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Niebuhr H, Reinpold W, Morgenroth F, Berger C, Dag H, Wehrenberg U, Trzewik J, Köckerling F. Assessment of myofascial medialization following intraoperative fascial traction (IFT) in a cadaveric model. Hernia 2024:10.1007/s10029-024-03003-1. [PMID: 38615297 DOI: 10.1007/s10029-024-03003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/20/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE Intraoperative fascial traction (IFT) for the treatment of large ventral hernias and loss of domain (LOD) hernias is a promising tool in abdominal wall surgery. However, little is known about the extent of gain in myofascial advancement especially for the anterior rectus sheath. We, therefore, used a cadaveric model to determine the medialization during IFT. METHODS 4 fresh frozen specimens were used. Retromuscular preparation was carried out followed by IFT with diagonal vertical traction for 30 min. Medial advancement of the anterior rectus sheath was measured after 15 and 30 min as well as traction forces. RESULTS Total medialization for anterior rectus sheath after 30 min of IFT was 10.5 cm (mean). The mean traction force was 16.28 kg. Total medialization was significantly higher during the first 15 min of vertical fascial traction (p < 0.05). CONCLUSIONS IFT provides significant medialization for the anterior rectus sheath in the cadaveric model. The findings align with results from a retrospective case study. Therefore, we see IFT as a beneficial tool in abdominal wall surgery.
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Affiliation(s)
- H Niebuhr
- Hamburg Hernia Centre, Hamburg, Germany.
| | | | - F Morgenroth
- Hamm-Lippstadt University of Applied Sciences, Hamm, Germany
| | - C Berger
- Hamburg Hernia Centre, Hamburg, Germany
| | - H Dag
- Hamburg Hernia Centre, Hamburg, Germany
| | - U Wehrenberg
- Anatomical Institute University of Hamburg, Hamburg, Germany
| | - J Trzewik
- Hamm-Lippstadt University of Applied Sciences, Hamm, Germany
| | - F Köckerling
- Hernia Centre Vivantes Humboldt-Klinikum Berlin, Berlin, Germany
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Hassanabadi N, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D, Morin SN. Geographic variation in bone mineral density and prevalent fractures in the Canadian longitudinal study on aging. Osteoporos Int 2024; 35:599-611. [PMID: 38040857 DOI: 10.1007/s00198-023-06975-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
Awareness of the prevalence of osteoporosis and fractures across jurisdictions can guide the development of local preventive programs and healthcare policies. We observed geographical variations in total hip bone mineral density and in the prevalence of major osteoporotic fractures across Canadian provinces, which persisted after adjusting for important covariates. PURPOSE We aimed to describe sex-specific total hip bone mineral density (aBMD) and prevalent major osteoporotic fractures (MOF) variation between Canadian provinces. METHODS We used baseline data from 21,227 Canadians (10,716 women, 10,511 men) aged 50-85 years in the Canadian Longitudinal Study on Aging (CLSA; baseline: 2012-2015). Linear and logistic regression models were used to examine associations between province of residence and total hip aBMD and self-reported MOF, stratified by sex. CLSA sampling weights were used to generate the prevalence and regression estimates. RESULTS The mean (SD) age of participants was 63.9 (9.1) years. The mean body mass index (kg/m2) was lowest in British Columbia (27.4 [5.0]) and highest in Newfoundland and Labrador (28.8 [5.3]). Women and men from British Columbia had the lowest mean total hip aBMD and the lowest prevalence of MOF. Alberta had the highest proportion of participants reporting recent falls (12.0%), and Manitoba (8.4%) the fewest (p-value=0.002). Linear regression analyses demonstrated significant differences in total hip aBMD: women and men from British Columbia and Alberta, and women from Manitoba and Nova Scotia had lower adjusted total hip aBMD than Ontario (p-values<0.02). Adjusted odds ratios (95% confidence intervals, CI) for prevalent MOF were significantly lower in women from British Columbia (0.47 [95% CI: 0.32; 0.69]) and Quebec (0.68 [95% CI: 0.48; 0.97]) and in men from British Columbia (0.40 [95% CI:0.22; 0.71]) compared to Ontario (p-values<0.03). Results were similar when adjusting for physical performance measures and when restricting the analyses to participants who reported White race/ethnicity. CONCLUSION Geographical variations in total hip aBMD and in the prevalence of MOF between provinces persisted after adjusting for important covariates which suggests an association with unmeasured individual and environmental factors.
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Affiliation(s)
- N Hassanabadi
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - C Berger
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, Canada
| | - A M Cheung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - E Rahme
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - D Goltzman
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montreal, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada.
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Reinpold W, Berger C, Adolf D, Köckerling F. Mini- or less-open sublay (E/MILOS) operation vs open sublay and laparoscopic IPOM repair for the treatment of incisional hernias: a registry-based propensity score matched analysis of the 5-year results. Hernia 2024; 28:179-190. [PMID: 37603090 DOI: 10.1007/s10029-023-02847-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Open sublay and laparoscopic IPOM repair have specific disadvantages and risks. In recent years, this evidence led to a paradigm shift and induced the development of new minimally invasive techniques of sublay mesh repair. METHODS Pioneering this trend, we developed the endoscopically assisted mini- or less-open sublay (MILOS) concept. The operation is performed trans-hernially via a small incision with light-holding laparoscopic instruments either under direct, or endoscopic visualization. After dissection of an extra-peritoneal space of at least 8 cm, port placement and CO2 insufflation, each MILOS operation can be continued endoscopically (EMILOS repair). All E/MILOS operations were prospectively documented in the Herniamed Registry with 1- and 5-year questionnaire follow-ups. Propensity score matching of incisional hernia operations comparing the results of the E/MILOS operation with the laparoscopic intraperitoneal onlay mesh operation (IPOM) and open sublay repair from all other institutions participating in the Herniamed Registry was performed. The results with perioperative complications and 1-year follow-up have been published previously. RESULTS This paper reports on the 5-year results. The 5-year follow-up rate was 87.5% (538 of 615 patients with E/MILOS incisional hernia operations). Comparing E/MILOS repair with laparoscopic IPOM and open sublay operation, propensity score matching analysis was possible with 448 and 520 pairs of operations, respectively. Compared with laparoscopic IPOM incisional hernia operation, the E/MILOS repair is associated with significantly fewer general complications (P = 0.004), recurrences (P < 0.001), less pain on exertion (P < 0.001), and less chronic pain requiring treatment (P = 0.016) and tends to result in fewer postoperative complications (P = 0.052), and less pain at rest (P = 0.053). Matched pair analysis with open sublay repair revealed significantly fewer general complications (P < 0.001), postoperative complications (P < 0.001), recurrences (P = 0.002), less pain at rest (P = 0.004), less pain on exertion (P < 0.001), and less chronic pain requiring treatment (P = 0.014). A limitation of this analysis is a relative low 5-year follow-up rate for laparoscopic IPOM and open sublay. CONCLUSIONS The E/MILOS technique allows minimally invasive trans-hernial repair of incisional hernias using large standard meshes with low morbidity and good long-term results. The technique combines the advantages of sub-lay repair and a mini- or less-invasive approach. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03133000.
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Affiliation(s)
- W Reinpold
- Department of Abdominal Wall Surgery, Hamburg Hernia Center, Helios Mariahilf Hospital Hamburg, Stader Strasse 203c, 21075, Hamburg, Germany.
| | - C Berger
- Department of Abdominal Wall Surgery, Hamburg Hernia Center, Helios Mariahilf Hospital Hamburg, Stader Strasse 203c, 21075, Hamburg, Germany
| | - D Adolf
- Institute for Statistics, Otto-Von-Guerike-University, Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - F Köckerling
- Center of Hernia Surgery, Vivantes Humboldt-Klinikum, Am Nordgraben 2, 13509, Berlin, Germany
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Audinot B, Drubay D, Gaspar N, Mohr A, Cordero C, Marec-Bérard P, Lervat C, Piperno-Neumann S, Jimenez M, Mansuy L, Castex MP, Revon-Riviere G, Marie-Cardine A, Berger C, Piguet C, Massau K, Job B, Moquin-Beaudry G, Le Deley MC, Tabone MD, Berlanga P, Brugières L, Crompton BD, Marchais A, Abbou S. ctDNA quantification improves estimation of outcomes in patients with high-grade osteosarcoma: a translational study from the OS2006 trial. Ann Oncol 2023:S0923-7534(23)05113-X. [PMID: 38142939 DOI: 10.1016/j.annonc.2023.12.006] [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: 10/13/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Osteosarcoma stratification relies on clinical parameters and histological response. We developed a new personalized stratification using less invasive circulating tumor DNA (ctDNA) quantification. PATIENTS AND METHODS Plasma from patients homogeneously treated in the prospective protocol OS2006, at diagnosis, before surgery and end of treatment, were sequenced using low-passage whole-genome sequencing (lpWGS) for copy number alteration detection. We developed a prediction tool including ctDNA quantification and known clinical parameters to estimate patients' individual risk of event. RESULTS ctDNA quantification at diagnosis (diagCPA) was evaluated for 183 patients of the protocol OS2006. diagCPA as a continuous variable was a major prognostic factor, independent of other clinical parameters, including metastatic status [diagCPA hazard ratio (HR) = 3.5, P = 0.002 and 3.51, P = 0.012, for progression-free survival (PFS) and overall survival (OS)]. At the time of surgery and until the end of treatment, diagCPA was also a major prognostic factor independent of histological response (diagCPA HR = 9.2, P < 0.001 and 11.6, P < 0.001, for PFS and OS). Therefore, the addition of diagCPA to metastatic status at diagnosis or poor histological response after surgery improved the prognostic stratification of patients with osteosarcoma. We developed the prediction tool PRONOS to generate individual risk estimations, showing great performance ctDNA quantification at the time of surgery and the end of treatment still required improvement to overcome the low sensitivity of lpWGS and to enable the follow-up of disease progression. CONCLUSIONS The addition of ctDNA quantification to known risk factors improves the estimation of prognosis calculated by our prediction tool PRONOS. To confirm its value, an external validation in the Sarcoma 13 trial is underway.
