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Mieloma multiplo (paziente anziano) - Copyright FSE 1

Novità dall’EHA >> [ Mieloma multiplo ]

(Paziente anziano)

27-28 ottobre 2008

Relatore: A PALUMBO

Borgo S. Luigi – Monteriggioni (Siena)

(Paziente anziano)


Superior efficacy with bortezomib plus

melphalan–prednisone (VMP) versus MP alone in

previously untreated MM: updated results of

the phase III VISTA trial

Jesús F. San Miguel,1 Rudolf Schlag,2 Nuriet K. Khuageva,3 Meletios A.

Dimopoulos,4 Ofer Shpilberg,5 Martin Kropff,6 Ivan Spicka,7 Maria T. Petrucci,8

Antonio Palumbo,9 Olga S. Samoilova,10 Anna Dmoszynska,11 Kudrat M.

Abdulkadyrov,12 Rik Schots,13 Bin Jiang,14 Maria-Victoria Mateos,1 Kenneth C.Abdulkadyrov,12 Rik Schots,13 Bin Jiang,14 Maria-Victoria Mateos,1 Kenneth C.

Anderson,15 Dixie L. Esseltine,16 Kevin Liu,17 Andrew Cakana,18 Helgi van de

Velde,18 Paul G. Richardson15

11Hospital Universitario Salamanca, CIC, IBMCC (USAL-CSIC), Spain; 2Praxisklinik Dr. Schlag, Würzburg, Germany;3SP Botkin Moscow City Clinical Hospital, Russian Federation; 4University of Athens School of Medicine, Greece;5Rabin Medical Center, Petah-Tiqva, Israel; 6University of Münster, Germany; 7University Hospital, Prague, Czech

Republic; 8University La Sapienza, Rome, Italy; 9Universita di Torino, Italy; 10Nizhnii Novgorod Region Clinical

Hospital, Russian Federation; 11Medical University of Lublin, Poland; 12St Petersburg Clinical Research Institute of

Hematology & Transfusiology, Russian Federation; 13Myeloma Study Group Belgian Hematological Society,

Belgium; 14People’s Hospital, Peking University, China; 15Dana-Farber Cancer Institute, Boston, USA; 16Millennium

Pharmaceuticals, Inc, Cambridge, USA; 17Johnson & Johnson Pharmaceutical Research & Development, L.L.C.,

Raritan, USA; 18Johnson & Johnson Pharmaceutical Research & Development, Beerse, Belgium


Time to progression~52% reduced risk of progression on VMP

3

VMP

MP

VMP: 24.0 months (83 events)

MP: 16.6 months (146 events)

HR = 0.483, p < 0.000001

Number of patients at risk

MP: 338 296 241 206 152 86 53 22 5

VMP: 344 295 272 245 185 111 65 31 17


Relationship between TFI and TNT

4

VMP� TNT not reached for VMP vs 20.8m for

MP (p=0.000009)

Time on therapyTreatment-free interval

Time to next therapy

Next Therapy

VMP

MPVMP: not reached (73 events)

MP: 20.8 months (127 events)

HR = 0.522, p = 0.000009

Number of patients at risk

MP: 338 309 261 229 178 119 77 38 15 4

VMP: 344 311 285 266 209 142 89 50 26 2

MP (p=0.000009)

•Patients on VMP were 48% less likely to

start second-line therapy

•For VMP vs MP patients, 36% vs 52% at

2-years started second-line therapy

� TFI not reached for VMP vs 9.4m for MP

(p=0.0001)


Overall survival~36% reduced risk of death on VMP

5

� 45% of MP patients received bortezomib upon progression

� Analysis Bortezomib>4 cycles: OS at 1 & 2 years: 98,5% & 89%

� Treatment-related death: 1% with VMP vs 2% with MP


Adverse eventsRate of serious adverse events: 46% with VMP vs 36% with MP

6

� Overall rate of peripheral sensory neuropathy with VMP was 44%, including 14% grade 1, 17% grade 2

� At data cut-off 74% of peripheral neuropathy (PN) events had resolved to baseline (56%) or decreased by at least one toxicity grade (18%) in a median of 2 months

� Herpes zoster was more frequent with VMP (13% vs 4%); rate with VMP only 3% among patients receiving antiviral prophylaxis

� Rate of DVT was low and similar with VMP vs MP (1% vs 2%)


Melphalan + Prednison versus

Melphalan + Prednison + Thalidomide in induction

therapy for multiple myeloma intherapy for multiple myeloma in

elderly patients: first interim results.

