1
|
Ayuk F, Wagner-Drouet EM, Wolff D, von Huenerbein N, von Pein UM, Klyuchnikov E, von Harsdorf S, Koenecke C, Sayer H, Kröger N. Treatment of newly diagnosed moderate or severe chronic graft-versus-host disease with prednisone and everolimus (PredEver first): a prospective multicenter phase IIA study. Bone Marrow Transplant 2024:10.1038/s41409-024-02289-0. [PMID: 38698080 DOI: 10.1038/s41409-024-02289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
Although most patients with chronic graft-versus-host disease (cGVHD) show initial response to first-line therapy, long-term clinically meaningful success of first-line treatment remains rare. In a prospective multicentre phase II trial in 6 German centers, patients with newly diagnosed moderate or severe cGVHD received prednisone and everolimus for 12 months followed by a 1-year follow-up period. Primary endpoint was treatment success (TS) at 6 months defined as patient being alive, achieving PR or CR of cGVHD, having no relapse of underlying disease and requiring no secondary treatment for cGVHD. Of the 34 patients evaluable for efficacy, 19 (56%) had TS at 6 months with 22 and 52% of the patients in a CR and PR respectively. Overall 30 patients (88%) had a CR or PR as best response, nearly all responses (29/30) occurring within the first 6 weeks of treatment. The cumulative incidence of treatment failure at 1 year was 63%, corresponding to 37% TS. Predefined safety endpoint (thrombotic microangiopathy, pneumonitis, and avascular necrosis) were not observed in any patient. Addition of everolimus to prednisolone is well tolerated and may improve long-term treatment success. Larger studies are necessary to ascertain the possible role of everolimus in first-line treatment of cGVHD.
Collapse
Affiliation(s)
- Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Eva-Maria Wagner-Drouet
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center, Mainz, Germany
| | - Daniel Wolff
- Department of Internal Medicine III, Hematology and Oncology, University Medical Center Regensburg, Regensburg, Germany
| | - Natascha von Huenerbein
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ute-Marie von Pein
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evgeny Klyuchnikov
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie von Harsdorf
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
- Department of Medicine, Diakonie Hospital, Stuttgart, Germany
| | - Christian Koenecke
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, MHH, Hanover, Germany
| | - Herbert Sayer
- Department of Internal Medicine II, University Medical Center Jena, Jena, Germany
- Department of Hematology, Oncology and Stem Cell Transplantation, Helios Klinikum Erfurt, University Campus of the Health and Medical University, Potsdam, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Niederwieser D, Lang T, Krahl R, Heinicke T, Maschmeyer G, Al-Ali HK, Schwind S, Jentzsch M, Cross M, Kahl C, Wolf HH, Sayer H, Schulze A, Dreger P, Hegenbart U, Krämer A, Junghanss C, Mügge LO, Hähling D, Hirt C, Späth C, Peter N, Opitz B, Florschütz A, Reifenrath K, Zojer N, Scholl S, Pönisch W, Heyn S, Vucinic V, Hochhaus A, Aul C, Giagounidis A, Balleisen L, Oldenkott B, Staib P, Kiehl M, Schütte W, Naumann R, Eimermacher H, Dörken B, Sauerland C, Lengfelder E, Hiddemann W, Wörmann B, Müller-Tidow C, Serve H, Schliemann C, Hehlmann R, Berdel WE, Pfirrmann M, Krug U, Hoffmann VS. Different treatment strategies versus a common standard arm (CSA) in patients with newly diagnosed AML over the age of 60 years: a randomized German inter-group study. Ann Hematol 2023; 102:547-561. [PMID: 36695874 PMCID: PMC9977880 DOI: 10.1007/s00277-023-05087-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/01/2023] [Indexed: 01/26/2023]
Abstract
A randomized inter-group trial comparing more intensive treatment strategies to a common standard arm 3 + 7 (CSA) was conducted in patients with non-M3 AML. Untreated patients ≥ 60 years were allocated to the CSA (n = 132) or to the study group arms (n = 1154) of the AMLCG (TAD/HAM versus HAM/HAM ± G-CSF followed by TAD and maintenance) and the OSHO (intermediate-dose ara-C/mitoxantrone followed by ara-C/mitoxantrone). Median age of the 1147 eligible patients was 69 (range 60-87) years. CR/CRi status at 90 days was not significantly different between the CSA (54% (95%CI: 45-64)) and the study group arms (53% (95%CI: 47-60) and 59% (95%CI: 58-63)). The five-year event-free survival (EFS) probability (primary endpoint) was 6.2% (95%CI: 2.7-14.0) in the CSA, 7.6% (95%CI: 4.5-12.8) in study group A and 11.1% (95%CI: 9.0-13.7) in B. The 5-year OS was 17.2% (95%CI: 11.0-26.9), 17.0% (95%CI: 2.0-23.9), and 19.5% (95%CI: 16.7-22.8) in CSA, study group A and B, respectively. Neither study group differed significantly from the CSA regarding EFS, OS, or relapse-free survival. In multivariate analyses, allocation to the treatment strategy was not significantly associated with the time-to-event endpoints. The evaluation of more intensive treatment strategies did not show clinically relevant outcome differences when compared to CSA.
