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Axt L, Naumann A, Toennies J, Haen SP, Vogel W, Schneidawind D, Wirths S, Moehle R, Faul C, Kanz L, Axt S, Bethge WA. Retrospective single center analysis of outcome, risk factors and therapy in steroid refractory graft-versus-host disease after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2019; 54:1805-1814. [PMID: 31089279 DOI: 10.1038/s41409-019-0544-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 01/09/2023]
Abstract
Acute and chronic graft-vs.-host disease (aGvHD and cGvHD) are major complications after allogeneic hematopoietic cell transplantation (HCT) leading to substantial morbidity and mortality. This retrospective single-center study analyzes incidence, therapy, and outcome of GvHD in n = 721 patients ≥18 years having received allogeneic HCT 2004-2013 with a special focus on steroid refractory GvHD. Acute (n = 355/49.2%) and chronic (n = 269/37.3%) GvHD were mainly treated by steroids in first-line therapy. The proportion of steroid refractory aGvHD and cGvHD was 35.7% and 31.4%, respectively. As there is no standard therapy for steroid refractory GvHD, a range of different agents was used. In aGvHD, the overall response rate (ORR) of steroid refractory GvHD to second-line treatment was 27.4%. Mycophenolate mofetil (MMF) and mTOR inhibitors led to superior response rates (ORR 50.0% and 53.3%, respectively). In steroid refractory cGvHD therapy, ORR was 44.4%. Use of calcineurin inhibitors (CNI; n = 11/45.5%), MMF (n = 18/50.0%), mTOR inhibitors (n = 10/60.0%), and extracorporeal photophoresis (ECP; n = 16/56.3%) showed ORR above average. Targeted therapies lead to responses in 7.7% (n = 13). This data may help to improve the design of future prospective clinical studies in GvHD.
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Affiliation(s)
- L Axt
- Department of Hematology and Oncology, Medical Center University Hospital Tuebingen, Tuebingen, Germany
| | - A Naumann
- Institute for Clinical Epidemiology and Applied Biometry, Eberhard-Karl University Tuebingen, Tuebingen, Germany
| | - J Toennies
- Department of Hematology and Oncology, Medical Center University Hospital Tuebingen, Tuebingen, Germany
| | - S P Haen
- Department of Hematology and Oncology, Medical Center University Hospital Tuebingen, Tuebingen, Germany
| | - W Vogel
- Department of Hematology and Oncology, Medical Center University Hospital Tuebingen, Tuebingen, Germany
| | - D Schneidawind
- Department of Hematology and Oncology, Medical Center University Hospital Tuebingen, Tuebingen, Germany
| | - S Wirths
- Department of Hematology and Oncology, Medical Center University Hospital Tuebingen, Tuebingen, Germany
| | - R Moehle
- Department of Hematology and Oncology, Medical Center University Hospital Tuebingen, Tuebingen, Germany
| | - C Faul
- Department of Hematology and Oncology, Medical Center University Hospital Tuebingen, Tuebingen, Germany
| | - L Kanz
- Department of Hematology and Oncology, Medical Center University Hospital Tuebingen, Tuebingen, Germany
| | - S Axt
- Department for Visceral, General and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - W A Bethge
- Department of Hematology and Oncology, Medical Center University Hospital Tuebingen, Tuebingen, Germany.
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2
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Hehlmann R, Lauseker M, Saußele S, Pfirrmann M, Krause S, Kolb HJ, Neubauer A, Hossfeld DK, Nerl C, Gratwohl A, Baerlocher GM, Heim D, Brümmendorf TH, Fabarius A, Haferlach C, Schlegelberger B, Müller MC, Jeromin S, Proetel U, Kohlbrenner K, Voskanyan A, Rinaldetti S, Seifarth W, Spieß B, Balleisen L, Goebeler MC, Hänel M, Ho A, Dengler J, Falge C, Kanz L, Kremers S, Burchert A, Kneba M, Stegelmann F, Köhne CA, Lindemann HW, Waller CF, Pfreundschuh M, Spiekermann K, Berdel WE, Müller L, Edinger M, Mayer J, Beelen DW, Bentz M, Link H, Hertenstein B, Fuchs R, Wernli M, Schlegel F, Schlag R, de Wit M, Trümper L, Hebart H, Hahn M, Thomalla J, Scheid C, Schafhausen P, Verbeek W, Eckart MJ, Gassmann W, Pezzutto A, Schenk M, Brossart P, Geer T, Bildat S, Schäfer E, Hochhaus A, Hasford J. Assessment of imatinib as first-line treatment of chronic myeloid leukemia: 10-year survival results of the randomized CML study IV and impact of non-CML determinants. Leukemia 2017; 31:2398-2406. [PMID: 28804124 PMCID: PMC5668495 DOI: 10.1038/leu.2017.253] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [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] [Received: 06/23/2017] [Accepted: 07/04/2017] [Indexed: 01/06/2023]
Abstract
Chronic myeloid leukemia (CML)-study IV was designed to explore whether treatment with imatinib (IM) at 400 mg/day (n=400) could be optimized by doubling the dose (n=420), adding interferon (IFN) (n=430) or cytarabine (n=158) or using IM after IFN-failure (n=128). From July 2002 to March 2012, 1551 newly diagnosed patients in chronic phase were randomized into a 5-arm study. The study was powered to detect a survival difference of 5% at 5 years. After a median observation time of 9.5 years, 10-year overall survival was 82%, 10-year progression-free survival was 80% and 10-year relative survival was 92%. Survival between IM400 mg and any experimental arm was not different. In a multivariate analysis, risk group, major-route chromosomal aberrations, comorbidities, smoking and treatment center (academic vs other) influenced survival significantly, but not any form of treatment optimization. Patients reaching the molecular response milestones at 3, 6 and 12 months had a significant survival advantage. For responders, monotherapy with IM400 mg provides a close to normal life expectancy independent of the time to response. Survival is more determined by patients' and disease factors than by initial treatment selection. Although improvements are also needed for refractory disease, more life-time can currently be gained by carefully addressing non-CML determinants of survival.
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Affiliation(s)
- R Hehlmann
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - M Lauseker
- IBE, Universität München, Munich, Germany
| | - S Saußele
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | | | - S Krause
- Medizinische Klinik 5, Universitätsklinikum, Erlangen, Germany
| | - H J Kolb
- Medizinische Klinik III, Universität München, Munich, Germany
| | - A Neubauer
- Klinik für innere Medizin, Universitätsklinikum, Marburg, Germany
| | - D K Hossfeld
- 2. Medizinische Klinik, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - C Nerl
- Klinikum Schwabing, Munich, Germany
| | | | | | - D Heim
- Universitätsspital, Basel, Switzerland
| | | | - A Fabarius
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | | | | | - M C Müller
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | | | - U Proetel
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - K Kohlbrenner
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - A Voskanyan
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - S Rinaldetti
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - W Seifarth
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - B Spieß
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | | | - M C Goebeler
- Medizinische Klinik und Poliklinik, Universitätsklinikum, Würzburg, Germany
| | - M Hänel
- Klinik für innere Medizin 3, Chemnitz, Germany
| | - A Ho
- Medizinische Klinik V, Universität Heidelberg, Heidelberg, Germany
| | - J Dengler
- Onkologische Schwerpunktpraxis, Heilbronn, Germany
| | - C Falge
- Medizinische Klinik 5, Klinikum Nürnberg-Nord, Nürnberg, Germany
| | - L Kanz
- Medizinische Abteilung 2, Universitätsklinikum, Tübingen, Germany
| | - S Kremers
- Caritas Krankenhaus, Lebach, Germany
| | - A Burchert
- Klinik für innere Medizin, Universitätsklinikum, Marburg, Germany
| | - M Kneba
- 2. Medizinische Klinik und Poliklinik, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - F Stegelmann
- Klinik für Innere Medizin 3, Universitätsklinikum, Ulm, Germany
| | - C A Köhne
- Klinik für Onkologie und Hämatologie, Oldenburg, Germany
| | | | - C F Waller
- Innere Medizin 1, Universitätsklinikum, Freiburg, Germany
| | - M Pfreundschuh
- Klinik für Innere Medizin 1, Universität des Saarlandes, Homburg, Germany
| | - K Spiekermann
- Medizinische Klinik III, Universität München, Munich, Germany
| | - W E Berdel
- Medizinische Klinik A, Universitätsklinikum, Münster, Germany
| | - L Müller
- Onkologie Leer UnterEms, Leer, Germany
| | - M Edinger
- Klinik und Poliklinik für Innere Medizin 3, Universitätsklinikum, Regensburg, Germany
