Publications by authors named "Monia Marchetti"

Community-acquired respiratory viral infections (CARV) significantly impact patients with hematological malignancies (HM), leading to high morbidity and mortality. However, large-scale, real-world data on CARV in these patients is limited. This study analyzed data from the EPICOVIDEHA-EPIFLUEHA registry, focusing on patients with HM diagnosed with CARV during the 2023-2024 autumn-winter season.

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Diagnostic boundaries between immune thrombocytopenia (ITP) and other thrombocytopenic states such as thrombocytopenic myelodysplastic syndromes, may be difficult to establish, and the detection of somatic mutations by next generation sequencing (NGS) may be of aid. Here we aimed at characterizing the prevalence and clinical significance of clonal hematopoiesis in ITP. In this multicentric retrospective observational study we enrolled 167 adult ITP patients, followed at 13 centers in Italy, UK, and USA.

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Article Synopsis
  • The WHO and International Consensus Classification 2022 aim to improve diagnosis and treatment decisions for myelodysplastic syndromes, but disparities in their implementation exist.
  • A panel of experts used a data-driven method and the Delphi consensus process to align the two classifications, focusing on genomic features to create harmonized labels for distinct clusters.
  • Key findings identified nine genomic clusters, with the most significant linked to biallelic TP53 inactivation, and highlighted the inadequacy of traditional morphological assessments in capturing the complexity of these diseases.
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  • * The update reflects new studies that reinforce the effectiveness of ECP in treating GVHD, with the goal of establishing consistent criteria for its use in both adults and children across Italy while ensuring patient safety and high-quality care.
  • * The guideline development involved a diverse group of specialists, including transfusionists and hematologists, with oversight by a hematologist skilled in systematic reviews, and also included input from a patient representative
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  • - Evans syndrome (ES) is a rare condition without established treatment guidelines, prompting a survey of 64 Italian clinicians involved in managing autoimmune cytopenias to assess disease awareness and management practices.
  • - The survey revealed that the combination of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenic purpura (ITP) is more prevalent than the combination involving neutropenia, with many patients having associated conditions like lymphoproliferative syndromes or autoimmune diseases.
  • - There was a notable variation in diagnostic test agreement among clinicians, indicating that while essential tests like blood counts were universally recognized, others like anti-platelet tests showed much less consensus; this highlights a need for more standardized treatment approaches for
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Evans syndrome is a rare disease marked by a severe clinical course, high relapse rate, infectious and thrombotic complications, and sometimes fatal outcome. Management is highly heterogeneous. There are several case reports but few large retrospective studies and no prospective or randomised trials.

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Article Synopsis
  • The COVID-19 pandemic has severely affected individuals with hematological malignancies due to their weakened immune systems, resulting in higher mortality rates and severe outcomes.
  • Data from the EPICOVIDEHA registry, which compiles COVID-19 cases from these patients worldwide, was collected from 2020 to 2022, including 8,767 cases from 152 centers across 41 countries.
  • Findings show a significant drop in critical infections and overall mortality rates, but hospitalization (especially in ICU) remains a serious risk factor; vaccination is linked to better survival outcomes, highlighting the need for ongoing monitoring and support for these patients.
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Chronic graft--host disease (cGvHD) is a common complication after allogeneic haematopoietic stem cell transplantation, characterised by a broad disease spectrum that can affect virtually any organ. Although pulmonary cGvHD is a less common manifestation, it is of great concern due to its severity and poor prognosis. Optimal management of patients with pulmonary cGvHD is complicated and no standardised approach is available.

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Article Synopsis
  • - Graft-versus-host disease (GVHD) significantly impacts patient health post-allogeneic hematopoietic stem-cell transplantation, prompting new drug approvals and clinical practice changes in its management over the last three years.
  • - The European Society for Blood and Marrow Transplantation (EBMT) convened a panel of 23 experts to update clinical recommendations using the GRADE process and PICO questions to ensure standardized treatment approaches.
  • - Key updates include making ruxolitinib the standard care for steroid-refractory GVHD, using rabbit anti-T-cell globulin or post-transplantation cyclophosphamide for GVHD prevention, and adding belumosudil for treating steroid-refractory chronic GVHD.
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Background: Hemoglobinopathies, among which thalassemic syndromes (transfusion-dependent and non-transfusion dependent thalassemias) and sickle cell disease (SCD), are the most widespread monogenic diseases worldwide. Hemoglobinopathies are endemic and spread-out all-over Italy, as result of internal and external migration flows. Nowadays, the increase therapeutic options associated to the general aging of patients with hemoglobinopathies related to the improvement in clinical management, contribute to the abnormalities in kidney function going from blood and urine test alterations to chronic kidney disease and end stage renal disease.

