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Niedoszytko M, Gorska A, Brockow K, Bonadonna P, Lange M, Kluin-Nelemans H, Oude-Elberink H, Sabato V, Shoumariyeh K, von Bubnoff D, Müller S, Illerhaus A, Doubek M, Angelova-Fischer I, Hermine O, Arock M, Elena C, Malcovati L, Yavuz AS, Schug TD, Fortina AB, Judit V, Gotlib J, Panse J, Vucinic V, Reiter A, Schwaab J, Triggiani M, Mattsson M, Breynaert C, Romantowski J, Zanotti R, Olivieri E, Zink A, van de Ven A, Stefan A, Barete S, Caroppo F, Perkins C, Kennedy V, Christen D, Jawhar M, Luebke J, Parente R, Levedahl K, Hadzijusufovic E, Hartmann K, Nedoszytko B, Sperr WR, Valent P. Prevalence of hypersensitivity reactions in various forms of mastocytosis: A pilot study of 2485 adult patients with mastocytosis collected in the ECNM registry. Allergy 2024. [PMID: 38651829 DOI: 10.1111/all.16132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Hypersensitivity reactions (HR) are common in mastocytosis. However, little is known about triggers and risk factors. The registry of the European Competence Network on Mastocytosis (ECNM) enables reliable studies in a larger cohort of mastocytosis patients. We assessed prevalence, triggers and risk factors of HR in adults with mastocytosis in the ECNM registry. METHODS Data were collected in 27 ECNM centers. We analyzed potential triggers (Hymenoptera venoms, food, drug, inhalant and others) and risk factors at diagnosis and during follow-up. The study group consisted of 2485 adults with mastocytosis, 1379 women (55.5%) and 1106 men (44.5%). Median age was 48.2 years (range 18-91 years). RESULTS Nine hundred and forty eight patients (38.1%) reported one or more HR`. Most common triggers were Hymenoptera venoms in cutaneous mastocytosis (CM) and indolent systemic mastocytosis (ISM), whereas in advanced SM (advSM), most common elicitors were drugs, including nonsteroidal anti-inflammatory agents and penicillin. In multivariate analyses, tryptase level < 90 ng/mL, <15% infiltration by mast cells in bone marrow biopsy-sections, and diagnosis of ISM were identified as independent risk factors for HR. For drug-induced HR, prominent risk factors were advSM and high tryptase levels. New reactions were observed in 4.8% of all patients during 4 years follow-up. CONCLUSIONS HR are mainly triggered by Hymenoptera venoms in patients with CM and ISM and by drugs in patients with advSM. Tryptase levels <90 ng/mL, mast cell bone marrow infiltration <15%, and WHO category ISM are predictors of HR. New HR occur in 4.8% of all patients within 4 years.
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Affiliation(s)
- Marek Niedoszytko
- Department of Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Aleksandra Gorska
- Department of Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, School of Medicine, Munich, Germany
| | - Patrizia Bonadonna
- Allergy Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Hanneke Kluin-Nelemans
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Vito Sabato
- Department of Immunology, Allergology Rheumatology University of Antwerp and Antwerp University Hospital, Edegem, Belgium
| | - Khalid Shoumariyeh
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany and German Cancer Consortium (DKTK), Partner Site Freiburg, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dagmar von Bubnoff
- Dagmar von Bubnoff, Department of Dermatology, Allergy and Venerology, University of Schleswig Holstein, Lübeck, Germany
| | - Sabine Müller
- Department of Dermatology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | | | - Olivier Hermine
- Unit of Dermatology and CEREMAST, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Michel Arock
- Department of Hematological Biology and CEREMAST, Pitié-Salpêtrière Hospital, Paris Sorbonne University, Paris, France
| | - Chiara Elena
- Department of Hematology, Fondazione IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Luca Malcovati
- Department of Hematology, Fondazione IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Akif Selim Yavuz
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Türkiye
| | | | - Anna Belloni Fortina
- Pediatric Dermatology, Internal Medicine, Azienda Ospedaliera, Università di Padova, Padova, Italy
| | | | - Jason Gotlib
- Stanford University, School of Medicine, Hematology Clinic, Stanford, USA
| | - Jens Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Center for Integrated Oncology Aachen, Bonn Cologne, Duesseldorf (CIO ABCD), Aachen, Germany
| | | | - Andreas Reiter
- Universitätsmedizin Mannheim, III.Medizinische Klinik, Mannhein, Germany
| | - Juliana Schwaab
- Universitätsmedizin Mannheim, III.Medizinische Klinik, Mannhein, Germany
| | | | | | - Christine Breynaert
- KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology ResearchGroup and MASTeL, University Hospitals Leuven, Leuven, Belgium
| | - Jan Romantowski
- Department of Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Roberta Zanotti
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Elisa Olivieri
- Allergy Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alexander Zink
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, School of Medicine, Munich, Germany
| | - Annick van de Ven
- Department of Allergology, University Medical Center, Groningen, The Netherlands
| | - Alex Stefan
- Clinic for Hematology and Oncology, Kepler University Hospital, Linz, Austria
| | - Stephane Barete
- Unit of Dermatology and CEREMAST, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Francesca Caroppo
- Pediatric Dermatology, Internal Medicine, Azienda Ospedaliera, Università di Padova, Padova, Italy
| | - Cecelia Perkins
- Stanford University, School of Medicine, Hematology Clinic, Stanford, USA
| | - Vanessa Kennedy
- Stanford University, School of Medicine, Hematology Clinic, Stanford, USA
| | - Deborah Christen
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Center for Integrated Oncology Aachen, Bonn Cologne, Duesseldorf (CIO ABCD), Aachen, Germany
| | - Mohamad Jawhar
- Universitätsmedizin Mannheim, III.Medizinische Klinik, Mannhein, Germany
- Department of Hematology and Oncology, Helios Pforzheim, Pforzheim, Germany
| | - Johannes Luebke
- Universitätsmedizin Mannheim, III.Medizinische Klinik, Mannhein, Germany
| | | | - Kerstin Levedahl
- Uppsala University Hospital, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Emir Hadzijusufovic
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Boguslaw Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
- Invicta Fertility and Reproductive Center, Molecular Laboratory, Sopot, Poland
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
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2
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Lübke J, Schmid A, Christen D, Oude Elberink HNG, Span LFR, Niedoszytko M, Górska A, Lange M, Gleixner KV, Hadzijusufovic E, Stefan A, Angelova-Fischer I, Zanotti R, Bonifacio M, Bonadonna P, Shoumariyeh K, von Bubnoff N, Müller S, Perkins C, Elena C, Malcovati L, Hagglund HG, Mattsson M, Parente R, Varkonyi J, Fortina AB, Caroppo F, Brockow K, Zink A, Breynaert C, Ieven T, Yavuz AS, Doubek M, Sabato V, Schug T, Hartmann K, Triggiani M, Gotlib J, Hermine O, Arock M, Kluin-Nelemans HC, Panse JP, Sperr WR, Valent P, Reiter A, Schwaab J. Serum chemistry profiling and prognostication in systemic mastocytosis: a registry-based study of the ECNM and GREM. Blood Adv 2024:bloodadvances.2024012756. [PMID: 38593217 DOI: 10.1182/bloodadvances.2024012756] [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: 01/24/2024] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
Certain laboratory abnormalities correlate with subvariants of systemic mastocytosis (SM) and are often prognostically relevant. To assess the diagnostic and prognostic value of individual serum chemistry parameters in SM, 2607 patients enrolled within the European Competence Network on Mastocytosis (ECNM) and 575 patients enrolled within the German Registry on Eosinophils and Mast Cells (GREM) were analyzed. For screening and diagnosis of SM, tryptase was identified as the most specific serum parameter. For differentiation between indolent and advanced SM (AdvSM), the following serum parameters were most relevant: tryptase, alkaline phosphatase (AP), ß2-microglobulin, lactate dehydrogenase (LDH), albumin, vitamin B12, and C-reactive protein (P<0.001). With regard to subvariants of AdvSM, an elevated LDH ≥260U/L was associated with multi-lineage expansion (leukocytosis, r=0.37, P<0.001; monocytosis, r=0.26, P<0.001) and the presence of an associated myeloid neoplasm (P<0.001), whereas tryptase levels were highest in mast cell leukemia (MCL vs. non-MCL, 308 µg/L vs. 146 µg/L, P=0.003). Based on multivariable analysis, the hazard-risk weighted assignment of 1 point to lactate dehydrogenase (HR 2.1 [95% CI 1.1-4.0], P=0.018) and 1.5 points each to ß2-microglobulin (HR 2.7 [95% CI 1.4-5.4], P=0.004) and albumin (HR 3.3 [95% CI 1.7-6.5], P=0.001) delineated a highly predictive three-tier risk classification system (0 points, 8.1 years vs. 1 point, 2.5 years, ≥1.5 points, 1.7 years; P<0.001). Moreover, serum chemistry parameters enabled further stratification of IPSM-AdvSM1/2 risk-score classified patients (P=0.027). In conclusion, serum chemistry profiling is a crucial tool in the clinical practice supporting diagnosis and prognostication of SM and its subvariants.
