1
|
Holch JW, Held S, Stintzing S, Fischer von Weikersthal L, Decker T, Kiani A, Kaiser F, Heintges T, Kahl C, Kullmann F, Scheithauer W, Moehler M, von Einem JC, Michl M, Heinemann V. Relation of cetuximab-induced skin toxicity and early tumor shrinkage in metastatic colorectal cancer patients: results of the randomized phase 3 trial FIRE-3 (AIO KRK0306). Ann Oncol 2021; 31:72-78. [PMID: 31912799 DOI: 10.1016/j.annonc.2019.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cetuximab-induced skin toxicity (Cet-ST) is positively associated with outcome in metastatic colorectal cancer (mCRC). Besides its predictive relevance for targeted therapy, we investigated its prognostic impact with early tumor shrinkage (ETS) ≥20%, another on-treatment surrogate for clinical outcome in FIRE-3. PATIENTS AND METHODS FIRE-3 evaluated first-line FOLFIRI (folinic acid, fluorouracil and irinotecan) plus cetuximab (FOLFIRI/Cet) versus FOLFIRI plus bevacizumab (FOLFIRI/Bev) in mCRC patients with RAS-WT tumors (i.e. wild-type in KRAS and NRAS exons 2-4). Retrospective data on Cet-ST that occurred during cycles 1-3 of treatment were correlated with efficacy endpoints, including ETS. To control for guarantee-time bias, only patients who had completed three or more treatment cycles were considered. RESULTS Of 199 patients treated with FOLFIRI/Cet, 181 (91.0%) completed three or more treatment cycles. A significant survival benefit of FOLFIRI/Cet over FOLFIRI/Bev was only evident in patients developing Cet-ST grade 2-3 [41.0 versus 26.6 months; hazard ratio (HR) = 0.73; 95% confidence interval (CI): 0.61-0.87; P < 0.001] compared with Cet-ST grade 0-1 (HR = 0.90; 95% CI: 0.67-1.20; P = 0.48). Regarding prognosis, Cet-ST grade 2-3 (n = 75; 41.4%), compared with Cet-ST grade 0-1 (n = 106; 58.6%), was associated with prolonged overall survival (OS; HR = 0.62; 95% CI: 0.42-0.91; P = 0.01). In multivariate analysis, both Cet-ST (HR = 0.66; 95% CI: 0.50-0.87; P = 0.003) and ETS (HR = 0.55; 95% CI: 0.41-0.74; P < 0.0001) were independently prognostic for OS. Absence of both Cet-ST grade ≥2 and ETS identified a subgroup of patients with very poor prognosis (median OS 15.1 months). CONCLUSIONS In FIRE-3, the addition of cetuximab to FOLFIRI was associated with superior OS compared with FOLFIRI/Bev only in patients developing Cet-ST grade ≥2. Regarding prognostic relevance, both Cet-ST and ETS were independent and early predictors of survival. The present analysis supports that a combined evaluation of on-treatment parameters such as Cet-ST and ETS may help to guide treatment of mCRC.
Collapse
Affiliation(s)
- J W Holch
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - S Held
- ClinAssess GmbH, Leverkusen, Germany
| | - S Stintzing
- Medical Department, Division of Hematology, Oncology and Tumor Immunology (CCM), Charité Universitaetsmedizin Berlin, Berlin, Germany
| | | | - T Decker
- Onkologie Ravensburg, Ravensburg, Germany
| | - A Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - F Kaiser
- Hämato-onkologische Tagesklinik, Landshut, Germany
| | - T Heintges
- Department of Medicine II, Lukaskrankenhaus, Neuss, Germany
| | - C Kahl
- Department of Hematology, Oncology and Palliative Care, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | - F Kullmann
- Department of Internal Medicine I, Klinikum Weiden, Weiden, Germany
| | - W Scheithauer
- Department of Internal Medicine I & CCC, Medical University Vienna, Vienna, Austria
| | - M Moehler
- University Medical Center Mainz, I. Department of Internal Medicine, Mainz, Germany
| | - J C von Einem
- Medical Department, Division of Hematology, Oncology and Tumor Immunology (CCM), Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - M Michl
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - V Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| |
Collapse
|
2
|
von Einem J, Heinemann V, Modest D, Stahler A, Miller-Phillips L, Fischer von Weikersthal L, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, Kahl C, Seipelt G, Kullmann F, Scheithauer W, Jung A, Kirchner T, Stintzing S. 441P Evaluation of conversion therapy in patients undergoing secondary resection of metastases in curative intent within the FIRE-3 (AIO KRK-0306) study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.552] [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: 10/23/2022] Open
|
3
|
Salum MEG, Erdmann AL, Cunha KSD, Kahl C, Lanzoni GMDM, Meirelles BHS. University educational management and clinical practice applied to nursing by the faculty of a public university. Rev Bras Enferm 2020; 73:e20180909. [PMID: 32785511 DOI: 10.1590/0034-7167-2018-0909] [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] [Received: 01/23/2019] [Accepted: 05/10/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to emphasize university educational management actions and their articulation to develop clinical practice in nursing training, designed by its faculty. METHODS a single-case study with qualitative approach. The sources were composed of documentary research, focused interview with key informant and direct non-participant observation. Data were organized with the help of NVivo®10. Analysis followed the explanation construction technique from the perspective of complex thinking. RESULTS three categories emerged: Characterization of university educational management actions; Articulation of university educational management with clinical practice and its repercussion; and Spaces to develop university educational management and clinical practice. Final considerations: university educational management actions are associated with the work of professors, supporting teaching, research, and extension in order to improve clinical knowledge in the general nursing training.
Collapse
Affiliation(s)
| | | | | | - Carolina Kahl
- Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | | |
Collapse
|
4
|
Cunha KSD, Erdmann AL, Andrade SRD, Kahl C, Salum MEG, Fabrizzio GC. Limitations and possibilities in university management performed by nursing managers. Rev Esc Enferm USP 2020; 54:e03556. [PMID: 32236340 DOI: 10.1590/s1980-220x2018044303556] [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] [Received: 10/18/2018] [Accepted: 07/18/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Understand limitations and possibilities in university management performed by nursing managers of the undergraduate nursing course of a public university. METHOD A qualitative study with theoretical and methodological framework anchored in the Grounded Theory. Data collection took place between May and September 2016, and the studied scenario was the Nursing Department of a public university in southern Brazil. RESULTS The entrepreneurial profile and the leadership in interpersonal relations were highlighted among the possibilities, in addition to the co-responsibility in raising public resources to solve the university educational demands; as limitations, the scarcity of financial resources and the high demand for bureaucratic activities which have repercussions on the slowness of university public management processes. CONCLUSION The nursing manager experiences limitations through their actions and interactions with people, and recognizes possibilities in the structure and processes of coordinating issues of collective interest in the university educational context.
Collapse
Affiliation(s)
- Kamylla Santos da Cunha
- Universidade Federal de Santa Catarina, Programa de Pós-graduação em Enfermagem, Florianópolis, SC, Brasil
| | | | - Selma Regina de Andrade
- Universidade Federal de Santa Catarina, Departamento de Enfermagem, Florianópolis, SC, Brasil
| | - Carolina Kahl
- Universidade Federal de Santa Catarina, Programa de Pós-graduação em Enfermagem, Florianópolis, SC, Brasil
| | - Maria Eduarda Grams Salum
- Universidade Federal de Santa Catarina, Programa de Pós-graduação em Enfermagem, Florianópolis, SC, Brasil
| | - Greici Capellari Fabrizzio
- Universidade Federal de Santa Catarina, Programa de Pós-graduação em Enfermagem, Florianópolis, SC, Brasil
| |
Collapse
|
5
|
Peiter CC, Santos JLGD, Kahl C, Copelli FHDS, Cunha KSD, Lacerda MR. GROUNDED THEORY: USE IN SCIENTIFIC ARTICLES PUBLISHED IN BRAZILIAN NURSING JOURNALS WITH QUALIS A CLASSIFICATION. ACTA ACUST UNITED AC 2020. [DOI: 10.1590/1980-265x-tce-2018-0177] [Citation(s) in RCA: 5] [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: 11/21/2022]
Abstract
ABSTRACT Objective: to analyze the use of Grounded Theory as a methodological framework in scientific articles published in Brazilian Nursing journals with Qualis Capes A1 and A2. Method: descriptive, documentary study with a quantitative approach. Five Brazilian nursing journals with Qualis A1 and A2 in the 2016 assessment were used as sources. Data were collected on the website of each journal through the Scientific Electronic Library Online (SciELO), by consulting the numbers published in the 2013-2016 quadrennium. Data were analyzed using descriptive statistics. Results: 49 articles were selected, most of them published by the Texto & Contexto Enfermagem journal (34.6%). Regarding the methodological aspect, the use of the Straussian perspective predominated (79,6). Regarding the methodological characteristics, most articles used theoretical sampling (63.3%), theoretical saturation (53.1%), comparative analysis (69.4%), and presented the development of a theoretical model or central category in the results (75.6%). However, only seven (14.3%) studies specified the use of memos, 22 (44.9%) mentioned the use of diagrams and 16 (32.7%) described the theory validation step. Conclusion: the need for consensus among Brazilian nursing researchers on the methodological characteristics to be described in studies using the Grounded Theory is highlighted.
