1
|
Mayer K, Serries M, Hahn-Ast C, Bisht S, Brossart P, Feldmann G. Treatment of acute myeloid leukaemia in older patients - scope of intensive therapy? - A retrospective analysis. Hematology 2023; 28:2212536. [PMID: 37204122 DOI: 10.1080/16078454.2023.2212536] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
PURPOSE Therapeutic regimens and outcome of acute myeloid leukaemia (AML) patients substantially improved over the past decades. However, AML in older patients is still widely understudied and therapeutic standards are far less well defined. This study provides a retrospective analysis of a cohort of AML patients above 65 years of age treated at a single university centre in Germany. METHODS Treatment regimens including intensive chemotherapy with or without subsequent allogenic stem cell transplantation (allo-SCT), hypomethylating agent (HMA) or low-dose cytarabine (LD-AraC) based therapy or best supportive care (BSC) were evaluated and compared to patient-specific variables, comorbidities indices such as Haematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) or Charlson Comorbidity Index (CCI), or Eastern Cooperative Oncology Group (ECOG) performance status to assess their potential impact on outcome. RESULTS 229 patients ≥ 65 years with newly diagnosed AML were included in this study. Patients received either intensive chemotherapy (IT) without (n = 101, 44%), or followed by allo-SCT (n = 27, 12%), HMA (n = 29, 13%), LD-Ara-C (n = 16, 7%) or best supportive care (BSC) only (n = 56, 24%). Of interest, ECOG performance status predicted overall survival in patients treated with IT, and combinatorial assessment of ECOG and HCT-CI was particularly useful to predict outcome in this subgroup of patients. CONCLUSION Subsets of AML patients above 65 years of age benefit from intensive chemotherapy and allogenic stem cell transplantation. Combined assessment of ECOG scores and HCT-CI might help to objectively identify suitable patients, and this concept should be further investigated in a prospective manner in future studies.
Collapse
Affiliation(s)
- Karin Mayer
- Department of Internal Medicine 3, Hematology and Medical Oncology, Centre of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Michael Serries
- Department of Internal Medicine 3, Hematology and Medical Oncology, Centre of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Corinna Hahn-Ast
- Department of Internal Medicine 3, Hematology and Medical Oncology, Centre of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Savita Bisht
- Department of Internal Medicine 3, Hematology and Medical Oncology, Centre of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Peter Brossart
- Department of Internal Medicine 3, Hematology and Medical Oncology, Centre of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Georg Feldmann
- Department of Internal Medicine 3, Hematology and Medical Oncology, Centre of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| |
Collapse
|
2
|
Döhner H, Weber D, Krzykalla J, Fiedler W, Kühn MWM, Schroeder T, Mayer K, Lübbert M, Wattad M, Götze K, Fransecky L, Koller E, Wulf G, Schleicher J, Ringhoffer M, Greil R, Hertenstein B, Krauter J, Martens UM, Nachbaur D, Samra MA, Machherndl-Spandl S, Basara N, Leis C, Schrade A, Kapp-Schwoerer S, Cocciardi S, Bullinger L, Thol F, Heuser M, Paschka P, Gaidzik VI, Saadati M, Benner A, Schlenk RF, Döhner K, Ganser A. Intensive chemotherapy with or without gemtuzumab ozogamicin in patients with NPM1-mutated acute myeloid leukaemia (AMLSG 09-09): a randomised, open-label, multicentre, phase 3 trial. Lancet Haematol 2023; 10:e495-e509. [PMID: 37187198 DOI: 10.1016/s2352-3026(23)00089-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 02/26/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Acute myeloid leukaemia with mutated NPM1 is associated with high CD33 expression and intermediate-risk cytogenetics. The aim of this study was to evaluate intensive chemotherapy with or without the anti-CD33 antibody-drug conjugate gemtuzumab ozogamicin in participants with newly diagnosed, NPM1-mutated acute myeloid leukaemia. METHODS This open-label, phase 3 trial was conducted at 56 hospitals in Germany and Austria. Eligible participants were 18 years or older and had newly diagnosed NPM1-mutated acute myeloid leukaemia and an Eastern Cooperative Oncology Group performance status of 0-2. Participants were randomly assigned, using age as a stratification factor (18-60 years vs >60 years), 1:1 to the two treatment groups using allocation concealment; there was no masking of participants and investigators to treatment groups. Participants received two cycles of induction therapy (idarubicin, cytarabine, and etoposide) plus all-trans retinoic acid (ATRA) followed by three consolidation cycles of high-dose cytarabine (or an intermediate dose for those older than 60 years) and ATRA, without or with gemtuzumab ozogamicin (3 mg/m2 administered intravenously on day 1 of induction cycles 1 and 2, and consolidation cycle 1). The primary endpoints were short-term event-free survival and overall survival in the intention-to-treat population (overall survival was added as a co-primary endpoint after amendment four of the protocol on Oct 13, 2013). The secondary endpoints were event-free survival with long-term follow-up, rates of complete remission, complete remission with partial haematological recovery (CRh), and complete remission with incomplete haematological recovery (CRi), cumulative incidences of relapse and death, and number of days in hospital. This trial is registered with ClinicalTrials.gov (NCT00893399) and has been completed. FINDINGS Between May 12, 2010, and Sept 1, 2017, 600 participants were enrolled, of which 588 (315 women and 273 men) were randomly assigned (296 to the standard group and 292 to the gemtuzumab ozogamicin group). No difference was found in short-term event-free survival (short-term event-free survival at 6-month follow-up, 53% [95% CI 47-59] in the standard group and 58% [53-64] in the gemtuzumab ozogamicin group; hazard ratio [HR] 0·83; 95% CI 0·65-1·04; p=0·10) and overall survival between treatment groups (2-year overall survival, 69% [63-74] in the standard group and 73% [68-78] in the gemtuzumab ozogamicin group; 0·90; 0·70-1·16; p=0·43). There was no difference in complete remission or CRi rates (n=267 [90%] in the standard group vs n=251 [86%] in the gemtuzumab ozogamicin group; odds ratio [OR] 0·67; 95% CI 0·40-1·11; p=0·15) and complete remission or CRh rates (n=214 [72%] vs n=195 [67%]; OR 0·77; 0·54-1·10; p=0·18), whereas the complete remission rate was lower with gemtuzumab ozogamicin (n=172 [58%] vs n=136 [47%]; OR 0·63; 0·45-0·80; p=0·0068). Cumulative incidence of relapse was significantly reduced by gemtuzumab ozogamicin (2-year cumulative incidence of relapse, 37% [95% CI 31-43] in the standard group and 25% [20-30] in the gemtuzumab ozogamicin group; cause-specific HR 0·65; 0·49-0·86; p=0·0028), and there was no difference in the cumulative incidence of death (2-year cumulative incidence of death 6% [4-10] in the standard group and 7% [5-11] in the gemtuzumab ozogamicin group; HR 1·03; 0·59-1·81; p=0·91). There were no differences in the number of days in hospital across all cycles between treatment groups. The most common treatment-related grade 3-4 adverse events were febrile neutropenia (n=135 [47%] in the gemtuzumab ozogamicin group vs n=122 [41%] in the standard group), thrombocytopenia (n=261 [90%] vs n=265 [90%]), pneumonia (n=71 [25%] vs n=64 [22%]), sepsis (n=85 [29%] vs n=73 [25%]). Treatment-related deaths were documented in 25 participants (4%; n=8 [3%] in the standard group and n=17 [6%] in the gemtuzumab ozogamicin group), mostly due to sepsis and infections. INTERPRETATION The primary endpoints of the trial of event-free survival and overall survival were not met. However, an anti-leukaemic efficacy of gemtuzumab ozogamicin in participants with NPM1-mutated acute myeloid leukaemia is shown by a significantly lower cumulative incidence of relapse rate, suggesting that the addition of gemtuzumab ozogamicin might reduce the need for salvage therapy in these participants. The results from this study provide further evidence that gemtuzumab ozogamicin should be added in the standard of care treatment in adults with NPM1-mutated acute myeloid leukaemia. FUNDING Pfizer and Amgen.
Collapse
Affiliation(s)
- Hartmut Döhner
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany.
| | - Daniela Weber
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Julia Krzykalla
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Walter Fiedler
- Hubertus Wald University Cancer Center, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael W M Kühn
- Department of Hematology, Medical Oncology & Pneumology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Schroeder
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Karin Mayer
- Department of Hematology, Oncology, University Hospital Bonn, Bonn, Germany
| | - Michael Lübbert
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mohammed Wattad
- Klinik für Hämatologie, Internistische Onkologie & Stammzelltransplantation, Evang. Krankenhaus Essen-Werden, Essen-Werden, Germany; Klinikum Hochsauerland, Meschede, Germany
| | - Katharina Götze
- Department of Medicine III, Hematology and Medical Oncology, Technical University of Munich, Munich, Germany
| | - Lars Fransecky
- Department of Internal Medicine II, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Elisabeth Koller
- Department of Internal Medicine III, Hanusch Krankenhaus Wien, Wien, Austria
| | - Gerald Wulf
- Department of Hematology and Medical Oncology, University Medicine Göttingen, Göttingen, Germany
| | - Jan Schleicher
- Klinik für Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Klinikum Stuttgart, Stuttgart, Germany
| | - Mark Ringhoffer
- Department of Internal Medicine III, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Richard Greil
- 3rd Medical Department Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute Center for Clinical Trials and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - Bernd Hertenstein
- Department of Hematology and Oncology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Jürgen Krauter
- Medizinische Klinik III, Städtisches Klinikum Braunschweig, Braunschweig, Germany
| | - Uwe M Martens
- Klinik für Innere Medizin III, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | - David Nachbaur
- Universitätsklinik für Innere Medizin V, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Maisun Abu Samra
- Medizinische Klinik IV, Universitätsklinikum Gießen, Gießen, Germany
| | | | - Nadezda Basara
- Medizinische Klinik I, Malteser Krankenhaus St Franziskus-Hospital Flensburg, Flensburg, Germany
| | - Claudia Leis
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Anika Schrade
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | | | - Sibylle Cocciardi
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Lars Bullinger
- Department of Hematology, Oncology and Cancer Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin, Germany
| | - Felicitas Thol
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Peter Paschka
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Verena I Gaidzik
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Maral Saadati
- Freelance Statistician, Saadati Solutions, Ladenburg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Richard F Schlenk
- National Center of Tumor Diseases, German Cancer Research Center, Heidelberg, Germany; Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| |
Collapse
|
3
|
Gaidzik VI, Paschka P, Schlenk RF, Weber D, Fröhling S, Krämer A, Wäsch R, Westermann J, Mayer K, de Wit M, Fiedler W, Benner A, Heuser M, Thol F, Döhner K, Ganser A, Döhner H. Palbociclib in Acute Leukemias With KMT2A-rearrangement: Results of AMLSG 23-14 Trial. Hemasphere 2023; 7:e877. [PMID: 37101762 PMCID: PMC10125418 DOI: 10.1097/hs9.0000000000000877] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/15/2023] [Indexed: 04/28/2023] Open
Affiliation(s)
- Verena I. Gaidzik
- Universitätsklinikum Ulm, Klinik für Innere Medizin III, Ulm, Germany
| | - Peter Paschka
- Universitätsklinikum Ulm, Klinik für Innere Medizin III, Ulm, Germany
- Klinikum der Stadt Ludwigshafen, Klinik für Innere Medizin, Hämato-Onkologie, Nephrologie Infektiologie und Rheumatologie, Ludwigshafen am Rhein, Germany
| | - Richard F. Schlenk
- Universitätsklinikum Heidelberg, Klinik für Hämatologie, Onkologie, Rheumatologie, Heidelberg, Germany
| | - Daniela Weber
- Universitätsklinikum Ulm, Klinik für Innere Medizin III, Ulm, Germany
| | - Stefan Fröhling
- Deutsches Krebsforschungszentrum (DKFZ)/Nationales Centrum für Tumorerkrankungen (NCT) Translationale Medizinische Onkologie, Heidelberg, Germany
| | - Alwin Krämer
- Universitätsklinikum Heidelberg, Klinik für Hämatologie, Onkologie, Rheumatologie, Heidelberg, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Klinische Kooperationseinheit Molekulare Hämatologie/Onkologie, Heidelberg, Germany
| | - Ralph Wäsch
- Universitätsklinikum Freiburg, Klinik für Innere Medizin I, Freiburg, Germany
| | - Jörg Westermann
- Charité-Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie | Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - Karin Mayer
- Universitätsklinikum Bonn, Medizinische Klinik III für Hämatologie-Onkologie, Bonn, Germany
| | - Maike de Wit
- Vivantes Klinikum Neukölln, Innere Medizin - Hämatologie, Onkologie und Palliativmedizin, Berlin, Germany
| | - Walter Fiedler
- Universitätsklinikum Hamburg-Eppendorf, II. Medizinische Klinik und Poliklinik (Onkologie, Hämatologie, Knochenmarktransplantation mit Abteilung für Pneumologie), Hamburg, Germany
| | - Axel Benner
- Deutsches Krebsforschungszentrum (DKFZ), Abteilung Biostatistik, Heidelberg, Germany
| | - Michael Heuser
- Medizinische Hochschule Hannover, Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Hannover, Germany
| | - Felicitas Thol
- Medizinische Hochschule Hannover, Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Hannover, Germany
| | - Konstanze Döhner
- Universitätsklinikum Ulm, Klinik für Innere Medizin III, Ulm, Germany
| | - Arnold Ganser
- Medizinische Hochschule Hannover, Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Hannover, Germany
| | - Hartmut Döhner
- Universitätsklinikum Ulm, Klinik für Innere Medizin III, Ulm, Germany
| |
Collapse
|
4
|
Rauca V, Iuliano C, Mayer K, Kaesler S, Biedermann T. 487 Mast cells alter the invasive properties of melanoma cells in vitro. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
5
|
Platzbecker U, Götze KS, Kiewe P, Germing U, Mayer K, Radsak M, Wolff T, Chromik J, Sockel K, Oelschlägel U, Haase D, Illmer T, Al-Ali HK, Silling G, Reynolds JG, Zhang X, Attie KM, Shetty JK, Giagounidis A. Long-Term Efficacy and Safety of Luspatercept for Anemia Treatment in Patients With Lower-Risk Myelodysplastic Syndromes: The Phase II PACE-MDS Study. J Clin Oncol 2022; 40:3800-3807. [PMID: 35998303 PMCID: PMC9671752 DOI: 10.1200/jco.21.02476] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 12/24/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.Luspatercept has high clinical activity in patients with transfusion-dependent lower-risk myelodysplastic syndromes (LR-MDS) and ring sideroblasts (RS) relapsed or refractory to erythropoietin. We report long-term luspatercept safety and efficacy in 108 patients with LR-MDS in the PACE-MDS study, including 44 non-RS and 34 non-transfusion-dependent or previously untreated patients. The primary end point was safety. Secondary end points included rates of hematologic improvement (HI) erythroid (HI-E), HI neutrophil, and HI platelet. Exploratory end points included erythropoiesis biomarker quantitation and mutation data. Median duration of luspatercept exposure was 315 days (range, 21-1,934 days). No new safety signals emerged. HI-E was observed in 53.7% of patients, including 36.4% of non-RS and 70.6% of non-transfusion-dependent patients. HI neutrophil and HI platelet were observed in 33.3% and 9.5% of patients, respectively. An almost three-fold increase in bone marrow late to early progenitor cell ratio accompanied HI-E response, irrespective of RS status. Lower baseline erythropoietin levels in non-RS patients (69.6 v 623.3 IU/L; P = .0077) and higher late to early erythroid progenitor cell ratio (10.44 v 4.48; P = .0106) in RS patients were associated with HI-E. This study highlights luspatercept's effects across LR-MDS subtypes, including untreated MDS-RS, serving as a platform for future trials.