Collapse
Affiliation(s)
- Dietger Niederwieser
- University Leipzig, 04106, Leipzig, Germany. .,Lithuanian University of Health Sciences, Kaunas, Lithuania. .,Aichi Medical University, Nagakute, Japan.
| | - Thomas Lang
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig Maximilian Universität München, München, Germany
| | | | - Thomas Heinicke
- Dept. Hematology and Oncology, Otto-Von-Guericke-University, Magdeburg, Germany
| | - Georg Maschmeyer
- Dept. Hematology, Oncology and Palliative Care, Klinikum Ernst Von Bergmann, Potsdam, Germany
| | - Haifa Kathrin Al-Ali
- Department of Internal Medicine IV, Oncology/Hematology, Krukenberg Cancer-Center, University Hospital Halle (Saale), Halle, Germany
| | | | | | | | - Christoph Kahl
- Dept. Internal Medicine, Clinic III - Hematology, Oncology and Palliative Care, Rostock University Medical Center, Rostock, Germany.,Dept. Hematology, Oncology and Palliative Care, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | | | - Herbert Sayer
- Medizinische Klinik (Hämatologie, Stammzelltransplantation, Onkologie), Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Peter Dreger
- Medical Department V, University Hospital, Heidelberg, Germany
| | - Ute Hegenbart
- Medical Department V, University Hospital, Heidelberg, Germany
| | - Alwin Krämer
- Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Dept. of Internal Medicine V, University, Heidelberg, Germany
| | - Christian Junghanss
- Department of Medicine, Clinic III (Hematology, Oncology, Palliative Medicine), Rostock University Medical Center, Rostock, Germany
| | - Lars-Olof Mügge
- Innere Medizin III (Hämatologie, Onkologie Und Palliativmedizin), Hospital Zwickau, Germany
| | - Detlev Hähling
- Dept. Hematology and Oncology, Klinikum Schwerin, Schwerin, Germany
| | - Carsten Hirt
- Innere Medizin C, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Christian Späth
- Innere Medizin C, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Norma Peter
- Medizinische Klinik, Carl-Thieme-Klinikum GmbH, Cottbus, Germany
| | - Bernhard Opitz
- St. Elisabeth Und St, Barbara Hospital Halle (Saale), Halle, Germany
| | | | | | - Niklas Zojer
- 1St Medical Department, Center for Oncology and Hematology & Palliative Care, Klinik Ottakring, Vienna, Austria
| | | | | | | | | | | | - Carlo Aul
- Klinik Für Hämatologie Und Onkologie, St. Johannes Hospital, Duisburg, Germany
| | - Aristoteles Giagounidis
- Klinik Für Hämatologie Und Onkologie, St. Johannes Hospital, Duisburg, Germany.,Dept. Oncology, Hematology and Palliative Care, Marienhospital Düsseldorf, Düsseldorf, Germany
| | | | - Bernd Oldenkott
- Dept. Hematology and Oncology, St. Hedwig Krankenhaus Berlin, Berlin, Germany
| | - Peter Staib
- Dept. Hematology/Oncology, St. Antonius Krankenhaus Eschweiler, Eschweiler, Germany
| | - Michael Kiehl
- Dept. Medicine I, Klinikum Frankfurt/Oder, FrankfurtOder, Germany
| | - Wolfgang Schütte
- Dept. Internal Medicine II, Krankenhaus Martha-Maria, Halle, Germany
| | - Ralph Naumann
- Dept. Hematology, Oncology and Palliative Care, St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - Hartmut Eimermacher
- Dept. Hematology and Oncology, Katholisches Krankenhaus Hagen, Hagen, Germany
| | - Bernd Dörken
- Dept. Hematology and Oncology, Charité Campus Virchow, Berlin, Germany
| | - Cristina Sauerland
- Institute of Biometry and Clinical Research, University Hospital Münster, Münster, Germany
| | - Eva Lengfelder
- IIIrd Medical Dept, University Hospital of Mannheim, Mannheim, Germany
| | | | - Bernhard Wörmann
- Division of Hematology, Oncology and Tumour Immunology, Department of Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie, Berlin, Germany
| | - Carsten Müller-Tidow
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany.,Dept. of Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hubert Serve
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany.,Department of Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | | | - Rüdiger Hehlmann
- Mannheim, University of Heidelberg, Mannheim, Germany.,European LeukemiaNet, Weinheim, Germany
| | - Wolfgang E Berdel
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig Maximilian Universität München, München, Germany
| | - Utz Krug
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany.,Dept. of Medicine 3, Klinikum Leverkusen, Leverkusen, Germany
| | - Verena S Hoffmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig Maximilian Universität München, München, Germany
| |
Collapse
|
3
|
