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Hauch R, Hinrichs M, Ruhwald R, Schrum J, Rutkowski S, Woessmann W, Winkler B. Correction: Impact of COVID-19 Related Restrictions on Infections in Children with Cancer or after Hematopoietic SCT. Klin Padiatr 2023; 235:e1-e2. [PMID: 37044121 DOI: 10.1055/a-2059-1033] [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] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Richard Hauch
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
- Research Institute Children's Cancer Center, Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malena Hinrichs
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
| | - Rebecca Ruhwald
- Medical controlling, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Schrum
- Department of Pediatric Hematology and Oncology, Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
| | - Wilhelm Woessmann
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
| | - Beate Winkler
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
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Hauch R, Hinrichs M, Ruhwald R, Schrum J, Rutkowski S, Woessmann W, Winkler B. Impact of COVID-19 Related Restrictions on Infections in Children with Cancer or after Hematopoietic SCTA. Klin Padiatr 2023; 235:159-166. [PMID: 36848939 DOI: 10.1055/a-2000-5388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Infections are a major concern for immunocompromised children. We investigated whether non-pharmaceutical interventions (NPIs) implemented in the general population during the coronavirus disease 2019 (COVID-19) pandemic in Germany had an impact on frequency, type and severity of infections in these patients. PATIENTS AND METHODS We analyzed all admissions to the clinic of pediatric hematology, oncology and stem cell transplantation (SCT) with (suspected) infection or fever of unknown origin (FUO) from 2018 to 2021. RESULTS We compared a 27-month period before NPIs (Pre-COVID: 01/2018-03/2020; 1041 cases) with a 12-month period with underlying NPIs (COVID: 04/2020-03/2021; 420 cases). During the COVID period the number of in-patient stays with FUO or infections decreased (38,6 cases/month vs. 35,0 cases/month), the median duration of hospital stays was longer (8 d (CI95: 7-8 d) vs. 9 d (CI95: 8-10 d) P=0,02)), the mean number of antibiotics per case increased (2,1 (CI95: 2,0-2,2) vs. 2,5 (CI95: 2,3-2,7); P=0,003)) and a substantial reduction of viral respiratory and gastrointestinal infections per case was seen (0,24 vs. 0,13; P<0,001). Notably, there was no detection of respiratory syncytial virus, influenza and norovirus, between May 2020 and March 2021. Based on need of intensive care measures and further parameters we conclude that severe (bacterial) infections were not significantly reduced by NPIs. CONCLUSIONS Introduction of NPIs in the general population during the COVID-pandemic substantially reduced viral respiratory and gastrointestinal infections in immunocompromised patients, while severe (bacterial) infections were not prevented.
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Affiliation(s)
- Richard Hauch
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany.,Research Institute Children's Cancer Center, Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malena Hinrichs
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
| | - Rebecca Ruhwald
- Medical controlling, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Schrum
- Department of Pediatric Hematology and Oncology, Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
| | - Wilhelm Woessmann
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
| | - Beate Winkler
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Center for Obstetrics and Pediatrics, Hamburg, Germany
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Dunay GA, Barroso M, Woidy M, Danecka MK, Engels G, Hermann K, Neumann FS, Paul K, Beime J, Escherich G, Fehse K, Grinstein L, Haniel F, Haupt LJ, Hecher L, Kehl T, Kemen C, Kemper MJ, Kobbe R, Kohl A, Klokow T, Nörz D, Olfe J, Schlenker F, Schmiesing J, Schrum J, Sibbertsen F, Stock P, Tiede S, Vettorazzi E, Zazara DE, Zapf A, Lütgehetmann M, Oh J, Mir TS, Muntau AC, Gersting SW. Long-Term Antibody Response to SARS-CoV-2 in Children. J Clin Immunol 2023; 43:46-56. [PMID: 36121535 PMCID: PMC9483535 DOI: 10.1007/s10875-022-01355-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 03/04/2022] [Accepted: 08/18/2022] [Indexed: 01/21/2023]
Abstract
Almost 2 years into the pandemic and with vaccination of children significantly lagging behind adults, long-term pediatric humoral immune responses to SARS-CoV-2 are understudied. The C19.CHILD Hamburg (COVID-19 Child Health Investigation of Latent Disease) Study is a prospective cohort study designed to identify and follow up children and their household contacts infected in the early 2020 first wave of SARS-CoV-2. We screened 6113 children < 18 years by nasopharyngeal swab-PCR in a low-incidence setting after general lockdown, from May 11 to June 30, 2020. A total of 4657 participants underwent antibody testing. Positive tests were followed up by repeated PCR and serological testing of all household contacts over 6 months. In total, the study identified 67 seropositive children (1.44%); the median time after infection at first presentation was 83 days post-symptom onset (PSO). Follow-up of household contacts showed less than 100% seroprevalence in most families, with higher seroprevalence in families with adult index cases compared to pediatric index cases (OR 1.79, P = 0.047). Most importantly, children showed sustained seroconversion up to 9 months PSO, and serum antibody concentrations persistently surpassed adult levels (ratio serum IgG spike children vs. adults 90 days PSO 1.75, P < 0.001; 180 days 1.38, P = 0.01; 270 days 1.54, P = 0.001). In a low-incidence setting, SARS-CoV-2 infection and humoral immune response present distinct patterns in children including higher antibody levels, and lower seroprevalence in families with pediatric index cases. Children show long-term SARS-CoV-2 antibody responses. These findings are relevant to novel variants with increased disease burden in children, as well as for the planning of age-appropriate vaccination strategies.
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Affiliation(s)
- Gabor A. Dunay
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Madalena Barroso
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Mathias Woidy
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Marta K. Danecka
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Geraldine Engels
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Katharina Hermann
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Friederike S. Neumann
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Kevin Paul
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Jan Beime
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Kristin Fehse
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Lev Grinstein
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Franziska Haniel
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Luka J. Haupt
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Laura Hecher
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Torben Kehl
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Christoph Kemen
- Wilhelmstift Children’s Hospital, Liliencronstraße 130, 22149 Hamburg, Germany
| | - Markus J. Kemper
- Asklepios Klinik Nord – Heidberg, Tangstedter Landstraße 400, 22417 Hamburg, Germany
| | - Robin Kobbe
- Institute for Infection Research and Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Aloisa Kohl
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Thomas Klokow
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Dominik Nörz
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Jakob Olfe
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Friderike Schlenker
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Jessica Schmiesing
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Johanna Schrum
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Freya Sibbertsen
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Philippe Stock
- Altona Children’s Hospital, Bleickenallee 38, 22763 Hamburg, Germany
| | - Stephan Tiede
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Dimitra E. Zazara
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany ,Department of Obstetrics and Prenatal Medicine, Division for Experimental Feto-Maternal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Jun Oh
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Thomas S. Mir
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Ania C. Muntau
- Department of Pediatrics, Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Søren W. Gersting
- University Children’s Research, UCR@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
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Kloehn J, Kruchen A, Schütze K, Wustrau K, Schrum J, Müller I. Immune Ablation and Stem Cell Rescue in Two Pediatric Patients with Progressive Severe Chronic Graft-Versus-Host Disease. Int J Mol Sci 2022; 23:ijms232315403. [PMID: 36499733 PMCID: PMC9735744 DOI: 10.3390/ijms232315403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Transplantation of allogeneic hematopoietic stem cells represents an established treatment for children with high-risk leukemia. However, steroid-refractory chronic graft-versus-host disease (SR-cGvHD) represents a severe life-threatening complication, for which there is no standard therapy. After failing several lines of immunosuppressive and biological treatment, we applied an immunoablative therapy with re-transplantation of purified CD34+ donor stem cells to reset the aberrant immune system. Two pediatric patients, who had been transplanted for high-risk acute lymphoblastic leukemia, underwent the procedure. Interestingly, enough stem cells could be mobilized, harvested, and purified to be used as grafts more than one year after allogeneic transplantation under intensive immunosuppressive therapy and ongoing SR-cGvHD. With a follow-up of 8 and 22 months, respectively, both patients are without immunosuppressive therapy and do not show signs of active disease. Regeneration of skin manifestations started promptly, other damaged organs did not progress and continue to show recovery from severe fibrotic transformation. Bone marrow function is robust and T cell receptor repertoires showed polyclonal immune reconstitution. In conclusion, stem cell harvest and re-transplantation of human CD34+-selected allogeneic stem cells is possible and represents a new therapeutic option in SR-cGvHD by resetting a profoundly disturbed immune network.
