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Hill W, Sotlar K, Hautmann A, Kolb HJ, Ullmann J, Hausmann A, Schmidt M, Tischer J, Pham TT, Rank A, Hoechstetter MA. Late transplant-associated thrombotic microangiopathy verified in bone marrow biopsy specimens is associated with chronic GVHD and viral infections. Eur J Haematol 2024; 112:819-831. [PMID: 38243840 DOI: 10.1111/ejh.14174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES To describe late transplant-associated thrombotic microangiopathy (TA-TMA) as chronic endothelial complication in bone marrow (BM) after allogeneic hematopoietic stem cell transplantation (HSCT). METHODS BM specimens along with conventional diagnostic parameters were assessed in 14 single-institutional patients with late TA-TMA (more than 100 days after HCST), including 11 late with history of early TA-TMA, 10 with early TA-TMA (within 100 days), and 12 non TA-TMA patients. Three non-HSCT patients served as control. The time points of BM biopsy were +1086, +798, +396, and +363 days after HSCT, respectively. RESULTS Late TA-TMA patients showed an increase of CD34+ and von Willebrand Factor (VWF)+ microvascular endothelial cells with atypical VWF+ conglomerates forming thickened VWF+ plaque sinus in the BM compared to patients without late TA-TMA and non-HSCT. Severe chronic (p = .002), steroid-refractory GVHD (p = .007) and reactivation of HHV6 (p = .002), EBV (p = .003), and adenovirus (p = .005) were pronounced in late TA-TMA. Overall and relapse-free survival were shorter in late TA-TMA than in patients without late TA-TMA (5-year OS and RFS: 78.6% vs. 90.2%, 71.4% vs. 86.4%, respectively). CONCLUSION Chronic allo-immune microangiopathy in BM associated with chronic, steroid-refractory GVHD and/or viral infections are key findings of late, high-risk TA-TMA, which deserves clinical attention.
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Affiliation(s)
- Wolfgang Hill
- Department of Internal Medicine III, University Hospital Munich, University of Munich, Munich, Germany
| | - Karl Sotlar
- University Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Anke Hautmann
- Private Practice and Day Clinic for Hematology and Oncology, Regensburg, Germany
| | - Hans-Jochem Kolb
- Department of Internal Medicine III, University Hospital Munich, University of Munich, Munich, Germany
| | - Johanna Ullmann
- Department of Internal Medicine III, University Hospital Munich, University of Munich, Munich, Germany
| | - Andreas Hausmann
- Department of Internal Medicine I, Academic Teaching Hospital, München Klinik Schwabing, Munich, Germany
| | - Michael Schmidt
- Munich Cancer Registry, Institute for Medical Information Processing, Biometry, and Epidemiology, University of Munich, Munich, Germany
| | - Johanna Tischer
- Department of Internal Medicine III, University Hospital Munich, University of Munich, Munich, Germany
| | - Thu-Trang Pham
- Department of Internal Medicine I, Academic Teaching Hospital, München Klinik Schwabing, Munich, Germany
| | - Andreas Rank
- Department of Hematology and Oncology, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Manuela A Hoechstetter
- Department of Internal Medicine I, Academic Teaching Hospital, München Klinik Schwabing, Munich, Germany
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Schorb E, Isbell LK, Kerkhoff A, Mathas S, Braulke F, Egerer G, Röth A, Schliffke S, Borchmann P, Brunnberg U, Kroschinsky F, Möhle R, Rank A, Wellnitz D, Kasenda B, Pospiech L, Wendler J, Scherer F, Deckert M, Henkes E, von Gottberg P, Gmehlin D, Backenstraß M, Jensch A, Burger-Martin E, Grishina O, Fricker H, Malenica N, Orbán A, Duyster J, Ihorst G, Finke J, Illerhaus G. High-dose chemotherapy and autologous haematopoietic stem-cell transplantation in older, fit patients with primary diffuse large B-cell CNS lymphoma (MARTA): a single-arm, phase 2 trial. Lancet Haematol 2024; 11:e196-e205. [PMID: 38301670 DOI: 10.1016/s2352-3026(23)00371-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Available treatments for older patients with primary diffuse large B-cell CNS lymphoma (PCNSL) offer progression-free survival of up to 16 months. We aimed to investigate an intensified treatment of high-dose chemotherapy and autologous haematopoietic stem-cell transplantation (HSCT) in older patients with PCNSL. METHODS MARTA was a prospective, single-arm, phase 2 study done at 15 research hospitals in Germany. Patients aged 65 years or older with newly diagnosed, untreated PCNSL were enrolled if they had an Eastern Cooperative Oncology Group performance status of 0-2 and were fit for high-dose chemotherapy and autologous HSCT. Induction treatment consisted of two 21-day cycles of high-dose intravenous methotrexate 3·5 g/m2 (day 1), intravenous cytarabine 2 g/m2 twice daily (days 2 and 3), and intravenous rituximab 375 mg/m2 (days 0 and 4) followed by high-dose chemotherapy with intravenous rituximab 375 mg/m2 (day -8), intravenous busulfan 3·2 mg/kg (days -7 and -6), and intravenous thiotepa 5 mg/kg (days -5 and -4) plus autologous HSCT. The primary endpoint was progression-free survival at 12 months in all patients who met eligibility criteria and started treatment. The study was registered with the German clinical trial registry, DRKS00011932, and recruitment is complete. FINDINGS Between Nov 28, 2017, and Sept 16, 2020, 54 patients started induction treatment and 51 were included in the full analysis set. Median age was 71 years (IQR 68-75); 27 (53%) patients were female and 24 (47%) were male. At a median follow-up of 23·0 months (IQR 16·8-37·4), 23 (45%) of 51 patients progressed, relapsed, or died. 12-month progression-free survival was 58·8% (80% CI 48·9-68·2; 95% CI 44·1-70·9). During induction treatment, the most common grade 3-5 toxicities were thrombocytopenia and leukopenia (each in 52 [96%] of 54 patients). During high-dose chemotherapy and autologous HSCT, the most common grade 3-5 toxicity was leukopenia (37 [100%] of 37 patients). Treatment-related deaths were reported in three (6%) of 54 patients, all due to infectious complications. INTERPRETATION Although the primary efficacy threshold was not met, short induction followed by high-dose chemotherapy and autologous HSCT is active in selected older patients with PCNSL and could serve as a benchmark for comparative trials. FUNDING Else Kröner-Fresenius Foundation, Riemser Pharma, and Medical Center-University of Freiburg.
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Affiliation(s)
- Elisabeth Schorb
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Lisa Kristina Isbell
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Kerkhoff
- Medizinische Klinik A, Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Stephan Mathas
- Charité-Universitätsmedizin Berlin, Haematology, Oncology and Cancer Immunology, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, Group Biology of Malignant Lymphomas, Berlin, Germany; Experimental and Clinical Research Center, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Friederike Braulke
- Comprehensive Cancer Center, University Medical Center Göttingen, Göttingen, Germany; Department of Haematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Gerlinde Egerer
- Department of Haematology and Oncology, Heidelberg University, Heidelberg, Germany
| | - Alexander Röth
- Department of Haematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Simon Schliffke
- Department of Oncology and Haematology, BMT with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Borchmann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Uta Brunnberg
- Department of Internal Medicine II, Haematology and Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Robert Möhle
- Department of Haematology and Oncology, University of Tübingen, Tübingen, Germany
| | - Andreas Rank
- Department of Haematology and Oncology, Augsburg Medical Center, Augsburg, Germany
| | - Dominique Wellnitz
- Department of Internal Medicine II-Haematology and Oncology, University Clinics Schleswig Holstein-Campus Kiel, Kiel, Germany
| | - Benjamin Kasenda
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Lisa Pospiech
- Department of Haematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Julia Wendler
- Department of Haematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martina Deckert
- Institute of Neuropathology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Elina Henkes
- Clinic for Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Dennis Gmehlin
- Institute for Clinical Psychology, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Antje Jensch
- Stuttgart Cancer Center-Tumorzentrum Eva Mayr-Stihl, Klinikum Stuttgart, Stuttgart, Germany
| | - Elvira Burger-Martin
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Olga Grishina
- Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heidi Fricker
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Natalie Malenica
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - András Orbán
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Finke
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerald Illerhaus
- Department of Haematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
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Stelljes M, Raffel S, Alakel N, Wäsch R, Kondakci M, Scholl S, Rank A, Hänel M, Spriewald B, Hanoun M, Martin S, Schwab K, Serve H, Reiser L, Knaden J, Pfeifer H, Marx J, Sauer T, Berdel WE, Lenz G, Brüggemann M, Gökbuget N, Wethmar K. Inotuzumab Ozogamicin as Induction Therapy for Patients Older Than 55 Years With Philadelphia Chromosome-Negative B-Precursor ALL. J Clin Oncol 2024; 42:273-282. [PMID: 37883727 DOI: 10.1200/jco.23.00546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/28/2023] [Accepted: 08/15/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE Despite recent advances in adapting the intensity of treatment for older patients with ALL, current protocols are associated with high rates of early deaths, treatment-related toxicity, and dismal prognosis. We evaluated inotuzumab ozogamicin and dexamethasone (Dex) as induction therapy in older patients with ALL within the German Multicenter Study Group for Adult ALL (GMALL). PATIENTS AND METHODS The open-label, multicenter, phase II, INITIAL-1 trial enrolled 45 patients older than 55 years with newly diagnosed, CD22-positive, BCR::ABL-negative B-precursor ALL (B-ALL). Patients received up to three cycles of inotuzumab ozogamicin/Dex and up to six cycles of age-adapted GMALL consolidation and maintenance therapy. RESULTS Forty-three evaluable patients with common/pre-B (n = 38) and pro-B ALL (n = 5), with a median age of 64 years (range, 56-80), received at least two cycles of inotuzumab ozogamicin induction therapy. All patients achieved complete remission (CR/CR with incomplete hematologic recovery). Twenty-three (53%) and 30 (71%) patients had no evidence of molecularly assessed measurable residual disease (minimum 10e-4 threshold) after the second and third inductions, respectively. After a median follow-up of 2.7 years, event-free survival at one (primary end point) and 3 years was 88% (95% CI, 79 to 98) and 55% (95% CI, 40 to 71), while overall survival (OS) was 91% (95% CI, 82 to 99) and 73% (95% CI, 59 to 87), respectively. None of the patients died during 6 months after the start of induction. Most common adverse events having common toxicity criteria grade ≥3 during induction were leukocytopenia, neutropenia, thrombocytopenia, anemia, and elevated liver enzymes. One patient developed nonfatal veno-occlusive disease after induction II. CONCLUSION Inotuzumab ozogamicin-based induction followed by age-adapted chemotherapy was well tolerated and resulted in high rates of remission and OS. These data provide a rationale for integrating inotuzumab ozogamicin into first-line regimens for older patients with B-ALL.
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Affiliation(s)
- Matthias Stelljes
- Department of Medicine A, Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Münster, Münster, Germany
| | - Simon Raffel
- Department of Medicine, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Nael Alakel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ralph Wäsch
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mustafa Kondakci
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Sebastian Scholl
- Klinik für Innere Medizin II, Abteilung Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Andreas Rank
- Department of Hematology and Oncology, University Medical Center Augsburg, Augsburg, Germany
| | - Mathias Hänel
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - Bernd Spriewald
- Department of Internal Medicine V, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Maher Hanoun
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - Sonja Martin
- Department of Hematology and Oncology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Katjana Schwab
- Department of Medicine III, Hematology, Oncology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Hubert Serve
- Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
| | - Lena Reiser
- Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
| | - Julian Knaden
- Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
| | - Heike Pfeifer
- Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
| | - Julia Marx
- Department of Medicine A, Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Münster, Münster, Germany
| | - Tim Sauer
- Department of Medicine, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Münster, Münster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Münster, Münster, Germany
| | - Monika Brüggemann
- Department of Medicine II, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Nicola Gökbuget
- Department of Medicine II, Hematology/Oncology, Goethe University, University Hospital, Frankfurt, Germany
| | - Klaus Wethmar
- Department of Medicine A, Hematology, Oncology, Hemostaseology and Pneumology, University Hospital Münster, Münster, Germany
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Unterfrauner M, Rejeski HA, Hartz A, Bohlscheid S, Baudrexler T, Feng X, Rackl E, Li L, Rank A, Filippini Velázquez G, Schmid C, Schmohl J, Bojko P, Schmetzer H. Granulocyte-Macrophage-Colony-Stimulating-Factor Combined with Prostaglandin E1 Create Dendritic Cells of Leukemic Origin from AML Patients' Whole Blood and Whole Bone Marrow That Mediate Antileukemic Processes after Mixed Lymphocyte Culture. Int J Mol Sci 2023; 24:17436. [PMID: 38139264 PMCID: PMC10743754 DOI: 10.3390/ijms242417436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Although several (chemotherapeutic) protocols to treat acute myeloid leukemia (AML) are available, high rates of relapses in successfully treated patients occur. Strategies to stabilize remissions are greatly needed. The combination of the (clinically approved) immune-modulatory compounds Granulocyte-Macrophage-Colony-Stimulating-Factor (GM-CSF) and Prostaglandine E1 (PGE-1) (Kit-M) converts myeloid blasts into dendritic cells of leukemic origin (DCleu). After stimulation with DCleu ex vivo, leukemia-specific antileukemic immune cells are activated. Therefore, Kit-M treatment may be an attractive immunotherapeutic tool to treat patients with myeloid leukemia. Kit-M-mediated antileukemic effects on whole bone marrow (WBM) were evaluated and compared to whole blood (WB) to evaluate the potential effects of Kit-M on both compartments. WB and WBM samples from 17 AML patients at first diagnosis, in persisting disease and at relapse after allogeneic stem cell transplantation (SCT) were treated in parallel with Kit-M to generate DC/DCleu. Untreated samples served as controls. After a mixed lymphocyte culture enriched with patients' T cells (MLC), the leukemia-specific antileukemic effects were assessed through the degranulation- (CD107a+ T cells), the intracellular IFNγ production- and the cytotoxicity fluorolysis assay. Quantification of cell subtypes was performed via flow cytometry. In both WB and WBM significantly higher frequencies of (mature) DCleu were generated without induction of blast proliferation in Kit-M-treated samples compared to control. After MLC with Kit-M-treated vs. not pretreated WB or WBM, frequencies of (leukemia-specific) immunoreactive cells (e.g., non-naive, effector-, memory-, CD3+β7+ T cells, NK- cells) were (significantly) increased, whereas leukemia-specific regulatory T cells (Treg, CD152+ T cells) were (significantly) decreased. The cytotoxicity fluorolysis assay showed a significantly improved blast lysis in Kit-M-treated WB and WBM compared to control. A parallel comparison of WB and WBM samples revealed no significant differences in frequencies of DCleu, (leukemia-specific) immunoreactive cells and achieved antileukemic processes. Kit-M was shown to have comparable effects on WB and WBM samples regarding the generation of DCleu and activation of (antileukemic) immune cells after MLC. This was true for samples before or after SCT. In summary, a potential Kit-M in vivo treatment could lead to antileukemic effects in WB as well as WBM in vivo and to stabilization of the disease or remission in patients before or after SCT. A clinical trial is currently being planned.