Authors

P.Wijermans, R. Schaafsma,Y van Norden, R.Ammerlaan, P.Sonneveld,

S. Wittebol, H.Sinnige, P.Huijgens, M.van Marwijk Kooy, R. van der Griend.

Corresponding author

P.Wijermans


Number of patients n=152

3 x MPTn=151 (100%)

Off Protocol n=46 (30%) - NR/PD/rel n= 9 - toxicity n=18 - death n= 6

Off protocol n= 1 - other n= 1

Flow diagram of patients in MPT-arm through HOVON 49 MM

5 x MPTn=105 (70%)

- death n= 6 - other n= 13

Continue MPT /maintenancen=68 (45%)

Off Protocol n=37(25%) - Complete n= 6 - NR/PD/rel n= 8 - toxicity n=11 - death n= 3 - other n=9


Number of patients n=149

3 x MPn=148 (100%)

Off Protocol n=45 (30%) - NR/PD/rel n=27 - toxicity n=4 - death n=5

Flow diagram of patients in MP-arm through HOVON 49 MM

Off protocol n= 1 - death n= 1

5 x MPn=103 (70%)

- death n=5 - other n=9

Continue MPn=18 (12%)

Off Protocol n=85(57%) - Complete n=42 - NR/PD/rel n=10 - toxicity n= 4 - death n= 1 - other n=17


50

75

100

C

umul

ativ

e pe

rcen

tage

Arm 1st randomisationEvent free survival

1 year 2 years

M+P 38% 8%

M+P+T 52% 27%

MPMP+TLogrank P <.001

N149152

F135120

MP

MP+T

At risk:149152

5478

8

26

2

10

02

MPMP+T

0

25

50

months0 12 24 36 48

Cum

ulat

ive

perc

enta

ge


50

75

100

C

umul

ativ

e pe

rcen

tage

Arm 1st randomisationPFS from registration

1 year 2 yearsM+P 59% 19%

M+P+T 58% 31%

MPMP+TLogrank P =.08

N149152

F125116

MP

MP+T

At risk:149152

8486

2129

5

12

02

MPMP+T

0

25

50

months0 12 24 36 48

Cum

ulat

ive

perc

enta

ge


ORAL MELPHALAN, PREDNISONE AND THALIDOMIDE IN

ELDERLY PATIENTS WITH MULTIPLE MYELOMA: UPDATED

RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Gimema: Italian Myeloma Network

12

Antonio Palumbo1, Sara Bringhen1, Anna M Liberati2, Tommaso Caravita3,

Antonietta Falcone4, Vincenzo Callea5, Clotilde Cangialosi6, Monica Galli7, Fausto

Rossini8, Lucio Catalano9, Valerio De Stefano10, Sergio Morandi11, Maria Teresa

Petrucci12, Patrizia Falco1, Alessandra Larocca1, Valeria Magarotto1, Giovannino

Ciccone13, Michele Cavo14, Mario Boccadoro1

From the Divisione di Ematologia dell’Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy1; Clinica Medica I, Policlinico

Monteluce, Perugia, Italy2; Cattedra e Divisione di Ematologia, Università Tor Vergata, Ospedale S Eugenio, Roma, Italy3; Unità Operativa di Ematologia

Trapianto di Cellule Staminali, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy4; Divisione di Ematologia, Ospedali Riuniti, Reggio Calabria,

Italy5; Divisione di Ematologia e Trapianto di Midollo Osseo, Azienda Ospedaliera Cervello, Palermo, Italy6; Divisione di Ematologia, Ospedali Riuniti,

