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Straka C, Liebisch P, Salwender H, Hennemann B, Metzner B, Knop S, Adler-Reichel S, Gerecke C, Wandt H, Bentz M, Bruemmendorf TH, Hentrich M, Pfreundschuh M, Wolf HH, Sezer O, Bargou R, Jung W, Trümper L, Hertenstein B, Heidemann E, Bernhard H, Lang N, Frickhofen N, Hebart H, Schmidmaier R, Sandermann A, Dechow T, Reichle A, Schnabel B, Schäfer-Eckart K, Langer C, Gramatzki M, Hinke A, Emmerich B, Einsele H. Autotransplant with and without induction chemotherapy in older multiple myeloma patients: long-term outcome of a randomized trial. Haematologica 2016; 101:1398-1406. [PMID: 27662018 DOI: 10.3324/haematol.2016.151860] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/03/2016] [Indexed: 12/22/2022] Open
Abstract
Autologous transplantation is controversial for older patients with multiple myeloma. The role of age-adjusted high-dose melphalan and the impact of induction chemotherapy cycles is still unclear. A total of 434 patients aged 60-70 years were randomly assigned to 4 cycles of standard anthracycline-based induction chemotherapy or no induction. For all patients, double autologous transplantation after melphalan 140 mg/m2 (MEL140) was planned. The primary end point was progression-free survival. Of 420 eligible patients, 85% received a first transplant and 69% completed double transplantation. Treatment duration was short with a median of 7.7 months with induction chemotherapy cycles and 4.6 months without induction. On an intention-to-treat basis, median progression-free survival with induction chemotherapy cycles (207 patients) was 21.4 months versus 20.0 months with no induction cycles (213 patients) (hazard ratio 1.04, 95% confidence interval 0.84-1.28; P=0.36). Per protocol, progression-free survival was 23.7 months versus 23.0 months (P=0.28). Patients aged 65 years or over (55%) did not have an inferior outcome. Patients with low-risk cytogenetics [absence of del17p13, t(4;14) and 1q21 gains] showed a favorable overall survival and included the patients with sustained first remission. MEL140 was associated with a low rate of severe mucositis (10%) and treatment-related deaths (1%). Based on hazard ratio, the short treatment arm consisting of mobilization chemotherapy and tandem MEL140 achieved 96% of the progression-free survival, demonstrating its value as an independent component of therapy in older patients with multiple myeloma who are considered fit for autologous transplantation. (clinicaltrials.gov identifier: 02288741).
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Affiliation(s)
- Christian Straka
- Schön Klinik Starnberger See, Berg, Germany .,Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (LMU), Germany
| | | | | | | | | | - Stefan Knop
- Universitätsklinikum Tübingen, Germany.,Universitätsklinikum Würzburg, Germany
| | - Sigrid Adler-Reichel
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (LMU), Germany
| | | | | | | | | | | | | | | | - Orhan Sezer
- Universitätsklinikum Charité, Berlin, Germany
| | - Ralf Bargou
- Universitätsklinikum Würzburg, Germany.,Universitätsklinikum Charité, Berlin, Germany
| | | | | | | | | | - Helga Bernhard
- Klinikum rechts der Isar, Technische Universität München, Germany
| | - Nicola Lang
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München (LMU), Germany
| | | | - Holger Hebart
- Stauferklinikum Schwäbisch Gmünd, Mutlangen, Germany
| | - Ralf Schmidmaier
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (LMU), Germany
| | | | - Tobias Dechow
- Klinikum rechts der Isar, Technische Universität München, Germany
| | | | - Brigitte Schnabel
- Schön Klinik Starnberger See, Berg, Germany.,Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (LMU), Germany
| | | | | | | | - Axel Hinke
- WISP Research Institute, Langenfeld, Germany
| | - Bertold Emmerich
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (LMU), Germany
| | - Hermann Einsele
- Universitätsklinikum Tübingen, Germany.,Universitätsklinikum Würzburg, Germany
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2
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Bendrat K, Fritz P, Müller S, Brockmöller S, Debus A, Friedrichs K, Lindner C, Brinkmann F, Heidemann E, Niendorf A. Improved Risk Stratification for Breast Cancer Samples Based on the Expression Ratio of the Estrogen and Progesterone Receptor. Anticancer Res 2016; 36:3855-3863. [PMID: 27466487] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The receptors for estrogen (ESR1) and progesterone (PGR) are both part of the same signaling pathway and routinely used for breast cancer stratification. We tested the hypothesis if a coordinated analysis could add extra information for prognostic stratification. MATERIALS AND METHODS ESR1 and PGR gene expression was first investigated by quantitative reverse transcription polymerase chain reaction in fresh-frozen invasive ductal breast cancer samples (Hamburg collective, case-control, n=317). Our results were then tested using two datasets generated by different technical approaches: i) a public DNA-chip data set (GSE3494, n=251) and ii) semiquantitative protein expression data based on immunohistochemistry (Stuttgart collective, n=18,528). RESULTS The PGR/ESR1 gene-expression ratio was a prognostic indicator in those with ESR1/PGR-positive breast cancer (Hamburg collective), with a high PGR/ESR1 expression ratio indicating a favorable outcome. In all three collectives, the PGR/ESR1 mRNA ratio or its protein equivalent was a univariate prognostic factor and also a multivariate prognostic factor in the Hamburg and Stuttgart collectives. CONCLUSION Calculation of the PGR/ESR1 gene-expression ratio and its immunohistochemical surrogate could be a useful and simple addition to routine breast cancer diagnostics. A high PGR/ESR1 ratio could be indicative of a favorable clinical outcome.
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Affiliation(s)
- Klaus Bendrat
- Institute for Molecular Cell Biology, University Hospital Hamburg-Eppendorf, Hamburg, Germany Pathology Hamburg-West, Hamburg, Germany
| | - Peter Fritz
- Oncological Center Stuttgart e.V., Stuttgart, Germany Institute for Pathology, Robert Bosch Hospital Stuttgart, Stuttgart, Germany
| | - Simon Müller
- MUON-STAT, Statistical Consulting, Stuttgart, Germany
| | | | | | - Kay Friedrichs
- Breast Center Hamburg, Jerusalem Hospital, Hamburg, Germany
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3
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Schroth W, Winter S, Büttner F, Goletz S, Faißt S, Brinkmann F, Saladores P, Heidemann E, Ott G, Gerteis A, Alscher MD, Dippon J, Schwab M, Brauch H, Fritz P. Clinical outcome and global gene expression data support the existence of the estrogen receptor-negative/progesterone receptor-positive invasive breast cancer phenotype. Breast Cancer Res Treat 2015; 155:85-97. [DOI: 10.1007/s10549-015-3651-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/26/2015] [Indexed: 01/08/2023]
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4
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Fritz P, Bendrat K, Sonnenberg M, Trautmann C, Ott G, Heidemann E, Brinkmann F, Faisst S, Gerteis A, Brauch H, Schwab M, Lindner C, Friedrichs K, Alscher MD, Dippon J, Niendorf A. Tubular breast cancer. A retrospective study. Anticancer Res 2014; 34:3647-3656. [PMID: 24982382] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The well-characterized tubular-type of breast tumors is classified as low-risk breast cancer. PATIENTS AND METHODS We report on the results of a retrospective analysis on clinical and biological features of 248 tubular breast tumors including follow-up and treatment data from two German series of 21,065 breast cancer cases. The majority of tumors were stage I or stage II, ER- and PR-positive and c-erbB2-negative with a 5-year survival-rate of 96.3%. 51.3% of patients received hormonal treatment, 75.5% had post-operative radiotherapy and 11.8% were treated with a chemotherapeutical regimen. CONCLUSION Our retrospective analysis showed no treatment benefit for either anti-hormonal or chemotherapeutical regimens. Post-operative radiotherapy, however, improved the survival rate of patients with tubular carcinoma (log-rank=5, p=0.025). Our data suggest that post-operative radiotherapy is an important treatment to prolong survival for patients suffering from tubular breast cancer.