Collapse
|
6
|
Zewdie E, Ciechanski P, Kuo HC, Giuffre A, Kahl C, King R, Cole L, Godfrey H, Seeger T, Swansburg R, Damji O, Rajapakse T, Hodge J, Nelson S, Selby B, Gan L, Jadavji Z, Larson JR, MacMaster F, Yang JF, Barlow K, Gorassini M, Brunton K, Kirton A. Safety and tolerability of transcranial magnetic and direct current stimulation in children: Prospective single center evidence from 3.5 million stimulations. Brain Stimul 2019; 13:565-575. [PMID: 32289678 DOI: 10.1016/j.brs.2019.12.025] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [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: 08/07/2019] [Revised: 11/20/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Non-invasive brain stimulation is being increasingly used to interrogate neurophysiology and modulate brain function. Despite the high scientific and therapeutic potential of non-invasive brain stimulation, experience in the developing brain has been limited. OBJECTIVE To determine the safety and tolerability of non-invasive neurostimulation in children across diverse modalities of stimulation and pediatric populations. METHODS A non-invasive brain stimulation program was established in 2008 at our pediatric, academic institution. Multi-disciplinary neurophysiological studies included single- and paired-pulse Transcranial Magnetic Stimulation (TMS) methods. Motor mapping employed robotic TMS. Interventional trials included repetitive TMS (rTMS) and transcranial direct current stimulation (tDCS). Standardized safety and tolerability measures were completed prospectively by all participants. RESULTS Over 10 years, 384 children underwent brain stimulation (median 13 years, range 0.8-18.0). Populations included typical development (n = 118), perinatal stroke/cerebral palsy (n = 101), mild traumatic brain injury (n = 121) neuropsychiatric disorders (n = 37), and other (n = 7). No serious adverse events occurred. Drop-outs were rare (<1%). No seizures were reported despite >100 participants having brain injuries and/or epilepsy. Tolerability between single and paired-pulse TMS (542340 stimulations) and rTMS (3.0 million stimulations) was comparable and favourable. TMS-related headache was more common in perinatal stroke (40%) than healthy participants (13%) but was mild and self-limiting. Tolerability improved over time with side-effect frequency decreasing by >50%. Robotic TMS motor mapping was well-tolerated though neck pain was more common than with manual TMS (33% vs 3%). Across 612 tDCS sessions including 92 children, tolerability was favourable with mild itching/tingling reported in 37%. CONCLUSIONS Standard non-invasive brain stimulation paradigms are safe and well-tolerated in children and should be considered minimal risk. Advancement of applications in the developing brain are warranted. A new and improved pediatric NIBS safety and tolerability form is included.
Collapse
Affiliation(s)
- E Zewdie
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada; Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - P Ciechanski
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - H C Kuo
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada; Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Giuffre
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada; Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - C Kahl
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - R King
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - L Cole
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada; Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - H Godfrey
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - T Seeger
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - R Swansburg
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - O Damji
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - T Rajapakse
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - J Hodge
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S Nelson
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - B Selby
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - L Gan
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Z Jadavji
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - J R Larson
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - F MacMaster
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - J F Yang
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - K Barlow
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Gorassini
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - K Brunton
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - A Kirton
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada; Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
7
|
Stintzing S, Wirapati P, Lenz HJ, Neureiter D, Fischer von Weikersthal L, Decker T, Kiani A, Kaiser F, Al-Batran S, Heintges T, Lerchenmüller C, Kahl C, Seipelt G, Kullmann F, Moehler M, Scheithauer W, Held S, Modest DP, Jung A, Kirchner T, Aderka D, Tejpar S, Heinemann V. Consensus molecular subgroups (CMS) of colorectal cancer (CRC) and first-line efficacy of FOLFIRI plus cetuximab or bevacizumab in the FIRE3 (AIO KRK-0306) trial. Ann Oncol 2019; 30:1796-1803. [PMID: 31868905 PMCID: PMC6927316 DOI: 10.1093/annonc/mdz387] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND FIRE-3 compared first-line therapy with FOLFIRI plus either cetuximab or bevacizumab in 592 KRAS exon 2 wild-type metastatic colorectal cancer (mCRC) patients. The consensus molecular subgroups (CMS) are grouping CRC samples according to their gene-signature in four different subtypes. Relevance of CMS for the treatment of mCRC has yet to be defined. PATIENTS AND METHODS In this exploratory analysis, patients were grouped according to the previously published tumor CRC-CMSs. Objective response rates (ORR) were compared using chi-square test. Overall survival (OS) and progression-free survival (PFS) times were compared using Kaplan-Meier estimation, log-rank tests. Hazard ratios (HR) were estimated according to the Cox proportional hazard method. RESULTS CMS classification could be determined in 438 out of 514 specimens available from the intent-to-treat (ITT) population (n = 592). Frequencies for the remaining 438 samples were as follows: CMS1 (14%), CMS2 (37%), CMS3 (15%), CMS4 (34%). For the 315 RAS wild-type tumors, frequencies were as follows: CMS1 (12%), CMS2 (41%), CMS3 (11%), CMS4 (34%). CMS distribution in right- versus (vs) left-sided primary tumors was as follows: CMS1 (27% versus 11%), CMS2 (28% versus 45%), CMS3 (10% versus 12%), CMS4 (35% versus 32%). Independent of the treatment, CMS was a strong prognostic factor for ORR (P = 0.051), PFS (P < 0.001), and OS (P < 0.001). Within the RAS wild-type population, OS observed in CMS4 significantly favored FOLFIRI cetuximab over FOLFIRI bevacizumab. In CMS3, OS showed a trend in favor of the cetuximab arm, while OS was comparable in CMS1 and CMS2, independent of targeted therapy. CONCLUSIONS CMS classification is prognostic for mCRC. Prolonged OS induced by FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab in the FIRE-3 study appears to be driven by CMS3 and CMS4. CMS classification provides deeper insights into the biology to CRC, but at present time has no direct impact on clinical decision-making.The FIRE-3 (AIO KRK-0306) study had been registered at ClinicalTrials.gov: NCT00433927.
Collapse
Affiliation(s)
- S Stintzing
- Department of Medicine, Division of Hematology, Oncology, and Tumor Immunology (CCM), Charité Universitaetsmedizin Berlin, Berlin, Germany.
| | - P Wirapati
- SIB Swiss Institute of Bioinformatics, Bioinformatic Core Facility, Lausanne, Switzerland
| | - H-J Lenz
- USC Norris Comprehensive Cancer Center, Los Angeles, USA
| | - D Neureiter
- Institute of Pathology, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
| | | | - T Decker
- Oncological Practice, Ravensburg
| | - A Kiani
- Medizinische Klinik IV, Klinikum Bayreuth, Bayreuth
| | | | - S Al-Batran
- Department of Hematology and Oncology, Krankenhaus Nordwest, Frankfurt/Main
| | - T Heintges
- Department of Medicine II, Städtisches Klinikum Neuss, Neuss
| | | | - C Kahl
- Haematology and Oncology, Staedtisches Klinikum Magdeburg, Magdeburg
| | | | - F Kullmann
- Department of Medicine I, Klinikum Weiden, Weiden
| | - M Moehler
- University Hospital Mainz, Mainz, Germany
| | - W Scheithauer
- Department of Internal Medicine I & Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - S Held
- ClinAssess GmbH, Leverkusen
| | - D P Modest
- Department of Medicine III, University Hospital, LMU Munich, Munich
| | - A Jung
- Institute of Pathology University of Munich, Munich, Germany
| | - T Kirchner
- Institute of Pathology University of Munich, Munich, Germany
| | - D Aderka
- Department of Gastrointestinal Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - S Tejpar
- Molecular Digestive Oncology, UZ Leuven, Belgium
| | - V Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich
| |
Collapse
|
8
|
Kahl C, Meirelles BHS, Cunha KSD, Bernardo MDS, Erdmann AL. Contributions of the nurse's clinical practice to Primary Care. Rev Bras Enferm 2019; 72:354-359. [PMID: 31017196 DOI: 10.1590/0034-7167-2018-0348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/18/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To understand the repercussions of the nurse's clinical practice on Primary Health Care. METHOD Qualitative research with the theoretical and methodological contribution of Grounded Theory. Data collection took place between May and October 2016 in Florianópolis' Primary Care service. The theoretical sample was comprised of 18 nurses divided into two groups. RESULTS nurses' clinical practice has repercussions on the consolidation of the trust bond between individuals, families and communities, by amplifying the problem-solving efficacy of the Primary Health Care professional's clinical practice. This is due to the implementation of clinical nursing protocols, and also the use of the International Classification for Nursing Practice. FINAL CONSIDERATIONS Nurses' clinical practice has positive repercussions on the health of Primary Health Care users.