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Affiliation(s)
- Johannes Lübke
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Alicia Schmid
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Deborah Christen
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Germany, Aachen, Germany
| | | | | | | | - Aleksandra Górska
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | | | | | | | | | | | | | | | | | - Khalid Shoumariyeh
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany, Freiburg, Germany
| | | | - Sabine Müller
- Department of Dermatology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cecelia Perkins
- Stanford Cancer Institute, Palo Alto, California, United States
| | - Chiara Elena
- Foundation IRCCS policlinico san matteo, pavia, Italy
| | | | | | - Mattias Mattsson
- Department of Immunology, Genetics and Pathology, Uppsala, Sweden
| | | | | | | | | | - Knut Brockow
- School of Medicine, Technical University of Munich, Munich, Florida, Germany
| | - Alexander Zink
- School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Toon Ieven
- ven Department of Microbiology, Immunology and Transplantation, Leuven, Belgium
| | - Akif Selim Yavuz
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Michael Doubek
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno & Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vito Sabato
- Antwerp University Hospital, Antwerp, Belgium
| | - Tanja Schug
- Med. Univ. Graz, Univ.Klinik für Dermatologie und Venereologie, Graz, Austria
| | - Karin Hartmann
- University Hospital Basel and University of Basel, Basel, Switzerland
| | | | - Jason Gotlib
- American Society of Hematology, Stanford, California, United States
| | | | | | | | | | | | | | - Andreas Reiter
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
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Lübke J, Christen D, Schwaab J, Kaiser A, Naumann N, Shoumariyeh K, Jentzsch M, Sockel K, Schaffrath J, Ayuk FA, Stelljes M, Hilgendorf I, Sala E, Kaivers J, Schönland S, Wittke C, Hertenstein B, Radsak M, Kaiser U, Brückl V, Kröger N, Brümmendorf TH, Hofmann WK, Klein S, Jost E, Reiter A, Panse J. Allogeneic Hematopoietic Cell Transplantation in Advanced Systemic Mastocytosis: A retrospective analysis of the DRST and GREM registries. Leukemia 2024; 38:810-821. [PMID: 38448757 PMCID: PMC10997505 DOI: 10.1038/s41375-024-02186-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/14/2024] [Indexed: 03/08/2024]
Abstract
We identified 71 patients with AdvSM (aggressive SM [ASM], SM with an associated hematologic neoplasm [SM-AHN, e.g., acute myeloid leukemia, SM-AML], mast cell leukemia [MCL]) in two national registries (DRST/GREM) who received an allogeneic hematopoietic cell transplantation (alloHCT) performed in Germany from 1999-2021. Median overall survival (OS) of ASM/SM-AHN (n = 30, 45%), SM-AML (n = 28, 39%) and MCL ± AHN (n = 13, 19%) was 9.0, 3.3 and 0.9 years (P = 0.007). Improved median OS was associated with response of SM (17/41, 41%; HR 0.4 [0.2-0.9], P = 0.035) and/or of AHN (26/43, 60%, HR 0.3 [0.1-0.7], P = 0.004) prior to alloHCT. Adverse predictors for OS included absence of KIT D816V (10/61, 16%, HR 2.9 [1.2-6.5], P < 0.001) and a complex karyotype (9/60, 15%, HR 4.2 [1.8-10.0], P = 0.016). HLA-match, conditioning type or transplantation at centers reporting above-average alloHCTs (≥7) had no impact on OS. Taking into account competing events at years 1, 3 and 5, relapse-related mortality and non-relapse mortality rate were 15%/23%, 20%/30% and 23%/35%, respectively. Irrespective of subtype, subsequent treatment response was achieved in 13/30 (43%) patients and was highest on midostaurin/avapritinib (7/9, 78%). We conclude that outcome of alloHCT in AdvSM is more affected by disease phenotype and treatment response prior to transplant than by transplant characteristics.
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Affiliation(s)
- Johannes Lübke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Deborah Christen
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany & Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Anne Kaiser
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany & Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
| | - Nicole Naumann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Khalid Shoumariyeh
- Department of Medicine I, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany and German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Madlen Jentzsch
- Clinic and Policlinic for Hematology and Cellular Therapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Katja Sockel
- Medical Department I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Judith Schaffrath
- Department of Internal Medicine IV, Hematology and Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Francis A Ayuk
- Department of Stem Cell Transplantation with Research Department Cell and Gene Therapy University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Stelljes
- Department of Medicine A/Hematology and Oncology, University of Muenster, Münster, Germany
| | - Inken Hilgendorf
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Jena, Germany
| | - Elisa Sala
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Jennifer Kaivers
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefan Schönland
- Department of Internal Medicine V, Division of Hematology/Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Wittke
- Department of Medicine, Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | | | - Markus Radsak
- 3rd Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Ulrich Kaiser
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Valeska Brückl
- Department of Internal Medicine 5, Hematology and Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation with Research Department Cell and Gene Therapy University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim H Brümmendorf
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany & Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Klein
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Edgar Jost
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany & Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
| | - Jens Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany & Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
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4
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Naumann N, Rudelius M, Lübke J, Christen D, Bresser J, Sotlar K, Metzgeroth G, Fabarius A, Hofmann WK, Panse J, Horny HP, Cross NCP, Reiter A, Schwaab J. Poor Applicability of Currently Available Prognostic Scoring Systems for Prediction of Outcome in KIT D816V-Negative Advanced Systemic Mastocytosis. Cancers (Basel) 2024; 16:593. [PMID: 38339343 PMCID: PMC10854835 DOI: 10.3390/cancers16030593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Within our nationwide registry, we identified a KIT D816V mutation (KIT D816Vpos.) in 280/299 (94%) patients with advanced systemic mastocytosis (AdvSM). Age, cytopenias and the presence of additional somatic mutations confer inferior overall survival (OS). However, little is known about the characteristics of KIT D816V-negative (D816Vneg.) AdvSM. In 19 D816Vneg. patients, a combination of clinical, morphological and genetic features revealed three subgroups: (a) KIT D816H- or Y-positive SM (KIT D816H/Ypos., n = 7), predominantly presenting as mast cell leukemia (MCL; 6/7 patients), (b) MCL with negative KIT sequencing (KITneg. MCL, n = 7) and (c) KITneg. SM with associated hematologic neoplasm (KITneg. SM-AHN, n = 5). Although >70% of patients in the two MCL cohorts (KIT D816H/Ypos. and KITneg.) were classified as low/intermediate risk according to prognostic scoring systems (PSS), treatment response was poor and median OS was shorter than in a KIT D816Vpos. MCL control cohort (n = 29; 1.7 vs. 0.9 vs. 2.6 years; p < 0.04). The KITneg. SM-AHN phenotype was dominated by the heterogeneous AHN (low mast cell burden, presence of additional mutations) with a better median OS of 4.5 years. We conclude that (i) in MCL, negativity for D816V is a relevant prognostic factor and (ii) PSS fail to correctly classify D816Vneg. patients.
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Affiliation(s)
- Nicole Naumann
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Martina Rudelius
- Institute of Pathology, Ludwig-Maximilian-University, 80337 Munich, Germany
| | - Johannes Lübke
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Deborah Christen
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), 52074 Aachen, Germany
| | - Jakob Bresser
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Karl Sotlar
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Georgia Metzgeroth
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Alice Fabarius
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Wolf-Karsten Hofmann
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Jens Panse
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), 52074 Aachen, Germany
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilian-University, 80337 Munich, Germany
| | - Nicholas C. P. Cross
- Wessex Genomics Laboratory Service, Salisbury SP2 8BJ, UK
- Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Andreas Reiter
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
| | - Juliana Schwaab
- Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (N.N.)