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Ammer LS, Pohl S, Breyer SR, Aries C, Denecke J, Perez A, Petzoldt M, Schrum J, Müller I, Muschol NM. Is hematopoietic stem cell transplantation a therapeutic option for mucolipidosis type II? Mol Genet Metab Rep 2021; 26:100704. [PMID: 33505859 PMCID: PMC7815485 DOI: 10.1016/j.ymgmr.2020.100704] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mucolipidosis type II (MLII) is an ultra-rare lysosomal storage disorder caused by defective lysosomal enzyme trafficking. Clinical hallmarks are craniofacial dysmorphia, cardiorespiratory dysfunction, hepatosplenomegaly, skeletal deformities and neurocognitive retardation. Death usually occurs in the first decade of life and no cure exists. Hematopoietic stem cell transplantation (HSCT) has been performed in few MLII patients, but comprehensive follow-up data are extremely scarce. METHODS MLII diagnosis was confirmed in a female three-month-old patient with the mutations c.2213C > A and c.2220_2221dup in the GNPTAB gene. At nine months of age, the patient received HSCT from a 9/10 human leukocyte antigen (HLA)-matched unrelated donor. RESULTS HSCT resulted in a sustained reduction of lysosomal storage und bone metabolism markers. At six years of age, the patient showed normal cardiac function, partial respiratory insufficiency and moderate hepatomegaly, whereas skeletal manifestations had progressed. However, the patient could walk and maintained an overall good quality of life. Neurocognitive testing revealed a developmental quotient of 36%. The patient died at 6.6 years of age following a human metapneumovirus (hMPV) pneumonia. CONCLUSIONS The exact benefit remains unclear as current literature vastly lacks comparable data on MLII natural history patients. In order to evaluate experimental therapies, in-depth prospective studies and registries of untreated MLII patients are indispensable.
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Affiliation(s)
- Luise Sophie Ammer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Pohl
- International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Rafaela Breyer
- International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatric Orthopedics, Children's Hospital Altona, Hamburg, Germany
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Aries
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Denecke
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Perez
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Petzoldt
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Schrum
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Müller
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Maria Muschol
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Aydin S, Kruchen A, Wustrau K, Doering M, Schrum J, Müller I. Irradiation-free re-conditioning in children following graft failure of a T cell-depleted graft from a haploidentical parent. Bone Marrow Transplant 2021; 56:1452-1454. [PMID: 33420389 PMCID: PMC7792555 DOI: 10.1038/s41409-020-01196-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Susanne Aydin
- Division for Pediatric Stem Cell Transplantation and Immunology, Clinic for Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Anne Kruchen
- Division for Pediatric Stem Cell Transplantation and Immunology, Clinic for Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Katharina Wustrau
- Division for Pediatric Stem Cell Transplantation and Immunology, Clinic for Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Michaela Doering
- Department I-General Pediatrics, Haematology/Oncology, University Hospital Tübingen-Children's Hospital, Tübingen, Germany
| | - Johanna Schrum
- Division for Pediatric Stem Cell Transplantation and Immunology, Clinic for Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Ingo Müller
- Division for Pediatric Stem Cell Transplantation and Immunology, Clinic for Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
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7
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Sauer MG, Lang PJ, Albert MH, Bader P, Creutzig U, Eyrich M, Greil J, Gruhn B, Holter W, Klingebiel T, Kremens B, von der Leyen H, Mauz-Körholz C, Meisel R, Mischke K, Müller I, Niemeyer CM, Peters C, Pohler C, Reinhardt D, Burkhardt B, Schlegel PG, Schulz AS, Schrum J, Sedlacek P, Strahm B, Woessmann W, Handgretinger R, Zimmermann M, Borkhardt A. Hematopoietic stem cell transplantation for children with acute myeloid leukemia—results of the AML SCT-BFM 2007 trial. Leukemia 2019; 34:613-624. [DOI: 10.1038/s41375-019-0584-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/11/2019] [Accepted: 09/20/2019] [Indexed: 01/04/2023]
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Pichler H, Lawitschka A, Glogova E, Willasch AM, Luettichau I, Lehrnbecher T, Matthes‐Martin S, Lang P, Bader P, Sykora KW, Schrum J, Kremens B, Ehlert K, Albert MH, Kuhlen M, Meisel R, Guengoer T, Strahm B, Gruhn B, Schulz A, Woessmann W, Poetschger U, Peters C. Allogeneic hematopoietic stem cell transplantation from unrelated donors is associated with higher infection rates in children with acute lymphoblastic leukemia-A prospective international multicenter trial on behalf of the BFM-SG and the EBMT-PDWP. Am J Hematol 2019; 94:880-890. [PMID: 31095771 PMCID: PMC6772138 DOI: 10.1002/ajh.25511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/09/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 01/28/2023]
Abstract
Severe infections (SI) significantly impact on non‐relapse mortality after hematopoietic stem cell transplantation (HSCT). We assessed 432 children and adolescents with acute lymphoblastic leukemia (ALL) after total body irradiation based myeloablative HSCT within the multicenter ALL‐BFM‐SCT 2003 trial for SI grade 3 or higher according to common terminology criteria for adverse events. A total 172 patients experienced at least one SI. Transplantation from matched unrelated donors (MUD) was associated with any type of SI in the pre‐engraftment period (hazard ratio [HR]: 2.57; P < .001), and with any SI between day +30 and + 100 (HR: 2.91; P = .011). Bacterial (HR: 2.24; P = .041) and fungal infections (HR: 4.06; P = .057) occurred more often in the pre‐engraftment phase and viral infections more often before day +30 (HR: 2.66; P = .007) or between day +30 and + 100 (HR: 3.89; P = .002) after HSCT from MUD as compared to matched sibling donors. Chronic GvHD was an independent risk factor for any type of SI after day +100 (HR: 2.57; P < .002). We conclude that allogeneic HSCT from MUD in children and adolescents with pediatric ALL is associated with higher infection rates, which seems attributable to an intensified GvHD prophylaxis including serotherapy and methotrexate.
