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Knefel M, Zeilinger EL, Erfurth A, Lubowitzki S, Lesch O, Wagner T, Unseld M, Bartsch R, Füreder T, Jäger U, Kiesewetter B, Krauth MT, Prager G, Raderer M, Staber PB, Valent P, Gaiger A. Affective temperament, fatigue, and pain in cancer patients. J Affect Disord 2023; 340:80-87. [PMID: 37543112 DOI: 10.1016/j.jad.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Matthias Knefel
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Department of Internal Medicine, Landesklinikum Baden-Mödling, Waltersdorfer Straße 75, 2500 Baden, Austria
| | - Elisabeth L Zeilinger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Academy for Ageing Research, Haus der Barmherzigkeit, Vienna, Austria
| | - Andreas Erfurth
- Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Otto Lesch
- Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Theresa Wagner
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Matthias Unseld
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Academy for Ageing Research, Haus der Barmherzigkeit, Vienna, Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Thorsten Füreder
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ulrich Jäger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Maria T Krauth
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Gerald Prager
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Philipp B Staber
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Alexander Gaiger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria.
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2
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Knefel M, Zeilinger EL, Lubowitzki S, Krammer K, Unseld M, Bartsch R, Fuereder T, Jäger U, Kiesewetter B, Krauth M, Raderer M, Staber PB, Valent P, Gaiger A. Risk as a pattern over time: Delineation of time-dependent risk factors in biological, psychological, and social variables in cancer patients. Cancer 2023; 129:3466-3475. [PMID: 37470252 DOI: 10.1002/cncr.34953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/04/2023] [Accepted: 05/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Survival in cancer patients is associated with a multitude of biological, social, and psychological factors. Although it is well established that all these factors add to overall mortality, it is not well understood how the predictive power of these parameters changes in a comprehensive model and over time. METHODS Patients who attended the authors' outpatient clinic were invited to participate. The authors followed 5180 mixed cancer patients (51.1% female; mean age, 59.1 years [SD = 13.8]) for up to 16 years and analyzed biological (age, sex, cancer site, anemia), psychological (anxiety, depression), and social variables (marital status, education, employment status) potentially predicting overall survival in a Cox proportional hazards model. RESULTS The median survival time for the entire sample was 4.3 years (95% confidence interval, 4.0-4.7). The overall survival probabilities for 1 and 10 years were 76.8% and 38.0%, respectively. Following an empirical approach, the authors split the time interval into five periods: acute, subacute, short-term, medium-term, and long-term. A complex pattern of variables predicted overall survival differently in the five periods. Biological parameters were important throughout most of the time, social parameters were either time-independent predictors or tended to be more important in the longer term. Of the psychological parameters, only depression was a significant predictor and lost its predictive power in the long-term. CONCLUSIONS The findings of this study allow the development of comprehensive patient-specific models of risk and resilience factors addressing biopsychosocial needs of cancer patients, paving the way for a personalized treatment plan that goes beyond biomedical cancer care.
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Affiliation(s)
- Matthias Knefel
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine, Landesklinikum Baden-Mödling, Baden, Austria
| | - Elisabeth L Zeilinger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Katharina Krammer
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Matthias Unseld
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Thorsten Fuereder
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ulrich Jäger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Maria Krauth
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Philipp B Staber
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Alexander Gaiger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
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3
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Zeilinger EL, Knefel M, Schneckenreiter C, Pietschnig J, Lubowitzki S, Unseld M, Füreder T, Bartsch R, Masel EK, Adamidis F, Kum L, Kiesewetter B, Zöchbauer-Müller S, Raderer M, Krauth MT, Staber PB, Valent P, Gaiger A. The impact of COVID-19 and socioeconomic status on psychological distress in cancer patients. Int J Clin Health Psychol 2023; 23:100404. [PMID: 37663044 PMCID: PMC10469068 DOI: 10.1016/j.ijchp.2023.100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Objective We aimed to investigate the impact of the COVID-19 pandemic on psychological symptom burden against the socioeconomic background of cancer patients using data from routine assessments before and during the pandemic. Method In this cross-sectional study, standardised assessment instruments were applied in N = 1,329 patients to screen for symptoms of anxiety, depression, post-traumatic stress, and fatigue from 2018 to 2022. Two MANOVAs with post-hoc tests were computed. First, only time was included as predictor to examine the isolated impact of the pandemic. Second, income level and education level were included as further predictors to additionally test the predictive power of socioeconomic factors. Results In the final model, only income had a significant impact on all aspects of psychological symptom burden, with patients with low income being highly burdened (partial η² = .01, p = .023). The highest mean difference was found for depressive symptoms (MD = 0.13, CI = [0.07; 0.19], p < .001). The pandemic had no further influence on psychological distress. Conclusions Although the pandemic is a major stressor in many respects, poverty may be the more important risk factor for psychological symptom burden in cancer outpatients, outweighing the impact of the pandemic.
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Affiliation(s)
- Elisabeth Lucia Zeilinger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Academy for Ageing Research, Haus der Barmherzigkeit, Vienna, Austria
| | - Matthias Knefel
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine, Landesklinikum Baden-Mödling, Baden, Austria
| | - Carmen Schneckenreiter
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Jakob Pietschnig
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Matthias Unseld
- Academy for Ageing Research, Haus der Barmherzigkeit, Vienna, Austria
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Thorsten Füreder
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Eva Katharina Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Feroniki Adamidis
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Lea Kum
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sabine Zöchbauer-Müller
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Maria Theresa Krauth
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Philipp B Staber
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Alexander Gaiger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
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Gaiger A, Lubowitzki S, Krammer K, Zeilinger EL, Acel A, Cenic O, Schrott A, Unseld M, Rassoulian AP, Skrabs C, Valent P, Gisslinger H, Marosi C, Preusser M, Prager G, Kornek G, Pirker R, Steger GG, Bartsch R, Raderer M, Simonitsch-Klupp I, Thalhammer R, Zielinski C, Jäger U. The cancer survival index-A prognostic score integrating psychosocial and biological factors in patients diagnosed with cancer or haematologic malignancies. Cancer Med 2022; 11:3387-3396. [PMID: 35315594 PMCID: PMC9487871 DOI: 10.1002/cam4.4697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 12/20/2022] Open
Abstract
Objective We aimed to investigate whether (1) psychological and social indicators influence survival in patients diagnosed with cancer or haematologic malignancies when important biological aspects are controlled for, (2) psychological, social and biological indicators can be utilised to design one collated index for survival, usable in clinical practice to identify patients at risk of shorter survival and to improve personalised healthcare provision. Methods In this cross‐sectional study, 2263 patients with cancer or haematologic malignancies participated. We analysed 15 biological, psychological and social indicators as risk factors for survival with a Cox proportional hazards model. Indicators significantly associated with survival were combined to compute models for the identification of patient groups with different risks of death. The training sample contained 1122 patients. Validation samples included the remaining 1141 patients, the total sample, as well as groups with different cancer entities. Results Five indicators were found to significantly impact survival: Cancer site (HR: 3.56), metastatic disease (HR: 1.88), symptoms of depression (HR: 1.34), female sex (HR: 0.73) and anaemia (HR: 0.48). Combining these indicators to a model, we developed the Cancer Survival Index, identifying three distinct groups of patients with estimated survival times of 47.2 months, 141 months and 198.2 months (p < 0.001). Post hoc analysis of the influence of depression on survival showed a mediating effect of the following four factors, related to both depression and survival: previous psychiatric conditions, employment status, metastatic disease and haemoglobin levels. Conclusions Psychosocial and biological factors impact survival in various malignancies and can be utilised jointly to compute an index for estimating the survival of each patient individually—the Cancer Survival Index.
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Affiliation(s)
- Alexander Gaiger
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Katharina Krammer
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Elisabeth L Zeilinger
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Andras Acel
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Olivera Cenic
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - Matthias Unseld
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | - Anahita Paula Rassoulian
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Cathrin Skrabs
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Haematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Heinz Gisslinger
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Gerald Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Gabriela Kornek
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Robert Pirker
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Günther G Steger
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Markus Raderer
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | | | - Renate Thalhammer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Centre, Medical University Vienna - General Hospital, Vienna, Austria
| | - Ulrich Jäger
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
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5
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Zeilinger EL, Lubowitzki S, Unseld M, Schneckenreiter C, Heindl D, Staber PB, Raderer M, Valent P, Zöchbauer‐Müller S, Bartsch R, Prager G, Jaeger U, Gaiger A. The impact of
COVID
‐19 on cancer care of outpatients with low socioeconomic status. Int J Cancer 2022; 151:77-82. [PMID: 35128650 PMCID: PMC9087749 DOI: 10.1002/ijc.33960] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/22/2022] [Accepted: 01/27/2022] [Indexed: 11/10/2022]
Abstract
Patients with low socioeconomic status (SES) are among the most underserved groups of people regarding cancer care. Analyzing the impact of the coronavirus‐induced disease 2019 (COVID‐19) pandemic on health care disparities and calling attention to inequalities in cancer care is crucial to justify and initiate adequate countermeasures. We aimed to determine whether the COVID‐19 pandemic aggravated health care disparities of cancer outpatients related to their SES and analyzed patient data of the largest university center providing services for patients with hematologic and oncologic disorders in Austria from 2018 to 2021. SES was assessed using three indicators: monthly net household income, level of education and occupational prestige. In total, 1217 cancer outpatients (51.1% female) with a mean age of 59.4 years (SD = 14.2) participated. In the first year of the pandemic, the relative proportion of individuals with low income, low education level and low occupational prestige seeking cancer care at our outpatient center decreased significantly (P ≤ .015). The strongest indicator was income, with a consistent effect throughout the first pandemic year. Countermeasures and specific interventions to support cancer patients with low SES in their access to health care should be initiated and prioritized.
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Affiliation(s)
- Elisabeth L. Zeilinger
- Division of Hematology and Hemostaseology, Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - Simone Lubowitzki
- Division of Hematology and Hemostaseology, Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - Matthias Unseld
- Division of Palliative Medicine, Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - Carmen Schneckenreiter
- Division of Hematology and Hemostaseology, Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - Daniel Heindl
- Division of Hematology and Hemostaseology, Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - Philipp B. Staber
- Division of Hematology and Hemostaseology, Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - Markus Raderer
- Division of Oncology, Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine I Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Institute for Hematology and Oncology Medical University of Vienna Vienna Austria
| | - Sabine Zöchbauer‐Müller
- Division of Oncology, Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - Gerald Prager
- Division of Oncology, Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - Ulrich Jaeger
- Division of Hematology and Hemostaseology, Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | - Alexander Gaiger
- Division of Hematology and Hemostaseology, Department of Internal Medicine I Medical University of Vienna Vienna Austria
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6
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Kornauth C, Pemovska T, Vladimer GI, Bayer G, Bergmann M, Eder S, Eichner R, Erl M, Esterbauer H, Exner R, Felsleitner-Hauer V, Forte M, Gaiger A, Geissler K, Greinix HT, Gstöttner W, Hacker M, Hartmann BL, Hauswirth AW, Heinemann T, Heintel D, Hoda MA, Hopfinger G, Jaeger U, Kazianka L, Kenner L, Kiesewetter B, Krall N, Krajnik G, Kubicek S, Le T, Lubowitzki S, Mayerhoefer ME, Menschel E, Merkel O, Miura K, Müllauer L, Neumeister P, Noesslinger T, Ocko K, Öhler L, Panny M, Pichler A, Porpaczy E, Prager GW, Raderer M, Ristl R, Ruckser R, Salamon J, Schiefer AI, Schmolke AS, Schwarzinger I, Selzer E, Sillaber C, Skrabs C, Sperr WR, Srndic I, Thalhammer R, Valent P, van der Kouwe E, Vanura K, Vogt S, Waldstein C, Wolf D, Zielinski CC, Zojer N, Simonitsch-Klupp I, Superti-Furga G, Snijder B, Staber PB. Functional Precision Medicine Provides Clinical Benefit in Advanced Aggressive Hematologic Cancers and Identifies Exceptional Responders. Cancer Discov 2022; 12:372-387. [PMID: 34635570 PMCID: PMC9762339 DOI: 10.1158/2159-8290.cd-21-0538] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/22/2021] [Accepted: 09/24/2021] [Indexed: 01/07/2023]
Abstract
Personalized medicine aims to match the right drug with the right patient by using specific features of the individual patient's tumor. However, current strategies of personalized therapy matching provide treatment opportunities for less than 10% of patients with cancer. A promising method may be drug profiling of patient biopsy specimens with single-cell resolution to directly quantify drug effects. We prospectively tested an image-based single-cell functional precision medicine (scFPM) approach to guide treatments in 143 patients with advanced aggressive hematologic cancers. Fifty-six patients (39%) were treated according to scFPM results. At a median follow-up of 23.9 months, 30 patients (54%) demonstrated a clinical benefit of more than 1.3-fold enhanced progression-free survival compared with their previous therapy. Twelve patients (40% of responders) experienced exceptional responses lasting three times longer than expected for their respective disease. We conclude that therapy matching by scFPM is clinically feasible and effective in advanced aggressive hematologic cancers. SIGNIFICANCE: This is the first precision medicine trial using a functional assay to instruct n-of-one therapies in oncology. It illustrates that for patients lacking standard therapies, high-content assay-based scFPM can have a significant value in clinical therapy guidance based on functional dependencies of each patient's cancer.See related commentary by Letai, p. 290.This article is highlighted in the In This Issue feature, p. 275.
