Lacerenza LG, Sposato B, Garofalo C
… +10 more, Bonini P, Campolmi C, Nencioni C, Francardi M, Gepponi A, Spaghetti S, Theodule M, Bechi L, Petrucci E, Meini B
Recenti Prog Med
· 2026 Mar · PMID 41869796
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INTRODUCTION: Healthcare-associated infections (HAIs) represent a significant health and economic problem, with high frequency and severity. The project aims to analyse the existing organisational model in order to maxim...INTRODUCTION: Healthcare-associated infections (HAIs) represent a significant health and economic problem, with high frequency and severity. The project aims to analyse the existing organisational model in order to maximise value for both patients and healthcare providers through Lean and Value-Based Healthcare (VBHC) methodologies. MATERIALS AND METHODS: From 2023 to 2024, a Lean programme, OPAT v2.0, was implemented to transfer antibiotic administration from the hospital to patients' homes, monitoring processes, costs and results using company databases and VBHC analysis. The costs of administration, antibiotic consumption and the economic impact of home care compared to hospital outpatient care were evaluated. RESULTS: In 2024, 268 personalised administrations were provided to home-based patients, for a total cost of € 107,011 in antibiotics. The estimated cost for home administration ranges from € 112,381.20 to € 243,064.80, while the hospital cost ranges from € 204,328.21 to € 464,442.10. The VBHC analysis showed significant economic savings in the home model compared to the hospital model, although this was limited by the availability of nursing staff and means of transport to patients' homes. The most commonly used antibiotics were ertapenem, daptomycin and ceftolozane tazobactam, the main choice being linked to the lower number of daily administrations. CONCLUSIONS: The OPAT v2.0 model demonstrates clinical and economic effectiveness, reducing hospital costs and improving quality of care. However, full implementation requires better territorial organisation, with home administration only for non-self-sufficient patients, while self-sufficient patients should be administered at district clinics in order to relieve congestion in hospital clinics.
D'Alonzo D, Trombetta L, Matino F
… +10 more, Di Lella E, Luppi M, Di Pede S, Iovino P, Melfi MA, Petriglieri I, Righi F, Celozzi R, Gulisano G, Sassoli V
Recenti Prog Med
· 2026 Mar · PMID 41869795
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BACKGROUND: Antibiotics can cause adverse drug reactions (ADRs) and hypersensitivity reactions (HSRs) through a variety of mechanisms. At our hospital, patients admitted with musculoskeletal tissue infection are followed...BACKGROUND: Antibiotics can cause adverse drug reactions (ADRs) and hypersensitivity reactions (HSRs) through a variety of mechanisms. At our hospital, patients admitted with musculoskeletal tissue infection are followed by infectious disease consultants. The pharmacist only provides the therapy after verifying the correspondence (molecule, dosage and posology) of the motivated request (RMP) with the infectious disease consultancy. The aim was to identify adverse drug reactions, report them and providing training. METHODS: Following the pharmacist's analysis of the infectious disease consultations, ADRs relating to antibiotics were identified and they were entered into the Network of Pharmacovigilance data from Italy, also managing any integrations, and subsequently collected in an Excel file. A qualitative analysis of clinical status, suspected drugs, adverse drug reactions (ADRs) description and its degree of seriousness were collected. A training course was organised "Rischio infettivo: Strumenti, best practice e approfondimenti". RESULTS: The most involved drugs were daptomycin and piperacillin tazobactam; the most observed adverse reactions were dermatological manifestations, eosinophilia, increased transaminases. Most of the reports were not serious. They organized 13 training courses and formats 400 health workers. CONCLUSIONS: Our experience confirms an under-reporting and has highlighted that the contribution to reporting by hospital doctors and nurses is closely related to the valuable work of awareness and support of hospital pharmacists. They assist clinicians in detecting phenomena that may underline the onset of adverse reactions and, consequently, carry out a reporting activity that guarantees useful information for the management of antibiotic therapy. Disseminating and discussing the results of pharmacovigilance is an aspect that motivates the healthcare professional to report. Working to increase the identification of ADRs and the consequent reporting allows us to contribute to the appropriate prescription of antibiotics, avoiding the onset of resistance and also the exposure of the individual patient to serious and disabling side effects.