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Affiliation(s)
- Herbert Pichler
- St. Anna Kinderspital and Children's Cancer Research Institute (CCRI), Department of PaediatricsMedical University of Vienna Vienna Austria
| | - Anita Lawitschka
- St. Anna Kinderspital and Children's Cancer Research Institute (CCRI), Department of PaediatricsMedical University of Vienna Vienna Austria
| | - Evgenia Glogova
- St. Anna Kinderspital and Children's Cancer Research Institute (CCRI), Department of PaediatricsMedical University of Vienna Vienna Austria
| | - Andre M. Willasch
- Department for Children and Adolescents, Division for Stem Cell Transplantation and ImmunologyUniversity Hospital Frankfurt, Goethe University Frankfurt Germany
| | - Irene Luettichau
- Department of Paediatrics, Klinikum rechts der IsarTechnische Universität München Munich Germany
- Comprehensive Cancer Centre Munich (CCCM) Munich Germany
| | - Thomas Lehrnbecher
- Department for Children and Adolescents, Division for Paediatric Haematology, Oncology and HaemostaseologyUniversity Hospital Frankfurt, Goethe University Frankfurt Germany
| | - Susanne Matthes‐Martin
- St. Anna Kinderspital and Children's Cancer Research Institute (CCRI), Department of PaediatricsMedical University of Vienna Vienna Austria
| | - Peter Lang
- University Hospital Tuebingen Tuebingen Germany
| | - Peter Bader
- Department for Children and Adolescents, Division for Stem Cell Transplantation and ImmunologyUniversity Hospital Frankfurt, Goethe University Frankfurt Germany
| | - Karl W. Sykora
- Department of Paediatric Haematology/OncologyHannover Medical School Hannover Germany
| | - Johanna Schrum
- Paediatric Hematology and OncologyUniversity Hospital Hamburg‐Eppendorf Hamburg Germany
| | | | - Karoline Ehlert
- Department of Pediatric Oncology and HematologyUniversity Medicine Greifswald Greifswald Germany
| | - Michael H. Albert
- Paediatric Haematology‐Oncology, Dr. von Hauner Children's HospitalLudwig‐Maximilians Universität Munich Germany
| | - Michaela Kuhlen
- Department of Paediatric Oncology, Haematology and Clinical Immunology, Medical FacultyUniversity Children's Hospital, Heinrich Heine University Duesseldorf Germany
| | - Roland Meisel
- Department of Paediatric Oncology, Haematology and Clinical Immunology, Medical FacultyUniversity Children's Hospital, Heinrich Heine University Duesseldorf Germany
| | - Tayfun Guengoer
- Division of Stem Cell TransplantationUniversity Children's Hospital Zürich Zürich Switzerland
| | - Brigitte Strahm
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Haematology and Oncology, Medical Centre, Faculty of MedicineUniversity of Freiburg Freiburg Germany
| | - Bernd Gruhn
- Department of PaediatricsJena University Hospital Jena Germany
| | | | - Wilhelm Woessmann
- Paediatric Hematology and OncologyUniversity Hospital Hamburg‐Eppendorf Hamburg Germany
| | - Ulrike Poetschger
- St. Anna Kinderspital and Children's Cancer Research Institute (CCRI), Department of PaediatricsMedical University of Vienna Vienna Austria
| | - Christina Peters
- St. Anna Kinderspital and Children's Cancer Research Institute (CCRI), Department of PaediatricsMedical University of Vienna Vienna Austria
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9
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Kuhlen M, Bader P, Sauer M, Albert MH, Gruhn B, Güngör T, Kropshofer G, Lang P, Lawitschka A, Metzler M, Pentek F, Rossig C, Schlegel PG, Schrappe M, Schrum J, Schulz A, Schwinger W, von Stackelberg A, Strahm B, Suttorp M, Luettichau ITV, Wößmann W, Borkhardt A, Meisel R, Poetschger U, Glogova E, Peters C. Low incidence of symptomatic osteonecrosis after allogeneic HSCT in children with high-risk or relapsed ALL - results of the ALL-SCT 2003 trial. Br J Haematol 2018; 183:104-109. [DOI: 10.1111/bjh.15511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Michaela Kuhlen
- Department of Paediatric Oncology, Haematology and Clinical Immunology; Centre for Child and Adolescent Health; Medical Faculty; Heinrich Heine University; Düsseldorf Germany
| | - Peter Bader
- Department for Children and Adolescents; Division for Stem Cell Transplantation and Immunology; University Hospital Frankfurt; Frankfurt am Main Germany
| | - Martin Sauer
- Department of Paediatric Haematology and Oncology; Hannover Medical School; Hannover Germany
| | - Michael H. Albert
- Department of Paediatrics; Dr. von Hauner University Children's Hospital; Ludwig-Maximilians Universität; Munich Germany
| | - Bernd Gruhn
- Department of Paediatrics; Jena University Hospital; Jena Germany
| | - Tayfun Güngör
- Division of Stem Cell Transplantation; University Children's Hospital Zürich; Zürich Switzerland
| | | | - Peter Lang
- Department of General Paediatrics, Oncology/Haematology; Tübingen University Hospital for Children and Adolescents; Tübingen Germany
| | - Anita Lawitschka
- Department of Paediatrics; Medical University of Vienna; Children's Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung; Vienna Austria
| | - Markus Metzler
- Department of Paediatrics and Adolescent Medicine; University Hospital Erlangen; Erlangen Germany
| | - Falk Pentek
- Department of Paediatric Haematology and Oncology; Kinderklinik III, Universitätsklinikum-Essen; and the University of Duisburg-Essen; Essen Germany
| | - Claudia Rossig
- Department of Paediatric Haematology and Oncology; University Children′s Hospital Münster; Münster Germany
| | - Paul G. Schlegel
- Paediatric Oncology, Haematology and Stem Cell Transplantation; University of Würzburg; University Children's Hospital; Würzburg Germany
| | - Martin Schrappe
- Department of Paediatrics; University Hospital Schleswig-Holstein, Campus Kiel; Kiel Germany
| | - Johanna Schrum
- Department of Paediatric Haematology and Oncology; University Children's Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Ansgar Schulz
- Department of Paediatrics; University Medical Centre; Ulm Germany
| | - Wolfgang Schwinger
- Department of Paediatrics and Adolescent Medicine; Medical University of Graz; Graz Austria
| | - Arend von Stackelberg
- Department of Paediatric Oncology/Haematology; CharitéUniversitätsmedizin Berlin; Charité Campus Virchow; Berlin Germany
| | - Brigitte Strahm
- Department of Paediatrics and Adolescent Medicine; Division of Paediatric Haematology and Oncology; Medical Centre; Faculty of Medicine; University of Freiburg; Freiburg Germany
| | - Meinolf Suttorp
- Department of Paediatrics; University Clinic Carl Gustav Carus; Technische Universität Dresden; Dresden Germany
| | | | - Wilhelm Wößmann
- Department of Paediatric Haematology and Oncology; Justus-Liebig-University; Giessen Germany
| | - Arndt Borkhardt
- Department of Paediatric Oncology, Haematology and Clinical Immunology; Centre for Child and Adolescent Health; Medical Faculty; Heinrich Heine University; Düsseldorf Germany
| | - Roland Meisel
- Department of Paediatric Oncology, Haematology and Clinical Immunology; Centre for Child and Adolescent Health; Medical Faculty; Heinrich Heine University; Düsseldorf Germany
| | - Ulrike Poetschger
- Department of Paediatrics; Medical University of Vienna; Children's Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung; Vienna Austria