Collapse
Affiliation(s)
- Uwe Platzbecker
- Department of Hematology, Cellular Therapy and Hemostaseology, Leipzig University Hospital, Leipzig, Germany,Uwe Platzbecker, MD, Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, Leipzig University Hospital, Johannisallee 32 A, 04103 Leipzig, Germany; e-mail:
| | - Katharina S. Götze
- Department of Medicine III, Hematology and Medical Oncology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Philipp Kiewe
- Onkologischer Schwerpunkt am Oskar-Helene-Heim, Berlin, Germany
| | | | - Karin Mayer
- Department of Internal Medicine III, University Hospital Bonn, Bonn, Germany
| | - Markus Radsak
- Johannes Gutenberg Universität Mainz, Mainz, Germany
| | | | - Joerg Chromik
- Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt/Main, Germany
| | - Katja Sockel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Uta Oelschlägel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Detlef Haase
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Haifa Kathrin Al-Ali
- Department of Hematology/Oncology, University Hospital Halle, Halle, Germany,Krukenberg Cancer Center Halle, University Hospital Halle, Halle, Germany
| | - Gerda Silling
- Department of Hematology and Oncology, University of Aachen, Aachen, Germany
| | | | | | | | - Jeevan K. Shetty
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | | |
Collapse
|
6
|
Lahu S, Presch A, Ndrepepa G, Bernlochner I, Joner M, Xhepa E, Kufner S, Sager HB, Mayer K, Kessler T, Laugwitz KL, Schunkert H, Neumann FJ, Kastrati A, Cassese S. Ticagrelor or prasugrel in patients with acute coronary syndrome and high bleeding risk. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1384] [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: 11/13/2022] Open
Abstract
Abstract
Background
The relative efficacy and safety of more potent P2Y12 inhibitors in patients with acute coronary syndrome (ACS) and high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) remains unclear.
Purpose
To study the treatment effect of ticagrelor and prasugrel in PCI patients presenting with ACS and HBR.
Methods
This post-hoc analysis of the ISAR-REACT 5 trial included patients with ACS undergoing PCI, randomized to ticagrelor or prasugrel, in whom HBR was defined as per Academic Research Consortium criteria. The primary (efficacy) endpoint was the composite of all-cause death, myocardial infarction, or stroke. The secondary (safety) endpoint was Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Outcomes were assessed 12 months after randomisation.
Results
Out of the 3,239 patients included in this analysis, 486 fulfilled the criteria for ARC-HBR definition (HBR group; ticagrelor, n=230 and prasugrel, n=256), whilst 2,753 did not (non-HBR group; ticagrelor, n=1,375 and prasugrel, n=1,378). Compared to the non-HBR group, the HBR group had a higher risk for the primary (hazard ratio [HR]=3.57, 95% confidence interval [CI], 2.79–4.57, p<0.001), and secondary endpoint (HR=2.94 [2.17–3.99], p<0.001). In the HBR group, the primary (HR=1.09; [0.73–1.62]) and secondary (HR=1.18 [0.67–2.08]) endpoints were not statistically different between patients assigned to ticagrelor and prasugrel. In the non-HBR group, the primary endpoint (HR=1.62 [1.19–2.20]) occurred more frequently in patients assigned to ticagrelor as compared to patients assigned to prasugrel, without difference in safety (HR=1.08 [0.74–1.58]). There was no treatment allocation-by-HBR status interaction with respect to the primary (p for interaction = 0.123), or secondary (p for interaction = 0.803) endpoints.
Conclusions
In patients with ACS undergoing PCI, HBR status increased both ischemic and bleeding risks without significant impact on the relative efficacy or safety of ticagrelor versus prasugrel. These results warrant confirmation in larger cohorts.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research (DZHK)Deutsches Herzzentrum München
Collapse
Affiliation(s)
- S Lahu
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - A Presch
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - G Ndrepepa
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - I Bernlochner
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik Innere Medizin I , Munich , Germany
| | - M Joner
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - E Xhepa
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - S Kufner
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - H B Sager
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - K Mayer
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - T Kessler
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - K L Laugwitz
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik Innere Medizin I , Munich , Germany
| | - H Schunkert
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology II , Bad Krozingen , Germany
| | - A Kastrati
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - S Cassese
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| |
Collapse
|
7
|
Scalamogna M, Lahu S, Ndrepepa G, Mayer K, Gewalt S, Menichelli M, Bernlochner I, Joner M, Xhepa E, Kufner S, Laugwitz KL, Neumann FJ, Schunkert H, Kastrati A, Cassese S. Ticagrelor or prasugrel in patients with acute coronary syndrome and prior myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1400] [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: 11/12/2022] Open
Abstract
Abstract
Objectives
To investigate the efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndrome (ACS) and prior myocardial infarction (MI).
Background
The efficacy and safety of ticagrelor versus prasugrel in ACS patients with prior MI remains unstudied.
Methods
Patients with ACS scheduled for an invasive strategy and randomized to ticagrelor or prasugrel in the ISAR-REACT 5 trial with available information concerning prior MI were included in the present analysis. The primary endpoint was the composite of all-cause death, myocardial infarction, or stroke; the secondary endpoint was Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Endpoints were assessed 12 months after randomization.
Results
A total of 4,015 patients were included in this analysis (prior MI= 631 patients; no prior MI = 3,384 patients). As compared to patients without prior MI, the primary endpoint occurred more frequently in patients with prior MI (12.6% vs. 7.2%; hazard ratio [HR] = 1.78, 95% confidence interval [CI] 1.38–2.29; p= <0.001) without significant difference in terms of secondary endpoint between groups (5.8% vs. 5.7%; HR=1.02 [0.71–1.45]; p=0.921). Patients with prior MI randomized to ticagrelor versus prasugrel displayed higher risk for primary (HR=1.62 [1.03–2.55]) but not secondary endpoint (HR=1.28 [0.56–2.91]). Patients without prior MI randomized to ticagrelor or prasugrel displayed no significant difference in terms of primary (HR=1.28 [0.99–1.65]) or secondary endpoints (HR=1.13 [0.82–1.55]). There was no treatment assignment-by-prior MI status interaction with respect to the primary (p for interaction = 0.373) and the secondary (p for interaction= 0.786) endpoints.
Conclusions
Patients with ACS and prior MI are at higher risk for recurrent ischemic but not bleeding events. The history of MI does not affect the relative efficacy and safety of ticagrelor versus prasugrel in patients with ACS.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research (DZHK)Deutsches Herzzentrum München
Collapse
Affiliation(s)
- M Scalamogna
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - S Lahu
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - G Ndrepepa
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - K Mayer
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - S Gewalt
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | | | - I Bernlochner
- Hospital right the Isar, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - M Joner
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - E Xhepa
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - S Kufner
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - K L Laugwitz
- Hospital right the Isar, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen , Bad Krozingen , Germany
| | - H Schunkert
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - A Kastrati
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - S Cassese
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| |
Collapse
|
8
|
Varga Z, Wallenius M, Krachler M, Rauff-Nisthar N, Fongaro L, Knott A, Nicholl A, Mayer K. Trends and perspectives in Nuclear Forensic Science. Trends Analyt Chem 2022. [DOI: 10.1016/j.trac.2021.116503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
9
|
Fredericksen RJ, Whitney BM, Trejo E, Nance RM, Fitzsimmons E, Altice FL, Carrico AW, Cleland CM, Del Rio C, Duerr A, El-Sadr WM, Kahana S, Kuo I, Mayer K, Mehta S, Ouellet LJ, Quan VM, Rich J, Seal DW, Springer S, Taxman F, Wechsberg W, Crane HM, Delaney JAC. Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort. BMC Public Health 2021; 21:2002. [PMID: 34736425 PMCID: PMC8567631 DOI: 10.1186/s12889-021-12026-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We analyzed the association between substance use (SU) and condomless sex (CS) among HIV-negative adults reporting heterosexual sex in the Seek, Test, Treat, and Retain (STTR) consortium. We describe the impact of SU as well as person/partner and context-related factors on CS, identifying combinations of factors that indicate the highest likelihood of CS. METHODS We analyzed data from four US-based STTR studies to examine the effect of SU on CS using two SU exposures: 1) recent SU (within 3 months) and 2) SU before/during sex. Behavioral data were collected via 1:1 or self-administered computerized interviews. Adjusted individual-study, multivariable relative risk regression was used to examine the relationship between CS and SU. We also examined interactions with type of sex and partner HIV status. Pooled effect estimates were calculated using traditional fixed-effects meta-analysis. We analyzed data for recent SU (n = 6781; 82% men, median age = 33 years) and SU before/during sex (n = 2915; 69% men, median age = 40 years). RESULTS For both exposure classifications, any SU other than cannabis increased the likelihood of CS relative to non-SU (8-16%, p-values< 0.001). In the recent SU group, however, polysubstance use did not increase the likelihood of CS compared to single-substance use. Cannabis use did not increase the likelihood of CS, regardless of frequency of use. Type of sex was associated with CS; those reporting vaginal and anal sex had a higher likelihood of CS compared to vaginal sex only for both exposure classifications (18-21%, p < 0.001). Recent SU increased likelihood of CS among those reporting vaginal sex only (9-10%, p < 0.001); results were similar for those reporting vaginal and anal sex (5-8%, p < 0.01). SU before/during sex increased the likelihood of CS among those reporting vaginal sex only (20%; p < 0.001) and among those reporting vaginal and anal sex (7%; p = 0.002). Single- and poly-SU before/during sex increased the likelihood of CS for those with exclusively HIV-negative partners (7-8%, p ≤ 0.02), and for those reporting HIV-negative and HIV-status unknown partners (9-13%, p ≤ 0.03). CONCLUSION Except for cannabis, any SU increased the likelihood of CS. CS was associated with having perceived HIV-negative partners and with having had both anal/vaginal sex.
Collapse
Affiliation(s)
- R. J. Fredericksen
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - B. M. Whitney
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - E. Trejo
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - R. M. Nance
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - E. Fitzsimmons
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - F. L. Altice
- Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510-2283 USA
| | - A. W. Carrico
- Division of Prevention Science and Community Health, University of Miami, 1120 NW 14th St, Miami, FL 33136 USA
| | - C. M. Cleland
- Center for Drug Use and HIV Research, NYU School of Global Public Health, 665 Broadway, 11th Floor, New York, NY 10012 USA
| | - C. Del Rio
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE Room 7011, Atlanta, GA 30322 USA
| | - A. Duerr
- Fred Hutchinson Cancer Research Center, HIV Vaccine Trials Network, Box 358080 (LE 500), Seattle, WA 98109 USA
| | - W. M. El-Sadr
- Mailman School of Public Health, Columbia University, 722 West 168th Street, 13th floor, New York, NY 10032 USA
| | - S. Kahana
- National Institute on Drug Abuse, 6001 Executive Blvd, Rockville, Maryland 20852 USA
| | - I. Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC 20052 USA
| | - K. Mayer
- The Fenway Institute, 1340 Boylston Street, Boston, MA 02215 USA
| | - S. Mehta
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - L. J. Ouellet
- School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL USA
| | - V. M. Quan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - J. Rich
- Center for Prisoner Health and Human Rights, Immunology Center, The Miriam Hospital, Warren Alpert Medical School, Brown University, 1125 North Main St, Providence, RI 02904 USA
| | - D. W. Seal
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, Suite 2200, New Orleans, LA 70112 USA
| | - S. Springer
- Department of Internal Medicine, School of Medicine, Yale University, 135 College Street, New Haven, CT 06510 USA
| | - F. Taxman
- Center for Advancing Correctional Excellence, Institute of Biohealth Innovation, George Mason University, 4461 Rockfish Creek Lane, Fairfax, VA 22030 USA
| | - W. Wechsberg
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599 USA
| | - H. M. Crane
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - J. A. C. Delaney
- College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Avenue, Winnipeg, Manitoba R3E 0T5 Canada
| |
Collapse
|
10
|
Lahu S, Ndrepepa G, Gewalt S, Schuepke S, Bernlochner I, Aytekin A, Neumann FJ, Menichelli M, Richardt G, Laugwitz KL, Schunkert H, Kastrati A, Mayer K. Efficacy and safety of ticagrelor versus prasugrel in smokers and nonsmokers with acute coronary syndromes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1432] [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: 11/14/2022] Open
Abstract
Abstract
Background
The efficacy and safety of ticagrelor versus prasugrel according to smoking status in patients with acute coronary syndromes (ACS) are not known.
Purpose
The aim of this study was to assess the efficacy and safety of ticagrelor versus prasugrel according to smoking status in patients with ACS undergoing invasive evaluation.
Methods
This pre-specified analysis of the ISAR-REACT 5 trial included 1349 smokers and 2652 nonsmokers randomised to receive ticagrelor or prasugrel. The primary endpoint was the incidence of death, myocardial infarction, or stroke; the secondary endpoint was the incidence of Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Both endpoints were assessed at 12 months after randomisation.
Results
There was no significant treatment arm-by-smoking status interaction regarding the efficacy outcome. The primary endpoint occurred in 47 patients (7.0%) in the ticagrelor group and 41 patients (6.2%) in the prasugrel group in smokers (hazard ratio [HR]=1.15; 95% confidence interval [CI] 0.76–1.75; P=0.510) and in 133 patients (10.2%) in the ticagrelor group and 94 patients (7.2%) in the prasugrel group in nonsmokers (HR=1.44 [1.10–1.87], P=0.007; Pint=0.378). The secondary endpoint occurred in 27 patients (4.6%) in the ticagrelor group and 33 patients (5.6%) in the prasugrel group in smokers (HR=0.81 [0.49–1.35]; P=0.412) and in 66 patients (6.0%) in the ticagrelor group and 46 patients (4.4%) in the prasugrel group in nonsmokers (HR=1.38 [0.94–2.01]; P=0.097).
Conlusions
Although there was no significant interaction between smoking and treatment effect, the present findings suggest a greater advantage of prasugrel over ticagrelor in nonsmoker vs. smoker patients with ACS.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Centre for Cardiovascular Research;Deutsches Herzzentrum München, Germany
Collapse
Affiliation(s)
- S Lahu
- German Heart Centre Munich, Munich, Germany
| | - G Ndrepepa
- German Heart Centre Munich, Munich, Germany
| | - S Gewalt
- German Heart Centre Munich, Munich, Germany
| | - S Schuepke
- German Heart Centre Munich, Munich, Germany
| | - I Bernlochner
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik Innere Medizin I, Munich, Germany
| | - A Aytekin
- German Heart Centre Munich, Munich, Germany
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology II, Bad Krozingen, Germany
| | - M Menichelli
- Hospital Fabrizio Spaziani, Cardiology, Frosinone, Italy
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - K L Laugwitz
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik Innere Medizin I, Munich, Germany
| | | | - A Kastrati
- German Heart Centre Munich, Munich, Germany
| | - K Mayer
- German Heart Centre Munich, Munich, Germany
| |
Collapse
|
11
|
Wohrle J, Seeger J, Lahr S, Mayer K, Bernlochner I, Gewalt S, Hochholzer W, Hemetsberger R, Hapfelmeier A, Sager H, Joner M, Richardt G, Neumann FJ, Schunkert H, Kastrati A. Ticagrelor or prasugrel in patients with acute coronary syndrome in relation to glomerular filtration rate. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1421] [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: 11/14/2022] Open
Abstract
Abstract
Objectives
The aim of this study was to assess the safety and efficacy of ticagrelor versus prasugrel for patients with acute coronary syndrome (ACS) according to their glomerular filtration rate (GFR).
Background
The outcomes of ticagrelor versus prasugrel in patients with ACS according to GFR have not been defined.
Methods
Patients (n=3985) with GFR available were categorized in three groups according to the tertiles of GFR. The primary endpoint was a composite of all-cause death, myocardial infarction and stroke at 1 year.
Results
The primary endpoint occurred significantly more often in patients with low GFR compared to high GFR as well as in patients with low GFR compared to intermediate GFR (picture 1). Patients in the lowest GFR group had significantly higher ischemic and bleeding risks than patients in the intermediate (hazard ratio [HR] 1.93 and 1.68) or high GFR groups (HR 3.52 and 2.96). In the group with low GFR, the primary endpoint occurred in 103 of 677 ticagrelor patients (15.4%) and in 72 of 652 prasugrel patients (11.2%; (HR=1.45, [1.07–1.96], p=.016, picture 2). In addition, each single component of the primary endpoint and stent thrombosis were numerically lower with prasugrel compared with ticagrelor. Occurrence of myocardial infarction was 3.7% with prasugrel compared to 6.6% with ticagrelor (p=0.019). BARC 3–5 bleeding events were similar with ticagrelor and prasugrel (8.8% versus 7.1%, p=0.278). In the intermediate and high GFR group the primary endpoint and bleeding events were similar between prasugrel and ticagrelor.