Bergamo, Italy7; Ematologia, Ospedale S. Gerardo, Monza, Italy8; Cattedra e Divisione di Ematologia, Università Federico II, Napoli, Italy9; Istituto di

Ematologia, Università Cattolica, Roma, Italy10; Unità di Ematologia, Azienda Istituti Ospitalieri, Cremona, Italy11; Dipartimento di biotecnologie ed

Ematologia, Università La Sapienza, Roma, Italy12; Unità di Epidemiologia dei Tumori, Azienda Ospedaliera S Giovanni Battista, and CPO Piemonte,

Torino, Italy13; Istituto di Ematologia e Oncologia Medica “Seràgnoli”, Policlinico S. Orsola, Bologna, Italy14.


0. 75

1. 00

Overall SurvivalP

rop

ort

ion

of

pa

tie

nts

MP 47.6 months

13

0. 00

0. 25

0. 50

os

0 10 20 30 40 50 60

P = .79Pro

po

rtio

n o

f p

ati

en

ts

Months

MPT 45 months

MP 47.6 months


Subgroup analysis


ββββ2-microglobulin and Survival

ββββββββ22--m m << 3.5 mg/L3.5 mg/L

Prognostic factor in MP

No impact in MPT

15

P = .19

Months

Months

P = .0002ββββββββ22--m > m > 33..5 5 mg/Lmg/L

ββββββββ22--m m ≤≤ 3.5 mg/L3.5 mg/L

ββββββββ22--m > 3.5 mg/Lm > 3.5 mg/L

No impact in MPT


GIMEMA: Italian Myeloma Network

Oral Melphalan, Prednisone and Lenalidomide for

Elderly Newly Diagnosed Myeloma Patients

16

Antonio Palumbo1, Patrizia Falco1, Paolo Corradini2, Claudia Crippa3, Francesco Di

Raimondo4, Antonietta Falcone5, Nicola Giuliani6, Pellegrino Musto7, Paola Omedè1,

Federica Cavallo1, Francesca D’Agostino1, Letizia Canepa8, Alessandro Gozzetti9, Fortunato

Morabito10, Robert Knight11, Jerome B. Zeldis11, Mario Boccadoro1, and Maria Teresa

Petrucci12

1Divisione di Ematologia dell’Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy; 2Divisione di Ematologia,Istituto Nazionale Tumori, Milano, Italy; 3Sezione Ematologia, Università di Brescia, Spedali Civili, Brescia, Italy; 4Cattedra diEmatologia, Ospedale Ferrarotto, Catania, Italy; 5UO Ematologia e Trapianto di Cellule Staminali, IRCCS Casa Sollievo della Sofferenza,San Giovanni Rotondo, Italy; 6Cattedra e UO Ematologia e Trapianti midollo, Università degli Studi di Parma, Parma, Italy;7UO diEmatologia e Trapianto di Cellule Staminali, CROB, Rionero in Vulture, Italy; 8Clinica Ematologica, Ospedale S. Martino, Università diGenova, Genova, Italy; 9Divisione di Ematologia, Azienda Ospedaliera Senese, Ospedale A. Sclavo, Siena, Italy; 10UOC Ematologia,Azienda Ospedaliera di Cosenza, Cosenza, Italy; 11Celgene, Summit, NJ; 12Dipartimento di Biotecnologie e Ematologia, Università La

Sapienza, Roma, Italy.


MPR in newly diagnosed MM:

response rates and survival benefit

Cohort 3 at median 7 cycles

33.3

40

50

60

(%)

85.6

Overall survival

(%)

75

100

17

Palumbo A, et al. J Clin Oncol. 2007;25:4459-65.

0

14.3

33.3

28.5

23.8

0

10

20

30

CR VGPR PR MR SD or PD

Pa

tie

nts

(%)

Time (months)

Pa

tie

nts

(%)

00

25

50

5 10 15 20 25

MPR: median follow-up 14.6 months (range 10.8–21.8); N = 53.