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Affiliation(s)
| | - Hazal Aslan Rejeski
- Department of Medicine III, University Hospital of Munich, 81377 Munich, Germany
| | - Anne Hartz
- Department of Medicine III, University Hospital of Munich, 81377 Munich, Germany
| | - Sophia Bohlscheid
- Department of Medicine III, University Hospital of Munich, 81377 Munich, Germany
| | - Tobias Baudrexler
- Department of Medicine III, University Hospital of Munich, 81377 Munich, Germany
| | - Xiaojia Feng
- Department of Medicine III, University Hospital of Munich, 81377 Munich, Germany
| | - Elias Rackl
- Department of Medicine III, University Hospital of Munich, 81377 Munich, Germany
| | - Lin Li
- Department of Medicine III, University Hospital of Munich, 81377 Munich, Germany
| | - Andreas Rank
- Department of Hematology and Oncology, University Hospital of Augsburg, 86156 Augsburg, Germany
| | | | - Christoph Schmid
- Department of Hematology and Oncology, University Hospital of Augsburg, 86156 Augsburg, Germany
| | - Jörg Schmohl
- Department of Hematology and Oncology, Diakonieklinikum Stuttgart, 70176 Stuttgart, Germany
| | - Peter Bojko
- Department of Hematology and Oncology, Rotkreuzklinikum Munich, 80634 Munich, Germany
| | - Helga Schmetzer
- Department of Medicine III, University Hospital of Munich, 81377 Munich, Germany
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5
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Kriegsmann K, Bittrich M, Sauer S, Tietze-Stolley C, Movassaghi K, Grube M, Vucinic V, Wehler D, Burchert A, Schmidt-Hieber M, Rank A, Dürk HA, Metzner B, Kimmich C, Hentrich M, Kunz C, Hartmann F, Khandanpour C, de Wit M, Holtick U, Kiehl M, Stoltefuß A, Kiani A, Naumann R, Scholz CW, Tischler HJ, Görner M, Brand F, Ehmer M, Kröger N. Mobilization and Hematopoietic Stem Cell Collection in Poor Mobilizing Patients with Lymphoma: Final Results of the German OPTIMOB Study. Transfus Med Hemother 2023; 50:403-416. [PMID: 37899991 PMCID: PMC10601601 DOI: 10.1159/000531936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/03/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Successful mobilization and collection of peripheral hematopoietic stem cells (HSCs) are necessary for lymphoma patients eligible for myeloablative chemotherapy with subsequent autologous stem cell transplantation (ASCT). Albeit G-CSF alone or combined with chemotherapy is well-established methods for HSC mobilization, up to 40% of the patients fail to mobilize (poor mobilizer, PM). Plerixafor (PLX) is commonly used in PM patients resulting in increased migration of HSCs into peripheral blood and thus improves the collection outcome. Methods The prospective, multicenter, open-label, non-interventional OPTIMOB study assessed mobilization and collection parameter of patients with lymphoma or multiple myeloma to get deep insights in the treatment of those patients in clinical routine focusing on PM patients. PM was defined as follows: (1) no achievement of ≥20 CD34+ progenitor cells/µL before first apheresis, (2) PLX administration at any time point during the observational period, (3) reduction of the initially planned CD34+ progenitor cell yield as necessity due to failed mobilization or HSC collection, and (4) no performance of apheresis due to low CD34+ progenitor level. Primary objective of the study was to assess mobilization success by the proportion of PM patients achieving >2 × 106 CD34+ progenitor cells/kg body weight on the first day of apheresis. Here, the data of the lymphoma cohort are presented. Results Out of 238 patients with lymphoma documented in the study, 32% were classified as PM. 87% of them received PLX. Demographic data revealed no obvious differences between PM and good mobilizing (GM) patients. All patients were treated highly individualized prior to mobilization. Majority of all PM patients were able to undergo apheresis (95%) and reached their individual requested CD34+ progenitor cell target (72%). 57% of the PM patients achieved >2.0 × 106 CD34+ progenitor cells/kg body weight on day 1 of apheresis and nearby 70% of them underwent ASCT. Median time to engraftment was similar in PM and GM patients of the lymphoma cohort. Conclusions Majority of PM patients with lymphoma were successfully mobilized and underwent ASCT. Most of them received PLX during the study.
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Affiliation(s)
- Katharina Kriegsmann
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Laborarztpraxis, Laborarztpraxis Rhein-Main MVZ GbR, Limbach Gruppe SE, Frankfurt, Germany
| | - Max Bittrich
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Sandra Sauer
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Carola Tietze-Stolley
- Department of Hematology and Oncology, Stem Cell Facility, University Hospital Charité, Berlin, Germany
| | - Kamran Movassaghi
- Department of Hematology and Oncology, Stem Cell Facility, University Hospital Charité, Berlin, Germany
| | - Matthias Grube
- Department of Hematology and Internistic Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Vladan Vucinic
- Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, University Hospital Leipzig, Leipzig, Germany
| | - Daniela Wehler
- Klinik und Poliklinik für Innere Medizin III, University Hospital of Mainz, Mainz, Germany
| | - Andreas Burchert
- Klinik für Hämatologie, Onkologie und Immunologie, University Hospital of Gießen and Marburg (UKGM), Marburg, Germany
| | - Martin Schmidt-Hieber
- 2. Medizinische Klinik für Hämatologie, Onkologie, Pneumologie und Nephrologie, Carl-Thiem Hospital Cottbus gGmbH, Cottbus, Germany
| | - Andreas Rank
- 2. Medizinische Klinik – Hämatologie, Internistische Onkologie und Hämostaseologie, University Hospital of Augsburg, Augsburg, Germany
| | - Heinz A. Dürk
- Klinik für Hämatologie und Onkologie, St. Barbara Hospital Hamm-Heessen, Hamm, Germany
| | - Bernd Metzner
- Universitätsklinik für Innere Medizin – Onkologie und Hämatologie, University Hospital Klinikum Oldenburg, Oldenburg, Germany
| | - Christoph Kimmich
- Universitätsklinik für Innere Medizin – Onkologie und Hämatologie, University Hospital Klinikum Oldenburg, Oldenburg, Germany
| | - Marcus Hentrich
- Abteilung für Innere Medizin III –Hämatologie und Onkologie, Rotkreuzklinikum München, Munich, Germany
| | - Christian Kunz
- Innere Medizin I, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
| | - Frank Hartmann
- Klinik für Onkologie und Hämatologie, Hospital Lippe-Lemgo, Lemgo, Germany
| | - Cyrus Khandanpour
- Medizinische Klinik A, University Hospital Münster, Münster, Germany
- Klinik für Hämatologie und Onkologie, University Hospital Schleswig-Holstein (Campus Lübeck) and University of Lübeck, Lübeck, Germany
| | - Maike de Wit
- Klinik für Innere Medizin – Hämatologie, Onkologie und Palliativmedizin, Vivantes Hospital Neukölln, Berlin, Germany
| | - Udo Holtick
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Michael Kiehl
- Medizinische Klinik I, Hospital Frankfurt (Oder), Frankfurt/Oder, Germany
| | - Andrea Stoltefuß
- Klinik für Innere Medizin II, Evangelisches Krankenhaus Hamm, Hamm, Germany
| | - Alexander Kiani
- Department of Hematology and Oncology, Klinikum Bayreuth, Bayreuth, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Ralph Naumann
- Klinik für Hämatologie, Medizinische Onkologie und Palliativmedizin, St. Marien-Krankenhaus Marien Gesellschaft Siegen gGmbH, Siegen, Germany
| | - Christian W. Scholz
- Klinik für Innere Medizin – Hämatologie und Onkologie, Vivantes Hospital Am Urban, Berlin, Germany
| | - Hans-Joachim Tischler
- Universitätsklinik für Hämatologie, Onkologie, Hämostaseologie und Palliativmedizin, Johannes Wesling Hospital Minden, Mühlenkreiskliniken, Minden, Germany
| | - Martin Görner
- Klinik für Hämatologie, Onkologie, Palliativmedizin und Stammzelltherapie, Hospital Bielefeld-Mitte, Bielefeld, Germany
| | | | - Martin Ehmer
- Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | - Nicolaus Kröger
- Interdisziplinäre Klinik und Poliklinik für Stammzelltransplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Baudrexler T, Boeselt T, Li L, Bohlscheid S, Boas U, Schmid C, Rank A, Schmohl J, Koczulla R, Schmetzer HM. Volatile Phases Derived from Serum, DC, or MLC Culture Supernatants to Deduce a VOC-Based Diagnostic Profiling Strategy for Leukemic Diseases. Biomolecules 2023; 13:989. [PMID: 37371569 DOI: 10.3390/biom13060989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Volatile organic compounds (VOCs) reflect the metabolism in healthy and pathological conditions, and can be collected easily in a noninvasive manner. They are directly measured using electronical nose (eNose), and may qualify as a systemic tool to monitor biomarkers related to disease. Myeloid leukemic blasts can be transformed into leukemia-derived dendritic cells (DCleu) able to improve (anti-leukemic) immune responses. To profile immunological changes in healthy and acute myeloid leukemic (AML) patients' ex vivo cell cultures, we correlated the cell biological data with the profiles of cell culture supernatant-derived VOCs. DC/DCleu from leukemic or healthy whole blood (WB) were generated without (Control) or with immunomodulatory Kit M (Granulocyte macrophage-colony-stimulating-factor (GM-CSF) + prostaglandin E1 (PGE1)) in dendritic cell cultures (DC culture). Kit-pretreated/not pretreated WB was used to stimulate T cell-enriched immunoreactive cells in mixed lymphocyte cultures (MLC culture). Leukemia-specific adaptive and innate immune cells were detected with a degranulation assay (Deg) and an intracellular cytokine assay (InCyt). Anti-leukemic cytotoxicity was explored with a cytotoxicity fluorolysis assay (CTX). VOCs collected from serum or DC- and MLC culture supernatants (with vs. without Kit M pretreatment and before vs. after culture) were measured using eNose. Compared to the Control (without treatment), Kit M-pretreated leukemic and healthy WB gave rise to higher frequencies of mature (leukemia-derived) DC subtypes of activated and (memory) T cells after MLC. Moreover, antigen (leukemia)-specific cells of several lines (innate and adaptive immunity cells) were induced, giving rise to blast-lysing cells. The eNose could significantly distinguish between healthy and leukemic patients' serum, DC and MLC culture supernatant-derived volatile phases and could significantly separate several supernatant (with vs. without Kit M treatment, cultured vs. uncultured)-derived VOCs within subgroups (healthy DC or leukemic DC, or healthy MLC or leukemic MLC supernatants). Interestingly, the eNose could indicate a Kit M- and culture-associated effect. The eNose may be a prospective option for the deduction of a VOC-based profiling strategy using serum or cell culture supernatants and could be a useful diagnostic tool to recognize or qualify AML disease.
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Affiliation(s)
- Tobias Baudrexler
- Medical Department III, Hospital Großhadern, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Tobias Boeselt
- Department of Pulmonary Rehabilitation, German Center for Lung Research (DZL), Phillipps-University of Marburg, 35043 Marburg, Germany
| | - Lin Li
- Medical Department III, Hospital Großhadern, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Sophia Bohlscheid
- Medical Department III, Hospital Großhadern, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Ursel Boas
- Department of Pulmonary Rehabilitation, German Center for Lung Research (DZL), Phillipps-University of Marburg, 35043 Marburg, Germany
| | - Christoph Schmid
- Department of Hematology and Oncology, University Hospital of Augsburg, 86156 Augsburg, Germany
| | - Andreas Rank
- Department of Hematology and Oncology, University Hospital of Augsburg, 86156 Augsburg, Germany
| | - Jörg Schmohl
- Department of Hematology and Oncology, Diaconia Hospital Stuttgart, 70176 Stuttgart, Germany
| | - Rembert Koczulla
- Department of Pulmonary Rehabilitation, German Center for Lung Research (DZL), Phillipps-University of Marburg, 35043 Marburg, Germany
| | - Helga Maria Schmetzer
- Medical Department III, Hospital Großhadern, Ludwig-Maximilians-University, 81377 Munich, Germany
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7
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Nicol P, Rank A, Lenz T, Schürmann F, Syryca F, Trenkwalder T, Reinhard W, Adolf R, Hadamitzky M, Kastrati A, Joner M, Schunkert H, Engel LC. Echocardiographic evaluation of left ventricular function using an automated analysis algorithm is feasible for beginners and experts: comparison with invasive and non-invasive methods. J Echocardiogr 2023; 21:65-73. [PMID: 36227498 PMCID: PMC10195710 DOI: 10.1007/s12574-022-00590-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022]
Abstract
AIMS Echocardiographic measurement of left ventricular function using a user-friendly automated three-dimensional algorithm is highly attractive as it promises quick and accurate diagnosis, circumventing limitations associated with visual estimation or manual biplane measurements. We sought to assess the feasibility and correlation of such automated analysis with clinically established methods. METHODS A total of 198 patients undergoing transthoracic echocardiography (TTE) with assessment of left ventricular parameters by automated software algorithm (Philips 3D-Heartmodel; 3D-HM) which additionally had either left ventricular angiography (LVA) or cardiac magnetic resonance (CMR) within 24 h of the TTE examination were analyzed. Left ventricular parameters (left ventricular end-diastolic volume, LVEDV, left ventricular end-systolic volume, LVESV as well as left ventricular ejection fraction, LVEF) were compared between 3D-HM, CMR and LVA. RESULTS Correlation of left ventricular measurements was overall good to excellent and stronger for CMR (EF r = 0.824) than for LVA (EF r = 0.746). Unexperienced and expert clinicians yielded comparable good results. For CMR, highest correlation was detected in patients with BMI < 25 and excellent image quality. High agreement was seen between 3D-HM and CMR or LVA when stratifying patients according to heart failure categories. CONCLUSIONS Echocardiographic quantification of left ventricular parameters using a software-based algorithm correlated well with established invasive and non-invasive modalities in the clinical setting, even for unexperienced clinicians. Such automated approaches are promising as they allow a reliable, more observer-independent as well as reproducible assessment of left ventricular function.
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Affiliation(s)
- Philipp Nicol
- Klinik Für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Andreas Rank
- Klinik Für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tobias Lenz
- Klinik Für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Friederike Schürmann
- Klinik Für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Finn Syryca
- Klinik Für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Teresa Trenkwalder
- Klinik Für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Wibke Reinhard
- Klinik Für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Rafael Adolf
- Institut Für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Martin Hadamitzky
- Institut Für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Klinik Für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Deutsches Zentrum Für Herz- und Kreislauf-Forschung (DZHK) E.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Joner
- Klinik Für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Deutsches Zentrum Für Herz- und Kreislauf-Forschung (DZHK) E.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Klinik Für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Deutsches Zentrum Für Herz- und Kreislauf-Forschung (DZHK) E.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Leif-Christopher Engel
- Klinik Für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
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Li L, Mussack V, Görgens A, Pepeldjiyska E, Hartz AS, Aslan H, Rackl E, Rank A, Schmohl J, El Andaloussi S, Pfaffl MW, Schmetzer H. The potential role of serum extracellular vesicle derived small RNAs in AML research as non-invasive biomarker. Nanoscale Adv 2023; 5:1691-1705. [PMID: 36926576 PMCID: PMC10012871 DOI: 10.1039/d2na00959e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Extracellular vesicles (EV) are cell-derived vesicles released by all cells in health and disease. Accordingly, EVs are also released by cells in acute myeloid leukemia (AML), a hematologic malignancy characterized by uncontrolled growth of immature myeloid cells, and these EVs likely carry markers and molecular cargo reflecting the malignant transformation occurring in diseased cells. Monitoring antileukemic or proleukemic processes during disease development and treatment is essential. Therefore, EVs and EV-derived microRNA (miRNA) from AML samples were explored as biomarkers to distinguish disease-related patterns ex vivo or in vivo. METHODOLOGY EVs were purified from serum of healthy (H) volunteers and AML patients by immunoaffinity. EV surface protein profiles were analyzed by multiplex bead-based flow cytometry (MBFCM) and total RNA was isolated from EVs prior to miRNA profiling via small RNA sequencing. RESULTS MBFCM revealed different surface protein patterns in H versus AML EVs. miRNA analysis showed individual as well as highly dysregulated patterns in H and AML samples. CONCLUSIONS In this study, we provide a proof-of-concept for the discriminative potential of EV derived miRNA profiles as biomarkers in H versus AML samples.
