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Papers by Alessia Elefante

Journal of Oncology Pharmacy Practice, 2012

The pharmacology, pharmacokinetics, clinical trials, adverse effects, dosage, and economic consid... more The pharmacology, pharmacokinetics, clinical trials, adverse effects, dosage, and economic considerations of pralatrexate (PDX) are reviewed. Peripheral T-cell lymphoma (PTCL) comprises approximately 15-20% of all aggressive lymphomas and 5-10% of all non-Hodgkin's lymphomas. Advanced PTCL is often refractory to traditional first-line chemotherapy regimens. PDX was developed as a synthetic folate analog antimetabolite that competitively inhibits dihydrofolate reductase (DHFR). This results in the depletion of thymidine, leading to interference with deoxyribonucleic acid synthesis and cancer cell death. PDX has a higher potency than methotrexate and edatrexate (EDX). The efficacy and safety of PDX have been demonstrated in the PROPEL trial, a prospective phase II trial in patients with relapsed or refractory PTCL. Patients with prior stem cell transplantation receiving PDX also had similar response rates (RRs). PDX was investigated on the treatment of relapsed or refractory cutaneous T-cell lymphoma, previously treated advanced non-small cell lung cancer and other solid malignancies. PDX has similar side effects to other DHFR inhibitors. The most common side effect of PDX is mucositis. The recommended dose of PDX is 30 mg/m(2) weekly once for 6 weeks in 7-week cycle until disease progresses or unacceptable toxicity for PTCL and may require dose reduction or discontinuation. Patients should be supplemented with oral folic acid and intramuscular vitamin B(12) injections. PDX provides clinical benefit to patients with relapsed or refractory PTCL with durable complete and partial responses in patients who had not responded to multiple prior treatment regimens.

American Journal of Health-System Pharmacy, 2010

The pharmacology, efficacy, safety, and dosage and administration of bendamustine and its use in ... more The pharmacology, efficacy, safety, and dosage and administration of bendamustine and its use in indolent non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL) are reviewed. Bendamustine is an alkylating agent that has a unique, multifaceted mechanism of action. Compared with other alkylators, bendamustine produces more-extensive and long-lasting DNA damage. Bendamustine also inhibits cell-cycle checkpoints, leading to mitotic catastrophe and apoptosis. Bendamustine is approved for the treatment of CLL and for indolent B-cell NHL that has progressed during or within 6 months of treatment with rituximab or a rituximab-based regimen. In Phase II and III trials in patients with indolent NHL and CLL, bendamustine has demonstrated response rates of 67-84% as a single agent and median durations of response of 7-21 months. Additional clinical trials are examining bendamustine as a single agent and in combination therapy for the treatment of hematologic malignancies and solid tumors. Adverse events associated with bendamustine are typically mild to moderate and can usually be managed with supportive care. Myelosuppression is the most common grade 3 or 4 adverse event. Tumor lysis syndrome has been reported to occur in some patients, and preventive measures should be taken in at-risk patients. The dosage and administration differ for the treatment of NHL and CLL. Bendamustine is a well- tolerated and effective chemotherapeutic agent indicated for the treatment of rituximab-refractory, indolent NHL and CLL. It has demonstrated efficacy in patients whose disease is refractory to other therapies, including other alkylating agents.

Case Reports, 2009

In GM , NAA reached 40% of control values, once again indicating impaired neuronal function. Cr w... more In GM , NAA reached 40% of control values, once again indicating impaired neuronal function. Cr was reduced to about 80%, and MI to 66% of control levels. There were normal amounts of Glx and Cho. Lipids and macromolecules were not detected, and lactate was ,0.5 mM.