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Affiliation(s)
- Christoph Kornauth
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
| | - Tea Pemovska
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Gregory I Vladimer
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Exscientia GmbH, Vienna, Austria
| | - Günther Bayer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Michael Bergmann
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Sandra Eder
- Department of Internal Medicine and Hematology/Oncology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Ruth Eichner
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Martin Erl
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Austria
| | - Harald Esterbauer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Maurizio Forte
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Alexander Gaiger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
| | - Klaus Geissler
- Medical School, Sigmund Freud University, Vienna, Austria
| | - Hildegard T Greinix
- Department of Internal Medicine, Division of Hematology, Medical University of Graz, Graz, Austria
| | - Wolfgang Gstöttner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Alexander W Hauswirth
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Tim Heinemann
- Department of Biology, Institute of Molecular Systems Biology, ETH Zürich, Zürich, Switzerland
| | - Daniel Heintel
- Division of Medicine I, Klinik Ottakring, Vienna, Austria
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Georg Hopfinger
- Third Medical Department, Centre for Oncology and Haematology, Klinik Favoriten, Vienna, Austria
| | - Ulrich Jaeger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
| | - Lukas Kazianka
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Lukas Kenner
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Krall
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Exscientia GmbH, Vienna, Austria
| | - Gerhard Krajnik
- Department of Medicine I, Universitätsklinikum St. Pölten, St. Pölten, Austria
| | - Stefan Kubicek
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Trang Le
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elisabeth Menschel
- Third Medical Department, Hematology & Oncology, Hanusch Hospital, Vienna, Austria
| | - Olaf Merkel
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Katsuhiro Miura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Peter Neumeister
- Department of Internal Medicine, Division of Hematology, Medical University of Graz, Graz, Austria
| | - Thomas Noesslinger
- Third Medical Department, Hematology & Oncology, Hanusch Hospital, Vienna, Austria
| | - Katharina Ocko
- Pharmacy Department, Vienna General Hospital, Vienna, Austria
| | - Leopold Öhler
- Internal Medicine I, Department of Oncology, St. Josef Hospital, Vienna, Austria
| | - Michael Panny
- Third Medical Department, Hematology & Oncology, Hanusch Hospital, Vienna, Austria
| | - Alexander Pichler
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Edit Porpaczy
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Gerald W Prager
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Robin Ristl
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Julius Salamon
- Department of Medicine, Landesklinikum Waidhofen a.d. Ybbs, Waidhofen-Ybbs, Austria
| | - Ana-Iris Schiefer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Ann-Sofie Schmolke
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Ilse Schwarzinger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Edgar Selzer
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Christian Sillaber
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Cathrin Skrabs
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang R Sperr
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Ismet Srndic
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Renate Thalhammer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Emiel van der Kouwe
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Katrina Vanura
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Stefan Vogt
- Department of Medicine and Oncology, LKH Wiener Neustadt, Wiener Neustadt, Austria
| | - Cora Waldstein
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Dominik Wolf
- Department of Internal Medicine V, Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Niklas Zojer
- Division of Medicine I, Klinik Ottakring, Vienna, Austria
| | | | - Giulio Superti-Furga
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Berend Snijder
- Department of Biology, Institute of Molecular Systems Biology, ETH Zürich, Zürich, Switzerland
| | - Philipp B Staber
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
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7
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Rassoulian A, Gaiger A, Loeffler-Stastka H. Gender Differences in Psychosocial, Religious, and Spiritual Aspects in Coping: A Cross-Sectional Study with Cancer Patients. Womens Health Rep (New Rochelle) 2021; 2:464-472. [PMID: 34841392 PMCID: PMC8617579 DOI: 10.1089/whr.2021.0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 02/06/2023]
Abstract
Background: There is a growing awareness of religiosity and/or spirituality (R/S) as a possible resource in coping with cancer. Gender differences in religious coping have not yet been thoroughly examined. This study aimed to analyze differences in religious coping between men and women with cancer and compare the impact of R/S on anxiety and depression symptoms. Methods: This cross-sectional study was conducted at the Divisions of Hematology and Oncology of the Medical University of Vienna. In total, 352 patients with a cancer diagnosis, who regarded themselves as religious and/or spiritual, were interviewed at Vienna's university hospital with standardized questionnaires. To answer our research questions, we used the Hospital Anxiety and Depression Scale (HADS), the Benefit Through Spirituality/Religiosity (Benefit) questionnaire, and collected demographic characteristics. Results: Of 689 cancer patients, 51% (352) regard themselves as religious and/or spiritual. Women with cancer tend toward R/S more significantly (57%) than men (45%). In patients with an R/S belief, women scored higher in almost all items of the Benefit questionnaire and showed higher prevalence of anxiety (p < 0.001) and depression than men. Regarding the socioeconomic characteristics, more women were widowed, and had significantly lower income than men. Conclusions: The results show a significant gender gap concerning the importance of R/S for cancer patients and the effect on psychological well-being. Women in this study were more religious/spiritual than men and scored higher on anxiety and depression. We support the notion that the gender perspective is essential and can contribute to better patient care in identifying gender-specific concerns.
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Affiliation(s)
- Anahita Rassoulian
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria.,Division of Hematology and Hemostaseology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander Gaiger
- Division of Hematology and Hemostaseology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
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8
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Maguire R, McCann L, Kotronoulas G, Kearney N, Ream E, Armes J, Patiraki E, Furlong E, Fox P, Gaiger A, McCrone P, Berg G, Miaskowski C, Cardone A, Orr D, Flowerday A, Katsaragakis S, Darley A, Lubowitzki S, Harris J, Skene S, Miller M, Moore M, Lewis L, DeSouza N, Donnan PT. Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART). BMJ 2021; 374:n1647. [PMID: 34289996 PMCID: PMC8293749 DOI: 10.1136/bmj.n1647] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy, and work limitations. DESIGN Multicentre, repeated measures, parallel group, evaluator masked, stratified randomised controlled trial. SETTING Twelve cancer centres in Austria, Greece, Norway, Republic of Ireland, and UK. PARTICIPANTS 829 patients with non-metastatic breast cancer, colorectal cancer, Hodgkin's disease, or non-Hodgkin's lymphoma receiving first line adjuvant chemotherapy or chemotherapy for the first time in five years. INTERVENTION Patients were randomised to ASyMS (intervention; n=415) or standard care (control; n=414) over six cycles of chemotherapy. MAIN OUTCOME MEASURES The primary outcome was symptom burden (Memorial Symptom Assessment Scale; MSAS). Secondary outcomes were health related quality of life (Functional Assessment of Cancer Therapy-General; FACT-G), Supportive Care Needs Survey Short-Form (SCNS-SF34), State-Trait Anxiety Inventory-Revised (STAI-R), Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer), and work limitations questionnaire (WLQ). RESULTS For the intervention group, symptom burden remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle 1 onwards (least squares absolute mean difference -0.15, 95% confidence interval -0.19 to -0.12; P<0.001; Cohen's D effect size=0.5). Analysis of MSAS sub-domains indicated significant reductions in favour of ASyMS for global distress index (-0.21, -0.27 to -0.16; P<0.001), psychological symptoms (-0.16, -0.23 to -0.10; P<0.001), and physical symptoms (-0.21, -0.26 to -0.17; P<0.001). FACT-G scores were higher in the intervention group across all cycles (mean difference 4.06, 95% confidence interval 2.65 to 5.46; P<0.001), whereas mean scores for STAI-R trait (-1.15, -1.90 to -0.41; P=0.003) and STAI-R state anxiety (-1.13, -2.06 to -0.20; P=0.02) were lower. CASE-Cancer scores were higher in the intervention group (mean difference 0.81, 0.19 to 1.43; P=0.01), and most SCNS-SF34 domains were lower, including sexuality needs (-1.56, -3.11 to -0.01; P<0.05), patient care and support needs (-1.74, -3.31 to -0.16; P=0.03), and physical and daily living needs (-2.8, -5.0 to -0.6; P=0.01). Other SCNS-SF34 domains and WLQ were not significantly different. Safety of ASyMS was satisfactory. Neutropenic events were higher in the intervention group. CONCLUSIONS Significant reduction in symptom burden supports the use of ASyMS for remote symptom monitoring in cancer care. A "medium" Cohen's effect size of 0.5 showed a sizable, positive clinical effect of ASyMS on patients' symptom experiences. Remote monitoring systems will be vital for future services, particularly with blended models of care delivery arising from the covid-19 pandemic. TRIAL REGISTRATION Clinicaltrials.gov NCT02356081.
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Affiliation(s)
- Roma Maguire
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Lisa McCann
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | | | | | - Emma Ream
- University of Surrey, School of Health Sciences, Guildford, UK
| | - Jo Armes
- University of Surrey, School of Health Sciences, Guildford, UK
| | - Elisabeth Patiraki
- National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Patricia Fox
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Alexander Gaiger
- Department of Internal Medicine 1, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Paul McCrone
- Department of Health Services and Population Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Geir Berg
- Department of Health Sciences, NTNU, Gjøvik, Norway
| | | | | | | | | | - Stylianos Katsaragakis
- National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Simone Lubowitzki
- Department of Internal Medicine 1, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Jenny Harris
- University of Surrey, School of Health Sciences, Guildford, UK
| | - Simon Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, UK
| | - Morven Miller
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Margaret Moore
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Liane Lewis
- Johnson and Johnson Medical, Norderstedt, Germany
| | - Nicosha DeSouza
- Population Health and Genomics, Medical School, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Population Health and Genomics, Medical School, University of Dundee, Dundee, UK
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Unseld M, Zeilinger EL, Fellinger M, Lubowitzki S, Krammer K, Nader IW, Hafner M, Kitta A, Adamidis F, Masel EK, Preusser M, Jäger U, Gaiger A. Prevalence of pain and its association with symptoms of post-traumatic stress disorder, depression, anxiety and distress in 846 cancer patients: A cross sectional study. Psychooncology 2020; 30:504-510. [PMID: 33210393 PMCID: PMC8049050 DOI: 10.1002/pon.5595] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/13/2022]
Abstract
Objective Pain depicts a severe physical symptom but its relationship to mental health problems is not well studied in cancer patients. The aim of this study was to investigate the prevalence of pain and its correlation with symptoms of post‐traumatic stress disorder (PTSD), depression, anxiety and psychological distress in a large sample of cancer patients. Methods From 2010 to 2019, cancer patients who received outpatient treatment at the Medical University of Vienna were assessed with the Post‐Traumatic Symptom Scale (PTSS‐10) and the Hospital Anxiety and Depression Scales. A visual analogue scale was used to assess pain perception. For statistical analysis, linear regression models were applied to log‐transformed data. Results Of the 846 cancer patients included in the study, 63.5% experienced pain (mild 43.5%, moderate 13.6%, severe 6.4%). About a third (31.2%) of the total sample presented with significant PTSD symptoms. Significant symptoms of depression, anxiety and distress were present in 13.9%, 15.1% and 25.3%, respectively. Women more often reported symptoms of PTSD, anxiety and distress. Pain scores were significantly related to symptoms of PTSD, depression and psychological distress (all with p < .001), but not to anxiety. Conclusions Results show a high prevalence of experienced pain and indicate a clear association of elevated pain levels with psychiatric symptoms in oncological patients in a large Austrian sample. In order to decrease experienced pain and to enable better treatment of mental health problems in cancer patients, diagnostic procedures and interventions based on a biopsychosocial model need to be intensified.