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Affiliation(s)
- Lin Li
- Immune-Modulation, Medical Department III, University Hospital of Munich Marchioninistraße 15 81377 Munich Germany +49 89 4400 76137 +49 89 4400 73137
| | - Veronika Mussack
- Department of Animal Physiology and Immunology, TUM School of Life Sciences Weihenstephan, Technical University of Munich Freising Germany
| | - André Görgens
- Department of Laboratory Medicine, Division of Biomolecular and Cellular Medicine, Karolinska Institutet Stockholm Sweden
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen Essen Germany
| | - Elena Pepeldjiyska
- Immune-Modulation, Medical Department III, University Hospital of Munich Marchioninistraße 15 81377 Munich Germany +49 89 4400 76137 +49 89 4400 73137
| | - Anne Sophie Hartz
- Immune-Modulation, Medical Department III, University Hospital of Munich Marchioninistraße 15 81377 Munich Germany +49 89 4400 76137 +49 89 4400 73137
| | - Hazal Aslan
- Immune-Modulation, Medical Department III, University Hospital of Munich Marchioninistraße 15 81377 Munich Germany +49 89 4400 76137 +49 89 4400 73137
| | - Elias Rackl
- Immune-Modulation, Medical Department III, University Hospital of Munich Marchioninistraße 15 81377 Munich Germany +49 89 4400 76137 +49 89 4400 73137
| | - Andreas Rank
- Department of Hematology and Oncology, University Hospital of Augsburg Augsburg Germany
| | - Jörg Schmohl
- Department of Hematology and Oncology, Hospital of Stuttgart Stuttgart Germany
| | - Samir El Andaloussi
- Department of Laboratory Medicine, Division of Biomolecular and Cellular Medicine, Karolinska Institutet Stockholm Sweden
| | - Michael W Pfaffl
- Department of Animal Physiology and Immunology, TUM School of Life Sciences Weihenstephan, Technical University of Munich Freising Germany
| | - Helga Schmetzer
- Immune-Modulation, Medical Department III, University Hospital of Munich Marchioninistraße 15 81377 Munich Germany +49 89 4400 76137 +49 89 4400 73137
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Plett C, Klauer LK, Amberger DC, Ugur S, Rabe A, Stankova Z, Deen D, Hirn-Lopez A, Gunsilius C, Werner JO, Schmohl J, Krämer D, Rank A, Schmid C, Schmetzer HM. Immunomodulatory kits generating leukaemia derived dendritic cells do not induce blast proliferation ex vivo: IPO-38 as a novel marker to quantify proliferating blasts in acute myeloid leukaemia. Clin Immunol 2022; 242:109083. [DOI: 10.1016/j.clim.2022.109083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
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10
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Waidhauser J, Nerlinger P, Sommer F, Wolf S, Eser S, Löhr P, Rank A, Märkl B. Circulating Lymphocytes Reflect the Local Immune Response in Patients with Colorectal Carcinoma. Diagnostics (Basel) 2022; 12:diagnostics12061408. [PMID: 35741218 PMCID: PMC9221878 DOI: 10.3390/diagnostics12061408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 12/04/2022] Open
Abstract
Tumor-infiltrating lymphocytes (TILs) correlate with the number and size of the surrounding lymph nodes in patients with colorectal carcinoma (CRC) and reflect the quality of the antitumor immune response. In this prospective study, we analyzed whether this response correlated with the circulating lymphocytes in peripheral blood (PB). In 47 patients with newly diagnosed CRC, flow cytometry was performed to analyze the B cells, T cells, NK cells, and a variety of their subsets in PB. The results were correlated with TILs in the resected tumor and with the number and size of the surrounding lymph nodes in nodal negative (N- patients (LN5: number of lymph nodes measuring ≥5 mm) and the metastasis-to-lymph node size ratio (MSR) in nodal positive patients (N+). Differences between the number of TILs could be seen between N+ and N- patients, dependent on the LN5 and MSR categories, with higher values in N- cases and in patients with a higher LN5 category or a lower MSR. Additionally, higher values of various circulating lymphocyte subgroups were observed in these patients. For the total PB lymphocytes, CD8 cells, and some of their subgroups, a positive correlation with the TILs was found. This study shows that circulating lymphocytes—in particular, cytotoxic T cells—correlate with the local antitumor immune response displayed by TILs and lymph node activation. Our findings indicate that local and generalized antitumor immune responses are concordant with their different components.
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Affiliation(s)
- Johanna Waidhauser
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (P.N.); (P.L.); (A.R.)
- Correspondence:
| | - Pia Nerlinger
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (P.N.); (P.L.); (A.R.)
| | - Florian Sommer
- Department of General, Visceral and Transplant Surgery, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (F.S.); (S.W.)
| | - Sebastian Wolf
- Department of General, Visceral and Transplant Surgery, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (F.S.); (S.W.)
| | - Stefan Eser
- Department of Gastroenterology and Infectious Diseases, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany;
| | - Phillip Löhr
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (P.N.); (P.L.); (A.R.)
| | - Andreas Rank
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (P.N.); (P.L.); (A.R.)
| | - Bruno Märkl
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany;
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Mayr P, Grünewald T, Filippini Velazquez G, Rank A, Schmid C, Harloff M, Märkl B, Trepel M, Hirschbühl K, Pfeiffer T, Claus R. Transfusion‐refractory pancytopenia with
MDS
‐like morphologic alterations of the bone marrow in a 29‐year old man: A mimicry manifestation caused by scurvy. Br J Haematol 2022; 197:627-630. [DOI: 10.1111/bjh.18064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Patrick Mayr
- Hematology and Oncology, Medical Faculty University of Augsburg Augsburg Germany
| | - Tatiana Grünewald
- Hematology and Oncology, Medical Faculty University of Augsburg Augsburg Germany
| | | | - Andreas Rank
- Hematology and Oncology, Medical Faculty University of Augsburg Augsburg Germany
| | - Christoph Schmid
- Hematology and Oncology, Medical Faculty University of Augsburg Augsburg Germany
| | - Manuela Harloff
- General Pathology and Molecular Diagnostics, Medical Faculty University of Augsburg Augsburg Germany
| | - Bruno Märkl
- General Pathology and Molecular Diagnostics, Medical Faculty University of Augsburg Augsburg Germany
| | - Martin Trepel
- Hematology and Oncology, Medical Faculty University of Augsburg Augsburg Germany
| | - Klaus Hirschbühl
- Hematology and Oncology, Medical Faculty University of Augsburg Augsburg Germany
| | - Tim Pfeiffer
- Hematology and Oncology, Medical Faculty University of Augsburg Augsburg Germany
| | - Rainer Claus
- Hematology and Oncology, Medical Faculty University of Augsburg Augsburg Germany
- General Pathology and Molecular Diagnostics, Medical Faculty University of Augsburg Augsburg Germany
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12
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Klauer LK, Schutti O, Ugur S, Doraneh-Gard F, Amberger DC, Rogers N, Krämer D, Rank A, Schmid C, Eiz-Vesper B, Schmetzer HM. Interferon Gamma Secretion of Adaptive and Innate Immune Cells as a Parameter to Describe Leukaemia-Derived Dendritic-Cell-Mediated Immune Responses in Acute Myeloid Leukaemia in vitro. Transfus Med Hemother 2022; 49:44-61. [PMID: 35221867 PMCID: PMC8832209 DOI: 10.1159/000516886] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/28/2021] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Myeloid leukaemic blasts can be converted into leukaemia-derived dendritic cells (DCleu), characterised by the simultaneous expression of dendritic- and leukaemia-associated antigens, which have the competence to prime and enhance (leukaemia-specific) immune responses with the whole leukaemic antigen repertoire. To display and further specify dendritic cell (DC)- and DCleu-mediated immune responses, we analysed the interferon gamma (IFNy) secretion of innate and adaptive immune cells. METHODS DC/DCleu were generated from leukaemic whole blood (WB) with (blast)modulatory Kit-I (granulocyte-macrophage colony-stimulating factor [GM-CSF] + Picibanil [OK-432]) and Kit-M (GM-CSF + prostaglandin E1) and were used to stimulate T cell-enriched immunoreactive cells. Initiated anti-leukaemic cytotoxicity was investigated with a cytotoxicity fluorolysis assay. Initiated IFNy secretion of T, NK, CIK, and iNKT cells was investigated with a cytokine secretion assay (CSA). IFNy positivity was additionally evaluated with an intracellular cytokine assay (ICA). Recent activation of leukaemia-specific cells was verified through addition of leukaemia-associated antigens (LAA; WT-1 and Prame). RESULTS We found Kit-I and Kit-M competent to generate mature DC and DCleu from leukaemic WB without induction of blast proliferation. Stimulation of immunoreactive cells with DC/DCleu regularly resulted in an increased anti-leukaemic cytotoxicity and increased IFNy secretion of T, NK, and CIK cells, pointing to the significant role of DC/DCleu in leukaemia-specific alongside anti-leukaemic reactions. Interestingly, an addition of LAA did not further increase IFNy secretion, suggesting an efficient activation of leukaemia-specific cells. Here, both the CSA and ICA yielded comparable frequencies of IFNy-positive cells. Remarkably, the anti-leukaemic cytotoxicity positively correlated with the IFNy secretion in TCD3+, TCD4+, TCD8+, and NKCD56+ cells. CONCLUSION Ultimately, the IFNy secretion of innate and adaptive immune cells appeared to be a suitable parameter to assess and monitor the efficacy of in vitro and potentially in vivo acute myeloid leukaemia immunotherapy. The CSA in this regard proved to be a convenient and reproducible technique to detect and phenotypically characterise IFNy-secreting cells. In respect to our studies on DC-based immunomodulation, we were able to display the potential of DC/DCleu to induce or improve leukaemia-specific and anti-leukaemic activity.
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Affiliation(s)
| | - Olga Schutti
- Department of Medicine III, University Hospital of Munich, Munich, Germany
| | - Selda Ugur
- Department of Medicine III, University Hospital of Munich, Munich, Germany
| | | | | | - Nicole Rogers
- Department of Medicine III, University Hospital of Munich, Munich, Germany
| | - Doris Krämer
- Department of Haematology and Oncology, St.-Josefs-Hospital, Hagen, Germany
| | - Andreas Rank
- Department of Haematology and Oncology, University Hospital of Augsburg, Augsburg, Germany
| | - Christoph Schmid
- Department of Haematology and Oncology, University Hospital of Augsburg, Augsburg, Germany
| | - Britta Eiz-Vesper
- Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany
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13
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Li L, Görgens A, Mussack V, Pepeldjiyska E, Hartz AS, Rank A, Schmohl J, Krämer D, Andaloussi SE, Pfaffl MW, Schmetzer H. Description and optimization of a multiplex bead-based flow cytometry method (MBFCM) to characterize extracellular vesicles in serum samples from patients with hematological malignancies. Cancer Gene Ther 2022; 29:1600-1615. [PMID: 35477770 PMCID: PMC9663305 DOI: 10.1038/s41417-022-00466-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/25/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
Extracellular Vesicles (EVs) are membranous vesicles produced by all cells under physiological and pathological conditions. In hematological malignancies, tumor-derived EVs might reprogram the bone marrow environment, suppress antileukemic immunity, mediate drug resistance and interfere with immunotherapies. EVs collected from the serum of leukemic samples might correlate with disease stage, drug-/immunological resistance, or might correlate with antileukemic immunity/immune response. Special EV surface protein patterns in serum have the potential as noninvasive biomarker candidates to distinguish several disease-related patterns ex vivo or in vivo. EVs were isolated from the serum of acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), chronic lymphoid leukemia (CLL) patients, and healthy volunteers. EVs were characterized by transmission electron microscopy and fluorescence nanoparticle tracking analysis, and EV surface protein profiles were analyzed by multiplex bead-based flow cytometry to identify tumor- or immune system-related EVs of AML, ALL, CLL, and healthy samples. Aiming to provide proof-of-concept evidence and methodology for the potential role of serum-derived EVs as biomarkers in leukemic versus healthy samples in this study, we hope to pave the way for future detection of promising biomarkers for imminent disease progression and the identification of potential targets to be used in a therapeutic strategy.
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Affiliation(s)
- Lin Li
- grid.411095.80000 0004 0477 2585Working-group: Immune-Modulation, Medical Department III, University Hospital of Munich, Munich, Germany
| | - André Görgens
- grid.4714.60000 0004 1937 0626Department of Laboratory Medicine, Division of Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Veronika Mussack
- grid.6936.a0000000123222966Department of Animal Physiology and Immunology, TUM School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Elena Pepeldjiyska
- grid.411095.80000 0004 0477 2585Working-group: Immune-Modulation, Medical Department III, University Hospital of Munich, Munich, Germany
| | - Anne Sophie Hartz
- grid.411095.80000 0004 0477 2585Working-group: Immune-Modulation, Medical Department III, University Hospital of Munich, Munich, Germany
| | - Andreas Rank
- grid.419801.50000 0000 9312 0220Department of Hematology and Oncology, University Hospital of Augsburg, Augsburg, Germany
| | - Jörg Schmohl
- Department of Hematology and Oncology, Hospital of Stuttgart, Stuttgart, Germany
| | - Doris Krämer
- Department of Heamatology, Oncology and Palliative Care, Ameos Klinikum Mitte, Bremerhaven, Germany
| | - Samir El Andaloussi
- grid.4714.60000 0004 1937 0626Department of Laboratory Medicine, Division of Biomolecular and Cellular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Michael W. Pfaffl
- grid.6936.a0000000123222966Department of Animal Physiology and Immunology, TUM School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Helga Schmetzer
- grid.411095.80000 0004 0477 2585Working-group: Immune-Modulation, Medical Department III, University Hospital of Munich, Munich, Germany
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14
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Holmberg O, Lenz T, Koch V, Alyagoob A, Utsch L, Rank A, Sabic E, Seguchi M, Xhepa E, Kufner S, Cassese S, Kastrati A, Marr C, Joner M, Nicol P. Histopathology-Based Deep-Learning Predicts Atherosclerotic Lesions in Intravascular Imaging. Front Cardiovasc Med 2021; 8:779807. [PMID: 34970608 PMCID: PMC8713728 DOI: 10.3389/fcvm.2021.779807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Optical coherence tomography is a powerful modality to assess atherosclerotic lesions, but detecting lesions in high-resolution OCT is challenging and requires expert knowledge. Deep-learning algorithms can be used to automatically identify atherosclerotic lesions, facilitating identification of patients at risk. We trained a deep-learning algorithm (DeepAD) with co-registered, annotated histopathology to predict atherosclerotic lesions in optical coherence tomography (OCT). Methods: Two datasets were used for training DeepAD: (i) a histopathology data set from 7 autopsy cases with 62 OCT frames and co-registered histopathology for high quality manual annotation and (ii) a clinical data set from 51 patients with 222 OCT frames in which manual annotations were based on clinical expertise only. A U-net based deep convolutional neural network (CNN) ensemble was employed as an atherosclerotic lesion prediction algorithm. Results were analyzed using intersection over union (IOU) for segmentation. Results: DeepAD showed good performance regarding the prediction of atherosclerotic lesions, with a median IOU of 0.68 ± 0.18 for segmentation of atherosclerotic lesions. Detection of calcified lesions yielded an IOU = 0.34. When training the algorithm without histopathology-based annotations, a performance drop of >0.25 IOU was observed. The practical application of DeepAD was evaluated retrospectively in a clinical cohort (n = 11 cases), showing high sensitivity as well as specificity and similar performance when compared to manual expert analysis. Conclusion: Automated detection of atherosclerotic lesions in OCT is improved using a histopathology-based deep-learning algorithm, allowing accurate detection in the clinical setting. An automated decision-support tool based on DeepAD could help in risk prediction and guide interventional treatment decisions.
