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Riedhammer C, Bassermann F, Besemer B, Bewarder M, Brunner F, Carpinteiro A, Einsele H, Faltin J, Frenking J, Gezer D, Goldman-Mazur S, Hänel M, Hoegner M, Kortuem KM, Krönke J, Kull M, Leitner T, Mann C, Mecklenbrauck R, Merz M, Morgner A, Nogai A, Raab MS, Teipel R, Wäsch R, Rasche L. Real-world analysis of teclistamab in 123 RRMM patients from Germany. Leukemia 2024; 38:365-371. [PMID: 38245601 PMCID: PMC10844072 DOI: 10.1038/s41375-024-02154-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/22/2024]
Abstract
Teclistamab, a B-cell maturation antigen (BCMA) × CD3 directed bispecific antibody, has shown high response rates and durable remissions in the MAJESTEC-1 trial in patients with relapsed and refractory multiple myeloma (RRMM). We retrospectively assessed efficacy and tolerability in 123 patients treated at 18 different German centers to determine whether outcome is comparable in the real-world setting. Most patients had triple-class (93%) or penta-drug (60%) refractory disease, 37% of patients had received BCMA-directed pretreatment including idecabtagene vicleucel (ide-cel) CAR-T cell therapy (21/123, 17.1%). With a follow-up of 5.5 months, we observed an overall response rate (ORR) of 59.3% and a median progression-free survival (PFS) of 8.7 months. In subgroup analyses, we found significantly lower ORR and median PFS in patients with extramedullary disease (37%/2.1 months), and/or an ISS of 3 (37%/1.3 months), and ide-cel pretreated patients (33%/1.8 months). Nonetheless, the duration of response in ide-cel pretreated patients was comparable to that of anti-BCMA naive patients. Infections and grade ≥3 cytopenias were the most frequent adverse events. In summary, we found that teclistamab exhibited a comparable efficacy and safety profile in the real-world setting as in the pivotal trial.
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Affiliation(s)
- C Riedhammer
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - F Bassermann
- Department of Medicine III, Klinikum rechts der Isar, TUM, Munich, Germany
| | - B Besemer
- Department of Hematology, Oncology, and Immunology, University Hospital of Tübingen, Tübingen, Germany
| | - M Bewarder
- Department of Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University Medical Center, Homburg, Germany
| | - F Brunner
- Department of Internal Medicine IV, University Hospital of Halle, Halle, Germany
| | - A Carpinteiro
- Department of Hematology and Stem Cell Transplantation, University Hospital of Essen, Essen, Germany
| | - H Einsele
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - J Faltin
- Department of Hematology and Stem Cell Transplantation, Helios-Klinik Berlin Buch, Berlin, Germany
| | - J Frenking
- Heidelberg Myeloma Center, Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - D Gezer
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
| | - S Goldman-Mazur
- Department of Hematology, Cell therapy and Hemostaseology, University Hospital of Leipzig, Leipzig, Germany
| | - M Hänel
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - M Hoegner
- Department of Medicine III, Klinikum rechts der Isar, TUM, Munich, Germany
| | - K M Kortuem
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - J Krönke
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M Kull
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - T Leitner
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - C Mann
- Department of Hematology, Oncology and Immunology, University Hospital of Gießen and Marburg, Marburg, Germany
| | - R Mecklenbrauck
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation Hannover Medical School, Hannover, Germany
| | - M Merz
- Department of Hematology, Cell therapy and Hemostaseology, University Hospital of Leipzig, Leipzig, Germany
| | - A Morgner
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - A Nogai
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M S Raab
- Heidelberg Myeloma Center, Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - R Teipel
- Department of Internal Medicine I, University Hospital of Dresden, Dresden, Germany
| | - R Wäsch
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - L Rasche
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany.
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Frontzek F, Ziepert M, Nickelsen M, Altmann B, Glaß B, Hänel M, Trümper L, Held G, Bentz M, Borchmann P, Dreyling M, Viardot A, Metzner B, Kroschinsky F, Staiger A, Ott G, Rosenwald A, Löffler M, Lenz G, Schmitz N. INTENSIVE IMMUNOCHEMOTHERAPY (R-CHOEP) VS HIGH-DOSE IMMUNOCHEMOTHERAPY (R-MegaCHOEP) IN YOUNG PATIENTS WITH AGGRESSIVE B-CELL LYMPHOMA: A 10-YEAR LONG-TERM FOLLOW-UP. Hematol Oncol 2019. [DOI: 10.1002/hon.104_2631] [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: 11/09/2022]
Affiliation(s)
- F. Frontzek
- Department of Hematology; Oncology and Pneumology, University Hospital Münster; Münster Germany
| | - M. Ziepert
- Institute for Informatics; Statistics and Epidemiology, University Leipzig; Leipzig Germany
| | - M. Nickelsen
- Oncology; Oncology Lerchenfeld, Hamburg; Germany
| | - B. Altmann
- Institute for Informatics; Statistics and Epidemiology, University Leipzig; Leipzig Germany
| | - B. Glaß
- Hematology and Stem Cell Transplantation; Helios-Klinikum Berlin-Buch; Berlin Germany
| | - M. Hänel
- Department of Internal Medicine III; Municipal Hospital Chemnitz; Chemnitz Germany
| | - L. Trümper
- Hematology and Oncology; University Göttingen; Göttingen Germany
| | - G. Held
- Departement of Internal Medicine I; Westpfalz-Klinikum GmbH; Kaiserlautern Germany
| | - M. Bentz
- Department of Internal Medicine III; Municipal Hospital Karlsruhe; Karlsruhe Germany
| | - P. Borchmann
- Department of Internal Medicine I; University Hospital Cologne; Cologne Germany
| | - M. Dreyling
- Department of Internal Medicine III; Ludwig-Maximilians University of München; München Germany
| | - A. Viardot
- Department of Internal Medicine III; University Hospital Ulm; Ulm Germany
| | - B. Metzner
- Oncology and Hematology; Hospital Oldenburg; Oldenburg Germany
| | - F. Kroschinsky
- Department Internal Medicine I; University Hospital Carl Gustav Carus; Dresden Germany
| | - A.M. Staiger
- Department of Clinical Pathology; Robert-Bosch Hospital; Stuttgart Germany
| | - G. Ott
- Department of Clinical Pathology; Robert-Bosch Hospital; Stuttgart Germany
| | - A. Rosenwald
- Institute of Pathology; University Würzburg; Würzburg Germany
| | - M. Löffler
- Institute for Informatics; Statistics and Epidemiology, University Leipzig; Leipzig Germany
| | - G. Lenz
- Department of Hematology; Oncology and Pneumology, University Hospital Münster; Münster Germany
| | - N. Schmitz
- Department of Hematology; Oncology and Pneumology, University Hospital Münster; Münster Germany
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Röllig C, Kramer M, Gabrecht M, Hänel M, Herbst R, Kaiser U, Schmitz N, Kullmer J, Fetscher S, Link H, Mantovani-Löffler L, Krümpelmann U, Neuhaus T, Heits F, Einsele H, Ritter B, Bornhäuser M, Schetelig J, Thiede C, Mohr B, Schaich M, Platzbecker U, Schäfer-Eckart K, Krämer A, Berdel W, Serve H, Ehninger G, Schuler U. Intermediate-dose cytarabine plus mitoxantrone versus standard-dose cytarabine plus daunorubicin for acute myeloid leukemia in elderly patients. Ann Oncol 2018; 29:973-978. [DOI: 10.1093/annonc/mdy030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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4
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Heidrich K, Thiede C, Schäfer-Eckart K, Schmitz N, Aulitzky WE, Krämer A, Rösler W, Hänel M, Einsele H, Baldus CD, Trappe RU, Stölzel F, Middeke JM, Röllig C, Taube F, Kramer M, Serve H, Berdel WE, Ehninger G, Bornhäuser M, Schetelig J. Allogeneic hematopoietic cell transplantation in intermediate risk acute myeloid leukemia negative for FLT3-ITD, NPM1- or biallelic CEBPA mutations. Ann Oncol 2018; 28:2793-2798. [PMID: 28945881 DOI: 10.1093/annonc/mdx500] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The value of allogeneic hematopoietic cell transplantation (alloHCT) as postremission treatment is not well defined for patients with intermediate-risk acute myeloid leukemia (AML) without FLT3-ITD, biallelic CEBPA-, or NPM1 mutations (here referred to as NPM1mut-neg/CEBPAdm-neg/FLT3-ITDneg AML) in first complete remission (CR1). Patients and methods We addressed this question using data from two prospective randomized controlled trials on intensive induction- and risk-stratified postremission therapy. The NPM1mut-neg/CEBPAdm-neg/FLT3-ITDneg AML subgroup comprised 497 patients, aged 18-60 years. Results In donor versus no-donor analyses, patients with a matched related donor had a longer relapse-free survival (HR 0.5; 95% CI 0.3-0.9, P = 0.02) and a trend toward better overall survival (HR 0.6, 95% CI 0.3-1.1, P = 0.08) compared with patients who received postremission chemotherapy. Notably, only 58% of patients in the donor group were transplanted in CR1. We therefore complemented the donor versus no-donor analysis with multivariable Cox regression analyses, where alloHCT was tested as a time-dependent covariate: overall survival (HR 0.58, 95% CI 0.37-0.9, P = 0.02) and relapse-free survival (HR 0.51, 95% CI 0.34-0.76; P = 0.001) for patients who received alloHCT compared with chemotherapy in CR1 were significantly longer. Conclusion Outside clinical trials, alloHCT should be the preferred postremission treatment of patients with intermediate risk NPM1mut-neg/CEBPAdm-neg/FLT3-ITDneg AML in CR1. Cinicaltrials.gov identifier NCT00180115, NCT00180102.