Conclusions
The incidence of a composite endpoint (all-cause death, myocardial infarction or stroke) occurred less frequently in patients who received prasugrel compared to patients who received ticagrelor in the low GFR population, whereas rate of bleeding events was similar.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Supported by a grant (FKZ 81X1600501) from the German Center for Cardiovascular Research and the Deutsches Herzzentrum München, Germany. Primary endpoint according to GFRLow GFR: Prasugrel versus Ticagrelor
Collapse
Affiliation(s)
- J Wohrle
- Medical Campus Lake Constance, Friedrichshafen, Germany
| | - J Seeger
- Medical Campus Lake Constance, Friedrichshafen, Germany
| | - S Lahr
- German Heart Centre Munich, Munich, Germany
| | - K Mayer
- German Heart Centre Munich, Munich, Germany
| | | | - S Gewalt
- German Heart Centre Munich, Munich, Germany
| | - W Hochholzer
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | | | - H Sager
- German Heart Centre Munich, Munich, Germany
| | - M Joner
- German Heart Centre Munich, Munich, Germany
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - A Kastrati
- German Heart Centre Munich, Munich, Germany
| | | |
Collapse
|
12
|
Lahu S, Behnes M, Ndrepepa G, Neumann FJ, Sibbing D, Bernlochner I, Menichelli M, Mayer K, Richardt G, Angiolillo DJ, Laugwitz KL, Schunkert H, Schuepke S, Kastrati A, Akin I. Body mass index and efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndromes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1431] [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: 11/14/2022] Open
Abstract
Abstract
Background
The efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndromes (ACS) according to body mass index (BMI) remain unknown.
Purpose
To assess the efficacy and safety of ticagrelor versus prasugrel in patients with ACS according to BMI.
Methods
This post-hoc analysis of the ISAR-REACT 5 trial included 3987 patients with BMI data available. BMI was grouped in 3 categories: low (BMI<25 kg/m2, n=1084), intermediate (BMI ≥25 to <30 kg/m2, n=1890) and high (BMI≥30 kg/m2, n=1013). The primary endpoint was the 12-month incidence of all-cause death, myocardial infarction, or stroke. The secondary endpoint was the 12-month incidence of Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding.
Results
There was no significant treatment arm-by-BMI interaction regarding the primary endpoint (Pint=0.578). However, the primary endpoint occurred in 63 patients assigned to ticagrelor and 39 patients assigned to prasugrel in the low BMI group (11.7% vs. 7.5%; hazard ratio [HR]=1.62; 95% confidence interval [CI], 1.09–2.42; P=0.018), 78 patients assigned to ticagrelor and 58 patients assigned to prasugrel in the intermediate BMI group (8.3% vs. 6.2%; HR=1.36 [0.97–1.91]; P=0.076), and 43 patients assigned to ticagrelor and 37 patients assigned to prasugrel in the high BMI group (8.6% vs. 7.3%; HR=1.18 [0.76–1.84]; P=0.451). BARC type 3 to 5 bleeding events did not differ between ticagrelor and prasugrel in patients with low (6.5% vs. 6.6%), intermediate (5.6% vs. 5.0%), or high (4.4% vs. 2.8%) BMI.
Conclusions
BMI of patients with ACS did not impact significantly on the treatment effect of ticagrelor vs. prasugrel in terms of both efficacy and safety.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research;Deutsches Herzzentrum München, Germany
Collapse
Affiliation(s)
- S Lahu
- German Heart Centre Munich, Munich, Germany
| | - M Behnes
- University Medical Centre of Mannheim, First Department of Medicine, Mannheim, Germany
| | - G Ndrepepa
- German Heart Centre Munich, Munich, Germany
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology II, Bad Krozingen, Germany
| | - D Sibbing
- Ludwig Maximilians University Hospital, Munich, Germany
| | - I Bernlochner
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik Innere Medizin I, Munich, Germany
| | - M Menichelli
- Hospital Fabrizio Spaziani, Cardiology, Frosinone, Italy
| | - K Mayer
- German Heart Centre Munich, Munich, Germany
| | - G Richardt
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - D J Angiolillo
- University of Florida College of Medicine, Jacksonville, United States of America
| | - K L Laugwitz
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik Innere Medizin I, Munich, Germany
| | | | - S Schuepke
- German Heart Centre Munich, Munich, Germany
| | - A Kastrati
- German Heart Centre Munich, Munich, Germany
| | - I Akin
- University Medical Centre of Mannheim, First Department of Medicine, Mannheim, Germany
| |
Collapse
|
13
|
Kovacs B, Burri H, Reek S, Sticherling C, Linka A, Ammann P, Mueller A, Kobza R, Haegeli L, Mayer K, Eriksson U, Reichlin T, Steffel J, Saguner A, Duru F. High incidence of inappropriate alarms in patients with wearable cardioverter-defibrillators: findings from the swiss WCD registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0668] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
The wearable cardioverter defibrillator (WCD) uses surface electrodes built into the vest to detect underlying arrhythmia before initiating a treatment sequence. However, it is also prone to inappropriate detection due to artefacts.
Purpose
The aim of this study was to assess the alarm burden in patients and its possible impact on clinical outcomes.
Methods
The Swiss WCD Registry is a nationwide, retrospective, observational registry. Patients were included from December 2011 until February 2018. Clinical characteristics and data from the WCDs, including alarm burden were analysed. Recordings ≥30 seconds of length were analysed and categorized as VT/VF, atrial fibrillation (AF), supraventricular tachycardia or artefact.
Results
A total of 10'653 device alarms were documented in 324 of 456 patients (71.1%) over a mean WCD wear-time of 2.0±1.6 months. Among these, the episode duration was 30 seconds or more in 2996 (28.2%). One hundred and eleven (3.7%) were VT/VF episodes. The remaining recordings were inappropriate arrhythmia detections (2736 (91%) due to artefacts; 117 (3.7%) AF; 48 (1.6%) supraventricular tachycardia). Two-hundred and seven patients (45.0%) had 3 or more alarms per month, whereas 49 patients (10.7%) had 1 or more alarms per day. Body mass index (BMI) was significantly higher in patients with 3 or more alarms per month (p=0.002, 25.6 vs. 27.3 kg/m2) High alarm burden was not associated with a lower average daily wear time (20.8 hours vs 20.7 hours, p=0.785) or a decreased implantable cardioverter defibrillator implantation rate after stopping WCD use (48% vs 47.3%, p=0.156).
Conclusions
In patients using WCDs, alarms emitted by the device and impending inappropriate shocks were frequent and most commonly caused by artefacts. A high alarm burden did not lead to a decreased adherence, as determined by average daily wear-times. Obesity was significantly associated with a higher alarm burden.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- B Kovacs
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - H Burri
- University Hospital of Geneva, Cardiology, Geneva, Switzerland
| | - S Reek
- Hirslanden Medical Center, Cardiology, Aarau, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - A Linka
- Cantonal Hospital Winterthur, Cardiology, Winterthur, Switzerland
| | - P Ammann
- Cantonal Hospital St. Gallen, Cardiology, St. Gallen, Switzerland
| | - A.S Mueller
- Triemli Hospital, Cardiology, Zurich, Switzerland
| | - R Kobza
- Lucerne Cantonal Hospital, Cardiology, Lucerne, Switzerland
| | - L Haegeli
- Cantonal Hospital Aarau, Cardiology, Aarau, Switzerland
| | - K Mayer
- Cantonal Hospital Grison, Cardiology, Chur, Switzerland
| | - U Eriksson
- GZO Zurich Regional Health Center, Cardiology, Wetzikon, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Cardiology, Bern, Switzerland
| | - J Steffel
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - A.M Saguner
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - F Duru
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | | |
Collapse
|
14
|
Mayer K, Briese W, Blieninger J, Brossart P, Bisht S, Feldmann G. Development of Skin Rash Predicts Outcome of Anti-PD-1- and Anti-CTLA4-Based Immune Checkpoint Inhibitor Therapy in Non-Small Cell Lung Cancer or Squamous Cell Carcinoma of the Head and Neck: A Single-Center Analysis. Oncol Res Treat 2021; 44:538-546. [PMID: 34515189 DOI: 10.1159/000518449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/13/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We report the spectrum of immune-related adverse effects (irAEs) and outcome observed in a single-center cohort of 100 patients treated with immune checkpoint inhibitors in a routine clinical setting. METHODS Tumor entities included non-small cell lung cancer (n = 28), head and neck squamous cell carcinoma (n = 28), urothelial carcinoma (n = 7), and others (n = 37). RESULTS irAEs were documented in 49% of cases analyzed, and the most frequent manifestation consisted of immune-mediated skin rash (28%), colitis (9%), pneumonitis (8%), hypothyroidism (7%), or hepatitis (6%). Skin rash correlated with improved progression-free survival. CONCLUSION Development of immune-related skin rash was found to correlate with favorable outcome, suggesting its practical feasibility as a potential predictive surrogate marker.
Collapse
Affiliation(s)
- Karin Mayer
- Department of Internal Medicine 3, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Wibke Briese
- Department of Internal Medicine 3, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Johannes Blieninger
- Department of Internal Medicine 3, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Peter Brossart
- Department of Internal Medicine 3, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Savita Bisht
- Department of Internal Medicine 3, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Georg Feldmann
- Department of Internal Medicine 3, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| |
Collapse
|
15
|
Classen AY, Henze L, von Lilienfeld-Toal M, Maschmeyer G, Sandherr M, Graeff LD, Alakel N, Christopeit M, Krause SW, Mayer K, Neumann S, Cornely OA, Penack O, Weißinger F, Wolf HH, Vehreschild JJ. Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors: 2020 updated guidelines of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO/DGHO). Ann Hematol 2021; 100:1603-1620. [PMID: 33846857 PMCID: PMC8116237 DOI: 10.1007/s00277-021-04452-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/04/2021] [Indexed: 12/11/2022]
Abstract
Hematologic and oncologic patients with chemo- or immunotherapy-related immunosuppression are at substantial risk for bacterial infections and Pneumocystis jirovecii pneumonia (PcP). As bacterial resistances are increasing worldwide and new research reshapes our understanding of the interactions between the human host and bacterial commensals, administration of antibacterial prophylaxis has become a matter of discussion. This guideline constitutes an update of the 2013 published guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). It gives an overview about current strategies for antibacterial prophylaxis in cancer patients while taking into account the impact of antibacterial prophylaxis on the human microbiome and resistance development. Current literature published from January 2012 to August 2020 was searched and evidence-based recommendations were developed by an expert panel. All recommendations were discussed and approved in a consensus conference of the AGIHO prior to publication. As a result, we present a comprehensive update and extension of our guideline for antibacterial and PcP prophylaxis in cancer patients.
Collapse
Affiliation(s)
- Annika Y Classen
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Larissa Henze
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Marie von Lilienfeld-Toal
- Department of Hematology and Oncology, Clinic for Internal Medicine II, University Hospital Jena, Jena, Germany
| | - Georg Maschmeyer
- Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Michael Sandherr
- Specialist Clinic for Haematology and Oncology, Medical Care Center Penzberg, Penzberg, Germany
| | - Luisa Durán Graeff
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Nael Alakel
- Department I of Internal Medicine, Hematology and Oncology, University Hospital Dresden, Dresden, Germany
| | - Maximilian Christopeit
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Stefan W Krause
- Department of Medicine 5 - Hematology and Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Karin Mayer
- Medical Clinic III for Oncology, Hematology, Immunooncology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany
| | - Silke Neumann
- Interdisciplinary Center for Oncology, Wolfsburg, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Olaf Penack
- Medical Department for Hematology, Oncology and Tumor Immunology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Florian Weißinger
- Department for Internal Medicine, Hematology/Oncology, and Palliative Care, Evangelisches Klinikum Bethel v. Bodelschwinghsche Stiftungen Bethel, Bielefeld, Germany
| | - Hans-Heinrich Wolf
- Department IV of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Jörg Janne Vehreschild
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany.
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany.
| |
Collapse
|
16
|
Teich K, Krzykalla J, Kapp-Schwoerer S, Gaidzik VI, Schlenk RF, Paschka P, Weber D, Fiedler W, Kühn MWM, Schroeder T, Mayer K, Lübbert M, Ramachandran D, Benner A, Ganser A, Döhner H, Heuser M, Döhner K, Thol F. Cluster of differentiation 33 single nucleotide polymorphism rs12459419 is a predictive factor in patients with nucleophosmin1 mutated acute myeloid leukemia receiving gemtuzumab ozogamicin. Haematologica 2021; 106:2986-2989. [PMID: 34047179 PMCID: PMC8561276 DOI: 10.3324/haematol.2021.278894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Katrin Teich
- Department of Hematology, Hemostaseology, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover
| | - Julia Krzykalla
- Division of Biostatistics, German Cancer Research Center Heidelberg, Heidelberg
| | | | - Verena I Gaidzik
- Department of Internal Medicine III, University Hospital of Ulm, Ulm
| | - Richard F Schlenk
- Nationales Centrum für Tumorerkrankungen Trial Center, National Center of Tumor Diseases, German Cancer Research Center, Heidelberg; Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg
| | - Peter Paschka
- Department of Internal Medicine III, University Hospital of Ulm, Ulm
| | - Daniela Weber
- Department of Internal Medicine III, University Hospital of Ulm, Ulm
| | - Walter Fiedler
- Department of Internal Medicine II, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Michael W M Kühn
- Department of Hematology, Medical Oncology and Pneumology, University Medical Center Mainz, Mainz
| | - Thomas Schroeder
- Department of Hematology, Oncology, and Clinical Immunology, University of Düsseldorf, Medical Faculty, Düsseldorf
| | - Karin Mayer
- Internal Medicine III, University Hospital of Bonn, Bonn
| | - Michael Lübbert
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Faculty of Medicine, Freiburg
| | | | - Axel Benner
- Division of Biostatistics, German Cancer Research Center Heidelberg, Heidelberg
| | - Arnold Ganser
- Department of Hematology, Hemostaseology, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm
| | - Michael Heuser
- Department of Hematology, Hemostaseology, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm
| | - Felicitas Thol
- Department of Hematology, Hemostaseology, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover
| |
Collapse
|
17
|
Willimsky EK, Munzig A, Mayer K, Biskup S, Abicht A, Hoertnagel K, Voss HV, Klein HG, Rost I, Larsen LHG, Dahl HA, Hoelz H, Stuelpnagel CV, Borggraefe I. Next Generation Sequencing in Pediatric Epilepsy Using Customized Panels: Size Matters. Neuropediatrics 2021; 52:92-97. [PMID: 33086385 DOI: 10.1055/s-0040-1712488] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Next generation sequencing (NGS) with customized gene panels is a helpful tool to identify monogenic epilepsy syndromes. The number of genes tested within a customized panel may vary greatly. The aim of the present study was to compare the diagnostic yield of small (<25 kb) and large (>25 kb) customized epilepsy panels. METHODS This retrospective cohort study investigated data of 190 patients of 18 years or younger, with the diagnosis of an epilepsy of unknown etiology who underwent NGS using customized gene panels. Small (<25 kb) and large (>25 kb) panels were compared regarding the distribution of benign/likely benign and pathogenic/likely pathogenic variants and variants of unclear significance. In addition, differences of the diagnostic yield with respect to epilepsy severity, i.e., developmental and epileptic encephalopathy [DEE] vs. non-DEE, were analyzed. RESULTS The diagnostic yield defined as pathogenic or likely pathogenic variants in large panels was significantly increased (29% [n = 14/48] vs. 13% [n = 18/142], p = 0.0198) compared with smaller panels. In non-DEE patients the increase of the diagnostic yield in large panels was significant(35% n = 6/17 vs. 13% n = 12/94, p = 0.0378), which was not true for DEE patients. DISCUSSION This study indicates that large panels are superior for pediatric patients with epilepsy forms without encephalopathy (non-DEE). For patients suffering from DEE small panels of a maximum of 10 genes seem to be sufficient. The proportion of unclear findings increases with rising panel sizes. CONCLUSION Customized epilepsy panels of >25 kb compared with smaller panels show a significant higher diagnostic yield in patients with epilepsy especially in non-DEE patients.