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Patients affected by multiple myeloma (MM) have an increased risk of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection and subsequent coronavirus (20)19 disease (COVID-19)-related death. The changing epidemiological and therapeutic scenarios suggest that there has been an improvement in severity and survival of COVID-19 during the different waves of the pandemic in the general population, but this has not been investigated yet in MM patients. Here we analyzed a large cohort of 1221 patients with MM and confirmed SARS-CoV-2 infection observed between February 2020, and August 2022, in the EPICOVIDEHA registry from 132 centers around the world.

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Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by aberrant myeloid lineage hematopoiesis with excessive red blood cell and pro-inflammatory cytokine production. Patients with PV present with a range of thrombotic and hemorrhagic symptoms that affect quality of life and reduce overall survival expectancy. Thrombotic events, transformation into acute myeloid leukemia, and myelofibrosis are largely responsible for the observed mortality.

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Since the beginning of the COVID-19 pandemic, there has been an overall improvement in patient mortality. However, haematological malignancy patients continue to experience significant impacts from COVID-19, including high rates of hospitalization, intensive care unit (ICU) admissions, and mortality. In comparison to other haematological malignancy patients, individuals with chronic myeloid leukemia (CML) generally have better prognosis.

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Objectives: Elderly patients with hematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection's impact on different age groups remains unstudied in detail.

Methods: We analyzed elderly patients (age groups: 65-70, 71-75, 76-80, and >80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022.

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In this retrospective international multicenter study, we describe the clinical characteristics and outcomes of patients with chronic lymphocytic leukemia (CLL) and related disorders (small lymphocytic lymphoma and high-count monoclonal B lymphocytosis) infected by SARS-CoV-2, including the development of post-COVID condition. Data from 1540 patients with CLL infected by SARS-CoV-2 from January 2020 to May 2022 were included in the analysis and assigned to four phases based on cases disposition and SARS-CoV-2 variants emergence. Post-COVID condition was defined according to the WHO criteria.

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Introduction: Molnupiravir and nirmatrelvir/ritonavir are antivirals used to prevent progression to severe SARS-CoV-2 infections and decrease hospitalisation and mortality rates. Nirmatrelvir/ritonavir was authorised in Europe in December 2021, whereas molnupiravir is not yet licensed in Europe as of February 2022. Molnupiravir may be an alternative to nirmatrelvir/ritonavir because it is associated with fewer drug-drug interactions and contraindications.

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Article Synopsis
  • - Patients who had CD19-directed CAR T-cell therapy remain highly susceptible to viral infections, especially with COVID-19, which showed a 31% overall mortality rate in the study population.
  • - Those infected with the Omicron variant had a significantly lower mortality risk (7%) compared to earlier variants (58%).
  • - Vaccination and monoclonal antibody treatment were found to improve outcomes, with a marked reduction in mortality (from 32% to 0%) for those treated with monoclonal antibodies, indicating better survival rates for CAR T-cell recipients over time.
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Background: Nirmatrelvir/ritonavir treatment decreases the hospitalisation rate in immunocompetent patients with COVID-19, but data on efficacy in patients with haematological malignancy are scarce. Here, we describe the outcome of nirmatrelvir/ritonavir treatment in a large cohort of the latter patients.

Methods: This is a retrospective cohort study from the multicentre EPICOVIDEHA registry (NCT04733729) on patients with haematological malignancy, who were diagnosed with COVID-19 between January and September 2022.

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Background: Patients with Philadelphia-negative chronic myeloproliferative neoplasms (MPN) typically incur high rates of infections and both drugs and comorbidities may modulate infection risk.

Objectives: The present study aims to assess the effect of immunosuppressive agents on clinical outcomes of MPN patients affected by the coronavirus disease 2019 (COVID-19).

Design: This is an observational study.

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Article Synopsis
  • * 326 patients were analyzed, showing that COVID-19 severity ranged from mild to critical, with 21% of patients experiencing mild cases and an overall mortality rate of 21%.
  • * Key risk factors for higher mortality included being over 50 years old, having multiple comorbidities, active hematologic disease, and experiencing COVID-19 within a year of transplantation.
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