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Affiliation(s)
- K Heidrich
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden.
| | - C Thiede
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden
| | | | - N Schmitz
- Asklepios Hospital St. Georg, Hamburg
| | - W E Aulitzky
- Department of Hematology, Oncology and Palliative Care, Robert-Bosch-Hospital, Stuttgart
| | - A Krämer
- Department of Internal Medicine V, Medical University Clinic, Heidelberg
| | - W Rösler
- Medical Clinic 5, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - M Hänel
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz
| | - H Einsele
- Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg
| | - C D Baldus
- Division of Hematology, Oncology and Tumor Immunology, Medical Department, Charité-Universitätsmedizin Berlin, Berlin
| | - R U Trappe
- Medical Clinic II, DIAKO Ev. Diakonie-Krankenhaus gGmbH, Bremen
| | - F Stölzel
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden
| | - J M Middeke
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden
| | - C Röllig
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden
| | - F Taube
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden
| | - M Kramer
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden
| | - H Serve
- Medical Clinic II, University Hospital Frankfurt, Frankfurt
| | - W E Berdel
- Medical Clinic A, University Hospital Münster, Münster
| | - G Ehninger
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden
| | - M Bornhäuser
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden; National Center for Tumor Diseases, Dresden, Germany
| | - J Schetelig
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden
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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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Hoster E, Unterhalt M, Hänel M, Prange-Krex G, Forstpointner R, Florschütz A, Graeven U, Frickhofen N, Wulf G, Lengfelder E, Lerchenmüller C, Schlag R, Dierlamm J, Fischer Von Weikersthal L, Ahmed A, Harich H, Rosenwald A, Klapper W, Dreyling M, Hiddemann W, Herold M. RITUXIMAB MAINTENANCE VERSUS OBSERVATION AFTER IMMUNOCHEMOTHERAPY (R-CHOP, R-MCP, R-FCM) IN PREVIOUSLY UNTREATED FOLLICULAR LYMPHOMA: A RANDOMISED TRIAL OF GLSG AND OSHO. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- E. Hoster
- Medizinische Klinik III; Klinikum der Ludwig-Maximilians-Universität München; Munich Germany
| | - M. Unterhalt
- Medizinische Klinik III; Klinikum der Ludwig-Maximilians-Universität München; Munich Germany
| | - M. Hänel
- Klinik für Innere Medizin III; Klinikum Chemnitz; Chemnitz Germany
| | - G. Prange-Krex
- Innere Medizin, Hämatologie, Onkologie, Gemeinschaftspraxis; Dresden Germany
| | - R. Forstpointner
- Medizinische Klinik III; Klinikum der Ludwig-Maximilians-Universität München; Munich Germany
| | - A. Florschütz
- Klinik für Innere Medizin; Städtisches Klinikum Dessau; Dessau Germany
| | - U. Graeven
- Klinik für Hämatologie, Onkologie und Gastroenterologie; Kliniken Maria Hilf; Mönchengladbach Germany
| | - N. Frickhofen
- Klinik Innere Medizin III; HELIOS Dr. Horst Schmidt Kliniken Wiesbaden; Wiesbaden Germany
| | - G. Wulf
- Hämatologie und Medizinische Onkologie; Universitätsmedizin Göttingen; Göttingen Germany
| | - E. Lengfelder
- III. Medizinische Klinik; Klinikum Mannheim; Mannheim Germany
| | | | - R. Schlag
- Innere Medizin, Hämatologie u. Internistische Onkologie; Gemeinschaftspraxis; Würzburg Germany
| | - J. Dierlamm
- II. Medizinischen Klinik und Poliklinik; Universitätsklinikum Eppendorf; Hamburg Germany
| | | | - A. Ahmed
- Medizinische Klinik III; Städtisches Klinikum Braunschweig; Braunschweig Germany
| | - H. Harich
- Onkologie Hof, Medizinisches Versorgungszentrum; Hof Germany
| | - A. Rosenwald
- Institut für Pathologie; Universität Würzburg; Würzburg Germany
| | - W. Klapper
- Sektion Hämatopathologie und Lymphknotenregister; Universitätsklinikum Schleswig-Holstein; Kiel Germany
| | - M. Dreyling
- Medizinische Klinik III; Klinikum der Ludwig-Maximilians-Universität München; Munich Germany
| | - W. Hiddemann
- Medizinische Klinik III; Klinikum der Ludwig-Maximilians-Universität München; Munich Germany
| | - M. Herold
- Onkologisches Zentrum; HELIOS Klinikum Erfurt; Erfurt Germany
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7
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Huhn S, Weinhold N, Nickel J, Pritsch M, Hielscher T, Hummel M, Bertsch U, Huegle-Doerr B, Vogel M, Angermund R, Hänel M, Salwender HJ, Weisel K, Dürig J, Görner M, Kirchner H, Peter N, Graeven U, Lordick F, Hoffmann M, Reimer P, Blau IW, Jauch A, Dembowsky K, Möhler T, Wuchter P, Goldschmidt H. Circulating tumor cells as a biomarker for response to therapy in multiple myeloma patients treated within the GMMG-MM5 trial. Bone Marrow Transplant 2017; 52:1194-1198. [PMID: 28504661 PMCID: PMC5543255 DOI: 10.1038/bmt.2017.91] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S Huhn
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - N Weinhold
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Nickel
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - M Pritsch
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - T Hielscher
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - M Hummel
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - U Bertsch
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
| | - B Huegle-Doerr
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - M Vogel
- Janssen-Cilag, Neuss, Germany
| | | | - M Hänel
- Department of Internal Medicine III, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - H J Salwender
- Department of Hematology/Oncology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Weisel
- Department of Internal Medicine II-Hematology and Oncology, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - J Dürig
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - M Görner
- Department of Hematology, Oncology and Palliative Care, Community Hospital Bielefeld, Bielefeld, Germany
| | - H Kirchner
- Medical Clinic III Hematology and Oncology, Städt. Krankenhaus Siloah, Hannover, Germany
| | - N Peter
- 2nd Medical Department, Academic Teaching Hospital of the Charité, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - U Graeven
- Hematology, Oncology and Gastroenterology, Maria-Hilf-Krankenhaus, Mönchengladbach, Germany
| | - F Lordick
- 3rd Medical Department, Haematology and Oncology, Klinikum Braunschweig, Braunschweig, Germany.,University Cancer Center Leipzig (UCCL), University Medical Center Leipzig, Leipzig, Germany
| | - M Hoffmann
- Medical Clinic A, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein, Germany
| | - P Reimer
- Hematology, Oncology and Stem Cell Transplantation, Evangelisches Krankenhaus Essen-Werden gGmbH, Essen, Germany
| | - I W Blau
- Medical Clinic III Hematology and Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - A Jauch
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | | | - T Möhler
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,inVentiv Health, Boston, MA, USA
| | - P Wuchter
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,Institute of Transfusion Medicine and Immunology, German Red Cross Blood Service Baden-Württemberg-Hessen, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - H Goldschmidt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases Heidelberg, Heidelberg, Germany
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Link CS, Mies F, Scheele J, Kramer M, Schetelig J, Ordemann R, Hänel M, Bornhäuser M, Ehninger G, Kroschinsky F. Long-term follow-up of patients with relapsed or refractory non-Hodgkin's lymphoma receiving allogeneic stem cell transplantation. Bone Marrow Transplant 2016; 51:1527-1529. [PMID: 27295271 DOI: 10.1038/bmt.2016.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- C S Link