MPR: haematological adverse events

4,000

1,000

3,000

2,000

Ne

utr

op

hil

s×

10

6/l

*Neutropenia

0

18

C1 C2 C3 C4 C5 C6 C7 C8 C9 M2 M4 M6

Ne

utr

op

hil

s

Treatment cycle

Pla

tele

ts×

10

9/l

*

50

100

150

200

250

C1 C2 C3 C4 C5 C6 C7 C8 C9 M2 M4 M6

Thrombocytopenia

0

0

* Mean ± SE.

Palumbo A, unpublished data.


Double-blind treatment phaseUp to 9 courses in the absence of PD or unacceptable adverse events

Pre-randomization

51 centres in Europe, Australia, and Israel (N = 450)

Eligible

candidates

with newly

Melphalan 0.18 mg/kg, days 1–4

Prednisone 2 mg/kg, days 1–4

Lenalidomide 10 mg/day p.o., days 1–21




LenalidomideLenalidomide

R

A

N

D

O

R

A

N

D

O

MM-015: MPR vs MP for long-term

control in newly diagnosed MM

19

Primary end-point: progression-free survival

Secondary end-points: OS, TTP, ORR, TTR, duration of response, and quality of life

All patients will receive aspirin prophylaxis (75–100 mg/day)

Palumbo A, et al. Presented at ASH Annual Meeting, 2006.

with newly

diagnosed,

untreated

MM



Placebo days 1–21 until progression



Placebo days 1–21 until progression

PlaceboPlacebo







PlaceboPlacebo

O

M

I

Z

A

T

I

O

N

O

M

I

Z

A

T

I

O

N

TTR = time to response.


MP vs MP-Thal

Hazard ratios: MP vs MP-Thal on PFS

Hazard ratios: MP-Thal vs ASCT on PFS20

0.4 0.6 0.8 1.0 1.2

MP-Thal*

ASCT11

Hazard Ratio

MP-Thal vs ASCT


Diagnosis

4 RD cycles

PBSC harvest

MPR vs MEL200

study design

21

random

A: 6 MPR cycles B: 1-2 MEL200 cycles

Len Len nono

MEL200 Conventional chemotherapy


A Prospective, Randomized, Phase III Study of Enoxaparin

Versus Aspirin Versus Low-fixed-dose of Warfarin in

Newly Diagnosed Myeloma Patients Treated with

Thalidomide-Containing Regimens.

Gimema: Italian Myeloma Network

22

Thalidomide-Containing Regimens.

Palumbo Antonio1*, Cavo Michele2*, Bringhen Sara1, Perrone Giulia2, Magarotto Valeria1,

Patriarca Francesca3, Petrucci Maria Teresa4, Galli Monica5, Di Raimondo Francesco6,

Rossi Davide7, Marasca Roberto8, Offidani Massimo9, Goldaniga Maria Cecilia10, Corradini

Paolo11, Crippa Claudia12, Catalano Lucio13, Callea Vincenzo14, Gozzini Antonella15, Tosi

Patrizia2, Boccadoro Mario1.

1Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliera San Giovanni Battista, Torino, Italy; 2Istituto di Ematologia e Oncologia Medica “Seragnoli”,

Università di Bologna, Italy; 3 Clinica Ematologica, Università di Udine, Italy; 4Dipartimento di Biotecnologie ed Ematologia, Università La Sapienza, Roma, Italy;5Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy; 6 Cattedra di Ematologia, Ospedale Ferrarotto, Catania; Italy; 7Divisione di Ematologia, Università del

Piemonte rientale Amedeo Avogadro, Azienda Ospedaliera Maggiore della Carità, Novara, Italy; 8Dipartimento di oncologia ed Ematologia, Università di Modena e

Reggio Emilia, Modena, Italy; 9Clinica di Ematologia Polo Ospedaliero-Universitario, Ospedali Riuniti Ancona Università Politecnica delle Marche, Ancona, Italy; 10

Divisione di Ematologia, Fondazione IRCCS Ospedale Maggiore Policlinico, Milano, Italy; 11Divisione di Ematologia, Istituto Nazionale Tumori, Milano, Italy;12Sezione Ematologia, Universita` di Brescia, Spedali Civili, Brescia, Italy; 13Cattedra e Divisione di Ematologia, Università Federico II, Napoli, Italy; 14Divisione di

Ematologia, Ospedali Riuniti, Reggio Calabria, Italy;15U.O. Ematologia, Università degli Studi di Firenze, AOU Careggi, Firenze, Italy.