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Affiliation(s)
- Olle Holmberg
- Institute of Computational Biology, German Research Center for Environmental Health, Helmholtz Zentrum München, Oberschleißheim, Germany
- School of Life Sciences Weihenstephan, Technische Universität München, Munich, Germany
| | - Tobias Lenz
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Valentin Koch
- Institute of AI for Health, German Research Center for Environmental Health, Helmholtz Zentrum München, Oberschleißheim, Germany
- TUM Department of Informatics, Technische Universität München, Munich, Germany
| | - Aseel Alyagoob
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Léa Utsch
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Andreas Rank
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Emina Sabic
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Masaru Seguchi
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sebastian Kufner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Carsten Marr
- Institute of Computational Biology, German Research Center for Environmental Health, Helmholtz Zentrum München, Oberschleißheim, Germany
- Institute of AI for Health, German Research Center for Environmental Health, Helmholtz Zentrum München, Oberschleißheim, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp Nicol
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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15
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Jaramillo S, Krisam J, Le Cornet L, Kratzmann M, Baumann L, Sauer T, Crysandt M, Rank A, Behringer D, Teichmann L, Görner M, Trappe RU, Röllig C, Krause S, Hanoun M, Hopfer O, Held G, Buske S, Fransecky L, Kayser S, Schliemann C, Schaefer-Eckart K, Al-Fareh Y, Schubert J, Geer T, Kaufmann M, Brecht A, Niemann D, Kieser M, Bornhäuser M, Platzbecker U, Serve H, Baldus CD, Müller-Tidow C, Schlenk RF. Rationale and design of the 2 by 2 factorial design GnG-trial: a randomized phase-III study to compare two schedules of gemtuzumab ozogamicin as adjunct to intensive induction therapy and to compare double-blinded intensive postremission therapy with or without glasdegib in older patients with newly diagnosed AML. Trials 2021; 22:765. [PMID: 34732236 PMCID: PMC8564967 DOI: 10.1186/s13063-021-05703-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/01/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Overall survival remains poor in older patients with acute myeloid leukemia (AML) with less than 10% being alive after 5 years. In recent studies, a significant improvement in event-free, relapse-free and overall survival was shown by adding gemtuzumab ozogamicin (GO), a humanized antibody-drug conjugate directed against CD33, to intensive induction therapy once or in a sequential dosing schedule. Glasdegib, the small-molecule inhibitor of smoothened (SMO), also showed improved overall survival in patients not eligible for intensive chemotherapy when combined with low-dose cytarabine compared to low-dose cytarabine alone. These findings warrant further investigations in the phase III GnG trial. METHODS/DESIGN This is a randomized phase III trial with measurable residual disease (MRD) after induction therapy and event-free survival (EFS) as primary endpoints. The two research questions are addressed in a 2 by 2 factorial design. Patients age 60 years and older are upfront randomized 1:1 in one of the two induction arms: GO administered to intensive induction therapy on days 1,4, and 7 versus GO administered once on day 1 (GO-147 versus GO-1), and double-blinded 1:1 in one of the subsequent treatment arms glasdegib vs. placebo as adjunct to consolidation therapy and as single-agent maintenance therapy for six months. Chemotherapy backbone for induction therapy consists of standard 7 + 3 schedule with cytarabine 200 mg/m2 continuously days 1 to 7, daunorubicin 60 mg/m2 days 1, 2, and 3 and high-dose cytarabine (1 g/m2, bi-daily, days 1, 2, and 3) for consolidation therapy. Addressing two primary endpoints, MRD-negativity after induction therapy and event-free survival (EFS), 252 evaluable patients are needed to reject each of the two null hypotheses at a two-sided significance level of 2.5% with a power of at least 85%. ETHICS AND DISSEMINATION Ethical approval and approvals from the local and federal competent authorities were granted. Trial results will be reported via peer-reviewed journals and presented at conferences and scientific meetings. TRIAL STATUS Protocol version: 1st version 20.10.2020, no amendments yet. Study initiation on February 16, 2021. First patient was recruited on April 1st. TRIAL REGISTRATION ClinicalTrials.gov NCT04093505 ; EudraCT 2019-003913-32. Registered on October 30, 2018.
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Affiliation(s)
- Sonia Jaramillo
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Lucian Le Cornet
- NCT-Trial Center, National Center of Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Markus Kratzmann
- NCT-Trial Center, National Center of Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Lukas Baumann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Tim Sauer
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Martina Crysandt
- Department of Medicine IV, Aachen University Hospital, Aachen, Germany
| | - Andreas Rank
- Department of Medicine II, Augsburg University Hospital, Augsburg, Germany
| | - Dirk Behringer
- Department of Hematology, Oncology and Palliative Medicine, Augusta Hospital Bochum, Bochum, Germany
| | - Lino Teichmann
- Department of Medicine and Polyclinic III, Bonn University Hospital, Bonn, Germany
| | - Martin Görner
- Department of Hematology, Oncology and Palliative Medicine, Community Hospital Bielefeld, Bielefeld, Germany
| | - Ralf-Ulrich Trappe
- Department of Medicine II, Prot. Diaconal Hospital Bremen, Bremen, Germany
| | - Christoph Röllig
- Department of Internal Medicine I, TU Dresden University Hospital, Dresden, Germany
| | - Stefan Krause
- Department of Medicine V, Erlangen University Hospital, Erlangen, Germany
| | - Maher Hanoun
- Department of Hematology, Essen University Hospital, Essen, Germany
| | - Olaf Hopfer
- Department of Medicine I, Hospital Frankfurt (Oder), Frankfurt (Oder), Germany
| | - Gerhard Held
- Department of Internal Medicine I, Westpfalz Hospital Kaiserslautern, Kaiserslautern, Germany
| | - Sebastian Buske
- Department of Medicine II, Community Hospital Kiel, Kiel, Germany
| | - Lars Fransecky
- Department of Internal Medicine II, Schleswig-Holstein University Hospital Kiel, Kiel, Germany
| | - Sabine Kayser
- NCT-Trial Center, National Center of Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany.,Department of Medicine I - Hematology and Cell Therapy, Leipzig University Hospital, Leipzig, Germany
| | | | | | - Yousef Al-Fareh
- Department of Hematology and Oncology, St. Josef Brothers' Hospital Paderborn, Paderborn, Germany
| | - Jörg Schubert
- Department of Internal Medicine II, Elbland Hospital Riesa, Riesa, Germany
| | - Thomas Geer
- Department of Medicine II, Diaconal Hospital Schwäbisch-Hall, Schwäbisch Hall, Germany
| | - Martin Kaufmann
- Department of Hematology, Oncology and Palliative Medicine, Robert-Bosch Hospital Stuttgart, Stuttgart, Germany
| | - Arne Brecht
- Department of Internal Medicine II, Helios Dr. Horst Schmidt Hospital Wiesbaden, Wiesbaden, Germany
| | - Dirk Niemann
- Department of Internal Medicine, Hematology, Oncology and Palliative Medicine, Prot. Monastery Hospital St. Jakob Koblenz, Koblenz, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, TU Dresden University Hospital, Dresden, Germany
| | - Uwe Platzbecker
- Department of Medicine I - Hematology and Cell Therapy, Leipzig University Hospital, Leipzig, Germany
| | - Hubert Serve
- Department of Hematology/Oncology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Claudia D Baldus
- Department of Internal Medicine II, Schleswig-Holstein University Hospital Kiel, Kiel, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Richard F Schlenk
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,NCT-Trial Center, National Center of Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
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16
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Cortella LRX, Cestari IA, Lahuerta RD, Araña MC, Soldera M, Rank A, Lasagni AF, Cestari IN. Conditioning of hiPSC-derived cardiomyocytes using surface topography obtained with high throughput technology. Biomed Mater 2021; 16. [PMID: 34412045 DOI: 10.1088/1748-605x/ac1f73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/19/2021] [Indexed: 12/31/2022]
Abstract
Surface functionalization of polymers aims to introduce novel properties that favor bioactive responses. We have investigated the possibility of surface functionalization of polyethylene terephthalate (PET) sheets by the combination of laser ablation with hot embossing and the application of such techniques in the field of stem cell research. We investigated the response of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) to topography in the low micrometer range. HiPSC-CMs are expected to offer new therapeutic tools for myocardial replacement or regeneration after an infarct or other causes of cardiac tissue loss. However, hiPSC-CMs are phenotypically immature compared to myocytes in the adult myocardium, hampering their clinical application. We aimed to develop and test a high-throughput technique for surface structuring that would improve hiPSC-CMs structural maturation. We used laser ablation with a ps-laser source in combination with nanoimprint lithography to fabricate large areas of homogeneous micron- to submicron line-like pattern with a spatial period of 3 µm on the PET surface. We evaluated cell morphology, alignment, sarcomeric myofibrils assembly, and calcium transients to evaluate phenotypic changes associated with culturing hiPSC-CMs on functionalized PET. Surface functionalization through hot embossing was able to generate, at low cost, low micrometer features on the PET surface that influenced the hiPSC-CMs phenotype, suggesting improved structural and functional maturation. This technique may be relevant for high-throughput technologies that require conditioning of hiPSC-CMs and may be useful for the production of these cells for drug screening and disease modeling applications with lower costs.
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Affiliation(s)
- Lucas R X Cortella
- Bioengineering Department, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr Enéas de Carvalho Aguiar, 44, 05403-900 São Paulo, Brazil
| | - Idágene A Cestari
- Bioengineering Department, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr Enéas de Carvalho Aguiar, 44, 05403-900 São Paulo, Brazil
| | - Ricardo D Lahuerta
- Bioengineering Department, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr Enéas de Carvalho Aguiar, 44, 05403-900 São Paulo, Brazil
| | - Matheus C Araña
- Bioengineering Department, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr Enéas de Carvalho Aguiar, 44, 05403-900 São Paulo, Brazil
| | - Marcos Soldera
- Institute for Manufacturing Technology, Technische Universität Dresden, George-Baehr-Str. 3c, 01069 Dresden, Germany.,PROBIEN-CONICET, Dto. de Electrotecnia, Universidad Nacional del Comahue, Buenos Aires 1400, 8300 Neuquén, Argentina
| | - Andreas Rank
- Institute for Manufacturing Technology, Technische Universität Dresden, George-Baehr-Str. 3c, 01069 Dresden, Germany
| | - Andrés F Lasagni
- Institute for Manufacturing Technology, Technische Universität Dresden, George-Baehr-Str. 3c, 01069 Dresden, Germany.,Fraunhofer-Institut für Werkstoff- und Strahltechnik IWS, Winterbergstr. 28, 01277 Dresden, Germany
| | - Ismar N Cestari
- Bioengineering Department, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr Enéas de Carvalho Aguiar, 44, 05403-900 São Paulo, Brazil
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17
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Rank A, Tzortzini A, Kling E, Schmid C, Claus R, Löll E, Burger R, Römmele C, Dhillon C, Müller K, Girl P, Hoffmann R, Grützner S, Dennehy KM. One Year after Mild COVID-19: The Majority of Patients Maintain Specific Immunity, But One in Four Still Suffer from Long-Term Symptoms. J Clin Med 2021; 10:3305. [PMID: 34362088 PMCID: PMC8347559 DOI: 10.3390/jcm10153305] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 12/27/2022] Open
Abstract
After COVID-19, some patients develop long-term symptoms. Whether such symptoms correlate with immune responses, and how long immunity persists, is not yet clear. This study focused on mild COVID-19 and investigated correlations of immunity with persistent symptoms and immune longevity. Persistent complications, including headache, concentration difficulties and loss of smell/taste, were reported by 51 of 83 (61%) participants and decreased over time to 28% one year after COVID-19. Specific IgA and IgG antibodies were detectable in 78% and 66% of participants, respectively, at a 12-month follow-up. Median antibody levels decreased by approximately 50% within the first 6 months but remained stable up to 12 months. Neutralizing antibodies could be found in 50% of participants; specific INFgamma-producing T-cells were present in two thirds one year after COVID-19. Activation-induced marker assays identified specific T-helper cells and central memory T-cells in 80% of participants at a 12-month follow-up. In correlative analyses, older age and a longer duration of the acute phase of COVID-19 were associated with higher humoral and T-cell responses. A weak correlation between long-term loss of taste/smell and low IgA levels was found at early time points. These data indicate a long-lasting immunological memory against SARS-CoV-2 after mild COVID-19.
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Affiliation(s)
- Andreas Rank
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (A.T.); (C.S.); (R.C.)
| | - Athanasia Tzortzini
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (A.T.); (C.S.); (R.C.)
| | - Elisabeth Kling
- Institute for Laboratory Medicine and Microbiology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (E.K.); (E.L.); (R.H.); (K.M.D.)
| | - Christoph Schmid
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (A.T.); (C.S.); (R.C.)
| | - Rainer Claus
- Department of Hematology and Oncology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (A.T.); (C.S.); (R.C.)
| | - Eva Löll
- Institute for Laboratory Medicine and Microbiology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (E.K.); (E.L.); (R.H.); (K.M.D.)
| | - Roswitha Burger
- Institute for Transfusion Medicine and Haemostasis, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (R.B.); (S.G.)
| | - Christoph Römmele
- Department of Gastroenterology and Infectious Diseases, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany;
| | - Christine Dhillon
- Department of Pathology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany;
| | - Katharina Müller
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany; (K.M.); (P.G.)
| | - Philipp Girl
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany; (K.M.); (P.G.)
| | - Reinhard Hoffmann
- Institute for Laboratory Medicine and Microbiology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (E.K.); (E.L.); (R.H.); (K.M.D.)
| | - Stefanie Grützner
- Institute for Transfusion Medicine and Haemostasis, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (R.B.); (S.G.)
| | - Kevin M. Dennehy
- Institute for Laboratory Medicine and Microbiology, Medical Faculty, University of Augsburg, 86156 Augsburg, Germany; (E.K.); (E.L.); (R.H.); (K.M.D.)