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - F Mies
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.,Klinik für Innere Medizin III, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - J Scheele
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - M Kramer
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - J Schetelig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - R Ordemann
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - M Hänel
- Klinik für Innere Medizin III, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - M Bornhäuser
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - G Ehninger
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - F Kroschinsky
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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9
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Kaifie A, Kirschner M, Wolf D, Maintz C, Hänel M, Gattermann N, Gökkurt E, Platzbecker U, Hollburg W, Göthert JR, Parmentier S, Lang F, Hansen R, Isfort S, Schmitt K, Jost E, Serve H, Ehninger G, Berdel WE, Brümmendorf TH, Koschmieder S. Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German SAL-MPN-registry. J Hematol Oncol 2016; 9:18. [PMID: 26944254 PMCID: PMC4779229 DOI: 10.1186/s13045-016-0242-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 02/10/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients with Ph-negative myeloproliferative neoplasms (MPN), such as polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are at increased risk for thrombosis/thromboembolism and major bleeding. Due to the morbidity and mortality of these events, antiplatelet and/or anticoagulant agents are commonly employed as primary and/or secondary prophylaxis. On the other hand, disease-related bleeding complications (i.e., from esophageal varices) are common in patients with MPN. This analysis was performed to define the frequency of such events, identify risk factors, and assess antiplatelet/anticoagulant therapy in a cohort of patients with MPN. METHODS The MPN registry of the Study Alliance Leukemia is a non-interventional prospective study including adult patients with an MPN according to WHO criteria (2008). For statistical analysis, descriptive methods and tests for significant differences as well as contingency tables were used to identify the odds of potential risk factors for vascular events. RESULTS MPN subgroups significantly differed in sex distribution, age at diagnosis, blood counts, LDH levels, JAK2V617F positivity, and spleen size (length). While most thromboembolic events occurred around the time of MPN diagnosis, one third of these events occurred after that date. Splanchnic vein thrombosis was most frequent in post-PV-MF and MPN-U patients. The chance of developing a thromboembolic event was significantly elevated if patients suffered from post-PV-MF (OR 3.43; 95% CI = 1.39-8.48) and splenomegaly (OR 1.76; 95% CI = 1.15-2.71). Significant odds for major bleeding were previous thromboembolic events (OR = 2.71; 95% CI = 1.36-5.40), splenomegaly (OR = 2.22; 95% CI 1.01-4.89), and the administration of heparin (OR = 5.64; 95% CI = 1.84-17.34). Major bleeding episodes were significantly less frequent in ET patients compared to other MPN subgroups. CONCLUSIONS Together, this report on an unselected "real-world" cohort of German MPN patients reveals important data on the prevalence, diagnosis, and treatment of thromboembolic and major bleeding complications of MPN.
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Affiliation(s)
- A. Kaifie
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - M. Kirschner
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - D. Wolf
- Internal Medicine 3, Oncology, Hematology and Rheumatology, University Clinic Bonn (UKB), Bonn, Germany
| | - C. Maintz
- Practice for Hematology and Oncology, Wuerselen, Germany
| | - M. Hänel
- Department for Hematology, Oncology, Stem Cell Transplantation, Hospital Chemnitz, Chemnitz, Germany
| | - N. Gattermann
- Department for Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - E. Gökkurt
- Practice for Hematology-Oncology Eppendorf, Hamburg, Germany
| | - U. Platzbecker
- Department for Hematology, University Hospital Dresden, Dresden, Germany
| | - W. Hollburg
- Practice for Hematology and Oncology Altona, Hamburg, Germany
| | - J. R. Göthert
- Department for Hematology, University Hospital Essen, Essen, Germany
| | - S. Parmentier
- Department for Hematology, Oncology and Palliative Care, Rems-Murr-Hospitals, Winnenden, Germany
| | - F. Lang
- Department for Hematology and Oncology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - R. Hansen
- Practice for Hematology and Oncology, Kaiserslautern, Germany
| | - S. Isfort
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - K. Schmitt
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - E. Jost
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - H. Serve
- Department for Hematology and Oncology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - G. Ehninger
- Department for Hematology, University Hospital Dresden, Dresden, Germany
| | - W. E. Berdel
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | - T. H. Brümmendorf
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - S. Koschmieder
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
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10
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Schneider-Schulze C, Hänel M, Schöning DV, Weichert A, Henrich W, Tucher EV. Fetales Fibronektin und Zervixlänge zur Prädiktion einer Frühgeburt bei symptomatischen Schwangeren. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566647] [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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11
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Müller-Tidow C, Tschanter P, Röllig C, Thiede C, Koschmieder A, Stelljes M, Koschmieder S, Dugas M, Gerss J, Butterfaß-Bahloul T, Wagner R, Eveslage M, Thiem U, Krause SW, Kaiser U, Kunzmann V, Steffen B, Noppeney R, Herr W, Baldus CD, Schmitz N, Götze K, Reichle A, Kaufmann M, Neubauer A, Schäfer-Eckart K, Hänel M, Peceny R, Frickhofen N, Kiehl M, Giagounidis A, Görner M, Repp R, Link H, Kiani A, Naumann R, Brümmendorf TH, Serve H, Ehninger G, Berdel WE, Krug U. Azacitidine in combination with intensive induction chemotherapy in older patients with acute myeloid leukemia: The AML-AZA trial of the Study Alliance Leukemia. Leukemia 2015; 30:555-61. [PMID: 26522083 DOI: 10.1038/leu.2015.306] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 11/09/2022]
Abstract
DNA methylation changes are a constant feature of acute myeloid leukemia. Hypomethylating drugs such as azacitidine are active in acute myeloid leukemia (AML) as monotherapy. Azacitidine monotherapy is not curative. The AML-AZA trial tested the hypothesis that DNA methyltransferase inhibitors such as azacitidine can improve chemotherapy outcome in AML. This randomized, controlled trial compared the efficacy of azacitidine applied before each cycle of intensive chemotherapy with chemotherapy alone in older patients with untreated AML. Event-free survival (EFS) was the primary end point. In total, 214 patients with a median age of 70 years were randomized to azacitidine/chemotherapy (arm-A) or chemotherapy (arm-B). More arm-A patients (39/105; 37%) than arm-B (25/109; 23%) showed adverse cytogenetics (P=0.057). Adverse events were more frequent in arm-A (15.44) versus 13.52 in arm-B, (P=0.26), but early death rates did not differ significantly (30-day mortality: 6% versus 5%, P=0.76). Median EFS was 6 months in both arms (P=0.96). Median overall survival was 15 months for patients in arm-A compared with 21 months in arm-B (P=0.35). Azacitidine added to standard chemotherapy increases toxicity in older patients with AML, but provides no additional benefit for unselected patients.