Straka C, Salwender H, Knop S, Vogel M, Müller J, Metzner B, Langer C, Sayer H, Jung W, Dürk HA, Bassermann F, Gramatzki M, Rösler W, Wolf HH, Brugger W, Engelhardt M, Fischer T, Liebisch P, Einsele H. Full or intensity-reduced high-dose melphalan and single or double autologous stem cell transplant with or without bortezomib consolidation in patients with newly diagnosed multiple myeloma. Eur J Haematol 2021; 107:529-542. [PMID: 34270825 DOI: 10.1111/ejh.13690] [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] [Received: 06/11/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE A post hoc subgroup analysis of two phase III trials (NCT00416273, NCT00416208) was carried out to investigate the influence of 100/140 and 200 mg/m² melphalan as well as single/double autologous stem cell transplantation (ASCT) on progression-free survival (PFS). Additionally, the effect of bortezomib consolidation on PFS was analyzed. METHODS Following induction therapy and high-dose melphalan with subsequent ASCT, patients with newly diagnosed multiple myeloma (NDMM) were randomized 1:1 to either four 35-day cycles of bortezomib consolidation (1.6 mg/m² IV on days 1, 8, 15, 22) or observation. RESULTS Of the 340 patients included in this analysis, 13.5% received 1 × MEL100/140, 22.9% 2 × MEL100/140, 31.2% 1 × MEL200, and 32.4% 2 × MEL200. With higher cumulative melphalan dose, PFS improved (P = .0085). PFS curves of patients treated with 2 × MEL100/140 and 1 × MEL200 were very similar. The superior dose effect of MEL200 over MEL100/140 was non-existent in the bortezomib consolidation arm but pronounced in the observation arm (P = .0015). Similarly, double ASCT was only beneficial in patients without bortezomib consolidation (P = .0569). CONCLUSIONS Full dose melphalan and double transplantation seem advantageous only as long as patients are not receiving bortezomib consolidation afterwards.
Collapse
Affiliation(s)
| | - Hans Salwender
- Asklepios Tumorzentrum, AK Altona und AK St. Georg, Hamburg, Germany
| | - Stefan Knop
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
| | | | | | - Bernd Metzner
- Universitätsklinik für Innere Medizin II, Oldenburg, Germany
| | - Christian Langer
- Universitätsklinikum Ulm, Klinik für Innere Medizin II, Ulm, Germany
| | - Herbert Sayer
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Jena, Germany
| | - Wolfram Jung
- Universitätsmedizin Göttingen, Göttingen, Germany
| | | | - Florian Bassermann
- Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | | | - Wolf Rösler
- Universitätsklinikum Erlangen, Erlangen, Germany
| | | | | | | | | | - Peter Liebisch
- Universitätsklinikum Ulm, Klinik für Innere Medizin II, Ulm, Germany
| | - Hermann Einsele
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
| |
Collapse
|
4
|
Brioli A, Vom Hofe F, Rucci P, Ernst T, Yomade O, Hilgendorf I, Scholl S, Sayer H, Mügge LO, Hochhaus A, von Lilienfeld-Toal M. Melphalan 200 mg/m 2 does not increase toxicity and improves survival in comparison to reduced doses of melphalan in multiple myeloma patients. Bone Marrow Transplant 2020; 56:1209-1212. [PMID: 33299059 DOI: 10.1038/s41409-020-01170-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/09/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022]
Abstract
Autologous stem cell transplantation (ASCT) conditioned with melphalan 200 mg/m2 (Mel200) is standard of care for young multiple myeloma (MM) patients. Lower doses of melphalan (MelRed) have been used to reduce toxicity, although data regarding their efficacy are not concordant. We retrospectively evaluated 313 MM patients receiving ASCT at Jena University Hospital between 2003 and 2017. Patients receiving MelRed were on average older (p < 0.001), had a worse renal function (p < 0.001) and more comorbidities (p < 0.001). No differences were seen in treatment response before ASCT between the two groups, whilst after ASCT the rate of at least very good partial responses (VGPR) was significantly higher for patients receiving Mel200 (93% vs. 76%, p < 0.001). PFS (39 vs. 20 months, p < 0.001) and OS (103 vs. 59 months, p = 0.001) were longer with Mel200. Toxicities were comparable in the two groups. After adjusting for age and clinical characteristics using the propensity score, for VGPR before and after ASCT and for double ASCT strategy in a Cox regression analysis, Mel200 was still associated with a lower risk of disease progression (HR = 0.40, 95% CI = 0.40-0.96) and of death (HR = 0.61, 95% CI = 0.35-1.07). Our results confirm that Mel200 is still the standard of care for ASCT eligible myeloma patients.