Collapse
Affiliation(s)
- Carolina Kahl
- Universidade Federal de Santa Catarina. Florianópolis-SC, Brasil
| | | | | | | | | |
Collapse
|
9
|
Zewdie E, Ciechanski P, Kuo H, Giuffre A, Kahl C, King R, Cole L, Grant H, Seeger T, Damji O, Hodge J, Selby B, Gan L, Barlow K, MacMaster F, Kirton A. Safety and tolerability of non-invasive neurostimulation in children. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.817] [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: 10/27/2022] Open
|
10
|
Giuffre A, Zewdie E, Kahl C, Kirton A. Robotic Transcranial Magnetic Stimulation (TMS) Motor Mapping in Children. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.813] [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: 10/27/2022] Open
|
11
|
Kahl C, Kirton A, Pringsheim T, Croarkin P, Zewdie E, Swansburg R, MacMaster F. Repetitive transcranial magnetic stimulation as a treatment for Tourette's syndrome in children: A pilot study. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
12
|
Holch JW, Ricard I, Stintzing S, Fischer von Weikersthal L, Decker T, Kiani A, Vehling-Kaiser U, Heintges T, Kahl C, Kullmann F, Scheithauer W, Moehler M, Jelas I, Modest DP, Westphalen CB, von Einem JC, Michl M, Heinemann V. Relevance of baseline carcinoembryonic antigen for first-line treatment against metastatic colorectal cancer with FOLFIRI plus cetuximab or bevacizumab (FIRE-3 trial). Eur J Cancer 2018; 106:115-125. [PMID: 30496943 DOI: 10.1016/j.ejca.2018.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 08/29/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Increased baseline carcinoembryonic antigen (CEA) serum level is associated with inferior overall survival (OS) in metastatic colorectal cancer (mCRC). However, limited data exist on its predictive relevance for targeted therapies. Therefore, we analysed its relevance in FIRE-3, a randomised phase III study. EXPERIMENTAL DESIGN FIRE-3 evaluated first-line FOLFIRI plus cetuximab (FOLFIRI/Cet) versus FOLFIRI plus bevacizumab (FOLFIRI/Bev) in mCRC patients with RAS-WT tumour (i.e. wild-type in KRAS and NRAS exons 2-4). Herein, the impact of CEA on patient outcome was investigated. RESULTS Of 400 patients, 356 (89.0%) were evaluable for CEA. High CEA (>10 ng/ml; N = 237) compared to low CEA (≤10 ng/ml; N = 119) was associated with shorter OS in the FOLFIRI/Bev arm (hazard ratio [HR] = 1.50; P = 0.036), while no significant OS difference was observed in the FOLFIRI/Cet arm (HR = 1.07; P = 0.74). In patients with high CEA, FOLFIRI/Cet compared to FOLFIRI/Bev showed a greater OS benefit (HR = 0.56; P < 0.001) than in patients with low CEA (HR = 0.78; P = 0.30). Furthermore, FOLFIRI/Cet exhibited significantly superior objective response rate in patients with high CEA (odds ratio = 2.21; P = 0.006) in contrast to patients with low CEA (odds ratio = 0.90; P = 0.85). CONCLUSION In patients with RAS-WT mCRC receiving first-line chemotherapy with FOLFIRI/Cet versus FOLFIRI/Bev, elevated CEA was associated with inferior survival in the bevacizumab arm, while this was not the case when cetuximab was applied. Comparison of OS and objective response rate according to treatment arms indicated that cetuximab was greatly superior to bevacizumab in patients with elevated CEA, while this effect was markedly lower and lost statistical significance in patients with low CEA.
Collapse
Affiliation(s)
- J W Holch
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - I Ricard
- Institute of Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany
| | - S Stintzing
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - L Fischer von Weikersthal
- Praxis für Onkologie/Haematologie, Gesundheitszentrum St. Marien GmbH, Mariahilfbergweg 7, 92224 Amberg, Germany
| | - T Decker
- Onkologie Ravensburg, Elisabethenstrasse 19, 88212 Ravensburg, Germany
| | - A Kiani
- Department of Medicine IV, Klinikum Bayreuth GmbH, Preuschwitzer Strasse 101, 95445 Bayreuth, Germany
| | - U Vehling-Kaiser
- Hämato-onkologische Tagesklinik, Dr. Med. Ursula Vehling-Kaiser, Ländgasse 132-135, 84028 Landshut, Germany
| | - T Heintges
- Department of Medicine II, Lukaskrankenhaus, Preußenstrasse 84, 41462 Neuss, Germany
| | - C Kahl
- Department of Hematology, Oncology and Palliative Care, Klinikum Magdeburg gGmbH, Birkenallee 34, 39130 Magdeburg, Germany
| | - F Kullmann
- Department of Internal Medicine I, Klinikum Weiden, Söllnerstrasse 16, 92637 Weiden, Germany
| | - W Scheithauer
- Department of Internal Medicine I & CCC, Medical University Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - M Moehler
- University Medical Center Mainz, I. Dept. of Internal Medicine, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - I Jelas
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - D P Modest
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - C B Westphalen
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - J C von Einem
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - M Michl
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - V Heinemann
- Department of Internal Medicine III, Comprehensive Cancer Center Munich, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| |
Collapse
|
13
|
Kahl C, Cunha KSD, Lanzoni GMDM, Higashi GDC, Erdmann AL, Baggio MA. Referral and counter-referral: repercussions of coronary artery bypass graft in the perspective of Primary Care. Rev Bras Enferm 2018; 71:2359-2366. [PMID: 30304163 DOI: 10.1590/0034-7167-2016-0598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 10/01/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to understand how repercussions of the referral and counter-referral of patients with indication/submitted to Coronary Artery Bypass Graft Surgery in the context of Primary Health Care. METHOD qualitative research with a theoretical-methodological contribution anchored in the Grounded Theory. Theoretical sampling was performed with 41 participants, divided into three sample groups (patients, health professionals and managers) in the Metropolitan Region and Western Region of Santa Catarina State. RESULTS the need for improvement in the process of recording clinical data in the regulation system emerged to strengthen patient referral; and the absence of a formal process of counter-referral and adaptation of lifestyle with repercussion in the counter-referral. FINAL CONSIDERATIONS the repercussions of the referral and counter-referral of patients with indication/submitted to the CABGS in the context of Primary Care are experienced through professional guidance and, in particular, by family support.
Collapse
Affiliation(s)
- Carolina Kahl
- Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil
| | | | | | | | | | | |
Collapse
|
14
|
Miller-Phillips L, Fischer von Weikersthal L, Kaiser F, Al-Batran SE, Heintges T, Neureiter D, Kahl C, Kullmann F, Moehler M, Scheithauer W, Vazart C, Fontaine K, Held S, Modest D, Neumann J, Jung A, Kirchner T, Heinemann V, Stintzing S. Association of microRNA-21 (miR-21) with efficacy of cetuximab (cet) and bevacizumab (bev) in patients with metastatic colorectal cancer (mCRC) within the FIRE-3 study (AIO KRK-0306). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
15
|
Cunha KSD, Kahl C, Koerich C, Lanzoni GMDM, Erdmann AL, Meirelles BHS. Myocardial revascularization: factors intervening in the reference and counter-reference in the hospital setting. Rev Bras Enferm 2018; 71:1817-1824. [PMID: 30156665 DOI: 10.1590/0034-7167-2017-0218] [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] [Received: 04/06/2017] [Accepted: 07/03/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To understand the intervening factors in the process of reference and counter-reference of the individual with heart disease in the scenario of high complexity in the health care network. METHOD Research anchored in the Grounded Theory (Teoria Fundamentada nos Dados). It totaled 21 participants. The data collection scenario was a cardiovascular reference hospital in the south of Brazil and occurred between March and June 2014. RESULTS The intervening factors in the reference process were the difficulty to access the points of the network and telemedicine and the central to manage the flow of patients in the network. In the counter-reference, there was a link with the hospital and the lack of communication among network professionals. CONCLUSION It reveals the need to reorganize the service flow in HCN, enhancing PHC, expanding the performance of medium complexity and increasing the capacity of high complexity in order to carry out the process of reference and counter-reference.
Collapse
Affiliation(s)
| | - Carolina Kahl
- Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil
| | - Cintia Koerich
- Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil
| | | | | | | |
Collapse
|
16
|
Fabrizzio GC, Gonçalves Júnior E, Cunha KSD, Kahl C, Santos JLGD, Erdmann AL. Care management of a patient with Devic's Disease in Primary Health Care. Rev Esc Enferm USP 2018; 52:e03345. [PMID: 30088542 DOI: 10.1590/s1980-220x2017024603345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 01/31/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Describing the care management of a patient affected by Devic's Disease in the Primary Health Care setting. METHOD A clinical-qualitative case study based on the health status of a Devic's Disease patient in a Health Center of the municipality of Florianópolis, accompanied by the Family Health Team. Data collection was carried out by electronic medical records, documents of the patient's domain, as well as a semi-structured interview with the participant. Ethical aspects of research involving human beings were respected. RESULTS The categories were defined according to relevance criteria with the purpose of reporting the case study, presenting a unique implemented therapeutic project and describing the patient's perception of her situation. CONCLUSION Acupuncture and auriculotherapy were successfully performed, evidencing an improvement in the patient's pain, which may contribute to new possibilities of care. Despite this, not all the available care tools were implemented, considering the range of complementary care therapies that go beyond the medicinal approach.
Collapse
Affiliation(s)
- Greici Capellari Fabrizzio
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brasil
| | | | - Kamylla Santos da Cunha
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brasil
| | - Carolina Kahl
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem, Florianópolis, SC, Brasil
| | | | | |
Collapse
|
17
|
Kahl C, Meirelles BHS, Lanzoni GMDM, Koerich C, Cunha KSD. Actions and interactions in clinical nursing practice in Primary Health Care. Rev Esc Enferm USP 2018; 52:e03327. [PMID: 29846488 DOI: 10.1590/s1980-220x2017025503327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/19/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Understanding the actions and interactions required for developing clinical nursing practice in Primary Health Care. METHOD A qualitative study anchored in the Grounded Theory. Data was collected between April and October 2016 with nurses divided into two sample groups. RESULTS Eighteen (18) nurses participated in the study. The category "Recognizing the Systematization of Nursing Care as an essential element for clinical nursing practice" supports the "actions-interactions" component and it is composed of two subcategories: "Accomplishing clinical practice in nursing consultations", which presents the challenges encountered in performing clinical practice; and "Highlighting management tools for evidence-based clinical practice", which operates through strategies in response to the studied phenomenon. CONCLUSION Care actions developed in clinical nursing practice are highlighted by the systematization of care in nursing consultations, a moment of direct interaction with the individual, thus contributing to improvement in the quality of care provided.
