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Schuler E, Uygun S, Mittempergher L, Pronin D, Mee S, Bao S, Cavness T, Witteveen A, Glas A. 234P Equivalence of NGS-based MammaPrint 70-gene signature risk of recurrence and BluePrint 80-gene signature of molecular subtyping tests to the centralized microarray tests. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.256] [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: 11/01/2022] Open
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2
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Luengas-Wuerzinger V, Rawert F, CLAßEN-VON Spee S, Baransi S, Schuler E, Carrizo K, Mallmann P, Lampe B. Role of the Cardiophrenic Lymph Node Status After Neoadjuvant Chemotherapy in Primary Advanced Ovarian Cancer. Anticancer Res 2021; 41:5025-5031. [PMID: 34593451 DOI: 10.21873/anticanres.15317] [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: 08/24/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study investigated the cardiophrenic lymph node (CPLN) status before and after neoadjuvant chemotherapy (NACT), as its presence seems to have a rather prognostic significance in patients with advanced ovarian cancer. PATIENTS AND METHODS The baseline computed tomography scans of 66 patients with advanced ovarian cancer primary treated with NACT between March 2015 and June 2020 were reviewed. A CPLN enlargement was defined as ≥5 mm. RESULTS 44% (n=29) of the patients had enlarged CPLNs; 10.7% (n=3) showed a complete response, 71.4% (n=20) a partial response, and 17.9% (n=5) a stable disease after NACT. There was no significant difference between the response to NACT measured according to the status of CPLN compared to other biomarkers in the CPLN group. CONCLUSION Patients with CPLN enlargement have a tendency to an impaired prognosis. The response of CPLN to NACT was comparable to the response of established biomarkers, adding a monitoring function to the CPLN.
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Affiliation(s)
| | - Friederike Rawert
- Florence-Nightingale Hospital, Department of Gynaecology and Obstetrics, Düsseldorf, Germany
| | - Sabrina CLAßEN-VON Spee
- Florence-Nightingale Hospital, Department of Gynaecology and Obstetrics, Düsseldorf, Germany
| | - Saher Baransi
- Florence-Nightingale Hospital, Department of Gynaecology and Obstetrics, Düsseldorf, Germany
| | - Esther Schuler
- Florence-Nightingale Hospital, Department of Gynaecology and Obstetrics, Düsseldorf, Germany
| | - Katharina Carrizo
- Florence-Nightingale Hospital, Department of Gynaecology and Obstetrics, Düsseldorf, Germany
| | - Peter Mallmann
- University Hospital of Cologne, Department of Obstetrics and Gynaecology, Cologne, Germany
| | - Bjoern Lampe
- Florence-Nightingale Hospital, Department of Gynaecology and Obstetrics, Düsseldorf, Germany
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Schuler E, Wagner-Drouet EM, Ajib S, Bug G, Crysandt M, Dressler S, Hausmann A, Heidenreich D, Hirschbühl K, Hoepting M, Jost E, Kaivers J, Klein S, Koldehoff M, Kordelas L, Kriege O, Müller LP, Rautenberg C, Schaffrath J, Schmid C, Wolff D, Haas R, Bornhäuser M, Schroeder T, Kobbe G. Correction to: Treatment of myeloid malignancies relapsing after allogeneic hematopoietic stem cell transplantation with venetoclax and hypomethylating agents-a retrospective multicenter analysis on behalf of the German Cooperative Transplant Study Group. Ann Hematol 2021; 100:2141-2142. [PMID: 34160650 DOI: 10.1007/s00277-021-04564-2] [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: 11/26/2022]
Affiliation(s)
- Esther Schuler
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Eva-Maria Wagner-Drouet
- Department of Hematology, Oncology, Pneumology, Medical Clinic III, UCT Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Salem Ajib
- Department of Medicine II, Goethe University, Frankfurt am Main, Germany
| | - Gesine Bug
- Department of Medicine II, Goethe University, Frankfurt am Main, Germany
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostasiology and Stem Cell Transplantation, Medical Clinic IV, University Hospital RWTH Aachen, Aachen, Germany
| | - Sabine Dressler
- Bone Marrow Transplantation Unit, Medical Clinic 5, Nürnberg, Germany
| | - Andreas Hausmann
- Department of Hematology, Oncology, Immunology, Palliative Care, Munich Clinic Schwabing, Munich, Germany
| | | | - Klaus Hirschbühl
- Department of Hematology and Oncology, Medical Clinic II, University Hospital Augsburg, Augsburg, Germany
| | - Matthias Hoepting
- Medical Clinic III, University Medicine Regensburg, Regensburg, Germany
| | - Edgar Jost
- Department of Hematology, Oncology, Hemostasiology and Stem Cell Transplantation, Medical Clinic IV, University Hospital RWTH Aachen, Aachen, Germany
| | - Jennifer Kaivers
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Stefan Klein
- Medical Clinic III, University Medicine Mannheim, Mannheim, Germany
| | - Michael Koldehoff
- Clinic for Bone Marrow Transplantation, University Hospital Essen, Essen, Germany
| | - Lambros Kordelas
- Clinic for Bone Marrow Transplantation, University Hospital Essen, Essen, Germany
| | - Oliver Kriege
- Department of Hematology, Oncology, Pneumology, Medical Clinic III, UCT Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lutz P Müller
- Department of Internal Medicine IV, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Christina Rautenberg
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Judith Schaffrath
- Department of Internal Medicine IV, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Christoph Schmid
- Department of Hematology and Oncology, Medical Clinic II, University Hospital Augsburg, Augsburg, Germany
| | - Daniel Wolff
- Medical Clinic III, University Medicine Regensburg, Regensburg, Germany
| | - Rainer Haas
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Technische Universität, Dresden, Germany
| | - Thomas Schroeder
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
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Nachtkamp K, Stark J, Kündgen A, Schroeder T, Strupp C, Strapatsas J, Schuler E, Kaivers J, Giagounidis A, Rautenberg C, Aul C, Runde V, Haas R, Kobbe G, Gattermann N, Germing U. Eligibility for clinical trials is unsatisfactory for patients with myelodysplastic syndromes, even at a tertiary referral center. Leuk Res 2021; 108:106611. [PMID: 33990002 DOI: 10.1016/j.leukres.2021.106611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/01/2022]
Abstract
Participation in clinical trials may allow patients with MDS to gain access to therapies not otherwise available. However, access is limited by strict inclusion and exclusion criteria, reflecting academic or regulatory questions addressed by the respective studies. We performed a simulation in order to estimate the average proportion of MDS patients eligible for participation in a clinical trial. The simulation drew upon 1809 patients in the Düsseldorf MDS Registry whose clinical data allowed eligibility screening for a wide range of clinical trials. This cohort was assumed to be alive and available for study participation. The simulation also posited that all MDS trials (n = 47) conducted in our center between 1987 and 2016 were open for recruitment. In addition, study activities in the year 2016 were analyzed to determine the proportion of patients eligible for at least one of the 9 MDS trials open at that time. On average, each clinical trial was suitable for about 18 % of patients in the simulation cohort. Conversely, 34 % of the patients were eligible for at least one of the 9 clinical studies in 2016. Inclusion/exclusion criteria of studies initiated by the pharmaceutical industry excluded more than twice the fraction of patients compared with investigator initiated trials (potential inclusion of 10 % vs. 21 %, respectively). Karyotype (average exclusion rate 58 %), comorbidities (40 %), and prior therapies (55 %) were the main reasons for exclusion. We suggest that in- and exclusion criteria should be less restrictive, in order to meet the needs of the real-life population of elderly MDS patients.