Collapse
Affiliation(s)
- Annamaria Brioli
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Hämatologie und Internistische Onkologie, Jena, Germany. .,Research Programm, Else Kröner-Forschungskolleg AntiAge, Universitätsklinikum Jena, Jena, Germany.
| | - Felix Vom Hofe
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Hämatologie und Internistische Onkologie, Jena, Germany
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Thomas Ernst
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Hämatologie und Internistische Onkologie, Jena, Germany
| | - Olaposi Yomade
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Hämatologie und Internistische Onkologie, Jena, Germany
| | - Inken Hilgendorf
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Hämatologie und Internistische Onkologie, Jena, Germany
| | - Sebastian Scholl
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Hämatologie und Internistische Onkologie, Jena, Germany
| | - Herbert Sayer
- HELIOS Klinikum, 4. Medizinische Klinik-Hämatologie und internistische Onkologie, Hämostaseologie, Erfurt, Germany
| | - Lars-Olof Mügge
- Heinrich-Braun-Klinikum, Klinik für Innere Medizin III (Hämatologie, Onkologie und Palliativmedizin), Zwickau, Germany
| | - Andreas Hochhaus
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Hämatologie und Internistische Onkologie, Jena, Germany
| | - Marie von Lilienfeld-Toal
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Hämatologie und Internistische Onkologie, Jena, Germany.,Leibniz Institut für Infektionsbiologie und Naturstoff-Forschung, Hans-Knöll Institut, Jena, Germany
| |
Collapse
|
5
|
Straka C, Knop S, Vogel M, Müller J, Kropff M, Metzner B, Langer C, Sayer H, Jung W, Dürk HA, Salwender H, Wandt H, Bassermann F, Gramatzki M, Rösler W, Wolf H, Brugger W, Fischer T, Liebisch P, Engelhardt M, Einsele H. Bortezomib consolidation following autologous transplant in younger and older patients with newly diagnosed multiple myeloma in two phase III trials. Eur J Haematol 2019; 103:255-267. [DOI: 10.1111/ejh.13281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 01/10/2023]
Affiliation(s)
| | - Stefan Knop
- Medizinische Klinik und Poliklinik II Julius Maximilians Universität Würzburg Würzburg Germany
| | | | | | | | - Bernd Metzner
- Universitätsklinik für Innere Medizin – Onkologie und Hämatologie Klinikum Oldenburg Oldenburg Germany
| | | | - Herbert Sayer
- Klinik für Innere Medizin II [Hämatologie/Onkologie] Universitätsklinikum Jena Jena Germany
| | - Wolfram Jung
- Onkologie Universitätsmedizin Göttingen Göttingen Germany
| | | | | | - Hannes Wandt
- Medizinische Klinik 5 Paracelsus Medizinische Privatuniversität Nürnberg Nürnberg Germany
| | - Florian Bassermann
- Klinikum rechts der Isar, III. Medizinische Klinik Technische Universität München München Germany
| | | | - Wolf Rösler
- Universitätsklinkum Erlangen Erlangen Germany
| | | | | | | | - Peter Liebisch
- Zentrum für Innere Medizin Universitätsklinikum Ulm Ulm Germany
| | | | - Hermann Einsele
- Medizinische Klinik und Poliklinik II Julius Maximilians Universität Würzburg Würzburg Germany
| |
Collapse
|
6
|
Niederwieser D, Lowenberg B, Berdel WE, Brand R, Chalandon Y, Junghanss C, Hasenclever D, Haenel M, Maschmeyer G, Mende M, Mohty M, Ten Ossenkoppele G, Passweg J, Sayer H, Schetelig J, Schouten HC, Schwind S, Stelljes M, Vucinic V, Cornelissen J. Feasibility of HSCT vs consolidation therapy for AML patients aged 60-75 in CR1: A randomized phase III, multicentre EBMT study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7045] [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)
- Dietger Niederwieser
- Universitatsklinikum Leipzig AoR, Abt. Hamatologie und internistische Onkologie, Leipzig, Germany
| | - Bob Lowenberg
- Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Ronald Brand
- Leiden University Medical Centre, Leiden, Netherlands
| | | | - Christian Junghanss
- Department of Hematology and Oncology, University Hospital, Rostock, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Mathias Haenel
- Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz, Germany
| | | | | | | | | | | | | | | | | | | | | | | | - Jan Cornelissen
- Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, Netherlands
| | | |
Collapse
|
7
|
Breinlich V, Eßer D, Kellner G, Gerlach R, Sayer H. [Rare differential diagnosis of chronic rhinosinusitis with nasal polyposis (CRSwNP)]. Laryngorhinootologie 2017; 96:787-789. [PMID: 28873493 DOI: 10.1055/s-0043-116667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
8
|
Kellner G, Breinlich V, Eßer D, Sayer H, Gerlach R. Multimodal Management of Patients with Sinonasal Neuroendocrine Carcinoma with Infiltration of the Skull Base and Intradural Frontobasal Brain Invasion. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1592496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
9
|
Niederwieser D, Al-Ali HK, Krahl R, Kahl C, Wolf HH, Kreibich U, Vucinic V, Hegenbart U, Hirt C, Peter N, Opitz B, Florschütz A, Schulze A, Scholl S, Jakob C, Junghanss C, Sayer H, Hochhaus A, Fischer T, Maschmeyer G. Hematopoietic stem cell transplantation (HSCT) compared to consolidation chemotherapy (CT) to increase leukemia free survival (LFS) in acute myelogenous leukemia (AML) patients between 60 and 75 years irrespective of genetic risk: Report from the AML 2004 of the East German Study Group (OSHO). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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)
- Dietger Niederwieser
- Universitatsklinikum Leipzig AoR, Abt. Hamatologie und internistische Onkologie, Leipzig, Germany
| | | | | | - Christoph Kahl
- Department for Hematology, Klinikum Magdeburg, Magdeburg, Germany
| | | | | | | | - Ute Hegenbart
- Department of Hematology, Oncology, and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Carsten Hirt
- Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany
| | | | | | | | | | | | | | - Christian Junghanss
- Department of Hematology and Oncology, University Hospital, Rostock, Germany
| | | | | | | | | | | |
Collapse
|
10
|
Sellner L, Boumendil A, Finel H, Choquet S, de Rosa G, Falzetti F, Scime R, Kobbe G, Ferrara F, Delmer A, Sayer H, Amorim S, Bouabdallah R, Finke J, Salles G, Yakoub-Agha I, Faber E, Nicolas-Virelizier E, Facchini L, Vallisa D, Zuffa E, Sureda A, Dreger P. Thiotepa-based high-dose therapy for autologous stem cell transplantation in lymphoma: a retrospective study from the EBMT. Bone Marrow Transplant 2016; 51:212-218. [PMID: 26569093 DOI: 10.1038/bmt.2015.273] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/08/2022]
Abstract
Clinical information about thiotepa-based autologous stem cell transplantation (auto-SCT) outside the primary central nervous system lymphoma (PCNSL) field is sparse. In this registry-based retrospective study, we evaluated potential risks and benefits of thiotepa-based preparative regimens compared with BEAM (carmustine, etoposide, cytarabine, melphalan) in auto-SCT for diffuse large B-cell lymphoma (DLBCL, excluding PCNSL), follicular lymphoma (FL) or Hodgkin lymphoma (HL). A total of 14 544 patients (589 thiotepa and 13 955 BEAM) met the eligibility criteria, and 535 thiotepa- and 1031 BEAM-treated patients were matched in a 1:2 ratio for final comparison. No significant differences between thiotepa and BEAM groups for any survival end point were identified in the whole sample or disease entity subsets. For a more detailed analysis, 47 TEAM (thiotepa, etoposide, cytarabine, melphalan)-treated patients were compared with 75 matched BEAM patients with additional collection of toxicity data. Again, there were no significant differences between the two groups for any survival end point. In addition, the frequency of common infectious and non-infectious complications including secondary malignancies was comparable between TEAM and BEAM. These results indicate that thiotepa-based high-dose therapy might be a valuable alternative to BEAM in DLBCL, HL and FL. Further evaluation by prospective clinical trials is warranted.
