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Sebastian M, Niederle N, Thomas M, Reck M, Schmittel A, Fischer B, Overbeck T, Gröschel A, Deppermann M, Pirker R, Huber R, Eberhardt W, Griesinger F. Molekulargenetische Untersuchungen bei fortgeschrittenem nicht-kleinzelligem Lungenkarzinom: praktische Relevanz. Dtsch Med Wochenschr 2014; 139:2096-100. [DOI: 10.1055/s-0034-1387294] [Citation(s) in RCA: 4] [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: 10/24/2022]
Affiliation(s)
- M. Sebastian
- Medizinische Klinik II, Hämatologie/Onkologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main
| | | | - M. Thomas
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL)
| | - M. Reck
- Onkologischer Schwerpunkt, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL)
| | - A. Schmittel
- Ärzteforum Berlin-Brandenbur üBAG, Seestr. 64, 13347 Berlin
| | - B. Fischer
- III. Medizinische Klinik und Poliklinik, Hämatologie, Onkologie und Pneumologie, Universitätsmedizin Mainz
| | - T. Overbeck
- Klinik für Hämatologie und Onkologie, Universitätsmedizin Göttingen
| | - A. Gröschel
- Ambulantes Aachener Zentrum für Lungenheilkunde, Luisenhospital, Aachen
| | | | - R. Pirker
- Universitätsklinik für Innere Medizin I, Wien
| | - R. Huber
- Sektion Pneumologie Innenstadt und Thorakale Onkologie, Medizinische Klinik V Klinikum der Universität München und Lungentumorzentrum München
| | - W. Eberhardt
- Innere Klinik (Tumorforschung), Ruhrlandklinik, Westdeutsches Tumorzentrum (WTZ), Essen, Universitätsklinikum Essen, Universität Duisburg-Essen
| | - F. Griesinger
- Klinik für Hämatologie und Onkologie, Universitätsklinik Innere Medizin-Onkologie, Pius-Hospital Oldenburg
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Goeckenjan G, Sitter H, Thomas M, Branscheid D, Flentje M, Griesinger F, Niederle N, Stuschke M, Blum T, Deppermann KM, Ficker J, Freitag L, Lübbe A, Reinhold T, Späth-Schwalbe E, Ukena D, Wickert M, Wolf M, Andreas S, Auberger T, Baum R, Baysal B, Beuth J, Bickeböller H, Böcking A, Bohle R, Brüske I, Burghuber O, Dickgreber N, Diederich S, Dienemann H, Eberhardt W, Eggeling S, Fink T, Fischer B, Franke M, Friedel G, Gauler T, Gütz S, Hautmann H, Hellmann A, Hellwig D, Herth F, Heußel C, Hilbe W, Hoffmeyer F, Horneber M, Huber R, Hübner J, Kauczor HU, Kirchbacher K, Kirsten D, Kraus T, Lang S, Martens U, Mohn-Staudner A, Müller KM, Müller-Nordhorn J, Nowak D, Ochmann U, Passlick B, Petersen I, Pirker R, Pokrajac B, Reck M, Riha S, Rübe C, Schmittel A, Schönfeld N, Schütte W, Serke M, Stamatis G, Steingräber M, Steins M, Stoelben E, Swoboda L, Teschler H, Tessen H, Weber M, Werner A, Wichmann HE, Irlinger Wimmer E, Witt C, Worth H. Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms. Pneumologie 2011; 65:e51-75. [DOI: 10.1055/s-0030-1256562] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Goeckenjan G, Sitter H, Thomas M, Branscheid D, Flentje M, Griesinger F, Niederle N, Stuschke M, Blum T, Deppermann KM, Ficker J, Freitag L, Lübbe A, Reinhold T, Späth-Schwalbe E, Ukena D, Wickert M, Wolf M, Andreas S, Auberger T, Baum R, Baysal B, Beuth J, Bickeböller H, Böcking A, Bohle R, Brüske I, Burghuber O, Dickgreber N, Diederich S, Dienemann H, Eberhardt W, Eggeling S, Fink T, Fischer B, Franke M, Friedel G, Gauler T, Gütz S, Hautmann H, Hellmann A, Hellwig D, Herth F, Heußel C, Hilbe W, Hoffmeyer F, Horneber M, Huber R, Hübner J, Kauczor HU, Kirchbacher K, Kirsten D, Kraus T, Lang S, Martens U, Mohn-Staudner A, Müller KM, Müller-Nordhorn J, Nowak D, Ochmann U, Passlick B, Petersen I, Pirker R, Pokrajac B, Reck M, Riha S, Rübe C, Schmittel A, Schönfeld N, Schütte W, Serke M, Stamatis G, Steingräber M, Steins M, Stoelben E, Swoboda L, Teschler H, Tessen H, Weber M, Werner A, Wichmann HE, Irlinger Wimmer E, Witt C, Worth H. Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer. Pneumologie 2010; 65:39-59. [DOI: 10.1055/s-0030-1255961] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [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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Goeckenjan G, Sitter H, Thomas M, Branscheid D, Flentje M, Griesinger F, Niederle N, Stuschke M, Blum T, Deppermann KM, Ficker JH, Freitag L, Lübbe AS, Reinhold T, Späth-Schwalbe E, Ukena D, Wickert M, Wolf M, Andreas S, Auberger T, Baum RP, Baysal B, Beuth J, Bickeböller H, Böcking A, Bohle RM, Brüske I, Burghuber O, Dickgreber N, Diederich S, Dienemann H, Eberhardt W, Eggeling S, Fink T, Fischer B, Franke M, Friedel G, Gauler T, Gütz S, Hautmann H, Hellmann A, Hellwig D, Herth F, Heussel CP, Hilbe W, Hoffmeyer F, Horneber M, Huber RM, Hübner J, Kauczor HU, Kirchbacher K, Kirsten D, Kraus T, Lang SM, Martens U, Mohn-Staudner A, Müller KM, Müller-Nordhorn J, Nowak D, Ochmann U, Passlick B, Petersen I, Pirker R, Pokrajac B, Reck M, Riha S, Rübe C, Schmittel A, Schönfeld N, Schütte W, Serke M, Stamatis G, Steingräber M, Steins M, Stoelben E, Swoboda L, Teschler H, Tessen HW, Weber M, Werner A, Wichmann HE, Irlinger Wimmer E, Witt C, Worth H. [Prevention, diagnosis, therapy, and follow-up of lung cancer]. Pneumologie 2010; 64 Suppl 2:e1-164. [PMID: 20217630 DOI: 10.1055/s-0029-1243837] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fischer B, Eberhardt W, Niederle N, Mohn-Staudner A, Ewert R, Benisch P, Pfeifer W, Griesinger F, Minar W, Sebastian M, Gauler T, Pirker R, Buhl R. Gemcitabin/Vinorelbin sequentiell mit Paclitaxel versus Gemcitabin/Vinorelbin/Cisplatin versus Paclitaxel/Cisplatin beim NSCLC im Stadium IV: eine AIO/AASLC Phase III Studie. Pneumologie 2010. [DOI: 10.1055/s-0030-1251118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Medgenberg D, Balleisen L, Heit W, Knauf W, Weib J, Freier W, Eimermacher H, Ibach S, Niederle N. 9210 Bendamustine vs. fludarabine as second-line treatment in chronic lymphocytic leukemia. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71901-9] [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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Eberhardt W, Niederle N, Wilke H, Weidmann B, Henss H, Engelhardt R, Zeidler D, Colajori E, Kerpel-Fronius S, Seeber S. Phase II Study of 4’-lodo-4’-Deoxydoxorubicin in Patients with Advanced, Measurable Non-Small Cell Lung Cancer. Oncol Res Treat 2009. [DOI: 10.1159/000218304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Stoehlmacher J, Goekkurt E, Arnold D, Keilholz U, Niederle N, Hohler T, Mogck U, Lordick F, Kubicka S, Schmoll H. Associations between the EGFR status as well as KRAS mutations and clinical outcome in colorectal cancer (CRC) patients (pts) treated with erlotinib monotherapy in 2nd or 3rd line—A study of the Arbeitsgemeinschaft Internistische. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.14574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kröpfl D, Ringert R, Niederle N, Scheulen M, Seeber S, Eickenberg HU, Hartung R. Ergebnisse der retroperitonealen Lymphadenektomie bei nicht-seminomatösen Hodentumoren im klinischen Stadium I - Analyse der Risikofaktoren, die zu einem Therapiemißerfolg führten. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1062772] [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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Schmid P, Kühnhardt D, Kiewe P, Lehenbauer-Dehm S, Schippinger W, Greil R, Lange W, Preiss J, Niederle N, Brossart P, Freier W, Kümmel S, Van de Velde H, Regierer A, Possinger K. A phase I/II study of bortezomib and capecitabine in patients with metastatic breast cancer previously treated with taxanes and/or anthracyclines. Ann Oncol 2008; 19:871-6. [PMID: 18209010 DOI: 10.1093/annonc/mdm569] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Proteasome inhibitors are a novel class of compounds entering clinical trials as a method to increase tumour sensitivity to standard chemotherapy. This phase I/II trial was carried out to evaluate the combination of capecitabine and the proteasome inhibitor bortezomib in anthracycline and/or taxane-pretreated patients with metastatic breast cancer. PATIENTS AND METHODS A total of 35 patients were treated with bortezomib (1.0-1.3 mg/m(2) on days 1, 4, 8 and 11) and capecitabine (1500-2500 mg/m(2) on days 1-14) in 3-week intervals for up to eight cycles. RESULTS The maximum tolerated doses (MTDs) were bortezomib 1.3 mg/m(2) and capecitabine 2500 mg/m(2). The treatment was generally well tolerated and associated with toxic effects that were consistent with the known side-effects of the individual agents. The intent-to-treat overall response rate was 15% and an additional 27% of patients had stable disease (SD). In the 20 patients treated at the MTD, the response rate was 15% and 40% had SD. Median time to progression and overall survival were 3.5 months [95% confidence interval (CI) 1.9-4.4] and 7.5 months (95% CI 5.6-14.6), respectively. Median duration of response was 4.4 months. CONCLUSION The combination of bortezomib and capecitabine is well tolerated and has moderate antitumour activity in heavily pretreated patients.
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Affiliation(s)
- P Schmid
- Medical Oncology, Imperial College London, Charing Cross Hospital, London, UK.