High Field Brain MRI, 2006

The use of high magnetic field strength fMRI units has the potential for improving considerably t... more The use of high magnetic field strength fMRI units has the potential for improving considerably the sensitivity and specificity of functional studies. As a result of the high-field studies, fundamental neural dynamics taking place at a very small dimensional scale in specific laminar, columnar and multicolumnar domains have become directly visible. The advantages in terms of spatial resolution, temporal resolution,

Neuroradiology, 2004

Hypoplasia of the internal carotid artery is a congenital anomaly that entails a diffuse narrowin... more Hypoplasia of the internal carotid artery is a congenital anomaly that entails a diffuse narrowing of the arterial lumen, which involves the entire course of the internal carotid from 1-2 cm above the bifurcation. This developmental condition is rare, with 55 reported cases, 20 of which were bilateral . We report a case of bilateral internal carotid hypoplasia, with collateral circulation through the vertebrobasilar system and saccular aneurysm of the basilar tip.

Neurological Sciences, 2012

Spinal subarachnoid spread is not uncommon in brain oligodendrogliomas; on the other hand, sympto... more Spinal subarachnoid spread is not uncommon in brain oligodendrogliomas; on the other hand, symptomatic involvement of the spinal cord and cauda is very rare, with only 16 reported cases. We report the case of a 41-year-old man who underwent resection of a low-grade frontal oligodendroglioma 4 years previously. He was again observed because of bilateral sciatic pain followed by left leg paresis. A spine MRI showed an intramedullary T12-L1 tumor with root enhancement. At operation, an intramedullary anaplastic oligodendroglioma with left exophytic component was found and partially resected. Two weeks later, a large left frontoparietal anaplastic oligodendroglioma was diagnosed and completely resected. The patient was neurologically stable for 8 months and died 1 year after the spinal surgery because of diffuse brain and spinal leptomeningeal spread. The review of the reported cases shows that spinal symptomatic metastases can occur in both low-grade and anaplastic oligodendrogliomas, even many years after surgery of the primary tumor; however, they exceptionally occur as first clinical manifestation or as anaplastic progression. The spinal seeding represents a negative event leading to a short survival.

min - Minimally Invasive Neurosurgery, 2004

Vertebral arteriovenous fistulas (VAF) are rare clinical entities. Most are post-traumatic in ori... more Vertebral arteriovenous fistulas (VAF) are rare clinical entities. Most are post-traumatic in origin, following direct injury, or iatrogenic. Treatment options include endovascular occlusion or direct surgical closure. We present a rare case of a spontaneous VAF, presenting with cervical and upper limb pain in a patient with previous chiropractic manipulations, successfully treated with electrodetachable coil embolization. While the natural history of the VAFs is still to be settled, endovascular occlusion appears to be a safe and reliable method to deal with such lesions, mainly in symptomatic cases. The use of electrically detachable coils may be considered as an effective alternative for the endovascular occlusion of these fistulas.

European Journal of Radiology, 2003

Functional magnetic resonance imaging (fMRI) has become the most widely used approach for studyin... more Functional magnetic resonance imaging (fMRI) has become the most widely used approach for studying brain functions in humans. The rapid and widespread diffusion of fMRI has been favoured by the properties this technique presents, and particularly by its sensitivity in analysing brain functional phenomena and by the lack of biological invasiveness, resulting in an unprecedented and unparalleled flexibility of use. These properties of fMRI brought the functional examination of the brain within the reach of the whole neuroscience community and have appreciably stimulated the research on the functional processes of the living brain. Among the main features of fMRI, its spatial and temporal resolution represents clear advantages compared with the other methods of functional neuroimaging. In fact, the high spatial resolution of fMRI permits to produce more precise and better localised information, and its temporal resolution provides the potential of a better understanding of neural dynamics at the level of single functional areas and of the neural constituents of functional patterns. A fundamental possibility of improving spatial and temporal resolution without excessively degrading signal-to-noise ratio consists in the use of high magnetic field intensity fMRI units. Besides, high field units make the use of more demanding fMRI paradigms, like single trial event related studies, much more compatible with the need of a solid statistical evaluation. This has notably promoted the diffusion of high field MRI units for human studies throughout the world, with very high field MRI units, up to 8 T, working in a few research centres, and a larger number of MRI units with field intensity ranging between 3 and 5 T. #