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Affiliation(s)
- C Müller-Tidow
- Department of Medicine, Hematology and Oncology, University of Halle, Halle, Germany.,Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany
| | - P Tschanter
- Department of Medicine, Hematology and Oncology, University of Halle, Halle, Germany.,Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany
| | - C Röllig
- Department of Internal Medicine I, Dresden University Medical Center, Dresden, Germany
| | - C Thiede
- Department of Internal Medicine I, Dresden University Medical Center, Dresden, Germany
| | - A Koschmieder
- Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany.,Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, RWTH Aachen University Hospital, Aachen, Germany
| | - M Stelljes
- Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany
| | - S Koschmieder
- Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany.,Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, RWTH Aachen University Hospital, Aachen, Germany
| | - M Dugas
- Institute of Medical Informatics, University Hospital of Muenster, Muenster, Germany
| | - J Gerss
- Institute of Biometry, University Hospital of Muenster, Muenster, Germany
| | | | - R Wagner
- Center for Clinical Trials, University Hospital Muenster, Muenster, Germany
| | - M Eveslage
- Institute of Biometry, University Hospital of Muenster, Muenster, Germany
| | - U Thiem
- Department of Medical Informatics, Biometry and Epidemiology, University Bochum, Bochum, Germany
| | - S W Krause
- Department of Internal Medicine 5, University of Erlangen-Nürnberg Medical Center, Erlangen, Germany
| | - U Kaiser
- Hematology and Oncology, St Bernward Hospital, Hildesheim, Germany
| | - V Kunzmann
- Department of Internal Medicine II, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - B Steffen
- Department of Medicine, Hematology/Oncology, Goethe University of Frankfurt, Frankfurt, Germany
| | - R Noppeney
- Department of Hematology, University of Essen Medical Center, Essen, Germany
| | - W Herr
- Department for Hematology/Oncology, University of Regensburg, Regensburg, Germany
| | - C D Baldus
- Department of Hematology and Oncology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - N Schmitz
- Department of Hematology and Stem Cell Transplantation, ASKLEPIOS Klinik St. Georg, Hamburg, Germany
| | - K Götze
- Department of Internal Medicine III, University Hospital of Munich, Munich, Germany
| | - A Reichle
- Department for Hematology/Oncology, University of Regensburg, Regensburg, Germany
| | - M Kaufmann
- Hematology and Oncology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - A Neubauer
- Department Hematology, Oncology and Immunology, Philipps University Marburg, Marburg, Germany
| | - K Schäfer-Eckart
- Department of Internal Medicine V, Klinikum Nuernberg Nord, Nuernberg, Germany
| | - M Hänel
- Department of Internal Medicine III, Klinikum Chemnitz GmbH, Chemnitz, Germany
| | - R Peceny
- Department of Hematology and Oncology, Klinikum Osnabrück, Osnabrück, Germany
| | - N Frickhofen
- Department of Hematology and Oncology, HSK, Dr -Horst-Schmidt-Klinik, Wiesbaden, Germany
| | - M Kiehl
- Department of Internal Medicine, Frankfurt (Oder) General hospital, Frankfurt/Oder, Germany
| | - A Giagounidis
- Department of Oncology and Hematology, Marien Hospital Düsseldorf, Duesseldorf, Germany
| | - M Görner
- Department of Hematology and Oncology, Städtische Kliniken, Bielefeld, Germany
| | - R Repp
- Department of Medicine V, Klinikum am Bruderwald, Bamberg, Germany
| | - H Link
- Department of Internal Medicine I, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - A Kiani
- Department IV Hematology and Onkology, Klinikum Bayreuth, Bayreuth, Germany
| | - R Naumann
- Department of Internal Medicine, Stiftungsklinikum Mittelrhein, Koblenz, Germany
| | - T H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, RWTH Aachen University Hospital, Aachen, Germany
| | - H Serve
- Department of Medicine, Hematology/Oncology, Goethe University of Frankfurt, Frankfurt, Germany
| | - G Ehninger
- Department of Internal Medicine I, Dresden University Medical Center, Dresden, Germany
| | - W E Berdel
- Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany
| | - U Krug
- Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany.,Department of Medicine, Hematology and Oncology, Klinikum Leverkusen, Leverkusen, Germany
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12
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Thiel A, Schetelig J, Pönisch W, Schäfer-Eckart K, Aulitzky W, Peter N, Schulze A, Maschmeyer G, Neugebauer S, Herbst R, Hänel A, Morgner A, Kroschinsky F, Bornhäuser M, Lange T, Wilhelm M, Niederwieser D, Ehninger G, Fiedler F, Hänel M. Mito-FLAG with Ara-C as bolus versus continuous infusion in recurrent or refractory AML—long-term results of a prospective randomized intergroup study of the East German Study Group Hematology/Oncology (OSHO) and the Study Alliance Leukemia (SAL). Ann Oncol 2015; 26:1434-40. [DOI: 10.1093/annonc/mdv205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 04/21/2015] [Indexed: 11/13/2022] Open
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13
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Murawski N, Pfreundschuh M, Zeynalova S, Poeschel V, Hänel M, Held G, Schmitz N, Viardot A, Schmidt C, Hallek M, Witzens-Harig M, Trümper L, Rixecker T, Zwick C. Optimization of rituximab for the treatment of DLBCL (I): dose-dense rituximab in the DENSE-R-CHOP-14 trial of the DSHNHL. Ann Oncol 2014; 25:1800-1806. [PMID: 24928834 DOI: 10.1093/annonc/mdu208] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND To improve outcome of elderly patients with diffuse large B-cell lymphoma, dose-dense rituximab was evaluated in the prospective DENSE-R-CHOP-14 trial. PATIENTS AND METHODS Rituximab (375 mg/m(2)) was given on days 0, 1, 4, 8, 15, 22, 29, 43, 57, 71, 85, and 99 together with six CHOP-14 cycles. Results were to be compared with patients who had received the same chemotherapy in combination with eight 2-week applications of rituximab in RICOVER-60. RESULTS One hundred twenty-four patients are assessable. Dose-dense rituximab resulted in considerably higher serum levels during the first 50 days of treatment, but rituximab exposure time was not prolonged. Grade 3 and 4 infections were exceptionally high in the first 20 patients without anti-infective prophylaxis, but decreased after introduction of prophylaxis with aciclovir and cotrimoxazole in the remaining 104 patients (from 13% to 6% per cycle and from 35% to 18% per patient; P = 0.007 and P = 0.125, respectively). Patients with international prognostic index = 3-5 had higher complete response/complete response unconfirmed rates (82% versus 68%; P = 0.033) than in the respective RICOVER-60 population, but this did not translate into better long-term outcome, even though male hazard was decreased (event-free survival: from 1.5 to 1.1; progression-free survival: from 1.7 to 1.1; overall survival: from 1.4 to 1.0). CONCLUSIONS Dose-dense rituximab achieved higher rituximab serum levels, but was not more effective than eight 2-week applications in the historical control population, even though minor improvements in poor-prognosis and male patients cannot be excluded. The increased, though manageable toxicity, precludes its use in routine practice. Our results strongly support anti-infective prophylaxis with aciclovir and cotrimoxazole for all patients receiving R-CHOP.
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MESH Headings
- Acyclovir/therapeutic use
- Aged
- Aged, 80 and over
- Aging
- Anti-Infective Agents/therapeutic use
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/blood
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiviral Agents/therapeutic use
- Communicable Disease Control
- Communicable Diseases/drug therapy
- Cyclophosphamide/therapeutic use
- Disease-Free Survival
- Doxorubicin/therapeutic use
- Drug Administration Schedule
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Male
- Middle Aged
- Prednisone/therapeutic use
- Prospective Studies
- Rituximab
- Treatment Outcome
- Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
- Vincristine/therapeutic use
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Affiliation(s)
- N Murawski
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg
| | - M Pfreundschuh
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg.
