Publications by authors named "Valeria Ferla"

10 Publications

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Biological Difference Between Epstein-Barr Virus Positive and Negative Post-transplant Lymphoproliferative Disorders and Their Clinical Impact.

Front Oncol 2020 8;10:506. Epub 2020 May 8.

Hematology Division, IRCCS Ca' Granda-Maggiore Policlinico Hospital Foundation, Milan, Italy.

Epstein-Barr virus (EBV) infection is correlated with several lymphoproliferative disorders, including Hodgkin disease, Burkitt lymphoma, diffuse large B-cell lymphoma (DLBCL), and post-transplant lymphoproliferative disorder (PTLD). The oncogenic EBV is present in 80% of PTLD. EBV infection influences immune response and has a causative role in the oncogenic transformation of lymphocytes. The development of PTLD is the consequence of an imbalance between immunosurveillance and immunosuppression. Different approaches have been proposed to treat this disorder, including suppression of the EBV viral load, reduction of immune suppression, and malignant clone destruction. In some cases, upfront chemotherapy offers better and durable clinical responses. In this work, we elucidate the clinicopathological and molecular-genetic characteristics of PTLD to clarify the biological differences of EBV(+) and EBV(-) PTLD. Gene expression profiling, next-generation sequencing, and microRNA profiles have recently provided many data that explore PTLD pathogenic mechanisms and identify potential therapeutic targets. This article aims to explore new insights into clinical behavior and pathogenesis of EBV(-)/(+) PTLD with the hope to support future therapeutic studies.
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http://dx.doi.org/10.3389/fonc.2020.00506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225286PMC
May 2020

Ponatinib as a Valid Alternative Strategy in Patients with Blast Crisis-Chronic Myeloid Leukemia Not Eligible for Allogeneic Stem Cells Transplantation and/or Conventional Chemotherapy: Report of a Case.

Case Rep Hematol 2017 14;2017:6167345. Epub 2017 Aug 14.

Hematology Division, IRCCS Ca' Granda-Maggiore Policlinico Hospital Foundation and University of Milan, Milan, Italy.

Currently, imatinib and dasatinib are the only tyrosine-kinase inhibitors approved in the US and Europe for the treatment of blast crisis of chronic myeloid leukemia (BC-CML) at diagnosis, while ponatinib is the only inhibitor used in patients bearing T315I mutation. Here we report the case of a 61-year-old man diagnosed with B-cell lymphoid BC-CML, initially treated with imatinib 800 mg day and then with dasatinib 140 mg day because of intolerance. A complete cytogenetic response (CCyR) was achieved at three months; however, three months later a relapse was observed, and the T315I mutation was detected. Ponatinib 45 mg once daily was then started together with a short course of chemotherapy. Bone marrow evaluation after six months of therapy showed the regaining of CCyR, together with the achievement of a deep molecular response. However, one year from ponatinib start the patient experienced a new disease relapse; he was effectively treated with ponatinib and chemotherapy once again, but in the meanwhile an ischemic stroke was detected. This case report confirms the high efficacy of ponatinib monotherapy in BC-CML patients, representing a valid option for non-allogeneic stem cells transplantation eligible cases and the only one available for those carrying the T315I mutation.
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http://dx.doi.org/10.1155/2017/6167345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584354PMC
August 2017

Concomitant Occurrence of Blastic Plasmacytoid Dendritic Cell Neoplasm and Acute Myeloid Leukaemia after Lenalidomide Treatment for.

Clin Lab 2017 Sep;63(9):1513-1517

Background: Myelodysplastic syndromes with chromosome 5 long arm deletion (5q-mds) may benefit from lenalidomide treatment. However, unresponsive patients have a high risk for clonal evolution and progression to acute myeloid leukemia. Case: We describe a 5q-patient treated with lenalidomide, who concomitantly developed acute myeloid leukemia and blastic plasmacytoid dendritic cell neoplasm, a rare and highly aggressive lymphoma.

Conclusions: Evolution of 5q- syndrome to acute myeloid leukemia and blastic plasmacytoid dendritic cell neoplasm may have occurred through various mechanisms, including persistence of neoplastic lenalidomide-resistant stem cells and selection of a more aggressive clone via lenalidomide augmentation of the ARPC1B gene, or because of lenalidomide stimulation on dendritic cells. Further studies are needed to clarify lenalidomide oncogenic potential.
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http://dx.doi.org/10.7754/Clin.Lab.2017.170322DOI Listing
September 2017

Paroxysmal nocturnal hemoglobinuria with spontaneous clinical remission.

Eur J Intern Med 2017 09 18;43:e11-e14. Epub 2017 May 18.