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Affiliation(s)
- Matthias Unseld
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Matthäus Fellinger
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Katharina Krammer
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - Matthias Hafner
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | - Anna Kitta
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | - Feroniki Adamidis
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | - Eva K Masel
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Ulrich Jäger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Alexander Gaiger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
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10
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Unseld M, Krammer K, Lubowitzki S, Jachs M, Baumann L, Vyssoki B, Riedel J, Puhr H, Zehentgruber S, Prager G, Masel EK, Preusser M, Jaeger U, Gaiger A. Screening for post-traumatic stress disorders in 1017 cancer patients and correlation with anxiety, depression, and distress. Psychooncology 2019; 28:2382-2388. [PMID: 31679172 PMCID: PMC6916606 DOI: 10.1002/pon.5239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/06/2019] [Accepted: 09/11/2019] [Indexed: 12/21/2022]
Abstract
Objective Post‐traumatic stress disorder (PTSD) is a severe psychiatric disorder, which might develop after a traumatic event, like cancer diagnosis, and threatens the patient's psychological and/or physiological integrity. Anxiety, depression, and mental distress are known to be common in cancer patients; however, the frequency of PTSD was not investigated thoroughly in this patient group so far. Here, we aim to screen cancer patients for PTSD symptoms and determine a possible correlation with anxiety, depression, and distress. Methods The study was performed at the Divisions of Hematology and Oncology of the Medical University of Vienna from 2010 to 2018. Following written consent, patients were asked to fill out the validated self‐assessment questionnaire for PTSS‐10 and HADS. The study was approved by the institutional ethics committee of the Medical University of Vienna (EC Nr: 2255/2016). Results A total of 1017 adult cancer patients (513 male, 504 female) were included in a cross‐sectional single‐center study. Mean age was 57.6 years (SD 14.4 years); 31.7%, 14.6%, 13.2%, and 27.4% of patients outscored the predefined thresholds for self‐assessed cases of PTSD, anxiety, depression, and distress, respectively. Compared with men, women showed a higher prevalence of symptoms for PTSD (38.9% vs 24.5%; P < .001) and anxiety (20.4% vs 8.6%; P < .001). The scores of HADS‐A, HADS‐D, and the combined HADS score (distress) were significantly correlated with PTSS‐10 scores (P < .01). No differences in age were observed among the different score groups. Conclusion The study shows a significant prevalence as well as a correlation of PTSD symptoms with anxiety, depression, and distress among cancer patients. Findings underscore the necessity of a serious screening for psychiatric disorders, especially in female patients. In order to enable multidisciplinary care for cancer patients and to reduce the burden for psychiatric disorders, interdisciplinary screening and treatment concepts, which take into account gender aspects, are urged.
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Affiliation(s)
- Matthias Unseld
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | - Katharina Krammer
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Mathias Jachs
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | - Lukas Baumann
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Benjamin Vyssoki
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Jasmin Riedel
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | - Hanna Puhr
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Stefan Zehentgruber
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | - Gerald Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Eva Katharina Masel
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Ulrich Jaeger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Alexander Gaiger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
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11
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Furlong E, Darley A, Fox P, Buick A, Kotronoulas G, Miller M, Flowerday A, Miaskowski C, Patiraki E, Katsaragakis S, Ream E, Armes J, Gaiger A, Berg G, McCrone P, Donnan P, McCann L, Maguire R. Adaptation and Implementation of a Mobile Phone-Based Remote Symptom Monitoring System for People With Cancer in Europe. JMIR Cancer 2019; 5:e10813. [PMID: 30869641 PMCID: PMC6437605 DOI: 10.2196/10813] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/30/2018] [Accepted: 12/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings. OBJECTIVE This study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone-based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care. METHODS There were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center. RESULTS The ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT. CONCLUSIONS Adapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries.
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Affiliation(s)
- Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Andrew Darley
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Patricia Fox
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Alison Buick
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Grigorios Kotronoulas
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Morven Miller
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | | | - Christine Miaskowski
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | | | | | - Emma Ream
- School of Health Sciences, University of Surrey, Surrey, United Kingdom
| | - Jo Armes
- School of Health Sciences, University of Surrey, Surrey, United Kingdom
| | - Alexander Gaiger
- Division of Hematology and Hemaostaseology, Medical University of Vienna, Vienna, Austria
| | - Geir Berg
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway.,Innlandet Hospital Trust Division Lillehammer, Lillehammer, Norway
| | - Paul McCrone
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Peter Donnan
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Dundee, United Kingdom
| | - Lisa McCann
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Roma Maguire
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
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12
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McCann L, Ream E, Armes J, Harris J, Kotronoulas G, Miaskowski C, Furlong E, Fox P, Patiraki E, Miller M, Donnan P, McCrone P, Flowerday A, Apostolidis K, Gaiger A, Berg G, Katsaragakis SS, O'Brien C, Kearney N, Maguire R. Remote monitoring systems in the cancer setting: eSMART: Electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology for patients with cancer. Breast 2018. [DOI: 10.1016/j.breast.2018.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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13
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Maguire R, Fox PA, McCann L, Miaskowski C, Kotronoulas G, Miller M, Furlong E, Ream E, Armes J, Patiraki E, Gaiger A, Berg GV, Flowerday A, Donnan P, McCrone P, Apostolidis K, Harris J, Katsaragakis S, Buick AR, Kearney N. The eSMART study protocol: a randomised controlled trial to evaluate electronic symptom management using the advanced symptom management system (ASyMS) remote technology for patients with cancer. BMJ Open 2017; 7:e015016. [PMID: 28592577 PMCID: PMC5734219 DOI: 10.1136/bmjopen-2016-015016] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION While some evidence exists that real-time remote symptom monitoring devices can decrease morbidity and prevent unplanned admissions in oncology patients, overall, these studies have significant methodological weaknesses. The electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology (eSMART) study is designed to specifically address these weaknesses with an appropriately powered, repeated-measures, parallel-group stratified randomised controlled trial of oncology patients. METHODS AND ANALYSIS A total of 1108 patients scheduled to commence first-line chemotherapy (CTX) for breast, colorectal or haematological cancer will be recruited from multiple sites across five European countries.Patients will be randomised (1:1) to the ASyMS intervention (intervention group) or to standard care currently available at each site (control group). Patients in the control and intervention groups will complete a demographic and clinical questionnaire, as well as a set of valid and reliable electronic patient-reported outcome measures at enrolment, after each of their CTX cycles (up to a maximum of six cycles) and at 3, 6, 9 and 12 months after completion of their sixth cycle of CTX. Outcomes that will be assessed include symptom burden (primary outcome), quality of life, supportive care needs, anxiety, self-care self-efficacy, work limitations and cost effectiveness and, from a health professional perspective, changes in clinical practice (secondary outcomes). ETHICS AND DISSEMINATION Ethical approval will be obtained prior to the implementation of all major study amendments. Applications will be submitted to all of the ethics committees that granted initial approval.eSMART received approval from the relevant ethics committees at all of the clinical sites across the five participating countries. In collaboration with the European Cancer Patient Coalition (ECPC), the trial results will be disseminated through publications in scientific journals, presentations at international conferences, and postings on the eSMART website and other relevant clinician and consumer websites; establishment of an eSMART website (www.esmartproject.eu) with publicly accessible general information; creation of an eSMART Twitter Handle, and production of a toolkit for implementing/utilising the ASyMS technology in a variety of clinical practices and other transferable health care contexts. TRIAL REGISTRATION NUMBER NCT02356081.
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Affiliation(s)
- Roma Maguire
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Surrey, Guildford, UK
| | - Patricia A Fox
- UCD School of Nursing, Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin, Ireland
| | - Lisa McCann
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Surrey, Guildford, UK
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, California, USA
| | - Grigorios Kotronoulas
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Surrey, Guildford, UK
| | - Morven Miller
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Surrey, Guildford, UK
| | - Eileen Furlong
- UCD School of Nursing, Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin, Ireland
| | - Emma Ream
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Surrey, Guildford, UK
| | - Jo Armes
- Florence Nightingale Faculty of Nursing & Midwifery, King’s College London, James Clerk Maxwell Building, England, UK
| | - Elisabeth Patiraki
- National and Kapodistrian University of Athens, Papadiamantopoulou, Goudi, Athens, Greece
| | - Alexander Gaiger
- Medical University Vienna Comprehensive Cancer Center, Spitalgasse, Austria
| | - Geir V Berg
- Innlandet Hospital Trust Lillehammer and Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | | | - Peter Donnan
- Division of Population Health Sciences, Medical Research Institute, University of Dundee, Dundee, Scotland
| | - Paul McCrone
- King’s College London, David Goldberg Centre, Denmark Hill, London, UK
| | | | - Jenny Harris
- Florence Nightingale Faculty of Nursing & Midwifery, King’s College London, James Clerk Maxwell Building, England, UK
| | - Stylianos Katsaragakis
- National and Kapodistrian University of Athens, Papadiamantopoulou, Goudi, Athens, Greece
| | - Alison R Buick
- UCD School of Nursing, Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin, Ireland
| | - Nora Kearney
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Surrey, Guildford, UK
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14
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Flechl B, Ackerl M, Mag CS, Crevenna R, Keilani M, Gaiger A, Widhalm G, Dieckmann K, Marosi C. The Association of Early Cognition Assessments and Progression-free Survival in Patients with Glioblastoma Multiforme. The Journal of OncoPathology 2014. [DOI: 10.13032/tjop.2052-5931.100071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Mayerhoefer ME, Karanikas G, Kletter K, Prosch H, Kiesewetter B, Skrabs C, Porpaczy E, Weber M, Pinker-Domenig K, Berzaczy D, Hoffmann M, Sillaber C, Jaeger U, Müllauer L, Simonitsch-Klupp I, Dolak W, Gaiger A, Ubl P, Lukas J, Raderer M. Evaluation of Diffusion-Weighted MRI for Pretherapeutic Assessment and Staging of Lymphoma: Results of a Prospective Study in 140 Patients. Clin Cancer Res 2014; 20:2984-93. [DOI: 10.1158/1078-0432.ccr-13-3355] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Flechl B, Sax C, Ackerl M, Crevenna R, Gaiger A, Dieckmann K, Widhalm G, Marosi C. The prognostic value of cognition in patients with glioblastoma multiforme. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2078 Background: In patients with glioblastoma multiforme (GBM) progressive disease leads sooner or later to cognitive decline. In this study we evaluated if two cognitive assessments performed early in the treatment course have a prognostic significance for predicting progression free survival (PFS). Methods: We assessed the cognition of 35 patients with GBM using the program NeuroCogFX with four subscales: working memory, attention, verbal and figural memory and verbal fluency. Baseline evaluation was done at initiation of radiotherapy (11-57 days after diagnosis) and second evaluation three months later (82-117 days after baseline). Results in subscales were categorized in “declined”, “stable” and “improved”. Tumor progression was based on MRI scans. Results: The patients (12 women, 23 men) were in median 54 years old (21-75 years). The majority (61%) showed stable cognitive results, 22% improved and 14% decreased in the summary scale of cognition. The median PFS was 11 months (2.6-27.4 months). An improvement of attention correlated significantly with longer PFS (p = 0.015) whereas the other three cognitive subscales were not associated with PFS. Conclusions: The present study shows evidence, that an increase or decrease of attention scales measured within the first 5 months of disease has prognostic value for PFS.
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Affiliation(s)
| | | | | | | | | | - Karin Dieckmann
- Department for Radiation Therapy and Radiation Biology, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department for Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
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17
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Flechl B, Ackerl M, Sax C, Oberndorfer S, Calabek B, Sizoo E, Reijneveld J, Crevenna R, Keilani M, Gaiger A, Dieckmann K, Preusser M, Taphoorn MJB, Marosi C. The caregivers' perspective on the end-of-life phase of glioblastoma patients. J Neurooncol 2013; 112:403-11. [PMID: 23412776 DOI: 10.1007/s11060-013-1069-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 02/05/2013] [Indexed: 11/29/2022]
Abstract
Glioblastoma multiforme (GBM) still harbors a fatal prognosis. The involvement of the neurocognition and psyche poses unique challenges for care provision by relatives. We lack data about the caregivers' perspective on the end-of-life (EOL) phase of GBM patients to improve counseling and support. In this study we investigated the experiences of 52 caregivers of deceased GBM patients treated in Austria. We used a questionnaire developed by the University Medical Centre of Amsterdam for exploration of the EOL-phase in glioma patients. The caregivers (17 men, 34 women) completed the questionnaire in median three years after the patients' death. 29 % of caregivers reported that they felt incompletely prepared for their tasks, however, those with higher education levels felt significantly better informed. 29 % suffered from financial difficulties, which was associated with burnout (60 %) and reduced quality of life (QOL). The patients' most common symptoms reported by caregivers were fatigue (87 %), reduced consciousness (81 %) and aphasia (77 %). 22 % of patients were bedbound during their last three months increasing to 80 % in the last week of life. The reported QOL of caregivers was very low and did not differ between caregivers of patients, who died at home (40 %) and caregivers of patients, who died in hospital (46 %). The caregiver reported that their QOL was only slightly better than the QOL they attributed to the patients. Furthermore, the high frequency of financial difficulties, burnout symptoms and feelings of insufficient information emphasize the urgent need for support and training dedicated to caregivers.