| | - J Mayer
- Masaryk University Hospital, Brno, Czech Republic
| | - D W Beelen
- Klinik für Knochenmarktransplantation, Essen, Germany
| | - M Bentz
- Medizinische Klinik 3, Städtisches Klinikum, Karlsruhe, Germany
| | - H Link
- Klinik für Innere Medizin 3, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - B Hertenstein
- 1. Medizinische Klinik, Klinikum Bremen Mitte, Bremen, Germany
| | | | - M Wernli
- Kantonsspital, Aarau, Switzerland
| | - F Schlegel
- St Antonius-Hospital, Eschweiler, Germany
| | - R Schlag
- Hämatologische-Onkologische Schwerpunktpraxis, Würzburg, Germany
| | - M de Wit
- Vivantes Klinikum Neukölln, Berlin, Germany
| | - L Trümper
- Klinik für Hämatologie und medizinische Onkologie, Universitätsmedizin, Göttingen, Germany
| | - H Hebart
- Stauferklinikum Schwäbisch Gmünd, Mutlangen, Germany
| | - M Hahn
- Onkologie Zentrum, Ansbach, Germany
| | - J Thomalla
- Praxisklinik für Hämatologie und Onkologie, Koblenz, Germany
| | - C Scheid
- Klinik 1 für Innere Medizin, Universitätsklinikum, Köln, Germany
| | - P Schafhausen
- 2. Medizinische Klinik, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - W Verbeek
- Ambulante Hämatologie und Onkologie, Bonn, Germany
| | - M J Eckart
- Internistische Schwerpunktpraxis, Erlangen, Germany
| | | | | | - M Schenk
- Barmherzige Brüder, Regensburg, Germany
| | - P Brossart
- Medizinische Klinik 3, Universität, Bonn, Germany
| | - T Geer
- Diakonie, Schwäbisch Hall, Germany
| | - S Bildat
- Medizinische Klinik 2, Herford, Germany
| | - E Schäfer
- Onkologische Schwerpunktpraxis, Bielefeld, Germany
| | - A Hochhaus
- Klinik für Innere Medizin 2, Universitätsklinikum, Jena, Germany
| | - J Hasford
- IBE, Universität München, Munich, Germany
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3
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Pfreundschuh M, Christofyllakis K, Altmann B, Ziepert M, Haenel M, Viardot A, Neubauer A, Held G, Truemper L, Dreyling M, Kanz L, Hallek M, Schmitz N, Heintges T, Kölbel C, Buecker A, Ruebe C, Hellwig D, Berdel C, Poeschel V, Murawski N. RADIOTHERAPY TO BULKY DISEASE PET-NEGATIVE AFTER IMMUNOCHEMOTHERAPY CAN BE SPARED IN ELDERLY DLBCL PATIENTS: RESULTS OF a PLANNED INTERIM ANALYSIS OF THE FIRST 187 PATIENTS WITH BULKY DISEASE TREATED IN THE OPTIMAL > 60 STUDY OF THE DSHNHL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- M. Pfreundschuh
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | | | - B. Altmann
- IMISE; University of Leipzig; Leipzig Germany
| | - M. Ziepert
- IMISE; University of Leipzig; Leipzig Germany
| | - M. Haenel
- Internal Medicine III; Chemnitz Hospital; Chemnitz Germany
| | - A. Viardot
- Internal Medicine III; University Hospital Ulm; Ulm Germany
| | - A. Neubauer
- Hematology/Oncology; University Hospital Marburg; Marburg Germany
| | - G. Held
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | - L. Truemper
- Department of Internal Medicine; University Hospital Goettingen; Goettingen Germany
| | - M. Dreyling
- Department for Internal Medicine 3; University Hospital Muenchen - Großhadern; Muenchen Germany
| | - L. Kanz
- Hematology/Oncology; University Hospital Tuebingen; Tuebingen Germany
| | - M. Hallek
- Internal Medicine I; University Hospital Koeln; Koeln Germany
| | - N. Schmitz
- Hematology; ASKLEPIOS Clinic Hamburg; Hamburg Germany
| | - T. Heintges
- Internal Medicine II; Lukaskrankenhaus Neuss; Neuss Germany
| | - C. Kölbel
- Internal Medicine I, Krankenhaus der Barmherzigen Brüder Trier; Trier Germany
| | - A. Buecker
- Department for Radiology; Saarland University Hospital; Homburg Germany
| | - C. Ruebe
- Department for Radiotherapy; Saarland University Hospital; Homburg Germany
| | - D. Hellwig
- Department for Nuclearmedicine; University Hospital Regensburg; Regensburg Germany
| | - C. Berdel
- Department for Radiotherapy; Saarland University Hospital; Homburg Germany
| | - V. Poeschel
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | - N. Murawski
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
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4
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Murawski N, Amam J, Altmann B, Ziepert M, Haenel M, Viardot A, Neubauer A, Held G, Truemper L, Dreyling M, Kanz L, Hallek M, Schmitz N, Heintges T, Koelbel C, Poeschel V, Pfreundschuh M. ANTI-INFECTIVE PROPHYLAXIS WITH ACICLOVIR AND COTRIMOXAZOLE SIGNIFICANTLY REDUCES THE RATE OF INFECTIONS AND THERAPY-ASSOCIATED DEATHS IN ELDERLY PATIENTS WITH DLBCL UNDERGOING R-CHOP IMMUNOCHEMOTHERAPY. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_63] [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: 11/10/2022]
Affiliation(s)
- N. Murawski
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | - J. Amam
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | - B. Altmann
- IMISE; University of Leipzig; Leipzig Germany
| | - M. Ziepert
- IMISE; University of Leipzig; Leipzig Germany
| | - M. Haenel
- Internal Medicine III; Chemnitz Hospital; Chemnitz Germany
| | - A. Viardot
- Internal Medicine III; University Hospital Ulm; Ulm Germany
| | - A. Neubauer
- Hematology/Oncology; University Hospital Marburg; Marburg Germany
| | - G. Held
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | - L. Truemper
- Department of Internal Medicine; University Hospital; Goettingen Germany
| | - M. Dreyling
- Department for Internal Medicine III; University Hospital Großhadern; Muenchen Germany
| | - L. Kanz
- Hematology/Oncology; University Hospital; Tuebingen Germany
| | - M. Hallek
- Internal Medicine I; University Hospital; Koeln Germany
| | - N. Schmitz
- Hematology, ASKLEPIOS clinic; Hamburg Germany
| | - T. Heintges
- Internal Medicine III, Lukaskrankenhaus; Neuss Germany
| | - C. Koelbel
- Internal Medicine I, Krankenhaus der Barmherzigen Brueder; Trier Germany
| | - V. Poeschel
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | - M. Pfreundschuh
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
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Pecher AC, Igney-Oertel A, Kanz L, Henes J. Treatment of familial Mediterranean fever with anakinra in patients unresponsive to colchicine. Scand J Rheumatol 2017; 46:407-409. [PMID: 28097903 DOI: 10.1080/03009742.2016.1245780] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A-C Pecher
- a Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases and Department of Internal Medicine II , University Hospital Tübingen , Tübingen , Germany
| | - A Igney-Oertel
- a Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases and Department of Internal Medicine II , University Hospital Tübingen , Tübingen , Germany
| | - L Kanz
- b Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology , University Hospital Tübingen , Tübingen , Germany
| | - J Henes
- a Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases and Department of Internal Medicine II , University Hospital Tübingen , Tübingen , Germany
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Eder S, Labopin M, Finke J, Bunjes D, Olivieri A, Santarone S, Rambaldi A, Kanz L, Messina G, Mohty M, Nagler A. Safety and efficacy of thiotepa-based conditioning for allogeneic transplantation in AML: a survey from the ALWP of the EBMT. Bone Marrow Transplant 2016; 52:238-244. [PMID: 27643865 DOI: 10.1038/bmt.2016.239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 12/27/2022]
Abstract
This study evaluated the safety and efficacy of thiotepa-based regimens before allogeneic stem cell transplantation in 310 adult patients with AML. Disease status at the time of transplantation was CR1 in 50%, CR2+ in 23.5% and advanced disease in 26.5%. Transplantation was performed from haploidentical (35%), matched sibling (27%), unrelated (20%) or cord blood (18%) donors. As for safety: mucositis occurred in 46.8% of the patients and the cumulative incidence (CI) of sinusoidal obstruction syndrome was 4.0%. With a median follow-up of 37 months, the CI of acute GvHD grade>II was 26.5%, whereas CI of chronic GvHD was 28.1% at 3 years. CI for non-relapse mortality at 3 years was 38.4%, 49.7% and 45.4% for patients in CR1, CR2+ and advanced disease, respectively (P=0.10). Relapse incidence at 3 years was 20.2, 30.7 and 40.6% in these three respective groups (P=0.002). CI for 3-year leukemia-free survival and overall survival were 41.4% and 45.6% (CR1), 19.6% and 27.7% (CR2+), and 13.9% and 13.6% (advanced disease), respectively (P<10-4 for both). Our data suggest that thiotepa-based conditioning therapy in AML is feasible, effective and safe, as investigated for sinusoidal obstruction syndrome and mucositis.
