Several papers authored by international experts have proposed recommendations on the management of BCR-ABL1+ chronic myeloid leukemia (CML). Following these recommendations, survival of CML patients has become very close to normal. The next, ambitious, step is to bring as many patients as possible into a condition of treatment-free remission (TFR). The Gruppo Italiano Malattie EMatologiche dell’Adulto (GIMEMA; Italian Group for Hematologic Diseases of the Adult) CML Working Party (WP) has developed a project aimed at selecting the treatment policies that may increase the probability of TFR, taking into account 4 variables: the need for TFR, the tyrosine kinase inhibitors (TKIs), the characteristics of leukemia, and the patient. A Delphi-like method was used to reach a consensus among the representatives of 50 centers of the CML WP. A consensus was reached on the assessment of disease risk (EUTOS Long Term Survival [ELTS] score), on the definition of the most appropriate age boundaries for the choice of first-line treatment, on the choice of the TKI for first-line treatment, and on the definition of the responses that do not require a change of the TKI (BCR-ABL1 ≤10% at 3 months, ≤1% at 6 months, ≤0.1% at 12 months, ≤0.01% at 24 months), and of the responses that require a change of the TKI, when the goal is TFR (BCR-ABL1 >10% at 3 and 6 months, >1% at 12 months, and >0.1% at 24 months). These suggestions may help optimize the treatment strategy for TFR.
The aims of this study were to assess types and prevalence of HIV‐related oral lesions and to correlate these lesions to the main laboratory parameters such as CD4+ cell count and plasma HIV‐RNA. The study population consisted of 104 consecutive HIV+ patients living in Sicily (M=67, 64.4%; F=37, 35.6%; median age=35 years). CD4+ cell count and viral load were measured within 24 h of oral examinations. Data were managed and analysed by Epi‐Info 6.0. HIV‐related oral lesions, as classified by the EC‐Clearinghouse, were diagnosed in 35.6% of patients: these were of the Strongly Associated (SA) type in 22.1%, the Less Common Associated (LCA) type in 12.5%, and the Lesions Seen in HIV Infection (LS) type in 3.8%. CD4+ cell counts <200x106/I were significantly associated only with SA lesions (P=0.03); median values of CD4+ cell count were also significantly correlated (P=0.02). Viral load, expressed both by median values of copies/ml (P=0.0001) and log10 copies/ml (P=0.0003), was significanly associated only with SA lesions. Treatment failure was significantly correlated to SA lesions (P=0.04). Besides the confirmed correlation with CD4 depletion, the strong association with a high level of viral load could make SA oral lesions a useful tool for identifying progression of HIV infection and could be of value in monitoring antiretroviral therapy.
We investigated the seasonal changes in blood pressure (BP) and in short-term BP variability determined using ambulatory blood pressure monitoring (ABPM). 1000 white subjects, who took part in the multicenter HARVEST study, underwent ABPM with the A&D TM-2420 or the Spacelabs 90207. Standard deviation of the mean daytime and nighttime BP was taken as an index of short-term BP variability (v). Maximal outdoor temperature (Tmax) during each ABPM was obtained from local Meteorological Centers. Subjects were divided according to season and to quartiles of Tmax. A subgroup of 46 persons who repeated ABPM in Winter and Summer was also studied. We observed evident seasonal differences in office and ambulatory systolic BP (SBP) with a peak during Winter. Diastolic BP (DBP) and heart rate did not vary throughout the four seasons. Office SBP (p < 0.01), 24-hour (p < 0.002), daytime SBP (p < 0.0001), both daytime SBPv (p < 0.0001), DBPv (p < 0.02), and nighttime SBPv (p < 0.05), DBPv (p < 0.02) as well as norepinephrine (p < 0.005) were significantly higher during Winter than Summer. Similar differences were observed in subjects grouped in quartiles of Tmax. In the subgroup daytime but not nighttime SBP was higher in the cold season. Average 24-hour SBP (p < 0.05), daytime SBP (p < 0.02), daytime SBPv (p < 0.001) and DBPv (p < 0.05) and norepinephrine (p < 0.0001) were significantly negatively correlated with Tmax in the whole population. BP is higher and subjected to wider oscillations during the cold season in patients with mild hypertension probably due to sympathetic activation. The assessment of a hypertensive subject may give different results according to the season.
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