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Affiliation(s)
- B Audinot
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif
| | - D Drubay
- Gustave Roussy, Office of Biostatistics and Epidemiology, Université Paris-Saclay, Villejuif; Inserm, Université Paris-Saclay, CESP U1018, Oncostat, labeled Ligue Contre le Cancer, Villejuif
| | - N Gaspar
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif; Gustave Roussy Cancer Campus, Children and Adolescent Oncology Department, Villejuif; French Cancer Society (SFCE), Bordeaux
| | - A Mohr
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif
| | - C Cordero
- Pediatric Department, Institut Curie, Paris; French Cancer Society (SFCE), Bordeaux
| | - P Marec-Bérard
- Department of Oncology for Child and Adolescent, Centre Léon Bérard, Pediatric Oncology and Hematology Institute (IHOPe), Lyon; French Cancer Society (SFCE), Bordeaux
| | - C Lervat
- Department of Pediatric Oncology, Adolescents and Young Adults, Centre Oscar Lambret, Lille; French Cancer Society (SFCE), Bordeaux
| | | | - M Jimenez
- Research and Development Department, Unicancer, Paris
| | - L Mansuy
- Department of Pediatric Hematology and Oncology, Nancy University Hospital, Vandœuvre-lès-Nancy; French Cancer Society (SFCE), Bordeaux
| | - M-P Castex
- Pediatric Oncology Immunology Hematology Unit, Children's University Hospital, Toulouse; French Cancer Society (SFCE), Bordeaux
| | - G Revon-Riviere
- Department of Pediatric Hematology and Oncology, La Timone Children's Hospital, Marseille; French Cancer Society (SFCE), Bordeaux
| | - A Marie-Cardine
- Department of Pediatric Hematology and Oncology, Rouen University Hospital, Rouen; French Cancer Society (SFCE), Bordeaux
| | - C Berger
- Department of Pediatric Oncology, North Hospital, University Hospital of Saint Etienne, Saint Etienne; French Cancer Society (SFCE), Bordeaux
| | - C Piguet
- Pediatric Oncology Hematology Unit, Limoges University Hospital, Limoges; French Cancer Society (SFCE), Bordeaux
| | - K Massau
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif
| | - B Job
- National Institute for Health and Medical Research (INSERM) US23, Gustave Roussy, Villejuif
| | - G Moquin-Beaudry
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif
| | - M-C Le Deley
- Gustave Roussy, Office of Biostatistics and Epidemiology, Université Paris-Saclay, Villejuif; Clinical Research Department, Centre Oscar Lambret, Lille
| | - M-D Tabone
- Pediatric Hematology Department, Trousseau Hospital, Sorbonne Université, Paris, France; French Cancer Society (SFCE), Bordeaux
| | - P Berlanga
- Gustave Roussy Cancer Campus, Children and Adolescent Oncology Department, Villejuif; French Cancer Society (SFCE), Bordeaux
| | - L Brugières
- Gustave Roussy Cancer Campus, Children and Adolescent Oncology Department, Villejuif; French Cancer Society (SFCE), Bordeaux
| | - B D Crompton
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston; Broad Institute of Harvard and MIT, Cambridge, USA
| | - A Marchais
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif
| | - S Abbou
- National Institute for Health and Medical Research (INSERM) U1015, Gustave Roussy, Villejuif; Gustave Roussy Cancer Campus, Children and Adolescent Oncology Department, Villejuif; French Cancer Society (SFCE), Bordeaux.
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Panagiota V, Kerschbaum JF, Penack O, Stein CM, Arends CM, Koenecke C, Strzelecka PM, Kloos A, Wiegand L, Lasch A, Altwasser R, Halik A, Gabdoulline R, Thomson J, Weibl K, Franke GN, Berger C, Hasenkamp J, Ayuk F, Na IK, Beutel G, Keller U, Bullinger L, Wulf GG, Kröger N, Vucinic V, Heuser M, Damm F. Clinical Implications and Dynamics of Clonal Hematopoiesis in Anti-CD19 CAR T-cell Treated Patients. Hemasphere 2023; 7:e957. [PMID: 37799345 PMCID: PMC10550045 DOI: 10.1097/hs9.0000000000000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/08/2023] [Indexed: 10/07/2023] Open
Abstract
Recent evidence revealed important interactions between clonal hematopoiesis (CH) and cellular therapies established for the treatment of hematologic malignancies. The impact of CH on safety, efficacy, and outcome of chimeric antigen receptor (CAR) T-cell therapy is currently under investigation. We analyzed 110 patients with relapsed/refractory B-cell non-Hodgkin lymphoma (n = 105) or acute lymphoblastic leukemia (ALL) (n = 5), treated with Axicabtagene-Ciloleucel (39%), Tisagenlecleucel (51%), or Brexucabtagene autoleucel (10%). Using error-corrected targeted sequencing, a high CH prevalence of 56.4% (variant allele frequency [VAF] ≥1%) at the time of CAR T-cell infusion was detected. The most frequently mutated gene was PPM1D followed by DNMT3A, TET2, ASXL1, and TP53. Variant allele frequencies were significantly lower in B and T cells compared with monocytes and granulocytes. CH did not increase the risk of CAR T-related toxicities. The incidences of cytokine release syndrome and immune effector-cell-associated neurotoxicity syndrome were similar between CHpos and CHneg patients, regardless of clone size, age, or CAR T product. Prolonged cytopenias were not associated with CH. Best overall response rates (ORRs) were numerically but not significantly higher in CHpos patients (ORR 76.7% versus 62.2%; P = 0.13). Furthermore, CH status did not predict progression-free survival or overall survival. Lastly, sequential analysis showed a modest VAF increase of 1.3% and acquisition of novel mutations within 100 days postinfusion. CH was frequent in large B-cell lymphoma/ALL patients receiving CAR T-cells but did not affect toxicity nor treatment response or outcome.
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Affiliation(s)
- Victoria Panagiota
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Johanna Franziska Kerschbaum
- Department of Hematology, Oncology, and Cancer Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
| | - Olaf Penack
- Department of Hematology, Oncology, and Cancer Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
| | - Catarina M. Stein
- Department of Hematology, Oncology, and Cancer Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
| | - Christopher M. Arends
- Department of Hematology, Oncology, and Cancer Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany
| | - Christian Koenecke
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Paulina M. Strzelecka
- Department of Hematology, Oncology, and Cancer Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
| | - Arnold Kloos
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Laura Wiegand
- Department of Hematology, Oncology, and Cancer Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
| | - Alina Lasch
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Robert Altwasser
- Department of Hematology, Oncology, and Cancer Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
| | - Adriane Halik
- Department of Hematology, Oncology, and Cancer Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany
| | - Razif Gabdoulline
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Julia Thomson
- Department of Hematology and Medical Oncology, University Medicine Göttingen, Germany
| | - Konstantin Weibl
- Medical Clinic and Policlinic 1, Hematology, Cellular Therapy and Hemostaseology, University of Leipzig Medical Center, Leipzig, Germany
| | - Georg-Nikolaus Franke
- Medical Clinic and Policlinic 1, Hematology, Cellular Therapy and Hemostaseology, University of Leipzig Medical Center, Leipzig, Germany
| | - Carolina Berger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany
| | - Justin Hasenkamp
- Department of Hematology and Medical Oncology, University Medicine Göttingen, Germany
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany
| | - Il-Kang Na
- Department of Hematology, Oncology, and Cancer Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany
| | - Gernot Beutel
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Ulrich Keller
- Department of Hematology, Oncology, and Cancer Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
| | - Lars Bullinger
- Department of Hematology, Oncology, and Cancer Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gerald Georg Wulf
- Department of Hematology and Medical Oncology, University Medicine Göttingen, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany
| | - Vladan Vucinic
- Medical Clinic and Policlinic 1, Hematology, Cellular Therapy and Hemostaseology, University of Leipzig Medical Center, Leipzig, Germany
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Frederik Damm
- Department of Hematology, Oncology, and Cancer Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
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Gagelmann N, Wolschke C, Badbaran A, Janson D, Berger C, Klyuchnikov E, Ayuk F, Fehse B, Kröger N. Donor Lymphocyte Infusion and Molecular Monitoring for Relapsed Myelofibrosis After Hematopoietic Cell Transplantation. Hemasphere 2023; 7:e921. [PMID: 37404772 PMCID: PMC10317484 DOI: 10.1097/hs9.0000000000000921] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/23/2023] [Indexed: 07/06/2023] Open
Abstract
Hematopoietic cell transplantation (HCT) is a curative approach for myelofibrosis patients, but relapse is a major cause of treatment failure. We investigated the effect of donor lymphocyte infusion (DLI) in 37 patients with molecular (n = 17) or hematological relapse (n = 20) after HCT. Patients received median of 2 (range, 1-5) cumulative DLI (total of 91 infusions). Median starting dose was 1 × 106 cells/kg, escalated by half-log ≥6 weeks if no response nor graft-versus-host disease (GvHD) occurred. Median time to first DLI was 40 weeks for molecular relapse versus 145 weeks for hematological relapse. Overall molecular complete response (mCR) at any time was 73% (n = 27) and was significantly higher for initial molecular relapse (88%) versus hematological relapse (60%; P = 0.05). The 6-year overall survival was 77% versus 32% (P = 0.03). Acute GvHD 2-4 occurred in 22% and half of the patients achieved mCR without any GvHD. All patients who relapsed from mCR achieved after first DLI could be salvaged with subsequent DLI, showing long-term survival. No second HCT was needed for molecular relapse versus 6 for hematological relapse. This comprehensive and largest study to date suggests molecular monitoring together with DLI as standard of care and a crucial approach to achieve excellent outcomes in relapsed myelofibrosis.