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Affiliation(s)
- S Eder
- EBMT Office Paris, Hôpital Saint-Antoine, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - M Labopin
- EBMT Office Paris, Hôpital Saint-Antoine, Paris, France
| | - J Finke
- Department of Medicine-Hematology, Oncology, University of Freiburg, Freiburg, Germany
| | - D Bunjes
- Klinik fuer Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - A Olivieri
- Department of Hematology, Azienda Ospedali Riuniti di Ancona, Ancona-Torrete, Italy
| | - S Santarone
- Department of Hematology, Ospedale Civile, Pescara, Italy
| | - A Rambaldi
- USC Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - L Kanz
- Abteilung II, Universität Tübingen, Tübingen, Germany
| | - G Messina
- Centro Trapianti Midollo Osseo, Azienda Ospedaliera 'BMM', Reggio Calabria, Italy
| | - M Mohty
- EBMT Office Paris, Hôpital Saint-Antoine, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - A Nagler
- EBMT Office Paris, Hôpital Saint-Antoine, Paris, France.,Chaim Sheba Medical Center, Tel-Hashomer, Israel
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7
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Pecher AC, Igney-Oertel A, Kanz L, Henes J. THU0564 Treatment of Familial Mediterranean Fever with Anakinra in Patients Unresponsive To Colchicine. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3471] [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: 11/04/2022]
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8
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Kowalewski DJ, Walz S, Backert L, Schuster H, Kohlbacher O, Weisel K, Rittig SM, Kanz L, Salih HR, Rammensee HG, Stevanović S, Stickel JS. Carfilzomib alters the HLA-presented peptidome of myeloma cells and impairs presentation of peptides with aromatic C-termini. Blood Cancer J 2016; 6:e411. [PMID: 27058226 PMCID: PMC4855252 DOI: 10.1038/bcj.2016.14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/02/2016] [Indexed: 02/03/2023] Open
Abstract
Recent studies suggest that multiple myeloma is an immunogenic disease, which might be effectively targeted by antigen-specific T-cell immunotherapy. As standard of care in myeloma includes proteasome inhibitor therapy, it is of great importance to characterize the effects of this treatment on HLA-restricted antigen presentation and implement only robustly presented targets for immunotherapeutic intervention. Here, we present a study that longitudinally and semi-quantitatively maps the effects of the proteasome inhibitor carfilzomib on HLA-restricted antigen presentation. The relative presentation levels of 4780 different HLA ligands were quantified in an in vitro model employing carfilzomib treatment of MM.1S and U266 myeloma cells, which revealed significant modulation of a substantial fraction of the HLA-presented peptidome. Strikingly, we detected selective down-modulation of HLA ligands with aromatic C-terminal anchor amino acids. This particularly manifested as a marked reduction in the presentation of HLA ligands through the HLA allotypes A*23:01 and A*24:02 on MM.1S cells. These findings implicate that carfilzomib mediates a direct, peptide motif-specific inhibitory effect on HLA ligand processing and presentation. As a substantial proportion of HLA allotypes present peptides with aromatic C-termini, our results may have broad implications for the implementation of antigen-specific treatment approaches in patients undergoing carfilzomib treatment.
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Affiliation(s)
- D J Kowalewski
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany
| | - S Walz
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany.,Department of Hematology and Oncology, University of Tübingen, Tübingen, Germany
| | - L Backert
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany.,Applied Bioinformatics, Department of Computer Science, Center for Bioinformatics, University of Tübingen, Tübingen, Germany
| | - H Schuster
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany
| | - O Kohlbacher
- Applied Bioinformatics, Department of Computer Science, Center for Bioinformatics, University of Tübingen, Tübingen, Germany.,Quantitative Biology Center, University of Tübingen, Tübingen, Germany.,Max Planck Institute for Developmental Biology, Tübingen, Germany
| | - K Weisel
- Department of Hematology and Oncology, University of Tübingen, Tübingen, Germany
| | - S M Rittig
- Department of Hematology and Oncology, University of Tübingen, Tübingen, Germany
| | - L Kanz
- Department of Hematology and Oncology, University of Tübingen, Tübingen, Germany
| | - H R Salih
- Department of Hematology and Oncology, University of Tübingen, Tübingen, Germany.,Clinical Cooperation Unit Translational Immunology, German Cancer Consortium (DKTK), DKFZ Partner Site, Tübingen, Germany
| | - H-G Rammensee
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ Partner Site, Tübingen, Germany
| | - S Stevanović
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK), DKFZ Partner Site, Tübingen, Germany
| | - J S Stickel
- Department of Hematology and Oncology, University of Tübingen, Tübingen, Germany
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Hetzel J, Böckeler M, Ehab A, Wagner R, Spengler W, Oberle A, Steger V, Bösmüller H, Fend F, Kanz L, Häntschel M. Molekulargenetische Charakterisierung des nicht-kleinzelligen Bronchialkarzinoms mittels Kryobiopsie – unterschätzten wir die EGFR Mutatiosrate? Pneumologie 2016. [DOI: 10.1055/s-0036-1572283] [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: 10/22/2022]
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10
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Vrhovac R, Labopin M, Ciceri F, Finke J, Holler E, Tischer J, Lioure B, Gribben J, Kanz L, Blaise D, Dreger P, Held G, Arnold R, Nagler A, Mohty M. Second reduced intensity conditioning allogeneic transplant as a rescue strategy for acute leukaemia patients who relapse after an initial RIC allogeneic transplantation: analysis of risk factors and treatment outcomes. Bone Marrow Transplant 2015; 51:186-93. [DOI: 10.1038/bmt.2015.221] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 11/09/2022]
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11
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Haap M, Neumayer B, Kopp HG, Peter S, Haen S, Riessen R, Artunc F, Fend F, Kanz L, Müller MR. [Pulmonary infection in neutropenia]. Dtsch Med Wochenschr 2015; 140:426-7. [PMID: 25774734 DOI: 10.1055/s-0041-100947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED MEDICAL HISTORY AND CLINICAL COURSE: A 42-year-old patient with hairy cell leukemia had been treated for 3 years by a hematologist in private practice. Initially the patient received 1 course of cladribine upon which the disease went into complete remission. 6 weeks ago a relapse was diagnosed and combination therapy with cladibrin and rituximab was initiated. Now the patient presented to the emergency room with shortness of breath and pain when breathing. INVESTIGATIONS, TREATMENT AND COURSE In the chest x-ray, patchy infiltrates and pleural effusions were found on both sides. The subsequently performed computed tomography showed bilateral compactions with an Halo suspicious for fungal infiltrates. Upon admission to the hospital, an empirical antibiotic therapy with clarithromycin and piperacillin/tazobactam was initiated, which was later escalated to meropenem and linezolid. Additionally, an antifungal therapy with voriconazole was started and later switched to liposomal amphotericin B. At his admission, a positive aspergillus antigen could be detected in the microbiological laboratory. Under antimycotic treatment the aspergillus antigen was repeatedly negative. The patient presented with pronounced cytopenias and after a switch of therapy to vemurafenib and filgrastim, the hematopoiesis could only be stimulated insufficiently. The patient was transferred to the intensive care unit three days after admission with severe respiratory failure. He died on day 8 after admission. AUTOPSY AND DIAGNOSIS: Diagnosis was consistent with relapse of hairy cell leukemia with positive BRAF mutation and a bone marrow infiltration > 80 %. Autopsy revealed a significant hepato-splenomegaly, a lack of erythro-, granulo- and thrombopoiesis. Clots interspersed with fungal hyphae were found in both lungs and an infarction of the spleen with evidence of fungal hyphae was detected. The cultural findings post mortem on yeast or mold were negative. CONCLUSION Patients with refractory hairy cell leukemia and prolonged neutropenia are at increased risk for systemic fungal infections. Therefore, prohylactic antimycotic therapy should be considered early in this group of patients. The therapeutic approach of vemurafenib in treatment-refractory hairy cell leukemia is promising and offers an additional treatment option. In the present case, the patient could unfortunately not be stabilized due to the septic complications.
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Affiliation(s)
- M Haap
- Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
| | - B Neumayer
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - H-G Kopp
- Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
| | - S Peter
- Abteilung für Onkologie, Hämatologie, Klinische Immunologie, Rheumatologie und Pulmonologie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
| | - S Haen
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - R Riessen
- Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
| | - F Artunc
- Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
| | - F Fend
- Institut für Pathologie, Universitätsklinikum Tübingen
| | - L Kanz
- Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
| | - M R Müller
- Abteilung für Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Medizinische Klinik und Poliklinik, Universitätsklinikum Tübingen
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Oberle A, Weyhern CHV, Horger M, Schuster T, Spengler W, Fend F, Kanz L, Hetzel J. Der diagnostische Algorithmus Interstitieller Lungenerkankungen wird durch transbronchiale Kryobiopsien im Vergleich zur Zangenbiopsie signifikant verbessert. Pneumologie 2015. [DOI: 10.1055/s-0035-1544627] [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: 10/24/2022]
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13
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Federmann B, Faul C, Meisner C, Vogel W, Kanz L, Bethge WA. Influence of age on outcome after allogeneic hematopoietic cell transplantation: a single center study in patients aged ⩾60. Bone Marrow Transplant 2015; 50:427-31. [DOI: 10.1038/bmt.2014.292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 10/17/2014] [Accepted: 10/21/2014] [Indexed: 11/09/2022]
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14
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Berlin C, Kowalewski DJ, Schuster H, Mirza N, Walz S, Handel M, Schmid-Horch B, Salih HR, Kanz L, Rammensee HG, Stevanović S, Stickel JS. Mapping the HLA ligandome landscape of acute myeloid leukemia: a targeted approach toward peptide-based immunotherapy. Leukemia 2014; 29:647-59. [PMID: 25092142 DOI: 10.1038/leu.2014.233] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/23/2014] [Accepted: 07/24/2014] [Indexed: 01/07/2023]
Abstract
Identification of physiologically relevant peptide vaccine targets calls for the direct analysis of the entirety of naturally presented human leukocyte antigen (HLA) ligands, termed the HLA ligandome. In this study, we implemented this direct approach using immunoprecipitation and mass spectrometry to define acute myeloid leukemia (AML)-associated peptide vaccine targets. Mapping the HLA class I ligandomes of 15 AML patients and 35 healthy controls, more than 25 000 different naturally presented HLA ligands were identified. Target prioritization based on AML exclusivity and high presentation frequency in the AML cohort identified a panel of 132 LiTAAs (ligandome-derived tumor-associated antigens), and 341 corresponding HLA ligands (LiTAPs (ligandome-derived tumor-associated peptides)) represented subset independently in >20% of AML patients. Functional characterization of LiTAPs by interferon-γ ELISPOT (Enzyme-Linked ImmunoSpot) and intracellular cytokine staining confirmed AML-specific CD8(+) T-cell recognition. Of note, our platform identified HLA ligands representing several established AML-associated antigens (e.g. NPM1, MAGED1, PRTN3, MPO, WT1), but found 80% of them to be also represented in healthy control samples. Mapping of HLA class II ligandomes provided additional CD4(+) T-cell epitopes and potentially synergistic embedded HLA ligands, allowing for complementation of a multipeptide vaccine for the immunotherapy of AML.