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5
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Wilhelm T, Toledo MAS, Simons I, Stuth C, Mohta V, Mülfarth R, Nitsche M, Maschke-Neuß K, Schmitz S, Kaiser A, Panse J, Christen D, Arock M, Zenke M, Huber M. Capitalizing on paradoxical activation of the mitogen-activated protein kinase pathway for treatment of Imatinib-resistant mast cell leukemia. Hematol Oncol 2023; 41:520-534. [PMID: 36383121 DOI: 10.1002/hon.3100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/29/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
Prevention of fatal side effects during cancer therapy of cancer patients with high-dosed pharmacological inhibitors is to date a major challenge. Moreover, the development of drug resistance poses severe problems for the treatment of patients with leukemia or solid tumors. Particularly drug-mediated dimerization of RAF kinases can be the cause of acquired resistance, also called "paradoxical activation." In the present work we re-analyzed the effects of different tyrosine kinase inhibitors (TKIs) on the proliferation, metabolic activity, and survival of the Imatinib-resistant, KIT V560G, D816V-expressing human mast cell (MC) leukemia (MCL) cell line HMC-1.2. We observed that low concentrations of the TKIs Nilotinib and Ponatinib resulted in enhanced proliferation, suggesting paradoxical activation of the MAPK pathway. Indeed, these TKIs caused BRAF-CRAF dimerization, resulting in ERK1/2 activation. The combination of Ponatinib with the MEK inhibitor Trametinib, at nanomolar concentrations, effectively suppressed HMC-1.2 proliferation, metabolic activity, and induced apoptotic cell death. Effectiveness of this drug combination was recapitulated in the human KIT D816V MC line ROSAKIT D816V and in KIT D816V hematopoietic progenitors obtained from patient-derived induced pluripotent stem cells (iPS cells) and systemic mastocytosis patient samples. In conclusion, mutated KIT-driven Imatinib resistance and possible TKI-induced paradoxical activation can be efficiently overcome by a low concentration Ponatinib and Trametinib co-treatment, potentially reducing the negative side effects associated with MCL therapy.
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Affiliation(s)
- Thomas Wilhelm
- Institute of Biochemistry and Molecular Immunology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Marcelo A S Toledo
- Department of Cell Biology, Institute for Biomedical Engineering, RWTH Aachen University Medical School, Aachen, Germany
- Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University Medical School, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Ilka Simons
- Institute of Biochemistry and Molecular Immunology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Christian Stuth
- Institute of Biochemistry and Molecular Immunology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Vrinda Mohta
- Institute of Biochemistry and Molecular Immunology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Ronja Mülfarth
- Institute of Biochemistry and Molecular Immunology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Marcus Nitsche
- Institute of Biochemistry and Molecular Immunology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Karin Maschke-Neuß
- Institute of Biochemistry and Molecular Immunology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Susanne Schmitz
- Department of Cell Biology, Institute for Biomedical Engineering, RWTH Aachen University Medical School, Aachen, Germany
- Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Anne Kaiser
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University Medical School, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Jens Panse
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University Medical School, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Deborah Christen
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University Medical School, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Michel Arock
- Department of Hematological Biology, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (UPMC), Paris, France
| | - Martin Zenke
- Department of Cell Biology, Institute for Biomedical Engineering, RWTH Aachen University Medical School, Aachen, Germany
- Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University Medical School, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Michael Huber
- Institute of Biochemistry and Molecular Immunology, Medical Faculty, RWTH Aachen University, Aachen, Germany
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6
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Kennedy VE, Perkins C, Reiter A, Jawhar M, Lübke J, Kluin-Nelemans HC, Shomali W, Langford C, Abuel J, Hermine O, Niedoszytko M, Gorska A, Mital A, Bonadonna P, Zanotti R, Tanasi I, Mattsson M, Hagglund H, Triggiani M, Yavuz AS, Panse J, Christen D, Heizmann M, Shoumariyeh K, Müller S, Elena C, Malcovati L, Fiorelli N, Wortmann F, Vucinic V, Brockow K, Fokoloros C, Papageorgiou SG, Breynaert C, Bullens D, Doubek M, Ilerhaus A, Angelova-Fischer I, Solomianyi O, Várkonyi J, Sabato V, Rüfer A, Schug TD, Hermans MAW, Fortina AB, Caroppo F, Bumbea H, Gulen T, Hartmann K, Elberink HO, Schwaab J, Arock M, Valent P, Sperr WR, Gotlib J. Mast cell leukemia: clinical and molecular features and survival outcomes of patients in the ECNM Registry. Blood Adv 2023; 7:1713-1724. [PMID: 36094848 PMCID: PMC10182174 DOI: 10.1182/bloodadvances.2022008292] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 11/20/2022] Open
Abstract
Mast cell leukemia (MCL) is a rare subtype of systemic mastocytosis defined by ≥20% mast cells (MC) on a bone marrow aspirate. We evaluated 92 patients with MCL from the European Competence Network on Mastocytosis registry. Thirty-one (34%) patients had a diagnosis of MCL with an associated hematologic neoplasm (MCL-AHN). Chronic MCL (lack of C-findings) comprised 14% of patients, and only 4.5% had "leukemic MCL" (≥10% circulating MCs). KIT D816V was found in 62/85 (73%) evaluable patients; 9 (11%) individuals exhibited alternative KIT mutations, and no KIT variants were detected in 14 (17%) subjects. Ten evaluable patients (17%) had an abnormal karyotype and the poor-risk SRSF2, ASXL1, and RUNX1 (S/A/R) mutations were identified in 16/36 (44%) patients who underwent next-generation sequencing. Midostaurin was the most common therapy administered to 65% of patients and 45% as first-line therapy. The median overall survival (OS) was 1.6 years. In multivariate analysis (S/A/R mutations excluded owing to low event rates), a diagnosis of MCL-AHN (hazard ratio [HR], 4.7; 95% confidence interval [CI], 1.7-13.0; P = .001) and abnormal karyotype (HR, 5.6; 95% CI, 1.4-13.3; P = .02) were associated with inferior OS; KIT D816V positivity (HR, 0.33; 95% CI, 0.11-0.98; P = .04) and midostaurin treatment (HR, 0.32; 95% CI, 0.08-0.72; P = .008) were associated with superior OS. These data provide the most comprehensive snapshot of the clinicopathologic, molecular, and treatment landscape of MCL to date, and should help further inform subtyping and prognostication of MCL.
