La Piastinopenia Immune (PTI) è una patologia autoimmune ad eziologia ignota caratterizzata da piastrinopenia. I linfociti T regolatori (Tregs) sono coinvolti nei meccanismi di tolleranza immunologica e agiscono regolando l’attività delle cellule T autoreattive e delle cellule dendritiche (DCs). Viceversa, le DCs, che esprimono Indoleamine 2,3-dioxygenase (IDO), partecipano al mantenimento della tolleranza agli auto-antigeni attraverso l’espansione dei Tregs. Inoltre, recenti studi hanno dimostrato che i linfociti T helper 17 (Th17) sono coinvolti nell’autoimmunità e che l’espressione di Interleuchina (IL)-17 è associata a numerose patologie autoimmuni. Il ruolo dell’interazione fra DCs e Tregs ed il ruolo dei Th17 nella patogenesi della PTI non sono mai stati studiati in maniera approfondita. Gli obiettivi principali di questa tesi sono stati: a) caratterizzare fenotipicamente e funzionalmente i linfociti Tregs e DCs; b) valutare il ruolo patogenetico dell’interazione tra Tregs e DCs; c) quantificare i Th17 circolanti. I risultati dimostrano che: 1) il numero dei Tregs circolanti dei pazienti, identificati tramite i marcatori Foxp3 e CD127, è significativamente ridotto rispetto alla controparte normale; 2) la conversione in vitro delle cellule CD4+CD25- in linfociti Tregs (CD4+CD25+Foxp3+) dopo stimolazione con DCs mature è significativamente ridotta nei pazienti rispetto ai controlli; 3) sia l’espressione dell’enzima IDO nelle DCs mature (mRNA) che i livelli di chinurenine prodotte (indice di attività enzimatica) sono risultati significativamente ridotti nei pazienti rispetto alla controparte normale. Questi risultati suggeriscono quindi che il ridotto numero dei Tregs circolanti nei pazienti con PTI può essere, almeno in parte, attribuito alla scarsa capacità di conversione delle DCs, in quanto tali cellule esprimono meno IDO. I risultati dimostrano inoltre che: 1) i Tregs dei pazienti con PTI hanno una capacità soppressoria che è significativamente inferiore rispetto ai soggetti normali; tale dato è stato confermato dal dosaggio di IFN- nel surnatante della coltura; 2) i Tregs di pazienti con PTI non sono in grado di inibire la maturazione delle DCs, a differenza di quanto avviene nei soggetti sani: infatti, l’espressione delle molecole costimolatorie CD80 e CD86 sulle DCs è risultata invariata in seguito a cocoltura con DCs immature; 3) il dosaggio delle citochine nel surnatante delle cocolture dimostra che la concentrazione di IL-10 e IL-6 è significativamente ridotta nei pazienti rispetto ai controlli. La scarsa abilità dei Tregs di inibire la maturazione delle DCs e l’alterato pattern di secrezione di citochine potrebbero quindi contribuire all’ insorgenza del fenotipo più maturo delle DCs nei pazienti con PTI. I linfociti Th17 circolanti di pazienti e controlli sono stati identificati in citofluorimetria come cellule CD4+CD161+CD196+. Da tale analisi è emerso che la frequenza dei Th17 circolanti non è significativamente diversa nei due gruppi. Questi dati dimostrano quindi che nella PTI l’interazione bidirezionale tra Tregs e DCs risulta alterata e svolge un ruolo patogenetico, in quanto, da un lato, ci sono Tregs con un deficit numerico e funzionale e, dall’altro, DCs con maggiore capacità immunogenica. Il numero dei Th17 non risulta invece alterato.

Evaluation of carotid artery intima-media thickness in patients affected by psoriasis Psoriasis is associated with an increased risk of atherosclerosis. This study compared subclinical atherosclerosis, evaluating intima-media thickness the of the carotid in psoriasis vulgaris patients and healthy controls using high-resolution ultrasonography and the correlation of this parameter with other cardiovascular risk factors, like insulin resistance and dyslipidemia, METHODS: We will study 40 psoriasis patients, asymptomatic for cardiovascular diseases, and 40 healthy controls matched for age and sex. Intima-media thickness of the common carotid arteries will be measured ultrasonographically. Diabetes mellitus, hypertension, renal failure, a history of cardiovascular or cerebrovascular disease will be exclusion criteria. Subjects who are receiving lipid-lowering therapy, antihypertensive or anti-aggregant drugs, nitrates or long-term systemic steroids will be also excluded. Objective of this study is the evaluation of carotid artery intima-media thickness and its correlation with other blood cardiovascular risk factors in patients affected by psoriasis but asinptomatic for coronary comparing this data with the healthy control subjects. Considering that the presence of psoriasis is an independent risk factor for subclinical atherosclerosis, we want to consider this method of evaluation of cardiovascular risk and to control this risk to prevent IMA.