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Affiliation(s)
- Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Wolschke
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anita Badbaran
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dietlinde Janson
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolina Berger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evgeny Klyuchnikov
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Boris Fehse
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Raptis CE, Andrey DO, Polysopoulos C, Berger C, Ciurea A, Lescuyer P, Maletic T, Riek M, Scherer A, von Loga I, Safford J, Lauper K, Moeller B, Vuilleumier N, Finckh A, Rubbert-Roth A. OP0175 TYPE OF mRNA COVID-19 VACCINE AND TREATMENT INFLUENCE ANTIBODY KINETICS IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients on immunomodulatory treatments mount an attenuated immune response following mRNA COVID-19 vaccination, yet long-term studies of vaccine-induced anti-SARS-CoV-2 antibody (Ab) kinetics are missing.ObjectivesIn this prospective observational study, we mapped the humoral antibody response to mRNA COVID-19 vaccines up to 24 weeks post full vaccination in patients with inflammatory rheumatic diseases (IRDs). We aimed to assess differences due to treatment, age, past SARS-CoV-2 infection, and vaccine (BNT162b2 vs. mRNA-1273).MethodsAdult patients from the SCQM cohort who assented to an mRNA COVID-19 vaccine were recruited between 3/21 – 9/21. Participants answered questionnaires via an app and received kits for the self-collection of capillary blood samples at baseline, 4, 12, and 24 weeks post full vaccination. Samples were tested for IgG Ab against the S1 domain of the SARS-CoV-2 spike protein (anti-S1-IgG) using the EUROIMMUN ELISA. To examine differences in Ab titres arising from the defined parameters, while accounting for inter-assay variability, mixed effects continuous outcome logistic regression models were applied at each timepoint.ResultsSamples were obtained from 570 patients: 67% female, mean age 53 y (SD 12 y) with 37% RA, 36% axSpA, 21% PsA, and 6% UA (undifferentiated arthritis), on no medication (no DMARDs & no glucocorticoids; 15%), csDMARDs (10%), TNFi (48%), IL-1/6/17/23i (14%), JAKi (6%), rituximab (RTX; 4%), or abatacept (ABA; 2%) in mono/combination therapy at the first vaccination. 10% of patients had a past SARS-CoV-2 infection, 54% received BNT162b2, 46% mRNA-1273.For any Ab threshold, the odds of having a higher Ab titre at 4, 12, and 24 weeks post full vaccination were 3.3 – 4 times higher with mRNA-1273 compared to BNT162b2 (Table 1, Figure 1). TNFi, JAKi, RTX, and ABA as monotherapy resulted in significantly lower Ab levels compared to no medication at almost all timepoints. In combination therapy, TNFi, IL-1/6/17/23i, RTX, and csDMARDs led to consistently lower Ab titres at all timepoints compared to respective monotherapy.Table 1.The OR of being above a given Ab threshold, regardless of the threshold. Ref. levels: mean age, no medication, no past SARS-CoV-2 inf., BNT162b2. Included in model but not shown: diagnosis, infrequently used medication (all non-signif.)Weeks post full vacc.41224OR (95% CI); pAge0.96 (0.94 – 0.97)****0.98 (0.96 – 0.996)*0.98 (0.97 – 1.00)mRNA-1273 (vs BNT162b2)3.28 (2.34 – 4.61)****3.96 (2.83 – 5.54)****3.94 (2.93 – 5.50)****Past COVID inf. (vs none)7.56 (4.32 – 13.2)****8.14 (4.78 – 13.86)****11.65 (6.62 – 20.50)****csDMARD†1.27 (0.67 – 2.41)1.78 (0.94 – 3.35)1.70 (0.86 – 3.36)TNFi†0.46 (0.28 – 0.71)****0.30 (0.19 – 0.48)****0.13 (0.081 – 0.22)****IL-1/6/17/23i†0.97 (0.54 – 1.75)1.04 (0.57 – 1.89)0.89 (0.49 – 1.64)JAKi†0.38 (0.16 – 0.91)*0.38 (0.16 – 0.91)*0.53 (0.22 – 1.28)RTX†0.078 (0.013 – 0.46)**0.078 (0.015 – 0.42)**0.16 (0.037 – 0.71)*ABA†0.14 (0.039 – 0.51)**0.087 (0.022 – 0.35)***0.068 (0.017 – 0.27)***Interactions§Age:vaccine‡1.04 (1.02 – 1.07)**1.02 (0.99 – 1.05)1.03 (1.0008 – 1.058)*csDMARD:combi0.12 (0.02 – 0.70)*0.17 (0.029 – 0.95)*0.11 (0.023 – 0.56)**TNFi:combi0.34 (0.20 – 0.59)***0.37 (0.22 – 0.61)***0.36 (0.21 – 0.62)***IL-1/6/17/23i:combi0.26 (0.09 – 0.78)*0.25 (0.085 – 0.70)**0.20 (0.071 – 0.58)**JAKi:combi1.76 (0.33 – 9.44)1.23 (0.32 – 4.70)0.95 (0.25 – 3.65)RTX:combi0.11 (0.01 – 0.87)*0.095 (0.012 – 0.73)*0.085 (0.0091 – 0.79)*ABA:combi1.75 (0.25 – 12.2)0.74 (0.096 – 5.75)0.51 (0.073 – 3.62)* p < 0.05; ** p < 0.01; *** p < 0.001; **** p < 0.0001;†Medication as monoth. vs no medication‡Interaction terms showing how OR of mRNA-1273 (vs BNT162b2) increases with age§Interaction terms with medications: medication in combination th. vs medication as monoth.ConclusionCompared to no medication, some immunomodulatory therapies resulted in markedly lower Ab levels at all timepoints. In IRD patients, a past SARS-CoV-2 infection resulted in strikingly increased immunogenicity, as did mRNA-1273 compared to BNT162b2.AcknowledgementsThis study is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM thanks the patients for their participation in this study. A list of rheumatology offices and hospitals that contribute to the SCQM registries can be found on www.scqm.ch/institutions. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors.Disclosure of InterestsCatherine Elizabeth Raptis Grant/research support from: The study presented in the abstract is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors, Diego Olivier Andrey: None declared, Christos Polysopoulos Grant/research support from: The study presented in the abstract is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors, Christoph Berger: None declared, Adrian Ciurea: None declared, Pierre Lescuyer: None declared, Tanja Maletic Grant/research support from: The study presented in the abstract is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors, Myriam Riek Grant/research support from: The study presented in the abstract is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors, Almut Scherer Grant/research support from: The study presented in the abstract is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors, Isabell von Loga Grant/research support from: The study presented in the abstract is investigator-initiated and received independent financial support from Moderna Switzerland GmbH. The SCQM is financially supported by pharmaceutical industries and donors. A list of financial supporters can be found on www.scqm.ch/sponsors, Judith Safford: None declared, Kim Lauper Speakers bureau: Kim Lauper reports consulting fees for Pfizer and speakers fees for Pfizer, Viatris and Celltrion outside of the submitted work., Consultant of: Kim Lauper reports consulting fees for Pfizer and speakers fees for Pfizer, Viatris and Celltrion outside of the submitted work., Burkhard Moeller: None declared, Nicolas Vuilleumier: None declared, Axel Finckh Speakers bureau: Axel Finckh has received consultancies or speaker honoraria for AbbVie, BMS, Eli-Lilly, Gilead, Pfizer, Sanofi, and UCB outside of the submitted work, Consultant of: Axel Finckh has received consultancies or speaker honoraria for AbbVie, BMS, Eli-Lilly, Gilead, Pfizer, Sanofi, and UCB outside of the submitted work, Grant/research support from: Axel Finckh has received research support from AbbVie, Eli-Lilly, Galapagos, and Pfizer outside of the submitted work, Andrea Rubbert-Roth: None declared
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Schubert ML, Berger C, Kunz A, Schmitt A, Badbaran A, Neuber B, Zeschke S, Wang L, Riecken K, Hückelhoven‑Krauss A, Müller I, Müller‑Tidow C, Dreger P, Kröger N, Ayuk F, Schmitt M, Fehse B. Comparison of single copy gene‑based duplex quantitative PCR and digital droplet PCR for monitoring of expansion of CD19‑directed CAR T cells in treated patients. Int J Oncol 2022; 60:48. [PMID: 35294040 PMCID: PMC8973917 DOI: 10.3892/ijo.2022.5338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/11/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Maria-Luisa Schubert
- Department of Internal Medicine V (Hematology/Oncology/Rheumatology), University Hospital Heidelberg, D‑69120 Heidelberg, Germany
| | - Carolina Berger
- Department of Stem Cell Transplantation, University Medical Centre Hamburg‑Eppendorf, D‑20246 Hamburg, Germany
| | - Alexander Kunz
- Department of Internal Medicine V (Hematology/Oncology/Rheumatology), University Hospital Heidelberg, D‑69120 Heidelberg, Germany
| | - Anita Schmitt
- Department of Internal Medicine V (Hematology/Oncology/Rheumatology), University Hospital Heidelberg, D‑69120 Heidelberg, Germany
| | - Anita Badbaran
- Department of Stem Cell Transplantation, University Medical Centre Hamburg‑Eppendorf, D‑20246 Hamburg, Germany
| | - Brigitte Neuber
- Department of Internal Medicine V (Hematology/Oncology/Rheumatology), University Hospital Heidelberg, D‑69120 Heidelberg, Germany
| | - Silke Zeschke
- Department of Stem Cell Transplantation, University Medical Centre Hamburg‑Eppendorf, D‑20246 Hamburg, Germany
| | - Lei Wang
- Department of Internal Medicine V (Hematology/Oncology/Rheumatology), University Hospital Heidelberg, D‑69120 Heidelberg, Germany
| | - Kristoffer Riecken
- Department of Stem Cell Transplantation, University Medical Centre Hamburg‑Eppendorf, D‑20246 Hamburg, Germany
| | - Angela Hückelhoven‑Krauss
- Department of Internal Medicine V (Hematology/Oncology/Rheumatology), University Hospital Heidelberg, D‑69120 Heidelberg, Germany
| | - Ingo Müller
- Department of Pediatric Hematology and Oncology, University Medical Centre Hamburg‑Eppendorf, D‑20246 Hamburg, Germany
| | - Carsten Müller‑Tidow
- Department of Internal Medicine V (Hematology/Oncology/Rheumatology), University Hospital Heidelberg, D‑69120 Heidelberg, Germany
| | - Peter Dreger
- Department of Internal Medicine V (Hematology/Oncology/Rheumatology), University Hospital Heidelberg, D‑69120 Heidelberg, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Centre Hamburg‑Eppendorf, D‑20246 Hamburg, Germany
| | - Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Centre Hamburg‑Eppendorf, D‑20246 Hamburg, Germany
| | - Michael Schmitt