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Affiliation(s)
- Kathrin Nachtkamp
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany.
| | - Josefine Stark
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Andrea Kündgen
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Thomas Schroeder
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Corinna Strupp
- Department of Oncology, Rheinland Klinikum Dormagen, Dr.-Geldmacher-Straße 20, 41540 Dormagen, Germany
| | - Judith Strapatsas
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Esther Schuler
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Jennifer Kaivers
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Aristoteles Giagounidis
- Department of Oncology and Hematology, VKKD Marienhospital Duesseldorf, Rochusstr. 2, 40479 Düsseldorf, Germany
| | - Christina Rautenberg
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Carlo Aul
- Department of Oncology and Hematology, VKKD Marienhospital Duesseldorf, Rochusstr. 2, 40479 Düsseldorf, Germany
| | - Volker Runde
- Department of Hematology and Oncology, Katholisches Karl-Leisner-Klinikum, Voßheider Str. 214, 47574 Goch, Germany
| | - Rainer Haas
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Norbert Gattermann
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
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Schuler E, Wagner-Drouet EM, Ajib S, Bug G, Crysandt M, Dressler S, Hausmann A, Heidenreich D, Hirschbühl K, Hoepting M, Jost E, Kaivers J, Klein S, Koldehoff M, Kordelas L, Kriege O, Müller LP, Rautenberg C, Schaffrath J, Schmid C, Wolff D, Haas R, Bornhäuser M, Schroeder T, Kobbe G. Treatment of myeloid malignancies relapsing after allogeneic hematopoietic stem cell transplantation with venetoclax and hypomethylating agents-a retrospective multicenter analysis on behalf of the German Cooperative Transplant Study Group. Ann Hematol 2020; 100:959-968. [PMID: 33191481 PMCID: PMC8448702 DOI: 10.1007/s00277-020-04321-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023]
Abstract
Treatment of relapse after allogeneic hematopoietic stem cell transplantation (alloHSCT) remains a great challenge. Aiming to evaluate the combination of venetoclax and hypomethylating agents (HMAClax) for the treatment of relapse of myeloid malignancies after alloHSCT, we retrospectively collected data from 32 patients treated at 11 German centers. Venetoclax was applied with azacitidine (n = 13) or decitabine (n = 19); 11 patients received DLI in addition. HMAClax was the first salvage therapy in 8 patients. The median number of cycles per patient was 2 (1–19). All but 1 patient had grade 3/4 neutropenia. Hospital admission for grade 3/4 infections was necessary in 23 patients (72%); 5 of these were fatal. In 30 evaluable patients, overall response rate (ORR) was 47% (14/30, 3 CR MRDneg, 5 CR, 2 CRi, 1 MLFS, 3 PR). ORR was 86% in first salvage patients versus 35% in later salvage patients (p = 0.03). In 6 patients with molecular relapse (MR), ORR was 67% versus 42% in patients with hematological relapse (HR) (n = 24, p = n.s.). After a median follow-up of 8.4 months, 25 patients (78%) had died and 7 were alive. Estimated median overall survival was 3.7 months. Median survival of patients with HMAClax for first versus later salvage therapy was 5.7 and 3.4 months (p = n.s.) and for patients with MR (not reached) compared to HR (3.4 months, p = 0.024). This retrospective case series shows that venetoclax is utilized in various different combinations, schedules, and doses. Toxicity is substantial and patients who receive venetoclax/HMA combinations for MR or as first salvage therapy derive the greatest benefit.
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Affiliation(s)
- Esther Schuler
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Eva-Maria Wagner-Drouet
- Department of Hematology, Oncology, Pneumology, Medical Clinic III, UCT Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Salem Ajib
- Department of Medicine II, Goethe University, Frankfurt am Main, Germany
| | - Gesine Bug
- Department of Medicine II, Goethe University, Frankfurt am Main, Germany
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostasiology and Stem Cell Transplantation, Medical Clinic IV, University Hospital RWTH Aachen, Aachen, Germany
| | - Sabine Dressler
- Bone Marrow Transplantation Unit, Medical Clinic 5, Nürnberg, Germany
| | - Andreas Hausmann
- Department of Hematology, Oncology, Immunology, Palliative Care, Munich Clinic Schwabing, Munich, Germany
| | | | - Klaus Hirschbühl
- Department of Hematology and Oncology, Medical Clinic II, University Hospital Augsburg, Augsburg, Germany
| | - Matthias Hoepting
- Medical Clinic III, University Medicine Regensburg, Regensburg, Germany
| | - Edgar Jost
- Department of Hematology, Oncology, Hemostasiology and Stem Cell Transplantation, Medical Clinic IV, University Hospital RWTH Aachen, Aachen, Germany
| | - Jennifer Kaivers
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Stefan Klein
- Medical Clinic III, University Medicine Mannheim, Mannheim, Germany
| | - Michael Koldehoff
- Clinic for Bone Marrow Transplantation, University Hospital Essen, Essen, Germany
| | - Lambros Kordelas
- Clinic for Bone Marrow Transplantation, University Hospital Essen, Essen, Germany
| | - Oliver Kriege
- Department of Hematology, Oncology, Pneumology, Medical Clinic III, UCT Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lutz P Müller
- Department of Internal Medicine IV, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Christina Rautenberg
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Judith Schaffrath
- Department of Internal Medicine IV, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Christoph Schmid
- Department of Hematology and Oncology, Medical Clinic II, University Hospital Augsburg, Augsburg, Germany
| | - Daniel Wolff
- Medical Clinic III, University Medicine Regensburg, Regensburg, Germany
| | - Rainer Haas
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus at the Technische Universität, Dresden, Germany
| | - Thomas Schroeder
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
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Vasudevan V, Huang C, Simiele E, Yu L, Xing L, Schuler E. Combining Monte Carlo with Deep Learning: Predicting High-resolution, Low-noise Dose Distributions Using a Generative Adversarial Network for Fast and Precise Monte Carlo Simulations. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rautenberg C, Bergmann A, Germing U, Fischermanns C, Pechtel S, Kaivers J, Jäger P, Schuler E, Haas R, Kobbe G, Schroeder T. Prediction of Response and Survival Following Treatment with Azacitidine for Relapse of Acute Myeloid Leukemia and Myelodysplastic Syndromes after Allogeneic Hematopoietic Stem Cell Transplantation. Cancers (Basel) 2020; 12:cancers12082255. [PMID: 32806572 PMCID: PMC7464210 DOI: 10.3390/cancers12082255] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/04/2020] [Accepted: 08/08/2020] [Indexed: 12/23/2022] Open
Abstract
To provide long-term outcome data and predictors for response and survival, we retrospectively analyzed all 151 patients with relapse of myeloid neoplasms after allogeneic hematopoietic stem cell transplantation (allo-HSCT) who were uniformly treated with first-line azacitidine (Aza) salvage therapy at our center. Patients were treated for molecular (39%) or hematologic relapse (61%), with a median of 5 cycles of Aza and at least one donor lymphocyte infusion in 70% of patients. Overall response was 46%, with 41% achieving complete (CR) and 5% achieving partial remission. CR was achieved after a median of 4 cycles and lasted for a median of 11 months (range 0.9 to 120 months). With a median follow-up of 22 months (range: 1 to 122 months), the 2-year survival rate was 38% ± 9%, including 17 patients with ongoing remission for >5 years. Based on results from multivariate analyses, molecular relapse and time to relapse were integrated into a score, clearly dividing patients into 3 subgroups with CR rates of 71%, 39%, and 29%; and 2-year survival rates of 64%, 38%, and 27%, respectively. In the subgroup of MDS and secondary AML, receiving upfront transplantation was associated with superior response and survival, and therefore pretransplant strategy was integrated together with relapse type into a MDS–sAML-specific score. Overall, Aza enables meaningful responses and long-term survival, which is a predictable with a simple-to-use scoring system.