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Schmid P, Regierer A, Kiewe P, Schippinger W, Greil R, Lehenbauer-Dehm S, Niederle N, Freier W, Van de Velde H, Possinger K, Kuehnhardt D. Bortezomib and capecitabine in patients with metastatic breast cancer previously treated with taxanes and/or anthracyclines: Final results of a phase I/II study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.1072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1072 Background: Capecitabine has shown substantial activity in taxane and/or anthracycline pretreated breast cancer patients. Bortezomib, a 26S proteasome inhibitor, has been shown to increase sensitivity to chemotherapy. This phase I/II trial was initiated to evaluate the combination of capecitabine and bortezomib in heavily pretreated patients with metastatic breast cancer. Methods: Patients with metastatic breast cancer and prior taxane and/or anthracycline therapy were treated with bortezomib (1.0–1.3 mg/m2; days 1, 4, 8 & 11) and capecitabine (1,500–2,500 mg/m2, days 1–14) in 3-weeks intervals for up to 8 cycles. Primary endpoints were to determine the optimal doses for the combination (phase I) and the tumor response rate (RR) (phase II). Secondary endpoints included safety, time to progression (TTP), duration of response (DR), and overall survival (OS). Results: A total of 35 patients were enrolled and 29 patients were assessable for response. The majority of patients had received 2 or 3 lines of chemotherapy (69% and 14%, respectively) prior to the study. The maximum tolerated doses (MTD) were bortezomib 1.3 mg/m2 and capecitabine 2500 mg/m2. Dose limiting toxicities were Grade 3 stomatitis in 1 out of 6 patients at 1.0/2,000 and Grade 3 diarrhea in 1 out of 6 patients at 1.3/2,500. Myelosuppression was low. Non-hematological toxicities were generally mild to moderate with no G4 toxicity being observed. Most common side effects were thrombocytopenia (Grade 3/4 27% of patients), diarrhea (18%), hand-foot syndrome (12%), peripheral neuropathy (12%), leucopenia (9%) and asthenia (9%). The overall RR was 17.2% and an additional 31% of patients had stable disease (31%; 4 unconfirmed). In the 21 patients treated at the MTD, RR was 17.6% and 47% of patients had SD. Median TTP and OS were 3.5 months (95% CI 1.9–4.4) and 7.5 months (95% CI 5.6–14.6), respectively. Median DR was 4.4 months. Conclusions: The combination of bortezomib and capecitabine is well tolerated and has moderate antitumour activity in heavily pretreated breast cancer. [Table: see text]
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Affiliation(s)
- P. Schmid
- Charing Cross Hospital, London, United Kingdom; Charite Campus Mitte, Berlin, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Universitaetsklinikum, Graz, Austria; Landeskliniken Salzburg, Salzburg, Austria; Klinikum Leverkusen, Leverkusen, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharmaceutical Research & Develo, Beerse, Belgium
| | - A. Regierer
- Charing Cross Hospital, London, United Kingdom; Charite Campus Mitte, Berlin, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Universitaetsklinikum, Graz, Austria; Landeskliniken Salzburg, Salzburg, Austria; Klinikum Leverkusen, Leverkusen, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharmaceutical Research & Develo, Beerse, Belgium
| | - P. Kiewe
- Charing Cross Hospital, London, United Kingdom; Charite Campus Mitte, Berlin, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Universitaetsklinikum, Graz, Austria; Landeskliniken Salzburg, Salzburg, Austria; Klinikum Leverkusen, Leverkusen, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharmaceutical Research & Develo, Beerse, Belgium
| | - W. Schippinger
- Charing Cross Hospital, London, United Kingdom; Charite Campus Mitte, Berlin, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Universitaetsklinikum, Graz, Austria; Landeskliniken Salzburg, Salzburg, Austria; Klinikum Leverkusen, Leverkusen, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharmaceutical Research & Develo, Beerse, Belgium
| | - R. Greil
- Charing Cross Hospital, London, United Kingdom; Charite Campus Mitte, Berlin, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Universitaetsklinikum, Graz, Austria; Landeskliniken Salzburg, Salzburg, Austria; Klinikum Leverkusen, Leverkusen, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharmaceutical Research & Develo, Beerse, Belgium
| | - S. Lehenbauer-Dehm
- Charing Cross Hospital, London, United Kingdom; Charite Campus Mitte, Berlin, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Universitaetsklinikum, Graz, Austria; Landeskliniken Salzburg, Salzburg, Austria; Klinikum Leverkusen, Leverkusen, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharmaceutical Research & Develo, Beerse, Belgium
| | - N. Niederle
- Charing Cross Hospital, London, United Kingdom; Charite Campus Mitte, Berlin, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Universitaetsklinikum, Graz, Austria; Landeskliniken Salzburg, Salzburg, Austria; Klinikum Leverkusen, Leverkusen, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharmaceutical Research & Develo, Beerse, Belgium
| | - W. Freier
- Charing Cross Hospital, London, United Kingdom; Charite Campus Mitte, Berlin, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Universitaetsklinikum, Graz, Austria; Landeskliniken Salzburg, Salzburg, Austria; Klinikum Leverkusen, Leverkusen, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharmaceutical Research & Develo, Beerse, Belgium
| | - H. Van de Velde
- Charing Cross Hospital, London, United Kingdom; Charite Campus Mitte, Berlin, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Universitaetsklinikum, Graz, Austria; Landeskliniken Salzburg, Salzburg, Austria; Klinikum Leverkusen, Leverkusen, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharmaceutical Research & Develo, Beerse, Belgium
| | - K. Possinger
- Charing Cross Hospital, London, United Kingdom; Charite Campus Mitte, Berlin, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Universitaetsklinikum, Graz, Austria; Landeskliniken Salzburg, Salzburg, Austria; Klinikum Leverkusen, Leverkusen, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharmaceutical Research & Develo, Beerse, Belgium
| | - D. Kuehnhardt
- Charing Cross Hospital, London, United Kingdom; Charite Campus Mitte, Berlin, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Universitaetsklinikum, Graz, Austria; Landeskliniken Salzburg, Salzburg, Austria; Klinikum Leverkusen, Leverkusen, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharmaceutical Research & Develo, Beerse, Belgium
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Rummel MJ, Atta J, Welslau M, Kofahl-Krause D, von Gruenhagen U, Schalk K, Boeck HP, Banat AG, Knauf W, Niederle N. Bendamustine and rituximab (BR) are effective in the treatment of relapsed or refractory indolent and mantle-cell lymphomas: Long-term follow-up of a phase II study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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
8034 Bendamustine combines a purine-like benzimidazol and bifunctionally alkylating nitrogen mustard group. The aim of this multicenter- study was to evaluate the progression-free survival (PFS), response rate and toxicity of BR in patients with mantle-cell or low-grade lymphomas in 1st to 3rd relapse or refractory to previous treatment. A median of 4 courses per patient were administered to 63 pts. Bendamustine was given at a dose of 90 mg/m2 on day 1 and 2 combined with 375 mg/m2 Rituximab on day 1 for a max. of 4 cycles every 4 weeks. Histologies: 24 follicular, 16 mantle cell, 17 lymphoplasmacytoid, 6 marginal zone lymphoma. 57 of 63 pts responded to BR corresponding to an overall response rate of 90% with a CR-rate of 60%. In mantle cell lymphomas BR showed a considerable activity achieving a response rate of 75% with a CR-rate of 50%. In an updated analysis the median time of PFS was 30 months and the median duration of overall survival has not yet been reached. With a median follow-up period of 3 years two secondary neoplasms have been observed (bronchial carcinoma). No MDS was observed to date. These results demonstrate that the combination of Bendamustine and Rituximab is a highly active regimen in the treatment of low-grade lymphomas and mantle cell lymphomas. Based upon these encouraging results the Studiengruppe indolente Lymphome (StiL) initiated two Phase III trials that compare BR to established chemo-immunotherapy regimens: BR vs R-CHOP in untreated pts, and BR vs Fludarabine- R in relapsed pts. These studies should provide considerable guidance for the appropriate role of Bendamustine in the treatment of low-grade and mantle cell lymphomas. No significant financial relationships to disclose.