Journal of Oncology Pharmacy Practice, 2012

The pharmacology, pharmacokinetics, clinical trials, adverse effects, dosage, and economic consid... more The pharmacology, pharmacokinetics, clinical trials, adverse effects, dosage, and economic considerations of pralatrexate (PDX) are reviewed. Peripheral T-cell lymphoma (PTCL) comprises approximately 15-20% of all aggressive lymphomas and 5-10% of all non-Hodgkin's lymphomas. Advanced PTCL is often refractory to traditional first-line chemotherapy regimens. PDX was developed as a synthetic folate analog antimetabolite that competitively inhibits dihydrofolate reductase (DHFR). This results in the depletion of thymidine, leading to interference with deoxyribonucleic acid synthesis and cancer cell death. PDX has a higher potency than methotrexate and edatrexate (EDX). The efficacy and safety of PDX have been demonstrated in the PROPEL trial, a prospective phase II trial in patients with relapsed or refractory PTCL. Patients with prior stem cell transplantation receiving PDX also had similar response rates (RRs). PDX was investigated on the treatment of relapsed or refractory cutaneous T-cell lymphoma, previously treated advanced non-small cell lung cancer and other solid malignancies. PDX has similar side effects to other DHFR inhibitors. The most common side effect of PDX is mucositis. The recommended dose of PDX is 30 mg/m(2) weekly once for 6 weeks in 7-week cycle until disease progresses or unacceptable toxicity for PTCL and may require dose reduction or discontinuation. Patients should be supplemented with oral folic acid and intramuscular vitamin B(12) injections. PDX provides clinical benefit to patients with relapsed or refractory PTCL with durable complete and partial responses in patients who had not responded to multiple prior treatment regimens.

American Journal of Health-System Pharmacy, 2010

The pharmacology, efficacy, safety, and dosage and administration of bendamustine and its use in ... more The pharmacology, efficacy, safety, and dosage and administration of bendamustine and its use in indolent non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL) are reviewed. Bendamustine is an alkylating agent that has a unique, multifaceted mechanism of action. Compared with other alkylators, bendamustine produces more-extensive and long-lasting DNA damage. Bendamustine also inhibits cell-cycle checkpoints, leading to mitotic catastrophe and apoptosis. Bendamustine is approved for the treatment of CLL and for indolent B-cell NHL that has progressed during or within 6 months of treatment with rituximab or a rituximab-based regimen. In Phase II and III trials in patients with indolent NHL and CLL, bendamustine has demonstrated response rates of 67-84% as a single agent and median durations of response of 7-21 months. Additional clinical trials are examining bendamustine as a single agent and in combination therapy for the treatment of hematologic malignancies and solid tumors. Adverse events associated with bendamustine are typically mild to moderate and can usually be managed with supportive care. Myelosuppression is the most common grade 3 or 4 adverse event. Tumor lysis syndrome has been reported to occur in some patients, and preventive measures should be taken in at-risk patients. The dosage and administration differ for the treatment of NHL and CLL. Bendamustine is a well- tolerated and effective chemotherapeutic agent indicated for the treatment of rituximab-refractory, indolent NHL and CLL. It has demonstrated efficacy in patients whose disease is refractory to other therapies, including other alkylating agents.

Case Reports, 2009

In GM , NAA reached 40% of control values, once again indicating impaired neuronal function. Cr w... more In GM , NAA reached 40% of control values, once again indicating impaired neuronal function. Cr was reduced to about 80%, and MI to 66% of control levels. There were normal amounts of Glx and Cho. Lipids and macromolecules were not detected, and lactate was ,0.5 mM.