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Affiliation(s)
- Birgit Flechl
- Department of Medicine I, Medical University of Vienna, Austria Comprehensive Cancer Center, Central Nervous System Tumors Unit (CCC-CNS), Währinger Gürtel 18-20, 1090 Vienna, Austria.
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18
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Atamaniuk J, Gleiss A, Porpaczy E, Kainz B, Grunt TW, Raderer M, Hilgarth B, Drach J, Ludwig H, Gisslinger H, Jaeger U, Gaiger A. Overexpression of G protein-coupled receptor 5D in the bone marrow is associated with poor prognosis in patients with multiple myeloma. Eur J Clin Invest 2012; 42:953-60. [PMID: 22591013 DOI: 10.1111/j.1365-2362.2012.02679.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND G protein-coupled receptor 5D (GPRC5D) is a novel surface receptor. As this new subtype of G protein-coupled receptors was discovered, little is known about the role of this gene. MATERIALS AND METHODS In this retrospective study, we investigated GPRC5D mRNA expression by real-time polymerase chain reaction (RT-PCR) in bone marrow (BM) of 48 patients with multiple myeloma (MM). RESULTS Highly variable levels of GPRC5D (median, 288; quartiles, 17-928) were detected in patients with MM, whereas only low expression was detected in normal tissues (median, 1; quartiles, 1-23). High mRNA expression of GPRC5D correlated positively with high plasma cell count in bone marrow (r = 0·64, P < 0·001), high β(2) -microglobulin (r = 0·42, P = 0·003) and poor-risk cytogenetics: deletion 13q14 (rb-1), P = 0·003; and 14q32 translocation t(4;14)(p16;q32), P = 0·029. GPRC5D mRNA expression showed a significant correlation with overall survival (P = 0·031). The estimated overall survival of patients expressing GPRC5D above or below the median of 288 was 43·9% vs. 70·2% at 48 months. Here, we report, for the first time, the association of GPRC5D expression and cancer. CONCLUSIONS Overexpression in poor-risk myeloma, low expression in normal tissues and cell surface expression identify GPRC5D as a potential novel cancer antigen. Our data demonstrate that GPRC5D is a prognostic factor in MM correlating with other major risk factors.
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Affiliation(s)
- Johanna Atamaniuk
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University Vienna, Austria
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19
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Flechl B, Sax C, Ackerl M, Crevenna R, Gaiger A, Keilani M, Preusser M, Dieckmann K, Widhalm G, Oberndorfer S, Calabek B, Reijneveld J, Sizoo E, Marosi C. Health-related quality of life (HRQOL) in patients with glioblastoma (GBM) and their caregivers in the end-of-life phase: A retrospective study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.2071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2071 Background: Glioblastoma multiforme (GBM) still harbours an inevitably fatal prognosis. The specially course of this disease poses unique challenges in care provision to the relatives. We still lack data about the end-of-life phase of GBM patients to improve counseling and supporting GBM patients and their proxies. Methods: In this retrospecitve study we included 52 caregivers of deceased GBM patients treated in two hospitals in Vienna, Austria. We used a specially developed questionnaire by the Medical University of Amsterdam to explore and document the last three months of living of GBM patients. Results: Most of the included caregivers were the partners of the patients (88%) and two thirds were female. The most common symptom in GBM patients was fatigue (87%), followed by reduced consciousness (81%) and aphasia (77%). 22% of the patients were bedbound during their last three months increasing to 80% in the last week of life. 30% of the caregivers told that they felt incompletely informed for their task and about the illness of their loved one. They stated the quality of life (QOL) of the patients with 2.2 and their own with 2.8 on a scale of 1 to 7 whereas 7 displays the best possible answer. The majority of the patients (46%) died in hospitals and 38% at home, which was the most often expressed wish for place of death (45%)by patients. Regarding the caregivers’ symptoms, sadness (90%), fear (69%), burnout (60%), less interest in others (54%) and irritation (42%) were the leading ones and did not differ significantly in-between the places of death. Conclusions: The end-of-life phase of GBM patients is different from that of patients dying from other cancers. Most alarmingly, one thirds of their caregivers feels poorly informed. About two thirds of the caregivers fell overstrained and stresses thereby the urgent need for support and dedicated educational programs.
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Affiliation(s)
| | | | | | | | | | | | | | - Karin Dieckmann
- Department for Radiation Therapy and Radiation Biology, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department for Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Jaap Reijneveld
- VU University Medical Center/Academic Medical Center Department of Neurology, The Hague, Netherlands
| | - Eefje Sizoo
- VU University Medical Center, Amsterdam, Netherlands
| | - Christine Marosi
- Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
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20
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Jäger U, Fridrik M, Zeitlinger M, Heintel D, Hopfinger G, Burgstaller S, Mannhalter C, Oberaigner W, Porpaczy E, Skrabs C, Einberger C, Drach J, Raderer M, Gaiger A, Putman M, Greil R. Rituximab serum concentrations during immuno-chemotherapy of follicular lymphoma correlate with patient gender, bone marrow infiltration and clinical response. Haematologica 2012; 97:1431-8. [PMID: 22511498 DOI: 10.3324/haematol.2011.059246] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Treatment of follicular lymphoma with rituximab is currently recommended at a dose of 375 mg/m(2). We aimed to provide a rationale for optimal dosing and scheduling of this anti-CD20 antibody based on pharmacokinetics. DESIGN AND METHODS Clinical efficacy of immunochemotherapy with rituximab, fludarabine and mitoxantrone followed by 2-monthly rituximab maintenance was evaluated in 29 patients with previously untreated follicular lymphoma in a prospective phase II trial (AGMT-NHL9). Pharmacokinetic analysis was assessed in 17 patients. RESULTS Induction treatment resulted in high clinical response rates (complete remission 66%; ORR 100%). Significantly higher complete remission rates were observed in female patients (86 vs. 47%; Odds Ratio 6.8, 95% CI: 1.12; 41.82; P=0.05). Rituximab pharmacokinetic analysis showed a high variability ranging over almost 1 order of magnitude at maintenance cycle 1 (area under the curve 1,540-12,025 g/L*days). Median area under the curve was lower in men (81%) and in patients with initial bone marrow infiltration (76%). Higher rituximab serum concentrations before next therapy (C(trough)) were associated with female sex (P=0.04) as well as with absence of initial bone marrow infiltration (P=0.001). C(trough) correlated with remission quality (complete vs. partial remission; P=0.005) and progression-free survival (P=0.03). A decline in rituximab C(trough) below 25,000 ng/mL was observed 9.5 to 62 months before clinical relapse (P=0.008). CONCLUSIONS The results of this pilot trial suggest that more differentiated dosing schedules based on gender and bone marrow infiltration should be explored for rituximab therapy for lymphoma. This study was registered in ClinicalTrials.gov (Identifier: NCT01560117).
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Affiliation(s)
- Ulrich Jäger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna Währinger Gürtel 18-20 A-1090 Vienna, Austria.
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21
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Gruber M, Fleiss K, Porpaczy E, Skrabs C, Hauswirth AW, Gaiger A, Vanura K, Heintel D, Shehata M, Einberger C, Thalhammer R, Fonatsch C, Jäger U. Prolonged progression-free survival in patients with chronic lymphocytic leukemia receiving granulocyte colony-stimulating factor during treatment with fludarabine, cyclophosphamide, and rituximab. Ann Hematol 2011; 90:1131-6. [PMID: 21617923 DOI: 10.1007/s00277-011-1260-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 05/16/2011] [Indexed: 11/25/2022]
Abstract
The clinical benefit of the addition of granulocyte colony-stimulating factor (G-CSF) to standard immunochemotherapy of chronic lymphocytic leukemia (CLL) with fludarabine, cyclophosphamide, and rituximab (FCR) is still unclear. In this retrospective study we analyzed the outcome of 32 consecutive patients with CLL during treatment with FCR. Sixteen patients received G-CSF for treatment of CTC grade 3 or 4 neutropenia or febrile neutropenia at some point during therapy and 16 did not. Both groups were well balanced for clinical and biological risk factors. Overall response rates were not significantly different (94% vs. 75%; p=0.144). Interestingly, a significantly better progression-free survival (100% vs. 35.4% at 24 months; p<0.001) and even overall survival (100% vs. 77.8% at 24 months; p=0.022) was observed in patients receiving G-CSF. While the underlying cause remains to be elucidated, these data strongly suggest an association of the addition of G-CSF to FCR therapy with final patient outcome.
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MESH Headings
- Aged
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cohort Studies
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Cyclophosphamide/therapeutic use
- Drug Monitoring
- Female
- Granulocyte Colony-Stimulating Factor/therapeutic use
- Hematologic Agents/therapeutic use
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/physiopathology
- Male
- Middle Aged
- Neutropenia/chemically induced
- Pilot Projects
- Recombinant Proteins
- Retrospective Studies
- Rituximab
- Survival Analysis
- Vidarabine/administration & dosage
- Vidarabine/adverse effects
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- Michaela Gruber
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
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22
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Stange-Rezende L, Stamm TA, Schiffert T, Sahinbegovic E, Gaiger A, Smolen J, Machold KP. Clinical study on the effect of infrared radiation of a tiled stove on patients with hand osteoarthritis. Scand J Rheumatol 2009; 35:476-80. [PMID: 17343258 DOI: 10.1080/03009740600906719] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 01/25/2023]
Abstract
OBJECTIVE To explore the effect of infrared radiation of a tiled stove on patients with hand osteoarthritis (OA). METHODS A randomized controlled crossover study was performed with 45 patients with hand OA. This sample was randomly assigned to two groups: group A [first 3 hours spent three times a week during 3 weeks in a heated tiled stove room ('Stove Period') and after 2 weeks without treatment this group was observed for another 3 weeks ('Control Period')]; and group B (first assigned to the control period and the stove period following the treatment-free period). Assessments included the visual analogue scale (VAS) for general pain, pain in the hands, and global hand function, grip strength, the Moberg Picking-up Test (MPUT), the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), and the Medical Outcomes Study (MOS) 36-item Short-Form Health Status Survey (SF-36). RESULTS Fourteen (31%) patients improved on the VAS for general pain at the end of the tiled stove period as compared to 10 patients (22%) during the control period (p = 0.314, chi2-test). The AUSCAN pain domain showed a significant improvement after the tiled stove period (p = 0.034). Others pain parameters analysed (VAS for pain in hands and SF-36 bodily pain) showed moderate but not significant improvement (p = 0.682 and p = 0.237, respectively) compared to the control period. CONCLUSION This study did not prove positive effects of the tiled stove exposure, although the numerical improvement in all pain measures suggests some possible positive effects on this symptom of hand OA.
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Affiliation(s)
- L Stange-Rezende
- Vienna Medical University, Department of Internal Medicine III, Division of Rheumatology, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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23
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SchüTzinger C, Esterbauer H, Hron G, Skrabs C, Uffmann M, Raderer M, Hauswirth A, Mannhalter C, Dieckmann K, Wagner O, Formanek M, Stift A, Friedl J, Gaiger A, Chott A, Jäger U. Prognostic value of T-cell receptor γ rearrangement in peripheral blood or bone marrow of patients with peripheral T-cell lymphomas. Leuk Lymphoma 2009; 49:237-46. [DOI: 10.1080/10428190701784409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Hauswirth AW, Skrabs C, Schützinger C, Gaiger A, Lechner K, Jäger U. Autoimmune hemolytic anemias, Evans' syndromes, and pure red cell aplasia in non-Hodgkin lymphomas. Leuk Lymphoma 2009; 48:1139-49. [PMID: 17577777 DOI: 10.1080/10428190701385173] [Citation(s) in RCA: 57] [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: 10/23/2022]
Abstract
We analyzed 108 cases of non-CLL non-Hodgkin lymphoma (NHL) associated with autoimmune hemolytic anemia (AIHA) (+/- pure red cell aplasia (PRCA)) or Evans' syndrome. The analysis was based on cases reported in the literature, which were retrieved by means of Pubmed and Medline searches and of an original series of 121 patients with NHL as well as reference lists of papers in the field. The number of cases in various NHL subtypes was small (n = 6-25). Nevertheless, interesting and sometimes unexpected differences in sex prevalence, temporal relationship between onset of lymphoma and AIHA, stage of lymphoma, relative frequency of warm antibody-AIHA (WA-AIHA) and cold antibody (CA-AIHA), association with PRCA and response of AIHA to treatments were noted for various lymphoma entities. WA-AIHA was more frequent in B-cell lymphomas, while CA-AIHA and PRCA predominantly occurred in T-cell lymphomas. Anti-lymphoma treatment seemed to be more effective against AIHA than conventional therapy with steroids or immunoglobulin. Although generated by a literature survey, this compilation of data indicates a complex relation of lymphoma and AIHA and warrants more attention and specific studies.