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Kaivers J, Schuler E, Hildebrandt B, Betz B, Rautenberg C, Haas R, Kobbe G, Gattermann N, Germing U. Improving the accuracy of prognostication in chronic myelomonocytic leukemia. Expert Rev Anticancer Ther 2020; 20:703-714. [PMID: 32700646 DOI: 10.1080/14737140.2020.1796644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Chronic myelomonocytic leukemia (CMML) is a hematological malignancy that is extremely variable regarding its clinical course. It may present either as a chronic disorder with mild symptoms and low disease burden for several years, thereby justifying a watch-and-wait-strategy, or may soon progress to acute myeloid leukemia (AML) leaving allogeneic stem cell transplantation as the only curative treatment option. AREAS COVERED Attempts have been made to integrate clinical, cytogenetic, and molecular parameters into scoring systems aiming at providing reliable prognostic information. In this article, we discuss several prognostic parameters and validate prognostic scores in a cohort of 645 patients with CMML. EXPERT OPINION We show that the CPSS (CMML prognostic scoring system) is a useful prognostic tool. The integration of molecular data into the new CPSS-mol will further improve prognostic accuracy, primarily by identifying an increased proportion of higher-risk patients.
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Affiliation(s)
- Jennifer Kaivers
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, University of Duesseldorf , Duesseldorf, Germany
| | - Esther Schuler
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, University of Duesseldorf , Duesseldorf, Germany
| | - Barbara Hildebrandt
- Institute of Human Genetics, Medical Faculty, University of Duesseldorf , Duesseldorf, Germany
| | - Beate Betz
- Institute of Human Genetics, Medical Faculty, University of Duesseldorf , Duesseldorf, Germany
| | - Christina Rautenberg
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, University of Duesseldorf , Duesseldorf, Germany
| | - Rainer Haas
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, University of Duesseldorf , Duesseldorf, Germany
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, University of Duesseldorf , Duesseldorf, Germany
| | - Norbert Gattermann
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, University of Duesseldorf , Duesseldorf, Germany
| | - Ulrich Germing
- Department of Hematology, Oncology and Clinical Immunology, Medical Faculty, University of Duesseldorf , Duesseldorf, Germany
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Maneck M, Köckerling F, Fahlenbrach C, Heidecke CD, Heller G, Meyer HJ, Rolle U, Schuler E, Waibel B, Jeschke E, Günster C. Hospital volume and outcome in inguinal hernia repair: analysis of routine data of 133,449 patients. Hernia 2019; 24:747-757. [PMID: 31786700 PMCID: PMC7395912 DOI: 10.1007/s10029-019-02091-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/17/2019] [Indexed: 01/20/2023]
Abstract
Introduction Inguinal hernias are repaired using either open or minimally invasive surgical techniques. For both types of surgery it has been demonstrated that a higher annual surgeon volume is associated with a lower risk of recurrence. This present study investigated the volume-outcome implications for recurrence operations, surgical complications, rate of chronic pain requiring treatment, and 30-day mortality based on the hospital volume. Materials and methods The data basis used was the routine data collected throughout the Federal Republic of Germany for persons insured by the Local General Sickness Fund “AOK” who had undergone inpatient inguinal hernia repair between 2013 and 2015. Complications were recorded by means of indicators. Hospitals were divided into five groups on the basis of the annual caseload volume: 1–50, 51–75, 76–100, 101–125, and ≥ 126 inguinal hernia repairs per year. The effect of the hospital volume on the indicators was assessed using multiple logistic regression. Results 133,449 inguinal hernia repairs were included. The incidence for recurrence operations was 0.95%, for surgical complications 4.22%, for chronic pain requiring treatment 2.87%, and for the 30-day mortality 0.28%. Low volume hospitals (1–50 and 51–75 inguinal hernia repairs per year) showed a significantly increased recurrence risk compared to high volume hospitals with ≥ 126 inguinal hernia repairs per year (odds ratio: 1.53 and 1.24). No significant correlations were found for the other results. Conclusions The study gives a detailed picture of hospital care for inguinal hernia repair in Germany. Furthermore, it was noted that the risk of hernia recurrence decreases in line with a rising caseload of the treating hospital.
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Affiliation(s)
- M Maneck
- AOK Research Institute (WIdO), Berlin, Germany
| | - F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany.
| | | | - C D Heidecke
- Department of General, Visceral, Thoracic and Vascular Surgery, University of Greifswald, Greifswald, Germany
| | - G Heller
- Department of Medicine, University of Marburg, Marburg, Germany
| | - H J Meyer
- German Society of Surgery, Berlin, Germany
| | - U Rolle
- Department of Pediatric Surgery and Pediatric Urology, University of Frankfurt/Main, Frankfurt/Main, Germany
| | - E Schuler
- Department of Quality Management, Helios Hospitals, Berlin, Germany
| | - B Waibel
- Medical Review Board of the Social Health Insurance Funds Baden-Württemberg, Freiburg, Germany
| | - E Jeschke
- AOK Research Institute (WIdO), Berlin, Germany
| | - C Günster
- AOK Research Institute (WIdO), Berlin, Germany
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Schmitz J, Kobbe G, Kondakci M, Schuler E, Magorsch M, Adams O. The Value of Torque Teno Virus (TTV) as a Marker for the Degree of Immunosuppression in Adult Patients after Hematopoietic Stem Cell Transplantation (HSCT). Biol Blood Marrow Transplant 2019; 26:643-650. [PMID: 31712192 DOI: 10.1016/j.bbmt.2019.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 12/28/2022]
Abstract
Torque teno virus (TTV) is a nonenveloped, single-stranded, circular DNA virus of the family of Anelloviridae. The first contact with TTV usually occurs in early childhood, followed by persistent infection in bone marrow and lymphocytes. Increased levels of TTV-DNA are found in the serum in various states of immune deficiency. The objective of this study was to assess if monitoring of TTV viremia after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a predictive marker for immune-related clinical complications. In a retrospective study, 2054 whole-blood samples from 123 patients were tested for viral loads of TTV-DNA by real-time PCR within 345 days after allo-HSCT. We enrolled all patients who underwent allo-HSCT between September 2015 and April 2018. Clinical and laboratory data were collected and statistically analyzed. Patients with an underlying lymphatic malignancy had significantly higher torque teno (TT) viral loads compared with patients with an underlying malignant myeloid disease (P < .05). Complete remission before allo-HSCT correlated significantly with higher TT viral loads after allo-HSCT (P < .05). Myeloablative conditioning regimens led to significantly higher TT viral loads than reduced-intensity conditioning regimens (P < .05). A higher anti-thymocyte globulin (ATG) dose was associated with a significantly higher TT viral load. We did not observe any significant differences of TT viral load correlating with accompanying clinically relevant events such as virus reactivations (cytomegalovirus, Epstein-Barr virus, Adenovirus), acute graft-versus-host disease (aGVHD), relapse, or death. TT viral load after allo-HSCT did weakly correlate with T cell, T suppressor cell, T helper cell, and natural killer and B cell count. Although statistically significant differences between study groups were observed, virus reactivations, aGVHD, and clinical outcomes could not be predicted by monitoring TTV viremia. Therefore, TTV seems not to be suitable as a marker for the degree of immunosuppression or as a prognostic marker for clinically critical events in patients after allo-HSCT.