| | | | - V Poeschel
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg
| | - M Hänel
- Internal Medicine III, Klinikum Chemnitz, Chemnitz
| | - G Held
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg
| | - N Schmitz
- Department of Haematology, Oncology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg
| | - A Viardot
- Innere Medizin, Universitätsklinikum Ulm, Ulm
| | | | - M Hallek
- Universitätsklinik Köln, Cologne
| | | | - L Trümper
- Universitätsklinikum Göttingen, Göttingen, Germany
| | - T Rixecker
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg
| | - C Zwick
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg
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14
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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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15
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Zunft S, Hänel M, Krüger M, Dreißigacker V. A Design Study for Regenerator-type Heat Storage in Solar Tower Plants–Results and Conclusions of the HOTSPOT Project. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.egypro.2014.03.118] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hänel M, Ramsauer B, Vetter K. Zervixverschlussoperation – Ein Lehrvideo. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361377] [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: 10/26/2022]
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Hänel M, Ramsauer B, Vetter K. Die Forzepsentbindung – Ein Lehrvideo. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361378] [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: 10/26/2022]
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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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Hänel M. Reinigungskonzepte für öffentliche Bäder - Stand und Perspektiven der Arbeitsgruppe „Reinigung und Desinfektion in Bädern“. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1307321] [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: 10/28/2022]
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Clemens LM, Ramsauer B, Vetter K, Hänel M. Uterustorsion in der Schwangerschaft nach einem Reitunfall. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293426] [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: 10/15/2022]
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Goeckenjan M, Hänel M, Koessler J, Schäfer-Graf U, Vetter K. Trainingsprogramm für Schwangere mit Gestationsdiabetes (DVD). Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089236] [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] Open
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23
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Goeckenjan M, Hänel M, Henz C, Hüwelmeier D, Sohn C. Stillen–eine Herausforderung. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1002810] [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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24
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Hänel M, Goeckenjan M, Steckel R, Vetter K. Die Technik der Sectio caesarea–ein Lehrfilm. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1002809] [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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Goeckenjan M, Hänel M, Maltzan AV, Schöndorf-Holland E, Schäfer-Graf U, Vetter K. Schwangerschaftsdiabetes – mit Bewegung geht es leichter. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1002807] [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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Kilavuz Ö, Hänel M, Vetter K. Der Weg zum optimalen Dopplersonogramm. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952163] [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] Open
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Goeckenjan M, Hänel M, Schöndorf-Holland E, Maul H, Beyer P, Sohn C. Informationsfilm zur Pränataldiagnostik. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952161] [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] Open
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Goeckenjan M, Hänel M, Steckel R, Schöndorf-Holland E, Maul H, Sohn C. Praktisches Lernen im Studium: Ein Trainings-Modell zur Durchführung einer Sectio caesarea. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952162] [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] Open
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Hänel M, Goeckenjan M, Henz C, Maul H, Vetter K. Stillen – eine Herausforderung. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952169] [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] Open
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Platzbecker U, Thiede C, Füssel M, Geissler G, Illmer T, Mohr B, Hänel M, Mahlberg R, Krümpelmann U, Weissinger F, Schaich M, Theuser C, Ehninger G, Bornhäuser M. Reduced intensity conditioning allows for up-front allogeneic hematopoietic stem cell transplantation after cytoreductive induction therapy in newly-diagnosed high-risk acute myeloid leukemia. Leukemia 2006; 20:707-14. [PMID: 16482208 DOI: 10.1038/sj.leu.2404143] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is substantial need to improve the outcome of patients with high-risk acute myeloid leukemia (AML). The clinical trial reported here investigated a new approach of up-front allogeneic hematopoietic stem cell transplantation (HSCT), provided a median of 40 days (range 22-74) after diagnosis, in twenty-six consecutive patients with newly-diagnosed high-risk AML characterized by poor-risk cytogenetics (n = 19) or inadequate blast clearance by induction chemotherapy (IC, n = 7). The median age was 49 years (range 17-68). During IC-induced aplasia after the 1st (n = 11) or 2nd (n = 15) cycle, patients received allogeneic peripheral blood stem cells (PBSC) from related (n = 11) or unrelated (n = 15) donors following a fludarabine-based reduced-intensity regimen. Seventeen patients were not in remission before HSCT with a median marrow blast count of 34% (range 6-70). All patients achieved rapid engraftment and went into remission with complete myeloid and lymphatic chimerism. Grades II to IV acute GvHD occurred in 14 (56%) and extensive chronic GvHD was documented in 8 (35%) patients. The probability of disease-free survival was 61% with only three patients relapsing 5, 6 and 7 months after transplantation, respectively. Up-front allogeneic HSCT as part of primary induction therapy seems to be an effective strategy in high-risk AML patients and warrants further investigation.
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Affiliation(s)
- U Platzbecker
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
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Dreyling M, Forstpointner R, Gramatzki M, Böck H, Hänel M, Seymour J, Planker M, Dührsen U, Wilms K, Unterhalt M, Hiddemann W. Rituximab maintenance improves progression-free and overall survival rates after combined immuno-chemotherapy (R-FCM) in patients with relapsed follicular and mantle cell lymphoma: Final results of a prospective randomized trial of the German Low Grade Lymphoma Study Group (GLSG). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7502] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7502 Background: Rituximab (R) prolongs the progression-free survival (PFS) in patients with follicular lymphoma (FL) when given either simultaneously with or as maintenance after chemotherapy only. Methods: In the current study the impact of R maintenance after remission induction with an R-containing combined immuno-chemotherapy (R-FCM) was evaluated. Patients with advanced stage relapsed or refractory FL and mantle cell lymphoma (MCL) were eligible. The study design comprized 4 courses of chemotherapy with Fludarabine (25 mg/m2/d days 1–3), Cyclophosphamide (200 mg/m2/d days 1–3) and Mitoxantrone (8 mg/m2/d day 1) (FCM) ± Rituximab (375 mg/m2/d day 0). Patients entering a complete (CR) or partial remission (PR) underwent a second randomization for R maintenance (4 weekly doses (375 mg/m2/d) at three and nine months after end of induction) or observation only. Randomization was stratified for histology, prior therapies (up to 2 lines vs. >2), induction (±R), and response (CR vs. PR). After improved outcome of the R-FCM arm had been observed in the initial 147 randomized patients, all subsequent patients received a combined immuno-chemotherapy induction. Results: 176 of 195 randomized cases are evaluable, 138 of whom had received an R-containing induction. In these patients (as well as the total group) the median PFS after end of induction has not been reached in the R-maintenance arm in contrast to 17 months in patients with no further treatment (p = 0.001). This improvement was seen both in FL (n = 81; p = 0,035) and MCL (n = 47; p = 0,049). More importantly, overall survival rate was also improved after R maintenance with borderline significance (3 y rate 82% vs. 55%; p = 0,056). No major sided effects of R maintenance have been observed and the rate of serious infections was similar in both study arms (p = 0.72). Conclusions: The final analysis of this study confirms that R maintenance after combined immuno-chemotherapy (R-FCM) is highly effective and improves the progression-free survival—with a strong trend towards improved overall survival—of patients with relapsed FL and MCL. [Table: see text]
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Affiliation(s)
- M. Dreyling
- University Hospital Grosshadern, Munich, Germany; University Hospital, Kiel, Germany; Practice, Offenbach, Germany; Hospital Küchwald, Chemnitz, Germany; Peter MacCallum Cancer Institute, East Melbourne, Australia; Hospital, Krefeld, Germany; University Hospital, Essen, Germany; University Hospital, Würzburg, Germany
| | - R. Forstpointner
- University Hospital Grosshadern, Munich, Germany; University Hospital, Kiel, Germany; Practice, Offenbach, Germany; Hospital Küchwald, Chemnitz, Germany; Peter MacCallum Cancer Institute, East Melbourne, Australia; Hospital, Krefeld, Germany; University Hospital, Essen, Germany; University Hospital, Würzburg, Germany
| | - M. Gramatzki