Collapse
Affiliation(s)
- Eva-Katharina Willimsky
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics Department of Pediatrics, Ludwig-Maximilians University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Anna Munzig
- Center of Human Genetics and Laboratory Diagnostics, Martinsried, Germany
| | - Karin Mayer
- Center of Human Genetics and Laboratory Diagnostics, Martinsried, Germany
| | | | | | | | - Hubertus von Voss
- Center of Human Genetics and Laboratory Diagnostics, Martinsried, Germany
| | - Hanns-Georg Klein
- Center of Human Genetics and Laboratory Diagnostics, Martinsried, Germany
| | - Imma Rost
- Center of Human Genetics and Laboratory Diagnostics, Martinsried, Germany
| | | | | | - Hannes Hoelz
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics Department of Pediatrics, Ludwig-Maximilians University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Celina von Stuelpnagel
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics Department of Pediatrics, Ludwig-Maximilians University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany.,Paracelsus Medical University, Salzburg, Austria
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics Department of Pediatrics, Ludwig-Maximilians University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany.,Comprehensive Epilepsy Center (Pediatric section), Ludwig-Maximilians University of Munich, Munich, Germany
| |
Collapse
|
18
|
John S, Riessen R, Karagiannidis C, Janssens U, Busch HJ, Kochanek M, Michels G, Hermes C, Buerke M, Kluge S, Baumgärtel M, Braune S, Erbguth F, Fuhrmann V, Lebiedz P, Mayer K, Müller-Werdan U, Oppert M, Sayk F, Sedding D, Willam C, Werdan K. [Core curriculum Medical intensive care medicine of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN)]. Med Klin Intensivmed Notfmed 2021; 116:1-45. [PMID: 33427907 PMCID: PMC7799161 DOI: 10.1007/s00063-020-00765-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/25/2022]
Abstract
Medical intensive care medicine treats patients with severe, potentially life-threatening diseases covering the complete spectrum of internal medicine. The qualification in medical intensive care medicine requires a broad spectrum of knowledge and skills in medical intensive care medicine, but also in the general field of internal medicine. Both sides of the coin must be taken into account, the treatment with life-sustaining strategies of the acute illness of the patient and also the treatment of patient's underlying chronic diseases. The indispensable foundation of medical intensive care medicine as described in this curriculum includes basic knowledge and skills (level of competence I-III) as well as of behavior and attitudes. This curriculum is primarily dedicated to the internist in advanced training in medical intensive care medicine. However, this curriculum also intends to reach trainers in intensive care medicine and also the German physician chambers with their examiners, showing them which knowledge, skills as well as behavior and attitudes should be taught to trainees according to the education criteria of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN).
Collapse
Affiliation(s)
- S John
- Klinikum Nürnberg-Süd, Medizinische Klinik 8, Abteilung für Internistische Intensivmedizin, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - R Riessen
- Dept. für Innere Medizin, Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - C Karagiannidis
- ARDS und ECMO Zentrum Köln-Merheim, Professur für extrakorporale Lungenersatzverfahren der Universität Witten-Herdecke, Abteilung Pneumologie, Intensiv- und Beatmungsmedizin, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - M Kochanek
- Klinik I für Innere Medizin (Hämatologie und Onkologie), Schwerpunkt Internistische Intensivmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | | | - M Buerke
- Medizinische Klinik II, St. Marien-Krankenhaus Siegen, Siegen, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Baumgärtel
- Klinikum Nürnberg-Nord, Intensivstation 10/II, Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - S Braune
- IV. Med. Klinik - Internistische Intensivmedizin und Notaufnahme, Franziskus-Hospital Münster, Münster, Deutschland
| | - F Erbguth
- Klinikum Nürnberg, Universitätsklinik für Neurologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - V Fuhrmann
- Klinik für Innere Medizin I, Evangelisches Klinikum Niederrhein, Duisburg, Deutschland
| | - P Lebiedz
- Klinik für Innere Medizin und Internistische Intensivmedizin, Ev. Krankenhaus Oldenburg, Steinweg 13-17, Oldenburg, Deutschland
| | - K Mayer
- Medizinische Klinik 4, Pneumologie und Schlafmedizin, ViDia Kliniken, Karlsruhe, Deutschland
| | - U Müller-Werdan
- Klinik für Geriatrie und Altersmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Evangelisches Geriatriezentrum Berlin (EGZB), Berlin, Deutschland
| | - M Oppert
- Klinik für Notfall- und Intensivmedizin, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - F Sayk
- Campus Lübeck, Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - D Sedding
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland
| | - C Willam
- Universitätsklinikum Erlangen, Medizinische Klinik 4, Nephrologie und Hypertensiologie, Friedrich-Alexander-Universität Erlangen, Erlangen, Deutschland
| | - K Werdan
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
| |
Collapse
|
19
|
David S, Mayer K, Gray T, Patel D, Velasquez J, Kirby N. Conjugation of Polymer-Coated Gold Nanoparticles with Anti-EGFR Antibodies for Enhanced Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
20
|
Bongiovanni D, Mayer K, Schreiner N, Karschin V, Wustrow I, Gosetti R, Schuepke S, Schunkert H, Laugwitz K, Kastrati A, Bernlochner I. ADP-induced platelet aggregation in patients with acute coronary syndrome treated with prasugrel or ticagrelor. Results of the ISAR REACT 5 platelet aggregation substudy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1721] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
The recently published randomized multicenter open label ISAR REACT 5 trial showed that prasugrel was superior to ticagrelor with respect to the composite primary end point of death, myocardial infarction, or stroke at one year after randomization in patients with acute coronary syndrome with planned invasive evaluation. The reasons for this finding are speculative.
Purpose
The aim of this prespecified platelet aggregation substudy was to assess platelet aggregation induced by adenosine-diphosphate (ADP) in patients who received prasugrel or ticagrelor treatment and underwent PCI.
Methods
We assessed all patients who underwent PCI and who had valid ADP-induced platelet aggregation values at hospital admission and at 2–24 hours after administration of prasugrel or ticagrelor loading dose followed by maintenance dose. ADP-induced platelet aggregation values were measured using the Mulitplate Analyzer®. Patients were recruited in the German Heart Center, Munich, Germany or in Klinikum rechts der Isar, Munich, Germany, Technical University of Munich.
Results
A total of 608 patients were analyzed. Patients in the prasugrel group were slightly but significantly older than patients in the ticagrelor group (66,5 years versus 64,6 years, P=0,048). The remaining baseline characteristics did not significantly differ between the two treatment groups. ADP-induced platelet aggregation (median [IQR]) at baseline did not differ between prasgurel- and ticagrelor treated patients (809 [556; 1057] AU x min versus 797 [534–1095] AU x min. At 2–24 hours after study drug administration ADP-induced platelet aggregation was significantly lower in patients who had received prasugrel in comparison to ticagrelor (105 [57–176] AU x min versus 138 [77–207] AU x min (Figure 1).
Conclusion
ADP-induced platelet aggregation was significantly lower in patients who received prasugrel in comparison to patients who received ticagrelor, which could have influenced patients' outcome in the ISAR-REACT 5 trial.
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- D Bongiovanni
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| | - K Mayer
- Deutsches Herzzentrum Muenchen Technical University of Munich, Cardiology, Munich, Germany
| | - N Schreiner
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| | - V Karschin
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| | - I Wustrow
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| | - R Gosetti
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| | - S Schuepke
- Deutsches Herzzentrum Muenchen Technical University of Munich, Cardiology, Munich, Germany
| | - H Schunkert
- Deutsches Herzzentrum Muenchen Technical University of Munich, Cardiology, Munich, Germany
| | - K.L Laugwitz
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| | - A Kastrati
- Deutsches Herzzentrum Muenchen Technical University of Munich, Cardiology, Munich, Germany
| | - I Bernlochner
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| |
Collapse
|
21
|
Bongiovanni D, Mayer K, Schreiner N, Karschin V, Wustrow I, Gosetti R, Schunkert H, Laugwitz K, Schuepke S, Kastrati A, Bernlochner I. Immature platelet fraction is a strong predictor of adverse cardiovascular events in patients with acute coronary syndrome. Results of the ISAR-REACT 5 reticulated platelet substudy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1668] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Reticulated or immature Platelets are pro-thrombotic RNA-rich young platelets, which have been reported to correlate with adverse events in several pathological settings including coronary artery disease. However, the predictive value of this subgroup of platelets in patients with acute coronary syndrome treated with the potent novel P2Y12 inhibitors prasugrel or ticagrelor has not been investigated yet. Moreover, their role as predictors of major bleeding is unclear.
Purpose
The primary aim of this prespecified reticulated platelet ISAR-REACT-5 substudy was to evaluate the immature platelet fraction (IPF%) in peripheral blood as a predictor of the composite primary endpoint consisting of death, myocardial infarction, or stroke at one year after randomization in patients with acute coronary syndrome.
Methods
IPF was assessed in the first 24h after randomization using a fully automated system and correlated to the incidence of the primary endpoint. All patients with available IPF values were included. The Sysmex system uses two fluorescent dyes to stain platelet RNA and a computer algorithm (Sysmex IPF Master) discriminates immature from mature platelets by the intensity of forward scattered light and fluorescence. The immature platelet fraction is displayed as percentage of the total optical platelet count (IPF%).
Results
IPF values within the first 24h after randomization were available in a total of 506 randomized patients. Baseline characteristics and IPF (median [IQR]) values did not differ between the 2 study groups (IPF: prasugrel 3.9% [2.7–5.8] ticagrelor 3.4% [2.5–5.6] p=0.56). Significantly higher IPF values were observed in patients reaching the primary endpoint (n=55 of 506) independent from the study group (p for interaction= 0.28). ROC-curve analysis revealed a cut-of value of IPF 3.6% for the prediction of death, myocardial infarction or stroke with a Hazard ratio (HR) according to cox-regression analysis of 1.98 (95% CI, 1.15–3.44), P=0.01 (Figure 1A). Interestingly, we also detected a trend for higher major bleedings (BARC 3–5) in patients with elevated IPF values above IPF>4.8% according to ROC-curve analysis (Figure 1B).
Conclusion
IPF was significantly associated with the primary endpoint in the ISAR-REACT 5 substudy independent from the treatment group and therefore is a promising novel biomarker for the prediction of adverse cardiovascular events in patients with acute coronary syndrome.
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- D Bongiovanni
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| | - K Mayer
- Deutsches Herzzentrum Muenchen Technical University of Munich, Cardiology, Munich, Germany
| | - N Schreiner
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| | - V Karschin
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| | - I Wustrow
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| | - R Gosetti
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| | - H Schunkert
- Deutsches Herzzentrum Muenchen Technical University of Munich, Cardiology, Munich, Germany
| | - K.L Laugwitz
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| | - S Schuepke
- Deutsches Herzzentrum Muenchen Technical University of Munich, Cardiology, Munich, Germany
| | - A Kastrati
- Deutsches Herzzentrum Muenchen Technical University of Munich, Cardiology, Munich, Germany
| | - I Bernlochner
- Hospital Rechts der Isar, I. Medizinische Klinik und Poliklinik, Munich, Germany
| |
Collapse
|
22
|
Brunkhorst FM, Weigand MA, Pletz M, Gastmeier P, Lemmen SW, Meier-Hellmann A, Ragaller M, Weyland A, Marx G, Bucher M, Gerlach H, Salzberger B, Grabein B, Welte T, Werdan K, Kluge S, Bone HG, Putensen C, Rossaint R, Quintel M, Spies C, Weiß B, John S, Oppert M, Jörres A, Brenner T, Elke G, Gründling M, Mayer K, Weimann A, Felbinger TW, Axer H, Heller T, Gagelmann N. [S3 guideline sepsis-prevention, diagnosis, treatment, and aftercare : Summary of the strong recommendations]. Med Klin Intensivmed Notfmed 2020; 115:178-188. [PMID: 32185422 DOI: 10.1007/s00063-020-00671-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- F M Brunkhorst
- Zentrum für Klinische Studien, Integriertes Forschungs- und Behandlungszentrum (IFB) Sepsis und Sepsisfolgen, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Salvador-Allende-Platz 27, 07747, Jena, Deutschland.
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Pletz
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | - P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S W Lemmen
- Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - A Meier-Hellmann
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Helios-Klinikum Erfurt GmbH, Erfurt, Deutschland
| | - M Ragaller
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Dresden, Dresden, Deutschland
| | - A Weyland
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
| | - G Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinikum Aachen, Aachen, Deutschland
| | - M Bucher
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Halle, Halle, Deutschland
| | - H Gerlach
- Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - B Salzberger
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - B Grabein
- Stabsstelle Klinische Mikrobiologie und Krankenhaushygiene, Klinikum der Universität München, München, Deutschland
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III, Klinikum der MLU Halle-Wittenberg, Halle, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - H G Bone
- Zentrum für Anästhesiologie, Intensivmedizin und Schmerztherapie, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Deutschland
| | - C Putensen
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Rossaint
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - M Quintel
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - C Spies
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - B Weiß
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S John
- Klinik für Innere Medizin 8, Schwerpunkt Kardiologie, Klinikum Nürnberg, Nürnberg, Deutschland
| | - M Oppert
- Klinik für Notfall- und Internistische Intensivmedizin, Klinikum Ernst von Bergmann Potsdam, Potsdam, Deutschland
| | - A Jörres
- Medizinische Klinik I, Klinik für Nephrologie, Transplantationsmedizin und internistische Intensivmedizin, Krankenhaus Merheim, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
| | - T Brenner
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - G Elke
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Kiel, Kiel, Deutschland
| | - M Gründling
- Klinik für Anästhesiologie - Anästhesie, Intensiv‑, Notfall- und Schmerzmedizin, Universitätsklinikum Greifswald, Greifswald, Deutschland
| | - K Mayer
- Medizinische Klinik und Poliklinik II, Klinikum der Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - A Weimann
- Klinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum "St. Georg" Leipzig gGmbH, Leipzig, Deutschland
| | - T W Felbinger
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Städtisches Klinikum München, München, Deutschland
| | - H Axer
- Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - T Heller
- Universitätsklinikum Jena, Jena, Deutschland
| | - N Gagelmann
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| |
Collapse
|
23
|
Tutschek B, Mayer K, Rauch A. Fetal tuberous sclerosis and diagnosis of paternal gonadal mosaicism. Ultrasound Obstet Gynecol 2020; 55:691-692. [PMID: 31587404 DOI: 10.1002/uog.21880] [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] [Received: 08/25/2019] [Accepted: 09/15/2019] [Indexed: 06/10/2023]
Affiliation(s)
- B Tutschek
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - K Mayer
- Center of Human Genetics and Laboratory Diagnostics, Martinsried, Germany
| | - A Rauch
- Institute of Medical Genetics, University of Zurich, Schlieren-Zürich, Switzerland
| |
Collapse
|
24
|
Mayer K, Hahn-Ast C, Schwab K, Schmidt-Wolf IGH, Brossart P, Glasmacher A, von Lilienfeld-Toal M. Long-term follow-up of Cladribine, high-dose Cytarabine, and Idarubicin as salvage treatment for relapsed acute myeloid leukemia and literature review. Eur J Haematol 2020; 104:538-545. [PMID: 32049382 DOI: 10.1111/ejh.13395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/29/2019] [Revised: 02/07/2020] [Accepted: 02/07/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Outcome for relapsed acute myeloid leukemia (AML) is poor. Cladribine has activity in AML, and an enhancing effect on other cytostatic drugs thus may help overcome resistance. Here, we present the final analysis of our phase II trial evaluating safety and efficacy of cladribine, cytarabine, and idarubicin (CAI) in relapsed AML. METHODS Patients with relapsed AML after at least 6 months remission received two courses of CAI. After 9 patients, prolonged neutropenia prompted protocol change (omission of idarubicin in 2nd course and dose-reduction of cytarabine). Primary endpoints were remission rate and safety. RESULTS Twenty patients received treatment, fourteen one, and six two courses CAI/CA. After first course, complete remission (CR/CRi) was achieved in 60%. Most frequent toxicity was infection. Median OS was 8.8 months in all patients and 21.1 months in those with CR. Nine patients (48%) proceeded to allogeneic stem cell transplantation (allo-SCT), four of those are still alive and in CR, accounting for a 5-year survival rate of 55% of transplanted patients. CONCLUSION Cladribine, cytarabine, and idarubicin in relapsed AML is feasible and induces good response rates. As expected, infections are the most important complication. However, combined with allo-SCT, long-term survival can be achieved in a substantial number of patients.
