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McLaughlin P, Grillo-López AJ, Link BK, Levy R, Czuczman MS, Williams ME, Heyman MR, Bence-Bruckler I, White CA, Cabanillas F, Jain V, Ho AD, Lister J, Wey K, Shen D, Dallaire BK. Rituximab Chimeric Anti-CD20 Monoclonal Antibody Therapy for Relapsed Indolent Lymphoma: Half of Patients Respond to a Four-Dose Treatment Program. J Clin Oncol 2023; 41:154-162. [PMID: 36603541 DOI: 10.1200/jco.22.02403] [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: 01/07/2023] Open
Abstract
PURPOSE The CD20 antigen is expressed on more than 90% of B-cell lymphomas. It is appealing for targeted therapy, because it does not shed or modulate. A chimeric monoclonal antibody more effectively mediates host effector functions and is itself less immunogenic than are murine antibodies. PATIENTS AND METHODS This was a multiinstitutional trial of the chimeric anti-CD20 antibody, IDEC-C2B8. Patients with relapsed low grade or follicular lymphoma received an outpatient treatment course of IDEC-C2B8 375 mg/m2 intravenously weekly for four doses. RESULTS From 31 centers, 166 patients were entered. Of this intent-to-treat group, 48% responded. With a median follow-up duration of 11.8 months, the projected median time to progression for responders is 13.0 months. Serum antibody levels were sustained longer after the fourth infusion than after the first, and were higher in responders and in patients with lower tumor burden. The majority of adverse events occurred during the first infusion and were grade 1 or 2; fever and chills were the most common events. Only 12% of patients had grade 3 and 3% grade 4 toxicities. A human antichimeric antibody was detected in only one patient. CONCLUSION The response rate of 48% with IDEC-C2B8 is comparable to results with single-agent cytotoxic chemotherapy. Toxicity was mild. Attention needs to be paid to the rate of antibody infusion, with titration according to toxicity. Further investigation of this agent is warranted, including its use in conjunction with standard chemotherapy.
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Affiliation(s)
- P McLaughlin
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - A J Grillo-López
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - B K Link
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - R Levy
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - M S Czuczman
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - M E Williams
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - M R Heyman
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - I Bence-Bruckler
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - C A White
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - F Cabanillas
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - V Jain
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - A D Ho
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - J Lister
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - K Wey
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - D Shen
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
| | - B K Dallaire
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
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Abstract
Background Our study aims to provide validity evidence for the EuroQol five dimensions questionnaire (EQ-5D) in the National Health Interview Survey of Taiwan in the 2013 wave and further interpret the EQ-5D scores for patients with chronic diseases. Another goal of the study was to use item response theory (IRT) to identify items that are informative for assessing quality of life using EQ-5D. Methods There were 17,260 participants, aged 12-64, who completed the interviews in our study. Psychometric methods, including factor analysis and the IRT model known as the Graded Response Model (GRM), were used to assess the unidimensionality of EQ-5D and its item properties. Correlation analysis was used to assess whether EQ-5D scores are associated with scores from the 36-Item Short Form Survey (SF-36). Results The EQ-5D scores have moderate internal consistency (Cronbach’s alpha: 0.60) and a scree plot suggests that the EQ-5D measure is unidimensional. The item information function analysis from the IRT model demonstrates that the first 3 items, “mobility,” “self-care,” and “usual activities” are the most informative items for patients who have chronic diseases and health-related quality of life below the 10th percentile. The EQ-5D scores have a moderate correlation (r: 0.61) with SF-36 scores. Conclusions The EQ-5D scale shows promise for use in the general population. The IRT model informs our interpretation of the EQ-5D scores. Given the time constraints in clinical settings, we suggest using the first three items in EQ-5D to measure the health-related quality of life for patients with chronic diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12334-y.
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Affiliation(s)
- Tzu-Hung Liu
- Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Road, Xindian District, New Taipei City, 231, Taiwan. .,Department of Medical Humanities, School of Medicine, Tzu Chi University, No. 701, Section 3, Zhongyang Road, Hualien City, Hualien County, 970, Taiwan.
| | - Andrew D Ho
- Harvard Graduate School of Education, Cambridge, USA
| | - Yu-Tien Hsu
- Department of Social & Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
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Ho AD, Verkerke H, Allen JW, Saeedi BJ, Boyer D, Owens J, Shin S, Horwath M, Patel K, Paul A, Wu SC, Chonat S, Zerra P, Lough C, Roback JD, Neish A, Josephson CD, Arthur CM, Stowell SR. An automated approach to determine antibody endpoint titers for COVID-19 by an enzyme-linked immunosorbent assay. Immunohematology 2021; 37:33-43. [PMID: 33962490 DOI: 10.21307/immunohematology-2021-007] [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] [Indexed: 06/12/2023]
Abstract
While a variety of therapeutic options continue to emerge for COVID-19 treatment, convalescent plasma (CP) has been used as a possible treatment option early in the pandemic. One of the most significant challenges with CP therapy, however, both when defining its efficacy and implementing its approach clinically, is accurately and efficiently characterizing an otherwise heterogenous therapeutic treatment. Given current limitations, our goal is to leverage a SARS antibody testing platform with a newly developed automated endpoint titer analysis program to rapidly define SARS-CoV-2 antibody levels in CP donors and hospitalized patients. A newly developed antibody detection platform was used to perform a serial dilution enzyme-linked immunosorbent assay (ELISA) for immunoglobulin (Ig)G, IgM, and IgA SARS-CoV-2 antibodies. Data were then analyzed using commercially available software, GraphPad Prism, or a newly developed program developed in Python called TiterScape, to analyze endpoint titers. Endpoint titer calculations and analysis times were then compared between the two analysis approaches. Serial dilution analysis of SARS-CoV-2 antibody levels revealed a high level of heterogeneity between individuals. Commercial platform analysis required significant time for manual data input and extrapolated endpoint titer values when the last serial dilution was above the endpoint cutoff, occasionally producing erroneously high results. By contrast, TiterScape processed 1008 samples for endpoint titer results in roughly 14 minutes compared with the 8 hours required for the commercial software program analysis. Equally important, results generated by TiterScape and Prism were highly similar, with differences averaging 1.26 ± 0.2 percent (mean ± SD). The pandemic has created unprecedented challenges when seeking to accurately test large numbers of individuals for SARS-CoV-2 antibody levels with a rapid turnaround time. ELISA platforms capable of serial dilution analysis coupled with a highly flexible software interface may provide a useful tool when seeking to define endpoint titers in a high-throughput manner. Immunohematology 2021;37:33-43. While a variety of therapeutic options continue to emerge for COVID-19 treatment, convalescent plasma (CP) has been used as a possible treatment option early in the pandemic. One of the most significant challenges with CP therapy, however, both when defining its efficacy and implementing its approach clinically, is accurately and efficiently characterizing an otherwise heterogenous therapeutic treatment. Given current limitations, our goal is to leverage a SARS antibody testing platform with a newly developed automated endpoint titer analysis program to rapidly define SARS-CoV-2 antibody levels in CP donors and hospitalized patients. A newly developed antibody detection platform was used to perform a serial dilution enzyme-linked immunosorbent assay (ELISA) for immunoglobulin (Ig)G, IgM, and IgA SARS-CoV-2 antibodies. Data were then analyzed using commercially available software, GraphPad Prism, or a newly developed program developed in Python called TiterScape, to analyze endpoint titers. Endpoint titer calculations and analysis times were then compared between the two analysis approaches. Serial dilution analysis of SARS-CoV-2 antibody levels revealed a high level of heterogeneity between individuals. Commercial platform analysis required significant time for manual data input and extrapolated endpoint titer values when the last serial dilution was above the endpoint cutoff, occasionally producing erroneously high results. By contrast, TiterScape processed 1008 samples for endpoint titer results in roughly 14 minutes compared with the 8 hours required for the commercial software program analysis. Equally important, results generated by TiterScape and Prism were highly similar, with differences averaging 1.26 ± 0.2 percent (mean ± SD). The pandemic has created unprecedented challenges when seeking to accurately test large numbers of individuals for SARS-CoV-2 antibody levels with a rapid turnaround time. ELISA platforms capable of serial dilution analysis coupled with a highly flexible software interface may provide a useful tool when seeking to define endpoint titers in a high-throughput manner. Immunohematology 2021;37:33–43.