Collapse
Affiliation(s)
- L Sellner
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - A Boumendil
- Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France
| | - H Finel
- Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France
| | - S Choquet
- Department of Hematology, Pitié-Salpêtrière Hospital, Paris, France
| | | | | | - R Scime
- Department of Hematology, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - G Kobbe
- University Hospital Düsseldorf, Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Düsseldorf, Germany
| | | | - A Delmer
- Service d'Hématologie Clinique, Hôpital Robert Debré, Centre Hospitalier Universitaire (CHU) de Reims, Reims, France
| | - H Sayer
- Department of Hematology and Oncology, Helios Hospital Erfurt, Erfurt, Germany
| | - S Amorim
- APHP, Hopital Saint-louis, Hemato-Oncology Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - R Bouabdallah
- Hematology Department, Paoli Calmettes Institute, Marseille Aix-Marseille University, Marseille, France
| | - J Finke
- Department of Hematology, Freiburg University Medical Center, Freiburg, Germany
| | - G Salles
- Hematologie, Hospices Civils de Lyon and Université Claude Bernard Lyon-1, Pierre Bénite, France
| | - I Yakoub-Agha
- LIRIC-U995, Hematology Department and Hematopoietic Stem Cell Transplantation Unit, University-Hospital of Lille, Lille, France
| | - E Faber
- Department of Hemato-Oncology, Faculty Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | | | - L Facchini
- Hematology Unit, Arcispedale S Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - D Vallisa
- Hematology Unit, Ospedale Civile, Piacenza, Italy
| | - E Zuffa
- Hematology Unit, S Maria delle Croci Hospital, Ravenna, Italy
| | - A Sureda
- Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France
- Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | - P Dreger
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- Lymphoma Working Party, European Society for Blood and Marrow Transplantation, Paris, France
| |
Collapse
|
11
|
Straka C, Vogel M, Müller J, Kropff M, Metzner B, Langer C, Sayer H, Jung W, Dürk HA, Wandt H, Bassermann F, Gramatzki M, Rösler W, Knop S, Wolf HH, Brugger W, Engelhardt MM, Fischer T, Einsele H. Results from two phase III studies of bortezomib (BTZ) consolidation vs observation (OBS) post-transplant in patients (pts) with newly diagnosed multiple myeloma (NDMM). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8511] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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)
| | | | | | - Martin Kropff
- Medizinische Klinik A, Universitätsklinikum Münster, Münster, Germany
| | | | - Christian Langer
- Klinik für Innere Medizin III, Zentrum für Innere Medizin, Universitätsklinikum Ulm, Ulm, Germany
| | - Herbert Sayer
- Klinik for Innere Medizin II, Hematologie und Onkologie, University Hospital Jena, Jena, Germany
| | - Wolfram Jung
- Klinik für Hämatologie und Medizinische Onkologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | | | | | | | - Martin Gramatzki
- Sektion für Stammzell- und Immuntherapie, II. Medizinische Klinik, Kiel, Germany
| | - Wolf Rösler
- Universitätsklinkum Erlangen, Medizinische Klinik 5 - Hämatologie und Internistische, Erlangen, Germany
| | - Stefan Knop
- Medizinische Klinik und Poliklinik II, Julius Maximilians Universität Würzburg, Würzburg, Germany
| | | | - Wolfram Brugger
- Schwarzwald-Baar Klinikum, Klinik für Innere Medizin II, Villingen-Schwenningen, Germany
| | | | - Thomas Fischer
- Department of Hematology/Oncology, Otto-von-Guericke University, Magdeburg, Germany
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Julius Maximilians Universität Würzburg, Würzburg, Germany
| |
Collapse
|
12
|
Aboud A, Marx G, Sayer H, Gummert JF. Successful treatment of an aggressive non-Hodgkin's lymphoma associated with acute respiratory insufficiency using extracorporeal membrane oxygenation. Interact Cardiovasc Thorac Surg 2008; 7:173-4. [DOI: 10.1510/icvts.2007.159921] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
13
|
Grahmann PR, Brauer M, Hüter L, Sayer H, Neumann R, Braun RK. Respiratorische Insuffizienz und pulmonale Fibrose als Spätfolge einer Chemotherapie - induziert durch Sauerstoffexposition. Pneumologie 2005; 59:763-9. [PMID: 16385437 DOI: 10.1055/s-2005-919069] [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: 10/25/2022]
Abstract
Pulmonary fibrosis (PF) may develop following successful chemotherapy for malignancy, even if such therapy is not combined with radiotherapy. Bleomycin, which is known to induce acute pneumonitis and lung fibrosis, is especially associated with chemotherapy-induced PF, and bleomycin-induced pulmonary fibrosis can occur more than five years after such therapy. Additionally, supplemental oxygen therapy can trigger the onset of pneumonitis and lethal PF in patients who have previously received bleomycin therapy. Careful assessment of lung function via spiroergometry and arterial blood gas analysis during exercise are required if the administration of supplemental oxygen is considered. Two case reports reveal the potential lethal risk of oxygen for patients who have been treated with bleomycin: (1) a patient with successfully resected and treated basal tongue carcinoma and (2) a patient in remission after being treated for non-Hodgkin lymphoma. Single and double lung transplantation is the only therapeutic option for patients with severe, oxygen-induced PF and should be included as an indication for lung transplantation. Early recognition of pulmonary diffusion abnormalities and establishing a risk profile, as well as consequent monitoring of pulmonary function, may help to avoid or at least reduce the risk of PF induced by oxygen therapy when administered to patients who have previously been given bleomycin.