Collapse
Affiliation(s)
- Carolina Kahl
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | | | | | - Cintia Koerich
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | | |
Collapse
|
18
|
Cunha KSD, Erdmann AL, Kahl C, Lazzari DD, Alves MP, Klock P. CONDITIONS THAT LEAD TEACHERS TO ASSUME UNIVERSITY MANAGEMENT POSITIONS. Reme Revista Mineira de Enfermagem 2018. [DOI: 10.5935/1415-2762.20180049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
19
|
Cunha KSD, Kahl C, Koerich C, Santos JLGD, Lanzoni GMDM, Erdmann AL. University management: contributions for nurses who are faculty members and managers. Rev Bras Enferm 2017; 70:1069-1074. [PMID: 28977236 DOI: 10.1590/0034-7167-2017-0068] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/18/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: To comprehend how university management contributes on the performance of nurses who are professors and managers in a public university. Method: Qualitative research anchored on the Grounded Theory. The setting to collect the data was a public university in south Brazil and it happened between May and September of 2016. A total of 19 nurses took part in the study, all of them also faculty members and managers that were divided in two sample groups. Results: Two subcategories were created: the comprehension that university management improves the faculty performance; obtaining a wider view of the university. Final considerations: The contributions of university management for faculty nurses who are managers are mainly on the personal and professional satisfaction through the production and dissemination of knowledge, reflecting positively on the refinement of the teaching competences to train Nurses with knowledge, technical skills and cognitive abilities to answer society's needs. Objetivo: Compreender como a gestão universitária contribui na atuação de enfermeiros docentes gestores de uma universidade pública. Método: Pesquisa qualitativa ancorada na Teoria Fundamentada nos Dados. O cenário de coleta de dados foi uma universidade pública do sul do Brasil e ocorreu entre maio e setembro de 2016. Participaram do estudo 19 enfermeiros docentes gestores divididos em dois grupos amostrais. Resultados: Elucidam duas subcategorias: compreender que a gestão universitária aperfeiçoa a atuação docente; obter uma visão ampliada da universidade. Considerações finais: As contribuições da gestão universitária para os enfermeiros docentes gestores encontram-se especialmente na satisfação profissional e pessoal através da produção e disseminação do conhecimento, repercutindo de forma positiva no aperfeiçoamento de competências docentes para a formação de Enfermeiros com conhecimentos, habilidades e aptidões técnicas e cognitivas para atender às necessidades da sociedade.
Collapse
Affiliation(s)
- Kamylla Santos da Cunha
- Universidade Federal de Santa Catarina, Postraduate Program in Nursing. Florianópolis, Santa Catarina, Brazil
| | - Carolina Kahl
- Universidade Federal de Santa Catarina, Postraduate Program in Nursing. Florianópolis, Santa Catarina, Brazil
| | - Cintia Koerich
- Universidade Federal de Santa Catarina, Postraduate Program in Nursing. Florianópolis, Santa Catarina, Brazil
| | - José Luís Guedes Dos Santos
- Universidade Federal de Santa Catarina, Postraduate Program in Nursing. Florianópolis, Santa Catarina, Brazil
| | | | - Alacoque Lorenzini Erdmann
- Universidade Federal de Santa Catarina, Postraduate Program in Nursing. Florianópolis, Santa Catarina, Brazil
| |
Collapse
|
20
|
Modest DP, Ricard I, Stintzing S, Fischer von Weikersthal L, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, Heintges T, Kahl C, Seipelt G, Kullmann F, Scheithauer W, Moehler M, Westphalen CB, Holch JW, von Einem JC, Held S, Heinemann V. Evaluation of survival across several treatment lines in metastatic colorectal cancer: Analysis of the FIRE-3 trial (AIO KRK0306). Eur J Cancer 2017; 84:262-269. [PMID: 28843184 DOI: 10.1016/j.ejca.2017.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We explored the impacts of sequential application of various treatment lines on survival kinetics. Therefore, differences in overall survival (OS) observed in FIRE-3 were investigated in the context of time and exposure to applied treatment. PATIENTS AND METHODS OS analyses (stratified by treatment with FOLFIRI plus either cetuximab or bevacizumab) were performed according to time intervals as well as using a Cox model to define changes of hazard ratio (HR) over time. RESULTS The fraction of patients with systemic treatment and time on treatment markedly decreases over treatment lines and time. OS evaluation by a Cox model indicated a trend towards a non-proportional hazard between treatment arms (P = 0.12/P = 0.09 for KRAS-intention-to-treat (ITT)/all-RAS wild-type populations, respectively). To improve the fit of the model, a change-point (point of curve separation) was estimated at 22.6 months (day 687) after randomisation. The HR between the two arms before 22.6 months was not significantly different from one. However, markedly different survival kinetics in favour of the cetuximab arm were apparent after the change-point (KRAS-ITT: P = 0.0018; HR, 0.60 [95% confidence interval [CI], 0.44-0.83] and RAS: P = 0.0006; HR, 0.51 [95% CI, 0.35-0.75]). CONCLUSION The differences in OS favouring the cetuximab arm become apparent about 22.6 months after randomisation, indicating that only those patients who survive 22.6 months after randomisation benefit from the superiority of the cetuximab arm. When OS curves separate, only few patients receive active systemic treatment in short courses, suggesting that earlier treatment effects are responsible for later kinetics of survival curves.
Collapse
Affiliation(s)
- D P Modest
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany.
| | - I Ricard
- Institute of Medical Informatics, Biometry, and Epidemiology, University of Munich, Munich, Germany
| | - S Stintzing
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | | | - T Decker
- Oncological Practice, Ravensburg, Germany
| | - A Kiani
- Medizinische Klinik IV, Klinikum Bayreuth, Bayreuth, Germany
| | | | - S-E Al-Batran
- Department of Hematology and Oncology, Krankenhaus Nordwest Frankfurt/Main, Germany
| | - T Heintges
- Department of Medicine II, Städtisches Klinikum Neuss, Germany
| | - C Kahl
- Haematology and Oncology, Staedtisches Klinikum Magdeburg, Germany
| | - G Seipelt
- Oncological Practice, Bad Soden, Germany
| | - F Kullmann
- Department of Medicine I, Klinikum Weiden, Germany
| | - W Scheithauer
- Department of Internal Medicine I and Comprehensive Cancer Center, Medical University Vienna, Austria
| | - M Moehler
- German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany; Medical Department 1, Johannes-Gutenberg Universität Mainz, Mainz, Germany; University Cancer Center Frankfurt/Mainz, Germany
| | - C B Westphalen
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, LMU Munich, Germany
| | - J W Holch
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, LMU Munich, Germany
| | - J C von Einem
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, LMU Munich, Germany
| | - S Held
- ClinAssess GmbH, Leverkusen, Germany
| | - V Heinemann
- Department of Medicine III and Comprehensive Cancer Center, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | | |
Collapse
|
21
|
Stintzing S, Miller-Phillips L, Modest DP, Fischer von Weikersthal L, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, Heintges T, Kahl C, Seipelt G, Kullmann F, Stauch M, Scheithauer W, Held S, Moehler M, Jagenburg A, Kirchner T, Jung A, Heinemann V. Impact of BRAF and RAS mutations on first-line efficacy of FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab: analysis of the FIRE-3 (AIO KRK-0306) study. Eur J Cancer 2017; 79:50-60. [PMID: 28463756 DOI: 10.1016/j.ejca.2017.03.023] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/18/2017] [Accepted: 03/20/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND RAS and BRAF mutations have been identified as negative prognostic factors in metastatic colorectal cancer. Efficacy of 5-fluorouracil, leucovorin, irinotecan (FOLFIRI) plus bevacizumab in patients with RAS-mutant tumours needs to be further evaluated. Whether to treat patients with BRAF-mutant tumours with either bevacizumab or anti-epidermal growth factor receptor (EGFR) antibodies remains unclear. METHODS Patients treated within the FIRE-3 trial were retrospectively tested for BRAF and RAS mutations using formalin fixated paraffin embedded (FFPE) tumour material applying pyrosequencing for KRAS and NRAS exon 2, 3 and 4 mutations as far as for BRAF mutations. Survival analysis was done using Kaplan-Meier estimation and differences were expressed using the log-rank test. Overall response rate (ORR) was compared using Fisher's exact test. Data from a central independent radiological response evaluation were used to calculate early tumour shrinkage (ETS) and depth of response (DpR). RESULTS Overall, 188 patients with RAS-mutant tumours and 48 with BRAF-mutant tumours were identified. In BRAF-mutant patients, ORR was numerically higher in the cetuximab versus the bevacizumab arm (52% versus 40%), while comparable results were achieved for progression-free survival (PFS; hazard ratio [HR] = 0.84, p = 0.56) and overall survival (OS; HR 0.79, p = 0.45). RAS mutation was associated with a trend towards lower ORR (37% versus 50.5%, p = 0.11) and shorter PFS (7.4 versus 9.7 months; HR 1.25; p = 0.14) in patients receiving FOLFIRI plus cetuximab versus bevacizumab, but OS was comparable (19.1 versus 20.1 months; HR 1.05; p = 0.73), respectively. ETS identified subgroups sensitive to cetuximab-based treatment in both BRAF- (9/17) and RAS-mutant (18/48) patients and was associated with significantly longer OS. DpR was comparable between both treatment arms in RAS- and BRAF-mutant patients, respectively. CONCLUSIONS In BRAF- and RAS-mutant patients, cetuximab- and bevacizumab-based treatment had comparable survival times. ETS represents an early parameter associated with the benefit from anti-EGFR, while this was not the case with vascular endothelial growth factor A blockade.