High Field Brain MRI, 2006

The use of high magnetic field strength fMRI units has the potential for improving considerably t... more The use of high magnetic field strength fMRI units has the potential for improving considerably the sensitivity and specificity of functional studies. As a result of the high-field studies, fundamental neural dynamics taking place at a very small dimensional scale in specific laminar, columnar and multicolumnar domains have become directly visible. The advantages in terms of spatial resolution, temporal resolution,

Neuroradiology, 2004

Hypoplasia of the internal carotid artery is a congenital anomaly that entails a diffuse narrowin... more Hypoplasia of the internal carotid artery is a congenital anomaly that entails a diffuse narrowing of the arterial lumen, which involves the entire course of the internal carotid from 1-2 cm above the bifurcation. This developmental condition is rare, with 55 reported cases, 20 of which were bilateral . We report a case of bilateral internal carotid hypoplasia, with collateral circulation through the vertebrobasilar system and saccular aneurysm of the basilar tip.

Neurological Sciences, 2012

Spinal subarachnoid spread is not uncommon in brain oligodendrogliomas; on the other hand, sympto... more Spinal subarachnoid spread is not uncommon in brain oligodendrogliomas; on the other hand, symptomatic involvement of the spinal cord and cauda is very rare, with only 16 reported cases. We report the case of a 41-year-old man who underwent resection of a low-grade frontal oligodendroglioma 4 years previously. He was again observed because of bilateral sciatic pain followed by left leg paresis. A spine MRI showed an intramedullary T12-L1 tumor with root enhancement. At operation, an intramedullary anaplastic oligodendroglioma with left exophytic component was found and partially resected. Two weeks later, a large left frontoparietal anaplastic oligodendroglioma was diagnosed and completely resected. The patient was neurologically stable for 8 months and died 1 year after the spinal surgery because of diffuse brain and spinal leptomeningeal spread. The review of the reported cases shows that spinal symptomatic metastases can occur in both low-grade and anaplastic oligodendrogliomas, even many years after surgery of the primary tumor; however, they exceptionally occur as first clinical manifestation or as anaplastic progression. The spinal seeding represents a negative event leading to a short survival.

min - Minimally Invasive Neurosurgery, 2004

Vertebral arteriovenous fistulas (VAF) are rare clinical entities. Most are post-traumatic in ori... more Vertebral arteriovenous fistulas (VAF) are rare clinical entities. Most are post-traumatic in origin, following direct injury, or iatrogenic. Treatment options include endovascular occlusion or direct surgical closure. We present a rare case of a spontaneous VAF, presenting with cervical and upper limb pain in a patient with previous chiropractic manipulations, successfully treated with electrodetachable coil embolization. While the natural history of the VAFs is still to be settled, endovascular occlusion appears to be a safe and reliable method to deal with such lesions, mainly in symptomatic cases. The use of electrically detachable coils may be considered as an effective alternative for the endovascular occlusion of these fistulas.

European Journal of Radiology, 2003

Functional magnetic resonance imaging (fMRI) has become the most widely used approach for studyin... more Functional magnetic resonance imaging (fMRI) has become the most widely used approach for studying brain functions in humans. The rapid and widespread diffusion of fMRI has been favoured by the properties this technique presents, and particularly by its sensitivity in analysing brain functional phenomena and by the lack of biological invasiveness, resulting in an unprecedented and unparalleled flexibility of use. These properties of fMRI brought the functional examination of the brain within the reach of the whole neuroscience community and have appreciably stimulated the research on the functional processes of the living brain. Among the main features of fMRI, its spatial and temporal resolution represents clear advantages compared with the other methods of functional neuroimaging. In fact, the high spatial resolution of fMRI permits to produce more precise and better localised information, and its temporal resolution provides the potential of a better understanding of neural dynamics at the level of single functional areas and of the neural constituents of functional patterns. A fundamental possibility of improving spatial and temporal resolution without excessively degrading signal-to-noise ratio consists in the use of high magnetic field intensity fMRI units. Besides, high field units make the use of more demanding fMRI paradigms, like single trial event related studies, much more compatible with the need of a solid statistical evaluation. This has notably promoted the diffusion of high field MRI units for human studies throughout the world, with very high field MRI units, up to 8 T, working in a few research centres, and a larger number of MRI units with field intensity ranging between 3 and 5 T. #