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Affiliation(s)
- C Berlin
- 1] Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany [2] Department of Hematology and Oncology, University of Tübingen, Tübingen, Germany
| | - D J Kowalewski
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany
| | - H Schuster
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany
| | - N Mirza
- 1] Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany [2] Department of Hematology and Oncology, University of Tübingen, Tübingen, Germany
| | - S Walz
- 1] Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany [2] Department of Hematology and Oncology, University of Tübingen, Tübingen, Germany
| | - M Handel
- Hospital Group South-West, Department of Orthopedics, Calw, Germany
| | - B Schmid-Horch
- Institute for Clinical and Experimental Transfusion Medicine, University of Tübingen, Tübingen, Germany
| | - H R Salih
- 1] Department of Hematology and Oncology, University of Tübingen, Tübingen, Germany [2] Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - L Kanz
- Department of Hematology and Oncology, University of Tübingen, Tübingen, Germany
| | - H-G Rammensee
- 1] Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany [2] Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Stevanović
- 1] Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany [2] Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - J S Stickel
- 1] Department of Immunology, Institute for Cell Biology, University of Tübingen, Tübingen, Germany [2] Department of Hematology and Oncology, University of Tübingen, Tübingen, Germany
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Hanfstein B, Shlyakhto V, Lauseker M, Hehlmann R, Saussele S, Dietz C, Erben P, Fabarius A, Proetel U, Schnittger S, Krause SW, Schubert J, Einsele H, Hänel M, Dengler J, Falge C, Kanz L, Neubauer A, Kneba M, Stegelmann F, Pfreundschuh M, Waller CF, Spiekermann K, Baerlocher GM, Pfirrmann M, Hasford J, Hofmann WK, Hochhaus A, Müller MC. Velocity of early BCR-ABL transcript elimination as an optimized predictor of outcome in chronic myeloid leukemia (CML) patients in chronic phase on treatment with imatinib. Leukemia 2014; 28:1988-92. [DOI: 10.1038/leu.2014.153] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 03/30/2014] [Accepted: 04/21/2014] [Indexed: 11/09/2022]
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16
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Haas F, Zeh G, Schmalzing M, Henes J, Kanz L, Horger M, Kurth R, Koetter I. AB1059 CRMO in adults: Does it really exist? difficult differential diagnosis with suprising results. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1058] [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: 11/04/2022]
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17
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Henes JC, Horger M, Schmalzing M, Vogel W, Kanz L, Koetter I. FRI0368 Autologous stem cell transplantation with a conditioning regimen using thiotepa in patients with systemic sclerosis and cardiac manifestation. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1495] [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: 11/03/2022]
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18
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Heni M, Besemer B, Guthoff M, Häntschel M, Wirths S, Mayer F, Kanz L, Häring HU, Schnauder G, Vogel W. [Endocrine abnormalities in a young patient with metastatic cancer - case 3/2013]. Dtsch Med Wochenschr 2013; 138:908. [PMID: 23625630 DOI: 10.1055/s-0032-1333050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HISTORY AND ADMISSION FINDINGS We report on a 24-year-old male patient who presented with worsening of the general condition and abdominal pain. INVESTIGATIONS On physical examination, gynecomastia was noted. Laboratory tests showed manifest hyperthyroidism. The beta-hCG levels were markedly increased. By ultrasound, the thyroid gland was hyperperfused without thyroid nodules. Several large echo mixed lesions were found in the liver. The testes appeared normal. DIAGNOSIS In light of the typical laboratory findings, a non-seminomatous extragonadal germ cell tumor was diagnosed. Hyperthyroidism was most probably HCG induced. TREATMENT AND COURSE Initially the patient was treated with thyreostatic drugs. After initiation of chemotherapy and a marked decrease in beta-hCG, thyreostatic therapy could be terminated. CONCLUSIONS Germ cell tumors may cause an increase in beta-hCG concentration. By cross-reacting with the TSH-receptor this could induce hyperthyroidism. Germ cell tumors are therefore a rare differential diagnosis of hyperthyreoidism.
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Affiliation(s)
- M Heni
- Medizinische Klinik IV, Endokrinologie und Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Universitätsklinikum Tübingen
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19
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Schneidawind D, Nann D, Vogel W, Faul C, Fend F, Horger M, Kanz L, Bethge W. Allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia and pulmonary mucormycosis. Transpl Infect Dis 2012; 14:E166-72. [PMID: 23075207 DOI: 10.1111/tid.12019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 06/18/2012] [Accepted: 07/04/2012] [Indexed: 11/28/2022]
Abstract
Mucormycosis is a serious invasive fungal infection in immunocompromised patients. Patients undergoing treatment for hematologic malignancies are predominantly prone to the pulmonary manifestation of mucormycosis. Historically, allogeneic hematopoietic cell transplantation (HCT) in patients suffering from pulmonary mucormycosis (PM) was considered contraindicated owing to mortality rates up to 90%. We present 3 patients with acute myeloid leukemia and PM who were treated with radical surgical debridement combined with high-dose liposomal amphotericin B (LAB), and subsequently underwent successful allogeneic HCT. To date, all 3 patients are in complete remission and show no signs of mucormycosis. Allogeneic HCT in patients with PM seems feasible provided that the infectious focus is completely removed surgically and adequate antifungal pharmacotherapy, such as high-dose LAB or posaconazole, is established.
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Affiliation(s)
- D Schneidawind
- Department of Medicine, University Hospital Tübingen, Tübingen, Germany
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20
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Daikeler T, Maas K, Weiss B, Hartmann J, Knobloch A, Arning M, Kanz L, Bokemeyer C. The influence of gemcitabine on the CD4/CD8 ratio in patients with solid tumours. Oncol Rep 2012; 4:561-4. [PMID: 21590098 DOI: 10.3892/or.4.3.561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Gemcitabine (dFdC) is a novel pyrimidine antimetabolite with documented antineoplastic activity against metastatic non-small cell lung cancer (NSCL), pancreatic carcinoma, ovarian and breast cancer. The side effects of gemcitabine are generally mild; severe infections are reported in less than Ilo of patients. In contrast, other new nucleoside analogues such as the purine antimetabolite fludarabine lead to a significant alteration of the CD4/CD8 lymphocyte ratio associated with an increased risk for opportunistic infections. This study investigates the effect of gemcitabine on different lymphocyte subsets during consecutive applications. 16 patients with solid rumours (3 non-small cell lung cancer, 3 pancreas, 3 testicular, 2 breast, ovarian germ-cell, 1 ovarian, 1 small cell lung, 1 gastric cancer, 1 carcinoma of unknown primary); 15 patients were previously treated, received at least 3 applications of gemcitabine (1,000 mg/m(2) as a 30 min infusion, at days 1, 8, 15; q 4 weeks). Lymphocytes surface antigens were analysed by standard technique flow cytometry prior to every infusion. The median number of leukocytes before therapy was 7823/mu l, with lymphocytes 875/mu l, including 68% T-cells (CD3(+)), 9% B-cells (CD19(+); CD20(+)) and 15% NK-cells (CD56(+); CD16(+); CD3(-)), the CD4/CD8 ratio was 1.7. After gemcitabine therapy the median number of leukocytes was 5136/mu l, with lymphocytes 1012/mu l, including 77% T-cells, 8% B-cells and 10% NK-cells and a CD4/CD8 ratio of 2.2. Severe complications or opportunistic infections were not seen in these 16 patients. No significant change of CD4/CD8 ratios and NK-ccll numbers was seen in our patients with solid tumours during weekly treatment with gemcitabine. A severely increased risk for opportunistic infections following treatment with the new antimetabolite gemcitabine appears unlikely.