| | - Evgenia Glogova
- Department of Paediatrics; Medical University of Vienna; Children's Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung; Vienna Austria
| | - Christina Peters
- Department of Paediatrics; Medical University of Vienna; Children's Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung; Vienna Austria
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Budde U, Beutel K, Hassenpflug WA, Hauch H, Obser T, Oyen F, Schneppenheim S, Schrum J, Schneppenheim R. Response to DDAVP in children with von Willebrand disease type 2. Hamostaseologie 2017. [DOI: 10.1055/s-0037-1617014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
SummaryWe have prospectively evaluated the biologic response to desmopressin (DDAVP) in 28 children with type 2 von Willebrand disease (VWD) in correlation with the phenotype and the molecular defect of VWF. The diagnosis of VWD type 2 was mainly based on VWF functional parameters and/or an aberrant VWF multimer pattern. Seventeen different mutations were identified (6 of them novel). No response with respect to the functional parameters VWF:RCo and/or VWF:CB was seen in patients with severe abnormality of the VWF multimer pattern. One patient with VWD type 2A phenotype IIC Miami did not respond with respect to VWF:CB, but showed a good response of VWF:Ag and FVIII:C as expected. Interestingly he showed a persistently high level of VWF:Ag and FVIII:C up to 4 hours after DDAVP infusion. Patients with minor alterations of multimer structure and particular mutations responded well to DDAVP, whereas patients with normal multimer structure but a defect in platelet dependent functional parameters did not respond with VWF:RCo. Conclusion: Children with VWD type 2 show a variable response to desmopressin depending on the mutation that correlates with the functional defect and the presence or absence as well as the half-life of large VWF multimers. Our data emphasize the usefulness of DDAVP testing even in patients with VWD type 2, possibly with the exception of VWD type 2B.
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11
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Groeschel S, Kühl JS, Bley AE, Kehrer C, Weschke B, Döring M, Böhringer J, Schrum J, Santer R, Kohlschütter A, Krägeloh-Mann I, Müller I. Long-term Outcome of Allogeneic Hematopoietic Stem Cell Transplantation in Patients With Juvenile Metachromatic Leukodystrophy Compared With Nontransplanted Control Patients. JAMA Neurol 2016; 73:1133-40. [DOI: 10.1001/jamaneurol.2016.2067] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Samuel Groeschel
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital of Tübingen, Tübingen, Germany
| | - Jörn-Sven Kühl
- Department of Pediatric Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - Annette E. Bley
- Department of Pediatrics, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Kehrer
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital of Tübingen, Tübingen, Germany
| | - Bernhard Weschke
- Department of Neuropediatrics, Charité University Medicine Berlin, Berlin, Germany
| | - Michaela Döring
- Department of Pediatric Hematology and Oncology, University Children’s Hospital of Tübingen, Tübingen, Germany
| | - Judith Böhringer
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital of Tübingen, Tübingen, Germany
| | - Johanna Schrum
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - René Santer
- Department of Pediatrics, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alfried Kohlschütter
- Department of Pediatrics, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ingeborg Krägeloh-Mann
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital of Tübingen, Tübingen, Germany
| | - Ingo Müller
- Department of Pediatric Hematology and Oncology, University Children’s Hospital of Tübingen, Tübingen, Germany6Department of Pediatric Hematology and Oncology, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
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12
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Blohm M, Lehmberg K, Schrum J, Helmke K, Ridderbusch I, Schneppenheim R, Singer D. Angeborene Gerinnungsstörungen – Unterarmgangrän bei „normaler“ Gerinnung. Z Geburtshilfe Neonatol 2016. [DOI: 10.1055/s-0042-107540] [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: 10/21/2022]
Affiliation(s)
- M. Blohm
- Sektion Neonatologie und Pädiatrische Intensivmedizin,
| | - K. Lehmberg
- Klinik und Poliklinik für Pädiatrische Hämatologie und Onkologie,
| | - J. Schrum
- Klinik und Poliklinik für Pädiatrische Hämatologie und Onkologie,
| | | | - I. Ridderbusch
- Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Eppendorf, Hamburg
| | - R. Schneppenheim
- Klinik und Poliklinik für Pädiatrische Hämatologie und Onkologie,
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13
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Preuner S, Peters C, Pötschger U, Daxberger H, Fritsch G, Geyeregger R, Schrauder A, von Stackelberg A, Schrappe M, Bader P, Ebell W, Eckert C, Lang P, Sykora KW, Schrum J, Kremens B, Ehlert K, Albert MH, Meisel R, Lawitschka A, Mann G, Panzer-Grümayer R, Güngör T, Holter W, Strahm B, Gruhn B, Schulz A, Woessmann W, Lion T. Risk assessment of relapse by lineage-specific monitoring of chimerism in children undergoing allogeneic stem cell transplantation for acute lymphoblastic leukemia. Haematologica 2016; 101:741-6. [PMID: 26869631 DOI: 10.3324/haematol.2015.135137] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/02/2016] [Indexed: 11/09/2022] Open
Abstract
UNLABELLED Allogeneic hematopoietic stem cell transplantation is required as rescue therapy in about 20% of pediatric patients with acute lymphoblastic leukemia. However, the relapse rates are considerable, and relapse confers a poor outcome. Early assessment of the risk of relapse is therefore of paramount importance for the development of appropriate measures. We used the EuroChimerism approach to investigate the potential impact of lineage-specific chimerism testing for relapse-risk analysis in 162 pediatric patients with acute lymphoblastic leukemia after allogeneic stem cell transplantation in a multicenter study based on standardized transplantation protocols. Within a median observation time of 4.5 years, relapses have occurred in 41/162 patients at a median of 0.6 years after transplantation (range, 0.13-5.7 years). Prospective screening at defined consecutive time points revealed that reappearance of recipient-derived cells within the CD34(+) and CD8(+) cell subsets display the most significant association with the occurrence of relapses with hazard ratios of 5.2 (P=0.003) and 2.8 (P=0.008), respectively. The appearance of recipient cells after a period of pure donor chimerism in the CD34(+) and CD8(+) leukocyte subsets revealed dynamics indicative of a significantly elevated risk of relapse or imminent disease recurrence. Assessment of chimerism within these lineages can therefore provide complementary information for further diagnostic and, potentially, therapeutic purposes aiming at the prevention of overt relapse. This study was registered at clinical. TRIALS gov with the number NC01423747.