Study design 2

Thalidomide regimens

VTD – TD – VMPT

Random

VMP

23

ASA WAR LMWH

Aspirin Warfarin Enoxaparin

100 mg/day 1.25 mg/day 40 mg/day

No

prophylaxis

• VTD-TD: 9 weeks before ASCT

• VMPT: 6 months


Grade 3-4 thromboembolic events

No

prophylaxis

LMWH

24

0 1 2 3 4 5 6Patients (%)

ASA

LMWH

WAR


Grade 3-4 thromboembolic events

VTDVTD

No No

prophylaxisprophylaxis

25

0 1 2 3 4 5 6 7 8Patients (%)

VTDVTD

TDTD

VMPTVMPT


GIMEMA: Italian Myeloma Network

BORTEZOMIB, PL-DOXORUBICIN, DEXAMETHASONE (PAD)

AUTOLOGOUS STEM CELL TRANSPLANT (MEL100)

LENALIDOMIDE - PREDNISONE (LP)

IN ELDERLY NEWLY DIAGNOSED MYELOMA

26

Palumbo Antonio1, Falco Patrizia1, Corradini Paolo2, Crippa Claudia2,

Patriarca Francesca2, Rossini Fausto2, Offidani Massimo2,

Liberati Anna Marina2, Petrucci Maria Teresa2, Boccadoro Mario1

1Myeloma Unit, Divisione di Ematologia, Università di Torino, Torino, I, EU,

2GIMEMA, Italian Myeloma Network, I, EU.


33%

VD-MEL200§

53%15%CR

PAD-MEL100-

LP-LDAV-MEL200*

WHY?

27

NA

NA

55%

83%63%EFS @ 2 years

88%36%> VGPR

92%85%OS @ 2 years

*Historical control – Palumbo et al. Blood 2007;108 [abs727]; §Harousseau et al. Haematologica 2006; 91:1498


Treatment Schedule

INDUCTION

28


28-day cycle

1 21 28

LENALIDOMIDE 25 mg/day

LP: CONSOLIDATION

Treatment Schedule

CONSOLIDATION AND MAINTENANCE

29

PREDNISONE 50 mg/every other day

L: MAINTENANCE28-day cycle

1 21 28

LENALIDOMIDE 10 mg/day


PAD

MEL100

n=5159

50

60

70 8888%%

% o

f p

ati

en

ts50

60

70PAD

4 Cycles

n=86

59%59%

% o

f p

ati

en

ts

Response RatePAD vs PAD-MEL100

30

29

6 6

0 00

10

20

30

40

% o

f p

ati

en

ts

CR/nCR

VGPR PR MR SD PD

21

3835

2 2 10

10

20

30

40

CR/nCR

VGPR PR MR SD PD

% o

f p

ati

en

ts


5970

80

90

100

% o

f p

ati

en

ts

70

60

70

80

90

100PAD

MEL100LP

n=34

PADMEL100

n=51

% o

f p

ati

en

ts

Response RatePAD-MEL100 vs PAD-MEL100-LP

31

59

29

6 60 0

0

10

20

30

40

50

60

% o

f p

ati

en

ts

CR/nCR

VGPR PR MR SD PD

1812

0 0 00

10

20

30

40

50

60

CR/nCR

VGPR PR MR SD PD

% o

f p

ati

en

ts


PFS OS

PAD-MEL100-LPPAD-MEL100-LP

PAD-MEL100-LP: Median Follow-up 13.6 months [n=86]

DAV-MEL200: Median Follow-up 26.5 months [n=124]

PAD-MEL100-LP vs DAV-MEL200

32

% o

f p

ati

en

ts

months months

% o

f p

ati

en

ts

DAV-MEL200

DAV-MEL200

P=0.01 P=0.46

*Historical control – Palumbo et al. Blood 2007;108 [abs727]