Collapse
Affiliation(s)
- Karin Mayer
- Medizinische Klinik III, Hämatologie/Onkologie/Rheumatologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Corinna Hahn-Ast
- Medizinische Klinik III, Hämatologie/Onkologie/Rheumatologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Katjana Schwab
- Medizinische Klinik III, Hämatologie/Onkologie/Rheumatologie, Universitätsklinikum Bonn, Bonn, Germany
| | | | - Peter Brossart
- Medizinische Klinik III, Hämatologie/Onkologie/Rheumatologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Axel Glasmacher
- Medizinische Klinik III, Hämatologie/Onkologie/Rheumatologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Marie von Lilienfeld-Toal
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Onkologie, Universitätsklinikum Jena, Jena, Germany.,Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie, Hans-Knöll Institut, Jena, Germany.,Center for Sepsis Control and Care (CSCC), Universitätsklinikum Jena, Jena, Germany
| |
Collapse
|
25
|
Wallach C, Mayer K, Henneberger T, Klein W, Fässler TF. Intermediates and products of the reaction of Zn(ii) organyls with tetrel element Zintl ions: cluster extension versus complexation. Dalton Trans 2020; 49:6191-6198. [DOI: 10.1039/d0dt01096k] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Upon reactions of Zintl ions with Zn(ii) organyls various Zn-Zintl clusters as well as Zn-amide intermediates were isolated.
Collapse
Affiliation(s)
- C. Wallach
- Department Chemie
- Technische Universität München
- 85747 Garching b. München
- Germany
| | - K. Mayer
- Department Chemie
- Technische Universität München
- 85747 Garching b. München
- Germany
| | - T. Henneberger
- Department Chemie
- Technische Universität München
- 85747 Garching b. München
- Germany
| | - W. Klein
- Department Chemie
- Technische Universität München
- 85747 Garching b. München
- Germany
| | - T. F. Fässler
- Department Chemie
- Technische Universität München
- 85747 Garching b. München
- Germany
| |
Collapse
|
26
|
Kayser S, Hills RK, Luskin MR, Brunner AM, Terré C, Westermann J, Menghrajani K, Shaw C, Baer MR, Elliott MA, Perl AE, Ráčil Z, Mayer J, Zak P, Szotkowski T, de Botton S, Grimwade D, Mayer K, Walter RB, Krämer A, Burnett AK, Ho AD, Platzbecker U, Thiede C, Ehninger G, Stone RM, Röllig C, Tallman MS, Estey EH, Müller-Tidow C, Russell NH, Schlenk RF, Levis MJ. Allogeneic hematopoietic cell transplantation improves outcome of adults with t(6;9) acute myeloid leukemia: results from an international collaborative study. Haematologica 2020; 105:161-169. [PMID: 31004014 PMCID: PMC6939530 DOI: 10.3324/haematol.2018.208678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/15/2019] [Indexed: 12/13/2022] Open
Abstract
Acute myeloid leukemia (AML) with t(6;9)(p22;q34) is a distinct entity accounting for 1-2% of AML cases. A substantial proportion of these patients have a concomitant FLT3-ITD. While outcomes are dismal with intensive chemotherapy, limited evidence suggests allogeneic hematopoietic cell transplantation (allo-HCT) may improve survival if performed early during first complete remission. We report on a cohort of 178 patients with t(6;9)(p22;q34) within an international, multicenter collaboration. Median age was 46 years (range: 16-76), AML was de novo in 88%, FLT3-ITD was present in 62%, and additional cytogenetic abnormalities in 21%. Complete remission was achieved in 81% (n=144), including 14 patients who received high-dose cytarabine after initial induction failure. With a median follow up of 5.43 years, estimated overall survival at five years was 38% (95%CI: 31-47%). Allo-HCT was performed in 117 (66%) patients, including 89 in first complete remission. Allo-HCT in first complete remission was associated with higher 5-year relapse-free and overall survival as compared to consolidation chemotherapy: 45% (95%CI: 35-59%) and 53% (95%CI: 42-66%) versus 7% (95%CI: 3-19%) and 23% (95%CI: 13-38%), respectively. For patients undergoing allo-HCT, there was no difference in overall survival rates at five years according to whether it was performed in first [53% (95%CI: 42-66%)], or second [58% (95%CI: 31-100%); n=10] complete remission or with active disease/relapse [54% (95%CI: 34-84%); n=18] (P=0.67). Neither FLT3-ITD nor additional chromosomal abnormalities impacted survival. In conclusion, outcomes of t(6;9)(p22;q34) AML are poor with chemotherapy, and can be substantially improved with allo-HCT.
Collapse
Affiliation(s)
- Sabine Kayser
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
- German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | | | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Christine Terré
- Laboratory of Hematology, André Mignot Hospital, Le Chesnay, France
| | - Jörg Westermann
- Department of Hematology, Oncology and Tumor Immunology, Charité-University Medical Center, Campus Virchow Clinic, Berlin, Germany
| | - Kamal Menghrajani
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Carole Shaw
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michelle A Elliott
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alexander E Perl
- Division of Hematology and Oncology, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Zdeněk Ráčil
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Pavel Zak
- 4 Department of Internal Medicine-Hematology, Faculty of Medicine, Charles University and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Tomas Szotkowski
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | | | - David Grimwade
- Department of Medical & Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Karin Mayer
- Medical Clinic III for Oncology, Hematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Alwin Krämer
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
- German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | | | - Anthony D Ho
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Christian Thiede
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Elihu H Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Hematology/Department of Medicine, University of Washington, Seattle, WA, USA
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Nigel H Russell
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Richard F Schlenk
- NCT Trial Center, National Center for Tumor Diseases, Heidelberg, Germany
| | - Mark J Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
27
|
Mayer K, Kiry S, Yordanova A, Ahmadzadehfar H, Gaertner FC, Bundschuh RA, Essler M, Gonzalez-Carmona MA, Strassburg CP, Matthaei H, Lingohr P, Bisht S, Brossart P, Feldmann G. Systemic Therapy of Neuroendocrine Neoplasia: Single Center Experience from a Cohort of 110 Consecutive Cases. Int J Endocrinol 2020; 2020:1491475. [PMID: 32089680 PMCID: PMC7013359 DOI: 10.1155/2020/1491475] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/16/2019] [Accepted: 12/26/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Neuroendocrine neoplasias (NENs) represent a rare and biologically heterogeneous group of malignancies. Treatment of NEN patients remains challenging due to lack of prospective evidence on the choice of ideal therapeutic sequence and therapeutic efficacy in specific individual scenarios. METHODS Clinical data on 110 consecutive patients suffering from NEN treated at a single German university center were analyzed, therapeutic regimens applied were assessed, and the outcome was evaluated. RESULTS Histological grading, Ki67 proliferation index, functional activity, and presence of metastases were identified as prognostic markers. 10-year overall survival rates were 92%, 44%, and 0% for G1, G2, and G3 tumors, and 60%, 39%, 69%, 53%, and 0% for Ki67 <2%, 3-5%, 6-20%, 21-49%, and >50%, respectively. Peptide receptor radionuclide therapy (PRRT) and cytostatic chemotherapy were the second most common options, with PRRT being used more frequently in NET G1 and G2 and chemotherapy in NEC G3. Combination chemotherapy with etoposide plus cisplatin or carboplatin showed disease control rates (DCRs) of overall 74%, with a short median progression-free survival (PFS) of 7 or 5 months, respectively. DCR and PFS for PRRT were 89% and 22 months when administered as monotherapy, versus 100% and 27 months upon combination with somatostatin analog (SSA) therapy. Of note, PRRT also achieved disease control as best response in 5/5 (100%) selected cases of NEC G3. CONCLUSION Further prospective studies are warranted to help stratify available options for therapeutic intervention in NEN patients.
Collapse
Affiliation(s)
- Karin Mayer
- Department of Internal Medicine 3, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Selina Kiry
- Department of Internal Medicine 3, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Anna Yordanova
- Department of Nuclear Medicine, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Hojjat Ahmadzadehfar
- Department of Nuclear Medicine, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Florian C. Gaertner
- Department of Nuclear Medicine, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Ralph A. Bundschuh
- Department of Nuclear Medicine, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Markus Essler
- Department of Nuclear Medicine, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Maria A. Gonzalez-Carmona
- Department of Internal Medicine 1, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Christian P. Strassburg
- Department of Internal Medicine 1, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Hanno Matthaei
- Department of Surgery, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Philipp Lingohr
- Department of Surgery, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Savita Bisht
- Department of Internal Medicine 3, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Peter Brossart
- Department of Internal Medicine 3, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| | - Georg Feldmann
- Department of Internal Medicine 3, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany
| |
Collapse
|
28
|
Mehmet S, Rohrbach S, Oswald I, Denke M, Weiss B, Uhlich H, Mayer K, Böning A, Niemann B. Influence of Nutrition on the Short- and Long-Term Outcome after ECLS and ECMO Therapy. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705491] [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: 10/24/2022]
|
29
|
Schlenk RF, Paschka P, Krzykalla J, Weber D, Kapp-Schwoerer S, Gaidzik VI, Leis C, Fiedler W, Kindler T, Schroeder T, Mayer K, Lübbert M, Wattad M, Götze K, Horst HA, Koller E, Wulf G, Schleicher J, Bentz M, Greil R, Hertenstein B, Krauter J, Martens U, Nachbaur D, Abu Samra M, Girschikofsky M, Basara N, Benner A, Thol F, Heuser M, Ganser A, Döhner K, Döhner H. Gemtuzumab Ozogamicin in NPM1-Mutated Acute Myeloid Leukemia: Early Results From the Prospective Randomized AMLSG 09-09 Phase III Study. J Clin Oncol 2019; 38:623-632. [PMID: 31851556 PMCID: PMC7030890 DOI: 10.1200/jco.19.01406] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [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] [Indexed: 01/01/2023] Open
Abstract
PURPOSE High CD33 expression in acute myeloid leukemia (AML) with mutated NPM1 provides a rationale for the evaluation of gemtuzumab ozogamicin (GO) in this AML entity. We conducted a randomized trial to evaluate GO in combination with intensive induction and consolidation therapy in NPM1-mutated AML. PATIENTS AND METHODS Between May 2010 and September 2017, patients ≥ 18 years old and considered eligible for intensive therapy were randomly assigned up front for induction therapy with idarubicin, cytarabine, etoposide, and all-trans-retinoic acid with or without GO. The early (P = .02) primary end point of event-free survival (EFS) was evaluated 6 months after completion of patient recruitment. RESULTS Five hundred eighty-eight patients were randomly assigned (standard arm, n = 296; GO arm, n = 292). EFS in the GO arm was not significantly different compared with that in the standard arm (hazard ratio, 0.83; 95% CI, 0.65 to 1.04; P = .10). The early death rate during induction therapy was 10.3% in the GO arm and 5.7% in the standard arm (P = .05). Causes of death in both arms were mainly infections. The cumulative incidence of relapse (CIR) in patients achieving a complete remission (CR) or CR with incomplete hematologic recovery (CRi) was significantly reduced in the GO arm compared with the standard arm (P = .005), with no difference in the cumulative incidence of death (P = .80). Subgroup analysis revealed a significant beneficial effect of GO in female, younger (≤ 70 years), and FLT3 internal tandem duplication-negative patients with respect to EFS and CIR. CONCLUSION The trial did not meet its early primary end point of EFS, mainly as a result of a higher early death rate in the GO arm. However, in patients achieving CR/CRi after induction therapy, significantly fewer relapses occurred in the GO compared with the standard arm.
Collapse
Affiliation(s)
- Richard F Schlenk
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany.,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Paschka
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Julia Krzykalla
- Division of Biostatistics, German Cancer Research Center Heidelberg, Heidelberg, Germany
| | - Daniela Weber
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | | | - Verena I Gaidzik
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Claudia Leis
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Walter Fiedler
- Department of Internal Medicine II, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Kindler
- Department of Hematology, Medical Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
| | - Thomas Schroeder
- Department of Hematology, Oncology, and Clinical Immunology, University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Karin Mayer
- Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Michael Lübbert
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Mohammed Wattad
- Department of Hematology and Oncology, Hospital Essen-Werden, Essen, Germany
| | - Katharina Götze
- Department of Internal Medicine III, University Hospital Klinikum Rechts der Isar, Munich, Germany
| | - Heinz A Horst
- Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Elisabeth Koller
- Department of Internal Medicine III, Hanuschkrankenhaus Wien, Wien, Austria
| | - Gerald Wulf
- Department of Hematology and Oncology, University Hospital of Göttingen, Göttingen, Germany
| | - Jan Schleicher
- Klinikum der Landeshauptstadt Stuttgart, Stuttgart, Germany
| | - Martin Bentz
- Department of Hematology and Oncology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Richard Greil
- IIIrd Medical Department, Paracelsus Medical University Salzburg; Salzburg Cancer Research Institute; and Cancer Cluster Salzburg, Salzburg, Austria
| | - Bernd Hertenstein
- Department of Hematology and Oncology, Klinikum Bremen Mitte, Bremen, Germany
| | - Jürgen Krauter
- Department Hematology and Oncology, Braunschweig Municipal Hospital, Braunschweig, Germany
| | - Uwe Martens
- Department of Hematology and Oncology, Klinikum am Gesundbrunnen, Heilbronn, Germany
| | - David Nachbaur
- Department of Internal Medicine V, University Hospital of Innsbruck, Innsbruck, Austria
| | - Maisun Abu Samra
- Department of Internal Medicine IV, University Hospital of Gießen, Gießen, Germany
| | | | - Nadezda Basara
- Department of Hematology and Oncology, Malteser Krankenhaus St Franziskus-Hospital, Flensburg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center Heidelberg, Heidelberg, Germany
| | - Felicitas Thol
- Department of Hematology, Hemostaseology, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Michael Heuser
- Department of Hematology, Hemostaseology, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Arnold Ganser
- Department of Hematology, Hemostaseology, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| |
Collapse
|
30
|
Johnson J, Anderson D, Li J, Santos Tino A, Politch J, Lipscomb J, Defelice J, Gelman M, Mayer K. HIV particles expressed in semen under INSTI-based suppressive therapy are largely myeloid cell-derived and exhibit widely diverse genotypes. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30172-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
31
|
Rieger CT, Liss B, Mellinghoff S, Buchheidt D, Cornely OA, Egerer G, Heinz WJ, Hentrich M, Maschmeyer G, Mayer K, Sandherr M, Silling G, Ullmann A, Vehreschild MJGT, von Lilienfeld-Toal M, Wolf HH, Lehners N. Anti-infective vaccination strategies in patients with hematologic malignancies or solid tumors-Guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Oncol 2019; 29:1354-1365. [PMID: 29688266 PMCID: PMC6005139 DOI: 10.1093/annonc/mdy117] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Infectious complications are a significant cause of morbidity and mortality in patients with malignancies specifically when receiving anticancer treatments. Prevention of infection through vaccines is an important aspect of clinical care of cancer patients. Immunocompromising effects of the underlying disease as well as of antineoplastic therapies need to be considered when devising vaccination strategies. This guideline provides clinical recommendations on vaccine use in cancer patients including autologous stem cell transplant recipients, while allogeneic stem cell transplantation is subject of a separate guideline. The document was prepared by the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) by reviewing currently available data and applying evidence-based medicine criteria.