Collapse
Affiliation(s)
- S Stintzing
- Department of Hematology and Oncology, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - L Miller-Phillips
- Department of Hematology and Oncology, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - D P Modest
- Department of Hematology and Oncology, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | | | - T Decker
- Studienzentrum Onkologie Ravensburg, Elisabethenstraße 19, 88212, Ravensburg, Germany.
| | - A Kiani
- Klinikum Bayreuth GmbH, Preuschwitzer Straße 101, 95445, Bayreuth, Germany.
| | - U Vehling-Kaiser
- Praxis Hämatologie/Onkologie/Palliativmedizin - Tagesklinik, Ländgasse 132-135, 84028, Landshut, Germany.
| | - S-E Al-Batran
- Krankenhaus Nordwest, Medizinische Klinik II/Onkologie, Steinbacher Hohl 2-26, 60488, Frankfurt, Germany.
| | - T Heintges
- Lukaskrankenhaus Neuss, Medizinische Klinik II, Preussenstr. 84, 41464, Neuss, Germany.
| | - C Kahl
- Städtisches Klinikum Magdeburg, Hämatologie/Onkologie, Birkenallee 34, 39130, Magdeburg, Germany.
| | - G Seipelt
- Onkologische Schwerpunktpraxis und Tagesklinik, Kronbergerstraße 38, 65812, Bad Soden, Germany.
| | - F Kullmann
- Klinikum Weiden, Medizinische Klinik I, Söllnerstr. 16, 92637, Weiden, Germany.
| | - M Stauch
- Praxis für Hämatologie und internistische Onkologie, Niederbronner Str. 2, 96317, Kronach, Germany.
| | - W Scheithauer
- Univ.-Klinik für Innere Medizin I, Klin. Abteilung für Onkologie, Währinger Gürtel 18-20, 1090, Wien, Austria.
| | - S Held
- ClinAssess GmbH, Birkenbergstraße 82, 51379 Leverkusen, Germany.
| | - M Moehler
- Johannes-Gutenberg Universität Mainz, 1. Medizinische Klinik und Poliklinik, 55101, Mainz, Germany.
| | - A Jagenburg
- Radiology Consulting GmbH, Burscheider Str. 398A, 51381, Leverkusen, Germany.
| | - T Kirchner
- Institute of Pathology, University of Munich, Thalkirchner Str. 37, 82036, Munich, Germany.
| | - A Jung
- Institute of Pathology, University of Munich, Thalkirchner Str. 37, 82036, Munich, Germany.
| | - V Heinemann
- Department of Hematology and Oncology, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | | |
Collapse
|
22
|
McLellan Q, Kirton A, Kahl C, Jasaui Y, Wilkes C, Swansburg R, Zewdie E, MacMaster F. Open label trial of rTMS for treatment resistant depression in youth. Brain Stimul 2017. [DOI: 10.1016/j.brs.2017.01.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
23
|
Cunha KSD, Higashi GDC, Erdmann AL, Kahl C, Koerich C, Meirelles BHS. Myocardial revascularization: factors intervening in the reference and counter-reference in Primary Health Care. Rev Esc Enferm USP 2017; 50:965-972. [PMID: 28198962 DOI: 10.1590/s0080-623420160000700013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/22/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Understanding the factors that influence the reference and counter-reference process of people indicated/submitted to Myocardial Revascularization surgery in the Primary Health Care scenario. METHOD A qualitative research anchored in the Grounded Theory, totaling 41 participants subdivided into three groups (patients, health professionals and managers) in the Metropolitan and West Region of Santa Catarina. RESULTS Two categories elucidate the intervening factors found, contrasting the potentialities and obstacles in (creating) the bond between people affected by cardiovascular diseases and primary health care for the reference process, highlighting weaknesses in the primary health care services provided, with failures in the counter-reference for people submitted to myocardial revascularization surgery. CONCLUSION Strengthening the potentialities presented in this study is essential for the reference process of people affected by Cardiovascular Disease, as well as strategic actions focused on solving the evidenced obstacles which contribute to deficiencies in the referral and counter-referral process, thus impeding integral care in the health care network. OBJETIVO Compreender os fatores que influenciam o processo de referência e contrarreferência da pessoa com indicação/submetida à Cirurgia de Revascularização Miocárdica no cenário da Atenção Primária à Saúde. MÉTODO Pesquisa qualitativa ancorada na Teoria Fundamentada nos Dados, totalizando 41 participantes subdivididos em três grupos (pacientes, profissionais de saúde e gestores) na Região Metropolitana e Região Oeste de Santa Catarina. RESULTADOS Duas categorias elucidam os fatores interventores encontrados, Contrastando as potencialidades e entraves no vínculo da pessoa acometida por doenças cardiovasculares com a atenção primária à saúde para o processo de referência e Destacando fragilidades nos serviços disponibilizados na atenção primária à saúde, com insucessos da contrarreferência da pessoa submetida à cirurgia de revascularização miocárdica. CONCLUSÃO Torna-se essencial o fortalecimento das potencialidades apresentadas neste estudo para o processo de referência da pessoa acometida por Doença Cardiovascular, assim como ações estratégicas com foco na resolução dos entraves apontados e que contribuem para a deficiência do processo de referência e contrarreferência, dificultando a integralidade do cuidado na rede de atenção à saúde.
Collapse
Affiliation(s)
| | | | | | - Carolina Kahl
- Universidade Federal de Santa Catarina. Florianópolis, SC, Brazil
| | - Cintia Koerich
- Universidade Federal de Santa Catarina. Florianópolis, SC, Brazil
| | | |
Collapse
|
24
|
Strydom P, Lühl J, Kahl C, Hoffman L. Comparison of shear force tenderness, drip and cooking loss, and ultimate muscle pH of the loin muscle among grass-fed steers of four major beef crosses slaughtered in Namibia. S AFR J ANIM SCI 2016. [DOI: 10.4314/sajas.v46i4.2] [Citation(s) in RCA: 10] [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: 11/17/2022]
|
25
|
Meißner C, Förster A, Rudolph S, Kliese D, Borchert K, Kahl C, Ridwelski K. Erfassung des Ernährungszustandes von Patienten vor einer Operation eines kolorektalen Karzinoms und dessen Einfluss auf die Komplikationsrate. Zentralbl Chir 2016. [DOI: 10.1055/s-0036-1586268] [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]
|
26
|
Stintzing S, Fischer von Weikersthal L, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, Heintges T, Lerchenmüller C, Kahl C, Seipelt G, Kullmann F, Stauch M, Hielscher J, Lerch M, Scheithauer W, Jagenburg A, Held S, Modest D, Jung A, Kirchner T, Heinemann V. PD-027 BRAF mutant and RAS mutant patients treated with FOLFIRI plus Bevacizumab or FOLFIRI plus Cetuximab. Role of ETS and molecular markers in FIRE-3 (AIO KRK-0306). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw200.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
27
|
|
28
|
Michl M, Stintzing S, Fischer von Weikersthal L, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, Heintges T, Lerchenmueller C, Kahl C, Seipelt G, Kullmann F, Stauch M, Scheithauer W, Hielscher J, Scholz M, Mueller S, Lerch MM, Modest DP, Kirchner T, Jung A, Heinemann V. CEA response is associated with tumor response and survival in patients with KRAS exon 2 wild-type and extended RAS wild-type metastatic colorectal cancer receiving first-line FOLFIRI plus cetuximab or bevacizumab (FIRE-3 trial). Ann Oncol 2016; 27:1565-72. [PMID: 27234640 DOI: 10.1093/annonc/mdw222] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/19/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To examine the relation of carcinoembryonic antigen (CEA) response with tumor response and survival in patients with (K)RAS wild-type metastatic colorectal cancer receiving first-line chemotherapy in the FIRE-3 trial comparing FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab. PATIENTS AND METHODS CEA response assessed as the percentage of CEA decrease from baseline to nadir was evaluated for its association with tumor response and survival. Receiver operating characteristic analysis revealed an optimal cut-off value of 75% using the maximum of sensitivity and specificity for CEA response to discriminate CEA responders from non-responders. In addition, the time to CEA nadir was calculated. RESULTS Of 592 patients in the intent-to-treat population, 472 were eligible for analysis of CEA (cetuximab arm: 230 and bevacizumab arm: 242). Maximal relative CEA decrease (%) significantly (P = 0.003) differed between the cetuximab arm (median 83.0%; IQR 40.9%-94.7%) and the bevacizumab arm (median 72.3%; IQR 26.3%-91.0%). In a longitudinal analysis, the CEA decrease occurred faster in the cetuximab arm and was greater than in the bevacizumab arm at all evaluated time points until 56 weeks after treatment start. CEA nadir occurred after 3.3 months (cetuximab arm) and 3.5 months (bevacizumab arm), (P = 0.49). In the cetuximab arm, CEA responders showed a significantly longer progression-free survival [11.8 versus 7.4 months; hazard ratio (HR) 1.53; 95% Cl, 1.15-2.04; P = 0.004] and longer overall survival (36.6 versus 21.3 months; HR 1.73; 95% Cl, 1.24-2.43; P = 0.001) than CEA non-responders. Analysis of extended RAS wild-type patients revealed similar results. CONCLUSION In the FIRE-3 trial, CEA decrease was significantly faster and greater in the cetuximab arm than in the bevacizumab arm and correlated with the prolonged survival observed in patients receiving FOLFIRI plus cetuximab. CLINICAL TRIALS NUMBER NCT00433927 (ClinicalTrials.gov); AIO KRK0306 FIRE-3.