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Affiliation(s)
- Peter Fritz
- Institute of Digital Medicine, Stuttgart, Germany Robert Bosch Hospital, Department of Clinical Pathology, Stuttgart, Germany
| | | | - Maike Sonnenberg
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology and University of Tuebingen, Stuttgart, Germany
| | | | - German Ott
- Robert Bosch Hospital, Department of Clinical Pathology, Stuttgart, Germany
| | - Else Heidemann
- Onkologischer Schwerpunkt Stuttgart e.V., Stuttgart, Germany
| | | | - Simone Faisst
- Onkologischer Schwerpunkt Stuttgart e.V., Stuttgart, Germany
| | - Andreas Gerteis
- Robert Bosch Hospital, Department of Gynecology, Stuttgart, Germany
| | - Hiltrud Brauch
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology and University of Tuebingen, Stuttgart, Germany
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology and University of Tuebingen, Stuttgart, Germany Department of Clinical Pharmacology, University Hospital Tubingen, Tubingen, Germany
| | | | | | | | - Juergen Dippon
- University of Stuttgart, Institute of Stochastics and Applications, Stuttgart, Germany
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5
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Bornhak S, Heidemann E, Meisner C, Herschlein HJ, Simon W, Merkle E, Schmidt B, Metzger H, Rössle S, Brinkmann F. [Symptom-oriented follow-up of early breast cancer compared to intensive surveillance. Results of a prospective multicentre study: update and 10-year overall survival]. Dtsch Med Wochenschr 2012; 137:2142-8. [PMID: 23055354 DOI: 10.1055/s-0032-1327219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE In a prospective, non-randomised, multicentre cohort study we compared intensive surveillance to symptom-oriented control in the follow-up of patients with early breast cancer after curative surgical treatment. Five-year overall survival had shown that symptom-oriented follow-up was not inferior to intensive control. However, a more intensive, instrumental based follow-up is still claimed by many patients and their physicians. In this context the recent data of 10-year overall survival (OS) are reported. PATIENTS AND METHODS In the prospective, non-randomised, multicentre cohort study carried out between 1995 and 2000, 244 patients underwent an intensive follow-up (scheduled laboratory tests including CEA and CA 15-3, chest X-rays and liver ultrasound). 426 patients were monitored in a symptom-oriented manner (additional tests only in the case of symptoms indicating possible recurrence). Mammography, structured histories and physical examinations were done regularly in both groups. RESULTS In the clinical follow-up group, 90 deaths (21.2 %) were observed with an estimated 10-year overall survival rate of 83.0 % (95 % CI 79.1 -86.3 %). In the intensive follow-up group, 59 deaths (24.2 %) were observed with an estimated 10-year overall survival rate of 78.5 % (95 % CI 72.6 -83.2 %). The Cox proportional hazards model for OS includes the variables follow-up form, stage of primary tumor and lymph nodes, hormone receptor status, grading and age at diagnosis. This model resulted in a hazard ratio of 1.10 (95 % CI 0.78-1.54) for the follow-up protocol (intensive vs. clinical). Welleks' test for non-inferiority showed that clinical follow-up is not inferior in comparison to intensive follow-up (p < 0.05) for a non-inferiority limit of + 7 % at 10-years. CONCLUSION This analysis of 10-year overall survival of patients with early breast cancer after curative primary treatment confirms that follow-up without regular imaging and laboratory tests is not inferior in the sense of a relevant higher mortality. To what extent new concepts in the treatment of breast cancer have any influence on follow-up care has to be examined in further studies.
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Affiliation(s)
- S Bornhak
- Onkologischer Schwerpunkt Stuttgart e.V
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6
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Heidemann E, Hiddemann W. Aktuelle Diagnostik und Behandlung in Hämatologie und Onkologie. Dtsch Med Wochenschr 2012; 137:2141. [DOI: 10.1055/s-0032-1327228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- E. Heidemann
- Onkologischer Schwerpunkt Stuttgart, Medizinische Klinik, Diakonie-Klinikum Stuttgart
| | - W. Hiddemann
- Medizinische Klinik III, Klinikum der Universität München
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7
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Gerber T, Mück R, Outrata J, Kistner H, Ernst R, Heidemann E. Zystischer Magentumor mit Verkalkungen. Internist (Berl) 2011; 52:205-8. [DOI: 10.1007/s00108-010-2655-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Meisner C, Brinkmann F, Henke D, Junack C, Faißt S, Heidemann E. Benchmarking der Ergebnisqualität am Onkologischen Schwerpunkt Stuttgart. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2011; 105:365-70. [DOI: 10.1016/j.zefq.2011.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Fritz P, Klenk S, Goletz S, Gerteis A, Simon W, Brinkmann F, Heidemann E, Lütttgen E, Ott G, Alscher MD, Schwab M, Dippon J. Clinical impacts of histological subtyping primary breast cancer. Anticancer Res 2010; 30:5137-5144. [PMID: 21187502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Treatment decisions in breast cancer depend on TNM classification and the assessment of additional variables with have an impact on survival. We examined whether histological subtyping breast cancer as either ductal or lobular is related to disease outcome. PATIENTS AND METHODS We examined a large data base of 14198 breast cancer patients. RESULTS Histological sub-classification of invasive breast cancer as either ductal or lobular is not correlated with disease outcome. However, the data further showed that invasive lobular carcinomas have a higher probability of being oestrogen receptor (ER)- and progesterone receptor (PR)-positive and a lower probability of being c-erbB2-positive. They also showed a higher average age at the time of diagnosis in comparison with invasive ductal carcinoma. Local recurrence rates were lower in invasive lobular carcinoma in comparison with invasive ductal carcinoma (3.5% vs. 6.2%; p = 0.031). The multivariable Cox regression analysis showed that ER, PR, nodal status, grade and tumour size predicted disease outcome with statistical significance, while the histological subtype (invasive ductal or lobular) was not a significant predictor of disease outcome. CONCLUSION Histological sub-classification of invasive breast cancer as either ductal or lobular is not correlated with disease outcome. On the other hand our data gives some indication that lobular and ductal breast cancer appear to be different biological entities.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/classification
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/pathology
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Multivariate Analysis
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Receptors, Estrogen/biosynthesis
- Receptors, Progesterone/biosynthesis
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Affiliation(s)
- P Fritz
- Institute of Digital Medicine, Stuttgart, Germany
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10