Collapse
Affiliation(s)
- C T Rieger
- Hematology and Oncology Germering, Lehrpraxis der Ludwig-Maximilians-Universität, University of Munich, Munich.
| | - B Liss
- Department of Internal Medicine, Helios University Hospital Wuppertal, Wuppertal
| | - S Mellinghoff
- Department I of Internal Medicine, University Hospital Cologne, Cologne; CECAD Cluster of Excellence, University of Cologne, Cologne
| | - D Buchheidt
- Department of Internal Medicine - Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Heidelberg
| | - O A Cornely
- Department I of Internal Medicine, University Hospital Cologne, Cologne; CECAD Cluster of Excellence, University of Cologne, Cologne; Clinical Trials Center Cologne, ZKS Köln, University Hospital of Cologne, Cologne
| | - G Egerer
- Department of Hematology, University Hospital Heidelberg, Heidelberg
| | - W J Heinz
- Department of Internal Medicine II - Hematology and Oncology, University of Würzburg, Würzburg
| | - M Hentrich
- Department of Hematology and Oncology, Rotkreuzklinikum München, Munich
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam
| | - K Mayer
- Department of Hematology and Oncology, University Hospital Bonn, Bonn
| | | | - G Silling
- Department of Hematology and Oncology, University of Aachen, Aachen
| | - A Ullmann
- Department of Internal Medicine II - Hematology and Oncology, University of Würzburg, Würzburg
| | - M J G T Vehreschild
- Department of Internal Medicine, Helios University Hospital Wuppertal, Wuppertal
| | - M von Lilienfeld-Toal
- Department of Hematology and Oncology, Internal Medicine II, University Hospital Jena, Jena
| | - H H Wolf
- Department of Hematology and Oncology, University Hospital Halle, Halle
| | - N Lehners
- Department of Hematology, University Hospital Heidelberg, Heidelberg; Max-Eder-Group Experimental Therapies for Hematologic Malignancies, German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
32
|
Pradelli L, Mayer K, Klek S, Omar Alsaleh A, Rosenthal M, Heller A, Muscaritoli M. SUN-LB640: Omega-3 Fatty-Acid Enriched Parenteral Nutrition Regimens in Hospitalized Patients in EU5 Countries: A Pharmacoeconomic Analysis. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32606-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
33
|
Richter DC, Heininger A, Brenner T, Hochreiter M, Bernhard M, Briegel J, Dubler S, Grabein B, Hecker A, Krüger WA, Mayer K, Pletz MW, Störzinger D, Pinder N, Hoppe-Tichy T, Weiterer S, Zimmermann S, Brinkmann A, Weigand MA, Lichtenstern C. [Bacterial sepsis : Diagnostics and calculated antibiotic therapy]. Anaesthesist 2018; 66:737-761. [PMID: 28980026 DOI: 10.1007/s00101-017-0363-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The mortality of patients with sepsis and septic shock is still unacceptably high. An effective antibiotic treatment within 1 h of recognition of sepsis is an important target of sepsis treatment. Delays lead to an increase in mortality; therefore, structured treatment concepts form a rational foundation, taking relevant diagnostic and treatment steps into consideration. In addition to the assumed focus and individual risks of each patient, local resistance patterns and specific problem pathogens must be taken into account for selection of anti-infection treatment. Many pathophysiological alterations influence the pharmacokinetics of antibiotics during sepsis. The principle of standard dosing should be abandoned and replaced by an individual treatment approach with stronger weighting of the pharmacokinetics/pharmacodynamics (PK/PD) index of the substance groups. Although this is not yet the clinical standard, prolonged (or continuous) infusion of beta-lactam antibiotics and therapeutic drug monitoring (TDM) can help to achieve defined PK targets. Prolonged infusion is sufficient without TDM but for continuous infusion TDM is basically necessary. A further argument for individual PK/PD-oriented antibiotic approaches is the increasing number of infections due to multidrug resistant pathogens (MDR) in the intensive care unit. For effective treatment antibiotic stewardship teams (ABS team) are becoming more established. Interdisciplinary cooperation of the ABS team with infectiologists, microbiologists and clinical pharmacists leads not only to a rational administration of antibiotics but also has a positive influence on the outcome. The gold standards for pathogen detection are still culture-based detection and microbiological resistance testing for the various antibiotic groups. Despite the rapid investigation time, novel polymerase chain reaction (PCR)-based procedures for pathogen identification and resistance determination, are currently only an adjunct to routine sepsis diagnostics due to the limited number of studies, high costs and limited availability. In complicated septic courses with multiple anti-infective treatment or recurrent sepsis, PCR-based procedures can be used in addition to therapy monitoring and diagnostics. Novel antibiotics represent potent alternatives in the treatment of MDR infections. Due to the often defined spectrum of pathogens and the practically absent resistance, they are suitable for targeted treatment of severe MDR infections (therapy escalation).
Collapse
Affiliation(s)
- D C Richter
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - A Heininger
- Zentrum für Infektiologie, Sektion für Krankenhaus- und Umwelthygiene, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - T Brenner
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - M Hochreiter
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - J Briegel
- Klinik für Anästhesiologie, Klinikum der Universität München, München, Deutschland
| | - S Dubler
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - B Grabein
- Stabsstelle "Klinische Mikrobiologie und Krankenhaushygiene", Klinikum der Universität München, München, Deutschland
| | - A Hecker
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - W A Krüger
- Klinik für Anästhesiologie und operative Intensivmedizin, Gesundheitsverbund Landkreis Konstanz, Klinikum Konstanz, Konstanz, Deutschland
| | - K Mayer
- Apotheke des Universitätsklinikums Heidelberg, Heidelberg, Deutschland
| | - M W Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | - D Störzinger
- Apotheke des Universitätsklinikums Heidelberg, Heidelberg, Deutschland
| | - N Pinder
- Apotheke des Universitätsklinikums Heidelberg, Heidelberg, Deutschland
| | - T Hoppe-Tichy
- Zentrum für Infektiologie, Sektion für Krankenhaus- und Umwelthygiene, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - S Weiterer
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - S Zimmermann
- Zentrum für Infektiologie, Sektion für Krankenhaus- und Umwelthygiene, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A Brinkmann
- Klinik für Anästhesie, operative Intensivmedizin und spezielle Schmerztherapie, Klinikum Heidenheim, Heidenheim, Deutschland
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - Christoph Lichtenstern
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| |
Collapse
|
34
|
Shahnaz Syed Abd Kadir S, Christopeit M, Wulf G, Wagner E, Bornhauser M, Schroeder T, Crysandt M, Mayer K, Jonas J, Stelljes M, Badbaran A, Ayuketang Ayuk F, Triviai I, Wolf D, Wolschke C, Kröger N. Impact of ruxolitinib pretreatment on outcomes after allogeneic stem cell transplantation in patients with myelofibrosis. Eur J Haematol 2018; 101:305-317. [PMID: 29791053 DOI: 10.1111/ejh.13099] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Ruxolitinib is the first approved drug for treatment of myelofibrosis, but its impact of outcome after allogeneic stem cell transplantation (ASCT) is unknown. PATIENTS AND METHODS We reported on 159 myelofibrosis patients (pts) with a median age of 59 years (r: 28-74) who received reduced intensity ASCT between 2000 and 2015 in eight German centers from related (n = 23), matched (n = 86) or mismatched (n = 50) unrelated donors. Forty-six (29%) patients received ruxolitinib at any time point prior to ASCT. The median daily dose of ruxolitinib was 30 mg (range 10-40 mg) and the median duration of treatment was 4.9 months (range 0.4-39.1 months). RESULTS Primary graft failure was seen in 2 pts (4%) in the ruxolitinib and 3 (2%) in the non-ruxolitinib group. Engraftment and incidence of acute GVHD grade II to IV and III/IV did not differ between groups (37% vs 39% and 19% vs 28%, respectively), nor did the non-relapse mortality at 2 years (23% vs 23%). A trend for lower risk of relapse was seen in the ruxolitinib group (9% vs 17%, P = .2), resulting in a similar 2 year DFS and OS (68% vs 60% and 73% vs 70%, respectively). No difference in any outcome variable could be seen between ruxolitinib responders and those who failed or lost response to ruxolitinib. CONCLUSIONS These results suggest that ruxolitinib pretreatment in myelofibrosis patient does not negatively influence outcome after allogeneic stem cell transplantation.
Collapse
Affiliation(s)
- Sharifah Shahnaz Syed Abd Kadir
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Haematology, Ampang Hospital, Selangor, Malaysia
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerald Wulf
- Department of Hematology/Oncology, University Hospital Göttingen, Göttingen, Germany
| | - Eva Wagner
- Department for Hematology and Oncology, University Hospital Mainz, Mainz, Germany
| | - Martin Bornhauser
- Department for Hematology and Oncology, University Hospital Dresden, Dresden, Germany
| | - Thomas Schroeder
- Department for Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Karin Mayer
- Medical Clinic 3, Oncology, Hematology, Immunoncology and Rheumatology, University Clinic Bonn (UKB), Bonn, Germany
| | - Julia Jonas
- Medical Clinic 3, Oncology, Hematology, Immunoncology and Rheumatology, University Clinic Bonn (UKB), Bonn, Germany
| | - Matthias Stelljes
- Department of Medicine A, Hematology and Oncology, University of Muenster, Muenster, Germany
| | - Anita Badbaran
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francis Ayuketang Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ioanna Triviai
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominik Wolf
- Medical Clinic 3, Oncology, Hematology, Immunoncology and Rheumatology, University Clinic Bonn (UKB), Bonn, Germany
| | - Christine Wolschke
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
35
|
Reppe K, Müller-Plathe M, Krause PM, Wienhold SM, Dietert K, Gurtner C, Gutbier B, Nouailles G, Müller-Redetzky HC, Gruber A, Hocke A, Mayer K, Witzenrath M. Einfluss von Resolvin E1 auf die pulmonale Entzündungsreaktion in verschiedenen Pneumoniemodellen. Pneumologie 2018. [DOI: 10.1055/s-0038-1660919] [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: 10/28/2022]
Affiliation(s)
- K Reppe
- Med. Klinik mit SP Infektiologie & Pneumologie, Arbeitsbereich Pulmonale Inflammation, Charité-Universitätsmedizin Berlin
| | - M Müller-Plathe
- Med. Klinik mit SP Infektiologie & Pneumologie, Arbeitsbereich Pulmonale Inflammation, Charité-Universitätsmedizin Berlin
| | - PM Krause
- Med. Klinik mit SP Infektiologie & Pneumologie, Arbeitsbereich Pulmonale Inflammation, Charité-Universitätsmedizin Berlin
| | - SM Wienhold
- Med. Klinik mit SP Infektiologie & Pneumologie, Arbeitsbereich Pulmonale Inflammation, Charité-Universitätsmedizin Berlin
| | - K Dietert
- Institut für Tierpathologie, FU Berlin
| | - C Gurtner
- Institut für Tierpathologie, FU Berlin
| | - B Gutbier
- Med. Klinik mit SP Infektiologie & Pneumologie, Arbeitsbereich Pulmonale Inflammation, Charité-Universitätsmedizin Berlin
| | - G Nouailles
- Med. Klinik mit SP Infektiologie & Pneumologie, Arbeitsbereich Pulmonale Inflammation, Charité-Universitätsmedizin Berlin
| | | | - A Gruber
- Institut für Tierpathologie, FU Berlin
| | - A Hocke
- Med. Klinik mit SP Infektiologie & Pneumologie, Arbeitsbereich Pulmonale Inflammation, Charité-Universitätsmedizin Berlin
| | - K Mayer
- Zentrum für Innere Medizin, Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, University of Gießen and Marburg Lung Center (UGMLC), Gießen
| | - M Witzenrath
- Med. Klinik mit SP Infektiologie & Pneumologie, Arbeitsbereich Pulmonale Inflammation, Charité-Universitätsmedizin Berlin
| |
Collapse
|
36
|
Yordanova A, Wicharz MM, Mayer K, Brossart P, Gonzalez-Carmona MA, Strassburg CP, Fimmers R, Essler M, Ahmadzadehfar H. The Role of Adding Somatostatin Analogues to Peptide Receptor Radionuclide Therapy as a Combination and Maintenance Therapy. Clin Cancer Res 2018; 24:4672-4679. [PMID: 29950352 DOI: 10.1158/1078-0432.ccr-18-0947] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/18/2018] [Accepted: 06/19/2018] [Indexed: 02/07/2023]
Abstract
Purpose: Although somatostatin analogues (SSA) and peptide receptor radionuclide therapy (PRRT) are validated therapies in patients with advanced gastroenteropancreatic neuroendocrine tumors (GEP-NET), it remains unclear whether SSA combined with PRRT or as maintenance therapy can provide prolonged survival compared with patients treated with PRRT alone. In this retrospective study, we aimed to investigate whether there is a survival benefit to adding SSA to PRRT as a combination therapy and/or maintenance therapy.Patients and Methods: The investigation included 168 patients with unresectable GEP-NETs treated at the University Hospital Bonn, Bonn, Germany. The patients were divided into two main groups: PRRT monotherapy (N = 81, group 1) and PRRT plus SSA (N = 87, group 2) as combined therapy with PRRT and/or as maintenance therapy after PRRT.Results: Data for overall survival (OS) were available from 168 patients, of whom 160 had data for progression-free survival (PFS). The median PFS was 27 months in group 1 versus 48 months in group 2 (P = 0.012). The median OS rates were 47 months in group 1 and 91 months in group 2 (P < 0.001). The death-event rates were lower in group 2 (26%) than in group 1 (63%). SSA as a combination therapy with PRRT and/or as a maintenance therapy showed a clinical benefit rate (objective response or stable disease) of 95%, which was significantly higher than group 1 (79%).Conclusions: SSA as a combination therapy and/or maintenance therapy may play a significant role in tumor control in patients with GEP-NET who underwent a PRRT. Clin Cancer Res; 24(19); 4672-9. ©2018 AACR.
Collapse
Affiliation(s)
- Anna Yordanova
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Marcel M Wicharz
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Karin Mayer
- Department of Internal Medicine 3, University Hospital Bonn, Bonn, Germany
| | - Peter Brossart
- Department of Internal Medicine 3, University Hospital Bonn, Bonn, Germany
| | | | | | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | | |
Collapse
|
37
|
Platzbecker U, Giagounidis A, Kiewe PM, Germing U, Gotze KS, Mayer K, Radsak M, Wolff T, Chromik J, Reynolds J, Barron C, Rovaldi C, Suragani RNVS, Zhang X, Laadem A, Linde PG, Sherman ML, Oelschlägel U. Erythropoietic cellular analyses in luspatercept-treated lower-risk myelodysplastic syndromes (MDS): Phase 2 PACE-MDS study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7018] [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)
| | | | | | | | | | | | | | | | - Jörg Chromik
- University Hospital Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Hecker M, Sommer N, Tello K, Hecker A, Seeger W, Mayer K. [Community-acquired pneumonia]. Med Klin Intensivmed Notfmed 2018; 113:313-324. [PMID: 29637219 DOI: 10.1007/s00063-018-0426-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
Community-acquired pneumonia (CAP) is a frequent and potentially fatal disorder. Due to the notably high mortality within the first days, the immediate initiation of rational diagnostic pathways and treatment is of tremendous prognostic impact. In this review article, the current German guideline on the diagnosis and therapy of CAP is presented. Special focus is put on structured patient management based on the individual risk for early identification of critically ill patients. In particular, risk assessment directly influences rational diagnostics and adequate therapy. New recommendations concerning preventive strategies are also discussed in this article.
