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von Bueren AO, Kortmann RD, von Hoff K, Friedrich C, Mynarek M, Müller K, Goschzik T, Zur Mühlen A, Gerber N, Warmuth-Metz M, Soerensen N, Deinlein F, Benesch M, Zwiener I, Kwiecien R, Faldum A, Bode U, Fleischhack G, Hovestadt V, Kool M, Jones D, Northcott P, Kuehl J, Pfister S, Pietsch T, Rutkowski S. Treatment of Children and Adolescents With Metastatic Medulloblastoma and Prognostic Relevance of Clinical and Biologic Parameters. J Clin Oncol 2016; 34:4151-4160. [PMID: 27863192 DOI: 10.1200/jco.2016.67.2428] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess an intensified treatment in the context of clinical and biologic risk factors in metastatic medulloblastoma. Patients and Methods Patients (4 to 21 years old, diagnosed between 2001 and 2007) received induction chemotherapy, dose-escalated hyperfractionated craniospinal radiotherapy, and maintenance chemotherapy. Subgroup status and other biologic parameters were assessed. Results In 123 eligible patients (median age, 8.2 years old; median follow-up, 5.38 years), 5-year event-free survival (EFS) and overall survival (OS) were 62% (95% CI, 52 to 72) and 74% (95% CI, 66 to 82), respectively. OS was superior compared with the precedent HIT '91 trial. The 5-year EFS and OS were both 89% (95% CI, 67 to 100) for desmoplastic/nodular (n = 11), 61% (95% CI, 51 to 71) and 75% (95% CI, 65 to 85) for classic (n = 107), and 20% (95% CI, 0 to 55) and 40% (95% CI, 0 to 83) for large-cell/anaplastic (n = 5) medulloblastoma ( P < .001 for EFS; P = .001 for OS). Histology (hazard ratio, 0.19 for desmoplastic/nodular and 45.97 for large-cell/anaplastic medulloblastoma) and nonresponse to the first chemotherapy cycle (hazard ratio, 1.97) were independent risk factors (EFS). Among 81 (66%) patients with tumor material, 5-year EFS and OS differed between low-risk (wingless [WNT], n = 4; both 100%), high-risk ( MYCC/ MYCN amplification; n = 5, both 20%), and intermediate-risk patients (neither; n = 72, 63% and 73%, respectively). Survival rates were different between molecular subgroups (WNT, n = 4; sonic hedgehog [SHH; n = 4]; group 4 [n = 41]; group 3 with [n = 3] or without [n = 17] MYCC/MYCN amplification; P < .001). All cases showed p53 immuno-negativity. There was no association between patients with nonresponding tumors to induction chemotherapy and WNT ( P = .143) or MYCC/MYCN status ( P = .075), histologic subtype ( P = .814), or molecular subtype ( P = .383), as assessed by Fisher's exact test. Conclusion This regimen was feasible and conferred overall favorable survival. Our data confirm the relevance of subgroup status and biologic parameters (WNT/ MYCC/ MYCN status) in a homogeneous prospective trial population, and show that metastatic group 3 patients do not uniformly have poor outcomes. Biologic subgroup, MYCC/ MYCN status, response to induction chemotherapy, and histologic subtype may serve for improved treatment stratification.
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Affiliation(s)
- André O von Bueren
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Rolf-Dieter Kortmann
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Katja von Hoff
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Carsten Friedrich
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Martin Mynarek
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Klaus Müller
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Tobias Goschzik
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Anja Zur Mühlen
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Nicolas Gerber
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Monika Warmuth-Metz
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Niels Soerensen
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Frank Deinlein
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Martin Benesch
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Isabella Zwiener
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Robert Kwiecien
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Andreas Faldum
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Udo Bode
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Gudrun Fleischhack
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Volker Hovestadt
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Marcel Kool
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - David Jones
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Paul Northcott
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Joachim Kuehl
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Stefan Pfister
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Torsten Pietsch
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
| | - Stefan Rutkowski
- André O. von Bueren, Katja von Hoff, Carsten Friedrich, Martin Mynarek, and Stefan Rutkowski, University Medical Center Hamburg-Eppendorf, Hamburg; André O. von Bueren, University Medical Center Goettingen, Goettingen; Rolf-Dieter Kortmann and Klaus Müller, University of Leipzig; Carsten Friedrich, University Hospital Leipzig, Leipzig; Katja von Hoff, Nicolas Gerber, Monika Warmuth-Metz, Niels Soerensen, Frank Deinlein, and Joachim Kuehl, University of Wuerzburg, Wuerzburg; Tobias Goschzik, Anja zur Mühlen, and Torsten Pietsch, University of Bonn Medical Center; Udo Bode, University Hospital of Bonn, Bonn; Isabella Zwiener and Andreas Faldum, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz; Robert Kwiecien and Andreas Faldum, University of Muenster, Muenster; Gudrun Fleischhack, University Hospital of Essen, Essen; Volker Hovestadt, Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Research Center; Marcel Kool, David Jones, Paul Northcott, and Stefan Pfister, German Cancer Consortium; Stefan Pfister, University Hospital and National Center for Tumor Diseases, Heidelberg, Germany; Nicolas Gerber, University Children's Hospital, Zurich, Switzerland; Martin Benesch, Medical University of Graz, Graz, Austria; and Paul Northcott, St Jude Children's Research Hospital, Memphis, TN
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