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Heidemann E, Steinke B, Hartlapp J, Schumacher K, Possinger K, Kunz S, Neeser E, Ingersleben G, Hossfeld D, Caffier H, Souchon R, Waldmann R, Blümner E, Clark J. Prognostic Subgroups: The Key Factor for Treatment Outcome in Metastatic Breast Cancer. Oncol Res Treat 2009. [DOI: 10.1159/000218287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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linger C, Herrmann R, Berdel W, Kleeberg U, Gatzemeier U, Illiger H, Wander H, Westerhausen M, Becher R, Bremer K, Rieche K, Essers U, Queißer W, Heidemann E, Fiebig H, Possinger K, Jourdain-Madl B, Heim M, Edler L. Topically Applied Miltefosine (Hexadecylphosphocholine) in Patients with Skin-Metastasized Breast Cancer. A Phase II Study. Oncol Res Treat 2009. [DOI: 10.1159/000218252] [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: 11/19/2022]
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12
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Heidemann E, Kaesberger J, Herschbach P, Sellschopp A. Graduated WHO Analogue and Satisfaction Scales for the Assessment of Quality of Life in Clinical Trials in Cancer Patients. Oncol Res Treat 2009. [DOI: 10.1159/000217018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Bornhak S, Heidemann E, Herschlein HJ, Simon W, Merkle E, Widmaier G, Ernst R, Greulich M, Bittner R, Kieninger G, Merkle P, Strosche H, Karg C, Wellhaeusser U, Aulitzky W, Schmidt B, Metzger H, Hahn M, Stauch A, Meisner C, Selbmann HK, Regelmann C, Brinkmann F. Symptom-oriented follow-up of early breast cancer is not inferior to conventional control. Results of a prospective multicentre study. Oncol Res Treat 2007; 30:443-9. [PMID: 17848816 DOI: 10.1159/000105257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The homogeneity of the schemes for follow-up care after curative surgical treatment of early breast cancer is still a matter of debate in Germany. We investigated whether symptom-oriented follow-up is equivalent in terms of survival rates to conventional surveillance based on scheduled tests. PATIENTS AND METHODS In a prospective, non-randomised, multicentre cohort study carried out between 1995 and 2000, 244 patients underwent a conventional follow-up (scheduled laboratory tests including CEA and CA 15-3, chest X-rays and liver ultrasound). 426 patients were monitored in a symptom-oriented manner (additional tests only in the case of symptoms indicating possible recurrence). Mammography, structured histories and physical examinations were done regularly in both branches. 1,108 patients did not participate in the project. They represent 'real world patients', unaffected by the implications of a study. RESULTS The symptom-oriented follow- up group produced results not inferior to those of the intensive one (p < 0.05) in terms of overall and relapse-free survival. Furthermore, no difference was indicated in terms of overall survival between study participants and the 'real world patients' (p = 0.316). CONCLUSION The results confirm that regular imaging and laboratory tests have no relevant effect on overall survival of patients after curative primary therapy of early breast cancer and support the implementation of a symptom-oriented routine follow-up.
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Affiliation(s)
- Sven Bornhak
- Oncological Comprehensive Centre, Stuttgart, Germany
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Lenz G, Dreyling M, Hoster E, Wörmann B, Dührsen U, Metzner B, Eimermacher H, Neubauer A, Wandt H, Steinhauer H, Martin S, Heidemann E, Aldaoud A, Parwaresch R, Hasford J, Unterhalt M, Hiddemann W. Immunochemotherapy with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone significantly improves response and time to treatment failure, but not long-term outcome in patients with previously untreated mantle cell lymphoma: results of a prospective randomized trial of the German Low Grade Lymphoma Study Group (GLSG). J Clin Oncol 2005; 23:1984-92. [PMID: 15668467 DOI: 10.1200/jco.2005.08.133] [Citation(s) in RCA: 435] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Mantle cell lymphoma (MCL) is characterized by a poor prognosis with a low to moderate sensitivity to chemotherapy and a median survival of only 3 to 4 years. In an attempt to improve outcome, the German Low Grade Lymphoma Study Group (GLSG) initiated a randomized trial comparing the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) and rituximab (R-CHOP) with CHOP alone as first-line therapy for advanced-stage MCL. PATIENTS AND METHODS One hundred twenty-two previously untreated patients with advanced-stage MCL were randomly assigned to six cycles of CHOP (n = 60) or R-CHOP (n = 62). Patients up to 65 years of age achieving a partial or complete remission underwent a second randomization to either myeloablative radiochemotherapy followed by autologous stem-cell transplantation or interferon alfa maintenance (IFNalpha). All patients older than 65 years received IFNalpha maintenance. RESULTS R-CHOP was significantly superior to CHOP in terms of overall response rate (94% v 75%; P = .0054), complete remission rate (34% v 7%; P = .00024), and time to treatment failure (TTF; median, 21 v 14 months; P = .0131). No differences were observed for progression-free survival. Toxicity was acceptable, with no major differences between the two therapeutic groups. CONCLUSION The combined immunochemotherapy with R-CHOP resulted in a significantly higher response rate and a prolongation of the TTF as compared with chemotherapy alone. Hence, R-CHOP may serve as a new baseline regimen for advanced stage MCL, but needs to be further improved by novel strategies in remission.
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Affiliation(s)
- Georg Lenz
- Department of Internal Medicine III of the Ludwig-Maximilians University, Marchioninistrasse 15, 81377 Munich, Germany
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Abstract
HISTORY AND CLINICAL FINDINGS A 60-year-old woman suffering from rheumatoid arthritis and taking methotrexate was admitted with recurrent episodes of nausea, vomiting, constipation, loss of appetite, myalgia and backache, sternal chest pain, costal and jaw pain. On examination the epigastrium was tender to palpation and nonrigid. INVESTIGATIONS Laboratory tests showed normocytic anemia (with a hemoglobin concentration of 8.6 g/dl), elevated blood urea and creatinine levels, hyponatremia, hypochloremia, hemolysis and polychromasia, anisocytosis, poikilocytosis and basophilic stippling of several red cells. On gastroscopy an ulcer was excluded, ultrasound scan of abdomen, X-ray of chest and pelvis showed no abnormalities. The electrocardiogram showed a right bundle branch block and left anterior hemiblock. DIAGNOSIS, TREATMENT, AND COURSE In the differential diagnosis of anemia with basophilic stippling and abdominal discomfort, lead poisoning was found. Whole-blood lead concentration was markedly raised to 852 micro g/l (normal < 100 micro g/l). Lead poisoning was the result of the use of ayurvedic drugs during a period of 7.5 months prior to admission to the authors' hospital. CONCLUSION Heavy metal poisoning, especially lead poisoning, should be considered in the differential diagnosis in patients with unspecific clinical symptoms taking traditional Indian remedies.