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Affiliation(s)
- T Daikeler
- UNIV TUBINGEN,DEPT HEMATOL ONCOL,MED CTR 2,D-72076 TUBINGEN,GERMANY. UNIV HOHENHEIM,DEPT FINANCE,D-7000 STUTTGART,GERMANY. LILLY PHARM RES,HOMBURG,GERMANY
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21
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Kluin-Nelemans HC, Hoster E, Hermine O, Walewski J, Trneny M, Geisler CH, Stilgenbauer S, Thieblemont C, Vehling-Kaiser U, Doorduijn JK, Coiffier B, Forstpointner R, Tilly H, Kanz L, Feugier P, Szymczyk M, Hallek M, Kremers S, Lepeu G, Sanhes L, Zijlstra JM, Bouabdallah R, Lugtenburg PJ, Macro M, Pfreundschuh M, Procházka V, Di Raimondo F, Ribrag V, Uppenkamp M, André M, Klapper W, Hiddemann W, Unterhalt M, Dreyling MH. Treatment of older patients with mantle-cell lymphoma. N Engl J Med 2012; 367:520-31. [PMID: 22873532 DOI: 10.1056/nejmoa1200920] [Citation(s) in RCA: 361] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The long-term prognosis for older patients with mantle-cell lymphoma is poor. Chemoimmunotherapy results in low rates of complete remission, and most patients have a relapse. We investigated whether a fludarabine-containing induction regimen improved the complete-remission rate and whether maintenance therapy with rituximab prolonged remission. METHODS We randomly assigned patients 60 years of age or older with mantle-cell lymphoma, stage II to IV, who were not eligible for high-dose therapy to six cycles of rituximab, fludarabine, and cyclophosphamide (R-FC) every 28 days or to eight cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) every 21 days. Patients who had a response underwent a second randomization to maintenance therapy with rituximab or interferon alfa, each given until progression. RESULTS Of the 560 patients enrolled, 532 were included in the intention-to-treat analysis for response, and 485 in the primary analysis for response. The median age was 70 years. Although complete-remission rates were similar with R-FC and R-CHOP (40% and 34%, respectively; P=0.10), progressive disease was more frequent with R-FC (14%, vs. 5% with R-CHOP). Overall survival was significantly shorter with R-FC than with R-CHOP (4-year survival rate, 47% vs. 62%; P=0.005), and more patients in the R-FC group died during the first remission (10% vs. 4%). Hematologic toxic effects occurred more frequently in the R-FC group than in the R-CHOP group, but the frequency of grade 3 or 4 infections was balanced (17% and 14%, respectively). In 274 of the 316 patients who were randomly assigned to maintenance therapy, rituximab reduced the risk of progression or death by 45% (in remission after 4 years, 58%, vs. 29% with interferon alfa; hazard ratio for progression or death, 0.55; 95% confidence interval, 0.36 to 0.87; P=0.01). Among patients who had a response to R-CHOP, maintenance therapy with rituximab significantly improved overall survival (4-year survival rate, 87%, vs. 63% with interferon alfa; P=0.005). CONCLUSIONS R-CHOP induction followed by maintenance therapy with rituximab is effective for older patients with mantle-cell lymphoma. (Funded by the European Commission and others; ClinicalTrials.gov number, NCT00209209.).
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Affiliation(s)
- H C Kluin-Nelemans
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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22
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Schneidawind D, Dorn C, Faul C, Vogel W, Berg C, Beck R, Korn K, Dittmann H, Schleicher J, Erbersdobler A, Jahn G, Kanz L, Bethge W. Allogene Stammzelltransplantation bei akuter myeloischer Leukämie und HIV-Infektion. Transfusionsmedizin 2012. [DOI: 10.1055/s-0031-1284010] [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)
- D. Schneidawind
- Abteilung für Hämatologie, Onkologie, Immunologie, Rheumatologie und Pulmologie, Medizinische Universitätsklinik Tübingen
| | - C. Dorn
- Abteilung für Hämatologie, Onkologie, Immunologie, Rheumatologie und Pulmologie, Medizinische Universitätsklinik Tübingen
| | - C. Faul
- Abteilung für Hämatologie, Onkologie, Immunologie, Rheumatologie und Pulmologie, Medizinische Universitätsklinik Tübingen
| | - W. Vogel
- Abteilung für Hämatologie, Onkologie, Immunologie, Rheumatologie und Pulmologie, Medizinische Universitätsklinik Tübingen
| | - C. Berg
- Abteilung für Gastroenterologie, Hepatologie und Infektionskrankheiten, Medizinische Universitätsklinik Tübingen
| | - R. Beck
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen
| | - K. Korn
- Virologisches Institut, Klinische und Molekulare Virologie, Nationales Referenzzentrum für Retroviren, Universitätsklinikum Erlangen
| | - H. Dittmann
- Abteilung für Nuklearmedizin, Radiologische Universitätsklinik Tübingen
| | - J. Schleicher
- Abteilung für Hämatologie und internistische Onkologie, Katharinenhospital Stuttgart
| | - A. Erbersdobler
- Institut für Pathologie, Medizinische Fakultät der Universität Rostock
| | - G. Jahn
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen
| | - L. Kanz
- Abteilung für Hämatologie, Onkologie, Immunologie, Rheumatologie und Pulmologie, Medizinische Universitätsklinik Tübingen
| | - W. Bethge
- Abteilung für Hämatologie, Onkologie, Immunologie, Rheumatologie und Pulmologie, Medizinische Universitätsklinik Tübingen
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Bethge WA, von Harsdorf S, Bornhauser M, Federmann B, Stelljes M, Trenschel R, Baurmann H, Dittmann H, Faul C, Vogel W, Kanz L, Bunjes D. Dose-escalated radioimmunotherapy as part of reduced intensity conditioning for allogeneic transplantation in patients with advanced high-grade non-Hodgkin lymphoma. Bone Marrow Transplant 2012; 47:1397-402. [DOI: 10.1038/bmt.2012.62] [Citation(s) in RCA: 18] [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: 11/09/2022]
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Hanfstein B, Müller MC, Hehlmann R, Erben P, Lauseker M, Fabarius A, Schnittger S, Haferlach C, Göhring G, Proetel U, Kolb HJ, Krause SW, Hofmann WK, Schubert J, Einsele H, Dengler J, Hänel M, Falge C, Kanz L, Neubauer A, Kneba M, Stegelmann F, Pfreundschuh M, Waller CF, Branford S, Hughes TP, Spiekermann K, Baerlocher GM, Pfirrmann M, Hasford J, Saußele S, Hochhaus A. Early molecular and cytogenetic response is predictive for long-term progression-free and overall survival in chronic myeloid leukemia (CML). Leukemia 2012; 26:2096-102. [PMID: 22446502 DOI: 10.1038/leu.2012.85] [Citation(s) in RCA: 335] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the face of competing first-line treatment options for CML, early prediction of prognosis on imatinib is desirable to assure favorable survival or otherwise consider the use of a second-generation tyrosine kinase inhibitor (TKI). A total of 1303 newly diagnosed imatinib-treated patients (pts) were investigated to correlate molecular and cytogenetic response at 3 and 6 months with progression-free and overall survival (PFS, OS). The persistence of BCR-ABL transcript levels >10% according to the international scale (BCR-ABL(IS)) at 3 months separated a high-risk group (28% of pts; 5-year OS: 87%) from a group with >1-10% BCR-ABL(IS) (41% of pts; 5-year OS: 94%; P=0.012) and from a group with ≤1% BCR-ABL(IS) (31% of pts; 5-year OS: 97%; P=0.004). Cytogenetics identified high-risk pts by >35% Philadelphia chromosome-positive metaphases (Ph+, 27% of pts; 5-year OS: 87%) compared with ≤35% Ph+ (73% of pts; 5-year OS: 95%; P=0.036). At 6 months, >1% BCR-ABL(IS) (37% of pts; 5-year OS: 89%) was associated with inferior survival compared with ≤1% (63% of pts; 5-year OS: 97%; P<0.001) and correspondingly >0% Ph+ (34% of pts; 5-year OS: 91%) compared with 0% Ph+ (66% of pts; 5-year OS: 97%; P=0.015). Treatment optimization is recommended for pts missing these landmarks.
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Affiliation(s)
- B Hanfstein
- III Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
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Schneidawind D, Dorn C, Faul C, Vogel W, Berg C, Beck R, Korn K, Dittmann H, Schleicher J, Erbersdobler A, Jahn G, Kanz L, Bethge W. [Allogeneic stem cell transplantation for acute myeloid leukemia and HIV infection--case 3/2012]. Dtsch Med Wochenschr 2012; 137:495. [PMID: 22374660 DOI: 10.1055/s-0031-1299022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 27-year-old male patient with a past medical history of HIV presented with acute myeloid leukemia for allogeneic hematopoietic stem cell transplantation (HSCT). Highly active anti-retroviral therapy suppressed the viral load below detection threshold. INVESTIGATIONS There were no contraindications for allogeneic HSCT. TREATMENT AND COURSE Myeloablative conditioning consisted of total body irradiation and cyclophosphamide. Anti-thymocyte globulin, tacrolimus and mycophenolate mofetil were used for immunosuppression. Combined anti-retroviral therapy (nucleoside and nucleotide analog reverse-transcriptase inhibitor, boostered protease inhibitor, maraviroc and raltegravir) was maintained for allogeneic HSCT and viral load remained below detection threshold. No graft-versus-host disease or serious infectious complications occurred. The patient showed good graft function with stable hematopoiesis. Localized Kaposi's sarcoma was diagnosed six months after allogeneic HSCT and treated successfully with surgical excision and reduction of immunosuppression. Almost one year after allogeneic HSCT, the CD4+ cell count is rising and viral load remains below detection threshold with combined anti-retroviral therapy. CONCLUSION Allogeneic HSCT can be safely performed in HIV positive patients. Kaposi's sarcoma is a rare event after allogeneic HSCT and linked to strong immunosuppression.