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Affiliation(s)
- Julia Schmitz
- Institute for Virology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Guido Kobbe
- Department of Haematology, Oncology and Clinical Immunology, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Mustafa Kondakci
- Department of Haematology, Oncology and Clinical Immunology, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Esther Schuler
- Department of Haematology, Oncology and Clinical Immunology, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Max Magorsch
- Technical University of Dortmund, Dortmund, Germany
| | - Ortwin Adams
- Institute for Virology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany.
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Silzle T, Blum S, Schuler E, Kaivers J, Rudelius M, Hildebrandt B, Gattermann N, Haas R, Germing U. Lymphopenia at diagnosis is highly prevalent in myelodysplastic syndromes and has an independent negative prognostic value in IPSS-R-low-risk patients. Blood Cancer J 2019; 9:63. [PMID: 31399557 PMCID: PMC6689049 DOI: 10.1038/s41408-019-0223-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 02/25/2019] [Revised: 05/05/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023] Open
Abstract
Lymphopenia is associated with an increased mortality in several medical conditions. Its prognostic impact in myelodysplastic syndromes (MDS) is less well studied. Hence, we analyzed 1023 patients from the Düsseldorf MDS-registry with regard to the absolute lymphocyte count (ALC) at diagnosis. An ALC below the median of the population (1.2 × 109/l) was associated with lower counts of neutrophils (median 1.35 vs. 1.92 × 109/l, p < 0.001) and platelets (median 100 vs. 138 × 109/l, p < 0.001) and with a significant lower overall survival in univariate analysis (whole cohort: median 36 vs. 46 months, p = 0.016; 721 patients without hematopoietic stem cell transplantation or induction chemotherapy: median 36 vs. 56 months, p = 0.001). For low-risk MDS according to IPSS-R, an ALC < 1.2 × 109/l was of additional prognostic value in a multivariate Cox regression model together with age (< or ≥65 years) and LDH (< or ≥normal value of 240 U/l; HR 1.46, 95% CI: 1.03-2.08, p = 0.033). These data support the hypothesis of subtle but clinical relevant changes of the adaptive immune system in MDS. Further studies are necessary to identify the ALC cut-off best suitable for prognostication and the mechanisms responsible for the impairment of lymphoid homeostasis in MDS.
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Affiliation(s)
- Tobias Silzle
- Department of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Sabine Blum
- Service and Central Laboratory of Hematology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Esther Schuler
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jennifer Kaivers
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Martina Rudelius
- Institute of Pathology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Barbara Hildebrandt
- Department of Human Genetics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Norbert Gattermann
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Rainer Haas
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ulrich Germing
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Schroeder T, Wegener N, Lauseker M, Rautenberg C, Nachtkamp K, Schuler E, Kondakci M, Haas R, Germing U, Kobbe G. Comparison between Upfront Transplantation and different Pretransplant Cytoreductive Treatment Approaches in Patients with High-Risk Myelodysplastic Syndrome and Secondary Acute Myelogenous Leukemia. Biol Blood Marrow Transplant 2019; 25:1550-1559. [DOI: 10.1016/j.bbmt.2019.03.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/11/2019] [Indexed: 12/14/2022]
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13
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Schuler E, Boughoufala S, Rautenberg C, Nachtkamp K, Dienst A, Fenk R, Haas R, Kondakci M, Germing U, Schroeder T, Kobbe G. Relapse patterns and treatment strategies in patients receiving allogeneic hematopoietic stem cell transplantation for myeloid malignancies. Ann Hematol 2019; 98:1225-1235. [DOI: 10.1007/s00277-019-03670-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022]
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Frick M, Chan W, Arends CM, Hablesreiter R, Halik A, Heuser M, Michonneau D, Blau O, Hoyer K, Christen F, Galan-Sousa J, Noerenberg D, Wais V, Stadler M, Yoshida K, Schetelig J, Schuler E, Thol F, Clappier E, Christopeit M, Ayuk F, Bornhäuser M, Blau IW, Ogawa S, Zemojtel T, Gerbitz A, Wagner EM, Spriewald BM, Schrezenmeier H, Kuchenbauer F, Kobbe G, Wiesneth M, Koldehoff M, Socié G, Kroeger N, Bullinger L, Thiede C, Damm F. Role of Donor Clonal Hematopoiesis in Allogeneic Hematopoietic Stem-Cell Transplantation. J Clin Oncol 2019; 37:375-385. [DOI: 10.1200/jco.2018.79.2184] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose Clonal hematopoiesis of indeterminate potential (CHIP) occurs in the blood of approximately 20% of older persons. CHIP is linked to an increased risk of hematologic malignancies and of all-cause mortality; thus, the eligibility of stem-cell donors with CHIP is questionable. We comprehensively investigated how donor CHIP affects outcome of allogeneic hematopoietic stem-cell transplantation (HSCT). Methods We collected blood samples from 500 healthy, related HSCT donors (age ≥ 55 years) at the time of stem-cell donation for targeted sequencing with a 66-gene panel. The effect of donor CHIP was assessed on recipient outcomes, including graft-versus-host disease (GVHD), cumulative incidence of relapse/progression (CIR/P), and overall survival (OS). Results A total of 92 clonal mutations with a median variant allele frequency of 5.9% were identified in 80 (16.0%) of 500 donors. CHIP prevalence was higher in donors related to patients with myeloid compared with lymphoid malignancies (19.2% v 6.3%; P ≤ .001). In recipients allografted with donor CHIP, we found a high cumulative incidence of chronic GVHD (cGVHD; hazard ratio [HR], 1.73; 95% CI, 1.21 to 2.49; P = .003) and lower CIR/P (univariate: HR, 0.62; 95% CI, 0.40 to 0.97; P = .027; multivariate: HR, 0.63; 95% CI, 0.41 to 0.98; P = .042) but no effect on nonrelapse mortality. Serial quantification of 25 mutations showed engraftment of 24 of 25 clones and disproportionate expansion in half of them. Donor-cell leukemia was observed in two recipients. OS was not affected by donor CHIP status (HR, 0.88; 95% CI, 0.65 to 1.321; P = .434). Conclusion Allogeneic HSCT from donors with CHIP seems safe and results in similar survival in the setting of older, related donors. Future studies in younger and unrelated donors are warranted to extend these results. Confirmatory studies and mechanistic experiments are warranted to challenge the hypothesis that donor CHIP might foster cGVHD development and reduce relapse/progression risk.