1. ALESSANDRIA1. ALESSANDRIA Levis, Levis, BaraldiBaraldi

2. ANCONA2. ANCONA LeoniLeoni, , OffidaniOffidani

3. AOSTA3. AOSTA Di VitoDi Vito

4. ASCOLI PICENO4. ASCOLI PICENO GalieniGalieni, , BigazziBigazzi

5. ASTI5. ASTI ScassaScassa, , CampaCampa

6. AVELLINO6. AVELLINO CantoreCantore, Volpe, Volpe

7. AVIANO7. AVIANO TirelliTirelli, , RupoloRupolo

8. BARI8. BARI DammaccoDammacco, , LautaLauta

9. BARI9. BARI LisoLiso

10. BERGAMO10. BERGAMO BarbuiBarbui, , GalliGalli

11. BIELLA11. BIELLA TonsoTonso

32. FOGGIA32. FOGGIA MonacoMonaco

33. FORLI’33. FORLI’ AmadoriAmadori, , GentiliniGentilini

34. GALLARATE34. GALLARATE CiambelliCiambelli

35. GENOVA35. GENOVA GobbiGobbi, , CanepaCanepa

36. GENOVA36. GENOVA CarellaCarella

37. LATINA37. LATINA ZaponeZapone

38. LECCE38. LECCE PavonePavone

39. MATERA39. MATERA CiancioCiancio

40. MESSINA40. MESSINA BrugiatelliBrugiatelli, , MamoneMamone

41. MESSINA41. MESSINA MusolinoMusolino

42. MILANO42. MILANO CorradiniCorradini, , MontefuscoMontefusco

65. PISA65. PISA PetriniPetrini/Benedetti/Benedetti

66. POTENZA66. POTENZA RicciutiRicciuti, , VertoneVertone

67. RAVENNA67. RAVENNA ZaccariaZaccaria, Molinari, Molinari

68. REGGIO CAL. 68. REGGIO CAL. Nobile, Nobile, CalleaCallea

69. REGGIO EMILIA69. REGGIO EMILIA Gugliotta,MasiniGugliotta,Masini

70. RIMINI70. RIMINI PasquiniPasquini, , FattoriFattori

71. ROMA71. ROMA AnninoAnnino, , BongarzoniBongarzoni

72. ROMA72. ROMA AndrianiAndriani

73. ROMA 173. ROMA 1 FoàFoà, , PetrucciPetrucci

74. ROMA 74. ROMA CattolicaCattolica Leone, De StefanoLeone, De Stefano

75. ROMA 75. ROMA R.ElenaR.Elena PettiPetti, , PisaniPisani

We Are Grateful to All Patients, Nurses and

Physicians of the Participating Centers

33

11. BIELLA11. BIELLA TonsoTonso

12. BOLOGNA12. BOLOGNA CavoCavo, , TosiTosi

13. BOLZANO13. BOLZANO PescostaPescosta

14. BRA14. BRA VanniVanni, Stefani, Stefani

15. BRESCIA15. BRESCIA Rossi, Rossi, CrippaCrippa

16. CAGLIARI16. CAGLIARI AngelucciAngelucci, , CarubelliCarubelli

17. CAGLIARI17. CAGLIARI MantovaniMantovani

18. CAMPOBASSO18. CAMPOBASSO StortiStorti

19. CANDIOLO19. CANDIOLO AgliettaAglietta, , CapaldiCapaldi

20. CATANIA20. CATANIA GiustolisiGiustolisi, Di , Di RaimondoRaimondo

21. CATANZARO21. CATANZARO PiroPiro

22. CATTOLICA22. CATTOLICA PasquiniPasquini

23. CESENA23. CESENA GuardigniGuardigni

24. CHIOGGIA24. CHIOGGIA BattistaBattista

25. CIRIE'25. CIRIE' FreiloneFreilone, , BeggiatoBeggiato

26. COSENZA26. COSENZA MorabitoMorabito

27. CREMONA27. CREMONA PassalacquaPassalacqua, , MorandiMorandi