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18
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Löhr P, Schiele S, Arndt TT, Grützner S, Claus R, Römmele C, Müller G, Schmid C, Dennehy KM, Rank A. Impact of age and gender on lymphocyte subset counts in patients with COVID-19. Cytometry A 2021; 103:127-135. [PMID: 34125495 PMCID: PMC8426831 DOI: 10.1002/cyto.a.24470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/05/2021] [Accepted: 05/25/2021] [Indexed: 12/15/2022]
Abstract
In symptomatic patients with acute Coronavirus disease 2019 (COVID-19), lymphocytopenia is one of the most prominent laboratory findings. However, to date age and gender have not been considered in assessment of COVID-19-related cell count alterations. In this study, the impact of COVID-19 as well as age and gender on a large variety of lymphocyte subsets was analyzed in 33 COVID-19 patients and compared with cell counts in 50 healthy humans. We confirm that cell counts of total lymphocytes, B, NK, cytotoxic and helper T cells are reduced in patients with severe COVID-19, and this tendency was observed in patients with moderate COVID-19. Decreased cell counts were also found in all subsets of these cell types, except for CD4+ and CD8+ effector memory RA+ (EMRA) and terminal effector CD8+ cells. In multivariate analysis however, we show that in addition to COVID-19, there is an age-dependent reduction of total, central memory (CM), and early CD8+ cell subsets, as well as naïve, CM, and regulatory CD4+ cell subsets. Remarkably, reduced naïve CD8+ cell counts could be attributed to age alone, and not to COVID-19. By contrast, decreases in other subsets could be largely attributed to COVID-19, and only partly to age. In addition to COVID-19, male gender was a major factor influencing lower counts of CD3+ and CD4+ lymphocyte numbers. Our study confirms that cell counts of lymphocytes and their subsets are reduced in patients with COVID-19, but that age and gender must be considered when interpreting the altered cell counts.
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Affiliation(s)
- Phillip Löhr
- Department of Hematology and Oncology, Medical FacultyUniversity of AugsburgAugsburgGermany
| | - Stefan Schiele
- Institute of MathematicsFaculty of Mathematics and Natural Sciences, University of AugsburgAugsburgGermany
| | - Tim Tobias Arndt
- Institute of MathematicsFaculty of Mathematics and Natural Sciences, University of AugsburgAugsburgGermany
| | - Stefanie Grützner
- Institute for Transfusion Medicine and HaemostasisMedical Faculty, University of AugsburgAugsburgGermany
| | - Rainer Claus
- Department of Hematology and Oncology, Medical FacultyUniversity of AugsburgAugsburgGermany
| | - Christoph Römmele
- Department of Gastroenterology and Infectious Diseases, Medical FacultyUniversity of AugsburgAugsburgGermany
| | - Gernot Müller
- Institute of MathematicsFaculty of Mathematics and Natural Sciences, University of AugsburgAugsburgGermany
| | - Christoph Schmid
- Department of Hematology and Oncology, Medical FacultyUniversity of AugsburgAugsburgGermany
| | - Kevin M. Dennehy
- Institute for Laboratory Medicine and MicrobiologyMedical Faculty, University of AugsburgAugsburgGermany
| | - Andreas Rank
- Department of Hematology and Oncology, Medical FacultyUniversity of AugsburgAugsburgGermany
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19
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Bayas A, Menacher M, Christ M, Behrens L, Rank A, Naumann M. Bilateral superior ophthalmic vein thrombosis, ischaemic stroke, and immune thrombocytopenia after ChAdOx1 nCoV-19 vaccination. Lancet 2021; 397:e11. [PMID: 33864750 PMCID: PMC8046413 DOI: 10.1016/s0140-6736(21)00872-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Antonios Bayas
- Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany.
| | - Martina Menacher
- Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Monika Christ
- Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Lars Behrens
- Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Andreas Rank
- Department of Haematology and Oncology, Interdisciplinary Cancer Center Augsburg, University Hospital Augsburg, Augsburg, Germany
| | - Markus Naumann
- Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
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20
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Rank A, Peczynski C, Labopin M, Stelljes M, Simand C, Helbig G, Finke J, Santarone S, Tischer J, Lange A, Mistrik M, Houhou M, Schmid C, Nagler A, Mohty M. Feasibility and Outcomes of a Third Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Analysis from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2021; 27:408.e1-408.e6. [PMID: 33965180 DOI: 10.1016/j.jtct.2021.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 01/09/2023]
Abstract
Few therapeutic options are available for patients with acute myeloid or lymphoblastic leukemia (AML/ALL) relapsing after a second allogeneic stem cell transplantation (alloSCT2). In selected patients a third allogeneic stem cell transplantation (alloSCT3) has been used, but no detailed analysis is available so far. The European Society for Blood and Marrow Transplantation (EBMT) registry was screened for patients with acute leukemia (AL) receiving alloSCT3 from an identical or alternative donor to treat AL in either haematological relapse or disease persistence after alloSCT2 between 2001 and 2018. Feasibility, efficacy, outcome, and risk factors of this approach were analyzed retrospectively. Forty-five patients (median age, 37 years, range 12-71) with AML (n=34) or ALL (n=11) were identified. Eleven patients received alloSCT3 in complete remission (CR), 34 had active disease. Fifteen patients were transplanted from the same donor at all three transplants, 30 patients had at least 2 different donors. Between alloSCT2 and alloSCT3, the donor was changed in 25 patients. After alloSCT3, 38 patients engrafted, and 26 achieved CR or CR with incomplete hematological reconstitution (CRi). Acute graft-versus-host disease (GvHD) grade II-IV was observed in 19%, chronic GvHD occurred in 13%. After 1-year, cumulative incidences of leukemia relapse and non-relapse mortality were 47% and 42%, respectively. Median progression free and overall survival (PFS/OS) from alloSCT3 were 2.5 and 4 months, respectively, 1-year PFS and OS were 11% and 20%,. Outcome was improved in patients with at least one donor change (1-year PFS/OS: 17%/30%), further factors for better outcome included an unrelated donor for alloSCT3, Karnofsky performance score >80, and more recent year of alloSCT3. Only patients with AML achieved >1 year OS. In conclusion, results after a third alloSCT are poor, limiting this procedure to few, highly selected patients. Recurrent relapses of acute leukemia after alloSCT remain an unmet therapeutic need.
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Affiliation(s)
- Andreas Rank
- Department of Hematology and Oncology, University Hospital and Medical Faculty, University of Augsburg, Augsburg, Germany
| | | | - Myriam Labopin
- EBMT Paris Study Office, Hôpital Saint Antoine, Paris, France
| | - Matthias Stelljes
- Department of Hematology and Oncology, University of Muenster, Muenster, Germany
| | - Celestine Simand
- Hematology, Oncology and Bone Marrow Transplantation, CHU Hautepierre, Strasbourg, France
| | - Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | - Jürgen Finke
- Department of Medicine, Hematology and Oncology, University of Freiburg, Freiburg, Germany
| | | | - Johanna Tischer
- Hämatopoetische Zelltransplantation, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Andrzej Lange
- Lower Silesian Center for Cellular Transplantation/National Bone Marrow Donor Registry, Wroclaw, Poland
| | - Martin Mistrik
- Department of Hematology and Transfusiology, University Hospital, Bratislava, Slovakia
| | - Mohamed Houhou
- EBMT Paris Study Office, Hôpital Saint Antoine, Paris, France
| | - Christoph Schmid
- Department of Hematology and Oncology, University Hospital and Medical Faculty, University of Augsburg, Augsburg, Germany.
| | - Arnon Nagler
- Hematology Division, BMT and Cord Blood Bank, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mohamad Mohty
- Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
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21
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Rank A, Löhr P, Hoffmann R, Ebigbo A, Grützner S, Schmid C, Claus R. Sustained cellular immunity in adults recovered from mild COVID-19. Cytometry A 2021; 99:429-434. [PMID: 33522107 PMCID: PMC8014675 DOI: 10.1002/cyto.a.24309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 01/08/2023]
Abstract
Transient lymphocytopenia is frequently observed in acute phase of coronavirus disease 2019 (COVID‐19). It remains a concern whether impairment of cellular immunity may be retained after COVID‐19. Here, we demonstrate by extensive lymphocyte profiling in 44 adults after mild COVID‐19 that cellular immunity is not fundamentally altered in convalescent patients. Except for increased activated CD8+ lymphocytes, total counts of B, T, and NK cells and their subsets did not differ significantly between patients after COVID‐19 and healthy controls after a median of 27 days (range 13–45) suggesting no residual cellular immune deficiency after recovery from mild COVID‐19.
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Affiliation(s)
- Andreas Rank
- Hematology and Oncology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Phillip Löhr
- Hematology and Oncology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Reinhard Hoffmann
- Institute for Laboratory Medicine and Microbiology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology and Infectious Diseases, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Stefanie Grützner
- Institute for Transfusion Medicine and Haemostasis, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Christoph Schmid
- Hematology and Oncology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Rainer Claus
- Hematology and Oncology, Medical Faculty, University of Augsburg, Augsburg, Germany
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22
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Bröckelmann PJ, Müller H, Guhl T, Behringer K, Fuchs M, Moccia AA, Rank A, Soekler M, Vieler T, Pabst T, Baues C, von Tresckow B, Borchmann P, Engert A. Relapse After Early-Stage, Favorable Hodgkin Lymphoma: Disease Characteristics and Outcomes With Conventional or High-Dose Chemotherapy. J Clin Oncol 2020; 39:107-115. [PMID: 33058716 DOI: 10.1200/jco.20.00947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We evaluated disease and treatment characteristics of patients with relapse after risk-adapted first-line treatment of early-stage, favorable, classic Hodgkin lymphoma (ES-HL). We compared second-line therapy with high-dose chemotherapy and autologous stem cell transplantation (ASCT) or conventional chemotherapy (CTx). METHODS We analyzed patients with relapse after ES-HL treated within the German Hodgkin Study Group HD10+HD13 trials. We compared, by Cox proportional hazards regression, progression-free survival (PFS) after relapse (second PFS) treated with either ASCT or CTx and performed sensitivity analyses with overall survival (OS) from relapse and Kaplan-Meier statistics. RESULTS A total of 174 patients' disease relapsed after treatment in the HD10 (n = 53) and HD13 (n = 121) trials. Relapse mostly occurred > 12 months after first diagnosis, predominantly with stage I-II disease. Of 172 patients with known second-line therapy, 85 received CTx (49%); 70, ASCT (41%); 11, radiotherapy only (6%); and 4, palliative single agent therapies (2%). CTx was predominantly bleomycin, etoposide, doxorubicin cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP [68%]), followed by the combination regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (19%), or other regimens (13%). Patients aged > 60 years at relapse had shorter second PFS (hazard ratio [HR], 3.0; P = .0029) and were mostly treated with CTx (n = 33 of 49; 67%) and rarely with ASCT (n = 8; 16%). After adjustment for age and a disadvantage of ASCT after the more historic HD10 trial, we did not observe a significant difference in the efficacy of CTx versus ASCT for second PFS (HR, 0.7; 95% CI, 0.3 to 1.6; P = .39). In patients in the HD13 trial who were aged ≤ 60 years, the 2-year, second PFS rate was 94.0% with CTx (95% CI, 85.7% to 100%) versus 83.3% with ASCT (95% CI, 71.8% to 94.8%). Additional sensitivity analyses including OS confirmed these observations. CONCLUSION After contemporary treatment of ES-HL, relapse mostly occurred > 12 months after first diagnosis. Polychemotherapy regimens such as BEACOPP are frequently administered and may constitute a reasonable treatment option for selected patients with relapse after ES-HL.
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Affiliation(s)
- Paul J Bröckelmann
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Horst Müller
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Teresa Guhl
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Karolin Behringer
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Michael Fuchs
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Alden A Moccia
- Swiss Group for Clinical Cancer Research, Bern, Switzerland.,Department of Internal Medicine II, University Hospital Tuebingen, Tuebingen, Germany
| | - Andreas Rank
- Department of Hematology and Oncology, University Hospital of Augsburg, Augsburg, Germany
| | - Martin Soekler
- Department of Internal Medicine II, University Hospital Tuebingen, Tuebingen, Germany
| | - Tom Vieler
- University Hospital Schleswig-Holstein, Karl Lennert-Cancer Center, Kiel, Germany
| | - Thomas Pabst
- Swiss Group for Clinical Cancer Research, Bern, Switzerland.,Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Christian Baues
- Department of Radiooncology and Cyberknife Center, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany
| | - Bastian von Tresckow
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Peter Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Andreas Engert
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
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Gebrekidan S, Schaller T, Rank A, Kircher M, Lapa C. Sarcoid-like reactions: a potential pitfall in oncologic imaging. Eur J Nucl Med Mol Imaging 2020; 48:931-932. [PMID: 32710223 PMCID: PMC8036196 DOI: 10.1007/s00259-020-04960-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | - Tina Schaller
- General Pathology and Molecular Diagnostics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Andreas Rank
- Internal Medicine II, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Malte Kircher
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Constantin Lapa
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany.
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Waidhauser J, Schuh A, Trepel M, Schmälter AK, Rank A. Chemotherapy markedly reduces B cells but not T cells and NK cells in patients with cancer. Cancer Immunol Immunother 2020; 69:147-157. [PMID: 31900508 DOI: 10.1007/s00262-019-02449-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 11/28/2019] [Indexed: 12/15/2022]
Abstract
Chemotherapy is still the backbone of systemic treatment in the majority of cancers. However, immunotherapies, especially those based on checkpoint inhibition, are additional therapy options for many. For this, functional T cells are a mandatory requirement. The aim of this prospective study was to investigate the influence of chemotherapy on the cellular immune status of individual patients. Peripheral blood samples of 26 patients with solid malignancies undergoing chemotherapy were analyzed for lymphocyte populations and their subsets in a longitudinal approach. Chemotherapy decreased total B lymphocyte counts [median value (25-75 percentile): before chemotherapy 76/µl (39-160) vs. after chemotherapy 49/µl (24-106); p = 0.001]. Among B cells, specific subsets decreased particularly [naïve B cells (49/µl (21-111) vs. 25/µl (13-56); p = 0.001], memory B cells [3/µl (2-8) vs. 2/µl (1-4); p = 0.001], and class-switched B cells [11/µl (6-20) vs. 6/µl (3-12); p = 0.011]. In contrast, chemotherapy had no influence on the total numbers of CD4 + and CD8 + T lymphocytes or on their subsets (T helper cells 1, 2, and 17 as well as cytotoxic T cells in early, intermediate, late, terminal effector and exhausted status as well as both T-cell types with naïve, center memory, effector memory, activated, or regulatory phenotype). Furthermore, the count of natural killer (NK) lymphocytes showed no significant change before and after chemotherapy. In summary, this study shows a decrease of B lymphocytes during systemic chemotherapy, but no relevant effect on T lymphocytes, NK lymphocytes and their subsets. This could support the idea of an effective additive T-cell-dependent immunotherapy to chemotherapy.