Recenti Prog Med
· 2026 Mar · PMID 41869794
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Healthcare-associated infections (HAIs) are infections that occur during hospitalization or healthcare treatment, representing a major public health threat. They have serious consequences: clinical (deterioration of cond...Healthcare-associated infections (HAIs) are infections that occur during hospitalization or healthcare treatment, representing a major public health threat. They have serious consequences: clinical (deterioration of conditions, increased mortality and disability), economic (costs to families and healthcare systems), and legal (professional liability). A substantial proportion of HAIs are preventable. Antimicrobial resistance further complicates management, with multidrug-resistant strains on the rise in Europe and globally. A fundamental pillar of effective programs against HAIs and antibiotic-resistant bacteria is the active and responsible involvement of all healthcare professions and disciplines, both in hospitals and communities. Implementing infection prevention and control requires a multidisciplinary approach, shared responsibilities, ongoing training, the use of tools such as bundles and audits with feedback, and, above all, a culture of safety that promotes effective adherence to prevention practices.
Ghizzardi G, Marson R, Vanzi V
… +3 more, Guarda M, Fortini G, Castiello G
Recenti Prog Med
· 2026 Mar · PMID 41869793
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Over the past decade, the concept of skin failure has received increasing international attention, including definitions such as terminal ulcers, Skin Changes at Life's End (SCALE), and unavoidable pressure injuries. In...Over the past decade, the concept of skin failure has received increasing international attention, including definitions such as terminal ulcers, Skin Changes at Life's End (SCALE), and unavoidable pressure injuries. In the absence of a shared Italian translation, in this paper we adopt the term "end-of-life skin lesions" to describe end-stage skin failure, keeping the term international for consistency with the literature. The emerging paradigm recognizes the skin as an organ that, under conditions of global physiological deterioration, can undergo terminal failure, especially in the last weeks or days of life, but also in highly complex acute settings. End-of-life skin lesions are often characterized by sudden onset, rapid progression, irregular margins, purplish discoloration or early necrosis, and poor response to conventional treatments, even in the presence of appropriate preventive strategies. Distinguishing between avoidable lesions and lesions expressing non-preventable multisystem collapse is crucial both for clinical practice and for medico-legal and organizational implications, in a context where terminology and operational criteria are still heterogeneous and the absence of specific coding limits epidemiological surveillance and the quality of documentation. From a healthcare perspective, the approach must focus on comfort, proportionality, and the reduction of burden: protection of residual skin, control of pain, exudates, and odor, and critical reevaluation of invasive interventions inconsistent with care objectives. In response to these needs, the Italian Wound Care Scientific Association (AISLeC) and the Italian Palliative Care Scientific Association (SICP) have initiated a collaboration to develop Recommendations for Good Clinical-Care Practice, promoting shared terminology, integrated pathways between wound care and palliative care, and educational support for caregivers for decisions truly focused on dignity and quality of life.
Recenti Prog Med
· 2026 Mar · PMID 41869792
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Medicine today faces a crisis rooted in several factors: increased social complexity, evolving patient expectations, and the need to move beyond purely technical and standardized models. The article discusses the importa...Medicine today faces a crisis rooted in several factors: increased social complexity, evolving patient expectations, and the need to move beyond purely technical and standardized models. The article discusses the importance of restoring the human relationship between caregiver and patient, the value of the philosophy of care, and a renewed focus on each person's uniqueness. It highlights a shift toward a more systemic and integrated approach, with the "One Health" model linking human, animal, and environmental health. Healthcare training must adapt to these new challenges, promoting a personalized and multidisciplinary perspective and making humanities a core competency. Strengthening health systems requires transforming medical education, aiming for excellence in postgraduate training and ongoing professional development.
Recenti Prog Med
· 2026 Feb · PMID 41716114
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Refractoriness to first-line therapy with daratumumab and lenalidomide represents the paradigm of patients with functional high-risk multiple myeloma. In Italy, the currently available second-line therapies have been app...Refractoriness to first-line therapy with daratumumab and lenalidomide represents the paradigm of patients with functional high-risk multiple myeloma. In Italy, the currently available second-line therapies have been approved based on phase 3 clinical trials with patients' populations that are not fully representative of this condition (only some patients were lenalidomide refractory and only in a few studies there were a small number of patients refractory to an anti-CD38 monoclonal antibody). For this reason, real-life studies and individual clinical experiences represent an important resource for the second-line therapeutic choice for such patients. In the reported clinical case, a patient with multiple myeloma refractory to first-line therapy with daratumumab-lenalidomide-dexamethasone was successfully treated with selinexor-bortezomib-dexamethasone, achieving a good and durable disease remission.