- Department of Internal Medicine V (Hematology/Oncology/Rheumatology), University Hospital Heidelberg, D‑69120 Heidelberg, Germany
| | - Boris Fehse
- Department of Stem Cell Transplantation, University Medical Centre Hamburg‑Eppendorf, D‑20246 Hamburg, Germany
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Rejeski K, Perez A, Sesques P, Berger C, Jentzsch L, Mougiakakos D, Frölich L, Ackermann J, Bücklein V, Blumenberg V, Schmidt C, Jallades L, Fehse B, Faul C, Karschnia P, Weigert O, Dreyling M, Hoster E, Locke F, Bergwelt‐Baildon M, Mackensen A, Bethge W, Ayuk F, Bachy E, Salles G, Jain M, Subklewe M. CAR‐HEMATOTOX: A DISCRIMINATIVE MODEL FOR CAR T‐CELL RELATED HEMATOTOXICITY IN RELAPSED/REFRACTORY LARGE B‐CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.82_2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- K. Rejeski
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - A. Perez
- Moffitt Cancer Center Department of Blood and Marrow Transplant and Cellular Immunotherapy Moffitt Cancer Center, Tampa, USA Tampa USA
| | - P. Sesques
- Hospices Civils de Lyon Institut National de la Santé et de la Recherche Médicale (INSERM) Lyon France
| | - C. Berger
- University Hospital Hamburg‐Eppendorf Department of Hematology, Oncology and Pulmonology Hamburg Germany
| | - L. Jentzsch
- University Hospital Tübingen Department of Hematology, Oncology, Immunology and Rheumatology Tübingen Germany
| | - D. Mougiakakos
- University Hospital of Erlangen Department of Internal Medicine 5, Hematology and Oncology Erlangen Germany
| | - L. Frölich
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - J. Ackermann
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - V. Bücklein
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - V. Blumenberg
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - C. Schmidt
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - L. Jallades
- Hospices Civils de Lyon Institut National de la Santé et de la Recherche Médicale (INSERM) Lyon France
| | - B. Fehse
- University Hospital Hamburg‐Eppendorf Department of Hematology, Oncology and Pulmonology Hamburg Germany
| | - C. Faul
- University Hospital Tübingen Department of Hematology, Oncology, Immunology and Rheumatology Tübingen Germany
| | - P. Karschnia
- University Hospital of the LMU Munich Department of Neurosurgery Munich Germany
| | - O. Weigert
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - M. Dreyling
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - E. Hoster
- LMU Munich Institute for Medical Informatics Biometry and Epidemiology Munich Germany
| | - F. Locke
- Moffitt Cancer Center Department of Blood and Marrow Transplant and Cellular Immunotherapy Moffitt Cancer Center, Tampa, USA Tampa USA
| | - M. Bergwelt‐Baildon
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
| | - A. Mackensen
- University Hospital of Erlangen Department of Internal Medicine 5, Hematology and Oncology Erlangen Germany
| | - W. Bethge
- University Hospital Tübingen Department of Hematology, Oncology, Immunology and Rheumatology Tübingen Germany
| | - F. Ayuk
- University Hospital Hamburg‐Eppendorf Department of Hematology, Oncology and Pulmonology Hamburg Germany
| | - E. Bachy
- Hospices Civils de Lyon Institut National de la Santé et de la Recherche Médicale (INSERM) Lyon France
| | - G. Salles
- MSKCC, Lymphoma Service Department of Medicine NYC New York USA
| | - M. Jain
- Moffitt Cancer Center Department of Blood and Marrow Transplant and Cellular Immunotherapy Moffitt Cancer Center, Tampa, USA Tampa USA
| | - M. Subklewe
- University Hospital of the LMU Munich Department of Hematology/Oncology Munich Germany
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Gozzoli DS, Hemmig A, Hemkens L, Werlen L, Ewald H, Berger C, Kyburz D, Imfeld S, Aschwanden M, Stegert M, Camellino D, Cimmino MA, Campochiaro C, Tomelleri A, Henckaerts L, Blockmans D, Moya P, Corominas H, Buchanan R, Owen C, Van Sleen Y, Brouwer E, Ymashita H, Daikeler T. POS0806 FINDINGS CONSISTENT WITH SUBCLINICAL VASCULITIS IN PATIENTS WITH NEW ONSET POLYMYALGIA: A SYSTEMATIC LITERATURE REVIEW AND A META-ANALYSIS OF COHORT DATA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:GCA is characterized by cranial symptoms but imaging techniques show that patients with non-specific symptoms such as systemic inflammation or PMR may have undiagnosed large vessel (LV) GCA1. Although silent GCA in patients with clinically isolated PMR may have consequences for patients’ outcome, little is known about its prevalence and characteristics of affected patients.Objectives:To review data on the prevalence of silent GCA in newly diagnosed PMR patients without cranial GCA symptoms and to analyze which characteristics are associated with vascular involvement among PMR patients.Methods:We systematically screened PubMed, Embase and Web of Science databases and included studies screening for GCA in steroid naïve PMR patients without cranial symptoms consistent with GCA. Authors of the publications that used PET for vasculitis screening were invited to share their individual patient data (IPD) for a meta-analysis. We sought to define patient characteristics that were associated with vasculitis using univariable mixed effects logistic regression models with vascular involvement as the outcome, missing values were imputed using multilevel joint modeling multiple imputation. To fit a multivariable model with the candidate predictors we excluded variables that were hypothesized to have less medical relevance for the outcome and highly correlated inflammation markers (ESR, Lc).Results:Out of the 3047 studies screened independently by 2 authors (DG and TD), 13 fulfilled the inclusion criteria. These studies (published 1963-2019) reported on 543 PMR patients examined by temporal artery biopsy (n=175), ultrasound (n=110), PET or PET-CT (n=258). 115 PMR patients were diagnosed with GCA (21.2%), with prevalence ranging from 0-92%.We collected IPD for 243 patients from 4 cohorts using PET and 3 using PET/CT for GCA diagnosis. The overall median age of patients was 72.3 years (IQR 66.4-78.0) and vasculitis was found in 65 patients (26.7%) (table 1).Table 1.OverallPMRPMR+GCAn (%)243178 (73.3)65 (26.7)Female sex (%)146 (60.1)98 (55.1)48 (73.8)Shoulder girdle pain (%)236 (97.1)174 (97.8)62 (95.4)Pelvic girdle pain (%)174 (71.6)127 (71.3)47 (72.3)Inflammatory back pain (%)No107 (44.0)83 (46.6)24 (36.9)Yes106 (43.6)70 (39.3)36 (55.4)Lower limb pain (%)No87 (35.8)61 (34.3)26 (40.0)Yes81 (33.3)68 (38.2)13 (20.0)Weight loss (%)112 (46.1)78 (43.8)34 (52.3)CRP (mg/l) (median [IQR])46.0 [19.0, 77.7]44.0 [16.9, 74.2]52.0 [27.9, 85.0]ESR (mm/h) (mean (SD))65.2 (30.3)62.7 (30.2)72.3 (29.7)Hemoglobin (g/dl) (mean (SD))12.1 (1.5)12.2 (1.5)11.7 (1.6)Thrombocytes (1e+09/ml) (mean (SD))341.9 (106.3)323.9 (103.2)375.8 (104.6)In the univariable analyses the following factors were most strongly associated with vasculitic PET findings: female sex (OR 2.31, CI 1.17-4.58), inflammatory back pain (OR 2.73, CI 1.32-5.64), temperature >37° (OR 1.83, CI 0.90-3.7), weight loss (OR 1.83, CI 0.96-3.51), thrombocytosis (i.e., patients with a thrombocyte count 1 SD above mean have an OR of 1.51, CI 1.05-2.18), anemia (i.e., 1 g/dl decrease in Hb below mean corresponds to an OR of 1.25, CI 1.00-1.56). Patients with lower limb pain were less likely to have vasculitis (OR 0.43, CI 0.19–0.95). The estimated ORs were very similar in the multivariable model although the 95%CIs became wider.Conclusion:Although the prevalence across published studies showed substantial variation, 6 out of 13 studies reported a prevalence of silent GCA in 18-40% of all PMR patients. The exploratory analysis of the collected IPD identified female sex, inflammatory back pain, fever, weight loss, absence of lower leg pain, thrombocytosis and anemia as factors associated with LV-GCA. These findings should be validated in future prospective cohort studies. The presence or absence of these factors may further aid in diagnosing LV-GCA in PMR patients.References:[1]Buttgereit F, Dejaco C, Matteson EL, Dasgupta B. Polymyalgia Rheumatica and Giant Cell Arteritis: A Systematic Review. JAMA. 2016 Jun 14;315(22):2442–58.Acknowledgements:The study is funded by the “Schweizerische Stiftung für die Erforschung der Muskelkrankheiten (SSEM)”.Disclosure of Interests:Daniele Silvio Gozzoli: None declared, Andrea Hemmig: None declared, Lars Hemkens: None declared, Laura Werlen: None declared, Hannah Ewald: None declared, Christoph Berger: None declared, Diego Kyburz Grant/research support from: DK reports personal fees from Abbvie, Gilead, Lilly, Novartis and Pfizer, outside of the submitted work, Stephan Imfeld: None declared, Markus Aschwanden: None declared, Mihaela Stegert: None declared, Dario Camellino: None declared, Marco Amedeo Cimmino: None declared, Corrado Campochiaro Grant/research support from: personal fees from Roche, Alessandro Tomelleri: None declared, Liesbet Henckaerts: None declared, Daniel Blockmans Speakers bureau: Paid speaker for Roche, Consultant of: Paid consultant for Roche, Patricia Moya: None declared, Hector Corominas: None declared, Russell Buchanan: None declared, Claire Owen Speakers bureau: CO has received speaking honoraria from Roche, Janssen, Novartis and Pfizer, and meeting sponsorship from Roche, UCB and Janssen, Yannick van Sleen: None declared, Elisabeth Brouwer Speakers bureau: E. Brouwer as an employee of the UMCG received speaker fees and consulting fees from Roche in 2017, 2018 which were paid to the UMCG, Consultant of: E. Brouwer as an employee of the UMCG received speaker fees and consulting fees from Roche in 2017, 2018 which were paid to the UMCG, Hiroyuki Ymashita: None declared, Thomas Daikeler: None declared