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Affiliation(s)
- M. J. Rummel
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - J. Atta
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - M. Welslau
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - D. Kofahl-Krause
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - U. von Gruenhagen
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - K. Schalk
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - H. P. Boeck
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - A. G. Banat
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - W. Knauf
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
| | - N. Niederle
- University Clinic, Giessen, Germany; Onk. Praxis, Aschaffenburg, Germany; MHH, Hannover, Germany; Onk. Praxis, Cottbus, Germany; Hospital, Limburg, Germany; Onk. Praxis, Offenbach, Germany; Onk. Praxis, Frankfurt, Germany; Hospital, Leverkusen, Germany
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Keilholz U, Arnold D, Niederle N, Freier W, Porschen R, Hoehler T, Lordick F, Kubicka S, Kettner E, Schmoll HJ. Erlotinib as 2nd and 3rd line monotherapy in patients with metastatic colorectal cancer. Results of a multicenter two-cohort phase II trial. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3575] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- U. Keilholz
- Charité, Univ Hosp of Berlin, Berlin, Germany; Martin Luther Univ, Halle, Germany; Klin, Leverkusen, Germany; Private Practice, Hildesheim, Germany; Klin Bremen Ost, Bremen, Germany; Univ Hosp, Mainz, Germany; Univ Hosp Klin rechts der Isar, Munich, Germany; Univ Hosp, Hannover, Germany; Altstadtklinikum, Magdeburg, Germany
| | - D. Arnold
- Charité, Univ Hosp of Berlin, Berlin, Germany; Martin Luther Univ, Halle, Germany; Klin, Leverkusen, Germany; Private Practice, Hildesheim, Germany; Klin Bremen Ost, Bremen, Germany; Univ Hosp, Mainz, Germany; Univ Hosp Klin rechts der Isar, Munich, Germany; Univ Hosp, Hannover, Germany; Altstadtklinikum, Magdeburg, Germany
| | - N. Niederle
- Charité, Univ Hosp of Berlin, Berlin, Germany; Martin Luther Univ, Halle, Germany; Klin, Leverkusen, Germany; Private Practice, Hildesheim, Germany; Klin Bremen Ost, Bremen, Germany; Univ Hosp, Mainz, Germany; Univ Hosp Klin rechts der Isar, Munich, Germany; Univ Hosp, Hannover, Germany; Altstadtklinikum, Magdeburg, Germany
| | - W. Freier
- Charité, Univ Hosp of Berlin, Berlin, Germany; Martin Luther Univ, Halle, Germany; Klin, Leverkusen, Germany; Private Practice, Hildesheim, Germany; Klin Bremen Ost, Bremen, Germany; Univ Hosp, Mainz, Germany; Univ Hosp Klin rechts der Isar, Munich, Germany; Univ Hosp, Hannover, Germany; Altstadtklinikum, Magdeburg, Germany
| | - R. Porschen
- Charité, Univ Hosp of Berlin, Berlin, Germany; Martin Luther Univ, Halle, Germany; Klin, Leverkusen, Germany; Private Practice, Hildesheim, Germany; Klin Bremen Ost, Bremen, Germany; Univ Hosp, Mainz, Germany; Univ Hosp Klin rechts der Isar, Munich, Germany; Univ Hosp, Hannover, Germany; Altstadtklinikum, Magdeburg, Germany
| | - T. Hoehler
- Charité, Univ Hosp of Berlin, Berlin, Germany; Martin Luther Univ, Halle, Germany; Klin, Leverkusen, Germany; Private Practice, Hildesheim, Germany; Klin Bremen Ost, Bremen, Germany; Univ Hosp, Mainz, Germany; Univ Hosp Klin rechts der Isar, Munich, Germany; Univ Hosp, Hannover, Germany; Altstadtklinikum, Magdeburg, Germany
| | - F. Lordick
- Charité, Univ Hosp of Berlin, Berlin, Germany; Martin Luther Univ, Halle, Germany; Klin, Leverkusen, Germany; Private Practice, Hildesheim, Germany; Klin Bremen Ost, Bremen, Germany; Univ Hosp, Mainz, Germany; Univ Hosp Klin rechts der Isar, Munich, Germany; Univ Hosp, Hannover, Germany; Altstadtklinikum, Magdeburg, Germany
| | - S. Kubicka
- Charité, Univ Hosp of Berlin, Berlin, Germany; Martin Luther Univ, Halle, Germany; Klin, Leverkusen, Germany; Private Practice, Hildesheim, Germany; Klin Bremen Ost, Bremen, Germany; Univ Hosp, Mainz, Germany; Univ Hosp Klin rechts der Isar, Munich, Germany; Univ Hosp, Hannover, Germany; Altstadtklinikum, Magdeburg, Germany
| | - E. Kettner
- Charité, Univ Hosp of Berlin, Berlin, Germany; Martin Luther Univ, Halle, Germany; Klin, Leverkusen, Germany; Private Practice, Hildesheim, Germany; Klin Bremen Ost, Bremen, Germany; Univ Hosp, Mainz, Germany; Univ Hosp Klin rechts der Isar, Munich, Germany; Univ Hosp, Hannover, Germany; Altstadtklinikum, Magdeburg, Germany
| | - H.-J. Schmoll
- Charité, Univ Hosp of Berlin, Berlin, Germany; Martin Luther Univ, Halle, Germany; Klin, Leverkusen, Germany; Private Practice, Hildesheim, Germany; Klin Bremen Ost, Bremen, Germany; Univ Hosp, Mainz, Germany; Univ Hosp Klin rechts der Isar, Munich, Germany; Univ Hosp, Hannover, Germany; Altstadtklinikum, Magdeburg, Germany
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15
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Possinger K, Schippinger W, Kiewe P, Lange W, Preiss J, Niederle N, Brossart P, Papke J, Freier W, van de Velde H, Schmid P. Phase I trial of bortezomib and capecitabine in patients with metastatic breast cancer previously treated with taxanes and/or anthracyclines. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- K. Possinger
- Charité Campus Mitte, Berlin, Germany; Universitätsklinikum Graz, Graz, Austria; Charité Campus Benjamin Franklin, Berlin, Germany; Johanniter-Krankenhaus Rheinhausen, Duisburg, Germany; Caritasklinik St. Theresia, Saarbrücken, Germany; Klin Leverkusen, Leverkusen, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Practice for Oncology and Hematology, Neustadt, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharm R & D, Beerse, Germany
| | - W. Schippinger
- Charité Campus Mitte, Berlin, Germany; Universitätsklinikum Graz, Graz, Austria; Charité Campus Benjamin Franklin, Berlin, Germany; Johanniter-Krankenhaus Rheinhausen, Duisburg, Germany; Caritasklinik St. Theresia, Saarbrücken, Germany; Klin Leverkusen, Leverkusen, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Practice for Oncology and Hematology, Neustadt, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharm R & D, Beerse, Germany
| | - P. Kiewe
- Charité Campus Mitte, Berlin, Germany; Universitätsklinikum Graz, Graz, Austria; Charité Campus Benjamin Franklin, Berlin, Germany; Johanniter-Krankenhaus Rheinhausen, Duisburg, Germany; Caritasklinik St. Theresia, Saarbrücken, Germany; Klin Leverkusen, Leverkusen, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Practice for Oncology and Hematology, Neustadt, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharm R & D, Beerse, Germany
| | - W. Lange
- Charité Campus Mitte, Berlin, Germany; Universitätsklinikum Graz, Graz, Austria; Charité Campus Benjamin Franklin, Berlin, Germany; Johanniter-Krankenhaus Rheinhausen, Duisburg, Germany; Caritasklinik St. Theresia, Saarbrücken, Germany; Klin Leverkusen, Leverkusen, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Practice for Oncology and Hematology, Neustadt, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharm R & D, Beerse, Germany
| | - J. Preiss
- Charité Campus Mitte, Berlin, Germany; Universitätsklinikum Graz, Graz, Austria; Charité Campus Benjamin Franklin, Berlin, Germany; Johanniter-Krankenhaus Rheinhausen, Duisburg, Germany; Caritasklinik St. Theresia, Saarbrücken, Germany; Klin Leverkusen, Leverkusen, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Practice for Oncology and Hematology, Neustadt, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharm R & D, Beerse, Germany
| | - N. Niederle
- Charité Campus Mitte, Berlin, Germany; Universitätsklinikum Graz, Graz, Austria; Charité Campus Benjamin Franklin, Berlin, Germany; Johanniter-Krankenhaus Rheinhausen, Duisburg, Germany; Caritasklinik St. Theresia, Saarbrücken, Germany; Klin Leverkusen, Leverkusen, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Practice for Oncology and Hematology, Neustadt, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharm R & D, Beerse, Germany
| | - P. Brossart
- Charité Campus Mitte, Berlin, Germany; Universitätsklinikum Graz, Graz, Austria; Charité Campus Benjamin Franklin, Berlin, Germany; Johanniter-Krankenhaus Rheinhausen, Duisburg, Germany; Caritasklinik St. Theresia, Saarbrücken, Germany; Klin Leverkusen, Leverkusen, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Practice for Oncology and Hematology, Neustadt, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharm R & D, Beerse, Germany
| | - J. Papke
- Charité Campus Mitte, Berlin, Germany; Universitätsklinikum Graz, Graz, Austria; Charité Campus Benjamin Franklin, Berlin, Germany; Johanniter-Krankenhaus Rheinhausen, Duisburg, Germany; Caritasklinik St. Theresia, Saarbrücken, Germany; Klin Leverkusen, Leverkusen, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Practice for Oncology and Hematology, Neustadt, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharm R & D, Beerse, Germany
| | - W. Freier
- Charité Campus Mitte, Berlin, Germany; Universitätsklinikum Graz, Graz, Austria; Charité Campus Benjamin Franklin, Berlin, Germany; Johanniter-Krankenhaus Rheinhausen, Duisburg, Germany; Caritasklinik St. Theresia, Saarbrücken, Germany; Klin Leverkusen, Leverkusen, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Practice for Oncology and Hematology, Neustadt, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharm R & D, Beerse, Germany
| | - H. van de Velde
- Charité Campus Mitte, Berlin, Germany; Universitätsklinikum Graz, Graz, Austria; Charité Campus Benjamin Franklin, Berlin, Germany; Johanniter-Krankenhaus Rheinhausen, Duisburg, Germany; Caritasklinik St. Theresia, Saarbrücken, Germany; Klin Leverkusen, Leverkusen, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Practice for Oncology and Hematology, Neustadt, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharm R & D, Beerse, Germany
| | - P. Schmid
- Charité Campus Mitte, Berlin, Germany; Universitätsklinikum Graz, Graz, Austria; Charité Campus Benjamin Franklin, Berlin, Germany; Johanniter-Krankenhaus Rheinhausen, Duisburg, Germany; Caritasklinik St. Theresia, Saarbrücken, Germany; Klin Leverkusen, Leverkusen, Germany; Universitätsklinikum Tübingen, Tübingen, Germany; Practice for Oncology and Hematology, Neustadt, Germany; Practice for Oncology and Hematology, Hildesheim, Germany; Johnson & Johnson Pharm R & D, Beerse, Germany
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16
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Koester W, Stamatis G, Niederle N, Heider A, Avramidis K, Wilke H, Stahl M. Phase-II-study with bendamustine / carboplatin in untreated patients with extensive disease small cell lung cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7265] [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: 11/20/2022] Open
Affiliation(s)
- W. Koester
- Klinken-Essen-Mitte, Essen, Germany; Ruhrlandklinik, Essen, Germany; Department of Oncology & Hematology, Leverkusen, Germany
| | - G. Stamatis
- Klinken-Essen-Mitte, Essen, Germany; Ruhrlandklinik, Essen, Germany; Department of Oncology & Hematology, Leverkusen, Germany
| | - N. Niederle
- Klinken-Essen-Mitte, Essen, Germany; Ruhrlandklinik, Essen, Germany; Department of Oncology & Hematology, Leverkusen, Germany
| | - A. Heider
- Klinken-Essen-Mitte, Essen, Germany; Ruhrlandklinik, Essen, Germany; Department of Oncology & Hematology, Leverkusen, Germany
| | - K. Avramidis
- Klinken-Essen-Mitte, Essen, Germany; Ruhrlandklinik, Essen, Germany; Department of Oncology & Hematology, Leverkusen, Germany
| | - H. Wilke
- Klinken-Essen-Mitte, Essen, Germany; Ruhrlandklinik, Essen, Germany; Department of Oncology & Hematology, Leverkusen, Germany
| | - M. Stahl
- Klinken-Essen-Mitte, Essen, Germany; Ruhrlandklinik, Essen, Germany; Department of Oncology & Hematology, Leverkusen, Germany
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17
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Köhne CH, Catane R, Klein B, Ducreux M, Thuss-Patience P, Niederle N, Gips M, Preusser P, Knuth A, Clemens M, Bugat R, Figer I, Shani A, Fages B, Di Betta D, Jacques C, Wilke HJ. Irinotecan is active in chemonaive patients with metastatic gastric cancer: a phase II multicentric trial. Br J Cancer 2003; 89:997-1001. [PMID: 12966415 PMCID: PMC2376958 DOI: 10.1038/sj.bjc.6601226] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
To assess the response rate and the tolerance of irinotecan as first-line therapy, 40 patients with metastatic gastric cancer received irinotecan 350 mg m(-2) every 3 weeks administered as a 30 min infusion. Among the 35 patients evaluable for response, two complete and five partial responses were recorded (response rate: 20.0% (95% CI:8.4-36.9%)). In total, 16 patients achieved stable disease and 12 progressive disease. In all, 66 percent of the patients benefited from tumour growth control. The median time to progression was 3.0 months (95% CI: 2.3-4.4%). The median overall survival was 7.1 months (95% CI: 5.2-9.0%). The probability of being alive at 6 months and 9 months was 61.0 and 32.4%, respectively. The median number of cycles per patient was 3 (range 1-14), and the relative dose intensity was 0.98. The most common grade 3-4 toxicities by patients were diarrhoea 20%, asthenia 10%, nausea 7.5%, vomiting 5.0%, abdominal pain 5%, neutropenia 38.5%, leucopenia 28.2%, anaemia 12.8% and thrombocytopenia 5.1%. Febrile neutropenia occurred in 12.5% of patients. These findings indicate that irinotecan is active and well tolerated in patients with metastatic gastric adenocarcinoma and warrants further evaluation in this clinical setting.