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Affiliation(s)
| | - Cecelia Perkins
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Lübke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | | | - William Shomali
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Cheryl Langford
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Justin Abuel
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
| | - Olivier Hermine
- Imagine Institute Université de Paris, Sorbonne, INSERM U1163, Centre national de référence des mastocytoses, Hôpital Necker, Assistance publique hôpitaux de Paris, Paris, France
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdansk, Gdańsk, Poland
| | - Aleksandra Gorska
- Department of Allergology, Medical University of Gdansk, Gdańsk, Poland
| | - Andrzej Mital
- Department of Hematology, Medical University of Gdansk, Gdańsk, Poland
| | - Patrizia Bonadonna
- Department of Medicine, Section of Hematology, Verona University Hospital, Verona, Italy
| | - Roberta Zanotti
- Department of Medicine, Section of Hematology, Verona University Hospital, Verona, Italy
| | - Ilaria Tanasi
- Department of Medicine, Section of Hematology, Verona University Hospital, Verona, Italy
| | - Mattias Mattsson
- Department of Hematology, Uppsala University Hospital and Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Hans Hagglund
- Department of Hematology, Uppsala University Hospital and Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Akif Selim Yavuz
- Division of Hematology, Istanbul Medical School, University of Istanbul, Istanbul, Turkey
| | - Jens Panse
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, and Center for Integrated Oncology, Aachen, Bonn, Cologne, Düsseldorf, Aachen, Germany
| | - Deborah Christen
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, and Center for Integrated Oncology, Aachen, Bonn, Cologne, Düsseldorf, Aachen, Germany
| | - Marc Heizmann
- Division of Oncology, Haematology and Transfusion Medicine, Kantonsspital Aarau AG, University Clinic of Medicine, Aarau, Switzerland
| | - Khalid Shoumariyeh
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg and German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Sabine Müller
- Department of Dermatology, Medical Center-University of Frieburg, Faculty of Medicine, University of Frieburg, Frieburg, Germany
| | - Chiara Elena
- Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Malcovati
- Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicolas Fiorelli
- Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Friederike Wortmann
- Klinik für Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | | | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christos Fokoloros
- Mastocytosis Clinic, Allergy Unit, 2nd Department of Dermatology & Venereology, University of Athens, Attikon General University Hospital, Athens, Greece
| | - Sotirios G. Papageorgiou
- Mastocytosis Clinic, Allergy Unit, 2nd Department of Dermatology & Venereology, University of Athens, Attikon General University Hospital, Athens, Greece
- 2nd Propaedeutic Department of Internal Medicine and Research Institute, Hematology Unit, University of Athens, Attikon University Hospital, Athens, Greece
| | - Christine Breynaert
- KU Leuven Department of Microbiology, Immunology, and Transplantation, Allergy and Clinical Immunology Research Group and MASTeL, University Hospitals Leuven, Leuven, Belgium
| | - Dominique Bullens
- KU Leuven Department of Microbiology, Immunology, and Transplantation, Allergy and Clinical Immunology Research Group and MASTeL, University Hospitals Leuven, Leuven, Belgium
| | - Michael Doubek
- Brno University Hospital and Faculty of Medicine, Brno, Czechia
| | - Anja Ilerhaus
- Uniklinik Köln, Klinik für Dermatologie und Venerologie, Cologne, Germany
| | | | | | - Judit Várkonyi
- Department of Hematology, Semmelweis University, Budapest, Hungary
| | - Vito Sabato
- Department of Immunology, Allergy, and Rheumatology, Universiteit Antwerpen, Campus Drie Eiken, Antwerp, Belgium
| | - Axel Rüfer
- Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Maud A. W. Hermans
- Department of Internal Medicine, Section Allergy & Clinical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anna Belloni Fortina
- Pediatric Dermatology, Internal Medicine, Azienda Ospedaliera, Università di Padov, Padua, Italy
| | - Francesca Caroppo
- Pediatric Dermatology, Internal Medicine, Azienda Ospedaliera, Università di Padov, Padua, Italy
| | - Horia Bumbea
- Department of Hematology, Carol Davila University of Medicine, Emergency University Hospital, Bucharest, Romania
| | - Theo Gulen
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, and Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Karin Hartmann
- Division of Allergy, Departments of Dermatology and Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Hanneke Oude Elberink
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Michel Arock
- Laboratory of Hematology, Pitié-Salpêtrière Hospital, Paris, France
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang R. Sperr
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Jason Gotlib
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, CA
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7
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Lübke J, Schwaab J, Christen D, Elberink HO, Span B, Niedoszytko M, Gorska A, Lange M, Gleixner KV, Hadzijusufovic E, Solomianyi O, Angelova-Fischer I, Zanotti R, Bonifacio M, Bonadonna P, Shoumariyeh K, von Bubnoff N, Müller S, Perkins C, Elena C, Malcovati L, Hagglund H, Mattsson M, Parente R, Varkonyi J, Fortina AB, Caroppo F, Zink A, Brockow K, Breynaert C, Bullens D, Yavuz AS, Doubek M, Sabato V, Schug T, Niederwieser D, Hartmann K, Triggiani M, Gotlib J, Hermine O, Arock M, Kluin-Nelemans HC, Panse J, Sperr WR, Valent P, Reiter A, Jawhar M. Prognostic Impact of Organomegaly in Mastocytosis: An Analysis of the European Competence Network on Mastocytosis. J Allergy Clin Immunol Pract 2023; 11:581-590.e5. [PMID: 36403897 DOI: 10.1016/j.jaip.2022.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/13/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Organomegaly, including splenomegaly, hepatomegaly, and/or lymphadenopathy, are important diagnostic and prognostic features in patients with cutaneous mastocytosis (CM) or systemic mastocytosis (SM). OBJECTIVES To investigate the prevalence and prognostic impact of 1 or more organomegalies on clinical course and survival in patients with CM/SM. METHODS Therefore, 3155 patients with CM (n = 1002 [32%]) or SM (n = 2153 [68%]) enrolled within the registry of the European Competence Network on Mastocytosis were analyzed. RESULTS Overall survival (OS) was adversely affected by the number of organomegalies (OS: #0 vs #1 hazard ratio [HR], 4.9; 95% CI, 3.4-7.1, P < .001; #1 vs #2 HR, 2.1, 95% CI, 1.4-3.1, P < .001; #2 vs #3 HR, 1.7, 95% CI, 1.2-2.5, P = .004). Lymphadenopathy was frequently detected in patients with smoldering SM (SSM, 18 of 60 [30%]) or advanced SM (AdvSM, 137 of 344 [40%]). Its presence confered an inferior outcome in patients with AdvSM compared with patients with AdvSM without lymphadenopathy (median OS, 3.8 vs 2.6 years; HR, 1.6; 95% CI, 1.2-2.2; P = .003). OS was not different between patients having organomegaly with either ISM or SSM (median, 25.5 years vs not reached; P = .435). At time of disease progression, a new occurrence of any organomegaly was observed in 17 of 40 (43%) patients with ISM, 4 of 10 (40%) patients with SSM, and 33 of 86 (38%) patients with AdvSM, respectively. CONCLUSIONS Organomegalies including lymphadenopathy are often found in SSM and AdvSM. ISM with organomegaly has a similar course and prognosis compared with SSM. The number of organomegalies is adversely associated with OS. A new occurrence of organomegaly in all variants of SM may indicate disease progression.
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Affiliation(s)
- Johannes Lübke
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Juliana Schwaab
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Deborah Christen
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Hanneke Oude Elberink
- Department of Allergology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bart Span
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Aleksandra Gorska
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Magdalena Lange
- Department of Dermatology, Medical University of Gdańsk, Gdańsk, Poland
| | - Karoline V Gleixner
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Emir Hadzijusufovic
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria; Internal Medicine Small Animals, University Clinic for Small Animals, Department/University Clinic for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Oleksii Solomianyi
- University Clinic for Hematology and Oncology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Irena Angelova-Fischer
- Department of Dermatology and Venereology, Allergy Center, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Roberta Zanotti
- Section of Hematology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Massimiliano Bonifacio
- Section of Hematology, Department of Medicine, Verona University Hospital, Verona, Italy
| | | | - Khalid Shoumariyeh
- Department of Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg, Germany
| | - Nikolas von Bubnoff
- Department of Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Freiburg, Germany; Department of Hematology and Oncology, Medical Center, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Sabine Müller
- Department of Dermatology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Cecelia Perkins
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Chiara Elena
- Department of Molecular Medicine and Department of Hematology Oncology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Malcovati
- Department of Molecular Medicine and Department of Hematology Oncology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hans Hagglund
- Division of Hematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mattias Mattsson
- Division of Hematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Roberta Parente
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Judit Varkonyi
- Department of Hematology, Semmelweis University, Budapest, Hungary
| | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Francesca Caroppo
