Predictors of Early Thrombotic Events in Adult Patients with Acute Myeloid Leukemia: A Real-World Experience

Information regarding the incidence and the prognostic impact of thrombotic events (TE) in non-promyelocytic acute myeloid leukemia (AML) is sparse. Although several risk factors associated with an increased risk of TE development have been recognized, we still lack universally approved guidelines for identification and management of these complications. We retrospectively analyzed 300 consecutive patients with newly diagnosed AML. Reporting the incidence of venous TE (VTE) and arterial TE (ATE) was the primary endpoint. Secondarily, we evaluated baseline patient- and disease-related characteristics with a possible influence of VTE-occurrence probability. Finally, we evaluated the impact of TE on survival. Overall, the VTE incidence was 12.3% and ATE incidence was 2.3%. We identified three independent predictors associated with early-VTE: comorbidities (p = 0.006), platelets count >50x10e9/L (p = 0.006), and a previous history of VTE (p = 0.003). Assigning 1 point to each variable, we observed an overall cumulative incidence of VTE of 18.4% in the high-risk group (>2 points) versus 6.4% in the low-risk group (0–1 point), log-rank = 0.002. Overall, ATE, but not VTE, was associated with poor prognosis (p < 0.001). In conclusion, TE incidence in AML patients is not negligible. We proposed an early-VTE risk score that could be useful for a proper management of VTE prophylaxis

FEVER OF UNKNOWN ORIGIN AND MULTIDRUG-RESISTANT ORGANISMS COLONIZATION IN AML PATIENTS.

Abstract. Background: Colonization by multidrug-resistant organisms (MDRO) is a frequent complication in hematologic departments, which puts patients at risk of life-threatening bacterial sepsis. Fever of unknown origin (FUO) is a condition related to the delivery of chemotherapy in hematologic malignancies, in which the use of antibiotics is debated. The incidence, risk factors, and influence on the outcome of these conditions in patients with acute myeloid leukemia (AML) are not clearly defined. Methods: We retrospectively analyzed 132 consecutive admissions of non-promyelocytic AML patients at the Hematology Unit of the University Tor Vergata in Rome between June 2019 and February 2022. MDRO swab-based screening was performed in all patients on the day of admission and once weekly after that. FUO was defined as fever with no evidence of infection. Results: Of 132 consecutive hospitalizations (69 AML patients), MDRO colonization was observed in 35 cases (26%) and resulted independently related to a previous MDRO colonization (p=0.001) and length of hospitalization (p=0.03). The colonization persistence rate in subsequent admissions was 64%. MDRO-related bloodstream infection was observed in 8 patients (23%) and correlated with grade III/IV mucositis (p=0.008) and length of hospitalization (p=0.02). FUO occurred in 68 cases (51%) and correlated with an absolute neutrophilic count <500μ/L at admission (0.04). Conclusion: In our experience, MDRO colonization is a frequent and difficult-to-eradicate condition that can arise at all stages of treatment. Prompt discharge of patients as soon as clinical conditions allow could limit the spread of MDRO. In addition, the appropriate use of antibiotics, especially in the case of FUO, and the contraction of hospitalization length, when feasible, are measures to tackle the further spread of MDRO

Autologous blood preparations rich in platelets, fibrin and growth factors

Bone regeneration is often needed prior to dental implant treatment due to the lack of adequate quantity and quality after infectious diseases. The greatest regenerative power was obtained with autologous tissue, primarily the bone alive, taken from the same site or adjacent sites, up to the use centrifugation of blood with the selection of the parts with the greatest potential regenerative. In fact, various techniques and technologies were chronologically successive to cope with an ever better preparation of these concentrates of blood. Our aim is to review these advances and discuss the ways in which platelet concentrates may provide such unexpected beneficial therapeutic effects

Injectable peptidic hydrogels for bone tissue repair and regeneration.

The ongoing growth in the incidence of bone injuries and diseases is producing an increment in the demand of medical and healthcare resources, with an urgent need to identify suitable alternatives to current common clinical treatments. In this context, bone tissue engineering is part of an emerging interdisciplinary field that applies the principles of engineering and life sciences towards the development of biological substitutes. Peptide hydrogels may be used in this context as biocompatible and biodegradable materials suitable for cell encapsulation and for the controlled spatial and temporal delivery of biomolecules (e.g. growth factors) able to direct cell differentiation. Recently, we developed an enzymatic approach for the preparation of injectable, self-assembling materials based on Fmoc-oligopeptides1. The reaction products (Fmoc peptides) spontaneously self-assemble in water to originate fibrils, that become entangled to form a three-dimensional structure of fibers with a diameter of approximately 7 nm, as evidenced by atomic force microscopy (AFM) measurements. Macroscopically, a stable, self-supporting hydrogel material is produced. These materials can be used as controlled drug delivery systems for a wide spectrum of bioactive molecules2 and may enhance cell production of growth factors3. Our results suggest the possibility of using Fmoc oligopetides as building blocks for a new class of injectable scaffolds that could play an important role in bone regeneration, i.e. to reconstruct anatomical defects caused by cancer surgery, malformations and trauma. We employed such hydrogels for the preparation of composite materials specifically designed for bone tissue regeneration. These tailor-made hydrogel systems contain biopolymeric spheres delivering bioactive molecules, as well as pure and substituted calcium phosphate (CaP) nanoparticles to provide bioactivity, osteoconductivity and improved mechanical properties. The morphological and viscoelastic properties of the synthesized hydrogels were investigated and their biocompatibility with different mammalian cells was assessed. Ongoing work is aimed at investigating the biological properties of the composite hydrogel systems, in terms of adhesion, growth and differentiation of human mesenchymal stem cells