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Affiliation(s)
- A D Ho
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , and Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - H Verkerke
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , and Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - J W Allen
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , and Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - B J Saeedi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - D Boyer
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - J Owens
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - S Shin
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - M Horwath
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - K Patel
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - A Paul
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - S-C Wu
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - S Chonat
- Department of Pediatrics, Emory University School of Medicine , Atlanta, GA
| | - P Zerra
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - C Lough
- Lifesouth Blood Donation Services , Gainesville, FL
| | - J D Roback
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - A Neish
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - C D Josephson
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - C M Arthur
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA
| | - S R Stowell
- Center for Transfusion Medicine and Cellular Therapies, and Department of Pathology and Laboratory Medicine, Emory University School of Medicine , 201 Dowman Drive, Atlanta, GA 30322 , and Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School , 630E New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115
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Jessen A, Ho AD, Corrales CE, Yueh B, Shin JJ. Improving Measurement Efficiency of the Inner EAR Scale with Item Response Theory. Otolaryngol Head Neck Surg 2018; 158:1093-1100. [DOI: 10.1177/0194599818760528] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives (1) To assess the 11-item Inner Effectiveness of Auditory Rehabilitation (Inner EAR) instrument with item response theory (IRT). (2) To determine whether the underlying latent ability could also be accurately represented by a subset of the items for use in high-volume clinical scenarios. (3) To determine whether the Inner EAR instrument correlates with pure tone thresholds and word recognition scores. Design IRT evaluation of prospective cohort data. Setting Tertiary care academic ambulatory otolaryngology clinic. Subjects and Methods Modern psychometric methods, including factor analysis and IRT, were used to assess unidimensionality and item properties. Regression methods were used to assess prediction of word recognition and pure tone audiometry scores. Results The Inner EAR scale is unidimensional, and items varied in their location and information. Information parameter estimates ranged from 1.63 to 4.52, with higher values indicating more useful items. The IRT model provided a basis for identifying 2 sets of items with relatively lower information parameters. Item information functions demonstrated which items added insubstantial value over and above other items and were removed in stages, creating a 8- and 3-item Inner EAR scale for more efficient assessment. The 8-item version accurately reflected the underlying construct. All versions correlated moderately with word recognition scores and pure tone averages. Conclusion The 11-, 8-, and 3-item versions of the Inner EAR scale have strong psychometric properties, and there is correlational validity evidence for the observed scores. Modern psychometric methods can help streamline care delivery by maximizing relevant information per item administered.
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Affiliation(s)
- Annika Jessen
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Andrew D. Ho
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - C. Eduardo Corrales
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Bevan Yueh
- Department of Otolaryngology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jennifer J. Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Kayser S, Krzykalla J, Elliott MA, Norsworthy K, Gonzales P, Hills RK, Baer MR, Ráčil Z, Mayer J, Novak J, Žák P, Szotkowski T, Grimwade D, Russell NH, Walter RB, Estey EH, Westermann J, Görner M, Benner A, Krämer A, Smith BD, Burnett AK, Thiede C, Röllig C, Ho AD, Ehninger G, Schlenk RF, Tallman MS, Levis MJ, Platzbecker U. Characteristics and outcome of patients with therapy-related acute promyelocytic leukemia front-line treated with or without arsenic trioxide. Leukemia 2017; 31:2347-2354. [PMID: 28322237 PMCID: PMC6037311 DOI: 10.1038/leu.2017.92] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 02/08/2023]
Abstract
Therapy-related acute promyelocytic leukemia (t-APL) is relatively rare, with limited data on outcome after treatment with arsenic trioxide (ATO) compared to standard intensive chemotherapy (CTX). We evaluated 103 adult t-APL patients undergoing treatment with all-trans retinoic acid (ATRA) alone (n=7) or in combination with ATO (n=24), CTX (n=53), or both (n=19). Complete remissions were achieved after induction therapy in 57% with ATRA, 100% with ATO/ATRA, 78% with CTX/ATRA, and 95% with CTX/ATO/ATRA. Early death rates were 43% for ATRA, 0% for ATO/ATRA, 12% for CTX/ATRA and 5% for CTX/ATO/ATRA. Three patients relapsed, two developed therapy-related acute myeloid leukemia and 13 died in remission including seven patients with recurrence of the prior malignancy. Median follow-up for survival was 3.7 years. None of the patients treated with ATRA alone survived beyond one year. Event-free survival was significantly higher after ATO-based therapy (95%, 95% CI, 82-99%) as compared to CTX/ATRA (78%, 95% CI, 64-87%; P=0.042), if deaths due to recurrence of the prior malignancy were censored. The estimated 2-year overall survival in intensively treated patients was 88% (95% CI, 80-93%) without difference according to treatment (P=0.47). ATO when added to ATRA or CTX/ATRA is feasible and leads to better outcomes as compared to CTX/ATRA in t-APL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Arsenic Trioxide
- Arsenicals/therapeutic use
- Female
- Humans
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/etiology
- Leukemia, Promyelocytic, Acute/genetics
- Male
- Middle Aged
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/genetics
- Oxides/therapeutic use
- Remission Induction
- Survival Analysis
- Treatment Outcome
- Young Adult
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Affiliation(s)
- S Kayser
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Internal Medicine V, Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - J Krzykalla
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - MA Elliott
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - K Norsworthy
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - P Gonzales
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - RK Hills
- Cardiff University School of Medicine, Cardiff, UK
| | - MR Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Z Ráčil
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - J Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - J Novak
- 3rd Faculty of Medicine, Department of Internal Medicine and Haematology, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - P Žák
- Faculty of Medicine, 4th Department of Internal Medicine-Hematology, Charles University and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - T Szotkowski
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - D Grimwade
- Faculty of Life Sciences and Medicine, Department of Medical & Molecular Genetics, King’s College London, London, UK
| | - NH Russell
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - RB Walter
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - EH Estey
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA
| | - J Westermann
- Department of Hematology, Oncology and Tumor Immunology, Charité-University Medical Center, Campus Virchow Clinic, Berlin, Germany
| | - M Görner
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - A Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - A Krämer
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Internal Medicine V, Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
| | - BD Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - AK Burnett
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Thiede
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - C Röllig
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - AD Ho
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - G Ehninger
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - RF Schlenk
- National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - MS Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - MJ Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - U Platzbecker
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
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Zeisbrich M, Becker N, Benner A, Radujkovic A, Schmitt K, Beimler J, Ho AD, Zeier M, Dreger P, Luft T. Transplant-associated thrombotic microangiopathy is an endothelial complication associated with refractoriness of acute GvHD. Bone Marrow Transplant 2017. [PMID: 28650448 DOI: 10.1038/bmt.2017.119] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
There is increasing evidence that endothelial dysfunction is involved in refractoriness of acute GvHD (aGvHD). Here we investigated the hypothesis that another endothelial complication, transplant-associated thrombotic microangiopathy (TMA), contributes to the pathogenesis of aGvHD refractoriness. TMA was retrospectively assessed in 771 patients after allogeneic stem cell transplantation (alloSCT). Incidences of TMA and refractory aGvHD were correlated with biomarkers of endothelial damage obtained before alloSCT for patients receiving or not receiving statin-based endothelial prophylaxis (SEP). Diagnostic criteria for TMA and refractory aGvHD were met by 41 (5.3%) and 76 (10%) patients, respectively. TMA was overrepresented in patients with refractory aGvHD (45.0 vs 2.3% in all other patients, P<0.001). TMA independently increased mortality. Elevated pretransplant suppressor of tumorigenicity-2 and nitrates along with high-risk variants of the thrombomodulin gene were associated with increased risk of TMA. In contrast, SEP abolished the unfavorable outcome predicted by pretransplant biomarkers on TMA risk. Patients on SEP had a significantly lower risk of TMA (P=0.001) and refractory aGvHD (P=0.055) in a multivariate multistate model. Our data provide evidence that TMA contributes to the pathogenesis of aGvHD refractoriness. Patients with an increased TMA risk can be identified pretransplant and may benefit from pharmacological endothelium protection.
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Affiliation(s)
- M Zeisbrich
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - N Becker
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - A Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - A Radujkovic
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - K Schmitt
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - J Beimler
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - A D Ho
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - M Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - P Dreger
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - T Luft
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
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7
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Lisenko K, Dingeldein G, Cremer M, Kriegsmann M, Ho AD, Rieger M, Witzens-Harig M. Addition of rituximab to CHOP-like chemotherapy in first line treatment of primary mediastinal B-cell lymphoma. BMC Cancer 2017; 17:359. [PMID: 28532396 PMCID: PMC5440917 DOI: 10.1186/s12885-017-3332-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 09/16/2016] [Accepted: 05/08/2017] [Indexed: 12/22/2022] Open
Abstract
Background The addition of rituximab (R) to CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) -like therapy has improved survival in primary mediastinal B-cell lymphoma (PMBCL) patients. However, these results were obtained in young low risk patients and a reevaluation in an unselected patient cohort is warranted. Methods In this study, we analyzed 80 PMBCL patients treated with a CHOP-based regimen with and without rituximab. Results In the non-rituximab cohort 10-year progression free survival (PFS) was 67% and 10-year overall survival (OS) was 72% versus a PFS of 95% and a OS of 92% in the rituximab group, PFS P = 0.001, OS P = 0.023. A subgroup PFS analysis by international prognostic index (IPI) risk revealed that all risk groups benefit from addition of rituximab to induction chemotherapy. In addition, OS probability was higher in the group of non-low risk patients who were treated with rituximab compared to those patients who did not receive rituximab (P = 0.035). In multivariate analysis, only addition of rituximab to induction chemotherapy and reaching complete remission (CR) after first line therapy had a beneficial effect on both PFS and OS, whereas IPI, age, upfront high dose (HD) chemotherapy/autologous blood stem cell transplantation (ABSCT) and rituximab maintenance had no impact on survival. Conclusions Our data demonstrate a survival benefit in unselected PMBCL patients treated with CHOP-like induction regimen and additional rituximab independently of the IPI risk score.