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Affiliation(s)
- C-H Köhne
- Robert Rossle Klinik, Charité University Hospital, Berlin, Germany.
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18
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Thiele J, Kvasnicka HM, Schmitt-Graeff A, Diehl V, Niederle N, Schaefer HE. Bone marrow histopathology predicting blast crisis in chronic myeloid leukemia. Acta Haematol 2001; 105:244-6. [PMID: 11528100 DOI: 10.1159/000046573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, Joseph-Stelzmannstrasse 9, D-50924 Cologne, Germany.
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19
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Abstract
Low-grade non-Hodgkin's lymphomas (NHL) are very sensitive to a broad range of chemotherapeutic and biological agents. Relapses, however, occur even after aggressive cytostatic combinations in first-line therapy. Therefore, effective and well-tolerated salvage therapies are very important. In this single-institution trial, the efficacy and toxicity of bendamustine in the treatment of relapsed low-grade NHL was investigated. Fifty-eight patients with low-grade NHL pretreated with different cytostatic regimens were included. All patients received bendamustine at 120 mg/m(2) as a 1-h infusion on 2 consecutive days. The treatment was repeated every 3 weeks until complete remission (CR), partial remission (PR) or stable disease (SD) was confirmed on two consecutive cycles. Efficacy and toxicity were evaluated in 52 patients: CR was induced in 11%, PR in 62% and SD in another 10% of the patients. No response to treatment was seen in 17%. The median duration of remission was 16 months and the median survival time was 36 months. Side effects were generally mild, and restricted to myelosuppression, gastrointestinal toxicity and allergic reactions. Bendamustine proved to be very effective and was well tolerated in pretreated patients with relapsed or primary resistant low-grade NHL.
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Affiliation(s)
- A Heider
- Department of Hematology and Oncology (Med Klinik 3), Klinikum Leverkusen, Dhünnberg 60, 51375 Leverkusen, Germany.
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20
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Kvasnicka HM, Thiele J, Schmitt-Graeff A, Diehl V, Zankovich R, Niederle N, Leder LD, Schaefer HE. Bone marrow features improve prognostic efficiency in multivariate risk classification of chronic-phase Ph(1+) chronic myelogenous leukemia: a multicenter trial. J Clin Oncol 2001; 19:2994-3009. [PMID: 11408494 DOI: 10.1200/jco.2001.19.12.2994] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Multivariate risk classifications for chronic (stable)-phase Ph(1+) chronic myelogenous leukemia (CML) are generally focused on hematologic variables, and the putative prognostic property of bone morphology has been neglected or even contested so far. PATIENTS AND METHODS A total of 510 consecutively recruited patients in first chronic phase Ph(1+) CML and pretreatment bone marrow biopsy specimens were entered onto this multicenter observational trial to evaluate the effect of bone marrow histopathology. According to generally accepted criteria, patients with any signs of accelerated disease were excluded. Treatment modalities included administration of interferon alfa-2b (IFN) and chemotherapy with hydroxyurea (HU) or busulfan. Immunohistochemical and morphometric techniques were applied to identify marrow cells and to quantify fiber density. Patients were separated into learning and validation samples, and classification and regression tree (CART) analysis was performed to establish a prognostic decision tree. RESULTS CART analysis of the validation sample (123 patients with HU therapy) revealed the amount of erythroid precursors in the bone marrow, myelofibrosis, and splenomegaly as the most important prognostic features. Three risk profiles with significantly different survival patterns were established, with median survival times ranging from 33 to 108 months (two-sided log-rank test, P =.0001). The new score was confirmed by application to the learning sample with IFN therapy (two-sided log-rank test, P =.0002). Furthermore, risk status defined by the new score was significantly correlated with the occurrence of blast transformation. CONCLUSION Our data strongly implicate that prognostic classification of chronic-phase Ph(1+) CML can be significantly improved by the inclusion of morphologic parameters. The variables of the presented scoring system may be easily assessed by routinely processed aspirates and bone marrow trephines.
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Affiliation(s)
- H M Kvasnicka
- Institutes of Pathology, Universities of Cologne, Freiburg, Germany.
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21
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Kvasnicka HM, Thiele J, Schmitt-Graeff A, Diehl V, Zankovich R, Niederle N, Leder LD, Schaefer HE. Prognostic impact of bone marrow erythropoietic precursor cells and myelofibrosis at diagnosis of Ph1+ chronic myelogenous leukaemia--a multicentre study on 495 patients. Br J Haematol 2001; 112:727-39. [PMID: 11260078 DOI: 10.1046/j.1365-2141.2001.02555.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A multicentre clinicopathological study was performed on 495 patients with chronic-phase Ph1+ chronic myelogenous leukaemia (CML) to determine bone marrow characteristics that exert a significant impact on survival under standard treatment regimens. Immunohistochemical and morphometric techniques were applied to identify nucleated erythroid precursor cells in the bone marrow and to quantify argyrophilic fibre density. Application of the Sokal index and another recently proposed CML score failed to distinguish three clearly defined risk groups. A borderline increase in fibre content (i.e. doubling of the normal density) and a relevant reduction of medullary erythropoiesis proved to be important predictors for survival, even in low-risk classified patients, according to both clinical scores. With regard to optimal treatment strategies, patients with manifest myelofibrosis showed no significant difference in survival rates under interferon or hydroxyurea treatment. Multivariate analysis confirmed the prognostic value of histological features. A risk model based on three variables (fibre density, erythropoietic precursors and spleen size) was constructed that enabled a distinct discrimination of risk profiles. In conclusion, the presented data provide compelling evidence that bone marrow features at diagnosis exert a significant impact on prognosis in CML. In this context, the generally clinical-based multivariate risk classification can be improved by consideration of morphological variables that are acting independently of treatment modalities.
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Affiliation(s)
- H M Kvasnicka
- Institute of Pathology, University of Cologne, Joseph-Stelzmann-Str. 9, D-50924 Cologne, Germany.
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22
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Kloke O, Opalka B, Niederle N. Interferon alfa as primary treatment of chronic myeloid leukemia: long-term follow-up of 71 patients observed in a single center. Leukemia 2000; 14:389-92. [PMID: 10720131 DOI: 10.1038/sj.leu.2401661] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to evaluate the long-term outcome of interferon (IFN) alfa treatment in patients with Philadelphia chromosome-positive chronic myeloid leukemia (CML). Between 1984 and 1990, a total of 71 patients with newly diagnosed CML had been enrolled into two consecutive IFN trials at our institution. Follow-up extended to December 1998, resulting in a median observation period for surviving patients of 11.4 years. The median survival time from diagnosis was 5.9 years. A plateau in the actuarial survival curve was found from 8.2 to 12.3 years following diagnosis with a projected 10-year survival rate of 32%. 'Landmark' studies showed a significant survival advantage for patients with karyotype responses. Of 68 patients accessible to calculation of the Hasford score, three were in the high risk group, 24 belonged to the medium risk group, and 41 had low risk features. The majority of cytogenetic responders including all eight assessable patients in complete cytogenetic remission were in the low risk group. Achieving a cytogenetic remission was found to provide a survival advantage also for patients with low risk disease. Of the seven patients surviving more than 11 years, six were in continuous complete cytogenetic remission. Their favorable outcome appears to translate into an out-flattening of the survival curve for the 71 single center patients presented. It will be of interest to see whether prolonged follow-ups of the large multicentric randomized trials will similarly show a subset of long-term surviving patients with ongoing IFN-induced remission.
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MESH Headings
- Adult
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Blast Crisis/epidemiology
- Female
- Follow-Up Studies
- Humans
- Immunologic Factors/administration & dosage
- Immunologic Factors/adverse effects
- Immunologic Factors/therapeutic use
- Interferon alpha-2
- Interferon-alpha/administration & dosage
- Interferon-alpha/adverse effects
- Interferon-alpha/therapeutic use
- Interferon-gamma/administration & dosage
- Interferon-gamma/therapeutic use
- Karyotyping
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Life Tables
- Male
- Philadelphia Chromosome
- Prognosis
- Recombinant Proteins
- Remission Induction
- Risk
- Severity of Illness Index
- Survival Analysis
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- O Kloke
- Department of Internal Medicine, West German Cancer Center, University of Essen Medical School, Germany
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23
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Thiele J, Kvasnicka HM, Schmitt-Graeff A, Zirbes TK, Birnbaum F, Kressmann C, Melguizo-Grahmann M, Frackenpohl H, Sprungmann C, Leder LD, Diehl V, Zankovich R, Schaefer HE, Niederle N, Fischer R. Bone marrow features and clinical findings in chronic myeloid leukemia--a comparative, multicenter, immunohistological and morphometric study on 614 patients. Leuk Lymphoma 2000; 36:295-308. [PMID: 10674901 DOI: 10.3109/10428190009148850] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [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: 11/13/2022]
Abstract
A multicenter, immunohistochemical and morphometric study was performed on diagnostic pretreatment bone marrow biopsies in 614 adult patients with Ph1+ chronic myeloid leukemia (CML) to compare histological features with clinical findings. For identification of megakaryopoiesis we used the monoclonal antibody CD61 and additionally the PAS reaction to determine the subfraction of atypical micromegakaryocytes and precursors. Labelling of erythroid precursors was carried out by a monoclonal antibody directed against glycophorin C. In order to selectively stain macrophages and their activated subset we applied CD68 and the GSA-I lectin. Density of argyrophilic fibers (reticulin plus collagen) was measured following Gomori's silver impregnation method. In accordance with laboratory data morphological variables revealed a comparable amount of congruence in the various groups of CML patients derived from different sources. In about 26% of patients early (reticulin) to advanced (collagen) fibrosis was detectable. Significant correlations were calculated between the extent of myelofibrosis with splenomegaly, anemia and increasing numbers of erythroblasts and myeloblasts in the peripheral blood count. These features were assumed to indicate more advanced stages of the disease process with ensuing transition into myeloid metaplasia and consequently were associated with an unfavorable prognosis. Significant relationships were revealed between the number of CD61+ megakaryocytes and more important, also their precursor fraction with the degree of fibrosis. This result extends previous experimental findings regarding the impact of immature elements of this cell lineage for the generation of myelofibrosis. The significant association of erythroid precursors with the number of mature (resident) macrophages including their activated GSA-I subset may shed some light on their functional involvement in iron turnover and hemoglobin synthesis. A modified histological classification of predominant bone marrow features is introduced. This simplified synthesis staging system (Cologne Classification) is not only associated with certain sets of laboratory data, but also with different survival patterns.