Collapse
Affiliation(s)
- M Michl
- Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University Munich, Munich
| | - S Stintzing
- Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University Munich, Munich German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | | | - T Decker
- Practice for Hematology and Medical Oncology, Onkonet-Onkologie Ravensburg, Ravensburg
| | - A Kiani
- Department of Hematology and Medical Oncology, Klinik Herzoghöhe, Bayreuth
| | | | - S-E Al-Batran
- Department of Hematology and Medical Oncology, Krankenhaus Nordwest, University Cancer Center Frankfurt, Frankfurt
| | - T Heintges
- Department of Gastroenterology and Oncology, Medical Department II, Lukaskrankenhaus, Städtisches Klinikum Neuss, Neuss
| | | | - C Kahl
- Department of Hematology and Medical Oncology, Klinikum Magdeburg, Magdeburg
| | - G Seipelt
- Practice for Hematology and Medical Oncology, Bad Soden
| | - F Kullmann
- Department of Gastroenterology, Hematology and Medical Oncology, Klinikum Weiden, Weiden
| | - M Stauch
- Practice for Hematology and Medical Oncology, Kronach, Germany
| | - W Scheithauer
- Department of Hematology and Medical Oncology, Medical University of Vienna, Vienna, Austria
| | - J Hielscher
- Department of Surgery, Klinikum Chemnitz, Chemnitz
| | - M Scholz
- Department of Medicine, Klinikum Stuttgart, Stuttgart
| | - S Mueller
- Practice for Hematology and Medical Oncology, Ansbach
| | - M M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald
| | - D P Modest
- Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University Munich, Munich German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - T Kirchner
- Department of Pathology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - A Jung
- Department of Pathology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - V Heinemann
- Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich, Ludwig-Maximilians-University Munich, Munich German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | | |
Collapse
|
29
|
Ruoff AB, Kahl C, Oliveira SND, Melo LVD, Andrade SRD, Prado MLD. EXPERIENTIAL LEARNING AND KNOWLEDGE CREATION: APPLICATIONS IN NURSING. REME: Revista Mineira de Enfermagem 2016. [DOI: 10.5935/1415-2762.20160056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
30
|
Maschmeyer G, Carratalà J, Buchheidt D, Hamprecht A, Heussel CP, Kahl C, Lorenz J, Neumann S, Rieger C, Ruhnke M, Salwender H, Schmidt-Hieber M, Azoulay E. Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients (allogeneic SCT excluded): updated guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol 2015; 26:21-33. [PMID: 24833776 PMCID: PMC4269340 DOI: 10.1093/annonc/mdu192] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 04/29/2014] [Accepted: 05/02/2014] [Indexed: 12/13/2022] Open
Abstract
Up to 25% of patients with profound neutropenia lasting for >10 days develop lung infiltrates, which frequently do not respond to broad-spectrum antibacterial therapy. While a causative pathogen remains undetected in the majority of cases, Aspergillus spp., Pneumocystis jirovecii, multi-resistant Gram-negative pathogens, mycobacteria or respiratory viruses may be involved. In at-risk patients who have received trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis, filamentous fungal pathogens appear to be predominant, yet commonly not proven at the time of treatment initiation. Pathogens isolated from blood cultures, bronchoalveolar lavage (BAL) or respiratory secretions are not always relevant for the etiology of pulmonary infiltrates and should therefore be interpreted critically. Laboratory tests for detecting Aspergillus galactomannan, β-D-glucan or DNA from blood, BAL or tissue samples may facilitate the diagnosis; however, most polymerase chain reaction assays are not yet standardized and validated. Apart from infectious agents, pulmonary side-effects from cytotoxic drugs, radiotherapy or pulmonary involvement by the underlying malignancy should be included into differential diagnosis and eventually be clarified by invasive diagnostic procedures. Pre-emptive treatment with mold-active systemic antifungal agents improves clinical outcome, while other microorganisms are preferably treated only when microbiologically documented. High-dose TMP/SMX is first choice for treatment of Pneumocystis pneumonia, while cytomegalovirus pneumonia is treated primarily with ganciclovir or foscarnet in most patients. In a considerable number of patients, clinical outcome may be favorable despite respiratory failure, so that intensive care should be unrestrictedly provided in patients whose prognosis is not desperate due to other reasons.
Collapse
Affiliation(s)
- G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany.
| | - J Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - D Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Mannheim
| | - A Hamprecht
- Institution for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne
| | - C P Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital, Heidelberg
| | - C Kahl
- Department of Hematology and Oncology, Klinikum Magdeburg, Magdeburg
| | - J Lorenz
- Department of Pneumology, Infectious Diseases, Sleep Medicine and Intensive Care, Klinikum Lüdenscheid, Lüdenscheid
| | - S Neumann
- Medical Oncology, AMO MVZ, Wolfsburg
| | - C Rieger
- Department of Medicine III, University Hospital Großhadern, München
| | - M Ruhnke
- Department of Medical Oncology and Hematology, Charité University Medicine Campus Mitte, Berlin
| | - H Salwender
- Department of Hematology, Oncology, Stem Cell Transplantation, Asklepios Klinik Altona, Hamburg
| | - M Schmidt-Hieber
- Department of Hematology, Oncology and Tumor Immunology, Helios-Klinikum Berlin-Buch, Berlin, Germany
| | - E Azoulay
- AP-HP, Hopital Saint-Louis, Service de Réanimation Médicale, Université Paris-Diderot, Sorbonne Paris-Cité, Faculté de Médecine, Paris, France
| |
Collapse
|
31
|
Vehreschild JJ, Böhme A, Cornely OA, Kahl C, Karthaus M, Kreuzer KA, Maschmeyer G, Mousset S, Ossendorf V, Penack O, Vehreschild MJGT, Bohlius J. Prophylaxis of infectious complications with colony-stimulating factors in adult cancer patients undergoing chemotherapy-evidence-based guidelines from the Infectious Diseases Working Party AGIHO of the German Society for Haematology and Medical Oncology (DGHO). Ann Oncol 2014; 25:1709-1718. [PMID: 24631945 DOI: 10.1093/annonc/mdu035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Current evidence on myelopoietic growth factors is difficult to overview for the practicing haematologist/oncologist. International guidelines are sometimes conflicting, exclude certain patient groups, or cannot directly be applied to the German health system. This guideline by the Infectious Diseases Working Party (AGIHO) of the German Society of Haematology and Medical Oncology (DGHO) gives evidence-based recommendations for the use of G-CSF, pegylated G-CSF, and biosimilars to prevent infectious complications in cancer patients undergoing chemotherapy, including those with haematological malignancies. METHODS We systematically searched and evaluated current evidence. An expert panel discussed the results and recommendations. We then compared our recommendations to current international guidelines. RESULTS We summarised the data from eligible studies in evidence tables, developed recommendations for different entities and risk groups. CONCLUSION Comprehensive literature search and expert panel consensus confirmed many key recommendations given by international guidelines. Evidence for growth factors during acute myeloid leukaemia induction chemotherapy and pegfilgrastim use in haematological malignancies was rated lower compared with other guidelines.
Collapse
Affiliation(s)
- J J Vehreschild
- 1st Department of Internal Medicine, University Hospital of Cologne, Cologne
| | - A Böhme
- Onkologikum Frankfurt am Museumsufer, Frankfurt a.M
| | - O A Cornely
- 1st Department of Internal Medicine, University Hospital of Cologne, Cologne; Clinical Trials Centre Cologne (ZKS Köln, BMBF 01KN1106); Centre for Integrated Oncology CIO KölnBonn, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne.