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Affiliation(s)
- K Lisenko
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | | | - M Cremer
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - M Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - A D Ho
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - M Rieger
- Oncology Outpatient Center, Darmstadt, Germany
| | - M Witzens-Harig
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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8
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Xu J, Pfarr N, Endris V, Mai EK, Md Hanafiah NH, Lehners N, Penzel R, Weichert W, Ho AD, Schirmacher P, Goldschmidt H, Andrulis M, Raab MS. Molecular signaling in multiple myeloma: association of RAS/RAF mutations and MEK/ERK pathway activation. Oncogenesis 2017; 6:e337. [PMID: 28504689 PMCID: PMC5523069 DOI: 10.1038/oncsis.2017.36] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 10/22/2016] [Revised: 02/10/2017] [Accepted: 03/28/2017] [Indexed: 12/27/2022] Open
Abstract
Multiple myeloma (MM) is a plasma cell malignancy that is still considered to be incurable in most cases. A dominant mutation cluster has been identified in RAS/RAF genes, emphasizing the potential significance of RAS/RAF/MEK/ERK signaling as a therapeutic target. As yet, however, the clinical relevance of this finding is unclear as clinical responses to MEK inhibition in RAS-mutant MM have been mixed. We therefore assessed RAS/RAF mutation status and MEK/ERK pathway activation by both targeted sequencing and phospho-ERK immunohistochemistry in 180 tissue biopsies from 103 patients with newly diagnosed MM (NDMM) and 77 patients with relapsed/refractory MM (rrMM). We found a significant enrichment of RAS/BRAF mutations in rrMM compared to NDMM (P=0.011), which was mainly due to an increase of NRAS mutations (P=0.010). As expected, BRAF mutations were significantly associated with activated downstream signaling. However, only KRAS and not NRAS mutations were associated with pathway activation compared to RAS/BRAFwt (P=0.030). More specifically, only KRASG12D and BRAFV600E were consistently associated with ERK activation (P<0.001 and P=0.006, respectively). Taken together, these results suggest the need for a more specific stratification strategy consisting of both confirmation of protein-level pathway activation as well as detailed RAS/RAF mutation status to allow for a more precise and more effective application of targeted therapies, for example, with BRAF/MEK inhibitors in MM.
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Affiliation(s)
- J Xu
- Max Eder Group Experimental Therapies for Hematologic Malignancies, Heidelberg University Hospital and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of General Pathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - N Pfarr
- Department of General Pathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - V Endris
- Department of General Pathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - E K Mai
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - N H Md Hanafiah
- Max Eder Group Experimental Therapies for Hematologic Malignancies, Heidelberg University Hospital and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - N Lehners
- Max Eder Group Experimental Therapies for Hematologic Malignancies, Heidelberg University Hospital and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - R Penzel
- Department of General Pathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - W Weichert
- Department of General Pathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - A D Ho
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - P Schirmacher
- Department of General Pathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - H Goldschmidt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - M Andrulis
- Department of General Pathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - M S Raab
- Max Eder Group Experimental Therapies for Hematologic Malignancies, Heidelberg University Hospital and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
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9
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Kayser S, Benner A, Thiede C, Martens U, Huber J, Stadtherr P, Janssen JWG, Röllig C, Uppenkamp MJ, Bochtler T, Hegenbart U, Ehninger G, Ho AD, Dreger P, Krämer A. Pretransplant NPM1 MRD levels predict outcome after allogeneic hematopoietic stem cell transplantation in patients with acute myeloid leukemia. Blood Cancer J 2016; 6:e449. [PMID: 27471865 PMCID: PMC5030374 DOI: 10.1038/bcj.2016.46] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [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: 05/01/2016] [Accepted: 05/19/2016] [Indexed: 12/19/2022] Open
Abstract
The objective was to evaluate the prognostic impact of pre-transplant minimal residual disease (MRD) as determined by real-time quantitative polymerase chain reaction in 67 adult NPM1-mutated acute myeloid leukemia patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). Twenty-eight of the 67 patients had a FLT3-ITD (42%). Median age at transplantation was 54.7 years, median follow-up for survival from time of allografting was 4.9 years. At transplantation, 31 patients were in first, 20 in second complete remission (CR) and 16 had refractory disease (RD). Pre-transplant NPM1 MRD levels were measured in 39 CR patients. Overall survival (OS) for patients transplanted in CR was significantly longer as compared to patients with RD (P=0.004), irrespective of whether the patients were transplanted in first or second CR (P=0.74). There was a highly significant difference in OS after allogeneic HSCT between pre-transplant MRD-positive and MRD-negative patients (estimated 5-year OS rates of 40 vs 89% P=0.007). Multivariable analyses on time to relapse and OS revealed pre-transplant NPM1 MRD levels >1% as an independent prognostic factor for poor survival after allogeneic HSCT, whereas FLT3-ITD had no impact. Notably, outcome of patients with pre-transplant NPM1 MRD positivity >1% was as poor as that of patients transplanted with RD.
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Affiliation(s)
- S Kayser
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - A Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Thiede
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - U Martens
- Cancer Center Heilbronn-Franken, Heilbronn, Germany
| | - J Huber
- Cancer Center Heilbronn-Franken, Heilbronn, Germany
| | - P Stadtherr
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - J W G Janssen
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - C Röllig
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - M J Uppenkamp
- Department of Oncology, Hospital of Ludwigshafen, Ludwigshafen, Germany
| | - T Bochtler
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - U Hegenbart
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - G Ehninger
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - A D Ho
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - P Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - A Krämer
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
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10
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Lisenko K, McClanahan F, Schöning T, Schwarzbich MA, Cremer M, Dittrich T, Ho AD, Witzens-Harig M. Minimal renal toxicity after Rituximab DHAP with a modified cisplatin application scheme in patients with relapsed or refractory diffuse large B-cell lymphoma. BMC Cancer 2016; 16:267. [PMID: 27067641 PMCID: PMC4828891 DOI: 10.1186/s12885-016-2289-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/02/2015] [Accepted: 03/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rituximab (R) in combination with DHAP is a widely accepted salvage regimen for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). A common adverse effect of this protocol is renal toxicity which may result in treatment discontinuation. Assuming that a lower single dose of cisplatin over several days would reduce renal toxicity, our institution has chosen to administer cisplatin in a dosage of 25 mg/m(2) per day as a 3-h infusion over 4 consecutive days. METHODS In this study, we analyzed the renal function of 122 patients with relapsed or refractory DLBCL treated with R-DHAP at our institution. Overall, 256 R-DHAP cycles were administered. 31 (25%), 61 (50%), 14 (12%) and 16 (13%) patients received one, two, three or four R-DHAP courses, respectively. RESULTS A glomerular filtration rate (GFR) decrease was observed after each R-DHAP cycle. However, in none of the subgroups the median GFR was lower than 60 ml/min/1.73 m(2). In most patients, only renal impairment stage I and II was observed. Renal impairment stage III was seen in 10% and stage IV only in 1% of patients. CONCLUSION We conclude that a modified R-DHAP regimen with administration of cisplatin 25 mg/m(2) over 4 consecutive cycles leads only to minimal renal toxicity.
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Affiliation(s)
- K Lisenko
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany.
| | - F McClanahan
- Centre for Haemato-Oncology/Barts Cancer Institute, Queen Mary University of London, London, UK
| | - T Schöning
- Pharmacy Department, University Hospital Heidelberg, Heidelberg, Germany
| | - M A Schwarzbich
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - M Cremer
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - T Dittrich
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - A D Ho
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - M Witzens-Harig
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
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11
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Balss J, Thiede C, Bochtler T, Okun JG, Saadati M, Benner A, Pusch S, Ehninger G, Schaich M, Ho AD, von Deimling A, Krämer A, Heilig CE. Pretreatment d-2-hydroxyglutarate serum levels negatively impact on outcome in IDH1-mutated acute myeloid leukemia. Leukemia 2015; 30:782-8. [DOI: 10.1038/leu.2015.317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 10/23/2015] [Accepted: 11/02/2015] [Indexed: 11/09/2022]
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12
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Madle M, Krämer I, Lehners N, Schwarzbich M, Wuchter P, Herfarth K, Egerer G, Ho AD, Witzens-Harig M. The influence of rituximab, high-dose therapy followed by autologous stem cell transplantation, and age in patients with primary CNS lymphoma. Ann Hematol 2015; 94:1853-7. [PMID: 26268792 DOI: 10.1007/s00277-015-2470-4] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
For patients with diffuse large B cell lymphoma without the involvement of the CNS, the addition of rituximab to standard chemotherapy has significantly improved survival. In this single-center, retrospective analysis, a total of 81 primary CNS lymphoma (PCNSL) patients treated in our institution between 2000 and 2011 were included. Beside first-line chemotherapy with or without rituximab, we evaluated the impact of age (≤/>60 years), autologous stem cell transplantation (ASCT +/-), and other factors upon overall survival (OS) and progression-free survival (PFS). In patients treated with rituximab (n = 27), 3-year OS was 77.8 % (95 % confidence interval (CI) 62-93 %). In contrast, in patients treated without rituximab (n = 52), 3-year OS was only 39.9 % (CI 27-53 %, Fig. 1). The difference in OS was significant in the univariate (p = 0.002) as well as in the multivariate analysis (p = 0.049, hazard ratio (HR) = 0.248). Patients ≤60 years of age (n = 28) had a 3-year OS of 78.2 % (CI 63-94 %); in patients >60 years (n = 51), 3-year OS was 38.7 % (CI 25-52 %). Patients who received high-dose therapy and ASCT had a 3-year OS of 85.2 % (CI 72-99 %), and 65.1 % were alive up to the time of analysis (range 9-131 months). Without ASCT, median OS was only 16 months (CI 11-21) and 3-year OS was 35.2 % (CI 22-48 %). Age and ASCT were significantly associated with better OS in univariate (p = 0.002 and p < 0.001) as well in multivariate analysis (p = 0.004, HR = 0.023 and p = 0.001, HR = 0.014). Rituximab treatment, ASCT, and age are independent prognostic factors for OS in the first-line treatment of PCNSL.