- Pediatric Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Alexander Zink
- Department of Dermatology and Allergy Biederstein, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Christine Breynaert
- KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group and MASTeL, University Hospitals Leuven, Leuven, Belgium
| | - Dominique Bullens
- KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group and MASTeL, University Hospitals Leuven, Leuven, Belgium
| | - Akif Selim Yavuz
- Division of Hematology, Istanbul Medical School, University of Istanbul, Istanbul, Turkey
| | - Michael Doubek
- University Hospital and Faculty of Medicine, Brno, Czechia
| | - Vito Sabato
- Faculty of Medicine and Health Sciences, Department of Immunology-Allergology-Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerpen, Belgium
| | - Tanja Schug
- Department of Dermatology and Venereology, University Hospital Graz, Graz, Austria
| | | | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Jason Gotlib
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Olivier Hermine
- French Reference Center for Mastocytosis (CEREMAST), Hôpital Necker, Assistance Publique Hôpitaux de Paris, Imagine Institute, University Paris Descartes, Paris, France
| | - Michel Arock
- Laboratory of Hematology, Pitié-Salpêtrière Hospital, Paris, France
| | - Hanneke C Kluin-Nelemans
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jens Panse
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany; Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
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8
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Atakhanov S, Christen D, Rolles B, Schüler HM, Panse J, Chatain N, Koschmieder S, Brümmendorf TH, Toledo MAS, Zenke M. Towards personalized medicine with iPS cell technology: a case report of advanced systemic mastocytosis with associated eosinophilia. Ann Hematol 2022; 101:2533-2536. [PMID: 36125543 PMCID: PMC9486762 DOI: 10.1007/s00277-022-04975-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/04/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Salim Atakhanov
- grid.1957.a0000 0001 0728 696XInstitute for Biomedical Engineering, Department of Cell Biology, RWTH Aachen University Medical School, Aachen, Germany ,grid.1957.a0000 0001 0728 696XHelmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany ,grid.1957.a0000 0001 0728 696XInstitute for Cell and Tumor Biology, RWTH Aachen University Medical School, Aachen, Germany
| | - Deborah Christen
- grid.1957.a0000 0001 0728 696XDepartment of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Benjamin Rolles
- grid.1957.a0000 0001 0728 696XDepartment of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany ,grid.38142.3c000000041936754XDivision of Hematology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Herdit M. Schüler
- grid.412301.50000 0000 8653 1507Institute for Human Genetics, RWTH Aachen University Hospital, Aachen, Germany
| | - Jens Panse
- grid.1957.a0000 0001 0728 696XDepartment of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Nicolas Chatain
- grid.1957.a0000 0001 0728 696XDepartment of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Steffen Koschmieder
- grid.1957.a0000 0001 0728 696XDepartment of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Tim H. Brümmendorf
- grid.1957.a0000 0001 0728 696XDepartment of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Marcelo A. S. Toledo
- grid.1957.a0000 0001 0728 696XInstitute for Biomedical Engineering, Department of Cell Biology, RWTH Aachen University Medical School, Aachen, Germany ,grid.1957.a0000 0001 0728 696XHelmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany ,grid.1957.a0000 0001 0728 696XDepartment of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - Martin Zenke
- grid.1957.a0000 0001 0728 696XInstitute for Biomedical Engineering, Department of Cell Biology, RWTH Aachen University Medical School, Aachen, Germany ,grid.1957.a0000 0001 0728 696XHelmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany ,grid.1957.a0000 0001 0728 696XDepartment of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany ,Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
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Dohrn MF, Schöne U, Küppers C, Christen D, Schulz JB, Gess B, Tauber S. Immunoglobulins to mitigate paraneoplastic Lambert Eaton Myasthenic Syndrome under checkpoint inhibition in Merkel cell carcinoma. Neurol Res Pract 2020; 2:52. [PMID: 33324947 PMCID: PMC7727206 DOI: 10.1186/s42466-020-00099-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023] Open
Abstract
Lambert-Eaton myasthenic syndrome (LEMS) is a rare, autoimmune or paraneoplastic condition characterized by muscle weakness and fatigability. In cancer therapy, immune checkpoint inhibitors (ICI) sensitize the immune system for tumor antigens. We report a 62-year-old, female patient with paraneoplastic LEMS as first manifestation of Merkel cell carcinoma. Under avelumab, the LEMS exacerbated with worsening of limb weakness and a severely reduced vital capacity (< 1 l). To treat this immunological side effect, we added a regimen with intravenous immunoglobulins. Hereby, the LEMS improved significantly. As we were able to continue the cancer treatment, the Merkel cell carcinoma has been in remission so far. This is the first description of paraneoplastic LEMS, avelumab, and Merkel cell carcinoma. We conclude that immunoglobulins are an option to control an ICI-associated deterioration of paraneoplastic symptoms.
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Affiliation(s)
- Maike F Dohrn
- Department of Neurology, Medical Faculty of the RWTH Aachen University, Aachen, Germany.,Dr. John T. Macdonald Foundation, Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, Florida USA
| | - Ulrike Schöne
- Department of Neurology, Medical Faculty of the RWTH Aachen University, Aachen, Germany
| | - Charlotte Küppers
- Department of Neurology, Medical Faculty of the RWTH Aachen University, Aachen, Germany
| | - Deborah Christen
- Department of Oncology and Hematology, Medical Faculty of the RWTH Aachen University, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, Medical Faculty of the RWTH Aachen University, Aachen, Germany
| | - Burkhard Gess
- Department of Neurology, Medical Faculty of the RWTH Aachen University, Aachen, Germany
| | - Simone Tauber
- Department of Neurology, Medical Faculty of the RWTH Aachen University, Aachen, Germany
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Christen D, Sohlbach K, Metzelder SK, Wollmer E, Hoeffkes HG, Naumann R, Burchardt A, Rummel M, Trenker C, Dohse M, Mack E, Klameth A, Mann C, Kostrewa P, Brendel C, Wündisch T, Neubauer A, Wilhelm C, Burchert A. Outcome of non-mold effective anti-fungal prophylaxis in patients at high-risk for invasive fungal infections after allogenic stem cell transplantation. Leuk Lymphoma 2019; 60:2056-2061. [PMID: 30644334 DOI: 10.1080/10428194.2018.1553303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Patients who develop severe graft-versus-host disease (GvHD) after allogeneic stem cell transplantation (alloSCT) have a higher risk for invasive fungal infection (IFI). At our center, fluconazole prophylaxis is standard and upfront mold-effective prophylaxis performed only in patients with specific risk constellations. A total of 290 patients undergoing alloSCT between May 2002 and August 2011 were analyzed. Patients were regarded as high-risk if they suffered from acute GvHD II-IV° or extensive chronic GvHD. The 2-year incidence of an IFI after alloSCT was 8.97% (26/290) in the entire cohort and 7.78% (7/90) in the high-risk group. Mortality due to IFI was 3.85% (1/26) without including a high-risk patient. In the multivariate analysis a pre-transplant fungal infection was the only significant risk factor for developing an IFI after alloSCT (HR = 5.298; p = .001). A fluconazole prophylaxis in patients with GvHD after alloSCT is feasible in facilities with HEPA filtration and high awareness of clinical signs for IFI.
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Affiliation(s)
- Deborah Christen
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Kristina Sohlbach
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Stephan K Metzelder
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Ellen Wollmer
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | | | - Ralph Naumann
- c Department of Hematology , Oncology and Palliative Care, St. Marien Krankenhaus Siegen , Siegen , Germany
| | - Alexander Burchardt
- d Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Gießen , Germany
| | - Mathias Rummel
- d Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Gießen , Germany
| | - Corinna Trenker
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Marius Dohse
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Elisabeth Mack
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Andreas Klameth
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Christoph Mann
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Philippe Kostrewa
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Cornelia Brendel
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Thomas Wündisch
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Andreas Neubauer
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Christian Wilhelm
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
| | - Andreas Burchert
- a Department of Hematology, Oncology and Immunology , University Hospital Giessen and Marburg , Marburg , Germany
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Abstract
Reasons for leukopenia can be numerous. To get close to the diagnosis it's always useful to check previous blood counts of the patient to get a feeling for the dynamic development of the leukopenia. Furthermore, it's important to check the red blood cell count and platelet count as well; a bi- or a pancytopenia usually implies an insufficient production in the bone marrow. Nevertheless, a manual counted peripheral blood smear is an essential step towards the right diagnosis in leukopenia: Beside cell counts of the single subgroups of leucocytes it also provides information on potential causes such as dysplasia.Leukopenia can be life-threatening for the patient especially if the patient presents with an agranulocytosis and fever: In this case admission is mandatory and the patient has to be treated immediately with broad-spectrum antibiotics to reduce mortality.