- University Hospital Grosshadern, Munich, Germany; University Hospital, Kiel, Germany; Practice, Offenbach, Germany; Hospital Küchwald, Chemnitz, Germany; Peter MacCallum Cancer Institute, East Melbourne, Australia; Hospital, Krefeld, Germany; University Hospital, Essen, Germany; University Hospital, Würzburg, Germany
| | - H. Böck
- University Hospital Grosshadern, Munich, Germany; University Hospital, Kiel, Germany; Practice, Offenbach, Germany; Hospital Küchwald, Chemnitz, Germany; Peter MacCallum Cancer Institute, East Melbourne, Australia; Hospital, Krefeld, Germany; University Hospital, Essen, Germany; University Hospital, Würzburg, Germany
| | - M. Hänel
- University Hospital Grosshadern, Munich, Germany; University Hospital, Kiel, Germany; Practice, Offenbach, Germany; Hospital Küchwald, Chemnitz, Germany; Peter MacCallum Cancer Institute, East Melbourne, Australia; Hospital, Krefeld, Germany; University Hospital, Essen, Germany; University Hospital, Würzburg, Germany
| | - J. Seymour
- University Hospital Grosshadern, Munich, Germany; University Hospital, Kiel, Germany; Practice, Offenbach, Germany; Hospital Küchwald, Chemnitz, Germany; Peter MacCallum Cancer Institute, East Melbourne, Australia; Hospital, Krefeld, Germany; University Hospital, Essen, Germany; University Hospital, Würzburg, Germany
| | - M. Planker
- University Hospital Grosshadern, Munich, Germany; University Hospital, Kiel, Germany; Practice, Offenbach, Germany; Hospital Küchwald, Chemnitz, Germany; Peter MacCallum Cancer Institute, East Melbourne, Australia; Hospital, Krefeld, Germany; University Hospital, Essen, Germany; University Hospital, Würzburg, Germany
| | - U. Dührsen
- University Hospital Grosshadern, Munich, Germany; University Hospital, Kiel, Germany; Practice, Offenbach, Germany; Hospital Küchwald, Chemnitz, Germany; Peter MacCallum Cancer Institute, East Melbourne, Australia; Hospital, Krefeld, Germany; University Hospital, Essen, Germany; University Hospital, Würzburg, Germany
| | - K. Wilms
- University Hospital Grosshadern, Munich, Germany; University Hospital, Kiel, Germany; Practice, Offenbach, Germany; Hospital Küchwald, Chemnitz, Germany; Peter MacCallum Cancer Institute, East Melbourne, Australia; Hospital, Krefeld, Germany; University Hospital, Essen, Germany; University Hospital, Würzburg, Germany
| | - M. Unterhalt
- University Hospital Grosshadern, Munich, Germany; University Hospital, Kiel, Germany; Practice, Offenbach, Germany; Hospital Küchwald, Chemnitz, Germany; Peter MacCallum Cancer Institute, East Melbourne, Australia; Hospital, Krefeld, Germany; University Hospital, Essen, Germany; University Hospital, Würzburg, Germany
| | - W. Hiddemann
- University Hospital Grosshadern, Munich, Germany; University Hospital, Kiel, Germany; Practice, Offenbach, Germany; Hospital Küchwald, Chemnitz, Germany; Peter MacCallum Cancer Institute, East Melbourne, Australia; Hospital, Krefeld, Germany; University Hospital, Essen, Germany; University Hospital, Würzburg, Germany
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Strodtbeck D, Bornhäuser M, Hänel M, Lerche L, Schaich M, Illmer T, Thiede C, Geissler G, Herbst R, Ehninger G, Platzbecker U. Graft clonogenicity and intensity of pre-treatment: factors affecting outcome of autologous peripheral hematopoietic cell transplantation in patients with acute myeloid leukemia in first remission. Bone Marrow Transplant 2006; 36:1083-8. [PMID: 16247435 DOI: 10.1038/sj.bmt.1705176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A total of 22 patients with acute myeloid leukemia (AML) in first complete remission receiving autologous blood stem cell transplantation (ABSCT) were investigated in order to determine factors affecting outcome. All but two patients had a normal karyotype and received the same high-dose chemotherapy followed by G-CSF-mobilized peripheral blood stem cells after the second (n=5) or third (n=17) course of induction and post-remission chemotherapy, respectively. With a median follow-up of 30 months, the median disease-free survival is 24.1 months. Univariate analysis showed that three chemotherapy cycles before ABSCT were associated with a significant better disease-free survival (P=0.0018) and overall survival (P=0.0033), whereas the presence of an FLT3-mutation (n=6) showed no impact. The number of megakaryocytic progenitors (CFU-MK) infused tended to correlate with primary platelet engraftment (P=0.07) and were predictive for neutrophil (P=0.011) and platelet counts (P=0.009) 180 days after transplantation. Patients receiving a higher amount of CFU-MK had a better event-free survival (P=0.02). Our data suggest that the content of CFU-MK within the graft predicts the quality of hematological recovery and long-term disease control. Additionally, a minimum of three chemotherapy cycles before ABSCT seems to be associated with an improved outcome.
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Affiliation(s)
- D Strodtbeck
- Medizinische Klinik und Poliklinik I, Universitätsklinikum 'Carl Gustav Carus', Dresden, Germany
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Stark K, Hänel M, Berg T, Schreier E. Nosocomial transmission of hepatitis C virus from an anesthesiologist to three patients – epidemiologic and molecular evidence. Arch Virol 2005; 151:1025-30. [PMID: 16329003 DOI: 10.1007/s00705-005-0674-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Accepted: 09/29/2005] [Indexed: 10/25/2022]
Abstract
Acute hepatitis C occurred in three patients who had undergone gynecologic surgery in an outpatient clinic on a single day. Epidemiologic and virologic investigations revealed virus transmission from an anesthesiologist with chronic hepatitis C. HCV sequencing demonstrated that all four persons were infected by the same strain. The precise mode of transmission could not be elucidated but hygienic standards had been severely neglected.
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Affiliation(s)
- K Stark
- Robert Koch-Institut Berlin, Berlin, Germany.
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Platzbecker U, Haase M, Herbst R, Hänel A, Voigtmann K, Thiede CH, Mohr B, Schleyer E, Leopold T, Orth M, Hänel M, Ehninger G, Bornhäuser M. Activity of sirolimus in patients with myelodysplastic syndrome - results of a pilot study. Br J Haematol 2005; 128:625-30. [PMID: 15725083 DOI: 10.1111/j.1365-2141.2005.05360.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The pathophysiology of the myelodysplastic syndromes (MDS) involves disturbed regulation of angiogenesis, apoptosis, proliferation and differentiation as well as immune surveillance. Increasing data suggest that sirolimus might affect these pathways positively, thus being of possible therapeutic benefit in patients with this disease. Nineteen patients (n = 19) with a median age of 72 years (range 54-80 years) diagnosed with MDS received sirolimus orally with a target blood concentration of 3-12 ng/ml. Sirolimus was administered for a median of 3.7 months (range 0.3-11 months). Three patients [1 x refractory anaemia with excess blasts (RAEB)-2, 1 x RAEB-1, 1 x refractory cytopenia with multilineage dysplasia] showed either a major (1 x platelet, 1 x neutrophil) or a minor (1 x erythroid, 2 x platelet) haematological response according to International Working Group criteria. Major side-effects were hyperlipidaemia (n = 4), stomatitis (n = 3), thrombocytopenia (n = 2) and urinary tract infection (n = 1). These data suggest that sirolimus has activity in a subset of patients with more advanced MDS.
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Affiliation(s)
- U Platzbecker
- Medizinische Klinik und Poliklinik I des Universitätsklinikum Carl Gustav Carus Dresden, 01307 Dresden, Germany.
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Goeckenjan-Festag M, Hänel M, Schäfer-Graf U, Vetter K. Schwangerschaftsdiabetes - Ein Informationsfilm über Erkennung und Behandlung. Z Geburtshilfe Neonatol 2005. [DOI: 10.1055/s-2005-923048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hänel M, Goeckenjan-Festag M, Kilavuz Ö, Vetter K. Die Zervixverschlussoperation - Lehrvideo über Technik und Outcome. Z Geburtshilfe Neonatol 2005. [DOI: 10.1055/s-2005-923045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Naumann R, Beuthien-Baumann B, Reiss A, Schulze J, Hänel A, Bredow J, Kühnel G, Kropp J, Hänel M, Laniado M, Kotzerke J, Ehninger G. Substantial impact of FDG PET imaging on the therapy decision in patients with early-stage Hodgkin's lymphoma. Br J Cancer 2004; 90:620-5. [PMID: 14760374 PMCID: PMC2409608 DOI: 10.1038/sj.bjc.6601561] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This prospective study assessed the impact of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the staging and possible consequential changes of treatment regimen in patients with Hodgkin's lymphoma (HL). A total of 88 consecutive patients with histologically verified Hodgkin's lymphoma underwent a PET scan in addition to conventional staging procedures. Treatment was based on the conventional staging only, and the results of the FDG-PET did not affect the treatment strategy. The evaluation focused on the suggested change in clinical stage according to the Ann Arbor classification and on the suggested change in treatment strategy rather than on a lesion-by-lesion analysis. Using all the methods performed as the standard of reference, (18)F-FDG-PET staging was concordant with conventional staging in 70 out of 88 patients (80%). (18)F-fluorodeoxyglucose positron emission tomography suggested a change to a different clinical stage in 18 patients (20%). Management would have been changed in 16 patients (18%): intensification of treatment in nine patients (10%) and minimisation of treatment in seven patients (8%). In the 44 patients with early disease (stage IA-IIB), treatment would have been intensified in nine out of 44 patients (20%). (18)F-fluorodeoxyglucose positron emission tomography is a relevant noninvasive method that supplements conventional staging procedures and should therefore be used routinely to stage Hodgkin's lymphoma, particularly in patients with an early stage.
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Affiliation(s)
- R Naumann
- Department of Medicine I, University Hospital Carl Gustav Carus at the Dresden University of Technology, Fetscherstr. 74, 01307 Dresden, Germany.