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, Germany
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24
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Thiele J, Kvasnicka HM, Schmitt-Graeff A, Spohr M, Diehl V, Zankovich R, Niederle N, Leder LD. Effects of interferon and hydroxyurea on bone marrow fibrosis in chronic myelogenous leukaemia: a comparative retrospective multicentre histological and clinical study. Br J Haematol 2000; 108:64-71. [PMID: 10651725 DOI: 10.1046/j.1365-2141.2000.01819.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A retrospective multicentre clinicopathological study was performed on sequential bone marrow trephine biopsies in 100 patients with Ph1+-chronic myelogenous leukaemia (CML) to elucidate the effect of interferon (IFN) alpha 2b and hydroxyurea (HU) treatment on myelofibrosis and megakaryopoiesis. According to strictly defined therapeutic regimens, 38 patients received IFN as monotherapy, 23 patients a combination of IFN and HU and 39 patients HU only. Using standardized intervals of biopsies and histochemical and morphometric methods, a significant increase in reticulin fibre density and in the number of CD61+ megakaryocytes was detectable in the majority of IFN-treated patients. To a lesser degree, these changes were also expressed in the cohort with a combined IFN and HU regimen. In contrast to these findings, in the group of patients with HU as single-agent treatment, a stable state or reversal of myelofibrosis was detectable together with corresponding changes in megakaryopoiesis. Further evaluations revealed that these effects had occurred within the first year, mostly after 6 months of treatment, and were prominently expressed in those patients with a slight to relevant grade of myelofibrosis at presentation. In conclusion, this study provides persuasive evidence that monotherapy by IFN exerts a fibrogenic effect, while HU treatment seems to prevent and even resolves bone marrow fibrosis in CML. Probably, in relation to the complex pathomechanisms responsible for the generation of myelofibrosis, the changing content of reticulin fibres was usually accompanied by corresponding alterations in the number of CD61+ megakaryocytes, including atypical microforms and precursor cells.
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Affiliation(s)
- J Thiele
- Institutes of Pathology, University of Cologne, Germany
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Fosså A, Santoro A, Hiddemann W, Truemper L, Niederle N, Buksmaui S, Bonadonna G, Seeber S, Nowrousian MR. Gemcitabine as a single agent in the treatment of relapsed or refractory aggressive non-Hodgkin's lymphoma. J Clin Oncol 1999; 17:3786-92. [PMID: 10577850 DOI: 10.1200/jco.1999.17.12.3786] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.8] [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: 12/30/2022] Open
Abstract
PURPOSE A multicenter phase II trial was conducted to evaluate the efficacy and toxicity of gemcitabine in patients with relapsed or refractory aggressive non-Hodgkin's lymphomas (NHL). PATIENTS AND METHODS Thirty-one patients with B-cell intermediate or high-grade NHL (Working Formulation) were enrolled onto the study. The median age was 61 years, with a Karnofsky performance status of </= 80% in 65% of patients. Forty-eight percent had stage III or IV (Ann Arbor Classification) at study entry. Pretreatment consisted of one, two, or three chemotherapeutic regimens in nine, 11, and 11 patients, respectively. Gemcitabine 1,250 mg/m(2) was administered intravenously over 30 minutes on days 1, 8, and 15 of a 28-day schedule. RESULTS Thirty patients were assessable for efficacy, and 31 were assessable for toxicity. No complete responses were observed, but six patients showed a partial response, 11 stable disease, and 13 progressive disease. The overall response rate was 20% (95% confidence interval, 8% to 39%) for assessable patients and 19% (95% confidence interval, 8% to 34%) for the intent-to-treat analysis. The median duration of partial response was 6 months (range, 3.7 to 15+ months). Nonhematologic World Health Organization grade 3 toxicity included hepatic toxicity in four patients and infection in two. Hematologic toxicity was observed as grade 3 anemia in three patients, grade 3 leukopenia in two patients, grade 3/4 neutropenia in two patients, and grade 3/4 thrombocytopenia in six patients. CONCLUSION The present schedule of gemcitabine displays modest efficacy and mild toxicity in pretreated aggressive NHL.
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Affiliation(s)
- A Fosså
- Westdeutsches Tumorzentrum, Essen, Germany.
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Heider A, Köster W, Grote-Kiehn J, Bremer K, Wilke H, Niederle N. Bendamustin in untreated small cell lung cancer (SCLC): Efficacy and toxicity. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81429-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Preusser P, Niederle N, Harstrick A, Lersch C, Berns T, Achterrath W. Phase II study of docetaxel as first line chemotherapy (CT) in metastatic adenocarcinoma of the pancreas. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81012-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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Bokemeyer C, Gerl A, Schöffski P, Harstrick A, Niederle N, Beyer J, Casper J, Schmoll HJ, Kanz L. Gemcitabine in patients with relapsed or cisplatin-refractory testicular cancer. J Clin Oncol 1999; 17:512-6. [PMID: 10080593 DOI: 10.1200/jco.1999.17.2.512] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.5] [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: 11/20/2022] Open
Abstract
PURPOSE Despite generally high cure rates in patients with metastatic testicular germ cell tumors, patients with incomplete response to cisplatin-based first-line therapy or with relapsed disease after high-dose salvage chemotherapy have a very poor prognosis. This phase II study evaluates the use of gemcitabine in patients with intensively pretreated or cisplatin-refractory testicular germ cell cancers. PATIENTS AND METHODS Thirty-five patients (median age, 33 years) were enrolled; 31 patients were fully assessable. All patients had metastatic nonseminomatous germ cell tumors; eight patients had extragonadal primary tumors. Twenty patients (63%) had lung metastases, and 12 patients (39%) had liver metastases. The median number of prior cisplatin-based chemotherapy cycles was seven; 22 patients (71%) had received high-dose chemotherapy with autologous stem-cell transplantation, and 19 patients (61%) had received treatment with paclitaxel. Seventeen patients (54%) were considered refractory or absolutely refractory to chemotherapy. RESULTS Six of 31 assessable patients (19%) responded favorably to gemcitabine, 11 patients (35%) displayed no change, and 14 patients (45%) had disease progression. The median time to treatment failure was 4 months (range, 2 to 9+ months), and the median survival was 6 months (range, 2 to 23 months). Patients received a median of six gemcitabine applications. Ten patients (32%) required dose reductions, mainly owing to hematologic toxicity. Grade 3/4 granulocytopenia occurred in four patients (13%) and grade 3/4 thrombocytopenia in seven patients (22%). One case of severe sepsis was observed. CONCLUSION Gemcitabine displays antitumor activity in intensively pretreated and refractory germ cell tumors. Responses were observed in approximately 20% of patients, including three of 22 patients after previous high-dose chemotherapy and one of four patients with mediastinal tumors. Gemcitabine may be a reasonable palliative option for intensively pretreated patients and should be further investigated to define its role in the risk-adapted treatment strategies for germ cell tumors.
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Affiliation(s)
- C Bokemeyer
- Department of Hematology/Oncology, Internal Medicine II, Eberhard Karls University, Tübingen, Germany.
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Doberauer C, Niederle N. Myeloma-Associated Amyloidosis of the Upper Gastrointestinal Tract. Oncol Res Treat 1999. [DOI: 10.1159/000027029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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30
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Rougier P, Van Cutsem E, Bajetta E, Niederle N, Possinger K, Labianca R, Navarro M, Morant R, Bleiberg H, Wils J, Awad L, Herait P, Jacques C. Randomised trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer. Lancet 1998; 352:1407-12. [PMID: 9807986 DOI: 10.1016/s0140-6736(98)03085-2] [Citation(s) in RCA: 781] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In phase II trials, irinotecan is active in patients with advanced colorectal cancer, but the survival and clinical benefit of irinotecan compared with second-line fluorouracil by continuous infusion is not known. METHODS 267 patients who had failed to respond to first-line fluorouracil, or whose disease had progressed after treatment with first-line fluorouracil were randomly allocated irinotecan 300-350 mg/m2 infused once every 3 weeks or fluorouracil by continuous infusion. Treatment was given until disease progression, unacceptable toxic effects, or the patient refused to continue treatment. The primary endpoint was survival, while progression-free survival, response rate, symptom-free survival, adverse events, and quality of life (QoL) were secondary endpoints. FINDINGS 133 patients were randomly allocated irinotecan and 134 were allocated fluorouracil by continuous infusion. Patients treated with irinotecan lived for significantly longer than patients on fluorouracil (p=0.035). Survival at 1 year was increased from 32% in the fluorouracil group to 45% in the irinotecan group. Median survival was 10.8 months in the irinotecan group and 8.5 months in the fluorouracil group. Median progression-free survival was longer with irinotecan (4.2 vs 2.9 months for irinotecan vs fluorouracil, respectively; p=0.030). The median pain-free survival was 10.3 months and 8.5 months (p=0.06) for irinotecan and fluorouracil, respectively. Both treatments were equally well tolerated. QoL was similar in both groups. INTERPRETATION Compared with fluorouracil by continuous infusion second-line irinotecan significantly improved survival in patients with advanced colorectal cancer.