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Affiliation(s)
- M Madle
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - I Krämer
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - N Lehners
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - M Schwarzbich
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - P Wuchter
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - K Herfarth
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - G Egerer
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - A D Ho
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - M Witzens-Harig
- Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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13
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Hahn M, Böttcher S, Dietrich S, Hegenbart U, Rieger M, Stadtherr P, Bondong A, Schulz R, Ritgen M, Schmitt T, Tran TH, Görner M, Herth I, Luft T, Schönland S, Witzens-Harig M, Zenz T, Kneba M, Ho AD, Dreger P. Allogeneic hematopoietic stem cell transplantation for poor-risk CLL: dissecting immune-modulating strategies for disease eradication and treatment of relapse. Bone Marrow Transplant 2015; 50:1279-85. [DOI: 10.1038/bmt.2015.150] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 12/21/2022]
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14
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Ho AD, Yu CC. Descriptive Statistics for Modern Test Score Distributions: Skewness, Kurtosis, Discreteness, and Ceiling Effects. Educ Psychol Meas 2015; 75:365-388. [PMID: 29795825 PMCID: PMC5965643 DOI: 10.1177/0013164414548576] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Many statistical analyses benefit from the assumption that unconditional or conditional distributions are continuous and normal. More than 50 years ago in this journal, Lord and Cook chronicled departures from normality in educational tests, and Micerri similarly showed that the normality assumption is met rarely in educational and psychological practice. In this article, the authors extend these previous analyses to state-level educational test score distributions that are an increasingly common target of high-stakes analysis and interpretation. Among 504 scale-score and raw-score distributions from state testing programs from recent years, nonnormal distributions are common and are often associated with particular state programs. The authors explain how scaling procedures from item response theory lead to nonnormal distributions as well as unusual patterns of discreteness. The authors recommend that distributional descriptive statistics be calculated routinely to inform model selection for large-scale test score data, and they illustrate consequences of nonnormality using sensitivity studies that compare baseline results to those from normalized score scales.
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Affiliation(s)
- Andrew D. Ho
- Harvard Graduate School of Education, Cambridge, MA, USA
| | - Carol C. Yu
- Harvard Graduate School of Education, Cambridge, MA, USA
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15
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Weidner CI, Ziegler P, Hahn M, Brümmendorf TH, Ho AD, Dreger P, Wagner W. Epigenetic aging upon allogeneic transplantation: the hematopoietic niche does not affect age-associated DNA methylation. Leukemia 2014; 29:985-8. [DOI: 10.1038/leu.2014.323] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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16
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Malcherek G, Jin N, Hückelhoven AG, Mani J, Wang L, Gern U, Diehlmann A, Wuchter P, Schmitt A, Chen B, Ho AD, Schmitt M. Mesenchymal stromal cells inhibit proliferation of virus-specific CD8(+) T cells. Leukemia 2014; 28:2388-94. [PMID: 25227910 DOI: 10.1038/leu.2014.273] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/01/2014] [Accepted: 09/09/2014] [Indexed: 01/12/2023]
Abstract
Mesenchymal stromal cells (MSCs) possess broad immunomodulatory capacities that are currently investigated for potential clinical application in treating autoimmune disorders. Third-party MSCs suppress alloantigen-induced proliferation of peripheral blood mononuclear cells providing the rationale for clinical use in graft-versus-host disease (GvHD). We confirmed that MSCs strongly inhibited proliferation of CD8(+) T cells in a mixed lymphocyte reaction. However, MSCs also suppressed proliferation of T cells specifically recognizing cytomegalovirus (CMV) and influenza virus. Inhibition was dose dependent, but independent of the culture medium. MSCs inhibited proliferation of specific CD8(+) T cells and the release of IFN-γ by specific CD8(+) T cells for immunodominant HLA-A2- and HLA-B7- restricted antigen epitopes derived from CMV phosphoprotein 65 and influenza matrix protein. This is in contrast to a recently reported scenario where MSCs exert differential effects on alloantigen and virus-specific T cells potentially having an impact on surveillance and prophylaxis of patients treated by MSCs.
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Affiliation(s)
- G Malcherek
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - N Jin
- 1] Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany [2] Department of Hematology, ZhongDa Hospital, Southeast University, Nanjing, PR China
| | - A G Hückelhoven
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - J Mani
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - L Wang
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - U Gern
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - A Diehlmann
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - P Wuchter
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - A Schmitt
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - B Chen
- Department of Hematology, ZhongDa Hospital, Southeast University, Nanjing, PR China
| | - A D Ho
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - M Schmitt
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
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17
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Herth I, Dietrich S, Benner A, Hegenbart U, Rieger M, Stadtherr P, Bondong A, Tran TH, Weide R, Hensel M, Knauf W, Franz-Werner J, Welslau M, Procaccianti M, Görner M, Meissner J, Luft T, Schönland S, Witzens-Harig M, Zenz T, Ho AD, Dreger P. The impact of allogeneic stem cell transplantation on the natural course of poor-risk chronic lymphocytic leukemia as defined by the EBMT consensus criteria: a retrospective donor versus no donor comparison. Ann Oncol 2014; 25:200-6. [PMID: 24356631 DOI: 10.1093/annonc/mdt511] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In a single-center retrospective donor versus no-donor comparison, we investigated if allogeneic stem cell transplantation (alloSCT) can improve the dismal course of poor-risk chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS All patients with CLL who were referred for evaluation of alloSCT within a 7-year time frame and had a donor search indication according to the EBMT criteria or because of Richter's transformation were included. Patients for whom a matched donor could be found within 3 months (matches) were compared with patients without such a donor (controls). Primary end point was overall survival measured from the 3-month landmark after search initiation. RESULTS Of 105 patients with donor search, 97 (matches 83; controls 14) were assessable at the 3-month landmark. Matches and controls were comparable for age, gender, time from diagnosis, number of previous regimens, and remission status. Disregarding if alloSCT was actually carried out or not, survival from the 3-month landmark was significantly better in matches versus controls [hazard ratio 0.38, 95% confidence interval (CI) 0.17-0.85; P = 0.014]. The survival benefit of matches remained significant on multivariate analysis. CONCLUSION This study provides first comparative evidence that alloSCT may have the potential to improve the natural course of poor-risk CLL as defined by the EBMT criteria.
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Affiliation(s)
- I Herth
- Department Medicine V, University of Heidelberg, Heidelberg
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18
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Breitkreutz I, Heiss C, Perne A, Beimler J, Jäger D, Egerer G, Ho AD, Neben K, Zeier M, Goldschmidt H, Raab MS. Bortezomib improves outcome after SCT in multiple myeloma patients with end-stage renal failure. Bone Marrow Transplant 2014; 49:1371-5. [DOI: 10.1038/bmt.2014.165] [Citation(s) in RCA: 11] [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] [Received: 02/28/2014] [Revised: 04/17/2014] [Accepted: 06/13/2014] [Indexed: 01/03/2023]
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19
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Becker-Kojić ZA, Ureña-Peralta JR, Saffrich R, Rodriguez-Jiménez FJ, Rubio MP, Rios P, Romero A, Ho AD, Stojković M. A novel human glycoprotein ACA is an upstream regulator of human hematopoiesis. Bull Exp Biol Med 2014; 155:536-51. [PMID: 24143385 DOI: 10.1007/s10517-013-2195-0] [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 central issue in stem cell biology is a better understanding of the molecular mechanisms that regulate self-renewal of human hematopoietic stem cells (HSCs). Control of the specific function of HSCs like self-renewal and differentiation might be regulated by a common set of critical genes. However, the regulation among these genes is yet to be elucidated. Here, we show that activation by a novel human GPI-linked glycoprotein ACA at the surface of human peripheral blood progenitor cells induces via PI3K/Akt/mTor/PTEN upregulation of WNT, Notch1, Bmi-1 and HoxB4 genes thus, promoting self-renewal and generation of primitive HSCs. ACA-generated self-renewing cells retained their lympho-myeloid repopulating potential in NOD/SCID mouse xeno-transplantation model with long term functional capacity. We conclude that ACA is an essential regulator of the genes involved in maintaining hematopoiesis and its use in clinical praxis could overcome many of the barriers present so far in transplantation medicine.