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MESH Headings
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/therapy
- Humans
- Leukemia, Hairy Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Lymphoma, B-Cell/complications
- Lymphoma, Follicular/complications
- Lymphoma, Mantle-Cell/complications
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, T-Cell, Peripheral/complications
- Multiple Myeloma/complications
- Prognosis
- Purpura, Thrombocytopenic, Idiopathic/etiology
- Red-Cell Aplasia, Pure/etiology
- Risk Factors
- Syndrome
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Affiliation(s)
- Alexander W Hauswirth
- Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Austria.
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25
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Vanura K, Le T, Esterbauer H, Spath F, Porpaczy E, Shehata M, Eigenberger K, Hauswirth A, Skrabs C, Kromer E, Schwarzinger I, Streubel B, Steininger C, Fonatsch C, Stilgenbauer S, Wagner O, Gaiger A, Jager U. Autoimmune conditions and chronic infections in chronic lymphocytic leukemia patients at diagnosis are associated with unmutated IgVH genes. Haematologica 2008; 93:1912-6. [DOI: 10.3324/haematol.12955] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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26
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Amsalem H, Gaiger A, Mizrahi S, Yagel S, Rachmilewitz J. Characterization of a lymphocyte subset displaying a unique regulatory activity in human decidua. Int Immunol 2008; 20:1147-54. [DOI: 10.1093/intimm/dxn072] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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27
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Azambuja AA, Viola LS, Piccoli J, Gaiger A, Barrios CH. ERCC1 expression is a predictor of clinical outcome in germ cell tumors treated with standard cisplatin based chemotherapy. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.16013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Gryshchenko I, Hofbauer S, Stoecher M, Daniel PT, Steurer M, Gaiger A, Eigenberger K, Greil R, Tinhofer I. MDM2 SNP309 Is Associated With Poor Outcome in B-Cell Chronic Lymphocytic Leukemia. J Clin Oncol 2008; 26:2252-7. [DOI: 10.1200/jco.2007.11.5212] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose A single nucleotide polymorphism (SNP) at position 309 in the promoter region of MDM2 leading to increased expression of MDM2 and attenuated function of p53 has been negatively associated with onset and outcome of disease in solid tumors. Because inactivation of p53 by deletion and/or mutations also impacts on the clinical course of B-cell chronic lymphocytic leukemia (B-CLL), we assessed the role of the SNP309 genotype in B-CLL. Patients and Methods The frequency of SNP309 T/T, T/G, or G/G genotypes and the p53 status (wild type, mutated, or deleted) were assessed and correlated with clinical outcome in 140 B-CLL patients and a second independent cohort. In addition, the correlation of the MDM2 SNP309 genotype with the MDM2 protein expression level in B-CLL cells was evaluated by immunoblotting. Results A significant negative association of the SNP309 T/G and G/G genotypes with overall survival was seen (T/G genotype, relative risk = 3.7; 95% CI, 1.2 to 11.5; P = .02; G/G genotype, relative risk = 9.1; 95% CI, 2.4 to 35.1; P = .001), but no correlation with incidence or onset of B-CLL was observed. The influence of the heterozygous SNP309 T/G genotype on treatment-free survival depended on the p53 status but not on the CD38, Zap-70, or IgVH mutational status or Rai stage of B-CLL patients. The unfavorable SNP309 T/G and G/G genotypes were associated with a gene-dosage–dependent increase of MDM2 expression. Conclusion The MDM2 SNP309 genotype influencing MDM2 expression levels was identified as an additional independent risk factor in B-CLL. Targeting MDM2-p53 interactions might emerge as a successful treatment strategy for B-CLL.
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Affiliation(s)
- Irina Gryshchenko
- From the Laboratory for Immunological and Molecular Cancer Research, Third Medical Department at the Salzburg General Hospital and the Paracelsus Private Medical University, Salzburg; Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck; Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; and Department of Hematology, Oncology, and Tumor Immunology, University Medical Center Charité, Berlin-Buch, Germany
| | - Sebastian Hofbauer
- From the Laboratory for Immunological and Molecular Cancer Research, Third Medical Department at the Salzburg General Hospital and the Paracelsus Private Medical University, Salzburg; Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck; Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; and Department of Hematology, Oncology, and Tumor Immunology, University Medical Center Charité, Berlin-Buch, Germany
| | - Markus Stoecher
- From the Laboratory for Immunological and Molecular Cancer Research, Third Medical Department at the Salzburg General Hospital and the Paracelsus Private Medical University, Salzburg; Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck; Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; and Department of Hematology, Oncology, and Tumor Immunology, University Medical Center Charité, Berlin-Buch, Germany
| | - Peter T. Daniel
- From the Laboratory for Immunological and Molecular Cancer Research, Third Medical Department at the Salzburg General Hospital and the Paracelsus Private Medical University, Salzburg; Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck; Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; and Department of Hematology, Oncology, and Tumor Immunology, University Medical Center Charité, Berlin-Buch, Germany
| | - Michael Steurer
- From the Laboratory for Immunological and Molecular Cancer Research, Third Medical Department at the Salzburg General Hospital and the Paracelsus Private Medical University, Salzburg; Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck; Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; and Department of Hematology, Oncology, and Tumor Immunology, University Medical Center Charité, Berlin-Buch, Germany
| | - Alexander Gaiger
- From the Laboratory for Immunological and Molecular Cancer Research, Third Medical Department at the Salzburg General Hospital and the Paracelsus Private Medical University, Salzburg; Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck; Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; and Department of Hematology, Oncology, and Tumor Immunology, University Medical Center Charité, Berlin-Buch, Germany
| | - Karin Eigenberger
- From the Laboratory for Immunological and Molecular Cancer Research, Third Medical Department at the Salzburg General Hospital and the Paracelsus Private Medical University, Salzburg; Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck; Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; and Department of Hematology, Oncology, and Tumor Immunology, University Medical Center Charité, Berlin-Buch, Germany
| | - Richard Greil
- From the Laboratory for Immunological and Molecular Cancer Research, Third Medical Department at the Salzburg General Hospital and the Paracelsus Private Medical University, Salzburg; Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck; Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; and Department of Hematology, Oncology, and Tumor Immunology, University Medical Center Charité, Berlin-Buch, Germany
| | - Inge Tinhofer
- From the Laboratory for Immunological and Molecular Cancer Research, Third Medical Department at the Salzburg General Hospital and the Paracelsus Private Medical University, Salzburg; Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck; Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; and Department of Hematology, Oncology, and Tumor Immunology, University Medical Center Charité, Berlin-Buch, Germany
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Epifanio M, Baldisserotto M, Spolidoro JV, Gaiger A. Grey-scale and colour Doppler sonography in the evaluation of children with suspected bowel inflammation: correlation with colonoscopy and histological findings. Clin Radiol 2008; 63:968-78. [PMID: 18718226 DOI: 10.1016/j.crad.2008.02.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 02/25/2008] [Accepted: 02/28/2008] [Indexed: 12/17/2022]
Abstract
AIM To evaluate the correlation of grey-scale and colour Doppler sonography with colonoscopy and histology to detect bowel inflammation in children. MATERIAL AND METHODS The records of 72 patients with suspected bowel inflammation were reviewed retrospectively. Patients were included in the study if sonography had been performed up to 30 days before colonoscopy. Grey-scale and colour Doppler sonography were used to evaluate bowel wall thickness and vascularity for the detection of distal bowel inflammation. Findings were correlated with colonoscopy and histological findings. The sensitivity and specificity of sonographic wall thickness to detect inflammation was determined. Spearman's coefficient (rs) was used to determine the correlation of Doppler findings with colonoscopy/histology. RESULTS Sonograms of 372 bowel segments were evaluated and results were correlated with colonoscopy and histological findings of 352 segments. The sensitivity and specificity of sonographic bowel thickness to detect inflammation in the terminal ileum and the right colon were high; in the other segments, specificity was high but sensitivity was low. The correlation of Doppler sonography with colonoscopy and histology to detect inflammation in the terminal ileum was strong (rs: 0.84; p<0.001) and in the other segments, weak to moderate; when the interval between examinations was shorter than 10 days, the correlation was stronger in all segments. Of nine patients with abnormal small bowel sonograms but normal colonoscopies, three had Crohn's disease. CONCLUSION Sensitivity and specificity of grey-scale sonography to detect inflammation in the terminal ileum and the right colon were high, and the correlation of Doppler with colonoscopy and histology was very strong in the same segments.
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Affiliation(s)
- M Epifanio
- Serviço de Gastroenterologia Pediátrica do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
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Heintel D, Zojer N, Schreder M, Strasser-Weippl K, Kainz B, Vesely M, Gisslinger H, Drach J, Gaiger A, Jäger U, Ludwig H. Expression of MUM1/IRF4 mRNA as a prognostic marker in patients with multiple myeloma. Leukemia 2007; 22:441-5. [PMID: 17690696 DOI: 10.1038/sj.leu.2404895] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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31
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Viola FS, Katz A, Arantes A, Gaiger A, Vasconcellos C, Passos V, Barrios CH. Phase II trial of high dose imatinib in recurrent glioblastoma multiforme (GBM) with platelet derived growth factor receptor (PDGFR) expression. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.2056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2056 Background: GBM are the most common primary brain tumors in adults. Despite available treatment they carry a poor prognosis with recurrences in most patients (pts) after initial therapy. PDGF signaling has been postulated to play a role in GBM transformation. We have demonstrated that PDGFRβ is expressed in tumor cells in 50% and in peritumoral endothelial cells in 65% of GBM (Barrios et al, abstract 11518, Proc ASCO 2006). Imatinib, an inhibitor of PDGFRa/β kinase activity could have therapeutic activity in these cases. Methods: We evaluated Imatinib in pts with recurrent GBM (previous radiation and chemotherapy) selected by PDGFR expression. Analysis of PDGFRa/β was performed by standard IHC. Positivity was considered in case of any qualitative expression. Pts were treated with 800 mg/day of Imatinib until tumor progression. All were on steroids and taking enzyme inducing antiepileptic drugs. Response was determined by MRI with spectroscopy and perfusion every 8 weeks according to RECIST criteria. Results: Twenty pts were enrolled (18 GBM, 2 AA). Median age: 51 (21–74), 7 were females. ECOG-PS at inclusion: 0 (3), 1 (10), 2 (7). All pts had expression of PDGFRa and 55% expressed PDGFRβ. Response data are available for all 20 pts. Main adverse events (all grade 1–2) were: edema (55%), nausea (50%), diarrhea and fatigue (35% each). We did not observe any PR but 13 pts (65%) showed disease stabilization. Median progression-free survival was 7.8 months with 60.8% of pts alive at 6 months; 6 months PFS was 52.2%. Conclusions: Imatinib was well tolerated in this group of poor prognosis highly pre-treated GBM pts demonstrating disease stabilization in a significant proportion of cases. These results, in a limited sample, compare favorably with historical data in similar populations. Selection of pts according to the specific molecular expression of their tumor may lead to better therapeutic results. No significant financial relationships to disclose.