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Affiliation(s)
- P Rougier
- Institute Gustave Roussy, Villejuif, France
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31
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Steffens F, Heider A, Niederle N. Treosulfan as Reinduction Chemotherapy in Small-Cell Lung Cancer. Oncol Res Treat 1998. [DOI: 10.1159/000026854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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32
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Thiele J, Kvasnicka HM, Zirbes TK, Flucke U, Niederle N, Leder LD, Diehl V, Fischer R. Impact of clinical and morphological variables in classification and regression tree-based survival (CART) analysis of CML with special emphasis on dynamic features. Eur J Haematol 1998; 60:35-46. [PMID: 9451426 DOI: 10.1111/j.1600-0609.1998.tb00994.x] [Citation(s) in RCA: 6] [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: 02/06/2023]
Abstract
To determine parameters of predictive value in CML, a retrospective clinico-pathological study was performed. This included laboratory data and (pretreatment) bone marrow biopsies of 120 patients with a monotherapy by busulfan (BU) and 50 patients with interferon-alpha 2b (IFN) treatment. Median survival in the BU group was 39 months and in the IFN-treated patients 65 months. Morphological features (CD61-positive megakaryocytes, argyrophilic fibres, pseudo-Gaucher cells) were evaluated by morphometry. Additionally, we measured the incidence of apoptosis (in situ end-labelling technique) and the expression of the proliferating cell nuclear antigen (PCNA). The ratio between the proliferative and apoptotic cell fraction was coined leukaemia turnover index (LTI). In order to estimate the impact of clinical and various morphological as well as dynamic features of prognostic significance, a multivariate analysis was carried out using the classification and regression tree approach (CART). Discrimination of single disease parameters revealed that fibrosis remained the most significant variable for survival in both therapeutic groups. Indicators of myeloid metaplasia such as occurrence of erythro-normoblasts and/or splenomegaly were important clinical parameters for prognosis. Inclusion of morphological as well as dynamic disease features in risk classification resulted in a substantial improvement of prognostic efficiency compared to other predictive scores which could be demonstrated by means of ROC-analysis.
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, Germany
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Abstract
In cancer patients, hypersensitivity reactions to adjunctive medications are easily mistaken for cytostatic toxicities. We report on three patients with systemic reactions (flush, dyspnea, tachycardia, hypotension, back pain) to a lipid emulsion containing long chain fatty acids (LCT). Reexposure to LCT and exposure to MCT (medium chain fatty acids) solutions of slightly different composition--no soybean lecithin used as an emulsifier--were well tolerated. These data suggest that traces of soybean proteins are the allergenic agents. Therefore, hypersensitivity to concomitant medications, including parenteral nutrition, has to be considered in oncologic patients demonstrating severe systemic reactions to intravenous therapy.
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Affiliation(s)
- B Weidmann
- Department of Oncology and Hematology, Klinikum Leverkusen, Germany
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34
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Thiele J, Schmitz B, Gross H, Kvasnicka HM, Niederle N, Leder LD, Fischer R. Fluorescence in-situ hybridization (FISH) reveals that in chronic myelogenous leukaemia (CML) following interferon-alpha therapy, normalization of megakaryocyte size is associated with the loss of bcr/abl translocation. Histopathology 1997; 31:215-21. [PMID: 9354890 DOI: 10.1046/j.1365-2559.1997.2480853.x] [Citation(s) in RCA: 13] [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: 02/05/2023]
Abstract
AIMS In addition to predominant granulocytic proliferation, bone marrow morphology in Philadelphia chromosome positive (Ph1+) CML is characterized by atypical dwarf or microforms of megakaryocytes. However, following therapy with interferon-alpha 2b (IFN), these micromegakaryocytes occur less frequently. The purpose of this study was to elucidate whether the reappearance of normal megakaryocytes may be associated also with a reduction of the bcr/abl-positive cell clone. METHODS AND RESULTS Fluorescence in-situ hybridization (FISH) technique in combination with immunomorphometry (CD61) was performed on trephine biopsies. A total of 311 CD61-positive megakaryocytes, including precursors and atypical microforms, were evaluated in pre-treatment specimens derived from 11 patients with Ph1+ CML. A specific fusion site marking the bcr/abl translocation was found in 87% of megakaryocytes which showed a size of 169 +/- 35 microns2. In untreated patients, atypical microforms (size 200 microns2) were observed in 66% of the total megakaryocytic population. Following IFN therapy 369 megakaryocytes could be analysed in sequential examinations and were found to display a significant decrease (63%) in positive fusion signals. In addition there was also a significant enhancement in average size (252 +/- 66 microns2) reflecting a reduction in the number of micromegakaryocytes (43%). These findings were particularly conspicuous in three patients with a major to complete cytogenetic remission. CONCLUSIONS A normalization of megakaryocyte size following IFN therapy in CML is significantly associated with a loss of the bcr/abl translocation site and therefore indicates a (partial) recovery of normal haematopoiesis.
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, Germany
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35
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Thiele J, Zirbes TK, Lorenzen J, Kvasnicka HM, Dresbach S, Manich B, Leder LD, Niederle N, Diehl V, Fischer R. Apoptosis and proliferation (PCNA labelling) in CML--a comparative immunohistological study on bone marrow biopsies following interferon and busulfan therapy. J Pathol 1997. [PMID: 9155719 DOI: 10.1002/(sici)1096-9896(199703)181:3<316::aid-path771>3.0.co;2-i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A comparative morphometric analysis was performed on smears and trephine biopsies of normal bone marrow and in chronic myelogenous leukaemia (CML) to assess the effects of therapy on apoptosis and cell proliferation. The in situ end-labelling (ISEL) technique was used for the demonstration of programmed cell death, in combination with the monoclonal antibody PG-M1 to identify macrophages. Cell proliferation was evaluated by employing the monoclonal antibody PC10 directed against proliferating cell nuclear antigen (PCNA). In CML (48 patients), significantly higher rates of apoptosis were observed than in normal bone marrow (smears, frozen sections, and paraffin-embedded samples) of 15 patients. In contrast, the PCNA labelling index of CML was not different from controls. In bone marrow tissue derived from CML patients, about 36 per cent of apoptotic bodies were ingested with CD68-positive macrophages. Study of the histotopographical distribution of labelled cells revealed that in CML, in contrast to the normal bone marrow, programmed cell death and PCNA activity were concentrated along the paratrabecular generation zone. In 28 patients with CML treated with interferon (IFN), sequential trephine biopsies displayed a significant enhancement of apoptosis which was associated with a decrease in PCNA reactivity. In contrast to this finding, no such alterations could be observed in 24 patients who received busulfan (BU) monotherapy. This study furthers the understanding of cell kinetics in CML. IFN therapy induces apoptosis and suppresses cell proliferation. The rate of programmed cell death prior to therapy and the extent of IFN-triggered apoptosis exert a significant predictive impact on survival. In this study, ISEL-positive (apoptotic) cells and bodies do not correspond to unscheduled cell repair as detected by PCNA immunoreactivity.
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, Germany
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36
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Thiele J, Zirbes TK, Lorenzen J, Kvasnicka HM, Dresbach S, Manich B, Leder LD, Niederle N, Diehl V, Fischer R. Apoptosis and proliferation (PCNA labelling) in CML--a comparative immunohistological study on bone marrow biopsies following interferon and busulfan therapy. J Pathol 1997; 181:316-22. [PMID: 9155719 DOI: 10.1002/(sici)1096-9896(199703)181:3<316::aid-path771>3.0.co;2-i] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A comparative morphometric analysis was performed on smears and trephine biopsies of normal bone marrow and in chronic myelogenous leukaemia (CML) to assess the effects of therapy on apoptosis and cell proliferation. The in situ end-labelling (ISEL) technique was used for the demonstration of programmed cell death, in combination with the monoclonal antibody PG-M1 to identify macrophages. Cell proliferation was evaluated by employing the monoclonal antibody PC10 directed against proliferating cell nuclear antigen (PCNA). In CML (48 patients), significantly higher rates of apoptosis were observed than in normal bone marrow (smears, frozen sections, and paraffin-embedded samples) of 15 patients. In contrast, the PCNA labelling index of CML was not different from controls. In bone marrow tissue derived from CML patients, about 36 per cent of apoptotic bodies were ingested with CD68-positive macrophages. Study of the histotopographical distribution of labelled cells revealed that in CML, in contrast to the normal bone marrow, programmed cell death and PCNA activity were concentrated along the paratrabecular generation zone. In 28 patients with CML treated with interferon (IFN), sequential trephine biopsies displayed a significant enhancement of apoptosis which was associated with a decrease in PCNA reactivity. In contrast to this finding, no such alterations could be observed in 24 patients who received busulfan (BU) monotherapy. This study furthers the understanding of cell kinetics in CML. IFN therapy induces apoptosis and suppresses cell proliferation. The rate of programmed cell death prior to therapy and the extent of IFN-triggered apoptosis exert a significant predictive impact on survival. In this study, ISEL-positive (apoptotic) cells and bodies do not correspond to unscheduled cell repair as detected by PCNA immunoreactivity.
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, Germany
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von Pawel J, Wagner H, Niederle N, Heider A, Koschel G, Hecker D, Hanske M. Phase II study of paclitaxel and cisplatin in patients with non-small cell lung cancer. Semin Oncol 1996; 23:47-50. [PMID: 9007121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few cytotoxic agents tested in adequate phase II trials involving patients with non-small cell lung cancer have produced single-agent response rates greater than 15%. Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) is one of them, with reported response rates ranging from 21% to 36%. Platinum-based regimens have been key to the development of the most effective combination therapies for NSCLC. We are currently investigating the efficacy and toxicity of combining paclitaxel (175 mg/m2) given by 3-hour infusion, followed by cisplatin (75 mg/m2) via 1-hour infusion, on a 21-day schedule for the treatment of 75 chemotherapy-naive patients with stage IIIB (17.3%) or stage IV (82.6%) non-small cell lung cancer. Patient characteristics include a median age of 58 years (age range, 28 to 75 years) and a median Eastern Cooperative Oncology Group performance status of 2; 19 patients (25.3%) are women and 56 (74.7%) are men. All patients received standard prophylactic premedication as well as adequate hydration. To date, 75 subjects and 328 courses are evaluable for toxicity. Hematologic toxicities have been moderate; grade 3 or 4 neutropenia occurred in 37% of cycles (50% of patients), and grade 3 or 4 thrombocytopenia was observed in only 2% of cycles (2% of patients). Other notable toxicities were World Health Organization grade 2 or 3 alopecia and nausea/vomiting. Grade 1 or 2 peripheral neuropathy occurred in 26% and grade 3 or 4 in only 1% of all courses. Of 67 patients evaluable for response, complete remission was noted in three (5%) patients, partial remission in 25 (37%) patients, stable disease in 22 (33%) patients, and progressive disease in 17 (25%) patients. These results suggest that combination paclitaxel/cisplatin is active and well tolerated in the treatment of non-small cell lung cancer.
