{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T01:13:05Z","timestamp":1771636385840,"version":"3.50.1"},"reference-count":24,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2018,5,3]],"date-time":"2018-05-03T00:00:00Z","timestamp":1525305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Introduction: The clinical and therapeutic management of mixed cryoglobulinemia (MC) remains a subject of controversy. In addition, most studies have not recorded the long-term follow-up and the outcome of these cases. Material and Methods: We enrolled 246 patients affected by MC who were consecutively admitted to our Department from January 1993 to February 2013. Clinical and biological data had been recorded until June 2014. Results: The median age (at diagnosis) was 60 years (range 26\u201383). The aetiology was HCV in 95% of patients, HBV in 3% and \u201cessential\u201d in 2%. HCV genotype was 1b in 57%, genotypes 2\u20133 in 43%. MC was Type II in 203 of the cases (87%) and Type III in 52 (13%). The most frequent clinical manifestations were purpura (72%), chronic liver disease (70%), glomerulonephritis (35%), arthralgias (58%), peripheral neuropathy (21%), non-Hodgkin lymphoma (15%) and cutaneous ulcers (3%). Purpura, arthralgias, peripheral neuropathy, glomerulonephritis and non-Hodgkin lymphoma were more frequently observed in Type II than in Type III MC (p &lt; 0.05). Treatments were interferon (IFN) or Pegilated-IFN (PEG-IFN) alone or plus Ribavirin (RIBA) in 101 cases, steroids with or without alkylating agents in 33 cases, Rituximab in 8 patients. The complete clinical, virological and immunological responses were associated with PEG-IFN plus RIBA. Severe infections were associated with renal failure. At 10 years, the overall survival rate was 71% in Type II MC and 84% in Type III (p &lt; 0.053). Conclusions: From our data, antiviral therapy is the first-line therapy in HCV-related MC, whereas steroids, alkylating agents and Rituximab should be considered as a second-line therapy. Given the heterogeneity of the disease, the role of these different therapeutic strategies should be checked in randomized controlled trials.<\/jats:p>","DOI":"10.3390\/diseases6020035","type":"journal-article","created":{"date-parts":[[2018,5,3]],"date-time":"2018-05-03T03:20:27Z","timestamp":1525317627000},"page":"35","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Survival and Prognostic Factors in Mixed Cryoglobulinemia: Data from 246 Cases"],"prefix":"10.3390","volume":"6","author":[{"given":"Cesare","family":"Mazzaro","sequence":"first","affiliation":[{"name":"Clinical and Experimental Onco-Haematology Unit, CRO Aviano National Cancer Institute IRCCS, 33081 Aviano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigino","family":"Dal Maso","sequence":"additional","affiliation":[{"name":"Epidemiology and Statistic Unit, CRO Aviano National Cancer Institute IRCCS, 33081 Aviano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Endri","family":"Mauro","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pordenone General Hospital, 33170 Pordenone, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valter","family":"Gattei","sequence":"additional","affiliation":[{"name":"Clinical and Experimental Onco-Haematology Unit, CRO Aviano National Cancer Institute IRCCS, 33081 Aviano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michela","family":"Ghersetti","sequence":"additional","affiliation":[{"name":"Epidemiology and Statistic Unit, CRO Aviano National Cancer Institute IRCCS, 33081 Aviano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pietro","family":"Bulian","sequence":"additional","affiliation":[{"name":"Clinical and Experimental Onco-Haematology Unit, CRO Aviano National Cancer Institute IRCCS, 33081 Aviano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Moratelli","sequence":"additional","affiliation":[{"name":"Department of Clinical and Surgical Sciences, University of Trieste, 34121 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriele","family":"Grassi","sequence":"additional","affiliation":[{"name":"Department of Life Sciences, University of Trieste, 34121 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Zorat","sequence":"additional","affiliation":[{"name":"Department of Clinical and Surgical Sciences, University of Trieste, 34121 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriele","family":"Pozzato","sequence":"additional","affiliation":[{"name":"Department of Clinical and Surgical Sciences, University of Trieste, 34121 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,5,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/0002-9343(74)90852-3","article-title":"Biologic and clinical significance of cryoglobulins. 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