28. CREMONA28. CREMONA MorandiMorandi

29. CUNEO29. CUNEO GallaminiGallamini, Grasso, Grasso

30. FIRENZE30. FIRENZE Bosi, Bosi, NozzoliNozzoli

31. FOGGIA31. FOGGIA Monaco, Monaco, FerrandinaFerrandina

42. MILANO42. MILANO CorradiniCorradini, , MontefuscoMontefusco

43. MILANO43. MILANO MorraMorra

44. MILANO44. MILANO BregniBregni

45. MODENA45. MODENA NarniNarni

46. MONTEFIASC.46. MONTEFIASC. MontanaroMontanaro, , NiscolaNiscola

49. MONZA49. MONZA PoglianiPogliani, Rossini, Rossini

50. NAPOLI50. NAPOLI Rotoli,CatalanoRotoli,Catalano

51. NAPOLI51. NAPOLI FerraraFerrara

52. NOCERA INF.52. NOCERA INF. D’ArcoD’Arco, , CalifanoCalifano

53. NOVARA53. NOVARA GaidanoGaidano, Rossi, Rossi

54. NUORO54. NUORO Latte, PalmasLatte, Palmas

55. ORBASSANO55. ORBASSANO SaglioSaglio, , GuglielmelliGuglielmelli

56. PADOVA56. PADOVA SemenzatoSemenzato, , ZambelloZambello

57. PALERMO 57. PALERMO MirtoMirto, , CangialosiCangialosi

58. PARMA58. PARMA Rizzoli, GiulianiRizzoli, Giuliani

59. PAVIA59. PAVIA LazzarinoLazzarino, , CorsoCorso

60. PERUGIA60. PERUGIA LiberatiLiberati, , NunziNunzi

61. PESARO61. PESARO VisaniVisani, Leopardi, Leopardi

62. PESCARA62. PESCARA FioritoniFioritoni, , SpadanoSpadano

63. PIACENZA63. PIACENZA CavannaCavanna, , LazzaroLazzaro

64. PINEROLO64. PINEROLO GrisoGriso

75. ROMA 75. ROMA R.ElenaR.Elena PettiPetti, , PisaniPisani

76. ROMA S. 76. ROMA S. CamilloCamillo MajolinoMajolino, De Rosa, De Rosa

77. ROMA T. 77. ROMA T. VergataVergata AmadoriAmadori, , CaravitaCaravita

78. ROZZANO 78. ROZZANO Santoro, Santoro, NozzaNozza

79. S. G. ROTONDO79. S. G. ROTONDO MustoMusto, , MerlaMerla

80. SASSARI80. SASSARI LonginottiLonginotti, Dore, Dore

81. SIENA81. SIENA LauriaLauria, , GozzettiGozzetti

82. TARANTO82. TARANTO MazzaMazza, , CasulliCasulli

83. TORINO 183. TORINO 1 BoccadoroBoccadoro

84. TORINO 284. TORINO 2 Gallo, Gallo, PregnoPregno

85. TORINO MAURIZ.85. TORINO MAURIZ. PoccardiPoccardi, , GottardiGottardi

86. TORINO S. VITO86. TORINO S. VITO MarinoneMarinone, , FicaraFicara

87. TORINO VALD.SE87. TORINO VALD.SE BazzanBazzan, , RusRus

88. TREVISO88. TREVISO FoscoloFoscolo, , GherlinzoniGherlinzoni

89. TRIESTE89. TRIESTE De De SabbataSabbata

90. UDINE90. UDINE FaninFanin, , PatriarcaPatriarca

91. VARESE91. VARESE PinottiPinotti

92. VENEZIA92. VENEZIA ChisesiChisesi

93. VERBANIA93. VERBANIA MontanaraMontanara, , LuraschiLuraschi

94. VERONA94. VERONA PizzoloPizzolo, , MeneghiniMeneghini

95. VICENZA95. VICENZA RodeghieroRodeghiero, , EliceElice

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