Collapse
Affiliation(s)
- M Hecker
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstraße 33, 35392, Gießen, Deutschland.
| | - N Sommer
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - K Tello
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - A Hecker
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - W Seeger
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - K Mayer
- Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| |
Collapse
|
39
|
Boone-Heinonen J, Tillotson CJ, O'Malley JP, Cottrell EK, Gaudino JA, Amofah A, Rivo ML, Brickman A, Mayer K, McBurnie MA, Gold R, DeVoe JE. Characterizing a "Big Data" Cohort of Over 200,000 Low-Income U.S. Infants and Children for Obesity Research: The ADVANCE Early Life Cohort. Matern Child Health J 2018; 21:421-431. [PMID: 28093689 DOI: 10.1007/s10995-016-2232-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction Low-income populations have elevated exposure to early life risk factors for obesity, but are understudied in longitudinal research. Our objective was to assess the utility of a cohort derived from electronic health record data from safety net clinics for investigation of obesity emerging in early life. Methods We examined data from the PCORNet ADVANCE Clinical Data Research Network, a national network of Federally-Qualified Health Centers serving >1.7 million safety net patients across the US. This cohort includes patients who, in 2012-2014, had ≥1 valid body mass index measure when they were 0-5 years of age. We characterized the cohort with respect to factors required for early life obesity research in vulnerable subgroups: sociodemographic diversity, weight status based on World Health Organization (<2 years) or Centers for Disease Control (≥2 years) growth curves, and data longitudinality. Results The cohort includes 216,473 children and is racially/ethnically diverse (e.g., 17.9% Black, 45.4% Hispanic). A majority (56.9%) had family incomes below the Federal Poverty Level (FPL); 32% were <50% of FPL. Among children <2 years, 7.6 and 5.3% had high and low weight-for-length, respectively. Among children 2-5 years, 15.0, 12.7 and 2.4% were overweight, obese, and severely obese, respectively; 5.3% were underweight. In the study period, 79.2% of children had ≥2 BMI measures. Among 4-5 year olds, 21.9% had >1 BMI measure when they were <2 years. Discussion The ADVANCE Early Life cohort offers unique opportunities to investigate early life determinants of obesity in the understudied population of low income and minority children.
Collapse
Affiliation(s)
- J Boone-Heinonen
- OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA.
| | - C J Tillotson
- OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA
| | - J P O'Malley
- OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA.,OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA
| | - E K Cottrell
- OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA.,Department of Family Medicine, OHSU, 3181 SW Sam Jackson Park Rd., Mail Code FM, Portland, OR, 97239-3098, USA
| | - J A Gaudino
- OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Rd., Mail Code CB669, Portland, OR, 97239-3098, USA.,OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA
| | - A Amofah
- Health Choice Network, 9064 NW 13th Terrace, Miami, FL, 33172, USA
| | - M L Rivo
- Health Choice Network, 9064 NW 13th Terrace, Miami, FL, 33172, USA
| | - A Brickman
- Health Choice Network, 9064 NW 13th Terrace, Miami, FL, 33172, USA
| | - K Mayer
- The Fenway Institute, 1340 Boylston St., Boston, MA, 02215, USA
| | - M A McBurnie
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - R Gold
- OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA.,Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - J E DeVoe
- OCHIN, 1881 SW Naito Parkway, Portland, OR, 97201, USA.,Department of Family Medicine, OHSU, 3181 SW Sam Jackson Park Rd., Mail Code FM, Portland, OR, 97239-3098, USA
| |
Collapse
|
40
|
Živčić-Ćosić S, Mayer K, Đorđević G, Nellist M, Hoogeveen-Westerveld M, Miletić D, Rački S, Klein HG, Trobonjača Z. Severe bleeding complications and multiple kidney transplants in a patient with tuberous sclerosis complex caused by a novel TSC2 missense variant. Croat Med J 2018; 58:416-423. [PMID: 29308833 PMCID: PMC5778681 DOI: 10.3325/cmj.2017.58.416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We presented an extremely severe case of tuberous sclerosis complex (TSC) in a female patient with recurring, life-threatening bleeding complications related to renal angiomyolipomas. Massive intratumoral hemorrhage required surgical removal of both angiomyolipomatous kidneys and kidney transplantation. During the follow-up period, the patient developed severe metrorrhagia that eventually led to hysterectomy and salpingo-oophorectomy. Bleeding from the operative sites caused the loss of the first kidney transplant received from the mother, and immediate hemorrhagic shock led to the loss of the second, cadaveric kidney allograft. The third kidney transplant had a successful outcome. Pathological analysis of all tissue specimens showed TSC-associated lesions and deformed blood vessels in the surgically removed organs. Molecular genetic analysis of TSC1 and TSC2 in the DNA of peripheral leukocytes identified a novel TSC2 c.3599G>C (p.R1200P) variant. Functional assessment confirmed the likely pathogenicity of the TSC2 c.3599G>C (p.R1200P) variant. To the best of our knowledge, this is the first report of the c.3599G>C (p.R1200P) variant in exon 29 of the TSC2 gene related to a severe clinical course and multiple kidney transplants in a patient with TSC.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Zlatko Trobonjača
- Zlatko Trobonjača, Department of Physiology and Immunology, University of Rijeka School of Medicine, Braće Branchetta 20, 51000 Rijeka, Croatia,
| |
Collapse
|
41
|
Bauermeister JA, Giguere R, Leu CS, Dolezal C, Febo I, Cranston RD, Mayer K, McGowan I, Carballo-Diéguez A. Patterns of a Rectal Microbicide Placebo Gel Use in a Preparatory Stage for a Phase I Trial Among Young Men Who Have Sex with Men. AIDS Behav 2018; 22:412-420. [PMID: 28688029 PMCID: PMC5756684 DOI: 10.1007/s10461-017-1847-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We examined young gay, bisexual, and other men who have sex with men's (YGBMSM) usage patterns of a pre-coital, applicator-administered rectal placebo gel. An ethnically diverse sample of 94 YGBMSM (aged 18-30 years) were asked to insert hydroxyethylcellulose placebo gel rectally before receptive anal intercourse (RAI) and report their gel use through an interactive voice response system (IVRS) across 12 weeks. We used trajectory analyses to characterize participants' use of the rectal gel over the 12 weeks, and examine whether these trajectories varied based on participants' sociodemographic characteristics, sexual behaviors, application and insertion behaviors, and experiences using the placebo gel. A cubic model was the best fit for these longitudinal data, with two distinct trajectories of gel use observed. The first trajectory ('High with Varying Gel Use per Week') represented YGBMSM (N = 38; 40.3%) who reported using the rectal gel on several occasions per week. The second trajectory ('Low and Consistent Gel Use per Week') represented participants (N = 56; 59.7%) who reported a consistent average use of one gel per week. Participants in the High with Varying Gel Use Trajectory reported trying out a greater number of positions when inserting the gel across the 12-weeks than peers in the Low and Consistent Gel Use Trajectory. YGBMSM reporting more RAI occasions during the trial were more likely be present in the High with Varying Gel Use Trajectory than peers in the Low and Consistent Gel Use Trajectory. Future research examining how to facilitate gel application and adherence among YGBMSM is merited.
Collapse
Affiliation(s)
- José A Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Suite 402, Philadelphia, PA, 19109, USA.
| | - R Giguere
- HIV Center for Clinical and Behavioral Studies, Columbia University and NY State Psychiatric Institute, New York, USA
| | - C S Leu
- HIV Center for Clinical and Behavioral Studies, Columbia University and NY State Psychiatric Institute, New York, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | - C Dolezal
- HIV Center for Clinical and Behavioral Studies, Columbia University and NY State Psychiatric Institute, New York, USA
| | - I Febo
- Department of Pediatrics, Gama Project, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - R D Cranston
- Division of Infectious Diseases, School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - K Mayer
- Fenway Health, Fenway Institute, Boston, USA
| | - I McGowan
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - A Carballo-Diéguez
- HIV Center for Clinical and Behavioral Studies, Columbia University and NY State Psychiatric Institute, New York, USA
| |
Collapse
|
42
|
Dalhoff K, Abele-Horn M, Andreas S, Deja M, Ewig S, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Heußel CP, Höffken G, Kolditz M, Kramme E, Kühl H, Lange C, Mayer K, Nachtigall I, Panning M, Pletz M, Rath PM, Rohde G, Rosseau S, Schaaf B, Schreiter D, Schütte H, Seifert H, Spies C, Welte T. [Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia - Update 2017 - S3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology]. Pneumologie 2018; 72:15-63. [PMID: 29341032 DOI: 10.1055/s-0043-121734] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However, infections on general wards are increasing. A central issue are infections with multidrug resistant (MDR) pathogens which are difficult to treat in the empirical setting potentially leading to inappropriate use of antimicrobial therapy.This guideline update was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and treatment of HAP on the basis of quality of evidence and benefit/risk ratio.This guideline has two parts. First an update on epidemiology, spectrum of pathogens and antimicrobials is provided. In the second part recommendations for the management of diagnosis and treatment are given. New recommendations with respect to imaging, diagnosis of nosocomial viral pneumonia and prolonged infusion of antibacterial drugs have been added. The statements to risk factors for infections with MDR pathogens and recommendations for monotherapy vs combination therapy have been actualised. The importance of structured deescalation concepts and limitation of treatment duration is emphasized.
Collapse
Affiliation(s)
- K Dalhoff
- Medizinische Klinik III, Pneumologie, Universitätsklinikum Schleswig-Holstein, Lübeck
| | - M Abele-Horn
- Institut für Hygiene und Mikrobiologie der Universität Würzburg, Würzburg
| | - S Andreas
- Lungenfachklinik Immenhausen, Immenhausen
| | - M Deja
- Charité, Universitätsmedizin Berlin, Klinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Berlin
| | - S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Evangelisches Krankenhaus Herne und Augusta-Kranken-Anstalt Bochum, Herne und Bochum
| | - P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - S Gatermann
- Institut für Hygiene und Mikrobiologie, Abteilung für Medizinische Mikrobiologie, Ruhr-Universität Bochum, Bochum
| | - H Gerlach
- Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes Klinikum Neukölln, Berlin
| | - B Grabein
- Stabsstelle Klinische Mikrobiologie und Krankenhaushygiene am Klinikum der Universität München, München
| | - C P Heußel
- Thoraxklinik Heidelberg gGmbH, Abteilung für Diagnostische und Interventionelle Radiologie
| | - G Höffken
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Medizinische Klinik und Poliklinik 1, Fachabteilung für Pneumologie, Dresden
| | - M Kolditz
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Medizinische Klinik und Poliklinik 1, Fachabteilung für Pneumologie, Dresden
| | - E Kramme
- Medizinische Klinik III, Pneumologie, Universitätsklinikum Schleswig-Holstein, Lübeck
| | - H Kühl
- St. Bernhard-Hospital Kamp-Lintfort GmbH, Klinik für Radiologie, Kamp-Lintfort
| | - C Lange
- Medizinische Klinik, Forschungszentrum Borstel, Borstel
| | - K Mayer
- Zentrum für Innere Medizin, Medizinische Klinik II, Pneumologie und Intensivmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen
| | | | - M Panning
- Universitätsklinikum Freiburg, Institut für Medizinische Mikrobiologie und Hygiene, Freiburg
| | - M Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena
| | - P-M Rath
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Essen, Essen
| | - G Rohde
- Klinikum der Johann Wolfgang Goethe-Universität, Pneumologie/Allergologie, Medizinische Klinik 1, Frankfurt am Main
| | - S Rosseau
- Klinik Ernst von Bergmann Bad Belzig gGmbH, Pneumologisches Beatmungszentrum, Bad Belzig
| | - B Schaaf
- Klinikum Dortmund gGmbH, Medizinischen Klinik, Pneumologie und Infektiologie, Dortmund
| | - D Schreiter
- Helios Park-Klinikum Leipzig GmbH und Herzzentrum Leipzig GmbH, Universitätsklinik, Leipzig
| | - H Schütte
- Klinikum Ernst von Bergmann gGmbH, Klinik für Pneumologie, Potsdam
| | - H Seifert
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Klinikum der Universität zu Köln, Köln
| | - C Spies
- Charitè, Universitätsmedizin Berlin, Klinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Berlin
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover
| | | | | | | | | | | |
Collapse
|
43
|
Mayer K, Schumacher M, Eis-Hübinger AM, Pietzonka S, Drosten C, Brossart P, Wolf D. Intravesical cidofovir application in BK virus cystitis after allogeneic hematopoetic stem cell transplantation (HSCT) is safe and highly effective. Bone Marrow Transplant 2018; 53:495-498. [DOI: 10.1038/s41409-017-0044-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 11/09/2022]
|
44
|
Benesch C, Bürstel D, Ennen S, Kaulfuß KH, Mayer K, Moog U, Moors E, Seelig B, Spengler D, Strobel H, Tegtmeyer P, Voigt K, Wagner HW, Ganter M. Empfehlung für die Haltung von Schafen und Ziegen der Deutschen Gesellschaft für die Krankheiten der kleinen Wiederkäuer, Fachgruppe der DVG. Tierarztl Prax Ausg G Grosstiere Nutztiere 2018. [DOI: 10.1055/s-0038-1623133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungEs werden Empfehlungen für die verschiedenen Haltungsformen auf der Basis der gesetzlichen Rahmenbedingungen für die Haltung von Schafen und Ziegen zusammengefasst. Berücksichtigung finden dabei die Wanderschäferei, die Hüte- und Koppelschafhaltung sowie die Alpung. Intensiv wird auf die Belange der Weidehaltung, der Stallhaltung, der Versorgung mit Futter und Wasser, der Geburt, der Lämmeraufzucht und der Gesundheitsvorsorge eingegangen. Dabei werden die Rahmenbedingungen sowohl für die extensive als auch für die intensive Haltung und Nutzung von Schafen und Ziegen abgesteckt. Die speziesspezifischen Kompensationsmöglichkeiten, deren Grenzen und Anzeichen der Dekompensation werden exemplarisch aufgezeigt. Durch die Einhaltung dieser Empfehlungen sollen den in unserer Obhut gehaltenen Nutztieren die „fünf Freiheiten (13)” zuverlässig gewährt werden: 1. Freisein von Hunger und Durst, 2. Freisein von Unbehagen, 3. Freisein von Schmerz, Verletzungen und Krankheiten, 4. Freisein zum Ausleben normaler Verhaltensweisen und 5. Freisein von Angst und Leiden.
Collapse
|
45
|
Mellinghoff SC, Panse J, Alakel N, Behre G, Buchheidt D, Christopeit M, Hasenkamp J, Kiehl M, Koldehoff M, Krause SW, Lehners N, von Lilienfeld-Toal M, Löhnert AY, Maschmeyer G, Teschner D, Ullmann AJ, Penack O, Ruhnke M, Mayer K, Ostermann H, Wolf HH, Cornely OA. Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO). Ann Hematol 2017; 97:197-207. [PMID: 29218389 PMCID: PMC5754425 DOI: 10.1007/s00277-017-3196-2] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022]
Abstract
Immunocompromised patients are at high risk of invasive fungal infections (IFI), in particular those with haematological malignancies undergoing remission-induction chemotherapy for acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS) and recipients of allogeneic haematopoietic stem cell transplants (HSCT). Despite the development of new treatment options in the past decades, IFI remains a concern due to substantial morbidity and mortality in these patient populations. In addition, the increasing use of new immune modulating drugs in cancer therapy has opened an entirely new spectrum of at risk periods. Since the last edition of antifungal prophylaxis recommendations of the German Society for Haematology and Medical Oncology in 2014, seven clinical trials regarding antifungal prophylaxis in patients with haematological malignancies have been published, comprising 1227 patients. This update assesses the impact of this additional evidence and effective revisions. Our key recommendations are the following: prophylaxis should be performed with posaconazole delayed release tablets during remission induction chemotherapy for AML and MDS (AI). Posaconazole iv can be used when the oral route is contraindicated or not feasible. Intravenous liposomal amphotericin B did not significantly decrease IFI rates in acute lymphoblastic leukaemia (ALL) patients during induction chemotherapy, and there is poor evidence to recommend it for prophylaxis in these patients (CI). Despite substantial risk of IFI, we cannot provide a stronger recommendation for these patients. There is poor evidence regarding voriconazole prophylaxis in patients with neutropenia (CII). Therapeutic drug monitoring TDM should be performed within 2 to 5 days of initiating voriconazole prophylaxis and should be repeated in case of suspicious adverse events or of dose changes of interacting drugs (BIItu). General TDM during posaconazole prophylaxis is not recommended (CIItu), but may be helpful in cases of clinical failure such as breakthrough IFI for verification of compliance or absorption.