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Affiliation(s)
- Z A Becker-Kojić
- Principe Felipe Research Centre, Valencia, Spain; Department of Medicine V, University of Heidelberg, Germany.
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20
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Weis B, Schmidt J, Maamar H, Raj A, Lin H, Tóth C, Riedmann K, Raddatz G, Seitz HK, Ho AD, Lyko F, Linhart HG. Inhibition of intestinal tumor formation by deletion of the DNA methyltransferase 3a. Oncogene 2014; 34:1822-30. [PMID: 24837369 DOI: 10.1038/onc.2014.114] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 03/13/2014] [Accepted: 03/26/2014] [Indexed: 12/31/2022]
Abstract
Aberrant de novo methylation of DNA is considered an important mediator of tumorigenesis. To investigate the role of de novo DNA methyltransferase 3a (Dnmt3a) in intestinal tumor development, we analyzed the expression of Dnmt3a in murine colon crypts, murine colon adenomas and human colorectal cancer using RNA fluorescence in situ hybridization (FISH), quantitative PCR and immunostaining. Following conditional deletion of Dnmt3a in the colon of APC((Min/+)) mice, we analyzed tumor numbers, genotype of macroadenomas and laser dissected microadenomas, global and regional DNA methylation and gene expression. Our results showed increased Dnmt3a expression in colon adenomas of APC((Min/+)) mice and human colorectal cancer samples when compared with control tissue. Interestingly, in tumor tissue, RNA FISH analysis showed highest Dnmt3a expression in Lgr5-positive stem/progenitor cells. Deletion of Dnmt3a in APC((Min/+)) mice reduced colon tumor numbers by ~40%. Remaining adenomas and microadenomas almost exclusively contained the non-recombined Dnmt3a allele; no tumors composed of the inactivated Dnmt3a allele were detected. DNA methylation was reduced at the Oct4, Nanog, Tff2 and Cdkn1c promoters and expression of the tumor-suppressor genes Tff2 and Cdkn1c was increased. In conclusion, our results show that Dnmt3a is predominantly expressed in the stem/progenitor cell compartment of tumors and that deletion of Dnmt3a inhibits the earliest stages of intestinal tumor development.
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Affiliation(s)
- B Weis
- Division of Epigenetics (A130), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J Schmidt
- Division of Epigenetics (A130), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H Maamar
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - A Raj
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - H Lin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - C Tóth
- 1] Department of Pathology, University of Heidelberg, National Center for Tumor Diseases (NCT) Tissue Bank, Heidelberg, Germany [2] Department of Pathology, Heinrich Heine University, Düsseldorf, Germany
| | - K Riedmann
- Division of Epigenetics (A130), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - G Raddatz
- Division of Epigenetics (A130), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H-K Seitz
- Department of Medicine, Salem Medical Center, Alcohol Research Center, University of Heidelberg, Heidelberg, Germany
| | - A D Ho
- Department of Hematology/Oncology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - F Lyko
- Division of Epigenetics (A130), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H G Linhart
- 1] Department of Medicine, Salem Medical Center, Alcohol Research Center, University of Heidelberg, Heidelberg, Germany [2] Department of Hematology/Oncology, University of Heidelberg Medical Center, Heidelberg, Germany [3] Division of Epigenetics (A130), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Stiehl T, Ho AD, Marciniak-Czochra A. The impact of CD34+ cell dose on engraftment after SCTs: personalized estimates based on mathematical modeling. Bone Marrow Transplant 2013; 49:30-7. [DOI: 10.1038/bmt.2013.138] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/05/2013] [Accepted: 08/03/2013] [Indexed: 11/09/2022]
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Schmitt M, Müller LP, Keyßer G, Lorenz HM, Ho AD, Wuchter P. [Mesenchymal stroma cells (MSCs) for the treatment of rheumatic disease]. Dtsch Med Wochenschr 2013; 138:1852-5. [PMID: 24006170 DOI: 10.1055/s-0033-1343346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M Schmitt
- Universitätsklinikum Heidelberg, Medizinische Klinik V (Hämatologie, Onkologie, Rheumatologie), Universität Heidelberg, Heidelberg
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Sigl M, Spoerl S, Schnittger S, Meissner J, Rummelt C, Peschel C, Duyster J, Ho AD, von Bubnoff N. Imatinib failure and response to dasatinib in a patient with chronic myeloid leukemia in blast crisis and a novel, nine-nucleotide BCR-ABL insertion mutation. Blood Cancer J 2013; 3:e104. [PMID: 23474746 PMCID: PMC3615216 DOI: 10.1038/bcj.2013.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- M Sigl
- III Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
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24
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Ebrahimi-Fakhari D, Schönland SO, Hegenbart U, Lohse P, Beimler J, Wahlster L, Ho AD, Lorenz HM, Blank N. Familial Mediterranean fever in Germany: clinical presentation and amyloidosis risk. Scand J Rheumatol 2012; 42:52-8. [DOI: 10.3109/03009742.2012.714796] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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25
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McClanahan F, Hielscher T, Rieger M, Hensel M, Bentz M, Schmidt-Wolf I, Käbisch A, Salwender H, Dürk H, Staiger H, Mandel T, Neben K, Hillengass J, Leo E, Krämer A, Ho AD, Witzens-Harig M. Final results of a randomized trial comparing 1, 3, or 6 infusions of Rituximab plus 6 cycles CHOP provide valuable preliminary data towards a more cost-effective and safer treatment of advanced follicular lymphoma. Am J Hematol 2012; 87:E68-71. [PMID: 22847344 DOI: 10.1002/ajh.23286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/economics
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/economics
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor
- Cost-Benefit Analysis
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Cyclophosphamide/economics
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Doxorubicin/economics
- Humans
- Kaplan-Meier Estimate
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/economics
- Lymphoma, Follicular/genetics
- Middle Aged
- Polymerase Chain Reaction
- Prednisone/administration & dosage
- Prednisone/adverse effects
- Prednisone/economics
- Proportional Hazards Models
- Remission Induction
- Rituximab
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/adverse effects
- Vincristine/economics
- Young Adult
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Affiliation(s)
- F McClanahan
- Internal Medicine V, University of Heidelberg, Heidelberg, Germany
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Hensel M, Brust J, Plöger C, Schuster D, Memmer ML, Franz-Werner J, Feustel HP, Karcher A, Fuxius S, Mosthaf FA, Rieger M, Ho AD, Witzens-Harig M. Excellent long-term survival of 170 patients with Waldenström's macroglobulinemia treated in private oncology practices and a university hospital. Ann Hematol 2012; 91:1923-8. [PMID: 22895554 DOI: 10.1007/s00277-012-1545-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 07/28/2012] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to compare treatment and outcome of patients with Waldenström's macroglobulinemia (WM) in four private oncology practices (PP) and a university hospital (UH) in southwest Germany. We retrospectively reviewed the charts of all patients with WM of the last two decades of four PP in Mannheim, Heidelberg, Karlsruhe, and Speyer and the Department of Hematology of the University of Heidelberg. One hundred seventy patients could be identified, 74 from PP, 96 from the UH. Median age was 63.3 years. Patients from PP were older (median 65.3 vs. 62.5 years, p = 0.01). Only 54 % of patients from PP have received treatment during the observation time, as compared to 78.1 % of the UH (p < 0.001). In PP, 35 % of treated patients have received rituximab, as compared to 62.6 % of the patients of the UH (p < 0.001). Sixty percent of treated patients of PP have received bendamustine, as compared to only 8 % of the patients of the UH (p < 0.001). Time to first treatment was significantly shorter in patients from the UH compared to PP (median 13.7 vs. 52.9 months, p = 0.05). A trend towards a better overall survival was observed for patients treated with a rituximab-containing first-line regimen. The International Prognostic Scoring System for WM had significant prognostic value. Median overall survival was 25.0 years and did not differ between PP and UH. Despite different treatment strategies between PP and UH today overall survival of patients with WM is excellent, and better than previously reported.