| | - C Kahl
- Clinic for Haematology and Oncology, Klinikum Magdeburg gGmbH
| | - M Karthaus
- Haematology-Oncology and Palliative Care, Hospital Neuperlach and Hospital Harlaching, Munich
| | - K-A Kreuzer
- 1st Department of Internal Medicine, University Hospital of Cologne, Cologne
| | - G Maschmeyer
- Department of Haematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam
| | - S Mousset
- Medizinische Klinik II, University Hospital Frankfurt a.M., Frankfurt a.M
| | - V Ossendorf
- Clinical Trials Centre Cologne (ZKS Köln, BMBF 01KN1106)
| | - O Penack
- Campus Benjamin Franklin; Medical Clinic for Haematology and Oncology, University Hospital Charité, Berlin, Germany
| | - M J G T Vehreschild
- 1st Department of Internal Medicine, University Hospital of Cologne, Cologne
| | - J Bohlius
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| |
Collapse
|
32
|
Modest D, Stintzing S, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran S, Heintges T, Lerchenmüller C, Kahl C, Seipelt G, Kullmann F, Stauch M, Scheithauer W, Held S, Giessen C, Jung A, Kirchner T, Heinemann V. 2Nd-Line Therapies After 1St-Line Therapy with Folfiri in Combination with Cetuximab or Bevacizumab in Patients with Kras Wild-Type Metastatic Colorectal Cancer (Mcrc)-Analysis of the Aio Krk 0306 (Fire 3)- Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
33
|
Stintzing S, Modest D, Fischer von Weikersthal L, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran S, Heintges T, Lerchenmueller C, Kahl C, Seipelt G, Kullmann F, Scheithauer W, Held S, Giessen C, Moehler M, Jagenburg A, Jung A, Kirchner T, Heinemann V. Independent Radiological Evaluation of Objective Response, Early Tumor Shrinkage, and Depth of Response in Fire-3 (Aio Krk-0306) in the Final Ras Evaluable Population. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
34
|
Heinemann V, Modest D, Fischer von Weikersthal L, Decker T, Kiani A, Vehling-Kaiser U, Al-Batran SE, Heintges T, Lerchenmüller C, Kahl C, Seipelt G, Kullmann F, Stauch M, Scheithauer W, Held S, Giessen C, Möhler M, Jagenburg A, Stintzing S. Independent Radiological Evaluation of Objective Response Early Tumor Shrinkage, and Depth of Response in FIRE-3 (AIO KRK-0306). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu193.30] [Citation(s) in RCA: 19] [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: 11/13/2022] Open
|
35
|
Modest D, Stintzing S, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, Al Batran S, Heintges T, Lerchenmüller C, Kahl C, Seipelt G, Kullmann F, Stauch M, Scheithauer W, Held S, Giessen C, Jung A, Kirchner R, Heinemann V. 2ND-Line Therapies After 1st-Line Therapy with Folfiri in Combination with Cetuximab or Bevacizumab in Patients with KRAS Wild-Type Metastatic Colorectal Cancer (MCRC)-Analysis of the AIO KRK 0306 (FIRE 3)- Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu193.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
36
|
Jaspers CHM, Salbeck R, Kahl C, Hans V, Berding G, Knappe UJ. Neuroendocrine carcinoma arising in the sella: Diagnosis and treatment. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336741] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
37
|
Bergmann L, Grünwald V, Kube U, Weikert S, Kube U, Kahl C, Gauler T, Maute L. Everolimus in the Sequence after Failure of Vegfr-Directed Therapy in MRCC - A Retrospective Analysis. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
38
|
Elter T, James R, Busch R, Winkler D, Ritgen M, Böttcher S, Kahl C, Gassmann W, Stauch M, Hasan I, Staib P, Fischer K, Fink AM, Bahlo J, Bühler A, Döhner H, Wendtner CM, Stilgenbauer S, Engert A, Hallek M. Fludarabine and cyclophosphamide in combination with alemtuzumab in patients with primary high-risk, relapsed or refractory chronic lymphocytic leukemia. Leukemia 2012; 26:2549-52. [DOI: 10.1038/leu.2012.129] [Citation(s) in RCA: 16] [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]
|
39
|
Kahl C, Sayer HG, Hinke A, Freund M, Casper J. Early versus late administration of pegfilgrastim after high-dose chemotherapy and autologous hematopoietic stem cell transplantation. J Cancer Res Clin Oncol 2011; 138:513-7. [PMID: 22198675 DOI: 10.1007/s00432-011-1116-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 12/05/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE Single-dose pegylated filgrastim (pegfilgrastim) after autologous hematopoietic stem cell transplantation (AHSCT) showed similar efficacy compared to daily lenograstim. To address the question of the optimal application time, we randomly assigned patients (pts) to pegfilgrastim on day + 1 (Peg1) or day + 4 (Peg4) after AHSCT. METHOD Fifty-three pts with different hematological malignancies were included in this prospective randomized multicenter study. Primary endpoint of this study was time to neutrophil recovery (>500 Gpt/l), and secondary endpoint was time to neutrophil recovery (>1,000 Gpt/l), platelet recovery (>20,000 Gpt/l), number and duration of febrile episodes, i.v. antibiotics, and number of transfusions. Time to engraftment endpoints were estimated according to Kaplan-Meier. RESULTS Median time to neutrophil recovery (>500 Gpt/l) was 10 days (95% CI: 10-11) in Peg1 versus 10 days (95% CI: 10-11) in Peg4 (P = 0.68, logrank test; hazard ratio: 0.93). The corresponding mean values were 10.2 and 10.4 days. Median time to platelet recovery (>20,000 Gpt/l) was 10 (95% CI: 10-11) in Peg1 versus 10 (95% CI: 9-11) in Peg4, again not significantly different (P = 0.54). There was no difference regarding the incidence (67% vs. 60%, P = 0.77, Fisher's exact test) or duration of febrile neutropenia episodes in both groups (median: 1 vs. 1; mean: 2.8 vs. 2.4 days; P = 0.73, Wilcoxon test). CONCLUSION In terms of neutrophil or platelet recovery after AHSCT, number and duration of febrile episodes, the use of i.v. antibiotics, early and late administration of pegfilgrastim are equally effective.
Collapse
Affiliation(s)
- C Kahl
- Department of Hematology and Oncology, Klinikum Magdeburg, Birkenallee 34, 39130 Magdeburg, Germany.
| | | | | | | | | |
Collapse
|
40
|
Kahl C, Jost K, Knauerhase A, Leithäuser M, Freund M, Bunke D, Rothacker D, Hampel R. [Recurrent hypoglycemia and a large intraabdominal tumor in a 61-year-old woman]. Dtsch Med Wochenschr 2011; 136:2542-6. [PMID: 22131074 DOI: 10.1055/s-0031-1292841] [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: 10/15/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 61-year-old woman was found unconscious by her husband. The emergency doctor detected hypoglycemia (blood glucose 1.7 mmol/l). This was the first such event, the patient had not been known to have diabetes mellitus. At admission the physical examination and the laboratory findings revealed no abnormalities. INVESTIGATIONS A fasting test was aborted shortly after the start because of the onset of neurological symptoms. An insulinoma was excluded by detecting suppressed levels of insulin and C-peptide. Computed tomography of the abdomen revealed a mesenteric tumour of 9 cm in diameter, which was identified immunhistologically as a grade 1 follicular lymphoma (FL). After exclusion of endocrinological causes the recurrent hypoglycaemia was diagnozed as part of a paraneoplastic syndrome associated with a non-islet cell tumour hypoglycaemia (NICTH) with a newly diagnosed FL. TREATMENT AND COURSE Specific medication with the CD20 antibody rituximab (375 mg/m2, once per week for a total of four cycles) was initiated. There were no further episodes of hypoglycaemia. After one year the patient remains free of any symptoms. CONCLUSIONS After exclusion of any endocrinological reasons for hypoglycemia, differential diagnosis should include NICTH as paraneoplastic syndrome. In rare cases a hematological malignancy may be the underlying disease. The specific treatment of this disease likewise represents the causal treatment of NICTH.
Collapse
Affiliation(s)
- C Kahl
- Klinik für Innere Medizin III, Klinikum Magdeburg gGmbH.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Kahl C, Neureither M, Reich K, Zschocke I. Zeitmanagement und Lebensqualität nach Umstellung einer topischen und/oder Fototherapie auf Fumarsäureester bei Patienten mit Psoriasis. Akt Dermatol 2011. [DOI: 10.1055/s-0030-1256613] [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: 10/18/2022]
|
42
|
Leithauser M, Kahl C, Aepinus C, Prall F, Maruschke M, Riemer H, Wolff D, Jost K, Hilgendorf I, Freund M, Junghanss C. Invasive zygomycosis in patients with graft-versus-host disease after allogeneic stem cell transplantation. Transpl Infect Dis 2009; 12:251-7. [PMID: 20002357 DOI: 10.1111/j.1399-3062.2009.00480.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Leithauser
- Department of Medicine, Division of Hematology/Oncology, University of Rostock, Rostock, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Kahl C, Herold M, Höffkes HG, Franke A. Bendamustine, Methotrexate, Mitoxantrone, and Prednisolone (BMMP) for the Treatment of Relapsed or Refractory High-Grade Non-Hodgkin’s Lymphoma. Oncol Res Treat 2009. [DOI: 10.1159/000218992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
44
|
Kahl C, Leithäuser M, Junghanss C, Prall F, Freund M. [Pancytopenia and lymph node swelling. Cardinal symptoms of an unusual differential diagnosis]. Internist (Berl) 2009; 50:734-9. [PMID: 19214464 DOI: 10.1007/s00108-008-2279-5] [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
A 47-year-old woman was admitted to our emergency room because of anemia and acute tonsillitis. She reported recurrent fever and a sore throat. Clinical examination and CT scans showed general lymph node swelling and liver enlargement. In the course of the disease she developed pancytopenia with neutropenic fever, pleuropneumonia, and deep vein thrombosis. The histological examination of a lymph node showed a reactive, EBV-associated lymphadenitis. The examination of the bone marrow showed an activated marrow. The diagnosis of an active EBV infection was established with 2 x 10(6)/ml EBV gene copies in the blood. In addition, systemic lupus erythematosus was diagnosed because of the typical autoantibody constellation and clinical findings. The immunohematological examination showed autoantibodies against the three blood cell compartments. Because of the severe pancytopenia as a result of the EBV- and SLE-associated autoantibodies and despite recurrent infections, we initiated immunosuppressive therapy with low-dose corticosteroids. This therapy resulted in normalization of the blood counts. Anitibody levels and the EBV genome levels became negative.
Collapse
Affiliation(s)
- C Kahl
- Abteilung Hämatologie und Onkologie, Klinik und Poliklinik für Innere Medizin, Ernst-Heydemann-Strasse 6, 18055 Rostock.
| | | | | | | | | |
Collapse
|
45
|
Nast A, Kopp I, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version). Arch Dermatol Res 2007; 299:111-38. [PMID: 17497162 PMCID: PMC1910890 DOI: 10.1007/s00403-007-0744-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 02/14/2007] [Indexed: 11/30/2022]
Abstract
Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1-S126, 2006; or http://www.psoriasis-leitlinie.de ).