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Affiliation(s)
- F. S. Viola
- Hospital São Lucas PUCRS, Porto Alegre, Brazil; Albert Einstein Hospital, São Paulo, Brazil; AC Camargo, São Paulo, Brazil; Novartis, São Paulo, Brazil
| | - A. Katz
- Hospital São Lucas PUCRS, Porto Alegre, Brazil; Albert Einstein Hospital, São Paulo, Brazil; AC Camargo, São Paulo, Brazil; Novartis, São Paulo, Brazil
| | - A. Arantes
- Hospital São Lucas PUCRS, Porto Alegre, Brazil; Albert Einstein Hospital, São Paulo, Brazil; AC Camargo, São Paulo, Brazil; Novartis, São Paulo, Brazil
| | - A. Gaiger
- Hospital São Lucas PUCRS, Porto Alegre, Brazil; Albert Einstein Hospital, São Paulo, Brazil; AC Camargo, São Paulo, Brazil; Novartis, São Paulo, Brazil
| | - C. Vasconcellos
- Hospital São Lucas PUCRS, Porto Alegre, Brazil; Albert Einstein Hospital, São Paulo, Brazil; AC Camargo, São Paulo, Brazil; Novartis, São Paulo, Brazil
| | - V. Passos
- Hospital São Lucas PUCRS, Porto Alegre, Brazil; Albert Einstein Hospital, São Paulo, Brazil; AC Camargo, São Paulo, Brazil; Novartis, São Paulo, Brazil
| | - C. H. Barrios
- Hospital São Lucas PUCRS, Porto Alegre, Brazil; Albert Einstein Hospital, São Paulo, Brazil; AC Camargo, São Paulo, Brazil; Novartis, São Paulo, Brazil
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Wöhrer S, Troch M, Zwerina J, Schett G, Skrabs C, Gaiger A, Jaeger U, Zielinski CC, Raderer M. Influence of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone on serologic parameters and clinical course in lymphoma patients with autoimmune diseases. Ann Oncol 2007; 18:647-51. [PMID: 17218490 DOI: 10.1093/annonc/mdl467] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND As patients with B-cell lymphomas suffering from an underlying autoimmune condition undergoing therapy with the CD20 antibody rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) offer the unique possibility of monitoring effects of therapy on various rheumatologic parameters, we have evaluated serologic autoimmune markers and the clinical outcome of patients with autoimmune diseases (ADs) who received lymphoma treatment with R-CHOP during the course of their disease. PATIENTS AND METHODS We have retrospectively analysed 13 patients with non-Hodgkin's lymphoma who concurrently suffered from ADs and were treated with the R-CHOP regimen. Subjective parameters along with rheumatoid factor (RF) and antinuclear antibodies (ANA) were serially measured. RESULTS The median levels of RF were 901 IU/ml [inter-quartile-range (IQR) 189-2520] before and 75 IU/ml (IQR 45-644) after therapy (P = 0.028). The median levels of ANA were 800 (IQR 140-2560) before and 100 (40-1280) after therapy (P = 0.027). Ten (77%) patients showed clinical improvement of their autoimmune symptoms, two (15%) reported no difference and one (7%) patient with rheumatoid arthritis-related worsening symptoms during therapy with R-CHOP. The autoimmune-related symptoms recurred after a median time of 7 weeks (IQR 6-8) in seven patients. In terms of lymphoma response, 11 patients achieved a complete remission and two a partial remission. CONCLUSIONS This analysis indicates that R-CHOP given for lymphoma treatment is also effective for therapy of concurrent rheumatoid diseases. Both rheumatoid parameters as well as clinical symptoms showed a significant decrease during treatment with this immunochemotherapy. The effects on the rheumatic diseases, however, seem to be of limited duration.
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Affiliation(s)
- S Wöhrer
- Division of Bone Marrow Transplantation, Department of Internal Medicine 1, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria.
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33
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Kainz B, Shehata M, Bilban M, Kienle D, Heintel D, Krömer-Holzinger E, Le T, Kröber A, Heller G, Schwarzinger I, Demirtas D, Chott A, Döhner H, Zöchbauer-Müller S, Fonatsch C, Zielinski C, Stilgenbauer S, Gaiger A, Wagner O, Jäger U. Overexpression of the paternally expressed gene10 (PEG10) from the imprinted locus on chromosome 7q21 in high-risk B-cell chronic lymphocytic leukemia. Int J Cancer 2007; 121:1984-1993. [PMID: 17621626 DOI: 10.1002/ijc.22929] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [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: 11/06/2022]
Abstract
We report high expression of the maternally imprinted gene PEG10 in high-risk B-CLL defined by high LPL mRNA expression. Differential expression was initially identified by microarray analysis and confirmed by real time PCR in 42 B-CLL patients. mRNA expression ranged from 0.3- to 375.4-fold compared to normal peripheral blood mononuclear cells (PBMNC). Expression levels in CD19+ B-CLL cells were 100-fold higher than in B-cells from healthy donors. PEG10 expression levels in B-CLL patient samples remained stable over time even after chemotherapy. High PEG10 expression correlated with high LPL expression (p=0.001) and a positive Coombs' test (p=0.04). Interestingly, similar expression patterns were observed for the neighbouring imprinted gene sarcoglycan-epsilon (SGCE). Monoallelic expression and maintained imprinting of PEG10 were found by allele- or methylation-specific PCR. The intensity of intracellular staining of PEG10 protein corresponded to mRNA levels as confirmed by immunofluorescence staining. Short term knock-down of PEG10 in B-CLL cells and HepG2 cells was not associated with changes in cell survival but resulted in a significant change in the expression of 80 genes. However, long term inhibition of PEG10 led to induction of apoptosis in B-CLL cells. Our data indicate (i) a prognostic value of PEG10 in B-CLL patients; (ii) specific deregulation of the imprinted locus at 7q21 in high-risk B-CLL; (iii) a potential functional and biological role of PEG10 protein expression. Altogether, PEG10 represents a novel marker in B-CLL.
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MESH Headings
- Alleles
- Apoptosis Regulatory Proteins
- Biomarkers, Tumor
- Cell Line, Tumor
- Chromosomes, Human, Pair 7/genetics
- DNA Methylation
- DNA-Binding Proteins
- Down-Regulation
- Gene Expression Regulation, Neoplastic
- Genomic Imprinting/genetics
- Health
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Nuclear Proteins/genetics
- Polysaccharides/metabolism
- Proteins/genetics
- Proteins/metabolism
- RNA, Messenger/genetics
- RNA, Small Interfering/genetics
- RNA-Binding Proteins
- Risk Factors
- Survival Rate
- Ubiquitin-Protein Ligases/genetics
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Affiliation(s)
- Birgit Kainz
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Medhat Shehata
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- K. Landsteiner Institute for Cytokine and Tumor Microenvironment, Vienna, Austria
| | - Martin Bilban
- Department of Clinical Chemistry and Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Dirk Kienle
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Daniel Heintel
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Trang Le
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Alexander Kröber
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Gerwin Heller
- Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ilse Schwarzinger
- Department of Clinical Chemistry and Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Dita Demirtas
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- K. Landsteiner Institute for Cytokine and Tumor Microenvironment, Vienna, Austria
| | - Andreas Chott
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Hartmut Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Sabine Zöchbauer-Müller
- Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christa Fonatsch
- Department of Human Genetics, Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- Center of Excellence in Clinical and Experimental Oncology (CLEXO), Vienna, Austria
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
- German CLL Study Group
| | - Alexander Gaiger
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oswald Wagner
- Department of Clinical Chemistry and Laboratory Medicine, Medical University of Vienna, Vienna, Austria
- Center of Excellence in Clinical and Experimental Oncology (CLEXO), Vienna, Austria
| | - Ulrich Jäger
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- Center of Excellence in Clinical and Experimental Oncology (CLEXO), Vienna, Austria
- German CLL Study Group
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Grunt TW, Tomek K, Wagner R, Puckmair K, Kainz B, Rünzler D, Gaiger A, Köhler G, Zielinski CC. Upregulation of retinoic acid receptor-β by the epidermal growth factor-receptor inhibitor PD153035 is not mediated by blockade of ErbB pathways. J Cell Physiol 2007; 211:803-15. [PMID: 17286282 DOI: 10.1002/jcp.20990] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/11/2022]
Abstract
Inhibiting epidermal growth factor-receptor (ErbB-1) represents a powerful anticancer strategy. Activation of retinoid pathways is also in development for cancer treatment. Retinoic acid receptor-beta-the tumor suppressor and main retinoid mediator--is silenced in many tumors. The ErbB-1 inhibitor PD153035 cooperates with retinoic acid during growth inhibition and induces retinoic acid receptor-beta suggesting that ErbB-1 controls retinoic acid receptor-beta. However, here we demonstrate that ErbB pathways are not involved in PD153035-mediated retinoic acid receptor-beta-upregulation. PD153035 inhibits ErbB-1-phosphorylation, whereas its derivative EBE-A22 is inactive. Yet both inhibit cell growth and upregulate retinoic acid receptor-beta in ErbB-1-overexpressing (MDA-MB-468), moderately expressing (OVCAR-3), ErbB-1-negative (MDA-MB-453) or ErbB-negative cells (CEM, Jurkat). Both bind DNA, whereas the closely related ErbB-1 inhibitors AG1478 and ZD1839, which are inactive on retinoic acid receptor-beta, do not significantly bind DNA. None of the other ErbB-1/ErbB-2 inhibitors tested (RG-14620, LFM-A12, AG879, AG825) affect retinoic acid receptor-beta. PD153035 decreases methylation of the retinoic acid receptor-beta2 promoter. In OVCAR-3, it stimulates dislodgement of histone deacetylase 1 from the promoter and acetylation of histones H3 and H4. Consequently, PD153035 facilitates recruitment of RNA polymerase II to the promoter and stimulates transcriptional activity. Moreover, PD153035 increases the retinoic acid receptor-beta mRNA half-life. No other retinoid receptor, nor estrogen receptor-alpha, nor RASSF1A is upregulated by PD153035. Thus PD153035 induces retinoic acid receptor-beta by ErbB-independent transcriptional and post-transcriptional mechanisms. This report highlights a triple action for an ErbB-1 inhibitor (ErbB-1 inhibition, DNA intercalation, retinoic acid receptor-beta-induction). Such multitargeting drugs bear great potential for cancer treatment.
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Affiliation(s)
- Thomas W Grunt
- Department of Medicine I, Division of Oncology, Signaling Networks Program, Medical University of Vienna, Vienna, Austria.
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Raderer M, Wöhrer S, Streubel B, Troch M, Turetschek K, Jäger U, Skrabs C, Gaiger A, Drach J, Puespoek A, Formanek M, Hoffmann M, Hauff W, Chott A. Assessment of Disease Dissemination in Gastric Compared With Extragastric Mucosa-Associated Lymphoid Tissue Lymphoma Using Extensive Staging: A Single-Center Experience. J Clin Oncol 2006; 24:3136-41. [PMID: 16769982 DOI: 10.1200/jco.2006.06.0723] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Molecular data and preliminary clinical findings have suggested mucosa-associated lymphoid tissue (MALT) lymphoma as a multifocal disease in a high percentage of patients. We report our findings with an extensive staging routine applied in patients diagnosed with MALT lymphoma at our institution. Patients and Methods A total of 140 consecutive patients (61 with gastric and 79 with extragastric MALT lymphoma) underwent staging according to a standardized protocol. Staging included gastroscopy with multiple biopsies, endosonography of the upper GI tract, computed tomography of thorax and abdomen, lymph node sonography, colonoscopy with multiple biopsies, otorhinolaryngologic assessment, magnetic resonance imaging of salivary and lacrimal glands, and bone marrow biopsy. All lesions suggestive of lymphoma involvement were subjected to biopsy, if accessible, and biopsies were evaluated for MALT lymphoma–specific genetic aberrations by means of reverse transcriptase polymerase chain reaction and/or fluorescent in situ hybridization. Results Fifteen (25%) of 61 patients with gastric MALT lymphoma had multiorgan involvement, with dissemination beyond the GI tract in six patients. By contrast, significantly more patients with extragastric MALT lymphoma had dissemination to another MALT organ (37 of 79 patients, 46%; P = .045). Nine of these 37 patients had dissemination to the stomach. Only three (2%) of 140 patients had bone marrow involvement. Multifocality was significantly associated with t(11;18)(q21;q21) in gastric lymphomas (P = .045) and with trisomy 18 in extragastric lymphomas (P = .011). Conclusion Our findings suggest that MALT lymphoma frequently presents as a multifocal disease. Extragastric MALT lymphomas are significantly more prone to dissemination than gastric MALT lymphomas.
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Affiliation(s)
- Markus Raderer
- Department of Internal Medicine I and IV, University of Vienna, Austria.