Onco-Hematology Unit, IRCCS Ca' Granda Policlinico Hospital, via F. Sforza 35, 20122 Milan, Italy; Hematopathology Service, Pathology Unit. IRCCS Ca' Granda Policlinico Hospital, via F. Sforza 35, 20122 Milan, Italy. Electronic address:

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http://dx.doi.org/10.1016/j.ejim.2017.04.011DOI Listing
September 2017

Hematologic malignancies in thalassemia: Adding new cases to the repertoire.

Am J Hematol 2017 May 27;92(5):E68-E70. Epub 2017 Feb 27.

American University of Beirut Medical Center, Beirut, Lebanon.

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http://dx.doi.org/10.1002/ajh.24681DOI Listing
May 2017

Thrombopoietin receptor agonists for preparing adult patients with immune thrombocytopenia to splenectomy: results of a retrospective, observational GIMEMA study.

Am J Hematol 2016 May 4;91(5):E293-5. Epub 2016 Apr 4.

Clinica Ematologica, DISM, a O U S. M. Misericordia, Udine, Italy.

In patients with immune thrombocytopenia (ITP) refractory to corticosteroids and intravenous immunoglobulins (IVIG), splenectomy may result at higher risk of peri-operative complications and, for this reason, potentially contraindicated. The thrombopoietin receptor agonists (TPO-RAs) romiplostim and eltrombopag have shown high therapeutic activity in primary ITP, but data of efficacy and safety regarding their use in preparation for splenectomy are missing. Thirty-one adult patients, median age 50 years, with corticosteroids and/or IVIG refractory persistent and chronic ITP who were treated with TPO-RAs (romiplostim= 24; eltrombopag= 7) with the aim to increase platelet count and allow a safer execution of splenectomy were retrospectively evaluated. Twenty-four patients (77%) responded to the use of TPO-RAs with a median platelet count that increased from 11 × 10(9) /L before starting TPO-RAs to 114 × 10(9) /L pre-splenectomy, but a concomitant treatment with corticosteroids and/or IVIG was required in 19 patients. Twenty-nine patients underwent splenectomy while two patients who responded to TPO-RAs subsequently refused surgery. Post-splenectomy complications were characterized by two Grade 3 thrombotic events (1 portal vein thrombosis in the patient with previous history of HCV hepatitis and 1 pulmonary embolism), with a platelet count at the time of thrombosis of 260 and 167 × 10(9) /L, respectively and one Grade 3 infectious event. TPO-RAs may represent a therapeutic option to improve platelet count and reduce the risk of peri-operative complications in ITP candidates to splenectomy. An increased risk of post-splenectomy thromboembolic events cannot be ruled out and thromboprophylaxis with low-molecular weight heparin is generally recommended.
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http://dx.doi.org/10.1002/ajh.24341DOI Listing
May 2016

Successful treatment with imatinib in a patient with chronic eosinophilic leukemia not otherwise specified.

J Clin Oncol 2014 Apr 21;32(10):e37-9. Epub 2014 Jan 21.

Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda-Maggiore Policlinico Hospital Foundation, Milan, Italy.

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http://dx.doi.org/10.1200/JCO.2012.48.0665DOI Listing
April 2014

High levels of vascular endothelial growth factor protein expression are associated with an increased risk of transfusion dependence in myelodysplastic syndromes.

Am J Clin Pathol 2013 Mar;139(3):380-7

Pathology Unit, Department of Pathophysiology and Transplantation, University of Milan School of Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy.

We evaluated the prognostic significance of vascular endothelial growth factor (VEGF) protein expression in 79 bone marrow biopsy specimens of patients with myelodysplastic syndromes (MDS). VEGF levels normalized for bone marrow cellularity (VEGF index [VEGFi]) were higher in the World Health Organization (WHO) classification-based prognostic scoring system (WPSS) "very high risk" than in the "very low risk" group (P = .009) and in patients with MDS with a poor karyotype than in the other cytogenetic risk groups (P = .015). High VEGFi (>75(th) percentile) predicted transfusion dependence (adjusted odds ratio, 10.38; 95% confidence interval, 1.02-106), and were correlated with leukemia-free survival and overall survival. The inclusion of VEGFi in the International Prognostic Scoring System and WPSS maintained its significant prognostic role in predicting leukemia-free and overall survival; it also seemed to improve the discrimination of the different prognostic classes, especially WPSS low-risk classes. Our findings support the clinical relevance of VEGFi expression in the bone marrow biopsy specimens of patients with MDS.
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http://dx.doi.org/10.1309/AJCP5O3YBKTGGWNQDOI Listing
March 2013