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Affiliation(s)
- D Schneidawind
- Abteilung für Hämatologie, Onkologie, Immunologie, Rheumatologie und Pulmologie, Medizinische Universitätsklinik Tübingen
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Fehm T, Kurth R, Lengerke C, Bareiss PM, Scheble V, Müller F, Schneider F, Wallwiener D, Kanz L, Fend F, Perner S, Staebler A, Neubauer H. Expression of the embryonic stem cell marker SOX2 in breast carcinoma. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286421] [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: 10/17/2022] Open
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Lawrenz B, Fehm T, Neunhoeffer E, Soekler M, Kanz L, Henes M, Mayer F. Fertilitätserhalt bei jungen Lymphom-Patientinnen: Implementierung in die klinische Routine. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286488] [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: 10/17/2022] Open
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Frank S, Meisinger I, Marckmann G, Kopp H, Kanz L, Wickert M, Mayer F. The patients’ perspective on maintanance therapy (MT): Results of a survey applying a semistructured interview. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19653] [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: 11/20/2022] Open
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29
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Müssig K, Staiger H, Kantartzis K, Fritsche A, Kanz L, Häring HU. Type 2 diabetes mellitus and risk of malignancy: is there a strategy to identify a subphenotype of patients with increased susceptibility to endogenous and exogenous hyperinsulinism? Diabet Med 2011; 28:276-86. [PMID: 21309835 DOI: 10.1111/j.1464-5491.2010.03132.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To give an overview on the relationship between diabetes mellitus and increased cancer risk. METHODS We identified studies evaluating the association between diabetes mellitus, its treatment with insulin and insulin analogues and malignancies, paying special attention to studies on in vitro and in vivo effects of the long-acting analogue insulin glargine. RESULTS Even although the pathophysiological mechanisms underlying the relationship between elevated cancer risk and Type 2 diabetes mellitus are not completely understood, hyperinsulinaemia in the presence of insulin resistance appears to be a key factor. Because of the mitogenic actions of insulin at high concentrations, hyperinsulinaemia may favour tumorigenesis. In line with this, an insulin-based therapy is associated with an increased cancer risk, whereas an insulin-sensitizing treatment results in a cancer risk reduction. Furthermore, alterations of the insulin receptor profile on tumour cells may contribute to an enhanced susceptibility towards insulin. Studies on the analogue insulin glargine have been controversial. In vitro data pointed to an elevated mitogenicity of insulin glargine, whereas in vivo data did not confirm cancerogenous effects. Moreover, recently published clinical studies on the association of insulin glargine (Lantus®) and cancer suggest that treatment with insulin glargine is not associated with increased cancer risk. CONCLUSIONS The relationship between elevated cancer risk and Type 2 diabetes mellitus has been shown by numerous epidemiological studies, with endogenous and exogenous hyperinsulinaemia in the presence of insulin resistance as potential underlying pathophysiological mechanisms. Recent clinical studies do not support an increased cancer risk in patients treated with insulin glargine.
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Affiliation(s)
- K Müssig
- Department of Internal Medicine, Eberhard Karls University, Member of the German Center for Diabetes Research, Tübingen, Germany
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Federmann B, Hägele M, Pfeiffer M, Wirths S, Schumm M, Faul C, Vogel W, Handgretinger R, Kanz L, Bethge WA. Immune reconstitution after haploidentical hematopoietic cell transplantation: impact of reduced intensity conditioning and CD3/CD19 depleted grafts. Leukemia 2010; 25:121-9. [PMID: 20944677 DOI: 10.1038/leu.2010.235] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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31
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Thiel E, Korfel A, Martus P, Kanz L, Griesinger F, Rauch M, Fischer L, Pietsch T, Bamberg M, Weller M. Should whole-brain radiotherapy be considered standard of care in newly diagnosed primary central nervous system lymphoma? The G-PCNSL-SG1 randomized phase IV trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kopp H, Krauss K, Fehm TN, Staebler A, Zahm J, Kanz L, Mayer F. Bone marrow carcinosis in breast cancer: Clinical presentation, treatment, and prognosis—A single institution review of 22 cases. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e11514] [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: 11/20/2022] Open
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Müssig K, Staiger H, Kantartzis K, Fritsche A, Kanz L, Häring HU. Diabetes, Insulin, Insulinanaloga und Karzinome. Dtsch Med Wochenschr 2010; 135:924-9. [DOI: 10.1055/s-0030-1253681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Henes JC, Kanz L, Koetter I. Rituximab and leflunomide for Wegener’s granulomatosis: a long-term follow-up. Rheumatol Int 2010; 31:425-6. [PMID: 20349065 DOI: 10.1007/s00296-010-1462-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 03/12/2010] [Indexed: 11/29/2022]
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Sauter AW, Boss A, Kolb A, Mantlik M, Bethge W, Kanz L, Pfannenberg C, Stegger L, Pichler B, Claussen C, Horger M. Erste Erfahrungen bei der Beurteilung hämato-onkologischer Krankheitsmanifestationen an den Extremitäten mit einem PET/MRT-Hybridsystem. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1253047] [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: 10/19/2022]
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Hetzel J, Horger M, Spengler W, Aebert H, Kanz L, Müssig K. Diagnostik und Therapie parapneumonischer Pleuraergüsse – Fall 10/2009. Dtsch Med Wochenschr 2009; 134:2341. [DOI: 10.1055/s-0028-1082834] [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: 10/20/2022]
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Diehl V, Haverkamp H, Mueller R, Mueller-Hermelink H, Cerny T, Markova J, Ho AD, Kanz L, Greil R, Engert A. Eight cycles of BEACOPP escalated compared with 4 cycles of BEACOPP escalated followed by 4 cycles of BEACOPP baseline with or without radiotherapy in patients in advanced stage Hodgkin lymphoma (HL): Final analysis of the HD12 trial of the German Hodgkin Study Group (GHSG). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8544] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8544 Background: The GHSG HD9 trial had established BEACOPP escalated (BE) as new standard of care for advanced-stage HL patients. The successor study, HD12, evaluated a possible reduction in toxicity by comparing 8 cycles of BE with 4 cycles BE followed by 4 cycles BB. The second question in this trial related to the need of additional radiotherapy (RT) to initial bulk and residual disease. Methods: HL patients in stage IIB with large mediastinal mass and/or E-lesions or stage III/IV were randomised according to a 2x2-factorial design between: 8BE + RT, 8BE no RT, 4BE+4BB + RT, 4BE+4BB no RT. Primary endpoint of the trial was FFTF. Between 9/1999 and 1/2003, a total of 1,670 patients aged 16–65 were randomized. For this final analysis at a median follow up of 78 months, 99 patients were excluded for various reasons resulting in 1,571 eligible patients. Results: Patient characteristics in the 4 groups were comparable. Treatment-related toxicity of WHO grade III/IV was observed in 97% of patients. Most prominent differences between pooled chemotherapy arms were anemia (65% 8BE vs 51% 4BE+4BB) and thrombopenia (65% vs 51%). Treatment outcome: complete remission 92.4%; early progression 2.2%; progression/relapse 7.8% (6.6% and 8.5%). A total of 156 (9.9%) deaths (72 vs 84) have been observed (22 vs 32 acute or salvage treatment toxicity; 15 vs 24 HL; 22 vs 13 secondary neoplasia). Most treatment related deaths occurred in the >60 years age group, the first 4 cycles and the IPS> 3 RF groups. Secondary neoplasias were observed in 77 patients (4.9%). At 5 years, OS was 91%, FFTF 85.5% and progression free survival (PFS) 86.2% (Kaplan-Meier estimates). Estimates for the difference at 5 years are 1.8% for OS, 2.3% for FFTF and 2.7% for PFS favoring BE. However, there was no statistical difference between 8x BE and 4BE+4BB in all outcome parameters (p>0.19, log rank test). There is also no significant difference between the RT or no-RT arms in this study. Conclusions: The adoption of 4BE+4BB as a new standard in the future GHSG studies will depend on a refined analysis of the total data set and will be presented. No significant financial relationships to disclose.