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Heidemann E, Minckwitz GV, Holländer N, Souchon R, Clemens M, Mahlke M, Eggeling B, Marseille A, Krekeler G, Kaufmann M. Mitoxantrone plus docetaxel vs single agent mitoxantrone in metastatic breast cancer (MBC): Results of a multicenter randomized trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. Heidemann
- Diakonie-Klinikum Stuttgart, Stuttgart, Germany; German Breast Group, Neu Isenburg, Germany; University Institute of Medicinal Biometrics, Freiburg, Germany; Strahlenklinik Allg. KH Hagen, Hagen, Germany; KA Mutterhaus d. Borromäerinnen, Trier, Germany; Universitätsfrauenklinik Mainz, Mainz, Germany; Städt. Kliniken, Kassel, Germany; Aventis, Bad Soden, Germany; Wyeth Pharma, Münster, Germany; Universitätsfrauenklinik, Frankfurt, Germany
| | - G. V. Minckwitz
- Diakonie-Klinikum Stuttgart, Stuttgart, Germany; German Breast Group, Neu Isenburg, Germany; University Institute of Medicinal Biometrics, Freiburg, Germany; Strahlenklinik Allg. KH Hagen, Hagen, Germany; KA Mutterhaus d. Borromäerinnen, Trier, Germany; Universitätsfrauenklinik Mainz, Mainz, Germany; Städt. Kliniken, Kassel, Germany; Aventis, Bad Soden, Germany; Wyeth Pharma, Münster, Germany; Universitätsfrauenklinik, Frankfurt, Germany
| | - N. Holländer
- Diakonie-Klinikum Stuttgart, Stuttgart, Germany; German Breast Group, Neu Isenburg, Germany; University Institute of Medicinal Biometrics, Freiburg, Germany; Strahlenklinik Allg. KH Hagen, Hagen, Germany; KA Mutterhaus d. Borromäerinnen, Trier, Germany; Universitätsfrauenklinik Mainz, Mainz, Germany; Städt. Kliniken, Kassel, Germany; Aventis, Bad Soden, Germany; Wyeth Pharma, Münster, Germany; Universitätsfrauenklinik, Frankfurt, Germany
| | - R. Souchon
- Diakonie-Klinikum Stuttgart, Stuttgart, Germany; German Breast Group, Neu Isenburg, Germany; University Institute of Medicinal Biometrics, Freiburg, Germany; Strahlenklinik Allg. KH Hagen, Hagen, Germany; KA Mutterhaus d. Borromäerinnen, Trier, Germany; Universitätsfrauenklinik Mainz, Mainz, Germany; Städt. Kliniken, Kassel, Germany; Aventis, Bad Soden, Germany; Wyeth Pharma, Münster, Germany; Universitätsfrauenklinik, Frankfurt, Germany
| | - M. Clemens
- Diakonie-Klinikum Stuttgart, Stuttgart, Germany; German Breast Group, Neu Isenburg, Germany; University Institute of Medicinal Biometrics, Freiburg, Germany; Strahlenklinik Allg. KH Hagen, Hagen, Germany; KA Mutterhaus d. Borromäerinnen, Trier, Germany; Universitätsfrauenklinik Mainz, Mainz, Germany; Städt. Kliniken, Kassel, Germany; Aventis, Bad Soden, Germany; Wyeth Pharma, Münster, Germany; Universitätsfrauenklinik, Frankfurt, Germany
| | - M. Mahlke
- Diakonie-Klinikum Stuttgart, Stuttgart, Germany; German Breast Group, Neu Isenburg, Germany; University Institute of Medicinal Biometrics, Freiburg, Germany; Strahlenklinik Allg. KH Hagen, Hagen, Germany; KA Mutterhaus d. Borromäerinnen, Trier, Germany; Universitätsfrauenklinik Mainz, Mainz, Germany; Städt. Kliniken, Kassel, Germany; Aventis, Bad Soden, Germany; Wyeth Pharma, Münster, Germany; Universitätsfrauenklinik, Frankfurt, Germany
| | - B. Eggeling
- Diakonie-Klinikum Stuttgart, Stuttgart, Germany; German Breast Group, Neu Isenburg, Germany; University Institute of Medicinal Biometrics, Freiburg, Germany; Strahlenklinik Allg. KH Hagen, Hagen, Germany; KA Mutterhaus d. Borromäerinnen, Trier, Germany; Universitätsfrauenklinik Mainz, Mainz, Germany; Städt. Kliniken, Kassel, Germany; Aventis, Bad Soden, Germany; Wyeth Pharma, Münster, Germany; Universitätsfrauenklinik, Frankfurt, Germany
| | - A. Marseille
- Diakonie-Klinikum Stuttgart, Stuttgart, Germany; German Breast Group, Neu Isenburg, Germany; University Institute of Medicinal Biometrics, Freiburg, Germany; Strahlenklinik Allg. KH Hagen, Hagen, Germany; KA Mutterhaus d. Borromäerinnen, Trier, Germany; Universitätsfrauenklinik Mainz, Mainz, Germany; Städt. Kliniken, Kassel, Germany; Aventis, Bad Soden, Germany; Wyeth Pharma, Münster, Germany; Universitätsfrauenklinik, Frankfurt, Germany
| | - G. Krekeler
- Diakonie-Klinikum Stuttgart, Stuttgart, Germany; German Breast Group, Neu Isenburg, Germany; University Institute of Medicinal Biometrics, Freiburg, Germany; Strahlenklinik Allg. KH Hagen, Hagen, Germany; KA Mutterhaus d. Borromäerinnen, Trier, Germany; Universitätsfrauenklinik Mainz, Mainz, Germany; Städt. Kliniken, Kassel, Germany; Aventis, Bad Soden, Germany; Wyeth Pharma, Münster, Germany; Universitätsfrauenklinik, Frankfurt, Germany
| | - M. Kaufmann
- Diakonie-Klinikum Stuttgart, Stuttgart, Germany; German Breast Group, Neu Isenburg, Germany; University Institute of Medicinal Biometrics, Freiburg, Germany; Strahlenklinik Allg. KH Hagen, Hagen, Germany; KA Mutterhaus d. Borromäerinnen, Trier, Germany; Universitätsfrauenklinik Mainz, Mainz, Germany; Städt. Kliniken, Kassel, Germany; Aventis, Bad Soden, Germany; Wyeth Pharma, Münster, Germany; Universitätsfrauenklinik, Frankfurt, Germany
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17
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Heidemann E, Stoeger H, Souchon R, Hirschmann WD, Bodenstein H, Oberhoff C, Fischer JT, Schulze M, Clemens M, Andreesen R, Mahlke M, König M, Scharl A, Fehnle K, Kaufmann M. Is first-line single-agent mitoxantrone in the treatment of high-risk metastatic breast cancer patients as effective as combination chemotherapy? No difference in survival but higher quality of life were found in a multicenter randomized trial. Ann Oncol 2002; 13:1717-29. [PMID: 12419743 DOI: 10.1093/annonc/mdf306] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To determine whether patients with high-risk metastatic breast cancer draw benefit from combination chemotherapy as first-line treatment. PATIENTS AND METHODS A total of 260 women with measurable metastatic breast cancer fulfilling high-risk criteria, previously untreated with chemotherapy for their metastatic disease, were randomized to receive either mitoxantrone 12 mg/m(2) or the combination of fluorouracil 500 mg/m(2), epirubicin 50 mg/m(2) and cyclophosphamide 500 mg/m(2) (FEC) every 3 weeks. Treatment was continued until complete remission plus two cycles, or until disease progression. In the case of partial remission or stable disease, treatment was stopped after 12 cycles. Second-line treatment was vindesine, mitomycin and prednisolone. Gain from treatment was estimated using a modified Brunner's score composed of time to progression, patients' rating of the treatment benefit, alopecia, vomiting and performance status. RESULTS After recruitment from 1992 to 1997 and observation from 1997 to 1999, the final evaluation showed that single-agent treatment with mitoxantrone does not differ significantly from combination treatment with FEC in terms of response, objective remission rate, remission duration, time to response, time to best response, time to progression or overall survival. There was, however, a significant difference in gain from treatment using a modified Brunner's score favoring the single-agent treatment arm. There was no evidence that any subgroup would fare better with combination treatment. CONCLUSIONS No significant difference was detected between the treatment with mitoxantrone as a single agent and the combination of low-dose FEC in terms of response or survival; therefore, the imperative of the necessity of first-line combination chemotherapy for patients with high-risk metastatic breast cancer may be questioned. Since toxicity and quality of life score favored the single-agent mitoxantrone treatment arm, this treatment may be offered to patients preferring quality of life to a potential small prolongation of survival.