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Affiliation(s)
| | | | | | | | | | | | - André Schrauder
- University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel, Department of Pediatrics, Kiel, Germany
| | | | - Martin Schrappe
- University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel, Department of Pediatrics, Kiel, Germany
| | - Peter Bader
- Johann Wolfgang Goethe University, Frankfurt, Germany
| | | | | | | | | | | | | | - Karoline Ehlert
- University Children's Hospital Münster, Germany (current address: Medical University Greifswald, Germany)
| | | | | | | | - Georg Mann
- St. Anna Children's Hospital, Vienna, Austria
| | | | - Tayfun Güngör
- University Children's Hospital Zürich, Division of Stem Cell Transplantation, Switzerland
| | - Wolfgang Holter
- Children's University Hospital Erlangen, Germany St. Anna Children's Hospital, Vienna, Austria Department of Pediatrics, Medical University Vienna, Austria
| | - Brigitte Strahm
- Pediatric Hematology and Oncology, University Medical Center Freiburg, Germany
| | | | | | | | - Thomas Lion
- Children's Cancer Research Institute, Vienna, Austria Department of Pediatrics, Medical University Vienna, Austria
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14
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Holstein K, Schneppenheim R, Schrum J, Bokemeyer C, Langer F. Successful second ITI with factor IX and combined immunosuppressive therapy. A patient with severe haemophilia B and recurrence of a factor IX inhibitor. Hamostaseologie 2015; 34 Suppl 1:S5-8. [PMID: 25382771 DOI: 10.5482/hamo-14-01-0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/31/2014] [Accepted: 09/17/2014] [Indexed: 11/05/2022] Open
Abstract
Immune tolerance induction (ITI) in patients with haemophilia B and inhibitors may be complicated by anaphylactic reactions and nephrotic syndrome with lower success rates than in haemophilia A (25% vs. 50-90%). According to case reports, immunosuppressive therapy in addition to high doses of factor IX (FIX) appears to be promising. We report an 18-year-old patient with severe haemophilia B and a FIX inhibitor with a maximum titre of 2.6 Bethesda units and allergic skin reactions to FIX infusions. At 5 years of age, this patient already had a FIX inhibitor with allergic reactions to FIX and activated prothrombin complex concentrate. ITI at 11 years of age with high-dose FIX, dexamethasone, rituximab, mycophenolate mofetil and intravenous immunoglobulins had induced a sustained response until the current presentation. The patient was restarted on the same ITI regimen with aforementioned immunosuppressants, which were initiated one week before high-dose FIX. No allergic reactions, nephrotic syndrome or serious infection occurred during ITI. The FIX inhibitor was undetectable after five weeks of treatment and remained so until 19 months of follow-up.
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Affiliation(s)
- K Holstein
- Dr. Katharina Holstein, II. Medizinische Klinik und Poliklinik, Universitätsklinikum Eppendorf, Martinistr. 52, 20246 Hamburg, Germany, Tel. +49/(0)40/741 05-24 53, Fax -5193, E-mail:
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15
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Peters C, Schrappe M, von Stackelberg A, Schrauder A, Bader P, Ebell W, Lang P, Sykora KW, Schrum J, Kremens B, Ehlert K, Albert MH, Meisel R, Matthes-Martin S, Gungor T, Holter W, Strahm B, Gruhn B, Schulz A, Woessmann W, Poetschger U, Zimmermann M, Klingebiel T. Stem-Cell Transplantation in Children With Acute Lymphoblastic Leukemia: A Prospective International Multicenter Trial Comparing Sibling Donors With Matched Unrelated Donors—The ALL-SCT-BFM-2003 Trial. J Clin Oncol 2015; 33:1265-74. [DOI: 10.1200/jco.2014.58.9747] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose Although hematopoietic stem-cell transplantation is widely performed in children with high-risk acute lymphoblastic leukemia (ALL), the influence of donor types is poorly understood. Thus, transplantation outcomes were compared in the prospective multinational Berlin-Frankfurt-Muenster (BFM) study group trial: ALL-SCT-BFM 2003 (Allogeneic Stem Cell Transplantation in Children and Adolescents with Acute Lymphoblastic Leukemia). Patients and Methods After conditioning with total-body irradiation and etoposide, 411 children with high-risk ALL received highly standardized stem-cell transplantations during the first or later remissions. Depending on donor availability, grafts originated from HLA-genoidentical siblings or from HLA-matched unrelated donors who were identified and matched by high-resolution allelic typing and were compatible in at least 9 of 10 HLA loci. Results Four-year event-free survival (± standard deviation [SD]) did not differ between patients with transplantations from unrelated or sibling donors (0.67 ± 0.03 v 0.71 ± 0.05; P = .405), with cumulative incidences of nonrelapse mortality (± SD) of 0.10 ± 0.02 and 0.03 ± 0.02 (P = .017) and relapse rates (± SD) of 0.22 ± 0.02 and 0.24 ± 0.04 (P = .732), respectively. Among recipients of transplantations from unrelated donors, no significant differences in event-free survival, overall survival, or nonrelapse mortality were observed between 9/10 and 10/10 matched grafts or between peripheral blood stem cells and bone marrow. The absence of chronic graft-versus-host disease had no effect on event-free survival. Engraftment was faster after bone marrow transplantation from siblings and was associated with fewer severe infections and pulmonary complications. Conclusion Outcome among high-risk pediatric patients with ALL after hematopoietic stem-cell transplantation was not affected by donor type. Standardized myeloablative conditioning produced a low incidence of treatment-related mortality and effective control of leukemia.