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Affiliation(s)
- V. Diehl
- German Hodgkin Study Group, University of Cologne; Klinik I Fur Innere Medizin, Koln, Lindenthal, Germany; Department of Radiotherapy, University of Cologne, Cologne, Germany; Institute of Pathology, University of Wuerzburg, Wuerzburg, Germany; Department of Internal Medicine, Kantonsspital, St. Gallen, Switzerland; Department of Hematology, University of Prague, Prague, Czech Republic; Department of Hematology and Oncology, University, Heidelberg, Germany; Department of Internal Medicine, University of
| | - H. Haverkamp
- German Hodgkin Study Group, University of Cologne; Klinik I Fur Innere Medizin, Koln, Lindenthal, Germany; Department of Radiotherapy, University of Cologne, Cologne, Germany; Institute of Pathology, University of Wuerzburg, Wuerzburg, Germany; Department of Internal Medicine, Kantonsspital, St. Gallen, Switzerland; Department of Hematology, University of Prague, Prague, Czech Republic; Department of Hematology and Oncology, University, Heidelberg, Germany; Department of Internal Medicine, University of
| | - R. Mueller
- German Hodgkin Study Group, University of Cologne; Klinik I Fur Innere Medizin, Koln, Lindenthal, Germany; Department of Radiotherapy, University of Cologne, Cologne, Germany; Institute of Pathology, University of Wuerzburg, Wuerzburg, Germany; Department of Internal Medicine, Kantonsspital, St. Gallen, Switzerland; Department of Hematology, University of Prague, Prague, Czech Republic; Department of Hematology and Oncology, University, Heidelberg, Germany; Department of Internal Medicine, University of
| | - H. Mueller-Hermelink
- German Hodgkin Study Group, University of Cologne; Klinik I Fur Innere Medizin, Koln, Lindenthal, Germany; Department of Radiotherapy, University of Cologne, Cologne, Germany; Institute of Pathology, University of Wuerzburg, Wuerzburg, Germany; Department of Internal Medicine, Kantonsspital, St. Gallen, Switzerland; Department of Hematology, University of Prague, Prague, Czech Republic; Department of Hematology and Oncology, University, Heidelberg, Germany; Department of Internal Medicine, University of
| | - T. Cerny
- German Hodgkin Study Group, University of Cologne; Klinik I Fur Innere Medizin, Koln, Lindenthal, Germany; Department of Radiotherapy, University of Cologne, Cologne, Germany; Institute of Pathology, University of Wuerzburg, Wuerzburg, Germany; Department of Internal Medicine, Kantonsspital, St. Gallen, Switzerland; Department of Hematology, University of Prague, Prague, Czech Republic; Department of Hematology and Oncology, University, Heidelberg, Germany; Department of Internal Medicine, University of
| | - J. Markova
- German Hodgkin Study Group, University of Cologne; Klinik I Fur Innere Medizin, Koln, Lindenthal, Germany; Department of Radiotherapy, University of Cologne, Cologne, Germany; Institute of Pathology, University of Wuerzburg, Wuerzburg, Germany; Department of Internal Medicine, Kantonsspital, St. Gallen, Switzerland; Department of Hematology, University of Prague, Prague, Czech Republic; Department of Hematology and Oncology, University, Heidelberg, Germany; Department of Internal Medicine, University of
| | - A. D. Ho
- German Hodgkin Study Group, University of Cologne; Klinik I Fur Innere Medizin, Koln, Lindenthal, Germany; Department of Radiotherapy, University of Cologne, Cologne, Germany; Institute of Pathology, University of Wuerzburg, Wuerzburg, Germany; Department of Internal Medicine, Kantonsspital, St. Gallen, Switzerland; Department of Hematology, University of Prague, Prague, Czech Republic; Department of Hematology and Oncology, University, Heidelberg, Germany; Department of Internal Medicine, University of
| | - L. Kanz
- German Hodgkin Study Group, University of Cologne; Klinik I Fur Innere Medizin, Koln, Lindenthal, Germany; Department of Radiotherapy, University of Cologne, Cologne, Germany; Institute of Pathology, University of Wuerzburg, Wuerzburg, Germany; Department of Internal Medicine, Kantonsspital, St. Gallen, Switzerland; Department of Hematology, University of Prague, Prague, Czech Republic; Department of Hematology and Oncology, University, Heidelberg, Germany; Department of Internal Medicine, University of
| | - R. Greil
- German Hodgkin Study Group, University of Cologne; Klinik I Fur Innere Medizin, Koln, Lindenthal, Germany; Department of Radiotherapy, University of Cologne, Cologne, Germany; Institute of Pathology, University of Wuerzburg, Wuerzburg, Germany; Department of Internal Medicine, Kantonsspital, St. Gallen, Switzerland; Department of Hematology, University of Prague, Prague, Czech Republic; Department of Hematology and Oncology, University, Heidelberg, Germany; Department of Internal Medicine, University of
| | - A. Engert
- German Hodgkin Study Group, University of Cologne; Klinik I Fur Innere Medizin, Koln, Lindenthal, Germany; Department of Radiotherapy, University of Cologne, Cologne, Germany; Institute of Pathology, University of Wuerzburg, Wuerzburg, Germany; Department of Internal Medicine, Kantonsspital, St. Gallen, Switzerland; Department of Hematology, University of Prague, Prague, Czech Republic; Department of Hematology and Oncology, University, Heidelberg, Germany; Department of Internal Medicine, University of
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Hartmann JT, Aschoff P, Dittmann H, Lichy M, Mayer F, Reischl G, von Weyhern C, Kanz L, Claussen CD, Pfannenberg C. The value of PET/CT with 18F-FLT and 18F-FDG in the management of metastatic germ cell tumors (GCT): A pilot study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16142 Background: The purpose is to assess the ability of [F-18]-3’-Fluoro-3’-deoxythymidin (FLT), a cell proliferation marker, for early response monitoring and prediction of histology of residual tumor masses in patients (pts) with metastatic GCT in comparison to the standard tracer F-18-FDG, CT-scans and tumor markers. Methods: 11 male pts, age 23–48 yrs, with metastatic GCT were evaluated with both FDG- and FLT-PET/CT prior to chemotherapy (CTh), after the first cycle (early response) and 3 weeks after completion of induction CTh. PET was analyzed visually and quantitatively. The results were validated by histopathology of resected residual masses after CTh in 7 pts or by clinical follow-up for at least 6 mos in 4 pts. Presence of necrosis was judged as responder, as well as CR/PRm- within a minimum progression-free interval (PFI) of 6 mos. In case of multiple resections, the worse histology was taken into account. Regarding early tumor response EORTC criterias were used. Results: 8 out of 11 pts had a PFI > 6 mos (range, 206–1337 days). Examination of resected masses revealed necrosis in 3/7, teratoma in 2/7 as well as 2/7 pts with viable tumors. Prior to CTh the reference lesions showed increased FDG uptake (SUVrange/mean, 2.9–15.0/8.8) in all pts but moderate FLT uptake (SUVrange/mean, 1.7–9.7/3.7) in 10 out of 11 pts. SUVavg decrease in early response FDG monitoring was 64% in responders and 60% in non-responders (p = 0.8), as well as 57% vs. 48% for FLT (p = 0.5), respectively, and 85% vs. 72% (FDG, p = 0.1) and 67% vs. 65% (FLT, p = 0.8) in the final monitoring. Results of early and final response were inconsistent in 6/11 pts in FDG and in 4/10 pts in FLT-PET. In 2 pts with teratoma false negative results in both FDG- and FLT-PET have been seen. The sensitivities, specificities, positive and negative predictive values (%) of FDG and FLT-PET for early and final response monitoring were 60/33/43/50, 60/80/75/67, 20/100/100/60, and 0/100/0/50, respectively. Conclusions: PET negative residual masses after CTh of metastatic GCT still require resection, since the low negative predictive value of FDG-PET cannot be improved by application of the proliferation marker FLT. No significant financial relationships to disclose.