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Hänel M, Goeckenjan M, Schäfer-Graf UM, Vetter K. Informationsfilm für Schwangere mit Gestationsdiabetes – erste Erfahrungen in der Risikoschwangerenberatung. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2003-818057] [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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Goeckenjan M, Hänel M, Nierhaus M, Unkels J, Vetter K. Die vaginale Beckenendlagengeburt. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2003-818059] [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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Hänel M, Bornhäuser M, Müller J, Thiede C, Ehninger G, Kroschinsky F. Evidence for a graft-versus-tumor effect in refractory ovarian cancer. J Cancer Res Clin Oncol 2003; 129:12-6. [PMID: 12618895 DOI: 10.1007/s00432-002-0399-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2002] [Accepted: 11/05/2002] [Indexed: 12/30/2022]
Abstract
PURPOSE A 31-year-old woman suffered a 4th relapse of epithelial ovarian cancer refractory to several cytotoxic drugs including platinum, paclitaxel, and topotecan. METHODS Sequential high-dose chemotherapy with autografting (three courses) led to a minor response of short duration. In order to induce a graft-versus-tumor effect, allogeneic hematopoietic stem cell transplantation (HSCT) from an HLA-identical sibling donor, after dose-reduced conditioning, was performed in January 2001. RESULTS On day +51 the patient developed acute grade II graft-versus-host disease of the skin and gastrointestinal tract, which was successfully treated by prednisolone. Six months after allogeneic HSCT a complete disappearance of the tumor could be seen. Unfortunately, 14 months later a 5th relapse was diagnosed. CONCLUSIONS This case demonstrates, on the one hand, that allogeneic HSCT is able to induce complete remissions (CR) in chemoresistant ovarian cancer. On the other hand, despite achievement of CR after allografting, the chance of cure remains limited for these patients.
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Affiliation(s)
- M Hänel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Hänel M, Kröger N, Sonnenberg S, Bornhäuser M, Krüger W, Kroschinsky F, Hänel A, Metzner B, Birkmann J, Schmid B, Hoffknecht MM, Fiedler F, Ehninger G, Zander AR. Busulfan, cyclophosphamide, and etoposide as high-dose conditioning regimen in patients with malignant lymphoma. Ann Hematol 2002; 81:96-102. [PMID: 11907790 DOI: 10.1007/s00277-001-0413-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2001] [Accepted: 11/12/2001] [Indexed: 10/27/2022]
Abstract
We investigated the efficacy and toxicity of the combination of busulfan, cyclophosphamide, and etoposide (Bu/Cy/VP-16) as a preparative regimen prior to autologous hematopoietic stem cell transplantation (ASCT) in patients with Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL). Fifty-three patients with recurrent ( n=30), refractory ( n=20), or high-risk ( n=3) lymphoma were enrolled. The 10 patients with HD and 43 with NHL (median age: 46 years, range: 18-64) received busulfan (16 mg/kg), cyclophosphamide (120 mg/kg), and etoposide (30 or 45 mg/kg) followed by ASCT. A total of 50 patients (94%) were consolidated in complete ( n=25) or partial ( n=25) remission, whereas 3 patients had chemoresistant disease before Bu/Cy/VP-16. Thirty-five patients (66%) had received prior radiotherapy (RT) excluding total body irradiation (TBI) as part of the conditioning regimen. The main nonhematological toxicities (grade II-IV according to the Bearman score) in 52 evaluable patients were mucositis (79%) and hepatic toxicity (15%). Severe veno-occlusive disease (VOD) occurred in three patients (5.8%) including one treatment-related death caused by VOD. Overall, treatment-related mortality was 3.8%. After a median follow-up for surviving patients of 21 months (range: 6-118), 20 patients (38%) are in continuous complete remission, 8 patients (15%) are alive in relapse, and 25 patients (47%) died. Probabilities of relapse, event-free survival, and overall survival at 3 years were 63% [95% confidence interval (CI): 48-79%], 31% (95% CI: 17-46%), and 43% (95% CI: 27-59%), respectively. In conclusion, Bu/Cy/VP-16 is an effective and well-tolerated conditioning regimen in patients with HD and NHL. Both toxicity and outcome were not significantly different in patients treated with 30 mg/kg and 45 mg/kg etoposide, respectively. The observed long-term results are even comparable to those published for other established high-dose protocols, including TBI-based regimens. However, further investigations are necessary to evaluate the value of Bu/Cy/VP-16 as a high-dose protocol for malignant lymphoma, especially in patients who have already received extensive RT.
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Affiliation(s)
- M Hänel
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Dresden, Germany
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Hänel M, Fiedler F, Thorns C. Anti-CD20 monoclonal antibody (Rituximab) and Cidofovir as successful treatment of an EBV-associated lymphoma with CNS involvement. Onkologie 2001; 24:491-4. [PMID: 11694778 DOI: 10.1159/000055132] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epstein-Barr virus(EBV)-associated posttransplant lymphoproliferative disease (PTLD) is a serious complication after allogeneic hematopoietic stem cell transplantation (HSCT). Especially in cases with involvement of the central nervous system (CNS) treatment is difficult because the efficacy of most chemotherapeutic agents as well as EBV-specific cytotoxic donor T cells in liquor is uncertain. In the last years the anti-CD20 monoclonal antibody Rituximab was intensively investigated in the treatment of EBV-PTLD. However, only 8 patients with B-cell lymphoma and CNS involvement treated with Rituximab were reported. CASE REPORT A 24-year-old female patient with acute T-lymphoblastic leukemia in second complete remission had received allogeneic, unrelated, T-cell depleted HSCT. 10 months later an EBV-associated PTLD was diagnosed. Beside peripheral lymphomas and B symptoms the patient showed neurological symptoms. Examination of the cerebrospinal fluid (CSF) revealed a meningeosis lymphoblastica caused by the EBV lymphoma. Treatment with Rituximab and the antiviral drug Cidofovir led to complete remission with regression of the peripheral lymphomas and disappearance of the neurological symptoms. In addition, the PCR control on EBV DNA became negative in the plasma as well as in CSF. CONCLUSION The combination of Rituximab and Cidofovir appears as an interesting alternative treatment in patients with EBV-associated PTLD and CNS involvement.
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Affiliation(s)
- M Hänel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, TU Dresden, Germany.
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Hänel M, Friedrichsen K, Hänel A, Herbst R, Morgner A, Neser S, Nicklisch M, Teich M, Ehninger G, Fiedler F. Mito-flag as salvage therapy for relapsed and refractory acute myeloid leukemia. Onkologie 2001; 24:356-60. [PMID: 11574763 DOI: 10.1159/000055107] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study was performed to examine the feasibility and toxicity of the combination of mitoxantrone, fludarabine, cytarabine as bolus (B) or continuous infusion (CI) and granulocyte- colony stimulating factor (G-CSF) in patients with recurrent and refractory acute myeloid leukemia (AML). PATIENTS AND METHODS 29 patients with relapsed (n =17) or refractory (n =12) AML were treated with the Mito-FLAG protocol consisting of mitoxantrone (7 mg/m(2), days 1/3/5), fludarabine (15mg/m(2), every 12 h, days 1-5), cytarabine (Ara-C) as bolus infusion (1000 mg/m(2) over 1 h, every 12 h, days 1-5) (n =15) or as continuous infusion (100-150 mg/m(2) over 24 h, days 1-5) (n =14), and G-CSF (5 mgr;g/ kg/day, day 0 until a neutrophile count of 0.5 x10(9)/l). RESULTS 17 patients (59%) and 1 patient (3%) achieved complete remission (CR) and partial remission (PR), respectively; thus the overall response rate was 62%. Following Mito-FLAG, 5 patients with CR underwent high-dose therapy (HDT) with allogeneic (n = 2) or autologous (n = 3) stem cell transplantation (SCT). With a median follow-up of 28 (range 6-54) months, 4 transplanted patients are alive in CR (n = 2) or in relapse (n = 2). The median duration of event-free survival (EFS) and overall survival (OS) was 3.2 and 6.8 months, and probabilities of EFS and OS after 1 year were 14 and 34%, respectively. The 1-year rates for EFS and OS in this group were 18 and 53%, respectively. Median duration of WHO grade 4 granulocytopenia and thrombocytopenia was 20 and 23 days, respectively. Nonhematological side effects were moderate, predominantly reaching WHO grades 1-2. Neutropenic fever was seen in 85% of courses, with a median duration of 4 (1-38) days. Four patients (14%) suffered an early death because of aplasia (n = 2), pneumonia (n =1) or progressive AML (1 nonresponding patient). CONCLUSIONS Our data suggest that the Mito-FLAG protocol is feasible and can be safely performed with both schedules of Ara-C. In this study the regimens have shown high efficacy and acceptable toxicity in patients with relapsed or refractory AML. We currently examine the importance of bolus versus continuous infusion of Ara-C as part of the Mito-FLAG regimen in a prospective randomized multicenter trial.