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van den Berg MH, van Dijk M, Byrne J, Berger C, Dirksen U, Winther JF, Fossa SD, Grabow D, Grandage VL, Haupt R, van den Heuvel-Eibrink MM, Kaiser M, Kepak T, van der Kooi ALF, Kremer LCM, Kruseova J, Lambalk CB, van Leeuwen FE, Leiper A, Modan-Moses D, Spix C, Twisk JWR, Ronckers CM, Kaatsch P, van Dulmen-den Broeder E. Treatment-related fertility impairment in long-term female childhood, adolescent and young adult cancer survivors: investigating dose-effect relationships in a European case-control study (PanCareLIFE). Hum Reprod 2021; 36:1561-1573. [PMID: 33744927 DOI: 10.1093/humrep/deab035] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/29/2019] [Revised: 01/21/2021] [Indexed: 02/02/2023] Open
Abstract
STUDY QUESTION Which chemotherapeutic agents and body site-specific radiation fields are dose-dependently associated with an increased risk of fertility impairment in long-term female childhood, adolescent and young adulthood (CAYA) cancer survivors? SUMMARY ANSWER Busulfan, lower abdominal radiotherapy (RT) and total body irradiation (TBI) seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (>140 mg/m2) or high dose (>5600 mg/m2) therapy, respectively. WHAT IS KNOWN ALREADY Several treatment-related fertility deficits, as assessed by both self-reported outcomes and hormonal markers are known to occur following treatment of CAYA cancer. However, knowledge regarding precise dose-related estimates of these treatment-related risks are scarce. STUDY DESIGN, SIZE, DURATION The current case-control study was nested within the PanCareLIFE cohort study. In total, 1332 CAYA survivors from 8 countries, 9 institutions and 11 cohorts, participated in and contributed data to the study. PARTICIPANTS/MATERIALS, SETTING, METHODS All participants were female 5-year CAYA cancer survivors. In total, 450 cases (fertility impaired survivors) and 882 matched controls (not fertility impaired survivors) were included. Fertility impairment was defined using both questionnaire data (primary or secondary amenorrhea; use of artificial reproductive techniques; unfulfilled wish to conceive) and hormonal data (FSH and anti-Müllerian hormone (AMH)). Multivariable logistic regression models were used to investigate the effect of (i) alkylating agent exposure, and (ii) dose categories for individual chemotherapeutic agents and for RT-exposed body sites. MAIN RESULTS AND THE ROLE OF CHANCE A positive dose-effect relationship between cyclophosphamide equivalent dose (CED) score and fertility impairment was found, with survivors with a CED score > 7121 mg/m2 being at a significantly increased risk of fertility impairment (odds ratio (95% CI) = 2.6 (1.9-3.6) P < 0.001). Moreover, cumulative dose variables of the following treatments were significantly associated with fertility impairment: busulfan, carmustine, cyclophosphamide, melphalan, procarbazine, lower abdominal RT and TBI. Busulfan, lower abdominal RT and TBI seem to be associated with fertility impairment at any dose, whereas gonadotoxicity of melphalan and procarbazine is suggested at medium/high (>140 mg/m2) or high dose (>5600 mg/m2) therapy, respectively. LIMITATIONS, REASONS FOR CAUTION Our study may have been subject to selection bias since data from about half of the original base cohorts were available for the current study. This could impact the generalizability of our study results. WIDER IMPLICATIONS OF THE FINDINGS We identified survivors at high risk for fertility impairment and, consequently, for a reduced or even absent reproductive life span. Both girls and young women who are about to start anti-cancer treatment, as well as adult female survivors, should be counselled about future parenthood and referred to a reproductive specialist for fertility preservation, if desired. STUDY FUNDING/COMPETING INTEREST(S) This study has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 602030. There are no competing interests. TRIAL REGISTRATION NUMBER n/a.
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Affiliation(s)
- M H van den Berg
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M van Dijk
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Byrne
- Boyne Research Institute, Department of Epidemiology, Drogheda, Ireland
| | - C Berger
- Department of Pediatric Hematology and Oncology, University-Hospital, Saint-Etienne, France
| | - U Dirksen
- Department of Paediatric Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - J F Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | - S D Fossa
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - D Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | | | - R Haupt
- Gaslini Children Hospital, Epidemiology and Biostatistics Section, Genova, Italy
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Paediatric Oncology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Kaiser
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - T Kepak
- University Hospital Brno, Brno, Czech Republic.,International Clinical Research Center (FNUSA-ICRC), Brno, Czech Republic
| | - A L F van der Kooi
- Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J Kruseova
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - C B Lambalk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam
| | - F E van Leeuwen
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Leiper
- Great Ormond Street Children's Hospital, London, UK
| | - D Modan-Moses
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - C Spix
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, THE Netherlands
| | - C M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Institute for Biostatistics and Registry Research, Medical University Brandenburg, Neuruppin, Germany
| | - P Kaatsch
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - E van Dulmen-den Broeder
- Department of Paediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Trauzeddel RF, Ertmer M, Nordine M, Groesdonk HV, Michels G, Pfister R, Reuter D, Scheeren TWL, Berger C, Treskatsch S. Perioperative echocardiography-guided hemodynamic therapy in high-risk patients: a practical expert approach of hemodynamically focused echocardiography. J Clin Monit Comput 2021; 35:229-243. [PMID: 32458170 PMCID: PMC7943502 DOI: 10.1007/s10877-020-00534-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Abstract
The number of high-risk patients undergoing surgery is growing. To maintain adequate hemodynamic functioning as well as oxygen delivery to the vital organs (DO2) amongst this patient population, a rapid assessment of cardiac functioning is essential for the anesthesiologist. Pinpointing any underlying cardiovascular pathophysiology can be decisive to guide interventions in the intraoperative setting. Various techniques are available to monitor the hemodynamic status of the patient, however due to intrinsic limitations, many of these methods may not be able to directly identify the underlying cause of cardiovascular impairment. Hemodynamic focused echocardiography, as a rapid diagnostic method, offers an excellent opportunity to examine signs of filling impairment, cardiac preload, myocardial contractility and the function of the heart valves. We thus propose a 6-step-echocardiographic approach to assess high-risk patients in order to improve and maintain perioperative DO2. The summary of all echocardiographic based findings allows a differentiated assessment of the patient's cardiovascular function and can thus help guide a (patho)physiological-orientated and individualized hemodynamic therapy.
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Affiliation(s)
- R. F. Trauzeddel
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - M. Ertmer
- Department of Anesthesiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - M. Nordine
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - H. V. Groesdonk
- Department of Interdisciplinary Intensive Care Medicine and Intermediate Care, Helios Hospital Erfurt, Erfurt, Germany
| | - G. Michels
- Department of Internal Medicine III, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - R. Pfister
- Department of Internal Medicine III, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - D. Reuter
- Department of Anesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany
| | - T. W. L. Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - C. Berger
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S. Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Trauzeddel RF, Nordine M, Groesdonk HV, Michels G, Pfister R, Reuter DA, Scheeren TWL, Berger C, Treskatsch S. [Perioperative optimization using hemodynamically focused echocardiography in high-risk patients-A practice guide]. Anaesthesist 2021; 70:772-784. [PMID: 33660043 DOI: 10.1007/s00101-021-00934-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The number of high-risk patients undergoing surgery is steadily increasing. In order to maintain and, if necessary, optimize perioperative hemodynamics as well as the oxygen supply to the organs (DO2) in this patient population, a timely assessment of cardiac function and the underlying pathophysiological causes of hemodynamic instability is essential for the anesthesiologist. A variety of hemodynamic monitoring procedures are available for this purpose; however, due to method-immanent limitations they are often not able to directly identify the underlying cause of cardiovascular impairment. OBJECTIVE To present a stepwise algorithm for a perioperative echocardiography-based hemodynamic optimization in noncardiac surgery high-risk patients. In this context, echocardiography on demand according to international guidelines can be performed under certain conditions (hemodynamic instability, nonresponse to hemodynamic treatment) as well as in the context of a planned intraoperative procedure, mostly as a transesophageal echocardiography. METHODS AND RESULTS Hemodynamically focused echocardiography as a rapidly available bedside method, enables the timely diagnosis and assessment of cardiac filling obstructions, volume status and volume response, right and left heart function, and the function of the heart valves. CONCLUSION Integrating all echocardiographic findings in a differentiated assessment of the patient's cardiovascular function enables a (patho)physiologically oriented and individualized hemodynamic treatment.