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36
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Bilban M, Heintel D, Scharl T, Woelfel T, Auer MM, Porpaczy E, Kainz B, Kröber A, Carey VJ, Shehata M, Zielinski C, Pickl W, Stilgenbauer S, Gaiger A, Wagner O, Jäger U. Deregulated expression of fat and muscle genes in B-cell chronic lymphocytic leukemia with high lipoprotein lipase expression. Leukemia 2006; 20:1080-8. [PMID: 16617321 DOI: 10.1038/sj.leu.2404220] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [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: 02/04/2023]
Abstract
Lipoprotein lipase (LPL) is a prognostic marker in B-cell chronic lymphocytic leukemia (B-CLL) related to immunoglobulin V(H) gene (IgV(H))mutational status. We determined gene expression profiles using Affymetrix U133A GeneChips in two groups of B-CLLs selected for either high ('LPL+', n=10) or low ('LPL-', n=10) LPL mRNA expression. Selected genes were verified by real-time PCR in an extended patient cohort (n=42). A total of 111 genes discriminated LPL+ from LPL- B-CLLs. Of these, the top three genes associated with time to first treatment were Septin10, DMD and Gravin (P</=0.01). The relationship of LPL+ and LPL- B-CLL gene expression signatures to 52 tissues was statistically analyzed. The LPL+ B-CLL expression signature, represented by 64 genes was significantly related to fat, muscle and PB dendritic cells (P<0.001). Exploration of microarray data to define functional alterations related to the biology of LPL+ CLL identified two functional modules, fatty acid degradation and MTA3 signaling, as being altered with higher statistical significance. Our data show that LPL+ B-CLL cells have not only acquired gene expression changes in fat and muscle-associated genes but also in functional pathways related to fatty acid degradation and signaling which may ultimately influence CLL biology and clinical outcome.
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MESH Headings
- Cohort Studies
- Cytoskeletal Proteins/genetics
- Dystrophin/genetics
- Fatty Acids/genetics
- Fatty Acids/metabolism
- GTP Phosphohydrolases/genetics
- Gene Expression Profiling
- Gene Expression Regulation, Enzymologic
- Gene Expression Regulation, Leukemic
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/enzymology
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Lipoprotein Lipase/biosynthesis
- Lipoprotein Lipase/genetics
- Mutation
- RNA, Messenger/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Septins
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Affiliation(s)
- M Bilban
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
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37
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Raderer M, Wöhrer S, Bartsch R, Prager G, Drach J, Hejna M, Gaiger A, Turetschek K, Jaeger U, Streubel B, Zielinski CC. Phase II study of oxaliplatin for treatment of patients with mucosa-associated lymphoid tissue lymphoma. J Clin Oncol 2005; 23:8442-6. [PMID: 16293875 DOI: 10.1200/jco.2004.00.8532] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [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] Open
Abstract
PURPOSE Various chemotherapeutic regimens have been applied for treatment of mucosa-associated lymphoid tissue (MALT) lymphoma, but no standard regimen has been identified to date. In view of the activity of oxaliplatin (L-OHP) in various types of lymphoma, we performed a phase II study to evaluate the activity of L-OHP for treatment of MALT lymphoma. The primary objective of this study was to determine the objective response rate according to WHO standard criteria. PATIENTS AND METHODS A total of 16 patients with MALT lymphoma of various sites of origin (four of the ocular adnexa, five of the salivary glands, three of the stomach, two of the lung, and one of the colon and the breast) were administered L-OHP at a dose of 130 mg/m2 infused during 2 hours every 3 weeks. Restaging was performed every two cycles; treatment was continued until complete remission (CR) or for a maximum of six cycles in responders. RESULTS Sixty-five cycles were administered (median, four; range, two to six); toxicity consisted of transient sensory neuropathy in eight patients and nausea/emesis WHO grade 2 in two patients, whereas hematologic adverse effects (thrombocytopenia and leukocytopenia grade 2) occurred in only one patient each. Fifteen patients responded to chemotherapy, with nine achieving CR (56%), six (37.5%) achieving partial response, and one achieving stable disease; the median time to response was 4 months (range; 2 to 4 months). CONCLUSION These data suggest L-OHP is a highly active agent for treatment of MALT lymphoma. However, a longer follow-up is needed to judge whether these remissions are durable.
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Affiliation(s)
- Markus Raderer
- Department of Medicine I, University of Vienna, Vienna, Austria.
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Schützinger C, Gaiger A, Thalhammer R, Vesely M, Fritsche-Polanz R, Schwarzinger I, Ohler L, Simonitsch-Klupp I, Reinhard F, Jäger U. Remission of pure red cell aplasia in T-cell receptor γδ-large granular lymphocyte leukemia after therapy with low-dose alemtuzumab. Leukemia 2005; 19:2005-8. [PMID: 16193089 DOI: 10.1038/sj.leu.2403956] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
MESH Headings
- Aged
- Aged, 80 and over
- Alemtuzumab
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/therapeutic use
- Antineoplastic Agents/therapeutic use
- Genes, T-Cell Receptor delta
- Genes, T-Cell Receptor gamma
- Humans
- Leukemia, T-Cell/complications
- Male
- Red-Cell Aplasia, Pure/drug therapy
- Red-Cell Aplasia, Pure/etiology
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39
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Keilholz U, Menssen HD, Gaiger A, Menke A, Oji Y, Oka Y, Scheibenbogen C, Stauss H, Thiel E, Sugiyama H. Wilms' tumour gene 1 (WT1) in human neoplasia. Leukemia 2005; 19:1318-23. [PMID: 15920488 DOI: 10.1038/sj.leu.2403817] [Citation(s) in RCA: 73] [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: 12/11/2022]
Abstract
The transcription factor Wilms' tumour gene 1 (WT1) is important as a prognostic marker as well as in the detection and monitoring of minimal residual disease in leukaemia and myelodysplastic syndromes. Evidence has accumulated over the past decade to show that WT1 is a key molecule for tumour proliferation in a large number of human neoplasms most prominent in acute leukaemias, making it a suitable target for therapeutic strategies. Based on animal results, showing safety and efficacy of immunization with WT1 peptides and protein, early clinical trials in leukaemia have recently been initiated. The First International Conference on WT1 in Human Neoplasia was held in Berlin, March 11--12, 2004. This report reviews the current knowledge on the role of WT1 in tumour promotion and as a diagnostic and therapeutic target, and summarizes the data presented and discussed in this meeting.
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Affiliation(s)
- U Keilholz
- Department of Medicine III, Charité, Campus Benjamin Franklin, Berlin, Germany.
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40
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Kainz B, Fonatsch C, Schwarzinger I, Sperr WR, Jäger U, Gaiger A. Limited value of FLT3 mRNA expression in the bone marrow for prognosis and monitoring of patients with acute myeloid leukemia. Haematologica 2005; 90:695-6. [PMID: 15921390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
We studied wild-type FLT3 mRNA expression at diagnosis in bone marrow samples from 85 patients with acute myeloid leukemia (AML), 23 of whom were in complete remission, and determined its utility as a marker for minimal residual disease (MRD). We conclude that FLT3 expression is of limited value as a prognostic marker and for MRD monitoring.
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MESH Headings
- Acute Disease
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Bone Marrow/chemistry
- Combined Modality Therapy
- Cytarabine/administration & dosage
- Daunorubicin/administration & dosage
- Etoposide/administration & dosage
- Female
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid/pathology
- Leukemia, Myeloid/surgery
- Male
- Middle Aged
- Neoplasm Proteins/genetics
- Neoplasm, Residual
- Prognosis
- RNA, Messenger/analysis
- RNA, Messenger/biosynthesis
- RNA, Neoplasm/analysis
- RNA, Neoplasm/biosynthesis
- Remission Induction
- Survival Analysis
- Tretinoin/therapeutic use
- fms-Like Tyrosine Kinase 3/genetics
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41
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Heintel D, Kienle D, Shehata M, Kröber A, Kroemer E, Schwarzinger I, Mitteregger D, Le T, Gleiss A, Mannhalter C, Chott A, Schwarzmeier J, Fonatsch C, Gaiger A, Döhner H, Stilgenbauer S, Jäger U. High expression of lipoprotein lipase in poor risk B-cell chronic lymphocytic leukemia. Leukemia 2005; 19:1216-23. [PMID: 15858619 DOI: 10.1038/sj.leu.2403748] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [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: 11/08/2022]
Abstract
We investigated the pattern of lipoprotein lipase (LPL) expression in B-cell chronic lymphocytic leukemia (B-CLL) and assessed its prognostic relevance. Expression of LPL mRNA as well as protein was highly restricted to leukemic B cells. The intensity of intracellular immunoreactivity of LPL was higher in samples of patients with unmutated immunoglobulin heavy-chain variable region genes (IGV(H)) compared to those with mutated IGV(H) genes. LPL mRNA levels in peripheral blood mononuclear cells (PBMNC) from 104 CLL patients differed by 1.5 orders of magnitude between cases with mutated (N=51) or unmutated (N=53) IGV(H) (median: 1.33 vs 45.22 compared to normal PBMNC). LPL expression correlated strongly with IGV(H) mutational status (R=0.614; P<0.0001). High LPL expression predicted unmutated IGV(H) status with an odds ratio of 25.90 (P<0.0001) and discriminated between mutated and unmutated cases in 87 of 104 patients (84%). LPL expression was higher in patients with poor risk cytogenetics. High LPL expression was associated with a shorter treatment-free survival (median 40 vs 96 months, P=0.001) and a trend for a shorter median overall survival (105 months vs not reached). Our data establish LPL as a prognostic marker and suggest functional consequences of LPL overexpression in patients with B-CLL.
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Affiliation(s)
- D Heintel
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
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42
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Grunt TW, Puckmair K, Tomek K, Kainz B, Gaiger A. An EGF receptor inhibitor induces RAR-β expression in breast and ovarian cancer cells. Biochem Biophys Res Commun 2005; 329:1253-9. [PMID: 15766561 DOI: 10.1016/j.bbrc.2005.02.104] [Citation(s) in RCA: 13] [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] [Received: 02/10/2005] [Indexed: 10/25/2022]
Abstract
Inhibition of the epidermal growth factor (EGF)-receptor (EGFR) has become a promising anticancer treatment strategy. In addition, application of retinoids yields encouraging results for cancer prevention and therapy. Many tumors express no or low amounts of retinoic acid receptor-beta2 (RAR-beta2) due to epigenetic silencing via DNA hypermethylation. RAR-beta2 is the main mediator of the antiproliferative effect of retinoids. RAR-beta2 re-expression causes reversal of transformation, cell cycle arrest, and restoration of retinoid sensitivity. RAR-beta2 is thus a tumor suppressor. Western blotting, colorimetric in vitro cell proliferation assays, and reverse transcription-polymerase chain reaction demonstrated that the EGFR inhibitor PD153035 not only blocked activation of EGFR and inhibited cell growth, but also stimulated RAR-beta expression in MDA-MB-468 breast and OVCAR-3 ovarian carcinoma cells. Upregulation of RAR-beta by PD153035 was confirmed by real-time reverse transcription-polymerase chain reaction. In contrast, expression of other retinoid receptors and of estrogen receptor-alpha was not affected. PD153035-mediated re-induction of RAR-beta was associated with demethylation of the RAR-beta2 gene promoter P2 as demonstrated by methylation-specific polymerase chain reaction. These novel results on the ErbB/retinoid receptor cross-talk may be useful for designing future anticancer combination regimens.
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Affiliation(s)
- Thomas W Grunt
- Signaling Networks Program, Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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43
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Abstract
B-cell lymphocytic leukaemia (B-CLL) is an indolent non-Hodgkin's lymphoma and the most frequent leukaemia. However, after many years, the incurable disease CLL has again become an exciting subject for research. Recently, both serum and molecular markers have been identified which could be used to predict the outcome of patients in early stages. With the advent of microarray analysis, novel diagnostic and therapeutic targets have been discovered. Here we describe the molecular strategies for target identification and validation. An evaluation of some established, and the most promising novel factors, with their diagnostic and prognostic applications is given. Potential therapeutic target molecules and their inhibitors are reviewed.
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Affiliation(s)
- A Gaiger
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, University of Vienna, Austria
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44
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Heintel D, Kroemer E, Kienle D, Schwarzinger I, Gleiss A, Schwarzmeier J, Marculescu R, Le T, Mannhalter C, Gaiger A, Stilgenbauer S, Döhner H, Fonatsch C, Jäger U. High expression of activation-induced cytidine deaminase (AID) mRNA is associated with unmutated IGVH gene status and unfavourable cytogenetic aberrations in patients with chronic lymphocytic leukaemia. Leukemia 2004; 18:756-62. [PMID: 14961036 DOI: 10.1038/sj.leu.2403294] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [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: 11/09/2022]
Abstract
Activation-induced cytidine deaminase (AID) is essential for somatic hypermutation of B-cells. We investigated the expression of AID mRNA by real-time polymerase chain reaction (PCR) in peripheral blood mononuclear cells of 80 patients with B-CLL. AID expression was detected in 45 of 80 patients (56%) at various levels, but was undetectable in 35 patients (44%). AID PCR positivity was associated with unmutated IGV(H) gene status (22 of 25 patients; P=0.002) and unfavourable cytogenetics (18 of 23 patients with deletion in 11q or loss of p53; P=0.040). Using a threshold level of 0.01-fold expression compared to Ramos control cells, even more significant associations were observed (P=0.001 for IGVH; P=0.002 for cytogenetics). A correlation was observed between individual AID levels and the percentage of V(H) homology (R=0.41; P=0.001). AID positivity predicted unmutated IGV(H) status with an odds ratio of 8.31 (P=0.003) and poor risk cytogenetics with an odds ratio of 3.46 (P=0.032). Significance was retained after adjustment for Binet or Rai stages. AID mRNA levels were stable over time. These data suggest a potential role of AID as a prognostic marker in B-CLL.