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Affiliation(s)
- Mareike Frick
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Willy Chan
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Christopher Maximilian Arends
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Raphael Hablesreiter
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Adriane Halik
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | | | - David Michonneau
- David Michonneau and Gérard Socié, INSERM U1160, Institut Universitaire d’Hematologie, Paris/University Paris Diderot, Paris, France
| | - Olga Blau
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Kaja Hoyer
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Friederike Christen
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Joel Galan-Sousa
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Daniel Noerenberg
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | | - Igor Wolfgang Blau
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | | | - Tomasz Zemojtel
- Berlin Institute of Health (BIH) Core Genomics Facility, Charité, University Medical Center, Berlin, Germany
| | - Armin Gerbitz
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Eva M. Wagner
- UCT Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bernd M. Spriewald
- University Hospital Erlangen, Friedrich Alexander University Erlangen Nürnberg (FAU), Erlangen, Germany
| | - Hubert Schrezenmeier
- German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and Institute of Transfusion Medicine, Ulm, Germany
| | | | - Guido Kobbe
- Heinrich Heine University, Düsseldorf, Germany
| | - Markus Wiesneth
- German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and Institute of Transfusion Medicine, Ulm, Germany
| | - Michael Koldehoff
- West German Cancer Centre, University Hospital of Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Gérard Socié
- David Michonneau and Gérard Socié, INSERM U1160, Institut Universitaire d’Hematologie, Paris/University Paris Diderot, Paris, France
| | | | - Lars Bullinger
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Thiede
- Carl Gustav Carus University Hospital Dresden, Dresden, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik Damm
- Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Schuler E, Zadrozny N, Blum S, Schroeder T, Strupp C, Hildebrandt B, Kündgen A, Gattermann N, Aul C, Kondakci M, Kobbe G, Haas R, Germing U. Long-term outcome of high risk patients with myelodysplastic syndromes or secondary acute myeloid leukemia receiving intensive chemotherapy. Ann Hematol 2018; 97:2325-2332. [DOI: 10.1007/s00277-018-3466-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/27/2018] [Indexed: 01/12/2023]
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16
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Schuler E, Frank F, Hildebrandt B, Betz B, Strupp C, Rudelius M, Aul C, Schroeder T, Gattermann N, Haas R, Germing U. Myelodysplastic syndromes without peripheral monocytosis but with evidence of marrow monocytosis share clinical and molecular characteristics with CMML. Leuk Res 2017; 65:1-4. [PMID: 29216536 DOI: 10.1016/j.leukres.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/27/2017] [Accepted: 12/01/2017] [Indexed: 12/31/2022]
Abstract
MDS patients may present with monocytic marrow proliferation not fulfilling criteria for CMML. We analyzed MDS patients with or without a marrow monocytic proliferation by following up the amount of monocytic proliferation and characterizing their molecular profile. 315 MDS patients of Duesseldorf MDS registry were divided into two groups: A) 183 patients with monocytic esterase positive cells in marrow and monocytes between 101 and 900/μl in blood and B) 132 patients without monocytic esterase positive cells in marrow and monocytes in blood ≤100/μl. Twenty patients of each group were screened with regard to ASXL1, TET2, RUNX1, SETBP1, NRAS, and SRSF2 using Illumina myeloid panel. Group A patients were older, had significantly higher WBC, hemoglobin levels, neutrophils and platelets. CMML evolution rates were 4.9% and 1.5%, respectively (p=n.s.). TET2, NRAS and SRFS2 mutation frequencies were higher in group A and four patients had coexisting TET2 and SRFS2 mutation, which was shown to be characteristic but not specific for CMML. MDS patients with marrow monocytic proliferation have a more CMML-like pheno- and genotype and develop CMML more often. Those patients could potentially be very early stages of CMML or represent a CMML-like myeloid neoplasma with marrow adherence of the monocytic cell population.
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Affiliation(s)
- E Schuler
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany.
| | - F Frank
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany
| | - B Hildebrandt
- Institute of Human Genetics and Anthropology, Heinrich Heine-University, Duesseldorf, Germany
| | - B Betz
- Institute of Human Genetics and Anthropology, Heinrich Heine-University, Duesseldorf, Germany
| | - C Strupp
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany
| | - M Rudelius
- Institute of Pathology, Heinrich Heine-University, Duesseldorf, Germany
| | - C Aul
- Department of Hematology and Oncology, Johannes Hospital Duisburg, Germany
| | - T Schroeder
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany
| | - N Gattermann
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany
| | - R Haas
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany
| | - U Germing
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany
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Nimptsch U, Bolczek C, Spoden M, Schuler E, Zacher J, Mansky T. Mengenentwicklung bei stationären Behandlungen im Wirbelsäulenbereich – Analyse der bundesweiten Krankenhausabrechnungsdaten von 2005 – 2014. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605669] [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: 10/18/2022]
Affiliation(s)
- U Nimptsch
- TU Berlin, Strukturentwicklung und Qualitätsmanagement im Gesundheitswesen, Berlin
| | - C Bolczek
- TU Berlin, Strukturentwicklung und Qualitätsmanagement im Gesundheitswesen, Berlin
| | - M Spoden
- TU Berlin, Strukturentwicklung und Qualitätsmanagement im Gesundheitswesen, Berlin
| | - E Schuler
- Helios Kliniken GmbH, Zentraler Dienst Medizin, Berlin
| | - J Zacher
- Helios Kliniken GmbH, Zentraler Dienst Medizin, Berlin
| | - T Mansky
- TU Berlin, Strukturentwicklung und Qualitätsmanagement im Gesundheitswesen, Berlin
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Buda S, Tolksdorf K, Schuler E, Kuhlen R, Haas W. Establishing an ICD-10 code based SARI-surveillance in Germany - description of the system and first results from five recent influenza seasons. BMC Public Health 2017; 17:612. [PMID: 28666433 PMCID: PMC5493063 DOI: 10.1186/s12889-017-4515-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 06/19/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Syndromic surveillance of severe acute respiratory infections (SARI) is important to assess seriousness of disease as recommended by WHO for influenza. In 2015 the Robert Koch Institute (RKI) started to collaborate with a private hospital network to develop a SARI surveillance system using case-based data on ICD-10 codes. This first-time description of the system shows its application to the analysis of five influenza seasons. METHODS Since week 40/2015, weekly updated anonymized data on discharged patients overall and on patients with respiratory illness including ICD-10 codes of primary and secondary diagnoses are transferred from the network data center to RKI. Retrospective datasets were also provided. Our descriptive analysis is based on data of 47 sentinel hospitals collected between weeks 1/2012 to 20/2016. We applied three different SARI case definitions (CD) based on ICD-10 codes for discharge diagnoses of respiratory tract infections (J09 - J22): basic CD (BCD), using only primary diagnoses; sensitive CD (SCD), using primary and secondary diagnoses; timely CD (TCD), using only primary diagnoses of patients hospitalized up to one week. We compared the CD with regard to severity, age distribution and timeliness and with results from the national primary care sentinel system. RESULTS The 47 sentinel hospitals covered 3.6% of patients discharged from all German hospitals in 2013. The SCD comprised 2.2 times patients as the BCD, and 3.6 times as many as the TCD. Time course of SARI cases corresponded well to results from primary care surveillance and influenza virus circulation. The patients fulfilling the TCD had been completely reported after 3 weeks, which was fastest among the CD. The proportion of SARI cases among patients was highest in the youngest age group of below 5-year-olds. However, the age group 60 years and above contributed most SARI cases. This was irrespective of the CD used. CONCLUSIONS In general, available data and the implemented reporting system are appropriate to provide timely and reliable information on SARI in inpatients in Germany. Our ICD-10-based approach proved to be useful for fulfilling requirements for SARI surveillance. The exploratory approach gave valuable insights in data structure and emphasized the advantages of different CD.