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Affiliation(s)
- J von Pawel
- Department of Oncology, Hospital Gauting, Munich, Germany
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38
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Weidmann B, Eisenbach T, Börger R, Niederle N. [Upper gastrointestinal bleeding as the first manifestation of a nonseminomatous testicular carcinoma]. Dtsch Med Wochenschr 1996; 121:1428-32. [PMID: 8974875 DOI: 10.1055/s-2008-1043164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
HISTORY AND CLINICAL FINDINGS For one week a 23-year-old man had been suffering from nausea and upper abdominal pain, followed by several bouts of haematemesis. On admission the haemoglobin level was 7.8 g/dl. INVESTIGATION Endoscopy revealed a bleeding vessel stump at the posterior gastric wall: adrenaline was injected around it. A chest radiogram showed numerous round foci in the lung, while physical examination found gynaecomastia and changes in the left testis suspicious of tumour. beta-HCG (human chorionic gonadotrophin) activity was 230,000 U/l. TREATMENT AND COURSE Histological examination of the immediately resected testis showed a necrotic non-seminomatous germ cell tumor (pT1N2M1). Repeat gastroscopy because of renewed tarry stools and haematemesis revealed bleeding from an area of polypoid mucosa. At laparotomy the lesion was excised. Histologically it was a submucosal metastasis of the testicular carcinoma. Chemotherapy resulted in normalisation of the beta-HCG-level. Subsequently retroperitoneal lymphadenectomy and bilateral thoracotomy with resection of residual tumour tissue were performed: no active tumour was found histologically. There has been no sign of tumour recurrence after 56 months. CONCLUSION Upper gastrointestinal bleeding from a haematogenous metastasis is a very rare initial manifestation of a testicular carcinoma. But a malignant tumour should be thought of in a young patient with unexplained haematemesis.
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Affiliation(s)
- B Weidmann
- Medizinische Klinik 3, Klinikum Leverkusen
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von Pawel J, Wagner H, Niederle N, Heider A, Koschel G, Gromotka E, Hanske M. Paclitaxel and cisplatin in patients with non-small cell lung cancer: results of a phase II trial. Semin Oncol 1996; 23:7-9. [PMID: 8941403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We performed a clinical phase II trial of the combination of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) and cisplatin in patients with locally advanced (stage IIIB) or metastatic non-small cell lung cancer (NSCLC), using a 3-hour infusion of paclitaxel followed by a 1-hour infusion of cisplatin. Treatment was repeated every 21 days, for a maximum of six cycles. The patients received paclitaxel 175 mg/m2 followed by cisplatin 75 mg/m2. At present, 52 chemotherapy-naive patients with stage IIIB (17.3%) or stage IV (82.7%) NSCLC have been entered into this ongoing trial. Ten (19%) of the patients are women and 42 (81%) are men. With 197 courses of chemotherapy given, all 52 patients are evaluable for toxicity. Hematologic toxicities were moderate: World Health Organization (WHO) grade 3 or 4 neutropenia occurred in 38.7% of the cycles (47.7% of patients), and WHO grade 3 or 4 thrombocytopenia was observed in 1.5% of cycles (3.8% of patients). Other toxicities consisted mainly of WHO grade 2 or 3 alopecia and nausea/vomiting. World Health Organization grade 1 or 2 polyneuropathy occurred in 30.4% and grade 3 or 4 only in 1% of all courses. Of 40 patients evaluable for response, a complete remission was noted in one patient, a partial remission occurred in 13 patients (32.5%), stable disease was seen in 14 patients (35%), and disease progressed in 12 patients (30%). These results suggest that the combination of paclitaxel and cisplatin is active and tolerable in the treatment of NSCLC. The efficacy of the combination seems high in this poor-prognosis population.
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Affiliation(s)
- J von Pawel
- Department of Oncology, Hospital Gauting, Munich, Germany
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Thiele J, Zirbes T, Kvasnicka HM, Niederle N, Dammasch J, Schmidt M, Windecker R, Leder LD, Diehl V, Fischer R. Interferon therapy, but not busulfan restores normal-sized megakaryopoiesis in CML--a comparative histo- and immunomorphometric study. Anal Cell Pathol 1996; 11:31-42. [PMID: 8844103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
To assess possible alterations of megakaryocytes associated with interferon (IFN) and busulfan (BU) therapy of Ph(1+)-CML, an immunohistochemical and morphometric study was performed on trephine biopsies of the bone marrow taken before and at varying intervals during treatment. For the identification of megakaryopoiesis and its endoreduplicative activity the monoclonal antibodies CD61 (anti-platelet glycoprotein IIIa) and PC10 raised against proliferating cell nuclear antigen (PCNA) were used. We compared 60 specimens from 20 patients following IFN alpha-2b administration (in combination with IFN gamma in seven patients) with 57 specimens from 22 patients after monotherapy with BU. A close correlation with clinical follow-up studies revealed that in the IFN-treated group the prevalence of atypical micro-megakaryocytes, usually characterizing CML, was conspicuously reduced in repeatedly taken bone marrow samples. Initially, even an increase in size which was levelled to normal values during maintenance therapy was observed. These features were most prominently expressed in the 13 patients with a complete hematologic and/or partial cytogenetic response. Associated with this phenomenon was a significant enhancement of the PCNA-labelling index which indicated a stimulation of endoreduplicative (endomitotic) activity necessary for achieving normal size and ploidy. In the second group of patients treated by BU these changes were absent. For this reason, our findings are in keeping with the assumption that during IFN treatment, there is at least partial recovery and expansion of a putative normal (Ph1-) megakaryopoiesis. In conclusion, megakaryocyte morphology, i.e. normalization in size, is thought to be a useful indicator to evaluate the response to IFN in CML patients.
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, Germany
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41
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Winkler U, Bohlen H, Schirrmacher V, Schlimok G, Voliotis D, Brach M, Niederle N, Tesch H, Diehl V, Engert A. [Immunotherapy of hemato-oncologic diseases]. Med Klin (Munich) 1996; 91:226-233. [PMID: 8692109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- U Winkler
- Klinik I für Medizin, Universität zu Köln
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42
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Thiele J, Zirbes TK, Kvasnicka HM, Lorenzen J, Niederle N, Leder LD, Fischer R. Effect of interferon therapy on bone marrow morphology in chronic myeloid leukemia: a cytochemical and immunohistochemical study of trephine biopsies. J Interferon Cytokine Res 1996; 16:217-24. [PMID: 8697144 DOI: 10.1089/jir.1996.16.217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The effect of interferon (IFN) therapy on bone marrow features in chronic myeloid leukemia (CML) has been studied on successive trephine biopsies (mean interval 13 +/- 8 months) by cytochemical and immunohistochemical methods in combination with morphometry and in comparison with a control group of patients who received monotherapy by busulfan (BU). Following IFN administration (IFN-alpha frequently in combination with IFN-gamma), there was a decrease in neutrophil granulopoiesis accompanied by a significant expansion of erythroid precursors and increased numbers of hemosiderin-laden macrophages. These changes corresponded with the hematologic response in 21 of the 25 patients investigated. Numbers of megakaryocytes and reticulin/collagen fiber density increased during treatment. Most conspicuously, in responding patients atypical micromegakaryocytes, usually characterizing CML, were partially replaced by normal-sized cells of this lineage. These features are in keeping with the assumption of a reappearance of the normal hematopoietic cell clone as the result of IFN therapy, which was not found in the BU-treated control group. On the other hand, a relevant subpopulation of micromegakaryocytes (about 30%) was still maintained. This result probably relates to the failure to improve myelofibrosis more effectively. Analysis of cell proliferation (proliferating cell nuclear antigen-PCNA) and apoptosis (in situ end labeling) revealed a reduction in PCNA labeling and increased numbers of cells undergoing programmed death. Identification of the activated subset of macrophages (alpha-D-galactosyl residues expression) by appropriate lectin histochemistry disclosed an increase in the number of GSA-I binding cells. These findings were exclusively limited to IFN administration and reflect an inhibitory effect of IFN on cell proliferation and stimulation of programmed cell death. The latter phenomenon probably results in increased phagocytosis of clonally transformed myeloid cells by GSA-I-positive (activated) macrophages.
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, Germany
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Thiele J, Kvasnicka HM, Zirbes TK, Baldus SE, Djuren O, Lienhard H, Lorenzen J, Leder LD, Niederle N, Fischer R. Effects of interferon treatment on the macrophage population in the bone marrow of patients with Ph1+-CML. Hematopathol Mol Hematol 1996; 10:201-12. [PMID: 9042663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In Ph1+-CML the abnormal function of bone marrow stroma was related to the presence of clonally transformed macrophages (MAs). Moreover, previous in vitro studies revealed that activation (phagocytosis, cytotoxicity) of MAs was associated with a pronounced increase in alpha-D-galactosyl residues on their membranes. Stimulation of this cell population has been shown to be easily accomplished by interferon (IFN) treatment. The latter caused an enhanced expression of binding sites for the lectin Griffonia simplicifolia isotype I-B4 (GSA-I), specific for this carbohydrate moiety. The present immuno- and lectinhistochemical study was designed to quantify MA subsets of the bone marrow in patients with Ph1+-CML under IFN therapy. For comparison a control group with monotherapy by busulfan (BU) was included. Identification of the total MA population was carried out by a monoclonal antibody against CD68 (PG-M1) and for the characterization of its activated fraction, the lectin GSA-I was employed. In both therapeutic groups morphometric analysis revealed a conspicuous increase in PG-M1-positive MAs in sequential trephine biopsies. However, following IFN therapy the relative amount of the GSA-I fraction was maintained or even increased and accompanied by enhanced apoptosis. On the other hand, BU generated a significant reduction of this subpopulation and the number of apoptotic cells as well. This finding is probably related to the immunomodulatory activity of IFN associated with MA activation and secretion of biogenic mediators. These are thought to belong partly to the so-called tumor necrosis factor superfamily, which is known to stimulate programmed cell death (apoptosis).