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Affiliation(s)
- R F Trauzeddel
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - M Nordine
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - H V Groesdonk
- Klinik für Interdisziplinäre Intensivmedizin und Intermediate Care, Helios Klinikum Erfurt, Erfurt, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - D A Reuter
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - T W L Scheeren
- Klinik für Anästhesiologie, Universitätsmedizin Groningen, Groningen, Niederlande
| | - C Berger
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - S Treskatsch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland.
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Srivastava S, Furlan SN, Jaeger-Ruckstuhl CA, Sarvothama M, Berger C, Smythe KS, Garrison SM, Specht JM, Lee SM, Amezquita RA, Voillet V, Muhunthan V, Yechan-Gunja S, Pillai SPS, Rader C, Houghton AM, Pierce RH, Gottardo R, Maloney DG, Riddell SR. Immunogenic Chemotherapy Enhances Recruitment of CAR-T Cells to Lung Tumors and Improves Antitumor Efficacy when Combined with Checkpoint Blockade. Cancer Cell 2021; 39:193-208.e10. [PMID: 33357452 PMCID: PMC7878409 DOI: 10.1016/j.ccell.2020.11.005] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/18/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022]
Abstract
Adoptive therapy using chimeric antigen receptor-modified T cells (CAR-T cells) is effective in hematologic but not epithelial malignancies, which cause the greatest mortality. In breast and lung cancer patients, CAR-T cells targeting the tumor-associated antigen receptor tyrosine kinase-like orphan receptor 1 (ROR1) infiltrate tumors poorly and become dysfunctional. To test strategies for enhancing efficacy, we adapted the KrasLSL-G12D/+;p53f/f autochthonous model of lung adenocarcinoma to express the CAR target ROR1. Murine ROR1 CAR-T cells transferred after lymphodepletion with cyclophosphamide (Cy) transiently control tumor growth but infiltrate tumors poorly and lose function, similar to what is seen in patients. Adding oxaliplatin (Ox) to the lymphodepletion regimen activates tumor macrophages to express T-cell-recruiting chemokines, resulting in improved CAR-T cell infiltration, remodeling of the tumor microenvironment, and increased tumor sensitivity to anti-PD-L1. Combination therapy with Ox/Cy and anti-PD-L1 synergistically improves CAR-T cell-mediated tumor control and survival, providing a strategy to improve CAR-T cell efficacy in the clinic.
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Affiliation(s)
- Shivani Srivastava
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Scott N Furlan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA
| | | | - Megha Sarvothama
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Carolina Berger
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kimberly S Smythe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sarah M Garrison
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jennifer M Specht
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Sylvia M Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Robert A Amezquita
- Vaccine and Infections Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Valentin Voillet
- Vaccine and Infections Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Vishaka Muhunthan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sushma Yechan-Gunja
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Smitha P S Pillai
- Department of Comparative Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Christoph Rader
- Department of Immunology and Microbiology, Scripps Research Institute, Jupiter, FL, USA
| | - A McGarry Houghton
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Robert H Pierce
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Raphael Gottardo
- Vaccine and Infections Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Stanley R Riddell
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
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Pudszuhn A, Voegeler S, Berger C, Treskatsch S, Angermair S, Hansen S, Hofmann VM. [Elective tracheostomy in COVID-19 patients: experience with a standardized interdisciplinary approach]. HNO 2020; 68:838-846. [PMID: 32840646 PMCID: PMC7445822 DOI: 10.1007/s00106-020-00917-x] [Citation(s) in RCA: 4] [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] [Indexed: 02/07/2023]
Abstract
Berichtet wird über die Erfahrungen mit einer interdisziplinären klinikinternen SOP (Standard Operation Procedure) zur Tracheostomie (TS) bei „Coronavirus-Disease“(COVID-19)-Patienten, unter Berücksichtigung der allgemeinen nationalen und internationalen Empfehlungen. Der interdisziplinär festgelegte operative Zeitpunkt der TS aufgrund einer prolongierten invasiven Beatmung und frustranen Weaning-Versuchen betraf Phasen sowohl hoher als auch niedriger Erkrankungsaktivität. Es wurden 5 TS bei Patienten mit einem Durchschnittsalter von 70,6 Jahren durchgeführt. Neben den Standard-COVID-19-Schutzmaßnahmen für das medizinische Personal zur Vermeidung einer nosokomialen COVID-19-Infektion führt die SOP-unterstützte Kommunikation während der TS zu einer periprozeduralen Sicherheit aller Beteiligten. COVID-19-Erkrankungen des medizinischen Personals der beteiligten Abteilungen sind bisher nicht bekannt.
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Affiliation(s)
- A Pudszuhn
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - S Voegeler
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - C Berger
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Treskatsch
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Angermair
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Hansen
- Institut für Hygiene und Umweltmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - V M Hofmann
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
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Berger C, Patel D, Kityamuwesi A, Ggita J, Tinka LK, Turimumahoro P, Neville K, Chehab L, Chen AZ, Gupta N, Turyahabwe S, Katamba A, Cattamanchi A, Sammann A. Opportunities to improve digital adherence technologies and TB care using human-centered design. Int J Tuberc Lung Dis 2020; 24:1112-1115. [PMID: 33126949 PMCID: PMC9094398 DOI: 10.5588/ijtld.20.0184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- C Berger
- Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine
| | - D Patel
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - A Kityamuwesi
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - J Ggita
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - L K Tinka
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - P Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - K Neville
- Design Impact Program, Department of Mechanical Engineering, Stanford University, Palo Alto, CA, USA
| | - L Chehab
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - A Z Chen
- Everwell Health Solutions, Bangalore, India
| | - N Gupta
- Everwell Health Solutions, Bangalore, India
| | - S Turyahabwe
- Uganda National Tuberculosis and Leprosy Programme, Kampala, Uganda
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, ,
| | - A Cattamanchi
- Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - A Sammann
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
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Wyler J, Meyer Sauteur PM, Zbinden R, Berger C. Improved diagnosis of cat-scratch disease with an IgM enzyme-linked immunosorbent assay for Bartonella henselae using N-lauroyl-sarcosine-insoluble protein antigen. Clin Microbiol Infect 2020; 26:1271-1273. [PMID: 32437955 DOI: 10.1016/j.cmi.2020.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Affiliation(s)
- J Wyler
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - P M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland.
| | - R Zbinden
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - C Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
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Ankli B, Bigler MB, Berger C, Daikeler T. AB0917 AGE PLAYS A CRUCIAL ROLE IN CRYSTAL ARTHRITIS SEVERITY – A SYNOVIAL FLUID STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Incidence and severity of gout and calcium pyrophosphate deposition disease (CPPD) increase with age (1). Aging is associated with immune senescence, leading to a deregulation of the innate immune system and hence inflammation (2). MRI studies hinted on a significantly higher synovial inflammation in older compared to younger arthritis patients(3). Whether inflammatory responses to synovial crystals are more pronounced in elderly patients or not is unknown.Objectives:To test the hypothesis whether aging associates with a more pronounced synovial inflammation in response to urate and CPP crystals.Methods:Gout or CPPD patients with a synovial fluid (SF) aspiration were included. Clinical, blood and synovial parameters were recorded. In the Cytokine study, SF was analyzed for interleukin (IL)-1-beta,IL-6, IL-8, IL-10, IL-12p70, interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), IL-17, and transforming growth factor-beta (TGF-beta) by multiplexed cytokine analysis.In the Cell study, SF samples were immunophenotyped by flow cytometry, including surface markers CD4+ (CD3+), CD8+ (CD3+), and following stimulation for intracellular IFN-gamma and IL-17. The patients were divided into two groups by age median-split.Statistical analysisCategorical variables were reported as frequencies. Continuous variables were compared using Student’s t-test or in case of non-normal distribution Mann-Whitney U test.Table 1.Patients CharacteristicsMedians, (IQR), Frequenciesin %Cytokine study(n=15)Cell study(n=19)Age [years]76.6 (69.5; 83.0)59.0 (54.5; 76.0)Age Median Split7565Male80.0%68%Gout; CPPD patients [n pat]crystals*10; 510; 9Oligo-/Polyarticular [n pat]78IQR=Interquartile ranges, CPPD=Calcium pyrophosphate deposition disease, n pat=number of patientsCytokine studyMedian C-reactive (CRP), SUA levels and synovial cell counts were higher in the older patient group. Serum creatinine levels were similar between the two groups. Synovial IL-1-beta, IL-8, and IL-17 levels were significantly higher in the older subjects. Age was correlated with SF IL-1-beta (r=0.62, p=0.02), IL-17 (r=0.63, p=0.04) and IL-8 (r=0.54, p=0.04) levels.Cell study:Median CRP was higher in older patients: 87 mg/l (IQR 65; 115) vs. 20 mg/l (IQR 7; 65, p=0.0129). Although not significant, a higher frequency of total Th17 (both CD4+IL17+ and CD8+IL17+) T-cells were seen in the SF of the older patient group. The remaining T-cell subsets were comparable between the two groups.Conclusion:Gout and CPPD are paradigms for auto-inflammatory diseases. We here show an important autoinflammation enhancing cofactor: age. Inflammation measured as serum CRP, SF-IL-8, SF-IL-1-beta, and SF-IL-17 was pronounced in the older patients. Moreover, the adaptive immune system with a predominant Th-17 immune response was more prominent in the older patient group. High IL-17 concentrations may promote differentiation of T-cells in Th-17 cells and thus perpetuate inflammation in older patients with crystal arthritis (4).References:[1]Kuo C-F, Grainge MJ, Zhang W, Doherty M. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 2015;11:649-62.[2]Goronzy JJ, Weyand CM. Immune aging and autoimmunity. Cell Mol Life Sci 2012;69:1615-23.[3]Nieuwenhuis WP, Mangnus L, van Steenbergen HW, Newsum EC, Huizinga TWJ, Reijnierse M, et al. Older age is associated with more MRI-detected inflammation in hand and foot joints. Rheumatology 2016;55:2212-9.[4]Eleftheriadis T, Pissas G, Sounidaki M, Antoniadi G, Tsialtas I, Liakopoulos V, et al. Urate crystals directly activate the T-cell receptor complex and induce T-cell proliferation. Biomed Rep 2017;7:365-9.Disclosure of Interests:None declared