Recenti Prog Med
· 2026 Feb · PMID 41716113
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In transplant-ineligible patients with multiple myeloma (MM), disease relapse represents a critical step in the therapeutic pathway. The increasingly early use of frontline regimens containing anti-CD38 monoclonal antibo...In transplant-ineligible patients with multiple myeloma (MM), disease relapse represents a critical step in the therapeutic pathway. The increasingly early use of frontline regimens containing anti-CD38 monoclonal antibodies has led to significant improvements in clinical outcomes, while simultaneously increasing the complexity of treatment selection in subsequent lines, particularly in elderly and frail patients. Current guidelines recommend the use of combination regimens based on triplets in the second-line setting, preferably incorporating mechanisms of action different from those previously employed. In this context, selinexor, an oral selective inhibitor of exportin-1 (XPO1), represents an innovative therapeutic option due to its ability to restore tumor suppressor protein activity and enhance the efficacy of other antimyeloma agents, including proteasome inhibitors. Data from the phase III BOSTON trial demonstrated that the selinexor-bortezomib-dexamethasone (SVd) combination is associated with a clinically meaningful benefit in terms of progression-free survival and overall survival in patients with relapsed MM, with a particularly relevant advantage in patients treated in the second-line setting who were not previously exposed to bortezomib. Overall, the SVd regimen may represent an effective and sustainable second-line therapeutic strategy, capable of combining antitumor activity with manageable tolerability, and addressing the clinical needs of a patient population increasingly representative of contemporary hematologic practice.
Recenti Prog Med
· 2026 Feb · PMID 41716112
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The management of relapsed or refractory multiple myeloma in elderly patients remains challenging, particularly in cases of early refractoriness to first-line anti-CD38-based regimens, which is associated with poor progn...The management of relapsed or refractory multiple myeloma in elderly patients remains challenging, particularly in cases of early refractoriness to first-line anti-CD38-based regimens, which is associated with poor prognosis and limited therapeutic options. We report the case of a 75-year-old woman with IgG kappa multiple myeloma, primarily refractory to first-line daratumumab, lenalidomide and dexamethasone, who was treated with second-line selinexor, bortezomib and dexamethasone. The patient achieved a very good partial response after four cycles and a complete response after ten cycles, which was durable over time. Treatment was well tolerated, allowing full-dose selinexor administration and preserving quality of life. This case supports the role of an early therapeutic class switch and highlights the effectiveness and feasibility of selinexor-based regimens in elderly and frail patients.
Recenti Prog Med
· 2026 Feb · PMID 41716111
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Chimeric Antigen Receptor T-cell (CAR-T) therapy has significantly improved the prognosis of patients with diffuse large B-cell lymphoma (DLBCL), setting as the new standard of care. Below, we describe the case history o...Chimeric Antigen Receptor T-cell (CAR-T) therapy has significantly improved the prognosis of patients with diffuse large B-cell lymphoma (DLBCL), setting as the new standard of care. Below, we describe the case history of a 69-year-old female patient diagnosed with DLBCL, treated in 2024 with axi-cel for refractory disease to first-line with R-CHOP, after bridging therapy with PolaBR and associated radiotherapy. 18F-FDG-PET scan performed one month after CAR-T therapy showed complete remission of the lymphoma, and the patient is still in remission, at more than one year after the infusion. Patient treatment after infusion required the management of a CRS and ICANS requiring tocilizumab for CRS and subsequently dexamethasone for the ICANS, with rapid resolution of symptoms. This experience confirms the potential efficacy of axi-cel in a very extensive, symptomatic, and chemorefractory disease, and is very informative due to the specific immuno-effector T cell toxicities that occurred, both for the importance of their recognition and for the importance of their early treatment. These factors now ensure that safety considerations are no longer a barrier to offering the most effective treatment to this group of patients.
Recenti Prog Med
· 2026 Feb · PMID 41716110
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We report a successful therapeutic case of axi-cell therapy in an elderly patient diagnosed with diffuse large B-cell lymphoma (DLBCL), experiencing early relapse after first-line treatment. The complications that arose...We report a successful therapeutic case of axi-cell therapy in an elderly patient diagnosed with diffuse large B-cell lymphoma (DLBCL), experiencing early relapse after first-line treatment. The complications that arose during hospitalization and following infusion were manageable and did not require intensive interventions, with a subsequent 10 months follow-up without any criticality.