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Affiliation(s)
- Johanna Waidhauser
- Department of Hematology and Oncology, University Medical Center Augsburg, Stenglinstr.2, 86156, Augsburg, Germany.
| | - Anja Schuh
- Department of Hematology and Oncology, University Medical Center Augsburg, Stenglinstr.2, 86156, Augsburg, Germany
| | - Martin Trepel
- Department of Hematology and Oncology, University Medical Center Augsburg, Stenglinstr.2, 86156, Augsburg, Germany
| | - Ann-Kristin Schmälter
- Department of Hematology and Oncology, University Medical Center Augsburg, Stenglinstr.2, 86156, Augsburg, Germany
| | - Andreas Rank
- Department of Hematology and Oncology, University Medical Center Augsburg, Stenglinstr.2, 86156, Augsburg, Germany
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25
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Amberger DC, Doraneh-Gard F, Gunsilius C, Weinmann M, Möbius S, Kugler C, Rogers N, Böck C, Ködel U, Werner JO, Krämer D, Eiz-Vesper B, Rank A, Schmid C, Schmetzer HM. PGE 1-Containing Protocols Generate Mature (Leukemia-Derived) Dendritic Cells Directly from Leukemic Whole Blood. Int J Mol Sci 2019; 20:ijms20184590. [PMID: 31533251 PMCID: PMC6769744 DOI: 10.3390/ijms20184590] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 02/07/2023] Open
Abstract
Dendritic cells (DCs) and leukemia-derived DC (DCleu) are potent stimulators of various immunoreactive cells and they play a pivotal role in the (re-) activation of the immune system. As a potential treatment tool for patients with acute myeloid leukemia, we developed and analyzed two new PGE1-containing protocols (Pici-PGE1, Kit M) to generate DC/DCleu ex vivo from leukemic peripheral blood mononuclear cells (PBMCs) or directly from leukemic whole blood (WB) to simulate physiological conditions. Pici-PGE1 generated significantly higher amounts of DCs from leukemic and healthy PBMCs when compared to control and comparable amounts as the already established protocol Pici-PGE2. The proportions of sufficient DC-generation were even higher after DC/DCleu-generation with Pici-PGE1. With Kits, it was possible to generate DCs and DCleu directly from leukemic and healthy WB without induction of blast proliferation. The average amounts of generated DCs and DCleu-subgroups were comparable with all Kits. The PGE1 containing Kit M generated significantly higher amounts of mature DCs when compared to the PGE2-containing Kit K and increased the anti-leukemic-activity. In summary PGE1-containing protocols were suitable for generating DC/DCleu from PBMCs as well as from WB, which reliably (re-) activated immunoreactive cells, improved the overall ex vivo anti-leukemic activity, and influenced cytokine-release-profiles.
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Affiliation(s)
- Daniel Christoph Amberger
- Medical Department 3, Working-group: Immune-Modulation, University Hospital Munich, 81377 Munich, Germany.
| | - Fatemeh Doraneh-Gard
- Medical Department 3, Working-group: Immune-Modulation, University Hospital Munich, 81377 Munich, Germany.
| | - Carina Gunsilius
- Medical Department 3, Working-group: Immune-Modulation, University Hospital Munich, 81377 Munich, Germany.
| | - Melanie Weinmann
- Medical Department 3, Working-group: Immune-Modulation, University Hospital Munich, 81377 Munich, Germany.
| | - Sabine Möbius
- Medical Department 3, Working-group: Immune-Modulation, University Hospital Munich, 81377 Munich, Germany.
| | - Christoph Kugler
- Medical Department 3, Working-group: Immune-Modulation, University Hospital Munich, 81377 Munich, Germany.
| | - Nicole Rogers
- Medical Department 3, Working-group: Immune-Modulation, University Hospital Munich, 81377 Munich, Germany.
| | - Corinna Böck
- Medical Department 3, Working-group: Immune-Modulation, University Hospital Munich, 81377 Munich, Germany.
| | - Uwe Ködel
- Department of Neurology, Klinikum Großhadern, Ludwig-Maximilians-University, 81377 Munich, Germany.
| | - Jan-Ole Werner
- Department of Hematology and Oncology, University Hospital of Tuebingen, 72076 Tuebingen, Germany.
| | - Doris Krämer
- Department for Hematology and Oncology, University Hospital of Oldenburg, 26133 Oldenburg, Germany.
| | - Britta Eiz-Vesper
- Institute for Transfusion Medicine, Hannover Medical School, 30625 Hannover, Germany.
| | - Andreas Rank
- Department of Hematology and Oncology, University Hospital of Augsburg, 86156 Augsburg, Germany.
| | - Christoph Schmid
- Department of Hematology and Oncology, University Hospital of Augsburg, 86156 Augsburg, Germany.
| | - Helga Maria Schmetzer
- Medical Department 3, Working-group: Immune-Modulation, University Hospital Munich, 81377 Munich, Germany.
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26
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Toth B, Rank A, Böttcher B, Ludwig M. Thrombophilie und Alter – wann ist eine Hormontherapie in der Postmenopause trotzdem möglich? Gynäkologische Endokrinologie 2019. [DOI: 10.1007/s10304-019-0265-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Hirschbuehl K, Rank A, Pfeiffer T, Schaller T, Haeckel T, Roeling J, Vlasenko D, Trepel M, Schmid C. Large Vessel Vasculitis as a Possible Mechanism of Vascular Side Effects of Ponatinib: A Case Report. J Hematol 2019; 8:83-85. [PMID: 32300450 PMCID: PMC7153681 DOI: 10.14740/jh519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/07/2019] [Indexed: 11/25/2022] Open
Abstract
Arterial occlusive events (AOEs) such as cerebrovascular, cardiovascular and peripheral arterial events are known side effects of ponatinib, assumed due to the rapid development and increase of arteriosclerosis, while the definitive pathomechanisms therefore are still unclear. We present a case of clinically apparent large vessel vasculitis and discuss this phenomenon as a possible mechanism of AOEs beside arteriosclerosis.
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Affiliation(s)
- Klaus Hirschbuehl
- Department of Hematology and Oncology, Universitaetsklinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Andreas Rank
- Department of Hematology and Oncology, Universitaetsklinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Tim Pfeiffer
- Department of Hematology and Oncology, Universitaetsklinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Tina Schaller
- Institute of Pathology, Universitaetsklinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Thomas Haeckel
- Department of Radiology, Universitaetsklinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Joerg Roeling
- Internistische Gemeinschaftspraxis am Vincentinum, Franziskanergasse 14, 86152 Augsburg, Germany
| | - Dmytro Vlasenko
- Department of Visceral Surgery, Universitaetsklinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Martin Trepel
- Department of Hematology and Oncology, Universitaetsklinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Christoph Schmid
- Department of Hematology and Oncology, Universitaetsklinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
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28
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Atzler M, Rank A, Inngjerdingen M, Rabe A, Deen D, Wang R, Eiz-Vesper B, Schmid C, Schmetzer H. Increased detection of (leukemiaspecific) adaptive and innate immune-reactive cells under treatment of AML-diseased rats and one therapy-refractory AML-patient with blastmodulating, clinically approved response modifiers. Eur J Cancer 2019. [DOI: 10.1016/j.ejca.2019.01.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rank A, Nieuwland R, Köhler A, Franz C, Waidhauser J, Toth B. Human bone marrow contains high levels of extracellular vesicles with a tissue-specific subtype distribution. PLoS One 2018; 13:e0207950. [PMID: 30521543 PMCID: PMC6283575 DOI: 10.1371/journal.pone.0207950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/08/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Extracellular vesicles (EV) are shed from a broad variety of cells and play an important role in activation of coagulation, cell to cell interaction and transport of membrane components. They are usually measured as circulating EV in peripheral blood (PB) and other body fluids. However, little is known about the distribution, presence and impact of EV and their subpopulations in bone marrow (BM). In our study, we focused on the analysis of different EV subtypes in human BM as compared to EV subsets in PB. Methods EV in BM and PB from 12 healthy stem cell donors were measured by flow-cytometry using Annexin V and cell-specific antibodies for hematopoietic stem cells, leucocytes, platelets, red blood cells, and endothelial cells. Additionally, concentrations of tissue factor-bearing EV were evaluated. Results High numbers of total EV were present in BM (median value [25–75 percentile]: 14.8 x109/l [8.5–19.3]). Non-significantly lower numbers of total EV were measured in PB (9.2 x109/l [3.8–14.5]). However, distribuation of EV subtypes showed substantial differences between BM and PB: In PB, distribution of EV fractions was similar as previously described. Most EV originated from platelets (93.9%), and only few EV were derived from leucocytes (4.5%), erythrocytes (1.8%), endothelial cells (1.0%), and hematopoietic stem cells (0.7%). In contrast, major fractions of BM-EV were derived from red blood cells or erythropoietic cells (43.2%), followed by megacaryocytes / platelets (27.6%), and by leucocytes as well as their progenitor cells (25,7%); only low EV proportions originated from endothelial cells and hematopoietic stem cells (2.0% and 1.5%, respectively). Similar fractions of tissue factor—bearing EV were found in BM and PB (1.3% and 0.9%). Conculsion Taken together, we describe EV numbers and their subtype distribution in the BM compartment for the first time. The tissue specific EV distribution reflects BM cell composition and favours the idea of a BM–PB barrier existing not only for cells, but also for EV.
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Affiliation(s)
- Andreas Rank
- 2. Medizinische Klinik, Klinikum Augsburg, Augsburg, Germany
- * E-mail:
| | - Rienk Nieuwland
- Laboratory of Experimental Clinical Chemistry, and Vesicle Observation Centre, Academic Medical Center, Amsterdam, The Netherlands
| | - Anton Köhler
- Medizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität München, München, Germany
| | - Cordula Franz
- Department of Obstetrics and Gynecology, University of Aachen, Aachen, Germany
| | | | - Bettina Toth
- Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Innsbruck, Austria
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Schmid C, Atzler M, Rank A, Inngjerdingen M, Rabe A, Deen D, Wang R, Eiz-Vesper B, Schmetzer H. Immune modulation of AML-blasts in therapy-refractory AML-patient in vivo with clinically approved response modifiers improves clinical status, blood cell regeneration and gives rise to leukemia specific adaptive and innate immune reactive cells. Eur J Cancer 2018. [DOI: 10.1016/j.ejca.2018.01.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Rank A, Fiegl M, Tischer J, Schiel X, Ostermann H, Kolb HJ, Rieger C. Allogeneic stem cell transplantation as a new treatment option for patients with severe Bernard-Soulier Syndrome. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1612582] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Toth B, Liebhardt S, Steinig K, Ditsch N, Rank A, Bauerfeind I, Spannagl M, Friese K, Reininger AJ. Platelet-derived microparticles and coagulation activation in breast cancer patients. Thromb Haemost 2017. [DOI: 10.1160/th07-10-0602] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryIn the mid 1800s Trousseau observed cancer-associated thrombosis, of which the underlying pathogenesis still remains unknown. We performed a prospective study on platelet-derived microparticles (PMP) and their procoagulant potential in breast cancer patients. Fifty-eight breast cancer patients and 13 women with benign breast tumors were included in the study. Microparticles (MP) were examined by electron microscopy and FACS analysis using labels for annexinV (total numbers), CD61 (PMP), CD62P and CD63 (activated platelets), CD62E (endothelial cells), CD45 (leukocytes) as well as CD142 (tissue factor). Prothrombin fragment 1+2 (F1+2) and thrombin generation were measured as blood coagulation markers. Numbers of annexin V+-MP were highest in breast cancer patients with larger tumor size (T2; median = 5,637×106/l; range = 2,852–8,613) and patients with distant metastases (M1; median = 6,102×106/l; range = 3,350–7,445), and differed significantly from patients with insitu tumor (Tis; median = 3,220×106/l; range = 2,277–4,124; p = 0.019), small tumor size (T1; median = 3,281×106/l; range 2,356–4,861; p = 0.043) and women with benign breast tumor (median = 4,108×106/l; range = 2,530–4,874; p = 0.040). A total of 82.3% of MP were from platelets,14.6 % from endothelial cells and 0.3% from leukocytes. Less than 10% of PMP showed degranulation markers. Larger tumor size (T2) and metastases correlated with high counts of PMP and with highest F1+2 levels. Since prothrombin levels and thrombin generation did not parallel MP levels, we speculate that MP act in the microenvironment of tumor tissue and may thus not be an exclusive parameter reflecting in-vivo procoagulant activity.
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Kruger S, Haas M, Burkl C, Goehring P, Kleespies A, Roeder F, Gallmeier E, Ormanns S, Westphalen CB, Heinemann V, Rank A, Boeck S. Incidence, outcome and risk stratification tools for venous thromboembolism in advanced pancreatic cancer - A retrospective cohort study. Thromb Res 2017; 157:9-15. [PMID: 28675831 DOI: 10.1016/j.thromres.2017.06.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/12/2017] [Accepted: 06/20/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is frequent in advanced pancreatic cancer (APC). Recent studies demonstrated that the Khorana score - an established risk stratification tool for VTE in cancer - performs poorly in identifying pancreatic cancer patients at high risk for VTE. MATERIALS AND METHODS We performed a retrospective cohort study in order to define incidence, treatment and outcome of VTE as well as the performance of VTE risk stratification tools (Khorana score, CONKO score and aPTT ratio) in a "real life" clinical cohort of APC patients undergoing palliative chemotherapy. RESULTS AND CONCLUSIONS One hundred and seventy-two eligible APC patients from our comprehensive cancer center were identified. VTE after start of palliative chemotherapy was diagnosed in 71 patients (41.3%). Most VTE events were asymptomatic (n=50, 29.1%) with only 21 symptomatic events (12.2%). On multivariate analysis - including age, performance status and carbohydrate antigen 19-9 (CA 19-9) - symptomatic VTE was an independent risk factor for death (hazard ratio [HR]: 2.22, 95% CI: 1.05-2.60, p<0.05). Khorana score, CONKO score and aPTT ratio alone were not able to predict the risk for symptomatic VTE. High risk patients could only be identified by using a combination of either Khorana or CONKO score with aPTT ratio (30% vs. 10% symptomatic VTE events in high vs. low risk patients, p<0.05). The combination of Khorana or CONKO score with aPTT thus may represent a novel risk stratification tool for symptomatic VTE in APC and should further be validated within prospective clinical trials.