Collapse
Affiliation(s)
- P R Grahmann
- Friedrich-Schiller-Universität Jena, Klinik für Innere Medizin I, Kardiologie, Angiologie, Intensivmedizin, Pneumologie und Allergologie/Immunologie.
| | | | | | | | | | | |
Collapse
|
14
|
Ottinger HD, Müller CR, Goldmann SF, Albert E, Arnold R, Beelen DW, Blasczyk R, Bunjes D, Casper J, Ebell W, Ehninger G, Eiermann T, Einsele H, Fauser A, Ferencik S, Finke J, Hertenstein B, Heyll A, Klingebiel T, Knipper A, Kremens B, Kolb HJ, Kolbe K, Lenartz E, Lindemann M, Müller CA, Mytilineos J, Niederwieser D, Runde V, Sayer H, Schaefer UW, Schmitz N, Schröder S, Schulze-Rath R, Schwerdtfeger R, Siegert W, Thiele B, Zander AR, Grosse-Wilde H. Second German consensus on immunogenetic donor search for allotransplantation of hematopoietic stem cells. Ann Hematol 2001; 80:706-14. [PMID: 11797110 DOI: 10.1007/s00277-001-0384-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2001] [Accepted: 09/09/2001] [Indexed: 11/24/2022]
Abstract
The present paper summarizes the results of the second German consensus meeting on immunogenetic donor search for allotransplantation of hematopoietic stem cells held in Essen in November 1999 under the auspices of the German Society for Immunogenetics (DGI) and the German Working Party for Blood and Marrow Transplantation (DAG-KBT). Immunogeneticists and transplant physicians from all over the country agreed to update the national standards for: (1) search strategy including the role of unrelated and extended family donor search after unsuccessful core family donor search, (2) histocompatibility loci to be typed, (3) histocompatibility typing techniques to be used (HLA serology vs DNA-based HLA typing, cellular tests, serum cross-match), and (4) acceptable HLA mismatches in the context of a defined underlying disease, donor type, and conditioning regimen.
Collapse
Affiliation(s)
- H D Ottinger
- Institut für Immunologie, Universitätsklinikum Essen, Virchowstr. 171, 45147 Essen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Ottinger H, Beelen D, Sayer H, Schaefer UW, Grosse-Wilde H. Bone marrow transplantation from partially HLA-matched related donors in adults with leukaemia: the experience at the University Hospital of Essen, Germany. Br J Haematol 1996; 92:913-21. [PMID: 8616085 DOI: 10.1046/j.1365-2141.1996.438977.x] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The Seattle group has demonstrated that bone marrow transplantation (BMT) using partially HLA-mismatched related donors is feasible in principal. However, it was unclear whether these results can also be achieved at smaller-sized BMT units. Therefore a matched pair analysis enrolling 52 BMTs from partially HLA-mismatched relatives and 52 control BMTs from HLA-identical siblings was performed at the University Hospital of Essen. Overall survival (OS) and incidence of graft-versus-host disease (GVHD) did not differ significantly after study and control BMTs (OS: 52% v 63% 1 year, 46% v 48% 5 years post transplant; acute GVHD: 37% v 35%, chronic GVHD: 67% v 55%). After study BMTs, however, therapy-related mortality (P=0.018) and incidence of graft failure (P=0.002) were increased, whereas relapse rate was reduced (11% v 27%). Two or three mismatches in HVG direction implied the same risk of graft failure as one mismatch. Therefore, (i) OS after BMT from one HLA antigen mismatched relative and from HLA-identical siblings does not differ significantly even when performed at a 'smaller' centre; (ii) two or even three HLA mismatches in host-versus graft (HVG) direction might be acceptable in family BMT for leukaemia.
Collapse
Affiliation(s)
- H Ottinger
- Institute of Immunology, University Hospital of Essen, Germany
| | | | | | | | | |
Collapse
|
16
|
Abstract
The incidence of mania in an inner-city area was estimated by both a casenote search with later interview and a prospective interview method. The incidence was found to be twice as high as that in a more rural area, as estimated by the casenote-based method. Though a high proportion of the inner-city population were from ethnic minorities, particularly Afro-Caribbean, this could not explain the discrepancy. It is suggested that the incidence of mania is related to the mobility of the local population.