Collapse
Affiliation(s)
- A Nast
- Division of Evidence Based Medicine, Klinik für Dermatologie, Venerologie, Allergologie, Charité-Universitätsmedizin Berlin, Schumannstrasse 20/21, Berlin, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Wolff D, Wilhelm S, Hahn J, Gentilini C, Hilgendorf I, Steiner B, Kahl C, Junghanss C, Hartung G, Casper J, Uharek L, Holler E, Freund M. Replacement of calcineurin inhibitors with daclizumab in patients with transplantation-associated microangiopathy or renal insufficiency associated with graft-versus-host disease. Bone Marrow Transplant 2006; 38:445-51. [PMID: 16951692 DOI: 10.1038/sj.bmt.1705454] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [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: 12/20/2022]
Abstract
Transplantation-associated microangiopathy (TAM) or renal insufficiency (RI) after allogeneic hematopoietic stem cell transplantation is associated with a high mortality. As calcineurin inhibitors (CI) may contribute to TAM or RI, we evaluated the efficacy of replacing CI by daclizumab in patients with graft-versus-host disease (GVHD). Thirteen patients with GVHD-associated TAM and five patients with RI were treated with daclizumab 1 mg/kg intravenous (i.v.)/week, discontinuation of the CI and continuation of the remaining GVHD treatment. All patients had acute GVHD (steroid-sensitive (n=4), steroid-refractory (n=10)) or chronic GVHD (n=4) and were treated with CI before the start of daclizumab. Nine of 13 patients with TAM treated with daclizumab and discontinuation of CI achieved complete remission of TAM, two had stable disease, and one patient did not respond. Patients receiving daclizumab for RI without TAM showed stabilization (2/5) or improvement (3/5) of renal function. Four of 14 patients with acute GVHD achieved CR, two partial remission, eight patients did not respond and 11/14 died at a median of 39 days after start of the daclizumab. Our data demonstrate that replacement of CI by daclizumab can improve TAM and RI. However, mortality remains high in patients with acute GVHD.
Collapse
Affiliation(s)
- D Wolff
- Department of Haematology and Oncology, University of Rostock, Rostock, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Sandherr M, Einsele H, Hebart H, Kahl C, Kern W, Kiehl M, Massenkeil G, Penack O, Schiel X, Schuettrumpf S, Ullmann AJ, Cornely OA. Antiviral prophylaxis in patients with haematological malignancies and solid tumours: Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Oncology (DGHO). Ann Oncol 2006; 17:1051-9. [PMID: 16410361 DOI: 10.1093/annonc/mdj132] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [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: 11/12/2022] Open
Abstract
Morbidity and mortality in patients with malignancies are increased by viral infections. These mostly are reactivations of asymptomatic latent infections. They primarily concern clinical entities associated with the reactivation of herpes viruses, such as varicella zoster virus (VZV) and cytomegalovirus (CMV). Respiratory tract infections caused by influenza, parainfluenza or respiratory syncytial virus (RSV) are less common. Since reactivation of latent infections has major clinical impact, antiviral prophylaxis is an attractive approach for patients expecting immunosuppression. The main risk factor for clinically relevant reactivation is profound disruption of cellular immune response. Duration and severity of chemotherapy induced neutropenia are of lesser importance. The risk of viral complications rises significantly in the presence of sustained suppression of T-cell function, e.g. in recipients of allogeneic stem cell transplants or of alemtuzumab (Campath-1H) antibody therapy. The objective of this guideline is to review the basis of prophylactic strategies and to provide recommendations for clinicians treating patients with haematological malignancies and solid tumors.
Collapse
Affiliation(s)
- M Sandherr
- Medizinische Klinik, Klinikum Augsburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Kahl C, Freund M. [Differential diagnosis of a macrocytic, hyperchromic anemia following alcohol abuse and simultaneous therapy with triamterene and cotrimoxazole]. Dtsch Med Wochenschr 2005; 130:2139-41. [PMID: 16172954 DOI: 10.1055/s-2005-916354] [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: 10/25/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 50-year-old woman was admitted to our emergency room because of progressive weakness. She collapsed the night before admission. Skin and mucosa were pale, she denied major infections or bleedings. An alcohol abuse was known for many years. Because of edema she received a therapy with triamteren, an infection of the urinary tract was treated with cotrimoxacol. INVESTIGATIONS In addition to thrombocytopenia (50 Gpt/l) and leukocytopenia (1,51 10 (9)/l) we diagnosed a hyperchromic and macrocytic anemia (Hb 3,6 mmol/l [5,8 g/dl], Hk 0,17, MCH 2.52 fmol, 116,8 fl). Folic acid was decreased to 0.677 ng/ml, whereas levels of cobalamin, ferritin and iron were normal. Examination of bone marrow showed a hypercellular marrow with typical megaloblastic features of erythropoiesis and granulopoiesis. A systemic hematological disorder could be ruled out. The folic acid deficiency in our patient was the result of a long time alcohol abuse and a simultaneous therapy with mild folate antagonists (triamteren and cotrimoxacol). CLINICAL COURSE The patient received folic acid (5 mg/d orally). Within one week the peripheral blood counts increased to normal, the follow up bone marrow examination showed a hyperplastic marrow with normal hematopoietic maturation. CONCLUSIONS Folic acid deficiency can be aggravated because of simultaneous therapy with mild folate antagonists. In addition to megaloblastic anemia this can lead to thrombocytopenia and/or leukocytopenia. Therefore in patients with pancytopenia a deficiency of folic acid should be ruled out.
Collapse
Affiliation(s)
- C Kahl
- Abteilung Hämatologie und Onkologie, Klinik und Poliklinik für Innere Medizin, Universität Rostock.
| | | |
Collapse
|
49
|
Casper J, Wilhelm S, Steiner B, Wolff D, Grobe N, Hähling D, Hartung G, Hilgendorf I, Lück A, Junghanss C, Kahl C, Baumgart J, Pichlmeier U, Freund M. Allogene Blutstammzelltransplantation von Risikopatienten nach Konditionierung mit Treosulfan und Fludarabin. Dtsch Med Wochenschr 2005; 130:2125-9. [PMID: 16172951 DOI: 10.1055/s-2005-916351] [Citation(s) in RCA: 2] [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] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Allogeneic transplantation can not be offered to many patients due to potential side-effects of conventional conditioning. Dose-reduced conditioning approaches improve tolerability, however, treatment efficacy may be reduced as well. We have, therefore, developed a dose intense but toxicity reduced conditioning regimen based on treosulfan and fludarabine and report first results. PATIENTS AND METHODS 65 patients with a median age of 50 years were transplanted from related (n = 21) or unrelated donors (n = 44) after conditioning with treosulfan (3 x 10, 3 x 12 or 3 x 14 g/m(2) i. v.) and fludarabine (5 x 30 mg/m(2) i. v.). 21 patients were in complete remission (CR) and 44 patients had not reached a CR at the time of transplantation. 59 of 65 patients were considered unfit for a conventional conditioning regimen. RESULTS The actuarial overall survival after 3 years is 59.2 %, the event-free survival 40.1 %. Patients with a related donor or transplantation in CR had a better overall (85.4 resp. 74.2 %) and event-free survival (52.2 % resp. 61.9 %). The cumulative incidence of relapse at 3 years was 26.2 %. Non-relapse mortality at day 100 is 17.4 % (cumulative incidence). In stepwise Cox regression analyses for overall survival, event-free survival and non-relapse mortality the covariables transplantation in CR vs. not in CR and the donor status were shown to be influential. CONCLUSIONS These results with a conditioning therapy of treosulfan and fludarabine indicate that patients despite higher age, concomitant disease or after intensive pretreatment can be successfully transplanted without increased treatment-related mortality.
Collapse
Affiliation(s)
- J Casper
- Abteilung Hämatologie und Onkologie der Medizinischen Fakultät der Universität Rostock.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Wolff D, Steiner B, Stilgenbauer S, Kahl C, Leithäuser M, Junghanss C, Wilhelm S, Kleine HD, Zimmermann R, Hartung G, Casper J, Freund M. Treatment with campath-1H for relapsed chronic lymphocytic leukemia after allogeneic peripheral blood stem cell transplantation does not abrogate the development of chronic GVHD. Eur J Haematol 2004; 72:145-8. [PMID: 14962253 DOI: 10.1046/j.0902-4441.2003.00181.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/20/2022]
Abstract
The graft vs. leukemia (GVL) effect is one of the most important factors of anti-tumor activity after allogeneic hematopoetic stem cell transplants (alloSCT). Its effectiveness depends mainly on the tumor biology as well as the tumor burden. Patients with a high tumor burden may not respond to GVL-effect despite otherwise sensitive biology. Campath-1H is known as an effective treatment of chronic lymphocytic leukemia (CLL). Due to its ability to induce profound immunosuppression, it has also been used as part of conditioning regimens before alloSCT. We report a patient, who received campath-1H in combination with docetaxel for treatment of chemotherapy and donor lymphocyte infusion resistant CLL after alloSCT, who developed shortly after discontinuation of treatment with campath-1H severe eosinophilia of the peripheral blood and typical clinical as well as histological signs of cutaneous chronic graft vs. host disease followed by complete clearance of CLL. The clinical course demonstrates the impact of the tumor burden on the GVL-effect, as well as the effectiveness of campath-1H in the presence chemo-resistance in a patient with CLL. Furthermore, the GVL effect was not abrogated by the use of campath-1H.
Collapse
Affiliation(s)
- Daniel Wolff
- Division of Haematology and Oncology, Department of Internal Medicine, University of Rostock, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|