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MESH Headings
- Biomarkers/analysis
- Chromosome Aberrations
- Cytidine Deaminase/biosynthesis
- Cytidine Deaminase/genetics
- Disease Progression
- Female
- Humans
- Immunoglobulin Variable Region/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Male
- Middle Aged
- Odds Ratio
- Polymerase Chain Reaction/methods
- Prognosis
- RNA, Messenger/analysis
- RNA, Messenger/biosynthesis
- RNA, Neoplasm/analysis
- Somatic Hypermutation, Immunoglobulin
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Affiliation(s)
- D Heintel
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, University of Vienna, Austria
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45
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Diamond DL, Zhang Y, Gaiger A, Smithgall M, Vedvick TS, Carter D. Use of ProteinChip array surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) to identify thymosin beta-4, a differentially secreted protein from lymphoblastoid cell lines. J Am Soc Mass Spectrom 2003; 14:760-765. [PMID: 12837598 DOI: 10.1016/s1044-0305(03)00265-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The identification of proteins differentially expressed between cancer and normal cells is vital for the development of cancer diagnostics, therapeutics and vaccines. Using a ProteinChip Biomarker System (Ciphergen Biosystems, Fremont, CA) which combines ProteinChip technology with time-of-flight mass spectrometry, we have developed a simple method to screen and identify differentially secreted proteins from tumor cell lines. Mass spectra of the range of proteins secreted from normal B-cells were generated along with those secreted from Epstein-Barr virus transformed B-cells. A mass peak at m/z = 4972.1 that was highly over-represented in the transformed B-cell line was chosen for identification and purified by reversed phase chromatography with concomitant monitoring of fractions by SELDI-TOF MS. The resulting purified protein was digested with trypsin and the peptide masses derived from the SELDI-TOF spectrum were used to search the public databases for protein identification. Fragment matching of the resulting peptides identified the protein as thymosin beta-4. Using LC-electrospray ionization MS/MS, the identity of this protein was confirmed. Thymosin beta-4 is a known marker in LCLs establishing the utility of this method to discover and identify proteins differentially expressed between cancers and their matched normal counterparts.
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46
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Rosenfeld C, Cheever MA, Gaiger A. WT1 in acute leukemia, chronic myelogenous leukemia and myelodysplastic syndrome: therapeutic potential of WT1 targeted therapies. Leukemia 2003; 17:1301-12. [PMID: 12835718 DOI: 10.1038/sj.leu.2402988] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Among clinicians, initial awareness of the Wilms' tumor gene was limited mostly to pediatric oncologists. Almost a decade ago, overexpression of Wilms' tumor 1 (WT1) was observed in adult acute leukemia. Subsequent studies indicated that WT1 overexpression occurs in most cases of acute myelogenous leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia (CML), and myelodysplastic syndrome (MDS). Limited tissue expression of WT1 in adults suggests that WT1 can be a target for leukemia/MDS therapy. WT1 expression in stem/progenitor cells remains unsettled. However, lack of progenitor cell suppression by WT1 antisense or WT1-specific cytotoxic T cells provide some assurance that WT1 expression in progenitor cells is minimal or absent. Immunotherapy-based WT1 approaches are furthest along in preclinical development. WT1-specific cytotoxic lymphocytes can be generated from normals and leukemic patients. In mice, WT1 vaccines elicit specific immune responses without evidence of tissue damage. In this paper, we review studies validating the immunogenicity of WT1 and propose that leukemia and MDS may be a good clinical model to test the efficacy of a WT1 vaccine.
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47
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Gaiger A, Carter L, Greinix H, Carter D, McNeill PD, Houghton RL, Cornellison CD, Vedvick TS, Skeiky YA, Cheever MA. WT1-specific serum antibodies in patients with leukemia. Clin Cancer Res 2001; 7:761s-765s. [PMID: 11300470] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
WT1 is an oncogenic protein expressed by the Wilms' tumor gene and overexpressed in the majority of acute myelogenous leukemias (AMLs) and chronic myelogenous leukemias (CMLs). The current study analyzed the sera of patients with AML and CML for the presence of antibodies to full-length and truncated WT1 proteins. Sixteen of 63 patients (25%) with AML had serum antibodies reactive with WT1/full-length protein. Serum antibodies from all 16 were also reactive with WT1/NH2-terminal protein. By marked contrast, only 2 had reactivity to WT1/COOH-terminal protein. Thus, the level of immunological tolerance to the COOH terminus may be higher than to the NH2 terminus. The WT1/COOH-terminal protein contains four zinc finger domains with homology to other self-proteins. By implication, these homologies may be related to the increased immunological tolerance. Results in patients with CML were similar with antibodies reactive to WT1/full-length protein detectable in serum of 15 of 81 patients (19%). Antibodies reactive with WT1/NH2-terminal protein were present in the serum of all 15, whereas antibodies reactive with WT1/COOH-terminal protein were present in only 3. By contrast to results in leukemia patients, antibodies reactive with WT1/full-length protein were detected in only 2 of 96 normal individuals. The greater incidence of antibody in leukemia patients provides strong evidence that immunization to the WT1 protein occurred as a result of patients bearing malignancy that expresses WT1. These data provide further stimulus to test therapeutic vaccines directed against WT1 with increased expectation that the vaccines will be able to elicit and/or boost an immune response to WT1.
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MESH Headings
- Adult
- Antibodies/blood
- DNA, Complementary/metabolism
- DNA-Binding Proteins/immunology
- Enzyme-Linked Immunosorbent Assay
- Humans
- Leukemia/blood
- Leukemia/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/mortality
- Recombinant Proteins/metabolism
- Transcription Factors/immunology
- WT1 Proteins
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Affiliation(s)
- A Gaiger
- Corixa Corporation, Seattle, Washington 98104, USA
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48
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Gaiger A, Reese V, Disis ML, Cheever MA. Immunity to WT1 in the animal model and in patients with acute myeloid leukemia. Blood 2000; 96:1480-9. [PMID: 10942395] [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: 02/17/2023] Open
Abstract
The Wilms' tumor (WT1) gene participates in leukemogenesis and is overexpressed in most types of leukemia in humans. WT1 is also detectable in many types of lung, thyroid, breast, testicular, and ovarian cancers and melanoma in humans. Initial studies evaluated whether immune responses to murine WT1 can be elicited in mice. Murine and human WT1 are similar. Thus, mouse models might lead to resolution of many of the critical issues for developing WT1 vaccines. C57/BL6 (B6) mice were injected with synthetic peptides from the natural sequence of WT1 containing motifs for binding to major histocompatibility (MHC) class II molecules. Immunization induced helper T-cell responses specific for the immunizing WT1 peptides and antibody responses specific for WT1 protein. Screening of multiple murine cancer cell lines identified 2 murine cancers, TRAMP-C and BLKSV40, that "naturally" overexpress WT1. Immunization with MHC class I binding peptides induced WT1 peptide-specific cytotoxic T-lymphocyte (CTL) that specifically lysed TRAMP-C and BLKSV40. WT1 specificity of lysis was confirmed by cold target inhibition. No toxicity was noted by histopathologic evaluation in the WT1 peptide-immunized animals. WT1 peptide immunization did not show any effect on TRAMP-C tumor growth in vivo. Immunization of B6 mice to syngeneic TRAMP-C elicited WT1-specific antibody, demonstrating that WT1 can be immunogenic in the context of cancer cells. To evaluate whether WT1 might be similarly immunogenic in humans, serum from patients with leukemia was evaluated for pre-existing antibody responses. Western blot analyses showed WT1-specific antibodies directed against the N-terminus portion of the WT1 protein in the sera of 3 of 18 patients with acute myeloid leukemia (AML). (Blood. 2000;96:1480-1489)
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Affiliation(s)
- A Gaiger
- Corixa Corporation, Seattle, WA 98104, USA
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49
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Gaiger A, Linnerth B, Mann G, Schmid D, Heinze G, Tisljar K, Haas OA, Gadner H, Lion T. Wilms' tumour gene (wt1) expression at diagnosis has no prognostic relevance in childhood acute lymphoblastic leukaemia treated by an intensive chemotherapy protocol. Eur J Haematol 1999; 63:86-93. [PMID: 10480287 DOI: 10.1111/j.1600-0609.1999.tb01121.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Expression of the Wilms' tumour gene (wt1) has been demonstrated in a large proportion of human acute leukaemias and is thought to play a role in leukaemogenesis. Recent observations in adult patients with acute leukaemia suggest that wt1 gene expression is a poor prognostic factor. In childhood acute leukaemia, the clinical role of wt1 gene expression has not been established. We have therefore investigated bone marrow samples from 50 children with acute lymphocytic leukaemia at the time of diagnosis for the presence of wt1 transcripts to determine whether wt1 gene expression is associated with specific characteristics of leukaemic cells and whether it is predictive of response to treatment. All patients were treated according to the ALL-BFM 90 protocol. The median observation time was 30 months. Wt1 transcripts were detected by RT-PCR in 60% of the diagnostic samples. Wt1 PCR positive patients showed a higher median leukocyte and peripheral blast cell count than wt1 negative patients. High and intermediate risk patients more frequently displayed wt1 transcripts than low risk patients. No correlation between wtl gene expression and FAB type, immunophenotype, co-expression of myeloid antigens or karyotype has been observed. Furthermore, there was no correlation between wt1 gene expression at diagnosis and achievement of complete remission (CR) and no difference in disease-free survival (DFS) or overall survival (OS) between wt1 positive and negative patients (p > 0.1). These data indicate that (1) wt1 gene expression at diagnosis is detected more frequently in patients with high leukocyte and peripheral blast cell counts, but is not associated with specific characteristics of leukaemic cells, (2) wt1 gene expression is not an independent prognostic factor for CR, DFS or OS in childhood ALL treated by an intensive therapy protocol.
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Affiliation(s)
- A Gaiger
- First Department of Medicine, University of Vienna, Austria
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50
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Sillaber C, Walchshofer S, Mosberger I, Gaiger A, Simonitsch I, Chott A, Lechner K, Valent P. Immunophenotypic characterization of human bone marrow endosteal cells. Tissue Antigens 1999; 53:559-68. [PMID: 10395106 DOI: 10.1034/j.1399-0039.1999.530606.x] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In order to determine the relationship between bone marrow (bm) endosteal cells (EDC) and hemopoietic progenitors, we have analyzed the immunophenotype of EDC using various antibodies (Ab) against mesenchymal antigens. The Ab were applied on paraffin sections of normal bm (iliac crest, n=17; talus, n=1; phalanx, n=1), myeloregenerative bm (after chemotherapy), and hematologic disorders (acute myeloid leukemia (AML), n=8; chronic myeloid leukemia (CML), n=6; myelodysplastic syndromes (MDS), n=14; severe aplastic anemia (SAA), n=4; essential thrombocythemia (ET), n=2; idiopathic (primary) osteomyelo-fibrosis (IMF), n=1; polycythemia vera (PV), n=1). In normal bm, EDC were found to react with Ab against vimentin, tenascin, alpha-smooth muscle actin, osteocalcin, CD51, and CD56, but did not react with Ab against CD3, CD15, CD20, CD34, CD45, CD68, or CD117. An identical phenotype of EDC was found in AML, MDS, SAA, ET, IMF, PV, myeloregenerative bm, and peripheral bones lacking active hemopoiesis (talus, phalanx). In patients with CML, EDC reacted with Ab to CD51, but did not react with Ab to CD56. Based on their unique antigen profile, EDC were enriched from normal bm by enzyme digestion and cell sorting. However, these enriched cells (CD56+, CD45-, CD34-) did not give rise to hemopoietic cells under the culture conditions used, i.e. in the presence of the growth factors IGF-1, bFGF, SCF, IL-3, and GM-CSF Together, our data do not support the hypothesis that EDC are totipotent mesenchymal progenitors giving rise to hemopoietic cells.
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Affiliation(s)
- C Sillaber
- Department of Internal Medicine I, The University of Vienna, Austria
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