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Affiliation(s)
- E Heidemann
- Department of Hematology and Medical Oncology, Deaconess Hospital, Oncological Center of Stuttgart, Germany.
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18
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Engel J, Nagel G, Breuer E, Meisner C, Albert US, Strelocke K, Sauer H, Katenkamp D, Mittermayer C, Heidemann E, Schulz KD, Kunath H, Lorenz W, Hölzel D. Primary breast cancer therapy in six regions of Germany. Eur J Cancer 2002; 38:578-85. [PMID: 11872353 DOI: 10.1016/s0959-8049(01)00407-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Studies from six regions of Germany (Aachen (W1), Dresden (E1), Jena (E2), Marburg (W2), Munich (W3), and Stuttgart (C1)) have been compared to verify and assess the quality of healthcare using breast cancer as an example. All of the data collection was carried out in comprehensive cancer centres and is population-based, with the exception of C1. Classic prognostic factors and the initial treatment of 8661 women with breast cancer, diagnosed between 1996 and 1998, were examined. Primary therapy, breast conserving therapy (BCT), and the use of subsequent local radiation and/or systemic therapy (chemotherapy or hormonal therapy) were analysed. BCT was performed on 39.3-57.7% of patients. By pT-category, the proportion of BCT in the six regions were as follows: for pTis between 37.8 and 64.3%, for pT1 between 51.7 and 71.5%, for pT2 between 25.9 and 51.1%, for pT3 between 0 and 13.1% and for pT4 between 0 and 15.2%. Multivariate analyses, adjusted for age and biological factors, showed a significant influence of the treating hospital on the mastectomy rate. The use of radiotherapy after BCT (80%) was quite homogeneous in the six regions. The application of radiotherapy after mastectomy, however, varied between 10.4 and 32.2%. In all regions, for premenopausal patients, the use of adjuvant systemic therapy almost reflected the St. Gallen-Consensus recommendations. In contrast, post-menopausal women with positive lymph nodes were not always treated according to these standards. In all regions, age had an influence on the administration of treatment: elderly breast cancer patients received less BCT, less radiotherapy and less adjuvant therapy than recommended in the St. Gallen-Consensus. Feedback of the results was made available to each hospital, providing a comparative summary of patient care that could be used by the participating hospitals for self-assessment and quality-control.
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Affiliation(s)
- J Engel
- Cancer Registry of the Comprehensive Cancer Center Munich, Marchioninistrasse 15, 81377, Munich, Germany.
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19
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Wöhr M, Mück R, Ziegler HR, Heidemann E. [Ischemic colitis as a primary manifestation of an embolizing small-cell bronchial carcinoma infiltrating a pulmonary vein]. Med Klin (Munich) 2000; 95:346-8. [PMID: 10935420 DOI: 10.1007/pl00002134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CASE REPORT A 59-year-old male patient was admitted to hospital for general malaise with muscle and bone pain. Some weeks ago he had been treated with roxithromycin because of pneumonia. Physical examination revealed melena. Hemoglobin was 7.6 g/l. Endoscopy of the upper gastrointestinal tract did not show a bleeding source. Colonoscopy and histologic examination revealed hemorrhage caused by ischemic colitis. To rule out cardiac embolies in the presence of paroxysmal tachyarrhythmia absoluta a transesophageal echocardiogram was performed. A mediastinal mass infiltrating the upper left pulmonary vein was detected. The mass had not been visible on routine chest X-ray. Histologic examination of a bronchoscopically taken specimen revealed an oat-cell bronchial carcinoma. CONCLUSION In this patient invasion of a pulmonary vein by the bronchial carcinoma lead to embolies which caused mesenterial ischemia. According to our researches this is the first report of ischemic colitis as a manifestation of bronchial carcinoma.
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Affiliation(s)
- M Wöhr
- Medizinische Kliniken, Diakonissenkrankenhaus Stuttgart.
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20
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Meyskens FL, Jungi WF, Gerber M, de Waard F, Heidemann E, Heim ME, Joossens JV, Salvini S, Trichopoulou A, Varela G, Wolfram G. WHO consensus conference on diet and cancer. Members of the breast cancer panel. Eur J Cancer Prev 2000; 9:213-6. [PMID: 10954261] [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: 02/17/2023]
Affiliation(s)
- F L Meyskens
- University of California Irvine, Chao Family Comprehensive Cancer Center, Orange 92868-3298, USA
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21
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Heidemann E, Souchon R, Stöger H, Hirschmann W, Bodenstein H, Oberhoff C, Fischer J, Schulze M, Clemens M, Mahlke M, König M, Scharl A, Fehnle K, Kaufmann M. First-Line Monochemotherapy with Mitoxantroneversus Combination with Fluorouracil, Epirubicin and Cyclophosphamide in High-Risk Metastatic Breast Cancer: A Prospective Randomized Multicenter Clinical Trial. Oncol Res Treat 2000. [DOI: 10.1159/000027078] [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: 11/19/2022]
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22
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Souchon R, Heidemann E, Hirschmann W, Minckwitz G. First line chemotherapy for low or high risk metastatic breast cancer (LR/HR-MBC) — Are 3 (CMF/FEC) or 2 (NDOC) agents better than 1 (N)? — A multicenter clinical trial of the “IMA”. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81691-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Since there is no epidemiologic assessment of the frequency of pain caused by tumor in Germany, tumor-pain-prevalence is estimated indirectly on the basis of mortality and median survival. Knowing that about 50% of all patients having metastases or incurable locoregional recurrence suffer from pain every day, the product of median survival times mortality was calculated to achieve the number of patients' days with tumor-caused pain per year (82,710,690 days in Germany 1995). By division with 365 (days), it is calculated that 226,605 patients require tumor pain related treatment at one day in Germany. Another calculation based on Bonica's publications that 60-90% of patients suffering from advanced cancer are having pain and based on an estimated tumor prevalence 1989/90 revealed a tumor pain prevalence of 221,826. DISCUSSION Thus both methods result in the estimation, that about 220,000 patients require tumor-pain-related treatment at one day in Germany.