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, Germany
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Kloke O, Niederle N, Opalka B, Hawig I, Seeber S, Becher R. Prognostic impact of interferon alpha-induced cytogenetic remission in chronic myelogenous leukaemia: long-term follow-up. Eur J Haematol 1996; 56:78-81. [PMID: 8599999 DOI: 10.1111/j.1600-0609.1996.tb00299.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To evaluate the long-term impact of the reduction of Philadelphia chromosome (Ph)-positive metaphases by treatment of chronic myelogenous leukaemia (CML) with interferon (IFN) alpha, we examined the outcome of 62 patients who had been enrolled between 1984 and 1990 into 2 IFN trials at our institution. As best cytogenetic response, 9 patients had achieved a complete remission and an additional 9 patients a partial remission. The remaining 44 patients had obtained either a minimal (n=29) or no cytogenetic response (n=15). Of the total of 62 patients, 9 were still on schedule and responsive to IFN in January 1995, including 7 patients in ongoing complete cytogenetic remission. The overall 5-year survival rate after a median follow-up from diagnosis of 51 months (range 3-102 months) was 62% and the median survival was reached at month 87. The effect of cytogenetic remission on survival was examined by "landmark" studies showing a significant survival advantage for patients with karyotype responses. In conclusion, in the patients studied, cytogenetic improvement was found to translate into improved survival expectancy. Long-term control by IFN alpha of CML, however, was restricted to a small minority of patients, predominantly to those attaining a complete suppression of the leukaemic cell clone as judged by cytogenetic criteria.
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MESH Headings
- Actuarial Analysis
- Adolescent
- Adult
- Aged
- Female
- Follow-Up Studies
- Genetic Techniques
- Humans
- Interferon alpha-2
- Interferon-alpha/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Metaphase
- Middle Aged
- Philadelphia Chromosome
- Predictive Value of Tests
- Prognosis
- Recombinant Proteins
- Remission Induction
- Survival Rate
- Time Factors
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Affiliation(s)
- O Kloke
- Department of Internal Medicine (Cancer Research), West German Cancer Center Essen, University of Essen Medical School, Germany
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Thiele J, Kvasnicka HM, Niederle N, Kloke O, Schmidt M, Lienhard H, Zirbes T, Meuter RB, Leder LD, Fischer R. Clinical and histological features retain their prognostic impact under interferon therapy of CML: a pilot study. Am J Hematol 1995; 50:30-9. [PMID: 7545352 DOI: 10.1002/ajh.2830500107] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In 55 patients with Ph1+ CML under interferon (IFN) monotherapy, an immunohistochemical and morphometric study on pretreatment bone marrow biopsies was performed to evaluate the prognostic impact of clinical as well as histological disease features. For identification of megakaryocytes we used the PAS stain and CD61 to calculate the subfraction of precursors (pro- and megakaryoblasts). Demonstration of macrophages and their different subsets was carried out by PG-M1 (CD68) and the GSA-1 lectin. The erythroid precursors were stained by Ret40f (anti-glycophorin C). Density of argyrophilic (reticulin plus collagen) fibers was determined by applying Gomori's silver impregnation method. Clinical variables like state of hematological response to IFN administration, age, spleen and liver size, myeloblasts plus promyelocytes, basophils as well as basophils and eosinophils exerted a predictive capacity by univariate statistical analysis. However, when entering these factors into previously published risk models, i.e., the so-called Sokal score and its modifications, to assess subgroups with different survival patterns or relative risk groups, a clear-cut discrimination was not feasible. Bone marrow features of prognostic value consisted of megakaryocytes and their precursors, fibers, and pro- and erythroblasts. Only when including histological variables into a formerly reported Cox model, could a significant separation of patients into the different categories or relative risk groups be computated. In conclusion, the present data emphasize the prognostic impact of histological parameters to be considered in all clinical trials on CML.
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Affiliation(s)
- J Thiele
- Institute of Pathology, Universities of Cologne, Germany
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Beelen DW, Graeven U, Elmaagacli AH, Niederle N, Kloke O, Opalka B, Schaefer UW. Prolonged administration of interferon-alpha in patients with chronic-phase Philadelphia chromosome-positive chronic myelogenous leukemia before allogeneic bone marrow transplantation may adversely affect transplant outcome. Blood 1995; 85:2981-90. [PMID: 7742558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
To assess the influence of pretransplant cytoreductive therapy with special reference to interferon-alpha (IFN-alpha) treatment on major endpoints of allogeneic bone marrow transplantation (BMT), we studied 133 consecutive patients with Philadelphia chromosome (Ph1)-positive chronic myelogenous leukemia (CML) in first chronic phase who received marrow grafts from HLA-identical family (n = 103) or alternative donors (n = 30) at a referral-based transplant center. Fifty of these patients (38%) were previously exposed to IFN-alpha for a median duration of 14 months (range, 1 to 61 months), whereas 83 patients (62%) exclusively received hydroxyurea and/or busulfan therapy between 1 and 129 months (median, 15 months) pretransplant. Using the categorized treatment duration with each pretransplant cytoreductive agent as a measure for individual patient exposure to each agent, prolonged ( > 12 months) IFN-alpha administration was identified as the sole significant pretransplant therapy-related predictor of transplant outcome by proportional hazards regression analysis. The adjusted risk ratio (RR) of transplant-related mortality (TRM) was 2.5-fold higher (95% confidence limits [95% CL], 1.4 to 4.5; P < .004) compared with other pretransplant therapy and this was mainly attributable to a 3.1-fold higher RR (95% CL, 1.4 to 6.4; P < .005) of fatal posttransplant infections after prolonged IFN-alpha treatment pretransplant. Marrow graft failure developed exclusively among 7 of 30 patients (23%) with donors other than HLA-identical family members and was further restricted to patients who had been previously exposed to IFN-alpha. The probability of graft failure was 49% +/- 28% in 17 patients pretreated with IFN-alpha compared with 0% for the other 13 patients with mismatched family or unrelated donors (P < .008). In addition, a significant delay in neutrophil and platelet count reconstitution was observed among patients with donors other than HLA-identical family members after pretransplant IFN-alpha exposure. No influence of pretransplant cytoreductive therapy on either acute and chronic graft-versus-host disease or leukemic relapse was detected in this study. As a consequence of its adverse effect on TRM, prolonged pretransplant IFN-alpha treatment was independently associated with a 2.5-fold lower likelihood (95% CL, 1.4 to 4.5; P < .003) of 5-year overall survival and with a 2.3-fold lower likelihood (95% CL, 1.3 to 4.2; P < .004) of 5-year disease-free survival postransplant after adjustment for other significant prognostic factors in multivariate analysis.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- D W Beelen
- Department of Bone Marrow Transplantation, University Hospital of Essen, Germany
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Thiele J, Kvasnicka HM, Niederle N, Zirbes TK, Schmidt M, Dammasch J, Meuter BR, Leder LD, Kloke O, Diehl V. The impact of interferon versus busulfan therapy on the reticulin stain-measured fibrosis in CML--a comparative morphometric study on sequential trephine biopsies. Ann Hematol 1995; 70:121-8. [PMID: 7536475 DOI: 10.1007/bf01682031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To evaluate treatment-related changes of the reticulin stain-measured fibrosis in Ph(1+)-CML, a clinicopathological study was performed on sequential trephine biopsies of the bone marrow following either interferon (IFN) or busulfan (BU) monotherapy. Using the monoclonal antibody CD61 for the identification of megakaryopoiesis and Gomori's silver impregnation method, number of megakaryocytes and density of argyrophilic (reticulin and collagen) fibers were determined by morphometry. We studied specimens from 26 patients with IFN-alpha 2b (including nine patients with additional IFN gamma) therapy and from 23 patients who had received BU. In both groups, repeated bone marrow biopsies (total 125) revealed a significant increase in the fiber content, as well as in the number of megakaryocytes during treatment. To assess the dynamics of myelofibrosis more precisely, computation of differences in the degree of fiber density between the first and last examination was carried out. Regarding the considerable variations in the biopsy intervals, a so-called myelofibrosis progression index (MPI) was calculated. Following this rationale, we were able to demonstrate that, in comparison to the BU-group, speed of progression of bone marrow fibrosis was significantly increased in CML patients treated with IFN. Preliminary statistical analysis indicated a relationship between myelofibrosis on admission, which was always associated with increased growth of megakaryocytes, and the MPI with survival. Even when these parameters were regarded, prognosis was significantly more favorable in the IFN-treated patients. The failure of IFN and BU to inhibit the evolution of myelofibrosis may be related to several conversely acting pathomechanisms. Among others, the inability of both therapeutic agents to reduce the number of megakaryocytes more effectively should be taken into consideration.
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Affiliation(s)
- J Thiele
- Institute of Pathology, University of Cologne, Germany
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Affiliation(s)
- B Weidmann
- Department of Medicine, Leverkusen Teaching Hospital, Germany
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Hillebrand K, Moritz T, Westhoff U, Niederle N, Grosse-Wilde H. Soluble HLA class I and beta-2-microglobulin plasma concentrations during interferon treatment of chronic myelogenous leukemia. Vox Sang 1994; 67:310-4. [PMID: 7863633 DOI: 10.1111/j.1423-0410.1994.tb01258.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Soluble class I molecules (sHLA-ABC) were measured by an enzyme-linked immunosorbent assay (ELISA) in plasma samples of 13 patients with chronic-phase Ph1-positive chronic myelogenous leukemia (CML). The patients were treated once daily with interferon (IFN) s.c. at a dosage of 4 x 10(6) IU/m2 IFN-alpha-2b or in combination with 50 micrograms IFN-gamma. Measurements were performed before 2, 4, 6, 8, 24, 48, and 72 h after the start of treatment and thereafter every 2-4 weeks. Baseline sHLA-ABC levels were within normal limits (mean 22.1 +/- 8.8 mg/l). An initial decrease of sHLA-ABC (mean 3.2 +/- 2.7 mg/l) was seen in all patients during the first 2-8 h of IFN treatment. Thereafter, sHLA-ABC levels increased steadily reaching maximum values within 2-5 weeks. The overall increase was 12.7 +/- 12.4 mg/l. During the following 2-4 months of IFN treatment sHLA-ABC decreased to near baseline levels in 12 of 13 patients. No difference was detected between IFN-alpha and IFN-alpha plus IFN-gamma treatment. beta 2-Microglobulin values were measured in 8 patients and were found to be correlated to sHLA-ABC concentrations (r = 0.48).
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MESH Headings
- Adult
- Aged
- Enzyme-Linked Immunosorbent Assay
- Female
- Gene Expression Regulation, Leukemic/drug effects
- HLA Antigens/biosynthesis
- HLA Antigens/blood
- HLA Antigens/genetics
- Humans
- Immunologic Factors/pharmacology
- Immunologic Factors/therapeutic use
- Interferon alpha-2
- Interferon-alpha/pharmacology
- Interferon-alpha/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Middle Aged
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/blood
- Neoplasm Proteins/genetics
- Recombinant Proteins
- Solubility
- beta 2-Microglobulin/analysis
- beta 2-Microglobulin/biosynthesis
- beta 2-Microglobulin/genetics
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Affiliation(s)
- K Hillebrand
- Institute of Immunology, University Hospital of Essen, Medical School, Germany
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