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Christen D, Camps C, Summermatter A, Gabioud Rebeaud S, Baumgartner D. PREDICTION OF THE PRE- AND POSTHARVEST APRICOT QUALITY WITH DIFFERENT VIS/NIRS DEVICES. ACTA ACUST UNITED AC 2012. [DOI: 10.17660/actahortic.2012.966.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Melton LJ, Riggs BL, Müller R, Achenbach SJ, Christen D, Atkinson EJ, Amin S, Khosla S. Determinants of forearm strength in postmenopausal women. Osteoporos Int 2011; 22:3047-54. [PMID: 21308363 PMCID: PMC3150635 DOI: 10.1007/s00198-011-1540-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 12/20/2010] [Indexed: 12/31/2022]
Abstract
UNLABELLED Bone strength at the ultradistal radius, quantified by micro-finite element modeling, can be predicted by variables obtained from high-resolution peripheral quantitative computed tomography scans. The specific formula for this bone strength surrogate (-555.2 + 8.1 × [trabecular vBMD] + 19.6 × [cortical area] + 4.2 × [total cross-sectional area]) should be validated and tested in fracture risk assessment. INTRODUCTION The purpose of this study was to identify key determinants of ultradistal radius (UDR) strength and evaluate their relationships with age, sex steroid levels, and measures of habitual skeletal loading. METHODS UDR failure load (~strength) was assessed by micro-finite element (μFE) modeling in 105 postmenopausal controls from an earlier forearm fracture case-control study. Predictors of bone strength obtained by high-resolution peripheral quantitative computed tomography (HRpQCT) in this group were then evaluated in a population-based cohort of 214 postmenopausal women. Sex steroids were measured by mass spectrometry. RESULTS A surrogate variable (-555.2 + 8.1 × [trabecular vBMD] + 19.6 × [cortical area] + 4.2 × [total cross-sectional area]) predicted UDR strength modeled by μFE (R(2) = 0.81), and all parameters except total cross-sectional area declined with age. Evaluated cross-sectionally, the 21% fall in predicted bone strength between ages 40-49 years and 80+ years more resembled the change in trabecular volumetric bone mineral density (vBMD) (-15%) than that in cortical area (-41%). In multivariable analyses, measures of body composition and physical activity were stronger predictors of UDR trabecular vBMD, cortical area, total cross-sectional area, and predicted bone strength than were sex steroid levels, but bio-available estradiol and testosterone were correlated with body mass. CONCLUSIONS Bone strength at the UDR, as quantified by μFE, can be predicted from variables obtained by HRpQCT. Predicted bone strength declines with age with changes in UDR trabecular vBMD and cortical area, related in turn to reduced skeletal loading and sex steroid levels. The predicted bone strength formula should be validated and tested in fracture risk assessment.
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Affiliation(s)
- L J Melton
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Basler S, Mueller T, Christen D, Wirth A, Müller R, van Lenthe G. Towards validation of computational analyses of peri-implant displacements by means of experimentally obtained displacement maps. Comput Methods Biomech Biomed Engin 2011; 14:165-74. [DOI: 10.1080/10255842.2010.537263] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Melton LJ, Christen D, Riggs BL, Achenbach SJ, Müller R, van Lenthe GH, Amin S, Atkinson EJ, Khosla S. Assessing forearm fracture risk in postmenopausal women. Osteoporos Int 2010; 21:1161-9. [PMID: 19714390 PMCID: PMC2889027 DOI: 10.1007/s00198-009-1047-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 08/06/2009] [Indexed: 12/31/2022]
Abstract
UNLABELLED A diverse array of bone density, structure, and strength parameters were significantly associated with distal forearm fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes. INTRODUCTION This study seeks to test the clinical utility of approaches for assessing forearm fracture risk. METHODS Among 100 postmenopausal women with a distal forearm fracture (cases) and 105 with no osteoporotic fracture (controls), we measured aBMD and assessed radius volumetric bone mineral density, geometry, and microstructure; ultradistal radius failure load was evaluated in microfinite element (microFE) models. RESULTS Fracture cases had inferior bone density, geometry, microstructure, and strength. The most significant determinant of fracture in five categories were bone density (femoral neck aBMD; odds ratio (OR) per standard deviation (SD), 2.0; 95% confidence interval (CI), 1.4-2.8), geometry (cortical thickness; OR, 1.5; 95% CI, 1.1-2.1), microstructure (structure model index (SMI); OR, 0.5; 95% CI, 0.4-0.7), and strength (microFE failure load; OR, 1.8; 95% CI, 1.3-2.5); the factor-of-risk (applied load in a forward fall / microFE failure load) was 15% worse in cases (OR, 1.9; 95% CI, 1.4-2.6). Areas under receiver operating characteristic curves (AUC) ranged from 0.62 to 0.68. The predictors of forearm fracture risk that entered a multivariable model were femoral neck aBMD and SMI (combined AUC, 0.71). CONCLUSIONS Detailed bone structure and strength measurements provide insight into forearm fracture pathogenesis, but femoral neck aBMD performs adequately for routine clinical risk assessment.
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Affiliation(s)
- L J Melton
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Christensen H, Poulsen M, Rasmussen P, Christen D. Development of an LC-MS/MS method for the determination of pesticides and patulin in apples. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2009; 26:1013-23. [DOI: 10.1080/02652030902806144] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hagen ME, Wagner OJ, Christen D, Morel P. Cosmetic issues of abdominal surgery: results of an enquiry into possible grounds for a natural orifice transluminal endoscopic surgery (NOTES) approach. Endoscopy 2008; 40:581-3. [PMID: 18609452 DOI: 10.1055/s-2008-1077363] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Decreased scarring is an advantage of minimally invasive surgery. The new experimental technique of natural orifice transluminal surgery (NOTES) aims at totally scarless surgery. We examined the general attitudes of patients and unaffected persons towards scarless surgery. METHODS AND PARTICIPANTS We used a 7-item questionnaire in structured interviews with hospital visitors, following detailed standardized explanation of terms used and of possible complications, to groups of 10 participants, during an "open ward" day. A visual analog scale (VAS) from 1 (none) to 10 (very much) was used for all but one item. Questions concerned the importance of cosmetic results in abdominal surgery, satisfaction regarding existing scars, hypothetical acceptance of increased risk as a trade-off for the absence of scars, and other issues. Data were analyzed for participants overall, and for three age groups and both sexes. RESULTS 292 participants (male : female 1 : 1; mean age 43 years) completed the questionnaire. Cosmetic issues were rated as important (median 8), but acceptance of existing scars was also high in those affected (median 8, n=68). Approval of scarless surgery decreased with a presumed risk increase (from score 9 down to score 5), and overall an increase in risk of 10 % was judged to be acceptable as a trade-off for total absence of scarring. Younger people tended to be less satisfied with scars, but were also less inclined than older people to accept higher surgical risk in this hypothetical context. CONCLUSIONS People generally seem to favor scarless abdominal surgery, even with some increase in risk.
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Affiliation(s)
- M E Hagen
- Department of Digestive Surgery, University Hospital Geneva, Geneva, Switzerland.
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Hermann A, Niemeyer J, Mack HG, Kopitzky R, Beuleke M, Willner H, Christen D, Schäfer M, Bauder A, Oberhammer H. Gas-phase structures of acetyl peroxynitrate and trifluoroacetyl peroxynitrate. Inorg Chem 2001; 40:1672-6. [PMID: 11261978 DOI: 10.1021/ic001077r] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The molecular structures and conformational properties of acetyl peroxynitrate (PAN, CH3C(O)OONO2) and trifluoroacetyl peroxynitrate (FPAN, CF3C(O)OONO2) were investigated in the gas phase by electron diffraction (GED), microwave spectroscopy (MW), and quantum chemical methods (HF/3-21G, HF/6-31G*, MP2/6-31G*, B3PW91/6-31G*, and B3PW91/6-311+G*). All experimental and theoretical methods show the syn conformer (C=O bond of acetyl group syn to O-O bond) to be strongly predominant relative to the anti conformer. The O-NO2 bonds are extremely long, 1.492(7) A in PAN and 1.526(10) A in FPAN, which correlates with their low bond energy and the easy formation of CX3C(O)OO* and *NO2 radicals in the atmosphere. The O-O bonds (1.418(12) A in PAN and 1.408(8) A in FPAN) are shorter than that in hydrogen peroxide (1.464 A). In both compounds the C-O-O-N dihedral angle is close to 85 degrees.
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Affiliation(s)
- A Hermann
- Institut für Physikalische und Theoretische Chemie, Universität Tübingen, D-72076 Tübingen, Germany
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Christen D, Coudert LH, Larsson JA, Cremer D. The Rotational-Torsional Spectrum of the g'Gg Conformer of Ethylene Glycol: Elucidation of an Unusual Tunneling Path. J Mol Spectrosc 2001; 205:185-196. [PMID: 11162205 DOI: 10.1006/jmsp.2000.8263] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The microwave spectrum of the energetically unfavored g'Gg conformer of ethylene glycol (CH(2)OH&bond;CH(2)OH) is reported. This spectrum is dominated by an interconversion geared-type large-amplitude motion during which each OH group in turn forms the intramolecular hydrogen bond. The microwave spectrum has been analyzed with the help of a Watson-type Hamiltonian plus a 1.4-GHz tunneling splitting. The rotational dependence of this tunneling splitting has been examined using an IAM approach and this yielded qualitative information on the tunneling path the molecule uses to interconvert between its two most stable conformers. Unexpectedly, but in agreement with ab initio calculations, when tunneling occurs between the energetically equivalent g'Gg and gGg' conformers, the OH groups are rotated stepwise through 240 degrees in the sense of a flip-flop rather than a concerted rotation and the molecule goes through the more stable g'Ga and aGg' forms. The electronic reasons for preferring a long rather than a short rotational path via a gGg form are discussed using calculated adiabatic vibrational modes. Copyright 2001 Academic Press.