Collapse
Affiliation(s)
- N Hunt
- Fulbourne Hospital, Cambridge, UK
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
The episodes of mania occurring in a cohort of 86 patients with bipolar affective disorder were recorded over a 6-year period. Of the 54 patients who had at least 2 episodes, 8 (15%) met our criteria for a seasonal pattern of relapse. There was no particular season in which these relapses clustered. Overall, the time of year of the first recorded episode during the 6-year period did not predict the timing of subsequent episodes.
Collapse
Affiliation(s)
- N Hunt
- Department of Psychological Medicine, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | | | | |
Collapse
|
18
|
Schaefer UW, Beelen DW, Graeven U, Kölbel M, Sayer H, Quabeck K, Becher R, Kremens B, Stollmann B, Grosse-Wilde H. Allogeneic and autologous bone marrow transplantation in acute leukemia: the Essen Experience. Haematol Blood Transfus 1990; 33:649-51. [PMID: 2323665 DOI: 10.1007/978-3-642-74643-7_117] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- U W Schaefer
- Department of Bone Marrow Transplantation, University Hospital Essen, FRG
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Beelen DW, Graeven U, Schulz G, Grosse-Wilde H, Doxiadis I, Schaefer UW, Quabeck K, Sayer H, Schmidt CG. Treatment of acute graft-versus-host disease after HLA-partially matched marrow transplantation with a monoclonal antibody (BMA031) against the T cell receptor. First results of a phase-I/II trial. Onkologie 1988; 11:56-8. [PMID: 3283628 DOI: 10.1159/000216484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
As part of an ongoing phase-I/II trial, 2 patients received a 5-day treatment course with a murine monoclonal antibody (MAB) directed against the human T cell receptor (BMA031) as primary therapy of acute grade III skin and gastro-intestinal graft-versus-host disease (GvHD) occurring after allogeneic bone marrow transplantation (BMT). All MAB infusions were tolerated without side effects. A complete response of all symptoms of acute GvHD could be attained by MAB therapy under a continued baseline immunosuppression with cyclosporin (CSP), and both patients remain alive and disease-free at 7 and 8 months after therapy without evidence of chronic GvHD. Although the exact treatment scheme has still to be defined, we conclude that this MAB may be useful as primary therapy of acute GvHD. However, the potential hazards of 'in vivo' therapy with MABs directed against T lymphocytes call for a critical evaluation of this treatment modality.
Collapse
Affiliation(s)
- D W Beelen
- Department of Internal Medicine (Tumor Research), West German Tumor Center, University Hospital Essen, FRG
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Zentner J, Wiethölter H, Oehmichen M, Sayer H. [Qualitative cerebrospinal fluid cytology in West Germany]. Nervenarzt 1983; 54:426-9. [PMID: 6621753] [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: 01/21/2023]
|
21
|
Sayer H, Wiethölter H, Oehmichen M, Zentner J. Diagnostic significance of nerve cells in human CSF with particular reference to CSF cytology in the brain death syndrome. J Neurol 1981; 225:109-17. [PMID: 6164762 DOI: 10.1007/bf00313324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cytological examination of the cerebrospinal fluid (CSF) in 5 cases of the brain death syndrome treated on a respirator revealed the presence of nerve cells (mostly Purkinje cells), massive pleocytosis with many polymorphonuclear leukocytes, and numerous macrophages containing erythrocytes, leukocytes, lipid droplets, and hemosiderin. Portions of connective tissue with well preserved capillaries, and debris which could not be more closely identified, were also found. Neuropathological examination in 4 cases revealed progressive autolysis of brain tissue and displacement of the autolyzed tissue into the subarachnoid space of the spinal canal, partly due to tonsillar herniation. All five patients exhibited clinical signs of brain death and had been placed on respirators for various periods of time. The cytological findings in the CSF, together with the clinical signs of brain death, constitute an intravital morphological indication of brain tissue autolysis.
Collapse
|
22
|
Wiethölter H, Oehmichen M, Sayer H. [Qualitative CSF cell diagnosis. Methods and conclusiveness (author's transl)]. MMW Munch Med Wochenschr 1979; 121:631-6. [PMID: 108589] [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: 12/13/2022]
Abstract
In a review, the methods and value of CSF cytology as routine diagnostic investigation should be described summarily. Among the various methods of cell concentration, the sedimentation method permits the best cytological differentiation of the cells of the cerebrospinal fluid. Both neuro-immunological processes and unspecific irritation processes (e. g. subarachnoid hemorrhage, traumata), brain tumors and metastases can be differentiated. For prognostic and therapeutic questions, cytology of the CSF is sometimes the method of choice, as for instance in questions of CNS involvement in hemoblastoses. The spectrum of diagnostic possibilities recommends the cytology of CSF as a routine method in all neurological, internal medical and pediatric clinics.
Collapse
|