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Affiliation(s)
- Christina Peters
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Martin Schrappe
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Arend von Stackelberg
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - André Schrauder
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Peter Bader
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Wolfram Ebell
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Peter Lang
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Karl-Walter Sykora
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Johanna Schrum
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Bernhard Kremens
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Karoline Ehlert
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Michael H. Albert
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Roland Meisel
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Susanne Matthes-Martin
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Tayfun Gungor
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Wolfgang Holter
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Brigitte Strahm
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Bernd Gruhn
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Ansgar Schulz
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Wilhelm Woessmann
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Ulrike Poetschger
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Martin Zimmermann
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
| | - Thomas Klingebiel
- Christina Peters, Susanne Matthes-Martin, and Ulrike Poetschger, St Anna Children's Hospital, Vienna, Austria; Martin Schrappe, University Medical Center Schleswig-Holstein and Christian-Albrechts-University Kiel; André Schrauder, Kinderarztpraxis am Aalborgring, Kiel; Arend von Stackelberg and Wolfram Ebell, Charité–Children's Hospital Berlin, Berlin; Peter Bader and Thomas Klingebiel, Johann Wolfgang Goethe University, Frankfurt; Peter Lang, University Hospital Tübingen, Tübingen; Karl-Walter Sykora
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Peters C, Schrauder A, von Stackelberg A, Schrappe M, Bader P, Strahm B, Ebell W, Handgretinger R, Sykora KW, Schrum J, Kremens B, Matthes-Leodolter S, Ehlert K, Albert M, Meisel R, Guengoer T, Stachel KD, Holter W, Gruhn B, Schulz A, Poetschger U, Zimmermann M, Klingebiel TE. Allogeneic HSCT from Unrelated and Sibling Donors are Equal for Children with Acute Lymphoblastic Leukemia. Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Corbacioglu S, Cesaro S, Faraci M, Valteau-Couanet D, Gruhn B, Rovelli A, Boelens JJ, Hewitt A, Schrum J, Schulz AS, Müller I, Stein J, Wynn R, Greil J, Sykora KW, Matthes-Martin S, Führer M, O'Meara A, Toporski J, Sedlacek P, Schlegel PG, Ehlert K, Fasth A, Winiarski J, Arvidson J, Mauz-Körholz C, Ozsahin H, Schrauder A, Bader P, Massaro J, D'Agostino R, Hoyle M, Iacobelli M, Debatin KM, Peters C, Dini G. Defibrotide for prophylaxis of hepatic veno-occlusive disease in paediatric haemopoietic stem-cell transplantation: an open-label, phase 3, randomised controlled trial. Lancet 2012; 379:1301-9. [PMID: 22364685 DOI: 10.1016/s0140-6736(11)61938-7] [Citation(s) in RCA: 242] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hepatic veno-occlusive disease is a leading cause of morbidity and mortality after haemopoietic stem-cell transplantation (HSCT). We aimed to assess whether defibrotide can reduce the incidence of veno-occlusive disease in this setting. METHODS In our phase 3 open-label, randomised controlled trial, we enrolled patients at 28 European university hospitals or academic medical centres. Eligible patients were younger than 18 years, had undergone myeloablative conditioning before allogeneic or autologous HSCT, and had one or more risk factor for veno-occlusive disease based on modified Seattle criteria. We centrally assigned eligible participants on the basis of a computer-generated randomisation sequence (1:1), stratified by centre and presence of osteopetrosis, to receive intravenous defibrotide prophylaxis (treatment group) or not (control group). The primary endpoint was incidence of veno-occlusive disease by 30 days after HSCT, adjudicated by a masked, independent review committee, in eligible patients who consented to randomisation (intention-to-treat population), and was assessed with a competing risk approach. Patients in either group who developed veno-occlusive disease received defibrotide for treatment. We assessed adverse events to 180 days after HSCT in all patients who received allocated prophylaxis. This trial is registered with ClinicalTrials.gov, number NCT00272948. FINDINGS Between Jan 25, 2006, and Jan 29, 2009, we enrolled 356 eligible patients to the intention-to-treat population. 22 (12%) of 180 patients randomly allocated to the defibrotide group had veno-occlusive disease by 30 days after HSCT compared with 35 (20%) of 176 controls (risk difference -7·7%, 95% CI -15·3 to -0·1; Z test for competing risk analysis p=0·0488; log-rank test p=0·0507). 154 (87%) of 177 patients in the defibrotide group had adverse events by day 180 compared with 155 (88%) of 176 controls. INTERPRETATION Defibrotide prophylaxis seems to reduce incidence of veno-occlusive disease and is well tolerated. Thus, such prophylaxis could present a useful clinical option for this serious complication of HSCT. FUNDING Gentium SpA, European Group for Blood and Marrow Transplantation.
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Vöhringer S, Schrum J, Ott H, Höger PH. Massive Phototoxizität unter Langzeiteinnahme von Voriconazol. J Dtsch Dermatol Ges 2011. [DOI: 10.1111/j.1610-0387.2010.07563_suppl.x] [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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Abstract
Voriconazole is a second-generation triazole antifungal approved for the treatment of invasive fungal infections, particularly with Aspergillus, Candida, Fusarium, and Scedosporium spp. Frequently reported adverse effects of voriconazole include visual disturbance (21 %), elevated liver enzymes (15.6 %) and rashes (7 %), which are largely attributable to drug-induced photosensitivity. We report a case of serious phototoxicity in a 8 year old boy who underwent chemotherapy for AML. He received voriconazole for the treatment and subsequent re-infection prophylaxis after pulmonary aspergillosis. One year after the start of therapy he developed blistering eruptions on his face after minimal sunlight exposure. Recent reports about the development of squamous cell carcinoma and melanoma, respectively, in children during and after oral therapy with voriconazole seem to warrant systematic follow-up investigations of all voriconazole-treated patients.
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Affiliation(s)
- Sabine Vöhringer
- Department of Pediatric Dermatology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
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Calaminus G, Göbel U, Schrum J, Wittkugel O, Westphal M, Timmermann B. Proton beam therapy for loco-regional control of a recurrent mixed malignant germ cell tumor of the skull in a 22-month-old girl. Klin Padiatr 2010; 222:175-9. [PMID: 20514623 DOI: 10.1055/s-0030-1252018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Germ cell tumors (GCT) situated in the head and neck region are very rare and occur predominantely in newborns or young infants. Recurrent CTs are often resectable only by mutilating surgery and the need for alternative treatment strategies is obvious. In this situation radiation therapy is the most important treatment option for loco-regional tumor control, but bear in this area the risk of possible impairment of brain function and face deformation as long term effects. CASE REPORT In a girl with a connatal expansive growing teratoma of the skull the tumor recurred in spite of repeated surgery as mixed malignant GCT at the age of 15 months. Tumor control could not be achieved with chemotherapy and additional surgery seemed not promising. Therefore high dose proton beam therapy (PT) (54 Gy) has been administered to the child at the age of 22 months and led to local tumor control with only mild side effects. CONCLUSION PT treatment may be an option for specific clinical conditions in germ cell tumors where local tumor control cannot be achieved by chemotherapy and/or surgery and long lasting side effects of conventional radiotherapy due to tumor localization and age have to be considered. However, PT should be implemented in treatment protocols for specific situations to guarantee supervised application, central documentation and follow-up.
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Affiliation(s)
- G Calaminus
- Pediatric Hematology and Oncology, University Münster, Münster, Germany.
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22
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Friedrich C, Schrum J, Chott A, Janka-Schaub G, Kabisch H. Ongoing remission after intensive ALL-type chemotherapy in pediatric intestinal T-cell lymphoma. Pediatr Blood Cancer 2010; 54:610-2. [PMID: 20049930 DOI: 10.1002/pbc.22330] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A rare case of primary intestinal T-cell lymphoma (ITL) of an 8-year-old boy is reported. Medium- to large-sized tumor cells were betaF1+, CD3+, CD8+. TIA-1+, but CD4-, CD5-, CD30-, CD56-, CD20-, CD79a-, TdT-, consistent with an intraepithelial lymphocyte (IEL) origin. They showed monoclonal rearrangement of the T-cell receptor gamma-chain and no evidence of EBV infection. No clinical, histologic, laboratory, or genetic evidence of celiac disease was detected. In adults, ITL is often associated with enteropathy and has a very poor outcome. Our patient remains in first remission 30 months after finishing the acute lymphoblastic leukemia protocol COALL-07-03 high risk standard.