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Rottenburger C, Mensch N, Imfeld S, Aschwanden M, Glatz K, Berger C, Deman E, Zeiner EA, Daikeler T. THU0302 HEAD-TO-HEAD COMPARISON OF 18F-FDG-PET/CT AND ULTRASOUND OF THE TEMPORAL ARTERY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:For the diagnosis of giant cell arteritis (GCA) several diagnostic tools do exist such as18F-FDG-PET/CT (PET) with excellent diagnostic accuracy for the larger vessels and ultrasound for the temporal arteries (TA). Recent data propose that PET is able to detect vasculitis in vessels as small as the TA (1). Comparison of PET, ultrasound (US) and histology of the TA on a segment level has not been done.Objectives:To describe diagnostic accuracy of PET of the TA in a vasculitis university clinic and to analyse strength and limitations of PET by comparing18F-FDG uptake to US and histology results on a segment level.Methods:We analysed patients, included in our ethical board approved local prospective GCA cohort having received a PET in between 2015 and 2019 because of suspected GCA.PET of the TA was performed using time-of flight technique and was scored ‘vasculitis’ if tracer uptake was higher than in the surrounding tissue. Standard uptake value (SUV) measurement in the trunk (T), parietal branch (PB) and frontal branch (FB) of the TA was recorded. US was performed for each branch.Results:From 37 consecutively recruited patients, GCA was confirmed in 19 patients and excluded in 18 patients which served as controls (Table 1). PET of the TA showed vasculitis in 12/19 GCA patients and in 1/18 controls. Median SUVmaxof all vasculitic FB (n=18) was 2.91, 2.20 for the T (n=14) and 2.34 for the PB (n=5).Table 1.Patient characteristics. Data are expressed as number (%) or median (interquartile range)GCA (n=19)(51%)Control (n=18)(49%)P-valueFemale11 (57)9 (50)0.64Median age (years) at PET73 (64-78)62.5 (57-71.75)0.04Amaurosis fugax/Loss of vision9 (47)9 (50)>0.99New onset headache13 (68)11 (61)0.74Jaw claudication7 (37)3 (16)0.38Scalp tenderness/pathological TA7 (37)6 (33)0.54Proximal muscle pain11 (58)8 (44)0.29Fever1 (5)5 (28)0.06Median Erythrocyte sedimentation rate (mm/h)73 (48-90)50 (28.5 - 68.5)0.06Median C-reactive protein (mg/L)66 (29-105)46 (13-133)0.5716 of the 19 GCA patients received US of the TA and 9 showed vasculitic findings. From the control group 2 patients showed vasculitic findings. Most often vasculitic findings were localized in the FB (n=16), followed by the T (n=13) and the PB (n=13).In the 16 patients that received US, diagnostic sensitivity and specificity of temporal PET for GCA within the TA was 56% and 94% and of US 56% and 89%, respectively.Whereas US detects vasculitis in comparable frequencies in all TA branches, PET recorded vasculitis less often in the PB (only 4 of the 13 in US vasculitic PB). Indeed, the median diameter of all PET positive TA branches, measured in the US, was higher (2.00mm) compared to PET negative branches (1.50mm). Vasculitis was confirmed histologically in 9 of the 13 biopsied patients. Only 2/9 patients showed vasculitis in the preceding PET in the biopsied branch.Conclusion:High diagnostic accuracy for temporal arteries supports PET as an ‘all-in-one’ exam for GCA. A limitation might be the vessel diameter, as sensitivity of PET for vasculitis of the small parietal branch is low. Thus, in cases with high suspicion of GCA despite a negative PET, US of the TA and or biopsy might enhance diagnostic sensitivity.References:[1]Nielsen et al. Simple dichotomous assessment of cranial artery inflammation by conventional 18F-FDG PET/CT shows high accuracy for the diagnosis of giant cell arteritis: a case-control study.Eur J Nucl Med Mol Imaging. 2019;46(1):184-193.doi:10.1007/s00259-018-4106-0Disclosure of Interests:None declared
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Papaioannou A, Adachi JD, Berger C, Jiang Y, Barron R, McGinley JS, Wirth RJ, Anastassiades TP, Davison KS, Hanley DA, Ioannidis G, Kaiser SM, Kovacs CS, Leslie WD, Morin SN, Prior JC, Towheed T, Goltzman D. Testing a theoretical model of imminent fracture risk in elderly women: an observational cohort analysis of the Canadian Multicentre Osteoporosis Study. Osteoporos Int 2020; 31:1145-1153. [PMID: 32034452 DOI: 10.1007/s00198-020-05330-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
UNLABELLED We examined the underlying relationship between fracture risk factors and their imminent risk. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher imminent fracture risk. Past year falls indirectly predicted imminent risk through physical functioning and general health. INTRODUCTION This study aimed to examine direct and indirect effects of several factors on imminent (1 year) fracture risk. METHODS Data from women age 65 and older from population-based Canadian Multicentre Osteoporosis Study were used. Predictors were identified from study years 5 and 10, and imminent fracture data (1-year fracture) came from years 6 and 11 (year 5 predicts year 6, year 10 predicts year 11). A structural equation model (SEM) was used to test the theoretical construct. General health and physical functioning were measured as latent variables using items from the 36-Item Short Form Health Survey (SF-36) and bone mineral density (BMD) T-score was a latent variable based on observed site-specific BMD data (spine L1-L4, femoral neck, total hip). Observed variables were fractures and falls. Model fit was evaluated using root mean square error of approximation (RMSEA), Tucker Lewis index (TLI), and comparative fit index (CFI). RESULTS The analysis included 3298 women. Model fit tests showed that the SEM fit the data well; χ2(172) = 1122.10 < .001, RMSEA = .03, TLI = .99, CFI = .99. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher risk of fracture in the subsequent year (p < .001). Past year falls had a statistically significant but indirect effect on imminent fracture risk through physical functioning and general health (p < .001). CONCLUSIONS We found several direct and indirect pathways that predicted imminent fracture risk in elderly women. Future studies should extend this work by developing risk scoring methods and defining imminent risk thresholds.
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Affiliation(s)
| | - J D Adachi
- McMaster University, Hamilton, ON, Canada
| | - C Berger
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Y Jiang
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
| | - R Barron
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - J S McGinley
- Vector Psychometric Group, LLC, Chapel Hill, NC, USA
| | - R J Wirth
- Vector Psychometric Group, LLC, Chapel Hill, NC, USA
| | | | - K S Davison
- University of Victoria, Victoria, BC, Canada
| | - D A Hanley
- Cumming School of Medicine, University of Calgary, Calgary, AL, Canada
| | | | - S M Kaiser
- Dalhousie University, Halifax, NS, Canada
| | - C S Kovacs
- Memorial University of Newfoundland, St. John's, NL, Canada
| | - W D Leslie
- University of Manitoba, Winnipeg, MB, Canada
| | - S N Morin
- McGill University, Montreal, QC, Canada
| | - J C Prior
- University of British Columbia, Vancouver, BC, Canada
| | - T Towheed
- Queen's University, Kingston, ON, Canada
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Ayuk F, Fehse B, Janson D, Berger C, Riecken K, Kröger N. Excellent proliferation and persistence of allogeneic donor-derived 41-BB based CAR-T cells despite immunosuppression with cyclosporine A. Haematologica 2020; 105:322-324. [PMID: 32241845 DOI: 10.3324/haematol.2019.245969] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Francis Ayuk
- Department of Stem Cell Transplantation with Research Department Cell and Gene Therapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Boris Fehse
- Department of Stem Cell Transplantation with Research Department Cell and Gene Therapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dietlinde Janson
- Department of Stem Cell Transplantation with Research Department Cell and Gene Therapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolina Berger
- Department of Stem Cell Transplantation with Research Department Cell and Gene Therapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristoffer Riecken
- Department of Stem Cell Transplantation with Research Department Cell and Gene Therapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation with Research Department Cell and Gene Therapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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22
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Fehse B, Badbaran A, Berger C, Sonntag T, Riecken K, Geffken M, Kröger N, Ayuk FA. Digital PCR Assays for Precise Quantification of CD19-CAR-T Cells after Treatment with Axicabtagene Ciloleucel. Mol Ther Methods Clin Dev 2020; 16:172-178. [PMID: 32055645 PMCID: PMC7005515 DOI: 10.1016/j.omtm.2019.12.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 12/24/2019] [Indexed: 12/20/2022]
Abstract
Treatment with axicabtagene ciloleucel (Axi-cel) CD19-CAR-T (chimeric antigen receptor T) cells has been approved for refractory/relapsed diffuse large B cell lymphoma (DLBCL) and primary mediastinal large B cell lymphoma (PMBCL). Because treatment success as well as side effects might depend on CAR-T cell expansion in vivo, we aimed at developing digital PCR (dPCR) assays for detection and quantification of CAR-T cells. To this end, we cloned and sequenced the complete cDNA of the CAR construct. We designed different combinations of primers and dual-labeled hydrolysis probes located in various CAR regions. Three combinations were successfully tested on CAR-positive and -negative cells in duplex reactions with a reference gene (REF) to concomitantly assess cell numbers. All assays demonstrated excellent specificity and reproducibility with neglectable inter-assay variations. For all three assays, almost perfect correlation between the two dPCRs (Axi-cel versus REF) was observed, and the limit of detection was one single CAR-transduced cell corresponding to a sensitivity of 0.01% for 100 ng genomic DNA. After cross-validation, we used one assay to monitor Axi-cel CAR-T numbers in patients. CAR-T expansion and contraction followed the expected kinetics with median peak value of 11.2 Axi-cel CAR-T cells/μL at 11.3 days (median). Clinically, we observed only two partial responses (PRs) in the five patients with CAR-T cell peak numbers below median, whereas four of the five patients with comparatively good expansion showed clinical responses (two complete responses [CRs] and two PRs) on day 30. In conclusion, we established a novel dPCR assay for the sensitive detection of transgenic CAR-T cells, which should be very useful in the context of Axi-cel treatment.