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Affiliation(s)
- D. Christen
- Institut für Physikalische und Theoretische Chemie, Universität Tübingen, Auf der Morgenstelle 8, Tübingen, D-72076, Germany
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Christen D, Mack HG, Müller H. Quantum chemical calculations of spectroscopic properties for chloryl chloride, ClClO 2 , and other Cl 2 O 2 isomers. J Mol Struct 1999. [DOI: 10.1016/s0022-2860(99)00216-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Asimus M, Schühle S, Christen D, Møllendal H, Vedova C, Lieb M, Oberhammer H. Structure and conformations of 1,1,1-trifluoromethanesulfenylamine, CF 3 SNH 2 . Gas electron diffraction, microwave spectroscopy and theoretical calculations. J Mol Struct 1999. [DOI: 10.1016/s0022-2860(99)00089-7] [Citation(s) in RCA: 2] [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: 11/28/2022]
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Buchmann P, Bischofberger U, De Lorenzi D, Christen D. [Early postoperative nutrition after laparoscopic and open colorectal resection]. Swiss Surg 1998; 4:146-55. [PMID: 9655010] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Discussions concerning postoperative nutrition were brought up again with laparoscopic colorectal surgery. We are looking whether there is any difference between open and minimal invasive procedures with respect to the start of oral intake. METHODS In a prospective controlled trial 152 patients were analysed after laparoscopic (n = 85) or open (n = 67) colorectal resections. At the first postoperative day fluid intake was unlimited and from the second day regular food was permitted according to the patients desire. RESULTS No influence on the beginning of nutrition was by age, diagnoses, type of operation nor their duration. Wound infection and specially cardiopulmonal decompensation prolonged lack of appetite, however, not a pneumonia. There was no increase of anastomotic leak rate. At day 4, a highly significant difference was found between laparoscopic and open surgery with 90% and 60% of patients having started regular nutrition (p < 0.001). CONCLUSION Early postoperative oral nutrition does not increase complication rate. Patients after laparoscopic procedures start earlier eating compared with those after conventional surgery. We recommend early postoperative oral intake after both techniques according to the patients desire.
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Affiliation(s)
- P Buchmann
- Chirurgische Klinik, Stadtspital Waid Zürich
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Buchmann P, Christen D, Buschta G, Sartoretti C. [Intraperitoneal tumor seeding in colorectal carcinoma surgery--follow-up of a comparison of laparoscopic versus open procedure]. Langenbecks Arch Chir Suppl Kongressbd 1998; 114:1122-4. [PMID: 9574353] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Follow-up 71 patients during 20 months (12-29) operated on for colorectal cancer by laparoscopic or open surgery demonstrated no correlation between port-side metastases (1/35) or tumor recurrences (5/71) and intraperitoneal tumor cells. All these patients were cytologic-negative; however, all were initial in an advanced tumor stage (pT3-4, N1-3). We conclude from these results that free tumor cells during operation do not seem to influence outcome or the development of port-side metastases.
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Christen D. Vibrational Information Extracted from Inertial Defects: The Complete General Valence Force Field for 1,1-Difluoroethene. J Mol Spectrosc 1998; 187:42-48. [PMID: 9473419 DOI: 10.1006/jmsp.1997.7481] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The method of extracting harmonic information from inertial defect differences has been used to obtain sufficient information for a determination of the complete force field for 1,1-difluoroethylene. The presumption that inertial defect differences for non-totally-symmetric vibrations of orthorhombic molecules contain purely harmonic information (1992. D. Christen, J. Mol. Spectrosc. 151, 1-11) must be revoked, however. Copyright 1998 Academic Press. Copyright 1998Academic Press
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Affiliation(s)
- D Christen
- Institut fur Physikalische und Theoretische Chemie, Universitat Tubingen, Tubingen, D-72076, Germany
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Christen D. [Rectal prolapse]. Ther Umsch 1997; 54:193-6. [PMID: 9221542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Rectal prolapse is the transposition of the entire rectal wall into the rectal lumen, the anal canal or through the anal canal out side. It differs from anal prolapse in thickness, circular plication of the mucosa and, if large, its extent. The cause is not clearly established, but disorders in bowel movement seem to be of importance. Symptoms reach from the feeling of incomplete evacuation to defecation block and irreducible prolapse. The diagnosis of outer prolapse is easy. The inner prolapse [intussusception] can be suspected by anamnesis and in the presence of solitary rectal ulcer. Defecography gives the conclusive examination. Conservative therapy is analogous to hemorrhoids: Fibres and sufficient liquid intake. Operative procedures can be divided in transabdominal and perineal procedures. From the latter Delorme's procedure gives good results with low stress for the patient. Of the transabdominal procedures we favor rectopexy with Ivalon-sponge, preservation of the lateral bands and sigmoid resection. This procedure can easily be done by laparoscopy. Postoperative constipation is observed above all if the lateral bands are dissected and no sigmoid resection is done. Preexistent constipation Improves in about 50% of the cases. Same does incontinence.
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Affiliation(s)
- D Christen
- Chirurgische Klinik, Stadtspital Waid, Zürich
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Glättli A, Birrer S, Buchmann P, Christen D, Frei E, Klaiber C, Krähenbühl L, Lange J, Metzger U. [Technique and results of laparoscopic rectum resection]. Schweiz Med Wochenschr Suppl 1996; 79:85S-88S. [PMID: 8701269] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The general principles of oncologic operations for colorectal cancer are the same for both open and laparoscopic surgery. Isolation of the tumor by occlusion of the intestinal lumen, early blockage of venous outflow, complete resection of the lymph node bearing mesenterium, high ligation of the artery and prevention of tumor cell dissemination during extirpation of the specimen are the most important factors. We present our technique for laparoscopic abdominoperineal resection, which fulfills the above mentioned criteria. From June 1993 to October 1994 we operated on 19 patients (median age 68 [47-91] years; male/female ratio 10/9). Laparoscopic abdominoperineal resection of the rectum was palliative in 3 patients and curative in 16. Tumors were located 3 (1-8) cm from the anal verge. In 3 patients the operation was converted to open surgery. Intraoperative complications were encountered in 3 patients. Median operation time was 300 (200-400) minutes and postoperative morbidity 8/19 (42%) leading to reoperation in one patient. 30-day mortality was nil. Three patients died 5, 8, and 14 months postoperatively due to metastatic disease (all 3 after initial palliation). One patient had local recurrence and liver metastasis and died 14 months after operation. Another patient died from liver metastases. In one patient a single liver metastasis was successfully removed. 14 patients were tumor-free after a median follow-up of 10 (3-14) months. There was no implantation metastasis on a trocar site. Laparoscopic abdominoperineal resection of the rectum is feasible and the results are comparable with those of open surgery. Local recurrence rate and incidence of liver metastases are comparable with open surgery after this short follow-up. However, 5-year survival is needed to judge the oncological radicality of laparoscopic abdominoperineal resection of the rectum.
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Affiliation(s)
- A Glättli
- Chirurgische Kliniken: Zieglerspital Bern
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Buchmann P, Christen D, Moll C, Flury R. [Intraperitoneal tumor seeding in colorectal carcinoma surgery--a comparison of laparoscopic versus open procedures in a longitudinal study]]. Langenbecks Arch Chir Suppl Kongressbd 1996; 113:573-6. [PMID: 9101936] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Tumor cell spread during laparoscopically assisted (n = 35) and open (n = 27) resections of colorectal cancer or patients with peritoneal carcinomatosis (PC) (n = 5) was studied by repeated lavage. Positive cytology was found in 3% during laparoscopy, 11% during open surgery and 80% in PC. We conclude that the risk of cancer cell mobilisation is minimal in laparoscopic surgery.