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Affiliation(s)
- S Buda
- Robert Koch Institute, Department for infectious disease epidemiology, Respiratory infections unit, Seestr. 10, 13353, Berlin, Germany.
| | - K Tolksdorf
- Robert Koch Institute, Department for infectious disease epidemiology, Respiratory infections unit, Seestr. 10, 13353, Berlin, Germany
| | - E Schuler
- HELIOS KLINIKEN GmbH, Friedrichstraße 136, 10117, Berlin, Germany
| | - R Kuhlen
- HELIOS KLINIKEN GmbH, Friedrichstraße 136, 10117, Berlin, Germany
| | - W Haas
- Robert Koch Institute, Department for infectious disease epidemiology, Respiratory infections unit, Seestr. 10, 13353, Berlin, Germany
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Silzle T, Schuler E, Hildebrandt B, Haas R, Templeton A, Germing U. Lymphocytosis, Neutrophil/Lymphocyte Ratio and Monocyte/Lymphocyte Ratio as Prognostic Markers in CMML. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30376-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rautenberg C, Schuler E, Nachtkamp K, Schroeder T, Blum S, Aul C, Haas R, Germing U. Validation of a New Clinically Based Classification System for Stratification of Prognosis in Patients with CMML. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30372-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schuler E, Frank F, Betz B, Hildebrandt B, Aul C, Strupp C, Schroeder T, Haas R, Germing U. Myelodysplastic Syndromes Showing Slight Monocytic Marrow Proliferation Are Prone to Progress to CMML. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Krahwinkel W, Schuler E, Liebetrau M, Meier-Hellmann A, Zacher J, Kuhlen R. The effect of peer review on mortality rates. Int J Qual Health Care 2016; 28:594-600. [DOI: 10.1093/intqhc/mzw072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 05/12/2016] [Accepted: 06/14/2016] [Indexed: 11/13/2022] Open
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Zeiser R, Burchert A, Lengerke C, Verbeek M, Maas-Bauer K, Metzelder SK, Spoerl S, Ditschkowski M, Ecsedi M, Sockel K, Ayuk F, Ajib S, de Fontbrune FS, Na IK, Penter L, Holtick U, Wolf D, Schuler E, Meyer E, Apostolova P, Bertz H, Marks R, Lübbert M, Wäsch R, Scheid C, Stölzel F, Ordemann R, Bug G, Kobbe G, Negrin R, Brune M, Spyridonidis A, Schmitt-Gräff A, van der Velden W, Huls G, Mielke S, Grigoleit GU, Kuball J, Flynn R, Ihorst G, Du J, Blazar BR, Arnold R, Kröger N, Passweg J, Halter J, Socié G, Beelen D, Peschel C, Neubauer A, Finke J, Duyster J, von Bubnoff N. Ruxolitinib in corticosteroid-refractory graft-versus-host disease after allogeneic stem cell transplantation: a multicenter survey. Leukemia 2015; 29:2062-8. [PMID: 26228813 DOI: 10.1038/leu.2015.212] [Citation(s) in RCA: 384] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 12/15/2022]
Abstract
Despite major improvements in allogeneic hematopoietic cell transplantation over the past decades, corticosteroid-refractory (SR) acute (a) and chronic (c) graft-versus-host disease (GVHD) cause high mortality. Preclinical evidence indicates the potent anti-inflammatory properties of the JAK1/2 inhibitor ruxolitinib. In this retrospective survey, 19 stem cell transplant centers in Europe and the United States reported outcome data from 95 patients who had received ruxolitinib as salvage therapy for SR-GVHD. Patients were classified as having SR-aGVHD (n=54, all grades III or IV) or SR-cGVHD (n=41, all moderate or severe). The median number of previous GVHD-therapies was 3 for both SR-aGVHD (1-7) and SR-cGVHD (1-10). The overall response rate was 81.5% (44/54) in SR-aGVHD including 25 complete responses (46.3%), while for SR-cGVHD the ORR was 85.4% (35/41). Of those patients responding to ruxolitinib, the rate of GVHD-relapse was 6.8% (3/44) and 5.7% (2/35) for SR-aGVHD and SR-cGVHD, respectively. The 6-month-survival was 79% (67.3-90.7%, 95% confidence interval (CI)) and 97.4% (92.3-100%, 95% CI) for SR-aGVHD and SR-cGVHD, respectively. Cytopenia and cytomegalovirus-reactivation were observed during ruxolitinib treatment in both SR-aGVHD (30/54, 55.6% and 18/54, 33.3%) and SR-cGVHD (7/41, 17.1% and 6/41, 14.6%) patients. Ruxolitinib may constitute a promising new treatment option for SR-aGVHD and SR-cGVHD that should be validated in a prospective trial.
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Affiliation(s)
- R Zeiser
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - A Burchert
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - C Lengerke
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - M Verbeek
- III Department of Internal Medicine, Technical University of Munich, Munich, Germany
| | - K Maas-Bauer
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - S K Metzelder
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - S Spoerl
- III Department of Internal Medicine, Technical University of Munich, Munich, Germany
| | - M Ditschkowski
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - M Ecsedi
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - K Sockel
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - F Ayuk
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - S Ajib
- Department of Internal Medicine II, University Hospital, Frankfurt/Main, Germany
| | - F S de Fontbrune
- Hematology Stem cell transplant Unit, Saint Louis Hospital, APHP, Paris, France
| | - I-K Na
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - L Penter
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - U Holtick
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - D Wolf
- Medical Clinic III, Oncology, Hematology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany
| | - E Schuler
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - E Meyer
- Department of Bone Marrow Transplantation, Stanford University Medical School, Stanford, CA, USA
| | - P Apostolova
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - H Bertz
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - R Marks
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - M Lübbert
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - R Wäsch
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - C Scheid
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - F Stölzel
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - R Ordemann
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - G Bug
- Department of Internal Medicine II, University Hospital, Frankfurt/Main, Germany
| | - G Kobbe
- Department of Hematology, Oncology and Clinical Immunology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - R Negrin
- Department of Bone Marrow Transplantation, Stanford University Medical School, Stanford, CA, USA
| | - M Brune
- Department of Internal Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - A Spyridonidis
- Department of Bone Marrow Transplantation, Patras University Medical School, Patras, Greece
| | - A Schmitt-Gräff
- Department of Pathology, Freiburg University Medical Center, Freiburg, Germany
| | | | - G Huls
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S Mielke
- Department of Hematology and Oncology, University Medical Centre Würzburg, Würzburg, Germany
| | - G U Grigoleit
- Department of Hematology and Oncology, University Medical Centre Würzburg, Würzburg, Germany
| | - J Kuball
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Flynn
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - G Ihorst
- Clinical Trials Unit, Department of Hematology, Freiburg University Medical Center, Freiburg, Germany
| | - J Du
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - B R Blazar
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - R Arnold
- Department of Stem Cell Transplantation, Charité University Medicine Berlin, Berlin, Germany
| | - N Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - J Passweg
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - J Halter
- Division of Hematology, University Hospital of Basel, Basel, Switzerland
| | - G Socié
- Hematology Stem cell transplant Unit, Saint Louis Hospital, APHP, Paris, France
| | - D Beelen
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - C Peschel
- III Department of Internal Medicine, Technical University of Munich, Munich, Germany
| | - A Neubauer
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, and University Medical Center Giessen and Marburg, Marburg, Germany
| | - J Finke
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - J Duyster
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
| | - N von Bubnoff
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Freiburg, Germany
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Schroeder T, Pechtel S, Lamers M, Dienst A, Schuler E, Rachlis E, Wegener N, Kündgen A, Kondakci M, Fenk R, Haas R, Germing U, Kobbe G. 121 PERIPHERAL BLOOD (PB) WILMS' TUMOR 1 (WT1) EXPRESSION QUANTIFIED BY A STANDARDIZED EUROPEAN LEUKEMIA NET (ELN)-CERTIFIED ASSAY AS PROGNOSTIC AND MINIMAL RESIDUAL DISEASE (MRD) MARKER IN MDS. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30122-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schuler E, Schemenau J, Giagounidis A, Haase D, Büsche G, Platzbecker U, Nolte F, Götze K, Schlenk R, Ganser A, Letsch A, Lübbert M, Schafhausen P, Bug G, Germing U. 120 RESULTS OF THE MULTICENTER, PHASE II STUDY OF THE SAFETY OF LENALIDOMIDE MONOTHERAPY IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES (MDS) ASSOCIATED WITH AN ISOLATED DEL(5Q). Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Riond B, Schuler E, Rogg E, Hofmann-Lehmann R, Lutz H. Prevalence of dog erythrocyte antigen 1.1 in dogs in Switzerland evaluated with the gel column technique. SCHWEIZ ARCH TIERH 2012; 153:369-74. [PMID: 21780065 DOI: 10.1024/0036-7281/a000223] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Canine blood typing has become an established and essential laboratory test due to the rising demand for safe and efficient blood transfusions. The most immunogenic and clinically important blood type is DEA 1.1. Little is known about DEA 1.1 frequencies or special characteristics among different canine breeds. 304 dogs were tested for DEA 1.1. DEA 1.1-typing was performed using a commercial gel column technique (ID-Gel Test Canine DEA 1.1, DiaMed, Cressier, Switzerland). Fifty-three percent of all tested dogs reacted positive for DEA 1.1, whereas 49 % of the mixed breeds tested DEA 1.1-positive. All Bernese mountain dogs (n = 22) and Rottweilers (n = 9) tested positive for DEA 1.1, while all Boxers (n = 8), Flat-Coated Retrievers (n = 9), and Border Collies (6) tested negative for DEA 1.1. The prevalence of DEA 1.1 in dogs in Switzerland was found to be comparable to that reported from other countries. The tested breeds were found to differ considerably in the frequency of DEA 1.1. This knowledge is useful for selection of blood donors. However, DEA 1.1 blood typing of donor and recipient prior to transfusion and cross matching in sensitized dogs is unavoidable.