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Affiliation(s)
- Carsten Friedrich
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Schneppenheim R, Budde U, Beutel K, Hassenpflug WA, Hauch H, Obser T, Oyen F, Schneppenheim S, Schrum J. Response to DDAVP in children with von Willebrand disease type 2. Hamostaseologie 2009; 29:143-148. [PMID: 19404524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
UNLABELLED We have prospectively evaluated the biologic response to desmopressin (DDAVP) in 28 children with type 2 von Willebrand disease (VWD) in correlation with the phenotype and the molecular defect of VWF. The diagnosis of VWD type 2 was mainly based on VWF functional parameters and/or an aberrant VWF multimer pattern. Seventeen different mutations were identified (6 of them novel). No response with respect to the functional parameters VWF:RCo and/or VWF:CB was seen in patients with severe abnormality of the VWF multimer pattern. One patient with VWD type 2A phenotype IIC Miami did not respond with respect to VWF:CB, but showed a good response of VWF:Ag and FVIII:C as expected. Interestingly he showed a persistently high level of VWF:Ag and FVIII:C up to 4 hours after DDAVP infusion. Patients with minor alterations of multimer structure and particular mutations responded well to DDAVP, whereas patients with normal multimer structure but a defect in platelet dependent functional parameters did not respond with VWF:RCo. CONCLUSION Children with VWD type 2 show a variable response to desmopressin depending on the mutation that correlates with the functional defect and the presence or absence as well as the half-life of large VWF multimers. Our data emphasize the usefulness of DDAVP testing even in patients with VWD type 2, possibly with the exception of VWD type 2B.
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Affiliation(s)
- Reinhard Schneppenheim
- Department of Paediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
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Kröger N, Zabelina T, Binder T, Ayuk F, Bacher U, Amtsfeld G, Lellek H, Schrum J, Erttmann R, Eiermann T, Zander A. HLA-Mismatched Unrelated Donors as an Alternative Graft Source for Allogeneic Stem Cell Transplantation after Antithymocyte Globulin-Containing Conditioning Regimen. Biol Blood Marrow Transplant 2009; 15:454-62. [DOI: 10.1016/j.bbmt.2009.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Accepted: 01/06/2009] [Indexed: 11/29/2022]
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Affiliation(s)
- Christian Lilje
- Department of Pediatric Cardiology, University Hospital, Hamburg, Germany
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Kröger N, Zabelina T, Renges H, Krüger W, Kordes U, Rischewski J, Schrum J, Horstmann M, Ayuk F, Erttmann R, Kabisch H, Zander AR. Long-term follow-up of allogeneic stem cell transplantation in patients with severe aplastic anemia after conditioning with cyclophosphamide plus antithymocyte globulin. Ann Hematol 2002; 81:627-31. [PMID: 12454700 DOI: 10.1007/s00277-002-0566-0] [Citation(s) in RCA: 21] [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: 05/27/2002] [Accepted: 10/08/2002] [Indexed: 10/27/2022]
Abstract
We investigated the efficacy of an antithymocyte globulin/cyclophosphamide preparative regimen prior to allogeneic stem cell transplantation from HLA-identical siblings in patients with severe aplastic anemia. Since 1990, 21 patients, 6 males and 15 females, with a median age of 25 years (range: 7-43) have been enrolled in the protocol consisting of 200 mg/kg cyclophosphamide and 90-120 mg/kg antithymocyte globulin (ATG, rabbit, Fresenius, Bad Homburg, Germany). For further graft-versus-host disease (GVHD) prophylaxis all patients received cyclosporin A and a short course of methotrexate (MTX). Only one patient had a primary graft failure (5%). All other patients engrafted with a leukocyte count >1.0 x 10(9)/l and a platelet count >20 x 10(9)/l after a median of 19 (range: 11-28) and 26 days (range: 13-67), respectively. No late graft failure or relapse was observed. Two patients experienced mild acute GVHD grade I (10%), and one patient developed grade II GVHD (5%). No severe grade III/IV GVHD was observed; 17% of the patients developed limited chronic GVHD. The treatment-related mortality was 14% and mainly due to fungal infection. After a median follow-up of 70 months (range: 2-139), the estimated overall and event-free survival at 10 years for all patients is 86% (95% confidence interval: 70-100%). We conclude that ATG plus cyclophosphamide is an effective conditioning regimen in patients with aplastic anemia undergoing stem cell transplantation with a low treatment-related mortality, resulting in an excellent outcome.
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Affiliation(s)
- N Kröger
- Department of Bone Marrow Transplantation, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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27
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Kröger N, Schetelig J, Zabelina T, Krüger W, Renges H, Stute N, Schrum J, Kabisch H, Siegert W, Zander AR. A fludarabine-based dose-reduced conditioning regimen followed by allogeneic stem cell transplantation from related or unrelated donors in patients with myelodysplastic syndrome. Bone Marrow Transplant 2001; 28:643-7. [PMID: 11704786 DOI: 10.1038/sj.bmt.1703215] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2001] [Accepted: 07/17/2001] [Indexed: 11/08/2022]
Abstract
We investigated the feasibility and efficacy of a fludarabine-based dose-reduced conditioning regimen followed by stem cell transplantation from related (n = 5) or unrelated HLA-matched donors (n = 7) in 12 patients with high risk MDS, who were not eligible for a standard myeloablative conditioning regimen. The conditioning regimen consisted of fludarabine 30 mg/m(2) daily for 6 days, busulfan 4 mg/kg daily for 2 days and anti-thymocyte globulin (ATG, rabbit) 10 mg/kg daily for 4 days in 11 patients, while one patient received fludarabine, ATG, cyclophosphamide and thiotepa. Graft-versus-host disease prophylaxis consisted of cyclosporine and a short course of methotrexate. The median age of the patients was 53 years (range 37-59). The median percentage of blasts in bone marrow aspirate at transplantation was 15% (range <5% to 35%). Diagnosis at transplant was RA (n = 1), RAEB (n = 5), RAEB-T (n = 5) and sAML (n = 1). A complex karyotype including monosomy 7 was noted in five patients. The reasons for using a dose-reduced conditioning regimen were prior autologous/syngeneic BMT (n = 4), active fungal infection (n = 2) or age/reduced performance status (n = 6). Engraftment was observed in all patients with complete donor chimerism. The incidence of acute GVHD (grade II-IV) was 33%. Eight patients died during follow-up due to relapse (n = 4), liver toxicity (n = 2), aspergillus (n = 1) or aGVHD grade IV (n = 1). After a median follow-up of 19 months, the 2-year estimated disease-free survival is 12% (95% CI: 2-23%) and the overall survival is 26% (95% CI: 4-52%). Fludarabine dose-reduced conditioning prior to allogeneic stem cell transplantation in high risk MDS patients, who were not eligible for standard transplantation, resulted in stable engraftment with complete chimerism, but the toxicity and relapse rate were considerable.
