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Paolo De Fabritiis

Publications and source records attributed to Paolo De Fabritiis.

8 recordsLinked to original sources
PubMed2006

Opioids in pain management of blood-related malignancies.

Opioids are basic analgesics used in the treatment of moderate to severe pain in patients affected by blood-related malignancies. They should be sequentially administered according to the World Health Organisation scale for cancer pain. Initial treatment and titration with opioids should be based on immediate-release preparations, to be administered at appropriate intervals in order to relieve pain and to satisfy the individual opioid requirement. Once a relatively good pain control has been achieved, a slow release formulation at equivalent doses can be given. Most patients can be adequately managed using oral formulation opioids. However, a small group, such as those presenting severe mucositis or requiring a rapid pain relief, should be managed by intravenous continuous infusion and/or by a patient-controlled analgesia system; while for patients in the community, there are distinct advantages to using the subcutaneous route. Other available routes of administration for opioids, can be used in selected circumstances, including rectal, transdermal, epidural, intrathecal and intramuscular. The invasive neuraxial route has a very limited role in patients with haematological malignancies, given the high risk of infection and bleeding. Through a close observation and a careful management, opioid-related side effects can be effectively prevented and treated. This article reviews the principles of opioid therapy and how opioids can be adapted for patients with pain due to haematological malignancies.

Analgesia, Patient-Controlled↗
PubMed2004

Clinico-pathological characteristics of myeloid sarcoma at diagnosis and during follow-up: report of 12 cases from a single institution.

The aim of this study was to describe the presenting features, the frequency and outcome of myeloid sarcoma (MS) diagnosed in our Institution from January 1995 to December 2000. Twelve MS were seen and the frequency account for only 2% of all acute myeloid leukemia (AML) patients observed in our department in the same period. Median age was 45 years (range: 4-84). All had been initially misdiagnosed as malignant lymphoma (ML) and a median of 2.9 months (range: 1-6) elapsed between the misdiagnosis and the correct of MS, effectuated in our department. At that time, a bone marrow examination revealed a myelodysplastic condition in seven patients, an infiltration by blast cells >30% in two patients, and normal features in the other three. In the non-leukemic patients a median of 5 months (range: 2-44 months) elapsed between the diagnosis of MS and acute leukemia. In all, 10 patients received intensive treatment. A total of seven patients (70%) achieved MS complete remission (CR). Patients who presented isolated skin localization and received only radiotherapy, obtained a MS-CR, but subsequently developed AML. Only in patients who were treated within 4 months from the initial ML diagnosis we achieved complete remission of both MS and leukemia, whereas in patients who were treated after this time, we obtained a complete disappearance of MS without response at the bone-marrow level, irrespectively of the specific therapy regimen. Median survival time from MS diagnosis was 7 months (range: 1-49 months), and only one patient is still alive, 49 months after bone marrow transplantation. Our data stress the importance of an accurate and prompt identification of this rare form of AML, and suggest that, even in patients with isolated MS, the early administration of AML-like intensive chemotherapy followed by bone marrow transplantation might reduce the risk of subsequently developing systemic disease.

Adolescent↗
PubMed2004

[Stem cell mobilization after coronary artery bypass grafting].