Collapse
Affiliation(s)
- Sibylle C Mellinghoff
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany. .,Department I of Internal Medicine, German Centre for Infection Research (DZIF), University Hospital of Cologne, University of Cologne, Cologne, Germany.
| | - Jens Panse
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Nael Alakel
- Department I of Internal Medicine, Haematology and Oncology, University Hospital Dresden, Dresden, Germany
| | - Gerhard Behre
- Division of Haematology and Oncology, Leipzig University Hospital, Leipzig, Germany
| | - Dieter Buchheidt
- Department of Internal Medicine-Haematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Justin Hasenkamp
- Clinic for Haematology and Medical Oncology with Department for Stem Cell Transplantation, University Medicine Göttingen, Göttingen, Germany
| | - Michael Kiehl
- Department I for Internal Medicine, Klinikum Frankfurt (Oder), Frankfurt (Oder), Germany
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Centre, University Hospital of Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Stefan W Krause
- Department V for Internal Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Nicola Lehners
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Annika Y Löhnert
- Department I of Internal Medicine, German Centre for Infection Research (DZIF), University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Georg Maschmeyer
- Department of Haematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Daniel Teschner
- Department of Haematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andrew J Ullmann
- Department II of Internal Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Olaf Penack
- Department for Haematology, Oncology and Tumour immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Ruhnke
- Department of Haematology and Oncology, Paracelsus-Kliniken Osnabrück, Osnabrück, Germany
| | - Karin Mayer
- Department III of Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Helmut Ostermann
- Department of Haematology and Oncology, University of Munich, Munich, Germany
| | - Hans-H Wolf
- Department IV of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Department I of Internal Medicine, German Centre for Infection Research (DZIF), University Hospital of Cologne, University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| |
Collapse
|
46
|
Platzbecker U, Germing U, Götze KS, Kiewe P, Mayer K, Chromik J, Radsak M, Wolff T, Zhang X, Laadem A, Sherman ML, Attie KM, Giagounidis A. Luspatercept for the treatment of anaemia in patients with lower-risk myelodysplastic syndromes (PACE-MDS): a multicentre, open-label phase 2 dose-finding study with long-term extension study. Lancet Oncol 2017; 18:1338-1347. [PMID: 28870615 DOI: 10.1016/s1470-2045(17)30615-0] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/07/2017] [Accepted: 07/17/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Myelodysplastic syndromes are characterised by ineffective erythropoiesis. Luspatercept (ACE-536) is a novel fusion protein that blocks transforming growth factor beta (TGF β) superfamily inhibitors of erythropoiesis, giving rise to a promising new investigative therapy. We aimed to assess the safety and efficacy of luspatercept in patients with anaemia due to lower-risk myelodysplastic syndromes. METHODS In this phase 2, multicentre, open-label, dose-finding study (PACE-MDS), with long-term extension, eligible patients were aged 18 years or older, had International Prognostic Scoring System-defined low or intermediate 1 risk myelodysplastic syndromes or non-proliferative chronic myelomonocytic leukaemia (white blood cell count <13 000/μL), and had anaemia with or without red blood cell transfusion support. Enrolled patients were classified as having low transfusion burden, defined as requiring less than 4 red blood cell units in the 8 weeks before treatment (and baseline haemoglobin <10 g/dL), or high transfusion burden, defined as requiring 4 or more red blood cell units in the 8 weeks before treatment. Patients received luspatercept subcutaneously once every 21 days at dose concentrations ranging from 0·125 mg/kg to 1·75 mg/kg bodyweight for five doses (over a maximum of 12 weeks). Patients in the expansion cohort were treated with 1·0 mg/kg luspatercept; dose titration up to 1·75 mg/kg was allowed, and patients could be treated with luspatercept for a maximum of 5 years. Patients in the base study were assessed for response and safety after 12 weeks in order to be considered for enrolment into the extension study. The primary endpoint was the proportion of patients achieving modified International Working Group-defined haematological improvement-erythroid (HI-E), defined as a haemoglobin concentration increase of 1·5 g/dL or higher from baseline for 14 days or longer in low transfusion burden patients, and a reduction in red blood cell transfusion of 4 or more red blood cell units or a 50% or higher reduction in red blood cell units over 8 weeks versus pre-treatment transfusion burden in high transfusion burden patients. Patient data were subcategorised by: luspatercept dose concentrations (0·125-0·5 mg/kg vs 0·75-1·75 mg/kg); pre-study transfusion burden (high transfusion burden vs low transfusion burden, defined as ≥4 vs <4 red blood cell units per 8 weeks); pre-study serum erythropoietin concentration (<200 IU/L, 200-500 IU/L, and >500 IU/L); presence of 15% or more ring sideroblasts; and presence of SF3B1 mutations. Efficacy analyses were carried out on the efficacy evaluable and intention-to-treat populations. This trial is currently ongoing. This study is registered with ClinicalTrials.gov, numbers NCT01749514 and NCT02268383. FINDINGS Between Jan 21, 2013, and Feb 12, 2015, 58 patients with myelodysplastic syndromes were enrolled in the 12 week base study at nine treatment centres in Germany; 27 patients were enrolled in the dose-escalation cohorts (0·125-1·75 mg/kg) and 31 patients in the expansion cohort (1·0-1·75 mg/kg). 32 (63% [95% CI 48-76]) of 51 patients receiving higher dose luspatercept concentrations (0·75-1·75 mg/kg) achieved HI-E versus two (22% [95% CI 3-60]) of nine receiving lower dose concentrations (0·125-0·5 mg/kg). Three treatment-related grade 3 adverse events occurred in one patient each: myalgia (one [2%]), increased blast cell count (one [2%]), and general physical health deterioration (one [2%]). Two of these treatment-related grade 3 adverse events were reversible serious grade 3 adverse events: one patient (2%) had myalgia and one patient (2%) had general physical health deterioration. INTERPRETATION Luspatercept was well tolerated and effective for the treatment of anaemia in lower-risk myelodysplastic syndromes and so could therefore provide a novel therapeutic approach for the treatment of anaemia associated with lower-risk myelodysplastic syndromes; further studies are ongoing. FUNDING Acceleron Pharma.
Collapse
Affiliation(s)
- Uwe Platzbecker
- Universitätsklinikum "Carl Gustav Carus" der Technischen Universität Dresden, Dresden, Germany.
| | - Ulrich Germing
- Klinik für Hämatologie, Onkologie und klinische Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Philipp Kiewe
- Onkologischer Schwerpunkt am Oskar-Helene-Heim, Berlin, Germany
| | | | - Jörg Chromik
- Universitätsklinikum Frankfurt, Johann-Wolfgang-Goethe-Universität, Frankfurt, Germany
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Horn D, Siebert E, Seidel U, Rost I, Mayer K, Abou Jamra R, Mitter D, Kornak U. Biallelic COL3A1 mutations result in a clinical spectrum of specific structural brain anomalies and connective tissue abnormalities. Am J Med Genet A 2017; 173:2534-2538. [PMID: 28742248 DOI: 10.1002/ajmg.a.38345] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 04/19/2017] [Revised: 06/02/2017] [Accepted: 06/06/2017] [Indexed: 11/11/2022]
Abstract
Vascular Ehlers-Danlos syndrome (type IV) is an autosomal dominant disorder caused by heterozygous variants of COL3A1. We identified biallelic COL3A1 variants in two unrelated families. In a 3-year-old female with developmental delay the nonsense variant c.1282C>T, p.(Arg428*) was detected in combination the c.2057delC, p.(Pro686Leufs*105) frame shift variant. Both compound heterozygous variants were novel. This patient was born with bilateral clubfoot, joint laxity, and dysmorphic facial features. At the age of 2 years she developed an aneurysmal brain hemorrhage. Cerebral MRI showed a peculiar pattern of profound cerebral abnormalities including bilateral frontoparietal polymicrogyria of the cobblestone variant. In the second family, the two affected siblings were homozygous for the missense variant c.145C<G, p.(Pro49Ala) of COL3A1 and showed cobblestone-like cortical malformation, cerebellar cysts, and white matter abnormalities, developmental delay, and seizures. To date, three further families have been reported with biallelic variants of this gene and specific structural brain anomalies in all, and a severe Ehlers-Danlos syndrome phenotype in some. Bilateral frontoparietal polymicrogyria of the cobblestone variant, cerebellar microcysts, and abnormalities of the white matter characterize this brain phenotype and resemble neurological manifestations in individuals with autosomal recessive mutations in GPR56, which serves as a ligand of COL3A1. In concordance with the findings in knock out mice, the collagen III protein plays a role in the regulation of cortical development in addition to its well-known function in connective tissue formation.
Collapse
Affiliation(s)
- Denise Horn
- Institut für Medizinische Genetik und Humangenetik, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eberhard Siebert
- Institut für Neuroradiologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Seidel
- Kinderklinik, SPZ, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Imma Rost
- Zentrum für Humangenetik und Laboratoriumsdiagnostik, Martinsried, Germany
| | - Karin Mayer
- Zentrum für Humangenetik und Laboratoriumsdiagnostik, Martinsried, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University Hospital Leipzig, Leipzig, Germany
| | - Diana Mitter
- Institute of Human Genetics, University Hospital Leipzig, Leipzig, Germany
| | - Uwe Kornak
- Institut für Medizinische Genetik und Humangenetik, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
48
|
Fredericksen RJ, Gibbons L, Brown S, Edwards TC, Yang FM, Fitzsimmons E, Alperovitz-Bichell K, Godfrey M, Wang A, Church A, Gutierrez C, Paez E, Dant L, Loo S, Walcott M, Mugavero MJ, Mayer K, Mathews WC, Patrick DL, Crane PK, Crane HM. Medication understanding among patients living with multiple chronic conditions: Implications for patient-reported measures of adherence. Res Social Adm Pharm 2017; 14:540-544. [PMID: 28651924 DOI: 10.1016/j.sapharm.2017.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/10/2017] [Accepted: 06/17/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Low health literacy is associated with poor medication adherence and poor health outcomes. Limited understanding of prescribed medications may decrease validity of patient-reported adherence measures. OBJECTIVES To assess knowledge of names and purposes of prescribed medications among patients with multiple chronic conditions. METHODS Individual interviews were conducted with a convenience sample of patients from six U.S. primary care clinics. Participants (n = 57) were English and/or Spanish-speaking patients prescribed 3+ medications for chronic conditions, for which non-adherence may lead to disability or death. In individual interviews, patients were asked to name their medications, explain the purpose of each, and to explain how they distinguish them from one another. Interviews were audio recorded, transcribed, and coded; coded content was quantified by 1) whether or not the patient could name medications; 2) method of categorizing medications; 3) whether or not the purpose of the medication was understood. Descriptive statistics were compiled using Fisher's exact test to determine the relationship between patient knowledge and medication characteristics. RESULTS Thirty percent of patients could not name at least one of their medications; 19% did not know their purpose; 30% held misconceptions about the purpose of one or more medications. There was no significant difference in ability to name medications or state their medication's purpose between patients using medi-sets, pre-packaged rolls, or blister packs, and patients who stored pills in their original containers (p = 0.56 and p = 0.73, respectively), or across demographic groups (p = 0.085 to 0.767). CONCLUSIONS Many patients demonstrated difficulty identifying the name and purpose of prescribed medications; this did not differ by demographic group or medication storage type. Patients may benefit from routine review of medications with their provider in order to improve health literacy, outcomes, and patient-reported adherence measurement.
Collapse
Affiliation(s)
| | - L Gibbons
- University of Washington, Center for AIDS Research, USA
| | - S Brown
- University of Washington, Center for AIDS Research, USA
| | - T C Edwards
- University of Washington, Seattle Quality of Life Group, USA
| | | | - E Fitzsimmons
- University of Washington, Center for AIDS Research, USA
| | | | - M Godfrey
- Beaufort Jasper Hampton Comprehensive Health Services, USA
| | - A Wang
- Chase Brexton Health Care, USA
| | - A Church
- University of Washington, Center for AIDS Research, USA
| | | | - E Paez
- University of California at San Diego, USA
| | - L Dant
- Fenway Community Health, USA
| | - S Loo
- Fenway Community Health, USA
| | - M Walcott
- University of Alabama at Birmingham, USA
| | | | - K Mayer
- Fenway Community Health, USA
| | | | - D L Patrick
- University of Washington, Seattle Quality of Life Group, USA
| | - P K Crane
- University of Washington, Center for AIDS Research, USA
| | - H M Crane
- University of Washington, Center for AIDS Research, USA
| |
Collapse
|
49
|
Schaefer MB, Schaefer CA, Hecker M, Morty RE, Witzenrath M, Seeger W, Mayer K. Co-incubation of PMN and CaCo-2 cells modulates inflammatory potential. ACTA ACUST UNITED AC 2017; 63:119-126. [PMID: 28719356 DOI: 10.14715/cmb/2017.63.5.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/19/2017] [Accepted: 03/18/2017] [Indexed: 11/18/2022]
Abstract
Polymorphonuclear granulocytes (PMN) are activated in inflammatory reactions. Intestinal epithelial cells are relevant for maintaining the intestinal barrier. We examined interactions of PMN and intestinal epithelial cell-like CaCo-2 cells to elucidate their regulation of inflammatory signalling and the impact of cyclooxygenase (COX), nitric oxide (NO) and platelet-activating factor (PAF). Human PMN and CaCo-2 cells, separately and in co-incubation, were stimulated with the calcium ionophore A23187 or with N-Formyl-methionyl-leucyl-phenylalanin (fMLP) that activates PMN only. Human neutrophil elastase (HNE) and respiratory Burst were measured. To evaluate the modulation of inflammatory crosstalk we applied inhibitors of COX (acetyl salicylic acid; ASA), NO-synthase (N-monomethyl-L-arginin; L-NMMA), and the PAF-receptor (WEB2086). Unstimulated, co-incubation of CaCo-2 cells and PMN led to significantly reduced Burst and elevated HNE as compared to PMN. After stimulation with A23187, co-incubation resulted in an inhibition of Burst and HNE. Using fMLP co-incubation failed to modulate Burst but increased HNE. Without stimulation, all three inhibitors abolished the effect of co-incubation on Burst but did not change HNE. ASA partly prevented modulation of Burst L-NMMA and WEB2086 did not change Burst but abolished mitigation of HNE. Without stimulation, co-incubation reduced Burst and elevated HNE. Activation of PMN and CaCo-2 cells by fMLP as compared to A23187 resulted in a completely different pattern of Burst and HNE, possibly due to single vs. dual cell activation. Anti-inflammatory effect of co-incubation might in part be due to due to COX-signalling governing Burst whereas NO- and PAF-dependent signalling seemed to control HNE release.
Collapse
Affiliation(s)
- M B Schaefer
- University of Giessen Lung Center (UGLC), University Hospital of Giessen and Marburg, Giessen, Germany
| | - C A Schaefer
- Department of Internal Medicine II, University Hospital of Bonn, Bonn, Germany
| | - M Hecker
- University of Giessen Lung Center (UGLC), University Hospital of Giessen and Marburg, Giessen, Germany
| | - R E Morty
- Department of Lung Development and Remodelling, Max-Planck-Institute, Bad Nauheim, Germany
| | - M Witzenrath
- Department of Infectious Diseases, Charité, University of Berlin, Berlin, Germany
| | - W Seeger
- University of Giessen Lung Center (UGLC), University Hospital of Giessen and Marburg, Giessen, Germany
| | - K Mayer
- University of Giessen Lung Center (UGLC), University Hospital of Giessen and Marburg, Giessen, Germany
| |
Collapse
|
50
|
Platzbecker U, Germing U, Götze K, Kiewe P, Wolff T, Mayer K, Chromik J, Radsak M, Wilson D, Zhang X, Laadem A, Sherman M, Attie K, Linde P, Giagounidis A. Luspatercept Response in New Subpopulations of Patients with Lower-Risk Myelodysplastic Syndromes (MDS): Update of the Pace Study. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|