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MESH Headings
- Adult
- Anemia, Refractory, with Excess of Blasts/genetics
- Anemia, Refractory, with Excess of Blasts/mortality
- Anemia, Refractory, with Excess of Blasts/pathology
- Anemia, Refractory, with Excess of Blasts/therapy
- Antilymphocyte Serum/administration & dosage
- Antilymphocyte Serum/adverse effects
- Bone Marrow/pathology
- Busulfan/administration & dosage
- Busulfan/adverse effects
- Cell Count
- Chromosomes, Human, Pair 7/genetics
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Disease-Free Survival
- Feasibility Studies
- Graft Survival
- Graft vs Host Disease/mortality
- Graft vs Host Disease/prevention & control
- Hematopoietic Stem Cell Transplantation
- Hepatic Veno-Occlusive Disease/etiology
- Hepatic Veno-Occlusive Disease/mortality
- Histocompatibility
- Humans
- Infections/etiology
- Infections/mortality
- Karyotyping
- Methotrexate/administration & dosage
- Methotrexate/adverse effects
- Middle Aged
- Monosomy
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/mortality
- Myelodysplastic Syndromes/pathology
- Myelodysplastic Syndromes/therapy
- Recurrence
- Survival Rate
- T-Lymphocytes
- Tissue Donors
- Transplantation Conditioning/adverse effects
- Transplantation Conditioning/methods
- Transplantation, Homologous
- Treatment Outcome
- Vidarabine/administration & dosage
- Vidarabine/adverse effects
- Vidarabine/analogs & derivatives
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Affiliation(s)
- N Kröger
- Bone Marrow Transplantation, University Hospital Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany
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28
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Kröger N, Zabelina T, Krüger W, Renges H, Stute N, Schrum J, Kabisch H, Schafhausen P, Jaburg N, Löliger C, Schäfer P, Hinke A, Zander AR. Patient cytomegalovirus seropositivity with or without reactivation is the most important prognostic factor for survival and treatment-related mortality in stem cell transplantation from unrelated donors using pretransplant in vivo T-cell depletion with anti-thymocyte globulin. Br J Haematol 2001; 113:1060-71. [PMID: 11442503 DOI: 10.1046/j.1365-2141.2001.02849.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We evaluated the cytomegalovirus (CMV) serostatus as a risk factor for survival and treatment-related mortality (TRM) in 125 patients allografted from an unrelated donor between 1994 and 1999. All patients received pretransplant in vivo T-cell depletion using rabbit anti-thymocyte globulin (ATG). Only one patient had primary graft failure and severe grade III/IV graft-versus-host disease occurred in 14% of the patients. The overall survival (OS) at 3 years was 70% for CMV-negative patients (n = 76) and 29% in the seropositive cohort (n = 49) (P > 0.001). In multivariate analyses, CMV seropositivity remained an independent negative prognostic factor for OS (RR: 2.1; CI: 1.2-3.8; P = 0.014), apart from age > 20 years (RR: 2.74; CI: 1.2-3.8; P = 0.004) and late leucocyte engraftment (RR: 2.4; CI: 1.2-4.9; P = 0.015). The TRM for all patients was 27%. Despite monitoring for CMV antigenaemia and preemptive therapy with ganciclovir when reactivation occurred, seropositive patients had a three times higher risk of fatal treatment-related complications than seronegative patients. In multivariate analyses, CMV seropositivity remained the strongest independent negative factor for TRM (RR: 5.3; CI: 1.9-14.6; P = 0.002), followed by age > 20 years (RR: 4.8; CI: 1.3-18.1; P = 0.02) and delayed leucocyte engraftment (RR: 3.6; CI: 1.2-11; P = 0.02). The TRM was identical in seropositive patients with (n = 27) or without (n = 22) CMV reactivation (44% versus 50%). We conclude that CMV seropositivity, despite preemptive ganciclovir therapy and even without reactivation, is a major negative prognostic factor for survival as well as for TRM in unrelated stem cell transplantation using pretransplant in vivo T-cell depletion with ATG.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Antilymphocyte Serum/administration & dosage
- Child
- Child, Preschool
- Cytomegalovirus
- Cytomegalovirus Infections/complications
- Female
- Hematopoietic Stem Cell Transplantation/mortality
- Humans
- Infant
- Leukemia/therapy
- Leukemia/virology
- Leukemia, Myeloid/therapy
- Leukemia, Myeloid/virology
- Leukemia, Myeloid, Accelerated Phase/therapy
- Leukemia, Myeloid, Accelerated Phase/virology
- Leukemia, Myeloid, Chronic-Phase/therapy
- Leukemia, Myeloid, Chronic-Phase/virology
- Leukemia, Myelomonocytic, Acute/therapy
- Leukemia, Myelomonocytic, Acute/virology
- Lymphoma/therapy
- Lymphoma/virology
- Male
- Middle Aged
- Multiple Myeloma/therapy
- Multiple Myeloma/virology
- Multivariate Analysis
- Myelodysplastic Syndromes/therapy
- Myelodysplastic Syndromes/virology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/virology
- Risk Factors
- Survival Rate
- Transplantation Conditioning/methods
- Transplantation, Homologous
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Affiliation(s)
- N Kröger
- Bone Marrow Transplantation, University Hospital Hamburg, Department of Bone Marrow Transplantation, Pavlow University, St Petersburg, Russia.
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29
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Schmitt C, David K, Hiller J, Schrum J, Bredehorst R, Vogel CW, Löliger C, Erttmann R. [Natural human IgM-antibodies in neuroblastoma therapy: preliminary findings of a phase I/II clinical trial]. Klin Padiatr 1999; 211:314-8. [PMID: 10472569 DOI: 10.1055/s-2008-1043807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sera from healthy individuals contain natural IgM antibodies (anti-NB-Ab) cytotoxic to neuroblastoma (NB) cells. In contrast to healthy children the prevalence of anti-NB-Ab in sera of NB patients is low. Binding of anti-NB-Ab to the NB cell surface leads to activation of complement in vitro. In vivo the injection of the purified IgM fraction from a cytotoxic blood donor results in complete growth arrest of NB xenografts in nude rats. Preliminary results from a phase I/II study to evaluate the pharmacokinetics and side effects of a therapy with anti-NB-Ab are presented here. PATIENTS Included in this study are patients with NB stage 4 according to INSS with relapse or non-responders to therapy according to the GPOH-NB-therapy protocol. The patients are negative for anti-NB-Ab and are older than one year. METHODS The therapy is based on a complete exchange of the anti-NB-Ab negative patient serum against serum from an anti-NB-Ab positive ABO-compatible donor by means of plasmapheresis. RESULTS Up to now, 14 cycles of plasmapheresis have been carried out in 6 NB patients. In 13 of 14 therapy cycles a significant increase in serum toxicity could be observed. Severe side effects have not been seen except a catheter associated thrombosis which was reversible under heparin treatment. After plasmapheresis, pain in the tumor site or regions of metastasis did occur regularly. In some cases temporary elevation of body temperature occurred. One patient had a reduced MIBG uptake after therapy. Tumor necrosis was observed in 2 patients. Three patients showed tumor progress. CONCLUSION Immunotherapy of NB in children by serum exchange using anti-NB-Ab positive ABO-compatible donor serum is feasible without major side effects and leads to a significant increase of serum toxicity against NB cells.
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Affiliation(s)
- C Schmitt
- Abt. für pädiatrische Hämatologie und Onkologie, Universität Hamburg
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