Il trapianto delle cellule staminali emopoietiche umane CD34+ in combinazione con le cellule T regolatorie CD4+/CD25+ FoxP3+ (Tregs) potrebbe prevenire l'alloreattività verso le cellule staminali emopoietiche e ridurre il rischio di rigetto in trapianti allogenici HLA non correlati. Per dimostrare questa ipotesi abbiamo messo in coltura le cellule CD34+ e le cellule CD4+/CD25+ isolate con metodica immunomagnetica (Miltnyi Biotec)da sangue periferico non manipolato,sangue periferico mobilizzato con G-CSF o da Cordone ombelicale. Gli esperimenti svolti in vitro, hanno evidenziato che le cellule Tregs arricchite, ottenute dalla stessa fonte delle cellule CD34+( autologhe), mostravano un effetto inibitorio maggiore sulle celulle T alloreattive, rispetto alle cellule Tregs ottenute da un donatore terzo(allogenico).Inoltre l'attività immunosoppressoria delle Tregs era mantenuta dopo stimolazione con cellule CD34+ allogeniche e i Tregs non modificavano l'attività clonogenica delle cellule staminali CD34+. Avendo ottenuto questi dati in vitro abbiamo trapiantato in topi NOD/SCID le cellule Tregs e le cellule CD34+ in rapporto 1:1 o 1:2 ed è stato osservato un normale attecchimento delle cellule staminali. Incubando queste cellule con dosi fisiologiche di timoglobulina derivata da coniglio (nota molecola immunosopressoria) non veniva modificato il numero dei Tregs dopo 6 giorni di coltura. Dopo l'esposizione alla Timoglobulina, inoltre, i Tregs mantenevano la loro attività soppressoria, aumentava l'espressione del recettore chemochinico CCR7, e venivano rilasciate diverse citochine principalmente l'interleuchina 10(IL-10). Tali dati dimostrano come sia le cellule tregs autologhe che quelle allogeniche potrebbero essere trapiantate insieme alle cellule staminali CD34+ dopo un regime preparatorio di terapia che include la timoglobulina. A tale scopo sono state eseguite selezioni di Tregs da aferesi di donatori sani mobilizzati con G-CSF su scala clinica utilizzando biglie immunomagnetiche Clinical grade (Miltenyi Biotec) e sono state confrontate 2 modalità di selezione con due o tre passaggi con o senza la deplezione dei monociti CD14+.Si è dimostrato così che è possibile selezionare un numero uguale di CD34+ e Tregs ,che con la metodica che prevede la deplezione dei monociti si ottiene una popolazione di cellule Tregs più pura ( > 80%) e infine le applicazioni possibili di questi risultati includo: trapianto di cellule CD34+ del donatore insieme a cellule Tregs in trapianti aploidentici ; infusione of cellule tregs isolate da PBSC mobilizzati con G-nei casi di pazienti con GVHD steroide-resistente; infusione di G-Tregs del donatore nei casi di rigetto di organo trapiantato da of donatore ancora vivente.

Background. Outcome of elderly acute myeloid leukemia (AML) patients is dismal. Targeted-therapies might improve current results by overcoming drug-resistance and reducing toxicity. Aim. We conduced a phase II study aiming to assess efficacy and toxicity of Tipifarnib (Zarnestra®) and Bortezomib (Velcade®) association in AML patients >18 years, unfit for conventional therapy, or >60 years, in relapse. Furthermore, we aimed to evaluated the predictive value of the RASGRP1/APTX ratio, which was previously found to be associated to treatment sensitivity in patients receiving Zarnestra alone. Methods. Velcade (1.0 mg/m2) was administered as weekly infusion for 3 weeks (days 1, 8, 15). Zarnestra was administered at dose of 300-600 mg BID for 21 consecutive days. Real-time quantitative-PCR (q-PCR) was used for RASGRP1/APTX quantification. Results. 50 patients were enrolled. Median age was 71 years (56-89). 3 patients achieved complete remission (CR) and 1 partial response (PR). 2 patients obtained an hematological improvement (HI), and 3 died during marrow aplasia. 10 had progressive disease (PD) and the remaining showed stable disease (SD). RASGRP1/APTX was evaluated before treatment initiation on bone marrow (BM) and/or peripheral blood (PB). The median RASGRP/APTX value on BM was higher in responder (R) patients than in non responders (NR) ones, respectively (p=0.006). Interestingly, no marrow responses were recorded in patients with BM RASGRP1/APTX ratio <12, while the response rate was 50% in patients with ratio >12. Toxicity was overall mild, the most common being febrile neutropenia. Conclusion. We conclude that the clinical efficacy of the combination Zarnestra-Velcade was similar to what reported for Zarnestra alone. However we could confirm that the RASGPR1/APTX level is an effective predictor of response. Though higher RASGRP1/APTX is relatively rare (~10% of cases), Zarnestra (±Velcade) may represent an important option in a subset of high risk/frail AML patients.