Recenti Prog Med
· 2026 Feb · PMID 41716109
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DLBCL represents the prototype of aggressive lymphomas; despite therapeutic advances, a substantial proportion of patients remain refractory to first-line treatment. Anti-CD19 CAR-T therapy has revolutionized the second-...DLBCL represents the prototype of aggressive lymphomas; despite therapeutic advances, a substantial proportion of patients remain refractory to first-line treatment. Anti-CD19 CAR-T therapy has revolutionized the second-line setting for patients with early relapse or refractory disease; however, real-world data in patients refractory to modern polatuzumab-containing regimens remain limited. We report the case of a 73-year-old woman with stage IVB GCB-type DLBCL, refractory to Pola-R-CHP and subsequently unresponsive to R-GEMOX. She was considered eligible for second-line axicabtagene ciloleucel. Due to rapid disease progression and worsening abdominal pain, palliative debulking radiotherapy to the abdominal mass was used as bridging therapy, achieving effective local control and clinical benefit. Following lymphodepleting conditioning, CAR-T infusion was well tolerated, with only grade 1 cytokine release syndrome and no ICANS. At 3 months post-infusion, PET imaging documented a complete metabolic response. This case supports the efficacy and feasibility of second-line CAR-T therapy even after failure of polatuzumab-based treatment and highlights radiotherapy as an effective and safe bridging strategy in patients with bulky or symptomatic disease.
Recenti Prog Med
· 2026 Feb · PMID 41716108
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CD19 CAR-T therapy is the second-line standard for relapsed/refractory DLBCL, yet the management of frail patients remains debated due to toxicity and non-relapse mortality risks. We report a 74-year-old man with high-ri...CD19 CAR-T therapy is the second-line standard for relapsed/refractory DLBCL, yet the management of frail patients remains debated due to toxicity and non-relapse mortality risks. We report a 74-year-old man with high-risk DLBCL and multiple comorbidities, refractory to first-line treatment, who received axicabtagene ciloleucel. Despite high CIRS and HCT-CI scores, he only developed grade 1 CRS successfully managed with early tocilizumab and transient cytopenia, achieving durable complete remission at 14 months. This case supports evidence from ALYCANTE and real-world cohorts showing comorbidities alone do not predict severe toxicities. Instead, dynamic parameters such as ECOG, mEASIX and CAR-HEMATOTOX better identify patients at risk. A priori exclusion of frail individuals may unjustly deny access to a potentially curative therapy.
Recenti Prog Med
· 2026 Feb · PMID 41716107
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CAR-T therapies represent a major advance in the management of large B-cell lymphomas. Axi-cel, the only product approved in Italy as a second-line treatment, demonstrated superiority over standard therapy in the randomi...CAR-T therapies represent a major advance in the management of large B-cell lymphomas. Axi-cel, the only product approved in Italy as a second-line treatment, demonstrated superiority over standard therapy in the randomized phase 3 ZUMA-7 trial. We report the case of a 66-year-old woman with large B-cell lymphoma, diagnosed at stage IV with a high disease burden. After achieving complete remission with first-line R-CHOP, she experienced an early relapse at 6 months. She was therefore selected for axi-cel CAR-T therapy, preceded by leukapheresis and one cycle of R-DHAP, resulting in a partial response. The patient developed only grade 1 CRS and grade 1 early ICANS, both easily managed. PET scans at 1, 3, and 6 months showed a complete metabolic response, which is ongoing with no long-term toxicities. This case underscores the importance of close follow-up and timely CAR-T eligibility in high-risk patients.Key words. Axi-cel, CAR-T, LBCL, second line.
Recenti Prog Med
· 2026 Feb · PMID 41716106
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CAR-T cell therapy has revolutionized second-line treatment for patients with refractory/relapsed large B-cell lymphoma within 12 months, demonstrating clear superiority in terms of both response rate and survival compar...CAR-T cell therapy has revolutionized second-line treatment for patients with refractory/relapsed large B-cell lymphoma within 12 months, demonstrating clear superiority in terms of both response rate and survival compared to salvage chemotherapy followed by autologous stem cell transplantation (auto-SCT). In this setting, CAR-T therapy also appears to overcome the poor prognosis associated with a diagnosis of high-grade B-cell lymphoma (HGBCL), as demonstrated by both clinical studies and real-world data, changing the outcome for a population of patients who would otherwise have no valid therapeutic alternatives. The diagnosis of HGBCL and a lack of complete response to interim re-evaluation during first-line therapy should lead to a CAR-T program, allowing for early referral and therefore rapid access to this cell therapy, impacting the outcome of the therapy itself.