6 research outputs found
Evidence that platelets from transfusion-dependent β-thalassemia patients induce T cell activation
A hypercoagulable state leading to increased risk for thrombotic events represents one of the most common complications observed in transfusion-dependent β-thalassemia (TDT) patients. TDT patients have increased frequencies of circulating activated platelets. However, there is no information so far if platelets from TDT patients can activate T cells. In the present study we showed that T cells treated with platelets from TDT patients showed significant increased surface expression of CD69 compared to the T cells treated with platelets from healthy individuals. Patients with splenectomy showed increased T cell activation compared to patients with intact spleen. No T cell activation was observed following incubation with plasma alone, nor with platelets from healthy subjects. The percentages of regulatory T cells (Tregs) were also examined. TDT patients showed statistically significant increased percentages of Tregs compared to healthy controls. Additionally, we observed a positive statistically significant correlation between the percentages of Tregs and the platelet-induced activated T cells in patients who were not treated with aspirin. TDT patients showed increased levels of sP-selectin, suPAR and GDF-15, molecules implicated in platelet activation. We show that platelets from TDT patients can activate T cells in vitro. This activation correlates with markers of platelet activation and increased numbers of Tregs, perhaps in an effort to eliminate immune dysregulation, conceivably secondary to platelet activation. © 202
Comparison of vincristine, carmustine, melphalan, cyclophosphamide, prednisone (VBMCP) and interferon- with melphalan and prednisone (MP) and interferon- (IFN-) in patients with good-prognosis multiple myeloma: a prospective randomized study
Objectives. The purpose of the study was to evaluate, in a selected
group of myeloma patients with favorable prognosis, the effect, on
response and survival, of polychymotherapy compared with melphalan
prednisone. plus interferon in both arms. Methods: Eighty-nine
previously untreated patients with multiple myeloma and prognostic
factors indicating a good prognosis were randomized to either oral
melphalan plus prednisone (MP) in combination with recombinant
interferon-alpha (rIFN-alpha) or combination chemotherapy with
vincristine, carmustine, melphalan, cyclophosphamide, and prednisone
(VBMCP) alternating with rIFN-alpha. The two treatment groups were
comparable in terms of pretreatment characteristics. Results. The
overall response rate was 67.4% (2.3% complete remission, 65.1%
partial response) in the MP/IFN-alpha group and 69.1% (14.3% complete
remission, 54.8% partial response) in the VBMCP/IFN-alpha group (p =
0.59). There were no differences also in response duration and overall
survival between the two treatment groups. The median response duration
was 39.1 months in the MP/IFN-alpha group and was not reached in the
VBMCP/IFN-alpha group (p = 0.6). Overall survival was long ill both
treatment groups. The estimated 5-yr survival was 66% and 62% in the
MP/IFN-alpha and VBMCP/IFN-alpha group, respectively (p = 0.8). Toxicity
was modest and treatments were well tolerated. Neutropenia (WHO grade 3
or 4) was higher, but not statistically significant, in the
VBMCP/IFN-alpha group. Conclusions: The results of the study show that
in myeloma patients with good prognosis, combination chemotherapy
alternating with interferon-a has no advantage over conventional MP plus
interferon-alpha, in regard to response rate, response duration, and
overall survival of patients
Comparison of vincristine, carmustine, melphalan, cyclophosphamide, prednisone (VBMCP) and interferon-alpha with melphalan and prednisone (MP) and interferon-alpha (IFN-alpha) in patients with good-prognosis multiple myeloma: a prospective randomized study
Objectives. The purpose of the study was to evaluate, in a selected
group of myeloma patients with favorable prognosis, the effect, on
response and survival, of polychymotherapy compared with melphalan
prednisone. plus interferon in both arms. Methods: Eighty-nine
previously untreated patients with multiple myeloma and prognostic
factors indicating a good prognosis were randomized to either oral
melphalan plus prednisone (MP) in combination with recombinant
interferon-alpha (rIFN-alpha) or combination chemotherapy with
vincristine, carmustine, melphalan, cyclophosphamide, and prednisone
(VBMCP) alternating with rIFN-alpha. The two treatment groups were
comparable in terms of pretreatment characteristics. Results. The
overall response rate was 67.4% (2.3% complete remission, 65.1%
partial response) in the MP/IFN-alpha group and 69.1% (14.3% complete
remission, 54.8% partial response) in the VBMCP/IFN-alpha group (p =
0.59). There were no differences also in response duration and overall
survival between the two treatment groups. The median response duration
was 39.1 months in the MP/IFN-alpha group and was not reached in the
VBMCP/IFN-alpha group (p = 0.6). Overall survival was long ill both
treatment groups. The estimated 5-yr survival was 66% and 62% in the
MP/IFN-alpha and VBMCP/IFN-alpha group, respectively (p = 0.8). Toxicity
was modest and treatments were well tolerated. Neutropenia (WHO grade 3
or 4) was higher, but not statistically significant, in the
VBMCP/IFN-alpha group. Conclusions: The results of the study show that
in myeloma patients with good prognosis, combination chemotherapy
alternating with interferon-a has no advantage over conventional MP plus
interferon-alpha, in regard to response rate, response duration, and
overall survival of patients
Prospective randomized comparison of vincristine, doxorubicin and dexamethasone (VAD) administered as intravenous bolus injection and VAD with liposomal doxorubicin as first-line treatment in multiple myeloma
Background: The combination of vincristine and doxorubicin administered
as a continuous infusion via an indwelling catheter together with
intermittent high-dose dexamethasone (VAD) is an effective primary
treatment for patients with symptomatic multiple myeloma. In order to
avoid the need for an indwelling catheter, which imposes logistic
problems for outpatient administration, several phase II studies have
explored the feasibility and efficacy of VAD-like outpatient regimens.
We designed a prospective randomized study to compare the objective
response rates of two VAD-like outpatient regimens as primary treatment
for symptomatic patients with multiple myeloma.
Patients and methods: Patients were entered in a randomized study
regardless of age, performance status and renal function. One hundred
and twenty-seven patients received VAD bolus, which consisted of
vincristine 0.4 mg i.v., doxorubicin 9 mg/m(2) i.v. and dexamethasone 40
mg p.o. daily for four consecutive days and 132 patients received VAD
doxil, which consisted of vincristine 2 mg i.v. and liposomal
doxorubicin 40 mg/m(2) i.v. on day 1 and dexamethasone 40 mg p.o. daily
for 4 days. The two regimens were administered every 28 days for four
courses and in courses 1 and 3, in both arms, dexamethasone was also
given on days 9-12 and 17-20.
Results: An objective response was documented in 61.4% and 61.3% of
patients treated with VAD bolus and VAD doxil, respectively.
Hematological and non-hematological toxicities were mild or moderate and
equally distributed between the two treatment arms with the exception of
alopecia, which was more common after VAD bolus, and of palmar-plantar
erythrodysesthesia, which was more common after VAD doxil.
Conclusions: Our multicenter trial, which included an unselected patient
population, indicated that both VAD bolus and VAD doxil can be
administered to outpatients and can provide an equal opportunity of
rapid response in many patients with multiple myeloma