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Affiliation(s)
- M Hensel
- Mannheimer Onkologie Praxis, Mannheim, Germany
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27
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Horn P, Bokermann G, Cholewa D, Bork S, Walenda T, Koch C, Drescher W, Hutschenreuther G, Zenke M, Ho AD, Wagner W. Impact of individual platelet lysates on isolation and growth of human mesenchymal stromal cells. J Stem Cells Regen Med 2010; 6:110. [PMID: 24693124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- P Horn
- University of Heidelberg, Department of MEdicine V , Heidelberg, Germany
| | - G Bokermann
- RWTH Aachen University Medical School, Helmholtz-Institute for Biomedical Engineering , Aachen, Germany
| | - D Cholewa
- RWTH Aachen University Medical School, Helmholtz-Institute for Biomedical Engineering , Aachen, Germany
| | - S Bork
- University of Heidelberg, Department of MEdicine V , Heidelberg, Germany ; Heidelberg Academy of Sciences and Humanities , Heidelberg, Germany
| | - T Walenda
- RWTH Aachen University Medical School, Helmholtz-Institute for Biomedical Engineering , Aachen, Germany
| | - C Koch
- RWTH Aachen University Medical School, Helmholtz-Institute for Biomedical Engineering , Aachen, Germany
| | - W Drescher
- RWTH Aachen University Medical School, Department for Orthopedics , Aachen, Germany
| | - G Hutschenreuther
- RWTH Aachen University Medical School, Institute for Transfusion Medicine , Aachen, Germany
| | - M Zenke
- RWTH Aachen University Medical School, Helmholtz-Institute for Biomedical Engineering , Aachen, Germany
| | - A D Ho
- University of Heidelberg, Department of MEdicine V , Heidelberg, Germany
| | - W Wagner
- RWTH Aachen University Medical School, Helmholtz-Institute for Biomedical Engineering , Aachen, Germany
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Ran D, Taubert I, Schubert M, Eckstein V, Bellos F, Ho AD. Leukemia stem cell candidates in acute myeloid leukemia predict refractoriness to conventional chemotherapy and adverse clinical outcome. J Stem Cells Regen Med 2010; 6:135-136. [PMID: 24693144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- D Ran
- University of Heidelberg, Medizinische Klinik V , Heidelberg, Germany
| | - I Taubert
- University of Heidelberg, Medizinische Klinik V , Heidelberg, Germany
| | - M Schubert
- University of Heidelberg, Medizinische Klinik V , Heidelberg, Germany
| | - V Eckstein
- University of Heidelberg, Medizinische Klinik V , Heidelberg, Germany
| | - F Bellos
- University of Heidelberg, Medizinische Klinik V , Heidelberg, Germany
| | - A D Ho
- University of Heidelberg, Medizinische Klinik V , Heidelberg, Germany
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29
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Rieger M, Österborg A, Pettengell R, White D, Gill D, Walewski J, Kuhnt E, Loeffler M, Pfreundschuh M, Ho AD. Primary mediastinal B-cell lymphoma treated with CHOP-like chemotherapy with or without rituximab: results of the Mabthera International Trial Group study. Ann Oncol 2010; 22:664-670. [PMID: 20724576 DOI: 10.1093/annonc/mdq418] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of this subgroup analysis of the Mabthera International Trial Group study was to evaluate the impact of chemotherapy and rituximab in primary mediastinal B-cell lymphoma (PMBCL) in comparison to other diffuse large B-cell lymphoma (DLBCL). METHODS Patients were randomly assigned to six cycles of CHOP-like regimens with or without rituximab. RESULTS Of 824 patients enrolled, 87 had PMBCL and 627 other types of DLBCL. Rituximab increased the rates of complete remission (unconfirmed) in both PMBCL (from 54% to 80%, P = 0.015) and DLBCL (from 72% to 87%, P < 0.001). In PMBCL, rituximab virtually eliminated progressive disease (PD) (2.5% versus 24%, P < 0.001), whereas without rituximab, PD was more frequent in PMBCL than in DLBCL (24% versus 10%, P = 0.010). With a median observation time of 34 months, 3-year event-free survival (EFS) was improved by rituximab for PMBCL (78% versus 52%, P = 0.012) and for DLBCL (81% versus 61%, P < 0.001). Overall survival benefit was similar for DLBCL (93% versus 85%, P < 0.001) and PMBCL (89% versus 78%, P = 0.158). CONCLUSION In young patients with PMBCL (age-adjusted International Prognostic Index 0-1), rituximab added to six cycles of CHOP-like chemotherapy increases response rate and EFS to the same extent as other DLBCL. The combination of rituximab with CHOP chemotherapy is an effective treatment in PMBCL with good prognosis features.
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Affiliation(s)
- M Rieger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.
| | - A Österborg
- Departments of Oncology, Haematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - D White
- Dalhousie University, Halifax, Nova Scotia for the NCIC Clinical Trials Group, Kingston, Ontario, Canada
| | - D Gill
- Department of Haematology, Princess Alexandra Hospital, Queensland, Australia
| | - J Walewski
- Department of Lymphoma, Maria Sklodowska-Curie Institute and Oncology Centre, Warszawa, Poland
| | - E Kuhnt
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig
| | - M Loeffler
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig
| | | | - A D Ho
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
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30
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Micallef INM, Ho AD, Klein LM, Marulkar S, Gandhi PJ, Calandra G, McSweeney PA. Plerixafor (Mozobil) for stem cell mobilization in patients with multiple myeloma previously treated with lenalidomide. Bone Marrow Transplant 2010; 46:350-5. [PMID: 20479709 DOI: 10.1038/bmt.2010.118] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Lenalidomide and other new agents have considerable activity in multiple myeloma (MM) and have changed the landscape of treatment. Data suggest that lenalidomide therapy before autologous hematopoietic stem cell transplantation has a detrimental effect on stem cell mobilization. This retrospective study examined the efficacy of plerixafor in combination with G-CSF among patients with MM previously treated with lenalidomide (median, 4 cycles; range, 1-20 cycles). Data were analyzed for 60 patients who received plerixafor plus G-CSF for frontline mobilization in a phase 3 clinical trial or an expanded access program (n=20) or for remobilization in a compassionate use program (n=40). The overall median number of CD34+ cells collected was 5.6 × 10(6) per kg (range, 0.45 × 10(6)-37.2 × 10(6)). The minimum number of CD34+ cells (2 × 10(6) per kg) was collected from 86.7% of patients in a median of 1 day. This minimum was collected from 100% of patients who underwent frontline mobilization and 80% of patients who underwent remobilization. These data suggest that CD34+ hematopoietic stem cells can be successfully and predictably collected with combination plerixafor plus G-CSF for primary or secondary mobilization in the majority of patients with MM who have been previously treated with lenalidomide.
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Affiliation(s)
- I N M Micallef
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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31
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Horn P, Bork S, Diehlmann A, Walenda T, Eckstein V, Ho AD, Wagner W. Isolation of human mesenchymal stromal cells is more efficient by red blood cell lysis. Cytotherapy 2009; 10:676-85. [PMID: 18985474 DOI: 10.1080/14653240802398845] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Human mesenchymal stromal cells (MSC) have raised high hopes for tissue engineering and clinical therapy. Their isolation usually involves density fractionation of mononuclear cells (MNC) but this is difficult to standardize, especially under good manufacturing practice (GMP) conditions. MSC represent a heterogeneous mixture of cell types and the composition of subpopulations is affected by the initial steps of cell preparation. METHODS This study describes a straightforward method for isolation of human MSC based on red blood cell (RBC) lysis with ammonium chloride. Colony formation was compared directly with Ficoll density fractionation and culture of an untreated whole bone marrow (BM) aspirate. RESULTS After 7 days the number of fibroblastic colony-forming units (CFU-F) per milliliter of BM aspirate was slightly higher upon RBC lysis and the colonies were significantly larger compared with density fractionation, possibly because of maintenance of platelets. In contrast, colony formation was much lower in untreated BM. The heterogeneous composition of subpopulations was reflected by differences between the initial colonies with regard to growth pattern (tight or disperse) and cell morphology (round or elongated). This heterogeneous composition was not affected by the three different isolation methods. Furthermore, enrichment of CD271(+) cells resulted in the same morphologic heterogeneity. All cell preparations demonstrated the same immunophenotype using a panel of surface markers and displayed adipogenic and osteogenic differentiation potential. DISCUSSION This study demonstrates that human MSC can be efficiently isolated by RBC lysis. This technique is faster and can be standardized more easily for clinical application of MSC.
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Affiliation(s)
- P Horn
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
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Fruehauf S, Ehninger G, Hübel K, Topaly J, Goldschmidt H, Ho AD, Müller S, Moos M, Badel K, Calandra G. Mobilization of peripheral blood stem cells for autologous transplant in non-Hodgkin's lymphoma and multiple myeloma patients by plerixafor and G-CSF and detection of tumor cell mobilization by PCR in multiple myeloma patients. Bone Marrow Transplant 2009; 45:269-75. [PMID: 19597422 DOI: 10.1038/bmt.2009.142] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This report describes the first investigational use of plerixafor in Europe and the determination of tumor cell mobilization by polymerase chain-reaction after plerixafor treatment in a subset of patients with multiple myeloma (MM). Thirty-five patients (31 MM and 4 NHL) received granulocyte colony-stimulating factor (G-CSF) (10 microg/kg) each morning for 4 days. Starting the evening of Day 4, patients recieved plerixafor 0.24 mg/kg. Apheresis was initiated 10-11 h later, in the morning of Day 5. This regimen of G-CSF treatment each morning before apheresis and plerixafor treatment in the evening was repeated for up to 5 consecutive days. Mobilization with plerixafor and G-CSF resulted in a median 2.6-fold increase in peripheral blood (PB) CD34+ cell count compared with before plerixafor treatment. All patients collected > or =2 x 10(6) CD34+ cells/kg and 32 of 35 patients collected > or =5 x 10(6) CD34+ cells/kg. After plerixafor treatment, 3 of 7 patients had a small increase and 4 of 7 patients had a small decrease in PB tumor cells. No G-CSF was given post transplant. The median number of days to polymorphonuclear leukocyte and platelet engraftment was 14.0 and 11.0, respectively. There were no reports of graft failure. Plerixafor was generally well tolerated. Mobilization of PB CD34+ cells was consistent with previous clinical trials. The addition of plerixafor did not significantly increase the relative number of PB MM tumor cells.