BACKGROUND: Recently, the role of stem cells as a potential therapeutic tool for ischemic heart disease has been evaluated by a number of experimental and clinical studies. Although preliminary clinical data appear to be promising, the precise pathophysiological role of stem cell mobilization during acute myocardial ischemia remains uncertain. The present study was aimed at assessing factors affecting stem cell mobilization after coronary artery bypass grafting used as a clinical model of controlled myocardial ischemia. METHODS: Eighteen patients (16 men, 2 women, mean age 66 +/- 8 years) with three-vessel coronary artery disease undergoing coronary artery bypass grafting were included in the study; 24 age- and sex-matched healthy subjects served as controls. On admission, 10 patients had stable angina and 8 had unstable angina. Clinical history and instrumental evidence of previous myocardial infarction were present in 11 patients. Venous peripheral blood was sampled at baseline and 6, 24, 48 and 72 hours after coronary surgery. Duration of cardiac arrest and extracorporeal circulation were recorded as well as the release of total creatine kinase (CK), CK-MB, troponin I and C-reactive protein. CD34+ stem cells were analyzed by flow cytometry according to published methods. RESULTS: In patients with ischemic heart disease the peripheral concentration of CD34+ cells was higher than that of control subjects (0.202 +/- 0.30 vs 0.068 +/- 0.059%, p = 0.03). However, patients with stable and unstable angina had similar concentration of CD34+ cells (0.171 +/- 0.33 vs 0.241 +/- 0.275%, p = 0.63) as well as patients with and without previous myocardial infarction (0.134 +/- 0.19 vs 0.245 +/- 0.352%, p = 0.4). Coronary artery bypass grafting caused a non-significant increase in concentration of CD34+ cells at 24 hours which was similar in patients with stable and unstable angina. Finally, no significant correlation was found between peripheral concentration of CD34+ cells and aortic clamping and extracorporeal circulation duration, peak release of total CK, CK-MB, troponin I and C-reactive protein. CONCLUSIONS: Peripheral concentration of CD34+ stem cells is higher in patients with ischemic heart disease than in healthy controls but it is similar in patients with stable and unstable coronary syndromes. Peripheral mobilization of CD34+ cells is not correlated with the duration and severity of ischemic insult induced by surgical cardiac arrest. These preliminary findings suggest that CD34+ cell mobilization may be modulated more by tonically active than phasic factors.

Aged↗
PubMed2003

Intermediate-dose cyclophosphamide and granulocyte colony-stimulating factor is a valid alternative to high-dose cyclophosphamide for mobilizing peripheral blood CD34+ cells in patients with multiple myeloma.

Peripheral blood stem cells (PBSC) are widely used in the setting of dose-intensive chemotherapies in patients with multiple myeloma (MM). Although the granulocyte colony-stimulating factor (G-CSF), following chemotherapy or not, is considered the standard growth factor for mobilizing PBSC, the optimal chemotherapeutic regimen still remains to be defined. Cyclophosphamide (CTX) is an effective drug in the treatment of MM which is capable of mobilizing PBSC if followed by growth factors, even though administration of high-dose CTX (7 g/m(2)) results in severe toxicity requiring hospitalization and increasing costs. We have retrospectively analyzed the results obtained in 38 newly diagnosed MM patients treated with 1.2 g/m(2) CTX on days 1 and 3 combined with 40 mg dexamethasone daily for 4 days. The results were compared with those obtained in 25 newly diagnosed MM patients treated with 7 g/m(2) CTX. A higher number of CD34+ cells/kg was collected during the first leukapheresis and a statistically significant lower consumption of G-CSF was observed following two doses of 1.2 g/m(2) CTX compared to the 7 g/m(2) CTX dose. The possibility of treating patients with day-hospital regimens, with a satisfactory yield of hematopoietic cells harvested, may have relevant economic implications for treatment strategies in MM patients.

Adult↗
PubMed2002

Complete remission through blast cell differentiation in PLZF/RARalpha-positive acute promyelocytic leukemia: in vitro and in vivo studies.

Acute leukemia with the t(11;17) expressing the PLZF-RARalpha gene fusion is a rare variant of acute promyelocytic leukemia (APL) that has been associated with poor clinical response to all-trans retinoic acid (ATRA) treatment. However, some recent reports have put into question the absolute refractoriness of this leukemia to ATRA. We describe here a patient with PLZF/RARalpha APL who was treated at relapse with ATRA and low-dose hydroxyurea. Complete hematologic remission was obtained through differentiation of leukemic blasts, as proven by morphologic, immunophenophenotypic, and genetic studies carried out in sequential bone marrow samples. Moreover, in vitro studies indicated that blast differentiation was potentiated by the addition of the histone deacetylase inhibitor tricostatin A, but not of hydroxyurea, to ATRA. Our findings indicate that the maturation block may be overcome and terminal differentiation obtained in this leukemia subset and support the view that sensitivity/refractoriness of this form to ATRA should be revisited.

Antineoplastic Combined Chemotherapy Protocols↗