This 9p21 locus, encode for important proteins involved in cell cycle regulation and apoptosis containing the p16/CDKN2A (cyclin-dependent kinase inhibitor 2a) tumor suppressor gene and two other related genes, p14/ARF and p15/CDKN2B. This locus, is a major target of inactivation in the pathogenesis of a number of human tumors, both solid and haematologic, and is a frequent site of loss or deletion also in acute lymphoblastic leukemia (ALL) ranging from 18% to 45% 1. In order to explore, at high resolution, the frequency and size of alterations affecting this locus in adult BCR-ABL1-positive ALL and to investigate their prognostic value, 112 patients (101 de novo and 11 relapse cases) were analyzed by genome-wide single nucleotide polymorphisms arrays and gene candidate deep exon sequencing. Paired diagnosis-relapse samples were further available and analyzed for 19 (19%) cases. CDKN2A/ARF and CDKN2B genomic alterations were identified in 29% and 25% of newly diagnosed patients, respectively. Deletions were monoallelic in 72% of cases and in 43% the minimal overlapping region of the lost area spanned only the CDKN2A/2B gene locus. The analysis at the time of relapse showed an almost significant increase in the detection rate of CDKN2A/ARF loss (47%) compared to diagnosis (p = 0.06). Point mutations within the 9p21 locus were found at very low level with only a non-synonymous substition in the exon 2 of CDKN2A. Finally, correlation with clinical outcome showed that deletions of CDKN2A/B are significantly associated with poor outcome in terms of overall survival (p = 0.0206), disease free-survival (p = 0.0010) and cumulative incidence of relapse (p = 0.0014). The inactivation of 9p21 locus by genomic deletions is a frequent event in BCR-ABL1-positive ALL. Deletions are frequently acquired at the leukemia progression and work as a poor prognostic marker.

No description available.

Background: Nilotinib is a potent and selective BCR-ABL inhibitor. The phase 3 ENESTnd trial demonstrated superior efficacy nilotinib vs imatinib, with higher and faster molecular responses. After 24 months, the rates of progression to accelerated-blastic phase (ABP) were 0.7% and 1.1% with nilotinib 300mg and 400mg BID, respectively, significantly lower compared to imatinib (4.2%). Nilotinib has been approved for the frontline treatment of Ph+ CML. With imatinib 400mg (IRIS trial), the rate of any event and of progression to ABP were higher during the first 3 years. Consequently, a confirmation of the durability of responses to nilotinib beyond 3 years is extremely important. Aims: To evaluate the response and the outcome of patients treated for 3 years with nilotinib 400mg BID as frontline therapy. Methods: A multicentre phase 2 trial was conducted by the GIMEMA CML WP (ClinicalTrials.gov.NCT00481052). Minimum 36-month follow-up data for all patients will be presented. Definitions: Major Molecular Response (MMR): BCR-ABL/ABL ratio <0,1%IS; Complete Molecular Response (CMR): undetectable transcript levels with ≥10,000 ABL transcripts; failures: according to the revised ELN recommendations; events: failures and treatment discontinuation for any reason. All the analysis has been made according to the intention-to-treat principle. Results: 73 patients enrolled: median age 51 years; 45% low, 41% intermediate and 14% high Sokal risk. The cumulative incidence of CCgR at 12 months was 100%. CCgR at each milestone: 78%, 96%, 96%, 95%, 92% at 3, 6, 12, 18 and 24 months, respectively. The overall estimated probability of MMR was 97%, while the rates of MMR at 3, 6, 12, 18 and 24 months were 52%, 66%, 85%, 81% and 82%, respectively. The overall estimated probability of CMR was 79%, while the rates of CMR at 12 and 24 months were 12% and 27%, respectively. No patient achieving a MMR progressed to AP. Only one patient progressed at 6 months to ABP and subsequently died (high Sokal risk, T315I mutation). Adverse events were mostly grade 1 or 2 and manageable with appropriate dose adaptations. During the first 12 months, the mean daily dose was 600-800mg in 74% of patients. The nilotinib last daily dose was as follows: 800mg in 46 (63%) patients, 600mg in 3 (4%) patients and 400mg in 18 (25%), 6 permanent discontinuations. Detail of discontinuation: 1 patient progressed to ABP; 3 patients had recurrent episodes of amylase and/or lipase increase (no pancreatitis); 1 patient had atrial fibrillation (unrelated to study drug) and 1 patient died after 32 months of mental deterioration and starvation (unrelated to study drug). Two patients are currently on imatinib second-line and 2 on dasatinib third-line. With a median follow-up of 39 months, the estimated probability of overall survival, progression-free survival and failure-free survival was 97%, the estimated probability of event-free survival was 91%. Conclusions: The rate of failures was very low during the first 3 years. Responses remain stable. The high rates of responses achieved during the first 12 months are being translated into optimal outcome for most of patients.

Mycosis fungoides: instrumental and laboratory examinations. Cutaneous lymphomas are a group of disorders characterized by localization of malignant lymphocytes to the skin. Approximately two-thirds of these lymphomas are of T-cell origin. The most common form of cutaneous T-cell lymphoma is mycosis fungoides. Several reviews and guidelines on the management of mycosis fungoides have been published. This study reviews the management and the follow-up of early-stage MF according to our experience.

No description available.

No description available.