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Affiliation(s)
- M Hänel
- Abteilung Hämatologie, Klinik für Innere Medizin III/Küchwald, Klinikum Chemnitz gGmbH, Chemnitz
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Hänel M, Kröger N, Kroschinsky F, Birkmann J, Hänel A, Herbst R, Naumann R, Friedrichsen K, Ehninger G, Zander AR, Fiedler F. Salvage chemotherapy with mitoxantrone, fludarabine, cytarabine, and cisplatin (MIFAP) in relapsing and refractory lymphoma. J Cancer Res Clin Oncol 2001; 127:387-95. [PMID: 11414199 DOI: 10.1007/s004320000226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of the study was to evaluate the feasibility and efficacy of the combination of mitoxantrone, fludarabine, cytarabine, and cisplatin (MIFAP) in patients with prognostically unfavorable recurrent and refractory Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). METHODS Forty-six patients (median age 43 years, range 18-63) with relapsed (n = 15) or refractory (n = 31) malignant lymphoma were enrolled (HD, n = 13; low-grade/transformed NHL, n = 4; high-grade NHL, n = 29). A total of 39 patients (85%) showed multiply relapsed diseases with a duration of prior remission of < 12 months (n = 8) or had lymphoma being resistant to prior chemotherapy (n = 31). The MIFAP therapy consisted of fludarabine (15 mg/m2, q. 12 h, day 1-4), cytarabine (50 mg/m2 by continuous infusion (CI) over 22 h, day 1-4), cisplatin (25 or 30 mg/m2 by CI over 24 h, day 1-4), and mitoxantrone (4 mg/m2, day 2-5). RESULTS Thirteen patients (28%) achieved complete remission (CR) and 15 patients (33%) partial remission (PR), for an overall response (OR) rate of 61%. Twenty-two patients responding to MIFAP (10 CR, 12 PR) have been consolidated by high-dose therapy (HDT) with hematopoietic stem cell transplantation (SCT). After a median follow-up of 12 months, 16 patients are in continuous CR (CCR) (n = 14) or CCRu (unconfirmed) (n = 2). The median duration of event-free survival (EFS) and overall survival (OS) were 6.5 and 19.3 months, respectively. Probabilities of EFS and OS after 3 years were 19% and 40%. Responders consolidated by subsequent HDT showed rates for 3-year EFS and OS of 40% and 66%, respectively. Unfavorable prognostic factors for EFS by univariate analysis were refractory lymphoma and the presence of B-symptoms. Significant prognostic factors for OS were NHL, refractory lymphoma, B-symptoms, and bone marrow involvement. The major toxicities were leukocytopenia and thrombocytopenia of the World Health Organization (WHO) grade IV in nearly all courses (median duration 10 and 11 days). In contrast, non-hematological side effects were moderate, predominantly of WHO grades I and II. Treatment-related mortality with MIFAP was 4% (two patients with septicemia by Aspergillus fumigatus). CONCLUSIONS MIFAP is an effective salvage protocol for patients with poor-risk recurrent or refractory HD and NHL. The observed toxicity seems to be acceptable considering the unfavorable prognosis and intensive pretreatment. The results in patients responding to MIFAP and afterwards undergoing HDT with autologous stem cell support are even comparable to those published in patients with prognostically more favorable diseases.
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Affiliation(s)
- M Hänel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
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Hänel M, Kröger N, Hoffknecht MM, Peters SO, Metzner B, Fiedler F, Braumann D, Schubert JC, Illiger HJ, Hänel A, Krüger WH, Zeller W, Weh HJ, Hossfeld DK, Zander AR. ASHAP--an effective salvage therapy for recurrent and refractory malignant lymphomas. Ann Hematol 2000; 79:304-11. [PMID: 10901609 DOI: 10.1007/s002779900150] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was performed to examine the efficacy and toxicity of the combination of adriamycin (ADR), methylprednisolone (solumedrol), cytarabine (Ara-C), and cisplatin (CDDP) in patients with recurrent and refractory malignant lymphomas. PATIENTS AND METHODS Sixty-five patients with Hodgkin's disease (HD) (n=14) or non-Hodgkin's lymphomas (NHL) (n = 51) were enrolled in the study. The ASHAP therapy consisted of ADR (40 mg/m2 by continuous infusion (CI) over 96 h), methylprednisolone (500 mg i.v., days 1-5), Ara-C (2 g/m2 as a 2-h infusion on day 5), and CDDP (100 mg/m2 by CI over 96 h). RESULTS Twenty-five patients (38%) achieved complete remission (CR) and 20 (31%) were taken into partial remission (PR) for an overall response rate of 69%. Thirty-two patients with CR or PR following ASHAP underwent high-dose therapy (HDT) with subsequent hematopoietic stem cell transplantation. After a median follow-up of 52 months, 13 patients are in continuous CR (CCR), the 3-year event-free survival (EFS) was 30% for responders and 21% for all patients. The median overall survival (OS) was 12 months (range 0-70 months), and the OS rate after 3 years was 32%. Unfavorable prognostic factors for EFS and OS by univariate analysis were an elevated value of the serum lactate dehydrogenase and refractory lymphoma. The most frequently observed side effects following ASHAP were leukocytopenia and thrombocytopenia of World Health Organization (WHO) grades III/IV in approximately 80% of all courses. Non-hematological toxicities such as gastrointestinal side effects, infections, mucositis, renal and neurotoxicity occurred more rarely and reached WHO grades III/IV only occasionally. No treatment-related mortality with ASHAP was observed. CONCLUSIONS ASHAP is an effective and moderately toxic salvage therapy for patients with recurrent or refractory HD and NHL. The results in patients responding to ASHAP and afterwards undergoing HDT with stem cell support are comparable with other established protocols and indicate an improvement in survival if HDT is carried out as intensification.
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Affiliation(s)
- M Hänel
- Department of Hematology, Clinic of Internal Medicine III, Chemnitz, Germany
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Kröger N, Hoffknecht M, Hänel M, Krüger W, Zeller W, Stockschläder M, de Wit M, Weh HJ, Kabisch H, Erttmann R, Zander AR. Busulfan, cyclophosphamide and etoposide as high-dose conditioning therapy in patients with malignant lymphoma and prior dose-limiting radiation therapy. Bone Marrow Transplant 1998; 21:1171-5. [PMID: 9674847 DOI: 10.1038/sj.bmt.1701245] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Relapse after transplant for malignant lymphomas remains the main cause of treatment failure. Most conditioning regimens contain total body irradiation (TBI). We investigated the toxicity and efficacy of an intensified chemotherapy conditioning regimen without TBI in patients with relapsed or high-risk malignant lymphoma who had received prior radiation therapy and were therefore not eligible for TBI. Twenty patients with a median age of 38 (18-56) and relapsed or high-risk malignant non-Hodgkin's lymphoma (NHL, n = 16) or Hodgkin's disease (HD, n = 4) underwent high-dose chemotherapy consisting of busulfan (16 mg/kg), cyclophosphamide (120 mg/kg) and etoposide 30 mg/kg (n = 8) or 45 mg/kg (n = 12) followed by peripheral stem cell support (n = 14), autologous bone marrow (n = 3), allogeneic (n = 2) or syngeneic (n = 1) transplantation. All but two had chemosensitive disease before high-dose chemotherapy. The main toxicity -- according to the Bearman score -- was mucositis II in 18 (90%) patients; five patients (25%) suffered a grade I hepatic toxicity. GI toxicity I occurred in three (15%) and renal toxicity I in two patients (10%). Sixty percent of the patients developed transient dermatitis with erythema and three of them (15%) had skin desquamation; one patient experienced asymptomatic pancreatitis. Toxicity was slightly higher in patients treated with 45 mg/kg etoposide. One patient (5%) died of treatment-related venoocclusive disease. After a median follow-up of 50 months (24-84) the disease-free and overall survival were 50% and 55%. One of the nine relapsing patients developed secondary AML 18 months after transplant. High-dose busulfan, cyclophosphamide and etoposide is an effective regimen resulting in long-term disease-free survival in 50% of patients with relapsed malignant lymphoma and prior radiation therapy. The toxicity is moderate with a low treatment-related mortality (5%).
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Affiliation(s)
- N Kröger
- Bone Marrow Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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