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Affiliation(s)
- B Riond
- Clinical Laboratory, University of Zurich
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27
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Krahwinkel W, Rink O, Liebetrau M, Günther M, Schuler E, Kuhlen R. 10 Jahre Peer Review – Verbesserung der medizinischen Behandlung durch Qualitätsindikatoren aus Routinedaten. Dtsch Med Wochenschr 2011; 136:2083-8. [DOI: 10.1055/s-0031-1272577] [Citation(s) in RCA: 10] [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: 10/17/2022]
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28
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Scheiffarth F, Schuler E, Berg G. Untersuchungen über die Beeinflussung der Serumproteine und der Antikörperproduktion durch ACTH und Cortison1. Dtsch Med Wochenschr 2009. [DOI: 10.1055/s-0028-1115077] [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: 10/20/2022]
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29
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Untch M, Keil E, Kettritz U, Mairinger T, Fleige B, Dresel S, Krempien R, Kretzschmar A, Preussker P, Loll H, Lüders H, Wildberger J, Schuler E. Das Interdisziplinäre Brustzentrum im HELIOS Klinikum Berlin-Buch. Breast Care (Basel) 2007. [DOI: 10.1159/000109748] [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] Open
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30
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Borrell JI, Teixidó J, Schuler E, Michelotti EL. Solid phase vs. solution phase differential behavior: formation of a salicylate structure from a malondialdehyde moiety. Mol Divers 2002; 5:163-6. [PMID: 12197073 DOI: 10.1023/a:1016246405906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Treatment of 2, solid supported synthetic equivalent of 3-formylchromone (4), and ethyl acetoacetate affords the salicylate structure 8 instead of the previously reported isophtalate 7. This is the first formation of a salicylate by a double carbonyl condensation of a malondialdehyde moiety ever reported.
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Affiliation(s)
- J I Borrell
- Grup d'Enginyeria Molecular, Institut Químic de Sarrià, Universitat Ramon Llull, Via Augusta 390, E-08017 Barcelona, Spain.
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31
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Borrell JI, Teixidó J, Matallana JL, Martínez-Teipel B, Colominas C, Costa M, Balcells M, Schuler E, Castillo MJ. Synthesis and biological activity of 7-oxo substituted analogues of 5-deaza-5,6,7,8-tetrahydrofolic acid (5-DATHF) and 5,10-dideaza-5,6,7,8-tetrahydrofolic acid (DDATHF). J Med Chem 2001; 44:2366-9. [PMID: 11428931 DOI: 10.1021/jm990411u] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [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: 11/28/2022]
Abstract
We recently described the syntheses of 12a-c, 4-amino-7-oxo substituted analogues of 5-deaza-5,6,7,8-tetrahydrofolic acid (5-DATHF), and 5,10-dideaza-5,6,7,8-tetrahydrofolic acid (DDATHF), in six steps from commercially available p-substituted methyl benzoates in 20-27% overall yields. Such analogues were tested in vitro against CCRF-CEM leukemia cells and showed that they are completely devoid of any activity, the IC(50) being higher than 20 microg/mL for all cases. To clarify if the presence of the carbonyl group in position C7, the distinctive feature of our synthetic methodology, is the reason for this lack of activity, we have now obtained the 7-oxo substituted analogues of 5-DATHF and DDATHF, 18a-c, in 10-30% overall yield. Testing of 18a-c in vitro against CCRF-CEM leukemia cells revealed that these compounds are totally inactive. A molecular modeling study of 18b inside the active site of the complex E. coliGARTFase-5-DATHF-GAR pointed to an electronic repulsion between the atoms of the 7-oxo group and the carbonyl group of Arg90 as a possible explanation for the inactivity of 18a-c.
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Affiliation(s)
- J I Borrell
- Departament de Química Orgànica, Institut Químic de Sarrià, Universitat Ramon Llull, Via Augusta 390, E-08017 Barcelona, Spain
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32
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Abstract
We present a case of decompensated nerve IV palsy with vertical diplopia afer bilateral laser in situ keratomileusis. As the patient was given monovision, we believe diplopia occurred with a decrease in vision in 1 eye and interruption of fusion. Although corrective spectacles to restore equal vision at distance were prescribes, the patient needed a prism to eliminate her double vision. We suggest a careful cover/uncover test and versions assessment in all candidates for refractive surgery who want monovision correction and a full ocular motility evaluation if there is any doubt about binocular issues.
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Silverberg M, Schuler E, Veronneau-Troutman S, Wald K, Schlossman A, Medow N. Nonsurgical management of binocular diplopia induced by macular pathology. Arch Ophthalmol 1999; 117:900-3. [PMID: 10408454 DOI: 10.1001/archopht.117.7.900] [Citation(s) in RCA: 31] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To treat binocular diplopia secondary to macular pathology. METHODS Seven patients underwent evaluation and treatment. All had constant vertical diplopia caused by various maculopathies, including subretinal neovascularization, epiretinal membrane, and central serous retinopathy. Visual acuity ranged from 20/20 to 20/30 in the affected eye. All except 1 patient had a small-angle, comitant hyperdeviation with no muscle paresis. Sensory evaluation demonstrated peripheral fusion and reduced stereoacuity. Neither prism correction nor manipulation of the refractive errors corrected the diplopia. A partially occlusive foil (Bangerter) of density ranging from 0.4 to 1.0 was placed in front of the affected eye to restore stable, single vision. RESULTS The Bangerter foil eliminated the diplopia in all patients. Two patients elected not to wear the foil; 1 patient was afraid of becoming dependent, and the other was bothered by the visual blur. Visual acuity in the affected eye was reduced on average by 3 lines. All patients maintained the same level of sensory fusion, with only 2 having reduced stereoacuity. Symptoms returned when the foil was removed or its density was reduced. CONCLUSION Low-density Bangerter foils provide an effective, inexpensive, and aesthetically acceptable management for refractory binocular diplopia induced by macular pathology, allowing peripheral fusion to be maintained.