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Affiliation(s)
- Stephan Kruger
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Michael Haas
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Carolin Burkl
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Peter Goehring
- Institute of Laboratory Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Axel Kleespies
- Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Falk Roeder
- Department of Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany; Department of Molecular Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Eike Gallmeier
- Department of Gastroenterology, Endocrinology and Metabolism, University Hospital of Marburg, Philipps-University of Marburg, Marburg, Germany
| | - Steffen Ormanns
- Institute of Pathology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Christoph Benedikt Westphalen
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Volker Heinemann
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Andreas Rank
- Department of Hematology and Oncology, Klinikum Augsburg, Augsburg, Germany
| | - Stefan Boeck
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Ženka J, Caisová V, Uher O, Nedbalová P, Kvardová K, Masáková K, Krejčová G, Paďouková L, Jochmanová I, Wolf KI, Chmelař J, Kopecký J, Loumagne L, Mestadier J, D’agostino S, Rohaut A, Ruffin Y, Croize V, Lemaître O, Sidhu SS, Althammer S, Steele K, Rebelatto M, Tan T, Wiestler T, Spitzmueller A, Korn R, Schmidt G, Higgs B, Li X, Shi L, Jin X, Ranade K, Koeck S, Amann A, Gamerith G, Zwierzina M, Lorenz E, Zwierzina H, Kern J, Riva M, Baert T, Coosemans A, Giovannoni R, Radaelli E, Gsell W, Himmelreich U, Van Ranst M, Xing F, Qian W, Dong C, Xu X, Guo S, Shi Q, Quandt D, Seliger B, Plett C, Amberger DC, Rabe A, Deen D, Stankova Z, Hirn A, Vokac Y, Werner J, Krämer D, Rank A, Schmid C, Schmetzer H, Guerin M, Weiss JM, Regnier F, Renault G, Vimeux L, Peranzoni E, Feuillet V, Thoreau M, Guilbert T, Trautmann A, Bercovici N, Amberger DC, Doraneh-Gard F, Boeck CL, Plett C, Gunsilius C, Kugler C, Werner J, Schmohl J, Kraemer D, Ismann B, Rank A, Schmid C, Schmetzer HM, Markota A, Ochs C, May P, Gottschlich A, Gosálvez JS, Karches C, Wenk D, Endres S, Kobold S, Hilmenyuk T, Klar R, Jaschinski F, Gamerith G, Augustin F, Lorenz E, Manzl C, Hoflehner E, Moser P, Zelger B, Köck S, Amann A, Kern J, Schäfer G, Öfner D, Maier H, Zwierzina H, Sopper S, Prado-Garcia H, Romero-Garcia S, Sandoval-Martínez R, Puerto-Aquino A, Lopez-Gonzalez J, Rumbo-Nava U, Klar R, Hilmenyuk T, Jaschinski F, Coosemans A, Baert T, Van Hoylandt A, Busschaert P, Vergote I, Baert T, Van Hoylandt A, Busschaert P, Vergote I, Coosemans A, Laengle J, Pilatova K, Budinska E, Bencsikova B, Sefr R, Nenutil R, Brychtova V, Fedorova L, Hanakova B, Zdrazilova-Dubska L, Allen C, Ku YC, Tom W, Sun Y, Pankov A, Looney T, Hyland F, Au-Young J, Mongan A, Becker A, Tan JBL, Chen A, Lawson K, Lindsey E, Powers JP, Walters M, Schindler U, Young S, Jaen JC, Yin S, Chen Y, Gullo I, Gonçalves G, Pinto ML, Athelogou M, Almeida G, Huss R, Oliveira C, Carneiro F, Merz C, Sykora J, Hermann K, Hussong R, Richards DM, Fricke H, Hill O, Gieffers C, Pinho MP, Barbuto JAM, McArdle SE, Foulds G, Vadakekolathu JN, Abdel-Fatah TMA, Johnson C, Hood S, Moseley P, Rees RC, Chan SYT, Pockley AG, Rutella S, Geppert C, Hartmann A, Kumar KS, Gokilavani M, Wang S, Merz C, Richards DM, Sykora J, Redondo-Müller M, Heinonen K, Marschall V, Thiemann M, Fricke H, Gieffers C, Hill O, Zhang L, Mao B, Jin Y, Zhai G, Li Z, Wang Z, Qian W, An X, Qiao M, Zhang J, Shi Q, Weber J, Kluger H, Halaban R, Sznol M, Roder H, Roder J, Grigorieva J, Asmellash S, Oliveira C, Meyer K, Steingrimsson A, Blackmon S, Sullivan R, Boeck CL, Amberger DC, Doraneh-Gard F, Sutanto W, Guenther T, Schmohl J, Schuster F, Salih H, Babor F, Borkhardt A, Schmetzer H, Kim Y, Oh I, Park C, Ahn S, Na K, Song S, Choi Y, Fedorova L, Poprach A, Lakomy R, Selingerova I, Demlova R, Pilatova K, Kozakova S, Valik D, Petrakova K, Vyzula R, Zdrazilova-Dubska L, Aguilar-Cazares D, Galicia-Velasco M, Camacho-Mendoza C, Islas-Vazquez L, Chavez-Dominguez R, Gonzalez-Gonzalez C, Prado-Garcia H, Lopez-Gonzalez JS, Yang S, Moynihan KD, Noh M, Bekdemir A, Stellacci F, Irvine DJ, Volz B, Kapp K, Oswald D, Wittig B, Schmidt M, Chavez-Dominguez R, Aguilar-Cazares D, Prado-Garcia H, Islas-Vazquez L, Lopez-Gonzalez JS, Kleef R, Bohdjalian A, McKee D, Moss RW, Saeed M, Zalba S, Debets R, ten Hagen TLM, Javed S, Becher J, Koch-Nolte F, Haag F, Gordon EM, Sankhala KK, Stumpf N, Tseng W, Chawla SP, Suárez NG, Báez GB, Rodríguez MC, Pérez AG, García LC, Fernández DH, Pous JR, Ramírez BS, Jacoberger-Foissac C, Saliba H, Seguin C, Brion A, Frisch B, Fournel S, Heurtault B, Otterhaug T, Håkerud M, Nedberg A, Edwards V, Selbo P, Høgset A, Jaitly T, Dörrie J, Schaft N, Gross S, Schuler-Thurner B, Gupta S, Taher L, Schuler G, Vera J, Rataj F, Kraus F, Grassmann S, Chaloupka M, Lesch S, Heise C, Endres S, Kobold S, Cadilha BML, Dorman K, Heise C, Rataj F, Endres S, Kobold S. Abstracts from the 4th ImmunoTherapy of Cancer Conference. J Immunother Cancer 2017. [PMCID: PMC5374589 DOI: 10.1186/s40425-017-0219-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Rank A, Liebhardt S, Zwirner J, Burges A, Nieuwland R, Toth B. Circulating microparticles in patients with benign and malignant ovarian tumors. Anticancer Res 2012; 32:2009-2014. [PMID: 22593480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Microparticles are known to be increased in various malignancies. In this prospective study, microparticle levels were evaluated in patients with benign and malignant ovarian lesions. PATIENTS AND METHODS Microparticles from platelets/megakaryocytes, activated platelets and endothelial cells, tissue factor exposing microparticles and D-dimer values were examined in patients with newly diagnosed ovarian lesions before surgery, and were correlated with tumor histology. RESULTS Higher counts of CD63-positive microparticles were detected in patients with ovarian cancer [mean=276×10(6) (range: 64-948)/l; n=12] as compared to patients with benign ovarian tumors [146×10(6) (45-390)/l; n=21; p=0.014]. D-dimer values were also increased in patients with cancer [860 (180-4500) ng/l versus 280 (170-2720) ng/l; p=0.001]. CONCLUSION Elevated levels of CD63-positive microparticles and D-dimer reflect the procoagulant phenotype of these patients. However, for the discrimination between benign and malignant ovarian tumors, measuring preoperative levels of microparticles does not seem to be helpful.
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Affiliation(s)
- A Rank
- 2nd Medical Clinic, Augsburg Clinic, Augsburg, Germany.
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Rank A, Nieuwland R, Roesner S, Nikolajek K, Hiller E, Toth B. Climacteric lowers plasma levels of platelet-derived microparticles: a pilot study in pre- versus postmenopausal women. Acta Haematol 2012; 128:53-9. [PMID: 22627113 DOI: 10.1159/000337327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 02/08/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Climacteric increases the risk of thrombotic events by alteration of plasmatic coagulation. Up to now, less is known about changes in platelet- (PMP) and endothelial cell-derived microparticles (EMP). METHODS In this prospective study, plasma levels of microparticles (MP) were compared in 21 premenopausal and 19 postmenopausal women. RESULTS No altered numbers of total MP or EMP were measured within the study groups. However, the plasma values of CD61-exposing MP from platelets/megakaryocytes were higher in premenopausal women (5,364 × 10(6)/l, range 4,384-17,167) as compared to postmenopausal women (3,808 × 10(6)/l, range 2,009-8,850; p = 0.020). This differentiation was also significant for the subgroup of premenopausal women without hormonal contraceptives (5,364 × 10(6)/l, range 4,223-15,916; p = 0.047; n = 15). Furthermore, in premenopausal women, higher plasma levels of PMP exposing CD62P were also present as compared to postmenopausal women (288 × 10(6)/l, range 139-462, vs. 121 × 10(6)/l, range 74-284; p = 0.024). This difference was also true for CD63+ PMP levels (281 × 10(6)/l, range 182-551, vs. 137 × 10(6)/l, range 64-432; p = 0.015). CONCLUSION Climacteric lowers the level of PMP but has no impact on the number of EMP in women. These data suggest that PMP and EMP do not play a significant role in enhancing the risk of thrombotic events in healthy, postmenopausal women.
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Affiliation(s)
- Andreas Rank
- Department of Clinical Chemistry, Academic Medical Center, Amsterdam, The Netherlands.
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Borchmann P, Haverkamp H, Diehl V, Cerny T, Markova J, Ho AD, Eich HT, Mueller-Hermelink HK, Kanz L, Greil R, Rank A, Paulus U, Smardova L, Huber C, Dörken B, Nerl C, Krause SW, Mueller RP, Fuchs M, Engert A. Eight Cycles of Escalated-Dose BEACOPP Compared With Four Cycles of Escalated-Dose BEACOPP Followed by Four Cycles of Baseline-Dose BEACOPP With or Without Radiotherapy in Patients With Advanced-Stage Hodgkin's Lymphoma: Final Analysis of the HD12 Trial of the German Hodgkin Study Group. J Clin Oncol 2011; 29:4234-42. [DOI: 10.1200/jco.2010.33.9549] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Eight cycles of BEACOPPescalated (escalated dose of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) followed by radiotherapy (RT) to initial bulk or residual tumor mass is the German Hodgkin Study Group standard of care for advanced-stage Hodgkin's lymphoma (HL). However, treatment-related toxicity is a concern, and the role of RT in this setting is unclear. The HD12 study thus aimed to reduce toxicity while maintaining efficacy. Patients and Methods In this prospectively randomized multicenter trial, eight cycles of BEACOPPescalated was compared with four cycles of BEACOPPescalated followed by four cycles of the baseline dose of BEACOPP (BEACOPPbaseline; 4 + 4), and RT with no RT in the case of initial bulk or residual disease. The study was designed to exclude a difference in 5-year freedom from treatment failure (FFTF) rate of 6%. Results Between January 1999 and January 2003, 1,670 patients age 16 to 65 years were enrolled onto the HD12 study. At 5 years, FFTF was 86.4% in the BEACOPPescalated arm and 84.8% in the 4 + 4 arm (difference, −1.6%; 95% CI, −5.2% to 1.9%), and overall survival was 92% versus 90.3% (difference, −1.7%; 95% CI, −4.6% to 1.1%). Deaths related to acute toxicity of chemotherapy were observed in 2.9% of patients (BEACOPPescalated, n = 19; 4 + 4, n = 27). FFTF was inferior without RT (90.4% v 87%; difference, −3.4%; 95% CI, −6.6% to −0.1%), particularly in patients who had residual disease after chemotherapy (difference, −5.8%; 95% CI, −10.7% to −1.0%), but not in patients with bulk in complete response after chemotherapy (difference, −1.1%; 95% CI, −6.2% to 4%). Conclusion The reduction of BEACOPP to the 4 + 4 regimen did not substantially reduce severe toxicity but might decrease efficacy. Our results do not support the omission of consolidation RT for patients with residual disease. Alternative strategies for improving the risk-to-benefit ratio for patients with advanced HL are needed.
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Affiliation(s)
- Peter Borchmann
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Heinz Haverkamp
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Volker Diehl
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Thomas Cerny
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Jana Markova
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Anthony D. Ho
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Hans-Theodor Eich
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Hans Konrad Mueller-Hermelink
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Lothar Kanz
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Richard Greil
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Andreas Rank
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Ursula Paulus
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Lenka Smardova
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Christoph Huber
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Bernd Dörken
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Christoph Nerl
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Stefan W. Krause
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Rolf-Peter Mueller
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Michael Fuchs
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Andreas Engert
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
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Rank A, Nieuwland R, Nikolajek K, Rösner S, Wallwiener LM, Hiller E, Toth B. Hormone replacement therapy leads to increased plasma levels of platelet derived microparticles in postmenopausal women. Arch Gynecol Obstet 2011; 285:1035-41. [DOI: 10.1007/s00404-011-2098-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 09/21/2011] [Indexed: 11/30/2022]
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Abstract
Allogeneic hematopoietic stem cell transplantation is a high risk but curative treatment option for leukemia, myelodysplasia and other hematological malignancies. After high dose radio- or chemo-therapy, recipient’s hematopoiesis is replaced by a new immunosystem and residual malignant cells are eliminated by the graft-versus-leukemia reaction. The benefit of this immunological effect is limited by the most frequent complication of hematopoietic stem cell transplantation: graft-versus-host disease. In addition to their well-known anti-tumor activity, epigenetic drugs mediate immunotolerance without reducing alloreactivity or even enhance graft-versus-leukemia effect without inducing graft-versus-host disease by regulating cytokine release, increasing the circulating number of regulatory T cells and interacting with natural killer cells. We focus on the use of epigenetic drugs in the allogeneic transplantation setting in relation to their anti-tumor and immunomodulatory potential.
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Affiliation(s)
- Nicole Engel
- Ludwig-Maximilians-University Munich (Munich, DE), Großhadern Medical Center, Medical Department III, Germany
| | - Andreas Rank
- Klinikum Augsburg (Augsburg, DE), Medical Department II, Germany
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Rank A, Nieuwland R, Delker R, Pihusch V, Wilkowski R, Toth B, Kolb HJ, Pihusch R. Surveillance of megakaryocytic function by measurement of CD61-exposing microparticles in allogeneic hematopoietic stem cell recipients. Clin Transplant 2011; 25:E233-42. [PMID: 21303416 DOI: 10.1111/j.1399-0012.2011.01406.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Increasing evidence suggests that circulating microparticles (MP) exposing CD61 originate predominantly from megakaryocytes. Dramatic changes in megakaryocytic homeostasis are regularly observed following allogeneic hematopoietic stem cell transplantation (HSCT) and associated with transplantation-associated complications. We studied MP plasma levels prospectively in healthy subjects (n = 10) and allogeneic HSCT recipients (n = 19) twice weekly from the start of conditioning therapy up to day 30. A total of 224 measurement points were evaluated. MP were isolated, double-stained with annexin V and anti-CD61, and analyzed by flow cytometry. In uncomplicated HSCT, we found a correlation between platelet and CD61-exposing MP count, which resulted in a constant ratio of MP per platelet. The ratio was increased in patients with active hematological malignancies before transplantation and normalized during conditioning therapy. After take, the MP ratio increased, whereas infections and microangiopathic hemolytic anemia did not affect the ratio. In patients with GvHD, a decreased MP ratio was observed depending on the grade of GvHD, possibly indicating megakaryocytic damage. The MP ratio was able to discriminate between toxic, septic, and GvHD-induced hyperbilirubinemia. We first describe CD61+ MP levels during allogeneic HSCT and postulate that the MP ratio might be a useful biomarker for the surveillance of megakaryocytes during HSCT.