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Affiliation(s)
- P Buchmann
- Chirurgische Klinik, Stadtspital Waid, Zürich
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Buchmann P, Christen D, Flury R, Lüthy A, Bischofberger U. [Does laparoscopic colonic carcinoma surgery satisfy the radicality criteria of open surgery?]. Schweiz Med Wochenschr 1995; 125:1825-1829. [PMID: 7481640] [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] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Minimal invasive surgery is applicable to almost all colorectal operations, with major benefit for the patient. Technically even cancer operations can be performed. However, in laparoscopic assisted colorectal surgery the question of radicality outweighs that of performability and patient comfort. From a prospective series of 88 laparoscopic colorectal operations, 36 were for carcinoma. 34 patients who underwent conventional surgery were matched with regard to age, sex, type of operation and tumor stage (TNM, grading) to compare the two techniques. The two interventions followed exactly the same guidelines. We compared the length of the fixed specimens, the number of resected lymph nodes and the need for blood transfusions. Postoperative complications were noted and follow-up was 3-12 months. The data obtained showed no difference between the two treatment groups, with a slight trend towards laparoscopic surgery with regard to number of resected lymph nodes. A portside metastasis was observed 9 months after an initial tumor stage T4N1M1. The close relation between the portside and infiltration of the adenocarcinoma into the abdominal wall together with a drain placed through this whole was suspected to be the cause of this complication. We conclude that laparoscopic assisted colorectal surgery for cancer is equal to open operation regarding radicality of resection. Long term results are mandatory to determine the value of minimal invasive surgery in the field of oncology.
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Affiliation(s)
- P Buchmann
- Chirurgische Klinik, Stadtspital Waid, Zürich
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Christen D, Buchmann P, Klingler K. [How safe is laparoscopic colon surgery?]. Schweiz Med Wochenschr 1995; 125:1597-601. [PMID: 7569832] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Like any new technique, laparoscopic colon surgery must display results of the same or even better quality than established methods. In this hospital every laparoscopic colon operation has been registered since 1993. Patients were informed orally or in writing that the laparoscopic procedure is a new surgical technique and that, in particular, long term results in colon carcinoma are lacking. Patients who did not undergo the laparoscopic method were those who did not agree to this type of surgery, had tumor infiltrations without extensive liver metastases, or tumor sizes where laparotomy to retrieve the specimen is not much smaller than the open surgery incision. All operations without exception were performed by two laparoscopically skilled abdominal surgeons. We used four 12 mm Troicarts placed in a diamond position, the criteria for mobilization and resection strictly following those of open surgery. In rectosigmoid resection the specimens were extracted suprapubically, with simultaneous implantation of the anvil, in the other cases at appropriate sites. The anastomoses were created either by the double stapling technique or with a single layer running suture. 88 patients underwent operation. The change to open surgery was 11%. The reasons for the change were chiefly inflamed, bleeding diverticulitis tumor, carcinoma infiltrations and, in one case, bleeding. The anastomosis failure rate of the descendorectostomy, and in all laparoscopic colon operations, was 4% and compares favourably with the literature. This was also true of stenosis incidence. The wound infection rate is on the whole the same as for open surgery. The complication in the descendorectostomy is reduced by half in the laparoscopic procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Christen
- Chirurgische Klinik, Stadtspital Waid, Zürich
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Abstract
The behaviour of 1H-cyclopropabenzene (1) and 1H-cyclopropa[b]naphthalene (23) towards a variety of radicals results in opening of the three- membered ring to give ortho -substituted benzyl and 2-methylnaphthalene derivatives, e.g. (13) and (28), respectively. Ring expansion into the cycloheptatriene manifold by way of addition to the bridge bond and norcaradiene formation have not been observed. Analogous reactions with the methylidenecyclopropa [b] naphthalenes (33) and (34) lead to much decomposition, and provide little evidence for the C1cycloproparenyl radicals (35) and (36).
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Stejic G, Gurevich A, Kadyrov E, Christen D, Joynt R, Larbalestier DC. Effect of geometry on the critical currents of thin films. Phys Rev B Condens Matter 1994; 49:1274-1288. [PMID: 10010437 DOI: 10.1103/physrevb.49.1274] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Abstract
Since July 1986 we started with following all patients with condylomata acuminata including HIV-testing and human papilloma virus (HPV) identification by DNA-DNA-hybridisation (southern blot). Seventy patients are included, 39 of them are seropositive. The ratio male to female is 59 to 11, in seropositives 35 to 4, in negatives 24 to 7. The average age is 28 and 31 years respectively. The number of homosexuals and junkies is significantly higher in seropositives. Seventeen patients are in HIV-stage II, 11 in stage III and 10 in stage IV according to CDC-classification. Characteristic for the seropositives was an extensive growth on the rectal mucosa and the very rapid growth of initially subtotally resected lesions in order to prevent stenosis. Sixty-five patients were treated by one stage radical operation with electrocauter. Surprisingly recurrency is more frequent in seronegatives, however, the lesion is much smaller in this group. A hypothesis to explain this observation is brought forward. Postoperative complications occurred only in HIV-stages III and IV. We therefore recommend single shot antibiotic prophylaxis in these patients. The HPV-identification showed no malignancy associated HPV-types in both groups but a higher incidence of HPV 11 in higher HIV-stages which we cannot explain. We conclude from our series that, if operation is indicated, one stage radical electrocoagulation of condylomata acuminata is a necessary procedure in seropositive patients and a save one in negative patients but antibiotic prophylaxis should be given in stage III and IV. Anal condylomata acuminata are a hint for possible HIV-positivity.
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Affiliation(s)
- D Christen
- Departement Chirurgie, Universitätsspital, Zürich
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Christen D, Britschgi F, Buchmann P, Müller C. [Herniation of the cecum and ascending colon through the foramen epiploicum]. Chirurg 1991; 62:65-7. [PMID: 2026074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- D Christen
- Chirurgische Abteilung, Kantonsspital Obwalden, Sarnen
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Buchmann P, Christen D, Rüdlinger R, Geroulanos S. [Anal condylomata acuminata. A prospective comparison of HIV positive and negative patients]. Chirurg 1991; 62:32-5. [PMID: 2026066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Between July 1986 and May 1987 23 patients suffering from anal condylomata acuminata were treated at the University Hospital of Zurich. The influence of HIV-infection on the disease is described. An almost equal frequency of recurrencies between positives and negatives was observed in a three year follow-up time. However, in positive patients recurrence was earlier and much more extensive. A two-stage procedure which sometimes is advocated in very extensive lesions gave very bad results in HIV positives. We use a radical excision by electrocoagulation on the mucosa and perianally and avoid circular necrosis in the lower anal canal only. Infectious complications are not to be feared except in patients with symptomatic HIV-infection resulting in the recommendation for a antibiotic prophylaxis in such cases.
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Affiliation(s)
- P Buchmann
- Klinik für Viszeralchirurgie, Departement Chirurgie, Universitätsspital Zürich
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Christen D, Buchmann P, Rüdlinger R. [The course of proctologic disorders in HIV-positive patients]. Schweiz Rundsch Med Prax 1988; 77:1208-11. [PMID: 3238246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Rüdlinger R, Grob R, Buchmann P, Christen D, Steiner R. Anogenital warts of the condyloma acuminatum type in HIV-positive patients. Dermatologica 1988; 176:277-81. [PMID: 2841174 DOI: 10.1159/000248735] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Anogenital warts of the condyloma acuminatum type seem to occur quite often during HIV infection. These warts--according to our study--are not commonly caused by malignancy-associated human papilloma virus types, but by types 6 and 11 as seen in the nonimmune-compromised population. Widespread condylomata acuminata may appear in rather early stages of HIV infection and they may therefore represent early warning signs of HIV infection.
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Affiliation(s)
- R Rüdlinger
- Department of Dermatology, University Hospital, Zürich, Switzerland
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Christen D, Mack H, Oberhammer H, Marsden C, Seppelt K, Willner H. The gas phase structure of trifluoroethylidynesulfur trifluoride, CF3CSF3. J Fluor Chem 1987. [DOI: 10.1016/0022-1139(87)95185-2] [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]
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Fehse W, Christen D, Zeil W. The construction of a microcomputer controlled microwave-microwave double resonance spectrometer incorporating two crossed fabry-perot resonators. J Mol Struct 1983. [DOI: 10.1016/0022-2860(83)90202-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cervellati R, Lister D, Christen D, Hoffmann V. The microwave spectrum and methoxy torsional frequency of the anti rotamer of m-fluoroanisole. J Mol Struct 1982. [DOI: 10.1016/0022-2860(82)80047-1] [Citation(s) in RCA: 6] [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: 10/18/2022]
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