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Affiliation(s)
- E Heidemann
- Diakonissenkrankenhaus, Onkologischer Schwerpunkt, Stuttgart
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25
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Heidemann E. [Pain therapy in oncology]. Internist (Berl) 1999; 40:168-75. [PMID: 10097975 DOI: 10.1007/s001080050321] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- E Heidemann
- Medizinische Klinik II, Diakonissenkrankenhaus Stuttgart
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26
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Heidemann E. Modern Strategies in Cancer Pain Treatment. Oncol Res Treat 1999. [DOI: 10.1159/000026994] [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: 11/19/2022]
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27
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Fritz M, Schmidt B, Heidemann E, Brinkmann F, Benöhr C, Bittner R, von Gaisberg U, Herschlein H, Jipp P, Karg C, Kieninger G, Littmann K, Meisner C, Merkle P, Metzger H, Strosche H, Widmaier G. Does Adjuvant Systemic Therapy Improve Prognosis in Breast Cancer with 4-9 Axillary Nodes and in the Age Group of 80 Years or More? Oncol Res Treat 1998. [DOI: 10.1159/000026861] [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: 11/19/2022]
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28
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Heidemann E. [No advantage to using the CMF-regimen for node positive, postmenopausal, receptor-positive mammary carcinoma with adjuvant tamoxifen therapy]. Strahlenther Onkol 1998; 174:290-1. [PMID: 9614963 DOI: 10.1007/bf03038727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Bohigas L, Brooks T, Donahue T, Donaldson B, Heidemann E, Shaw C, Smith D. A comparative analysis of surveyors from six hospital accreditation programmes and a consideration of the related management issues. Int J Qual Health Care 1998; 10:7-13. [PMID: 10030782 DOI: 10.1093/intqhc/10.1.7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To gather data on how accreditors manage surveyors, to compare these data and to offer them to the accreditors for improvement and to the scientific community for knowledge of the accreditation process and reinforcement of the credibility of these processes. DATA SOURCE The data were gathered with the aid of a questionnaire sent to all accreditors participating in the study. RESULTS An important finding in this comparative study is the different contractual relationships that exist between the accreditors and their surveyors. CONCLUSION Surveyors around the world share many common features in terms of careers, training, work history and expectations. These similarities probably arise from the objectives of the accreditors who try to provide a developmental process to their clients rather than an 'inspection'.
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Affiliation(s)
- L Bohigas
- Avedis Donabedian Foundation, Spain.
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30
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Bohigas L, Smith D, Brooks T, Donahue T, Heidemann E, Donaldson B, Shaw C. Accreditation programs for hospitals: funding and operation. Int J Qual Health Care 1996; 8:583-9. [PMID: 9007608 DOI: 10.1093/intqhc/8.6.583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Accreditation is a formal process by which an authorized body assesses and recognizes an individual, an organization (like a hospital), a program, or a group as complying with requirements such as standards or criteria. This article analyses and compares the activity and funding of six health care accrediting bodies which operate in five different countries, and which in 1994, accredited over 5000 health centres. The data included in this article could be useful for other institutions who wish to commence accreditation programmes for health care organizations.
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Affiliation(s)
- L Bohigas
- Australian Council on Healthcare Standards, Australia
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31
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Wassner A, Heidemann E. Levamisole and 5 Fluorouracil as an Adjuvant Therapy for Patients after Curative Resection of Colon Carcinoma Dukes’ Stage C (TNM III): More Disadvantages than Advantages. Oncol Res Treat 1996. [DOI: 10.1159/000218780] [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: 11/19/2022]
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32
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Heidemann E, Laflèche AM. The client-centred approach to accreditation: an exciting new direction. Leadersh Health Serv 1995; 4:9-11. [PMID: 10142932] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- E Heidemann
- Canadian Council on Health Services Accreditation, Ottawa
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33
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Heidemann E. The Canadian health care system: cost and quality. Bull Pan Am Health Organ 1994; 28:169-76. [PMID: 8069337] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- E Heidemann
- Canadian Council on Health Facilities Accreditation, Ottawa
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34
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Mross K, Bohn C, Edler L, Jonat W, Queisser W, Heidemann E, Goebel M, Hossfeld DK. Randomized phase II study of single-agent epirubicin +/- verapamil in patients with advanced metastatic breast cancer. An AIO clinical trial. Arbeitsgemeinschaft Internistische Onkologie of the German Cancer Society. Ann Oncol 1993; 4:45-50. [PMID: 8435362 DOI: 10.1093/oxfordjournals.annonc.a058356] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Anthracyclines are the most active cytostatic agents in patients with metastatic breast cancer. Drug resistance and dose intensity are relevant issues in the treatment of cancer. METHODS A randomized phase II study in 51 patients with advanced progressive metastatic breast cancer was performed. Twenty-six were treated with epirubicin (EPI) 120 mg/m2 i.v. bolus injection divided over three days combined with a daily dose of 480 mg verapamil (VPL) orally administered one day before and during EPI. Twenty-five patients received the same dose and schedule of EPI without VPL. Evaluation of response was carried out after three 21-day cycles. Study endpoints were objective response rate and overall survival. RESULTS Among the 24 evaluable patients treated with EPI+VPL 1 CR (4%), 7 PR (29%), 9 NC (38%) and 7 PD (29%) were observed. Two patients were excluded because of toxicity. Among the 24 evaluable patients treated with EPI alone 8 PR (28%), 6 NC (24%) and 10 PD (40%) were observed, and one patient was excluded because of toxicity. Myelotoxicity was the major side effect followed by alopecia, stomatitis/mucositis and nausea. The patient group treated with VPL had lower blood pressure levels during therapy, with complete normalization after discontinuation of VPL. The median overall survival times were similar: 7.4 month in the EPI group and 8.9 month in the EPI+VPL group. CONCLUSION In both treatment groups the objective response rate was about 30% and the overall survival rates were also the same. No clinical relevance could be demonstrated for the hypothesized resistance modifying action of VPL. Furthermore, VPL did not increase the toxicity of EPI.
