 8th International Conference on Health Informatics, Proceedings; Part of 8th International Joint Conference on Biomedical Engineering Systems and Technologies, BIOSTEC 2015 | Year: 2015

Clinical practice guidelines are widely used to support physicians, but only on individual pathologies. The treatment of patients affected by multiple diseases (comorbid patients) requires the development of new approaches, supporting physicians in the detection of interactions between guidelines. We propose a new methodology, supporting flexible and physician-driven search and detection. In particular, we provide a flexible and interactive mechanism to navigate guidelines and our ontology of interactions (between drugs, or between actions' goals) at multiple levels of detail, focusing on specific parts of it (e.g., on a specific pair of actions, or of drugs) to look for interactions. We introduce the notion of "navigation tree", as the basic data structure to support multiple-level interaction analysis, and describe navigation and focusing algorithms operating on it. We also introduce a visualization tool that is based on the "navigation tree", and further enhances the user-friendliness of our approach. Source

Palumbo A.,University of Turin | Larocca A.,University of Turin | Genuardi M.,University of Turin | Kotwica K.,University of Turin | And 14 more authors.
Haematologica | Year: 2010

Background Defibrotide is a novel orally bioavailable polydisperse oligonucleotide with anti-thrombotic and anti-adhesive effects. In SCID/NOD mice, defibrotide showed activity in human myeloma xenografts. This phase I/II study was conducted to identify the most appropriate dose of defibrotide in combination with melphalan, prednisone and thalidomide in patients with relapsed and relapsed/refractory multiple myeloma, and to determine its safety and tolerability as part of this regimen. Design and Methods This was a phase I/II, multicenter, dose-escalating, non-comparative, open label study. Oral melphalan was administered at a dose of 0.25 mg/kg on days 1-4, prednisone at a dose of 1.5 mg/kg also on days 1-4 and thalidomide at a dose of 50-100 mg/day continuously. Defibrotide was administered orally at three dose-levels: 2.4, 4.8 or 7.2 g on days 1-4 and 1.6, 3.2, or 4.8 g on days 5-35.Results Twenty-four patients with relapsed/refractory multiple myeloma were enrolled. No dose-limiting toxicity was observed. In all patients, the complete response plus very good partial response rate was 9%, and the partial response rate was 43%. The 1-year progression-free survival and 1-year overall survival rates were 34% and 90%, respectively. The most frequent grade 3-4 adverse events included neutropenia, thrombocytopenia, anemia and fatigue. Deep vein thrombosis was reported in only one patient. Conclusions This combination of melphalan, prednisone and thalidomide together with defibrotide showed anti-tumor activity with a favorable tolerability. The maximum tolerated dose of defibrotide was identified as 7.2 g p.o. on days 1-4 followed by 4.8 g p.o. on days 5-35. Further trials are needed to confirm the role of this regimen and to evaluate the combination of defibrotide with new drugs (ClinicalTrials.gov Identifier: NCT00406978). © 20-10 Ferrata Storti Foundation. Source

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