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Affiliation(s)
- M Silverberg
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA.
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Abstract
We have studied intracranial pressure (ICP) B-waves and their association with rhythmic changes in blood flow velocity (B-wave equivalents) by transcranial Doppler sonography (TCD) monitoring. In overnight TCD recordings in 10 normal young adults, these rhythmic changes in blood flow velocity were higher and more frequent during REM sleep and sleep stage 1 than during other sleep stages. B-wave equivalents also had a longer wavelength during REM sleep. Their relative frequency in these normal subjects over one night ranged from 35 to 73%. Peripheral resistance (assessed by the Pourcelot index) was lower and heart rate was higher at the peak of these oscillations. These results support the hypothesis that ICP B-waves are caused by vasodilation. A non-linear relationship between ICP and blood flow velocity was found during B-waves in 9 of 11 patients with suspected NPH. Our results throw doubt on the suggestion that a relative frequency of less than 80% B-wave activity can be a valid indicator for shunt responsiveness in patients with suspected normal pressure hydrocephalus (NPH). ICP recordings in suspected NPH should be accompanied by polysomnography to avoid misleading results due to variability of B-wave appearance dependent on sleep pattern.
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Affiliation(s)
- D W Droste
- Department of Neurology, University of Freiburg, Germany
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35
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Schuler E, Lin F, Worman HJ. Characterization of the human gene encoding LBR, an integral protein of the nuclear envelope inner membrane. J Biol Chem 1994; 269:11312-7. [PMID: 8157663] [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: 01/29/2023] Open
Abstract
We have characterized the human gene encoding LBR, an integral protein of the nuclear envelope inner membrane. Restriction mapping shows that the transcription unit spans approximately 35 kilobases. A transcription start site is located approximately 4 kilobases 5' to the translation initiation codon, and an RNA splice of 3863 bases occurs in the 5'-untranslated region to generate mature HeLa cell mRNA. 5' to the identified transcription start site are two CCAAT sequences and potential recognition sites for several transcription factors including Sp1, AP-1, AP-2, and NF-kB. There are 13 protein coding exons in the LBR gene. LBR's nucleoplasmic domain is encoded by exons 1-4, and its hydrophobic domain, with eight putative transmembrane segments, is encoded by exons 5-13. The hydrophobic domain is homologous to three yeast polypeptides, suggesting that this higher eukaryotic gene could have evolved from recombination between a gene that encoded a soluble nuclear protein and a membrane protein gene similar to those in yeast. These results are the first to demonstrate the structural organization of a vertebrate gene encoding an integral membrane protein of the nuclear envelope that may be a member of a family of polypeptides conserved in evolution.
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Affiliation(s)
- E Schuler
- Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029
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36
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Droste DW, Berger W, Schuler E, Krauss JK. Middle cerebral artery blood flow velocity in healthy persons during wakefulness and sleep: a transcranial Doppler study. Sleep 1993; 16:603-9. [PMID: 7904769] [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: 01/27/2023] Open
Abstract
In 10 normal young adults, middle cerebral artery blood flow velocity was measured continuously over one night by transcranial Doppler sonography. Polysomnography was used to assess the different sleep stages and waking state. During rapid eye movement (REM) sleep, middle cerebral artery blood flow velocity was higher than in any other sleep stage and wakefulness. During the waking state the velocity was higher than in sleep stage 2. Spontaneous rhythmic oscillations of cerebral blood flow velocity were found related to different stages of sleep. A fast Fourier's transformation of the Doppler wave forms revealed a periodicity of 20-75 seconds, which was most prominent during REM sleep and to a lesser degree during sleep stages 1, 2 and 3 and the waking state. These waves may correspond to intracranial pressure changes referred to as B-waves.
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Affiliation(s)
- D W Droste
- Department of Neurology, University of Freiburg, Germany
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37
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Tarsetti F, Lenzi R, Salvi R, Schuler E, Rijhsinghani K, Lenzen R, Tavoloni N. Liver carcinogenesis associated with feeding of ethionine in a choline-free diet: evidence against a role of oval cells in the emergence of hepatocellular carcinoma. Hepatology 1993; 18:596-603. [PMID: 8359801] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
In an attempt to clarify the role of oval cells in the emergence of hepatocellular carcinoma, we fed rats a choline-free diet containing 0%, 0.05% or 0.1% ethionine. The incidence and nature of premalignant and malignant hepatic lesions were then related to the degree of oval cell proliferation. Intake of choline-free diet alone for up to 12 mo was associated with minimal oval cell proliferation; cholangiofibrosis, hepatocellular nodules and hepatocellular carcinoma were observed in 55%, 23% and 14% of the animals, respectively. When rats were given the choline-free diet with 0.05% ethionine, proliferation of oval cells was more pronounced; after a 6- to 12 mo feeding period, cholangiofibrosis (57%) was again observed. However, hepatocellular nodules (91%) and hepatocellular carcinoma (74%) were the most common lesions seen with this feeding regimen. Finally, rats fed the choline-free diet with 0.1% ethionine had massive oval cell proliferation and progressive loss of parenchymal liver tissue. Most of these animals died before they had consumed the choline-free diet with 0.1% ethionine for 12 mo. Rats in this group (96%) exhibited large and numerous cholangiofibrotic lesions, but hepatocellular nodules and carcinoma were not detected. In all animals of each experimental group, hyperplastic bile duct cells in areas of cholangiofibrosis and oval cells were positive for cytokeratin 19, an intermediate filament protein present only in bile duct cells in normal liver. Hepatocellular nodules and hepatocellular carcinoma were invariably negative for cytokeratin 19. We interpret these findings to suggest that oval cells are not involved in the histogenesis of hepatocellular carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F Tarsetti
- Department of Medicine, Mount Sinai School of Medicine, City University of New York, New York 10029
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38
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Wagenknecht K, Barleben H, Junker L, Guchker A, Schuler E, Vagenknekht K, Barleben K, Iunker L, Guchker A, Shiuler E. [Malate dehydrogenase isoenzymes in myocardial infarction]. Kardiologiia 1988; 28:55-7. [PMID: 3230777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Plasma CPK activity and the activity of isoenzymes MDH, AST and LDH were assessed in 60 patients with myocardial infarction of different severity, with reference to the time since the onset of the attack. The peaks of CPK and MDH-C activity were reached sooner than those of LDH-M and AST-C, while the CPK and MDH-C curves were similar. The severity of the disease showed correlation to later onset of enzyme peaks and markedly delayed decrease in the respective values. Increased activity of mitochondrial isoenzymes and blood LDH-M provided additional information on the severity of the disease. Delayed normalization of these activities was associated with a poor diagnosis.
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39
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Scheiffarth F, Berg G, Schuler E, Götz H, Frenger W, Roller E. Quantitative Antikörperbestimmungen. Int Arch Allergy Immunol 1957. [DOI: 10.1159/000228422] [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] Open
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