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Affiliation(s)
- K Mross
- University Hospital Eppendorf, Dept. Oncology and Hematology, Hamburg
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35
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Steinke B, Bross K, Reinold HM, Heim ME, Schalk KP, Heidemann E, Josten K, Arnold H, Manegold C, Hoffman I. Cyclic alternating chemotherapy of high-grade malignant non-Hodgkin lymphomas with VIM-Bleo and CHOP. Eur J Cancer 1992; 28:100-4. [PMID: 1373634 DOI: 10.1016/0959-8049(92)90395-i] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Between 1986 and 1988, 81 patients with high grade malignant non-Hodgkin lymphoma according to the Kiel classification were treated with the VIM-Bleo/CHOP-regimen: etoposide 100 mg/m2 intravenously on days 1-3, ifosfamide 1.5 g/m2 intravenously days 1-5 with mesna for prophylaxis of cystitis, methotrexate 30 mg/m2 intravenously on days 3, bleomycin 10 mg intravenously on days 8 and 15, cyclophosphamide 750 mg/m2 day 22, doxorubicin 50 mg/m2 day 22, vincristine 1.4 mg/m2 on day 22, and prednisolone 100 mg postoperatively on days 1-5 and 22-26. Cycles were repeated four times beginning on day 43. Regions with bulky disease were irradiated after chemotherapy. 36 patients (44%) had stage II, 12 (15%) stage III and 33 (41%) stage IV disease. B-symptoms were present in 49% of patients. Serum lactate dehydrogenase activity was elevated in 53%. Overall, 59 patients (73%) achieved a complete and 14 (17%) a partial remission. 8 (9%) had stable or progressive disease. After a median follow up of 30 months thus far, probability of long-term relapse free survival is 66% for patients in complete remission. Overall survival is 72% at 24 months. Toxicity from treatment was very low with leukopenia being the main side effect. Major infections were observed in only 2% of cycles with one treatment related death. VIM-Bleo/CHOP is a well tolerated regimen with remission rates in the range of other, more toxic regimens. However, cyclic alternating treatment did not improve results as compared with repeated treatment with a single standard protocol.
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Affiliation(s)
- B Steinke
- Medizinische Universitätklinik, Tübingen, Germany
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36
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Abstract
In the treatment of metastatic breast cancer patients, remission rates and survival are determined by prognostic criteria and not by the choice of treatment. It remains to be proven whether or not the intensification of chemotherapy leads to a higher complete remission rate and/or prolongs survival. Generally, patients derive benefit from achieving a "no change" status. Therefore, milder treatment regimens are preferred except in clinical trials. However, additional research is mandatory to analyze treatment results in clearly defined prognostic subgroups to determine if specific subgroups benefit with prolonged survival and/or improved quality of life. Aggressive treatment with severe side effects should only be administered in such studies or if milder treatment regimes are no longer effective. The aim of palliation has to be kept in mind.
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Heidemann E, Steinke B, Hartlapp J, Schumacher K, Possinger K, Kunz S, Neeser E, von Ingersleben G, Hossfeld D, Waldmann R. Randomized clinical trial comparing mitoxantrone with epirubicin and with doxorubicin, each combined with cyclophosphamide in the first-line treatment of patients with metastatic breast cancer. Onkologie 1990; 13:24-7. [PMID: 2186320 DOI: 10.1159/000216714] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Two hundred and twenty-four patients with advanced breast cancer were enrolled in a multicenter prospective randomized clinical study and received either doxorubicin (40 mg/m2), or epirubicin (40 mg/m2) or mitoxantrone (12 mg/m2) each combined with cyclophosphamide (600 mg/m2) i.v. In the patient collective the following response rates were observed: complete response 12.1%; partial response 30.6%; stable disease 40.5%; progressive disease 16.8%. A complete response was observed significantly less often in patients where more than one organ site was involved as compared to those patients with only one metastatic site. The mean time period required to reach a best response was 3.7 months. There was no significant difference between the response rates in the three arms. In comparing the observed toxicities in 1,434 treatment cycles, there was a significant difference with regard to leukocytopenia (mitoxantrone arm exhibiting more than either epirubicin and doxorubicin) although infections did not occur more frequently in the mitoxantrone arm; with regard to alopecia, mitoxantrone and epirubicin arms both exhibited less than doxorubicin. It is noteworthy that no patient who had previously received adjuvant chemotherapy achieved a complete response (p = 0.006). The overall significance of these findings can only be clearly evaluated when survival times can be measured.
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Affiliation(s)
- E Heidemann
- Medical Department, Deaconess Hospital, Stuttgart, FRG
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38
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Steinke B, Kraft A, Reinold HM, Heim ME, Löffler B, Heidemann E, Richter C, Josten K, Bross K, Hofmann I. [Sequential alternating chemotherapy of highly malignant non-Hodgkin's lymphomas with VIM-Bleo and CHOP. Initial results]. Onkologie 1989; 12:19-21. [PMID: 2469999 DOI: 10.1159/000216591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
54 patients with high grade malignant NHL (stage II 19, stage III 10, stage IV 25 patients, medium age 56 years) were treated in an ongoing study with the VIM-Bleo/CHOP-regimen: Etoposide 100 mg/m2 i.v. days 1-3, Ifosfamide 1.5 g/m2 i.v. days 1-5 with Mesna for prophylaxis of cystitis, Methotrexate 30 mg/m2 i.v. day 3, Bleomycin 10 mg i.v. days 8 and 15, Cyclophosphamide 750 mg/m2 day 22, Adriamycin 50 mg/m2 day 22, Vincristine 1.4 mg/m2 day 22 and prednisolone 100 mg po days 1-5 and 22-26. Cycles were repeated on day 43. After completion of therapy (4 cycles of VIM-Bleo/CHOP), 27 out of 35 patients (77%) were in complete remission. 6 patients (17%) had a partial remission and 2 (6%) progressive disease. After a median follow up of 8 months so far, 6 relapses occurred. Probability of survival at 12 months is 82%. Toxicity of treatment was very low with leukopenia being the main side effect. Only in 2 cycles (3%), major infections were observed. Nausea and vomiting were severe only in 4% of patients. We conclude that VIM-Bleo/CHOP is a well tolerated regimen with good remission rates in high grade malignant NHL. However, longer follow up is necessary for a final evaluation.
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Affiliation(s)
- B Steinke
- Medizinische Universitätsklinik Tübingen
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Abstract
Allysine is a very important crosslink precursor in connective tissue proteins. We describe the reactions of Phthalyl-Allysine-p-Nitrobenzylester, which is a suitable compound to investigate the reactions of the aldehyde group in vitro. Crosslinked compounds are synthesized by mixing suitable stoichiometric amounts of Phthalyl-Allysine-p-Nitrobenzylester and nucleophiles in aqueous organic solvents. The results are compared with the reaction pathways which have been proposed for crosslink synthesis in vivo.