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Affiliation(s)
- Andreas Rank
- Medizinische Klinik III - Großhadern, Klinikum der Ludwig Maximilians-Universität München, München, Germany.
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Abstract
At present, little is known about the clearance of platelet-derived microparticles (PMP) in human blood, as due to ethical considerations infusion experiments with labeled microparticles are delicate. Therefore, we investigated the kinetics of PMP, which are abundantly present in apheresis platelet concentrates (PC), following platelet transfusion in severe thrombocytopenic patients (n=11). PMP were double-stained with annexin V and cell-specific antibodies (anti-CD61, anti-CD63 or anti-CD62P, respectively) and detected by flow cytometry before and after transfusion of a single PC at fixed time intervals. Upon transfusion, the plasma levels of MP binding annexin V (2.5-fold), PMP (CD61+; 2.9-fold), and PMP from activated platelets (CD63+; 1.9-fold) or P-selectin (2.5-fold) increased immediately. The plasma levels of MP decreased with a half life of 5.8 hours (annexin V; 95% CI: 1.8?18.3) and 5.3 hours (CD61; 95% CI: 2.0?14.2). This is the first report in which the half life time of transfused PMP has been investigated in humans.
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Affiliation(s)
- A Rank
- Medizinische Klinik III-Grosshadern, Klinikum der Ludwig Maximilians-Universität München, München, Germany.
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Rank A, Nieuwland R, Liebhardt S, Iberer M, Grützner S, Toth B, Pihusch R. Apheresis platelet concentrates contain platelet-derived and endothelial cell-derived microparticles. Vox Sang 2011; 100:179-86. [DOI: 10.1111/j.1423-0410.2010.01385.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rank A, Nieuwland R, Delker R, Köhler A, Toth B, Pihusch V, Wilkowski R, Pihusch R. Cellular origin of platelet-derived microparticles in vivo. Thromb Res 2010; 126:e255-9. [DOI: 10.1016/j.thromres.2010.07.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 07/15/2010] [Accepted: 07/16/2010] [Indexed: 12/20/2022]
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Eich HT, Diehl V, Görgen H, Pabst T, Markova J, Debus J, Ho A, Dörken B, Rank A, Grosu AL, Wiegel T, Karstens JH, Greil R, Willich N, Schmidberger H, Döhner H, Borchmann P, Müller-Hermelink HK, Müller RP, Engert A. Intensified Chemotherapy and Dose-Reduced Involved-Field Radiotherapy in Patients With Early Unfavorable Hodgkin's Lymphoma: Final Analysis of the German Hodgkin Study Group HD11 Trial. J Clin Oncol 2010; 28:4199-206. [DOI: 10.1200/jco.2010.29.8018] [Citation(s) in RCA: 332] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeCombined-modality treatment consisting of four to six cycles of chemotherapy followed by involved-field radiotherapy (IFRT) is the standard of care for patients with early unfavorable Hodgkin's lymphoma (HL). It is unclear whether treatment results can be improved with more intensive chemotherapy and which radiation dose needs to be applied.Patients and MethodsPatients age 16 to 75 years with newly diagnosed early unfavorable HL were randomly assigned in a 2 × 2 factorial design to one of the following treatment arms: four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) + 30 Gy of IFRT; four cycles of ABVD + 20 Gy of IFRT; four cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPbaseline) + 30 Gy of IFRT; or four cycles of BEACOPPbaseline+ 20 Gy of IFRT.ResultsWith a total of 1,395 patients included, the freedom from treatment failure (FFTF) at 5 years was 85.0%, overall survival was 94.5%, and progression-free survival was 86.0%. BEACOPPbaselinewas more effective than ABVD when followed by 20 Gy of IFRT (5-year FFTF difference, 5.7%; 95% CI, 0.1% to 11.3%). However, there was no difference between BEACOPPbaselineand ABVD when followed by 30 Gy of IFRT (5-year FFTF difference, 1.6%; 95% CI, −3.6% to 6.9%). Similar results were observed for the radiotherapy question; after four cycles of BEACOPPbaseline, 20 Gy was not inferior to 30 Gy (5-year FFTF difference, −0.8%; 95% CI, −5.8% to 4.2%), whereas inferiority of 20 Gy cannot be excluded after four cycles of ABVD (5-year FFTF difference, −4.7%; 95% CI, −10.3% to 0.8%). Treatment-related toxicity occurred more often in the arms with more intensive therapy.ConclusionModerate dose escalation using BEACOPPbaselinedid not significantly improve outcome in early unfavorable HL. Four cycles of ABVD should be followed by 30 Gy of IFRT.
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Affiliation(s)
- Hans Theodor Eich
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Volker Diehl
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Helen Görgen
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Thomas Pabst
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Jana Markova
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Jürgen Debus
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Anthony Ho
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Bernd Dörken
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Andreas Rank
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Anca-Ligia Grosu
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Thomas Wiegel
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Johann Hinrich Karstens
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Richard Greil
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Normann Willich
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Heinz Schmidberger
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Hartmut Döhner
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Peter Borchmann
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Hans-Konrad Müller-Hermelink
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Rolf-Peter Müller
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
| | - Andreas Engert
- From the University of Cologne; German Hodgkin Study Group, Köln; University of Heidelberg, Heidelberg; Charité-Universitätsmedizin Berlin, Berlin; University of Munich, Munich; University of Freiburg, Freiburg; University of Ulm, Ulm; University of Hannover, Hannover; University of Muenster, Muenster; University Hospital Mainz, Mainz; University of Würzburg, Würzburg, Germany; Swiss Group for Clinical Cancer Research, Bern, Switzerland; University Hospital Kralovske Vinohrady, Charles University, Prague
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Engert A, Plütschow A, Eich HT, Lohri A, Dörken B, Borchmann P, Berger B, Greil R, Willborn KC, Wilhelm M, Debus J, Eble MJ, Sökler M, Ho A, Rank A, Ganser A, Trümper L, Bokemeyer C, Kirchner H, Schubert J, Král Z, Fuchs M, Müller-Hermelink HK, Müller RP, Diehl V. Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma. N Engl J Med 2010; 363:640-52. [PMID: 20818855 DOI: 10.1056/nejmoa1000067] [Citation(s) in RCA: 608] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Whether it is possible to reduce the intensity of treatment in early (stage I or II) Hodgkin's lymphoma with a favorable prognosis remains unclear. We therefore conducted a multicenter, randomized trial comparing four treatment groups consisting of a combination chemotherapy regimen of two different intensities followed by involved-field radiation therapy at two different dose levels. METHODS We randomly assigned 1370 patients with newly diagnosed early-stage Hodgkin's lymphoma with a favorable prognosis to one of four treatment groups: four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by 30 Gy of radiation therapy (group 1), four cycles of ABVD followed by 20 Gy of radiation therapy (group 2), two cycles of ABVD followed by 30 Gy of radiation therapy (group 3), or two cycles of ABVD followed by 20 Gy of radiation therapy (group 4). The primary end point was freedom from treatment failure; secondary end points included efficacy and toxicity of treatment. RESULTS The two chemotherapy regimens did not differ significantly with respect to freedom from treatment failure (P=0.39) or overall survival (P=0.61). At 5 years, the rates of freedom from treatment failure were 93.0% (95% confidence interval [CI], 90.5 to 94.8) with the four-cycle ABVD regimen and 91.1% (95% CI, 88.3 to 93.2) with the two-cycle regimen. When the effects of 20-Gy and 30-Gy doses of radiation therapy were compared, there were also no significant differences in freedom from treatment failure (P=1.00) or overall survival (P=0.61). Adverse events and acute toxic effects of treatment were most common in the patients who received four cycles of ABVD and 30 Gy of radiation therapy (group 1). CONCLUSIONS In patients with early-stage Hodgkin's lymphoma and a favorable prognosis, treatment with two cycles of ABVD followed by 20 Gy of involved-field radiation therapy is as effective as, and less toxic than, four cycles of ABVD followed by 30 Gy of involved-field radiation therapy. Long-term effects of these treatments have not yet been fully assessed. (Funded by the Deutsche Krebshilfe and the Swiss Federal Government; ClinicalTrials.gov number, NCT00265018.)
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Affiliation(s)
- Andreas Engert
- Department of Internal Medicine, University of Cologne, Cologne, Germany.
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Weigert O, Wittmann G, Grützner S, Christ O, Christ B, Rank A, Ostermann H. Vincristine-loaded platelets for immune thrombocytopenia. Thromb Haemost 2010; 104:418-9. [PMID: 20508905 DOI: 10.1160/th09-11-0752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 03/19/2010] [Indexed: 11/05/2022]
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Rank A, Weigert O, Ostermann H. Management of chronic immune thrombocytopenic purpura: targeting insufficient megakaryopoiesis as a novel therapeutic principle. Biologics 2010; 4:139-45. [PMID: 20531970 PMCID: PMC2880346 DOI: 10.2147/btt.s3436] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Indexed: 12/20/2022]
Abstract
Traditionally, anti-platelet autoantibodies accelerating platelet clearance from the peripheral circulation have been recognized as the primary pathopysiological mechanism in chronic immune thrombocytopenia (ITP). Recently, increasing evidence supports the co-existence of insufficient megakaryopoiesis. Inadequate low thrombopoietin (TPO) levels are associated with insufficient proliferation and differentiation of megakaryocytes, decreased proplatelet formation, and subsequent platelet release. Recently two novel activators of TPO receptors have been made available: romiplostim and eltrombopag. In several phase III studies, both agents demonstrated increase of platelet counts in about 80% of chronic ITP patients within 2 to 3 weeks. These agents substantially broaden the therapeutic options for patients with chronic ITP although long-term results are still pending. This review will provide an update on the current conception of underlying mechanisms in ITP and novel, pathophysiologically based treatment options.
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Affiliation(s)
- Andreas Rank
- Medizinische Klinik III - Grosshadern, Klinikum der Ludwig Maximilians-Universitaet Munich, Munich, Germany
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Liebhardt S, Ditsch N, Nieuwland R, Rank A, Jeschke U, Von Koch F, Friese K, Toth B. CEA-, Her2/neu-, BCRP- and Hsp27-positive microparticles in breast cancer patients. Anticancer Res 2010; 30:1707-1712. [PMID: 20592365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND This is the first prospective case-control study that evaluates the expression of tumour-specific antigens on circulating microparticles (MP) in breast cancer patients and in women with benign breast tumour. MATERIALS AND METHODS MP were determined by flow cytometry in patients with breast cancer (n=34; T1 (n=19) and T2 (n=15)) and women with benign breast tumour (n=19). RESULTS Patients with lymph node metastases (N1, n=9) showed significantly higher numbers of annexin V(+) MP (p=0.042), CD66(+) MP (p=0.045), BCRP1(+) MP (breast cancer resistance protein) (p=0.025) and Hsp27(+) MP (p=0.034) than controls. Furthermore, T1 patients had significantly higher levels of annexin V(+) MP (p=0.004), CD66(+) MP (p=0.025), BCRP1(+) MP (p=0.008) and Hsp27(+) MP (p=0.02) than controls. CONCLUSION Significant differences are present between breast cancer patients with lymph node metastases and controls concerning annexin V-, CD66-, BCRP1- and Hsp27-positive MP. To specify the role of these MP subpopulations in breast cancer progression, further studies enrolling larger patient groups are part of ongoing research.
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Affiliation(s)
- Susanne Liebhardt
- Department of Obstetrics and Gynecology - Grosshadern, Ludwig Maximilians University, Munich, Germany.
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Engert A, Josting A, Haverkamp H, Villalobos M, Lohri A, Sökler M, Zijlstra J, Sturm I, Topp MS, Rank A, Zenz T, Vogelhuber M, Nogova L, Borchmann P, Fuchs M, Flechtner HH, Diehl V. Epoetin Alfa in Patients With Advanced-Stage Hodgkin's Lymphoma: Results of the Randomized Placebo-Controlled GHSG HD15EPO Trial. J Clin Oncol 2010; 28:2239-45. [DOI: 10.1200/jco.2009.25.1835] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine whether epoetin alfa reduces anemia-related fatigue, improves other aspects of health-related patient-recorded outcomes (PROs), reduces the number of RBC transfusions, and has an impact on freedom from treatment failure (FFTF) and overall survival (OS) in patients with advanced-stage Hodgkin's lymphoma (HL). Patients and Methods The prospectively randomized HD15EPO study performed by the German Hodgkin Study Group investigated epoetin alfa administered at doses of 40,000 U weekly during and after chemotherapy (six to eight cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone [BEACOPP]) in a double-blind, placebo-controlled setting. The study accrued 1,379 patients, of whom 1,328 were assessable for safety, 1,303 were assessable for clinical outcome, and 930 were assessable for PROs. Results PROs were not different in patients receiving placebo or epoetin alfa, both after the end of chemotherapy and 6 months thereafter. There was no difference between patients treated with epoetin alfa or placebo with respect to FFTF and OS. There were also no differences in the numbers of deaths, progressions, relapses, and thromboembolic events. The median number of RBC transfusions was reduced from four per patient in the placebo group to two per patient in the epoetin alfa group (P < .001), with 27.4% of patients needing no RBC transfusion in the placebo group compared with 36.7% of patients in the epoetin alfa group (P < .001). Conclusion Epoetin alfa administered at 40,000 U weekly parallel to BEACOPP chemotherapy was safe in patients with advanced-stage HL and reduced the number of RBC transfusions but had no impact on fatigue and other PRO domains.
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Affiliation(s)
- Andreas Engert
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Andreas Josting
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Heinz Haverkamp
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Matthias Villalobos
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Andreas Lohri
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Martin Sökler
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Josée Zijlstra
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Isrid Sturm
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Max S. Topp
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Andreas Rank
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Thorsten Zenz
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Martin Vogelhuber
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Lucia Nogova
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Peter Borchmann
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Michael Fuchs
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Hans-Henning Flechtner
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
| | - Volker Diehl
- From the First Department of Internal Medicine; German Hodgkin Study Group, University of Cologne, Cologne; Department of Internal Medicine V, University of Heidelberg, Heidelberg; Department of Hematology/Oncology, University of Tübingen, Tübingen; Department of Hematology and Oncology, Charité-Campus Virchow, Berlin; Medical Clinic and Polyclinic II, Julius-Maximilian University of Würzburg, Würzburg; Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich; Department of
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Schinwald N, Rank A, Tischer J, Kolb HJ. [Steroid-refractory graft-versus-host disease: extracorporeal irradiation of leucocytes induces immunotolerance]. Internist (Berl) 2009; 50:1270-5. [PMID: 19565209 DOI: 10.1007/s00108-009-2374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 42 year-old woman develops steroid refractory graft-versus-host disease (GVHD) after second allogeneic stem cell transplantation for acute myelogenous leukemia with severe GVHD of her skin with blisters, severe GVHD of her gut with watery and bloody diarrhea and GVHD of her liver with cholestasis. In a further attempt to control GVHD extracorporeal photochemotherapy is administered. The treatment exposures peripheral mononuclear cells to photoactivated psoralen before they subsequently are given back to the patient. This approach apparently offers selective immune tolerance.
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Affiliation(s)
- N Schinwald
- Medizinische Klinik III, Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistrasse 15, 81377, München, Deutschland.
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