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Affiliation(s)
- S Fruehauf
- Center for Tumor Diagnostics and Therapy, Paracelsus Klinik, Osnabrueck, Germany.
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Abstract
Amyloidoses are protein-folding disorders in which soluble proteins are deposited as insoluble fibrillar aggregates due to a change in protein conformation. This might occur intra- or extracellularly, systemically or in a localized manner. The light chain type is the most common form of systemic amyloidoses and has the worst prognosis. The underlying disease is a monoclonal, mostly non-malignant plasma cell disorder. The causative treatment is the reduction of the amyloidogenic light chains with conventional or high-dose chemotherapy. Meanwhile, the"new drugs" used in multiple myeloma are also successfully applied. Early diagnosis is important to be able to treat patients effectively and to avoid further deterioration of organ function. Patients with newly diagnosed amyloidosis should be referred to a specialized center for consultation, diagnosis and treatment recommendation.
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Affiliation(s)
- S O Schönland
- Medizinische Klinik V, Abteilung Hämatologie, Onkologie, Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
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Gottschling S, Jauch A, Granzow M, Kuner R, Muley T, Hoffmann H, Dienemann H, Eckstein V, Ho AD, Herth FJF, Thomas M, Meister M. Stromal Cells Derived from Non-Small Cell Lung Cancer and Normal Lung Tissue Display Mesenchymal Stem Cell Characteristics and Differ in Their Gene Expression Profiles and Functional Behaviour. Pneumologie 2009. [DOI: 10.1055/s-0029-1213954] [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: 10/21/2022]
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Gottschling S, Granzow M, Kuner R, Jauch A, Chang Xu E, Muley T, Hoffmann H, Dienemann H, Eckstein V, Ho AD, Herth FJF, Thomas M, Meister M. The Individuality of Tumour-Stroma Interaction in Non-Small Cell Lung Cancer: Insights from Funtional and Molecular Analysis. Pneumologie 2009. [DOI: 10.1055/s-0029-1213953] [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: 10/21/2022]
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Abstract
As an archetype of human adult stem cells that can readily be harvested, enriched and expanded in vitro, mesenchymal stromal cells (MSC) have been reported to be of significance for regenerative medicine. The literature is replete with reports on their developmental potentials in pre-clinical model systems. Different preparative protocols have been shown to yield MSC-like cell cultures or even cell lines, from starting materials as diverse as bone marrow, fat tissue, fetal cord blood and peripheral blood. However, MSC are still ill-defined by physical, phenotypic and functional properties. The quality of preparations from different laboratories varies tremendously and the cell products are notoriously heterogeneous. The source and freshness of the starting material, culture media used, presence of animal sera, cytokines, cell density, number of passages upon culture, etc., all have a significant impact on the (1) cell type components and heterogeneity of the initial population, (2) differential expansion of specific subsets, with different potentials of the end products, and (3) long-term functional fate of MSC as well as other types of progenitor cells that are co-cultivated with them. Consequently, there is an urgent need for the development of reliable reagents, common guidelines and standards for MSC preparations and of precise molecular and cellular markers to define subpopulations with diverse pathways of differentiation and divergent potentials.
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Affiliation(s)
- A D Ho
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany.
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Steinhoff G, Tiedemann G, Thalheimer M, Ho AD. [From basic research to the clinic. Regulations for preclinical and clinical studies with stem cells]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008; 51:973-9. [PMID: 18773175 DOI: 10.1007/s00103-008-0624-4] [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] [Indexed: 11/25/2022]
Abstract
The discovery of human embryonic stem cells at the end of 1998 had a strong influence on the development of stem cell research and led to controversial discussions. The first therapeutic application of adult blood stem cells began after their discovery in 1963 and was accepted as an authorized therapy in the early 1980s. The way from basic research to therapeutic use needed about 20 years and was also discussed in a controversial way similar to the discussions of today. The regulatory environment at that time, however, allowed a quick translation of the results from basic research to the clinic. Today many new stem cell therapies for a multitude of diseases are under development. Their clinical realization is regulated by the AMG (Arzneimittelgesetz). For nonclinical research as well as for clinical research, specific regulations are enacted to guarantee a structured and safe launch. Time, know how and money for planning, request for authorization and conduction of a clinical trial should not be underestimated. For clinical application of stem cell products authorization by the proper authorities is mandatory.
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Affiliation(s)
- G Steinhoff
- Medizinische Fakultät, Klinik und Poliklinik für Herzchirurgie, Universität Rostock, Rostock, BRD.
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Kornacker M, Kornacker B, Schmitt C, Leo E, Ho AD, Hensel M. Commercial LightCycler-based quantitative real-time PCR compared to nested PCR for monitoring of Bcl-2/IgH rearrangement in patients with follicular lymphoma. Ann Hematol 2008; 88:43-50. [PMID: 18636259 DOI: 10.1007/s00277-008-0550-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/06/2008] [Accepted: 06/24/2008] [Indexed: 10/21/2022]
Abstract
Translocation of chromosomes 14 and 18 [t(14;18)] for detection of minimal residual disease in follicular lymphoma patients can be analyzed by nested polymerase chain reaction (PCR) or by quantitative PCR like LightCycler-based assays. We have compared both methods in blood and bone marrow samples of 28 patients enrolled in a clinical study on immunochemotherapy. In 42% of samples, the bcl2-IgH rearrangement was detectable by nested PCR, but not by LightCycler PCR. Nested PCR was able to reveal a significant drop in positive bone marrow or peripheral blood samples after therapy. In contrast, with LightCycler PCR, the detected drop in t(14;18)-positive cells did not reach statistical significance. The majority of patients showed positive results with nested PCR of peripheral blood or bone marrow without any associations to presence or absence of histological bone marrow (BM) infiltration by lymphoma cells. With LightCycler PCR, the numbers of positive cells were higher in samples from patients with BM infiltration of lymphoma cells (1.9 x 10(-2)) compared to samples from patients without involvement (4.08 x 10(-5)). A similar trend was seen in samples derived from the peripheral blood. Positivity for t(14;18) after therapy in two patients correlated with clinical relapse 6 months later. The data shown here demonstrate a lower sensitivity of LightCycler vs. nested PCR for detection of t(14;18). The usefulness of nested PCR for t(14;18) for risk stratification after primary therapy has to be validated in larger trials.
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Affiliation(s)
- M Kornacker
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
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Lannert H, Able T, Becker S, Sommer M, Braun M, Stadtherr P, Ho AD. Optimizing BM harvesting from normal adult donors. Bone Marrow Transplant 2008; 42:443-7. [DOI: 10.1038/bmt.2008.196] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kallifatidis G, Beckermann BM, Groth A, Schubert M, Apel A, Khamidjanov A, Ryschich E, Wenger T, Wagner W, Diehlmann A, Saffrich R, Krause U, Eckstein V, Mattern J, Chai M, Schütz G, Ho AD, Gebhard MM, Büchler MW, Friess H, Büchler P, Herr I. Improved lentiviral transduction of human mesenchymal stem cells for therapeutic intervention in pancreatic cancer. Cancer Gene Ther 2008; 15:231-40. [PMID: 18202717 DOI: 10.1038/sj.cgt.7701097] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Genetic modification of human bone marrow mesenchymal stem cells (MSC) is highly valuable for their exploitation in basic science and therapeutic applications, for example in cancer. We present here a new, fast and easy-to-use method to enrich a functional population of lentiviral (LV)-transduced MSC expressing enhanced green fluorescent protein (eGFP). We replaced the eGFP gene by a fusion gene of puromycin acetyltransferase and eGFP. Upon LV gene transfer and puromycin selection, we quickly obtained a pure transduced MSC population, in which growth, differentiation capacity and migration preferences were not compromised. Furthermore, we are the first to report the migration velocity of MSC among which 30% were moving and velocity of about 15 mum h(-1) was not altered by LV transduction. Manipulated MSC underwent senescence one passage earlier than non-transduced cells, suggesting the use for therapeutic intervention in early passage numbers. Upon tail vein application in nude mice, the majority of LV-transduced MSC could be detected in human orthotopic pancreatic tumor xenografts and to a minor extent in mouse liver, kidney and lung. Together, LV transduction of genes to MSC followed by puromycin selection is a powerful tool for basic research and improves the therapeutic prospects of MSC as vehicles in gene therapy.
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Affiliation(s)
- G Kallifatidis
- Molecular OncoSurgery, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany
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41
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Schiller M, Bekeredjian-Ding I, Heyder P, Blank N, Ho AD, Lorenz HM. Autoantigens are translocated into small apoptotic bodies during early stages of apoptosis. Cell Death Differ 2007; 15:183-91. [PMID: 17932498 DOI: 10.1038/sj.cdd.4402239] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A dysregulation of apoptosis or an ineffective clearance of apoptotic material is suspected to be involved in the pathogenesis of systemic lupus erythematodes. Subcellular fragments such as apoptotic bodies (ABs) have been recognized as modulators of intercellular communication and immune function. In this context, we have been interested whether nuclear and cytoplasmic antigens are relocated into ABs. In the present study, we characterized ABs isolated from apoptozing lymphoblasts. We found an accumulation of the linker-histone (histone 1) as well as the core-histones (histone 2A, histone 2B, histone 3, histone 4) in ABs. Further, they contained DNA, RNA and the ribonuclear protein La/SSB. Proteins such as cytochrome c, HSP 70, prohibitin, p53, nuclear matrix antigen or lamin B were excluded from ABs. The content of ABs differed from that observed in membrane microparticles isolated from viable cells. Formation of ABs occurred early during apoptosis. It was observed before DNA-degradation or phosphatidylserine exposure was detected. ABs were engulfed by monocyte-derived phagocytes. These findings suggest that immunogenic molecules are actively translocated into ABs followed by a rapid engulfment of the latter by environmental phagocytes. In autoimmune diseases, a defect in the clearance of ABs or AB formation may contribute to the development of autoimmunity.