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Affiliation(s)
- J. T. Hartmann
- Eberhard-Karls-University, Oncology and Hematology, Tuebingen, Germany; Eberhard-Karls-University, Radiology and Nuclear Medicine, Tuebingen, Germany; Eberhard-Karls-University, Radiopharmacy, Tuebingen, Germany; Eberhard-Karls-University, Pathology, Tuebingen, Germany
| | - P. Aschoff
- Eberhard-Karls-University, Oncology and Hematology, Tuebingen, Germany; Eberhard-Karls-University, Radiology and Nuclear Medicine, Tuebingen, Germany; Eberhard-Karls-University, Radiopharmacy, Tuebingen, Germany; Eberhard-Karls-University, Pathology, Tuebingen, Germany
| | - H. Dittmann
- Eberhard-Karls-University, Oncology and Hematology, Tuebingen, Germany; Eberhard-Karls-University, Radiology and Nuclear Medicine, Tuebingen, Germany; Eberhard-Karls-University, Radiopharmacy, Tuebingen, Germany; Eberhard-Karls-University, Pathology, Tuebingen, Germany
| | - M. Lichy
- Eberhard-Karls-University, Oncology and Hematology, Tuebingen, Germany; Eberhard-Karls-University, Radiology and Nuclear Medicine, Tuebingen, Germany; Eberhard-Karls-University, Radiopharmacy, Tuebingen, Germany; Eberhard-Karls-University, Pathology, Tuebingen, Germany
| | - F. Mayer
- Eberhard-Karls-University, Oncology and Hematology, Tuebingen, Germany; Eberhard-Karls-University, Radiology and Nuclear Medicine, Tuebingen, Germany; Eberhard-Karls-University, Radiopharmacy, Tuebingen, Germany; Eberhard-Karls-University, Pathology, Tuebingen, Germany
| | - G. Reischl
- Eberhard-Karls-University, Oncology and Hematology, Tuebingen, Germany; Eberhard-Karls-University, Radiology and Nuclear Medicine, Tuebingen, Germany; Eberhard-Karls-University, Radiopharmacy, Tuebingen, Germany; Eberhard-Karls-University, Pathology, Tuebingen, Germany
| | - C. von Weyhern
- Eberhard-Karls-University, Oncology and Hematology, Tuebingen, Germany; Eberhard-Karls-University, Radiology and Nuclear Medicine, Tuebingen, Germany; Eberhard-Karls-University, Radiopharmacy, Tuebingen, Germany; Eberhard-Karls-University, Pathology, Tuebingen, Germany
| | - L. Kanz
- Eberhard-Karls-University, Oncology and Hematology, Tuebingen, Germany; Eberhard-Karls-University, Radiology and Nuclear Medicine, Tuebingen, Germany; Eberhard-Karls-University, Radiopharmacy, Tuebingen, Germany; Eberhard-Karls-University, Pathology, Tuebingen, Germany
| | - C. D. Claussen
- Eberhard-Karls-University, Oncology and Hematology, Tuebingen, Germany; Eberhard-Karls-University, Radiology and Nuclear Medicine, Tuebingen, Germany; Eberhard-Karls-University, Radiopharmacy, Tuebingen, Germany; Eberhard-Karls-University, Pathology, Tuebingen, Germany
| | - C. Pfannenberg
- Eberhard-Karls-University, Oncology and Hematology, Tuebingen, Germany; Eberhard-Karls-University, Radiology and Nuclear Medicine, Tuebingen, Germany; Eberhard-Karls-University, Radiopharmacy, Tuebingen, Germany; Eberhard-Karls-University, Pathology, Tuebingen, Germany
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Mayer F, Weidmann J, Federmann B, Schwarz S, Hartmann JT, Kanz L, Bethge W. Clinical impact and follow-up of taste disturbances following myeloablative or nonmyeloablative chemotherapy and stem cell transplantation. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20609 Background: Stem cell transplantation (SCT) after myeloablative (MA) or non-myeloablative (NMA) chemotherapy is a successful treatment option for a variety of diseases. Although alterations of taste and smell are frequently encountered after these modalities, no systematic evaluation is available so far. Methods: A questionaire was developed covering aspects of the dietary pattern and changes in the perception of taste and smell. Clinical data were gathered from the charts. The study was approved by the institutional review board. Data of the first 100 of 200 planned patients’ (pts) are presented. Results: pts were surveyed after a median of 22 months from SCT (range 1–292), their age ranged from 20–76 years. Indications for SCT included acute leukemia (n=38), myeloproliferative disease (n=20), lymphoma (n=13), and others (n=29). Pts received an allogeneic graft after MA (n=48) or NMA (n=32) conditioning, 20 pts received an autologous one. 75% of pts reported moderate to severe changes in taste perception on a semiquantitative visual analogue scale during the acute phase of SCT with no differences between the three groups (73%, 79%, 75%). 28% of the pts reported a complete regression at the time of survey, 25% still suffered from moderate to severe changes. This finding was more prevalent after allogeneic SCT (30% after MA conditioning, 28% after NMA) compared to pts with autologous grafts (10%). Whereas pts without persisting changes in taste perception lost a median of 3 kg of body weight, pts suffering from severe changes lost 15 kg. Conclusions: Taste disturbances are a common after SCT. Symptoms are persistant in one third of the pts. In the allogeneic setting, no differences exist between MA and NMA conditioning. The lower incidence of persiting changes in taste perception after autologous SCT might be attributed to the absence of graft versus host disease or the dispensability of immunosuppression. Changes in taste perception correlate with weight loss. No significant financial relationships to disclose.
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Affiliation(s)
- F. Mayer
- University of Tuebingen Medical Center, Tuebingen, Germany; Hohenheim University, Stuttgart, Germany
| | - J. Weidmann
- University of Tuebingen Medical Center, Tuebingen, Germany; Hohenheim University, Stuttgart, Germany
| | - B. Federmann
- University of Tuebingen Medical Center, Tuebingen, Germany; Hohenheim University, Stuttgart, Germany
| | - S. Schwarz
- University of Tuebingen Medical Center, Tuebingen, Germany; Hohenheim University, Stuttgart, Germany
| | - J. T. Hartmann
- University of Tuebingen Medical Center, Tuebingen, Germany; Hohenheim University, Stuttgart, Germany
| | - L. Kanz
- University of Tuebingen Medical Center, Tuebingen, Germany; Hohenheim University, Stuttgart, Germany
| | - W. Bethge
- University of Tuebingen Medical Center, Tuebingen, Germany; Hohenheim University, Stuttgart, Germany
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Abstract
Transplantations of autologous or allogeneic stem cells from bone marrow or peripheral blood are preformed for the treatment of resistant autoimmune diseases. Data have been systematically collected since 1996. We describe the historical development of this procedure for autoimmune diseases, the possible mechanisms of action, the options for stem cell collection, purging and conditioning (high-dose chemotherapy, combination with monoclonal anti-T- or B-cell antibodies, total body irradiation), as well as the reported outcomes in the literature.
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Affiliation(s)
- I Kötter
- Abteilung Innere Medizin II, Medizinische Universitätsklinik Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
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Daikeler T, Waidelich HP, Melms A, Jakob A, Bauer J, Kanz L, Bokemeyer C, Einsele H. A 63-Year-Old Patient with Multicentric Castleman’s Disease and Severe Polyradiculitis. Oncol Res Treat 2009. [DOI: 10.1159/000219011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kanz L, Mayer F. Update 2009: Systematische Therapie von Lebermetastasen bei kolorektalen Karzinomen. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1220970] [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: 10/20/2022]
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Kanz L, Weisel K, Horger M. Multiples Myelom: Derzeitige Therapiestrategien und radiologisches Response-Monitoring. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1220974] [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: 10/20/2022]
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Hetzel J, Böckeler M, Hann von Weyhern C, Beyer T, Fend F, Kanz L. Wertigkeit der Imprintzytologie von Kryobiopsien in der Diagnostik endobronchialer Tumore. Pneumologie 2009. [DOI: 10.1055/s-0029-1213909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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45
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Henes JC, Heinzelmann F, Wacker A, Seelig HP, Klein R, Bornemann A, Faul C, Kanz L, Koetter I. Antisignal recognition particle-positive polymyositis successfully treated with myeloablative autologous stem cell transplantation. Ann Rheum Dis 2009; 68:447-8. [DOI: 10.1136/ard.2008.094755] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kopp HG, Yildirim S, Weisel KC, Kanz L, Vogel W. Contamination of autologous peripheral blood progenitor cell grafts predicts overall survival after high-dose chemotherapy in multiple myeloma. J Cancer Res Clin Oncol 2008; 135:637-42. [DOI: 10.1007/s00432-008-0499-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 10/01/2008] [Indexed: 11/29/2022]
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Horger M, Pereira P, Claussen CD, Kanz L, Vonthein R, Denecke B, Driessen C. Hyperattenuating bone marrow abnormalities in myeloma patients using whole-body non-enhanced low-dose MDCT: correlation with haematological parameters. Br J Radiol 2008; 81:386-96. [PMID: 18440943 DOI: 10.1259/bjr/21850180] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We aimed to establish the role of hyperattenuating medullary abnormalities detected by whole-body non-enhanced low-dose multidetector CT (WBLD-MDCT) in multiple myeloma (MM) patients referred for primary evaluation. 50 consecutive patients with untreated Stage I (n(I) = 11), Stage II (n(II) = 10) and Stage III (n(III) = 29) MM underwent WBLD-MDCT for staging. The number and size of osteolysis, as well as haematologic parameters including paraprotein and beta2-microglobulin levels, were assessed and related to the number, size and density of medullary abnormalities assumed to represent myeloma involvement. Bone marrow abnormalities were found in 2/11 (18%) Stage I, 6/10 (60%) Stage II and 20/29 (69%) Stage III myeloma patients, and did not parallel the incidence of osteolysis. Patients with medullary lesions had higher levels of immunoglobulin A (median, 4730 mg dl(-1) vs 1520 mg dl(-1)), light-chain proteinuria (median, 690 mg dl(-1) vs 214 mg dl(-1)) and IgG paraprotein (median, 3270 mg dl(-1) vs 2610 mg dl(-1)) compared with patients without medullary lesions. In patients with medullary abnormalities, levels of serum beta2-microglobulin were significantly higher than in patients without detectable marrow infiltrates (median, 4.3 mg dl(-1) vs 2.4 mg dl(-1); p = 0.0015). In conclusion, medullary abnormalities visualized by WBLD-MDCT are encountered in all stages of myeloma, including cases without osteolysis. They are associated with significantly elevated serum levels of paraprotein (reflecting tumour mass) and beta2-microglobulin, a prospective prognostic marker for myeloma. The nature and possible prognostic significance of medullary abnormalities detected by WBLD-MDCT therefore warrants further investigation.
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Affiliation(s)
- M Horger
- Department of Diagnostic Radiology, Eberhard-Karls University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
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Horger M, Weisel KC, Brodoefel H, Denecke B, Claussen CD, Kanz L. The importance of combined hematologic and CT diagnosis for monitoring response in patients with multiple myeloma treated with Bortezomib based therapy. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8597] [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: 11/20/2022] Open
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Hartmann JT, Bauer S, Schaedel S, Meisinger I, Bruecher BL, Kasper B, Kopp H, Kanz L, Mayer F, Gruenwald V. A non-comparative phase II study of pemetrexed in patients with pretreated soft tissue sarcoma: German Sarcoma Group/AIO 005. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.10575] [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: 11/20/2022] Open
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Schmidt SM, Haentschel M, Mueller MR, Wierecky J, Kanz L, Maksimovic O, Stenzl A, Brugger W, Pascolo S, Brossart P. Vaccinations with RNA coding for tumor associated antigens in advanced RCC patients—A phase I/II study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.3017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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