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Affiliation(s)
- R Dölz
- Institute of Macromolecular Chemistry, Dept. of Protein and Leather, FRG
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Kennedy I, Mariono DR, Heidemann E, Dupuis HM, Wynen A. Euthanasia/prolongation of life--panel discussion. World Hosp 1988; 25:28-33. [PMID: 10313518] [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: 02/12/2023]
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41
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42
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Mergenthaler HG, Brühl P, Ehninger G, Heidemann E. Comparative in vitro toxicity of mitoxantrone and adriamycin in human granulocyte-macrophage progenitor cells. Cancer Chemother Pharmacol 1987; 20:8-12. [PMID: 3621456 DOI: 10.1007/bf00252951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Mitoxantrone (MIT) has recently been introduced into cancer therapy as a possible substitute for the structurally related drug, adriamycin (ADR), because it causes less cardiotoxicity and fewer gastrointestinal side effects. However, the dose-limiting toxicity of MIT is pronounced neutropenia. The in vitro hematoxicity of both drugs in granulocyte-macrophage precursor cells (GM-CFCs) was analyzed using drug-exposure schedules analogous to the principles of the in vivo pharmacokinetics of MIT. Bone-marrow and peripheral-blood cells were exposed to 0.075-20 ng/ml MIT or ADR for 5, 20, 60, and 120 min, and for 14 days. The 14-day exposure resulted in Do values of 0.95 and 0.68 ng/ml for bone-marrow and peripheral-blood GM-CFCs subjected to MIT. Exposure to ADR resulted in Do values of 5.43 and 5.13 ng/ml, respectively. As was the case after 14-day exposure to MIT or ADR, short-term exposure again revealed that peripheral-blood GM-CFCs were more sensitive to both drugs. Moreover, at low concentrations, ADR was less toxic than MIT in both types of GM-CFCs, but was more toxic than MIT when a concentration of 20 ng/ml was used. The intracellular concentration of MIT, as measured by high-performance liquid chromatography, was constantly below 1 ng per 2 X 10(7) cells, even when it was applied at a concentration of 20 ng/ml for an exposure time of 2 h. The fact that such low concentrations of MIT are toxic for hemopoietic precursor cells may explain the myelotoxicity of this drug. However, the difference between the precursor-cell toxicity of MIT and that of ADR was small when their respective therapeutic doses were taken into consideration. Further analyses of their toxicity in stem cells and/or the microenvironment would appear to be needed.
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43
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Heidemann E, Weber J, Schmidt H, Reichmann U. Recombinant interferon alpha 2 stimulation of target-binding by natural killer cells. Klin Wochenschr 1986; 64:1036-40. [PMID: 3465970 DOI: 10.1007/bf01757211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Even though the enhancement of the lyitc capacity and the kinetics of lysis of natural killer cells (NK) by interferon has been well documented, an increase of the target-effector cell binding percentage is still disputed. We, therefore, modified the Grimm-Bonavida single-cell assay so that 400 to 600 cells per individual determination could be reliably evaluated. Using this assay, which makes possible separate determination of effector-target cell binding and target lysis, we demonstrated that, in addition to lytic capacity, target-effector cell binding is also increased by preincubating NK with 100 to 1,000 IU interferon alpha 2 per 10(6) cells. Our data indicate that interferon alpha 2 induces pre-NK cells to bind target cells and that it activates these pre-NK cells to kill the targets.
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Dölz R, Heidemann E. Influence of different tripeptides on the stability of the collagen triple helix. I. Analysis of the collagen sequence and identification of typical tripeptides. Biopolymers 1986; 25:1069-80. [PMID: 3730513 DOI: 10.1002/bip.360250607] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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45
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Thakur S, Vadolas D, Germann HP, Heidemann E. Influence of different tripeptides on the stability of the collagen triple helix. II. An experimental approach with appropriate variations of a trimer model oligotripeptide. Biopolymers 1986; 25:1081-6. [PMID: 3730514 DOI: 10.1002/bip.360250608] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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46
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Dhrenfeld M, Riediger D, Heidemann E. [Amyloidosis and its significance as a risk factor in dental treatment]. Dtsch Zahnarztl Z 1986; 41:457-60. [PMID: 2943584] [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: 01/03/2023]
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47
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Heidemann E, Schmidt H, Schüch K, Ostendorf P, Waller HD. Natural killer cell activity against a thymoma cell line Thy 121 in bone marrow transplant recipients. Klin Wochenschr 1986; 64:125-30. [PMID: 3512902 DOI: 10.1007/bf01732635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Twenty-one patients with acute and chronic leukemia or severe aplastic anemia were studied for NK activity against a thymoma cell line (Thy 121) before and after allogeneic bone marrow transplantation. The means of the pretransplant and post-transplant levels did not differ from the mean of 134 NK determinations in 67 healthy donors. There was no correlation between pretransplant NK levels and the appearance of graft-versus-host disease. Three weeks following bone marrow transplantation, pretransplant NK levels were observed. The sensitivity of NK cells to interferon was the same as in normal donors both before and after bone marrow transplantation. In contrast to methotrexate, cyclosporin A inhibited NK activity in patients and controls in vitro. In vivo cyclosporin A treatment, however, did not decrease NK levels in bone marrow recipients.
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Schabet M, Kloeter I, Adam T, Heidemann E, Wiethölter H. Diagnosis and treatment of meningeal carcinomatosis in ten patients with breast cancer. Eur Neurol 1986; 25:403-11. [PMID: 3792399 DOI: 10.1159/000116043] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Clinical and radiological findings of 10 breast cancer patients with meningeal carcinomatosis were recorded. Special attention was drawn to CSF findings. Initial CSF cytology revealed malignant cells in all cases with a background of inflammatory cells in 7. Oligoclonal bands were found in the CSF of 3 out of 5 cases examined. Repeated CSF control under therapy showed elevation of lactate to be a better diagnostic parameter than lowered glucose. Six patients responded well to CNS radiation therapy and intrathecal chemotherapy. Median duration of survival was 6.4 months.
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Meyer P, Ho AD, Ehninger G, Mjaaland I, Heidemann E, Seither E. Mitoxantrone in the treatment of relapsed and refractory acute leukemia. Invest New Drugs 1985; 3:203-6. [PMID: 3860490 DOI: 10.1007/bf00174171] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Twenty-four patients with acute leukemia or blast crisis (BC) of chronic myelocytic leukemia (CML) in relapse or refractory to standard chemotherapy, were eligible for treatment with mitoxantrone. Mitoxantrone (Novantrone; dihydroxyanthracenedione) was administered in a dose of 8-13 mg/m2 on five consecutive days. Five of 20 evaluable patients were induced into complete remission, one patient achieved a partial remission. Side-effects included moderate to severe bone marrow suppression, moderate mucositis and hair loss. No cardiotoxicity was observed. We believe that mitoxantrone is an active agent in the treatment of acute leukemia and suggest further studies in combination chemotherapy.
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50
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