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Affiliation(s)
- M Schiller
- Department of Medicine V, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, Germany.
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42
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Hundemer M, Klein U, Hose D, Raab MS, Cremer FW, Jauch A, Benner A, Heiss C, Moos M, Ho AD, Goldschmidt H. Lack of CD56 expression on myeloma cells is not a marker for poor prognosis in patients treated by high-dose chemotherapy and is associated with translocation t(11;14). Bone Marrow Transplant 2007; 40:1033-7. [PMID: 17891186 DOI: 10.1038/sj.bmt.1705857] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lack of CD56 expression was reported to be associated with a poor prognosis in multiple myeloma (MM) patients treated with conventional chemotherapy. Aim of our retrospective study was to analyse whether CD56 expression on MM cells reveals as a prognostic factor in patients treated with high-dose chemotherapy. MM cells of 99 patients prior to treatment with high-dose chemotherapy were analysed for CD56 expression by flow cytometry. Multivariable analysis of event-free survival in these patients showed no statistically significant difference between the CD56(-) (n=28) and the CD56(+) (n=71) group. The lack of CD56 expression on MM cells of these patients correlated significantly with the presence of translocation (11;14) (t(11;14)) (estimated correlation coefficient=0.655 95%, confidence interval (0.481; 0.779)). In summary, our results indicate that lack of CD56 expression on MM cells is not a prognostic marker in patients treated with high-dose chemotherapy, but is associated with t(11;14).
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Affiliation(s)
- M Hundemer
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
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43
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Platten M, Opitz CA, Kohlhof P, Hegenbart U, Ho AD, Wick W. Painful neuropathy due to intraneural leukemic spread in a patient with acute myeloid leukemia. Neurology 2007; 69:707. [PMID: 17698797 DOI: 10.1212/01.wnl.0000275547.39894.a6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M Platten
- Department of Neurooncology, University Hospital of Heidelberg, Heidelberg, Germany.
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44
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Heyder P, Bekeredjian-Ding I, Parcina M, Blank N, Ho AD, Herrmann M, Lorenz HM, Heeg K, Schiller M. Purified apoptotic bodies stimulate plasmacytoid dendritic cells to produce IFN-alpha. Autoimmunity 2007; 40:331-2. [PMID: 17516221 DOI: 10.1080/08916930701356515] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- P Heyder
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
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45
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Schiller M, Blank N, Franz S, Gaipl US, Ho AD, Lorenz HM. Apoptotic bodies derived from apoptotic lymphoblasts contain a distinct pattern of antigens. Autoimmunity 2007; 40:340-1. [PMID: 17516224 DOI: 10.1080/08916930701356598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M Schiller
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany.
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46
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Fruehauf S, Klaus J, Huesing J, Veldwijk MR, Buss EC, Topaly J, Seeger T, Zeller LWJ, Moehler T, Ho AD, Goldschmidt H. Efficient mobilization of peripheral blood stem cells following CAD chemotherapy and a single dose of pegylated G-CSF in patients with multiple myeloma. Bone Marrow Transplant 2007; 39:743-50. [PMID: 17450182 DOI: 10.1038/sj.bmt.1705675] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
High-dose chemotherapy followed by autologous blood stem cell transplantation is the standard treatment for myeloma patients. In this study, CAD (cyclophosphamide, adriamycin, dexamethasone) chemotherapy and a single dose of pegfilgrastim (12 mg) was highly effective in mobilizing peripheral blood stem cells (PBSCs) for subsequent transplantation, with 88% of patients (n = 26) achieving the CD34+ cell harvest target of > or = 7.50 x 10(6) CD34+ cells/kg body weight, following a median of two apheresis procedures (range 1-4) and with first apheresis performed at a median day 13 after CAD application (range 10-20). Patients treated with pegfilgrastim showed a reduced time to first apheresis procedure from mobilization compared with filgrastim-mobilized historical matched controls (n = 52, P = 0.015). The pegfilgrastim mobilization regimen allowed for transplantation of a median of 3.58 x 10(6) CD34+ cells/kg body weight while leaving sufficient stored cells for a second high-dose regimen and back-ups in most patients. Engraftment following transplantation was comparable to filgrastim, with a median time of 14 days to leucocyte > or =1.0 x 10(9)/l (range 10-21) and 11 days to platelets > or = 20 x 10(9)/l (range 0-15). The results of this study thus provide further support for the clinical utility of pegfilgrastim for the mobilization of PBSC following chemotherapy in cancer patients scheduled for transplantation.
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Affiliation(s)
- S Fruehauf
- Department of Tumor Diagnostics and Therapy, Paracelsus Hospital, Osnabrueck, Germany.
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47
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Dransfeld CL, Schaich M, Ho AD, Thiede C, Ehninger G, Mahlknecht U. Class I HDAC SNP analysis in healthy donors compared to AML patients. Leukemia 2007; 21:1587-90. [PMID: 17410193 DOI: 10.1038/sj.leu.2404673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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48
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Schneider M, Munder M, Karakhanova S, Ho AD, Goerner M. The initial phase of graft-versus-host disease is associated with a decrease of CD4+CD25+ regulatory T cells in the peripheral blood of patients after allogeneic stem cell transplantation. ACTA ACUST UNITED AC 2007; 28:382-90. [PMID: 17105491 DOI: 10.1111/j.1365-2257.2006.00825.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The mechanisms that induce and control the alloimmune inflammation of graft-versus-host disease (GvHD) after allogeneic stem cell transplantation (allo-SCT) are still incompletely understood. In the murine system, GvHD can be suppressed by CD4(+)CD25(+) regulatory T cells (TREG), which are generally involved in the suppression of inflammatory reactions. A disruption of the homeostasis between TREG and conventional T cells might therefore be associated with the inflammatory reactions of GvHD. We repetitively measured the frequency of TREG in the peripheral blood of 29 patients within the first 71-373 days after allo-SCT and correlated the results with the clinical course. We demonstrate that the initial phase of GvHD is associated with a significant reduction of TREG in the peripheral blood, while at later stages and during intensified immunosuppressive therapy, increased numbers of TREG appear. These results might indicate a pathogenic role for reduced numbers of TREG in the induction of human GvHD.
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Affiliation(s)
- M Schneider
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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49
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Giordano FA, Fehse B, Hotz-Wagenblatt A, Jonnakuty S, del Val C, Appelt JU, Nagy KZ, Kuehlcke K, Naundorf S, Zander AR, Zeller WJ, Ho AD, Fruehauf S, Laufs S. Retroviral vector insertions in T-lymphocytes used for suicide gene therapy occur in gene groups with specific molecular functions. Bone Marrow Transplant 2006; 38:229-35. [PMID: 16785865 DOI: 10.1038/sj.bmt.1705424] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Graft-versus-host disease (GvHD) is a severe complication in the context of allogeneic stem cell transplantation and adoptive immunotherapy. The transfer of a suicide gene into donor T-lymphocytes (TLCs) allows selective elimination of GvHD-causing cells. As retroviral gene transfer into hematopoietic stem cells can induce leukaemia, there is an urgent need also to analyze retroviral integration sites in TLCs. We examined suicide gene-transduced TLCs in four grafts and from four transplanted patients. One-hundred and fifteen integration sites were detected in vitro. Of these 90 could be mapped to the human genome; 50% (45) were located in genes and 32% (29) were detected 10 kb upstream or downstream of transcription start sites. We found a significant overrepresentation of genes encoding for proteins with receptor activity, signal transducer activity, transcription regulator activity, nucleic acid binding activity and translation regulator activity. Similar data were obtained from patient samples. Our results point to preferred vector integration patterns, which are specific for the target cell population and probably independent of selection processes. Thus, future preclinical analysis of the integration repertoire with abundant amounts of transduced cells could allow a prediction also for the in vivo situation, where target cells are scarce.
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Affiliation(s)
- F A Giordano
- Research Program Innovative Cancer Diagnostics and Therapy, German Cancer Research Center (DKFZ), Heidelberg, Germany
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50
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Fiehn C, Wilmes A, Max R, Willand L, Löwe B, Andrassy K, Ho AD, Lorenz HM. Musculoskeletal and neuropsychiatric manifestations are the main source of persisting affection and organ damage in a German population of patients with systemic lupus erythematosus. Scand J Rheumatol 2006; 35:157-9. [PMID: 16641055 DOI: 10.1080/03009740500339920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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