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Affiliation(s)
- Boris Fehse
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Research Department Cell and Gene Therapy at Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anita Badbaran
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolina Berger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tanja Sonntag
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Research Department Cell and Gene Therapy at Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristoffer Riecken
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Research Department Cell and Gene Therapy at Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Geffken
- Institute for Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francis A Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Dueck A, Wunsch K, Reis O, Böttcher H, Häßler F, Buchmann J, Kölch M, Oster H, Astiz M, Berger C. Dance to another rhythm - chronobiology and sleep in ADHD children. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.271] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Belin C, Simard C, Dos Santos A, Ayrignac X, Berger C, Cartron G, Le Gouill S, Sesques P, Thieblemont C, Carpentier AF. JS1.4 Neurological follow-up of neurotoxicity after CAR T cell therapy in lymphoma patients: A French neurological multi-center survey. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.013] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Chimeric antigen receptor-modified T (CAR T) cell therapy is a highly promising treatment for haematological malignancies but is frequently associated with cytokine-release syndrome (CRS) and neurotoxicity. The physiopathological mechanisms of neurological complications and their links with CRS remain largely unknown. The aims of this study are: a) to follow-up longitudinally patients treated with CAR-T cell therapy; b) to exhaustively identify neurological signs and symptoms and; c) to describe their occurrence over time.
MATERIAL AND METHODS
Since September 2018, all patients treated with CD19-targeted CAR T cell therapy for relapsing lymphoma were systematically followed-up and monitored for signs of neurotoxicity by a neurologist. Five different centres (Paris-Saint-Louis, Nantes, Lyon, Montpellier, and Rennes) participated in this study.
RESULTS
As of April 1st 2019, 57 patients, mean age 49 years (range from 22 to 72 years, median age 50 years), 22 females / 35 males, all treated for lymphoma, were included in this study Neurotoxicity, defined as the presence of at least one neurological sign or symptoms appearing after treatment infusion, was present in 33 % of patients. The median time to onset was 7.5 days after infusion with a median duration of symptoms of 5 days. Neurological symptoms were: Encephalopathy (52%), cerebellar syndrome (26%), aphasia (15%), agraphia (15%), executive syndrome (10%), myoclonus (10%), dysarthria (10%), meningismus (5%), transverse myelitis (5%), seizure (5%), neuralgia (5%), and dysesthesia (5%). The severity grade of neurotoxicity was grade 4: 2 patients, Grade 3: 7 patients, grade 2: 5 patients and grade 1: 5 patients (CTCAE grading). CRS was observed in 75% of patients. All patients who developed neurological disorders also had CRS (grade 1: 68%, grade 2: 10%, grade 3: 15%, grade 4: 5%) that preceded neurotoxicity. As the study is still ongoing, updated results will be presented at the EANO meeting.
CONCLUSION
Neurotoxicity associated with CAR-T therapies occurs in one third of patients. This high frequency underlines the need: 1 - to neurologically assess all patients before and repeatedly after therapy infusions; 2 - to provide guidelines for neurological assessment and relevant investigations to improve early recognition of neurotoxicity and its management
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Affiliation(s)
- C Belin
- Hopital Saint-Louis AP-HP, Paris, France
| | - C Simard
- Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | | | | | - C Berger
- Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - G Cartron
- CHU Montpellier, Montpellier, France
| | | | - P Sesques
- Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
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Hopman WM, Berger C, Joseph L, Morin SN, Towheed T, Anastassiades T, Adachi JD, Hanley DA, Prior JC, Goltzman D. Longitudinal assessment of health-related quality of life in osteoporosis: data from the population-based Canadian Multicentre Osteoporosis Study. Osteoporos Int 2019; 30:1635-1644. [PMID: 31069440 DOI: 10.1007/s00198-019-05000-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/22/2019] [Indexed: 01/22/2023]
Abstract
UNLABELLED Little is known about the association between health-related quality of life (HRQOL) and osteoporosis in the absence of fracture, and how HRQOL may change over time. This study provides evidence of substantially reduced HRQOL in women and men with self-reported and/or BMD-confirmed osteoporosis, even in the absence of fragility fracture. INTRODUCTION Fragility fractures have a detrimental effect on the health-related quality of life (HRQOL) of those with osteoporosis. Less is known about the association between HRQOL and osteoporosis in the absence of fracture. METHODS Canadian Multicentre Osteoporosis Study participants completed the SF-36, a detailed health questionnaire and measures of bone mineral density (BMD) at baseline and follow-up. We report the results of participants ≥ 50 years with 10-year follow-up. Self-reported osteoporosis at baseline and BMD-based osteoporosis at follow-up were ascertained. Multivariable linear regression models were developed for baseline SF-36 domains, component summaries, and change over time, adjusting for relevant baseline information. RESULTS Baseline data were available for 5266 women and 2112 men. Women in the osteoporosis group had substantially lower SF-36 baseline scores, particularly in the physically oriented domains, than those without osteoporosis. A similar but attenuated pattern was evident for the men. After 10-year follow-up (2797 women and 1023 men), most domain scores dropped for women and men regardless of osteoporosis status, with the exception of mentally-oriented ones. In general, a fragility fracture was associated with lower SF-36 scores and larger declines over time. CONCLUSIONS This study provides evidence of substantially reduced HRQOL in women and men with self-reported and/or BMD-confirmed osteoporosis, even in the absence of fragility fracture. HRQOL should be thoroughly investigated even prior to fracture, to develop appropriate interventions for all stages of the disease.
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Affiliation(s)
- W M Hopman
- Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, Ontario, Canada.
- Department of Public Health Sciences, Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - C Berger
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - L Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montréal, QC, Canada
| | - T Towheed
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - T Anastassiades
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - D A Hanley
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada
| | - J C Prior
- Department of Medicine/Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - D Goltzman
- Department of Medicine, McGill University, Montréal, QC, Canada
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Bliuc D, Tran T, van Geel T, Adachi JD, Berger C, van den Bergh J, Eisman JA, Geusens P, Goltzman D, Hanley DA, Josse RG, Kaiser S, Kovacs CS, Langsetmo L, Prior JC, Nguyen TV, Center JR. Mortality risk reduction differs according to bisphosphonate class: a 15-year observational study. Osteoporos Int 2019; 30:817-828. [PMID: 30607457 DOI: 10.1007/s00198-018-4806-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/11/2018] [Indexed: 11/26/2022]
Abstract
UNLABELLED In this prospective cohort of 6120 participants aged 50+, nitrogen-bisphosphonates but not non-nitrogen bisphosphonates were associated with a significant 34% mortality risk reduction compared to non-treated propensity score matched controls. These findings open new avenues for research into mechanistic pathways. INTRODUCTION Emerging evidence suggests that bisphosphonates (BP), first-line treatment of osteoporosis, are associated with reduced risks for all-cause mortality. This study aimed to determine the association between different BP types and mortality risk in participants with or without a fracture. METHODS A prospective cohort study of users of different BPs matched to non-users by propensity score (age, gender, co-morbidities, fragility fracture status) and time to starting the BP medication from the population-based Canadian Multicentre Osteoporosis Study from nine Canadian centres followed from 1995 to 2013. Mortality risk for bisphosphonate users vs matched non-users was assessed using pairwise multivariable Cox proportional hazards models. RESULTS There were 2048 women and 308 men on BP and 1970 women and 1794 men who did not receive medication for osteoporosis. The relationship between BP and mortality risk was explored in three separate 1:1 propensity score-matched cohorts of BP users and no treatment (etidronate, n = 599, alendronate, n = 498, and risedronate n = 213). Nitrogen BP (n-BP) (alendronate and risedronate) was associated with lower mortality risks [pairwise HR, 0.66 (95% CI, 0.48-0.91)] while the less potent non-n-BP, etidronate, was not [pairwise HR: 0.89 (95% CI, 0.66-1.20)]. A direct comparison between n-BP and etidronate (n = 340 pairs) also suggested a better survival for n-BP [paired HR, 0.47 (95%CI, (95% CI, 031-0.70)] for n-BP vs. etidronate]. CONCLUSION Compared to no treatment, nitrogen but not non-nitrogen bisphosphonates appear to be associated with better survival.
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Affiliation(s)
- D Bliuc
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.
| | - T Tran
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia
| | - T van Geel
- Maastricht University Medical Center, Research School CAPHRI, Care and Public Health Research Institute, Maastricht, The Netherlands
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - C Berger
- CaMos National Coordinating Centre, McGill University, Montreal, Quebec, Canada
| | - J van den Bergh
- Research School Nutrim, Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Centre of Noord-Limburg, Venlo, The Netherlands
| | - J A Eisman
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
| | - P Geusens
- Maastricht University Medical Center, Research School CAPHRI, Care and Public Health Research Institute, Maastricht, The Netherlands
- Biomedical Research Institute, University Hasselt, Hasselt, Belgium
| | - D Goltzman
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - D A Hanley
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - R G Josse
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - S Kaiser
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - C S Kovacs
- Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - L Langsetmo
- School of Public Health, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - J C Prior
- Department of Medicine and Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
| | - T V Nguyen
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia
- Clinical School, Faculty of Medicine, St Vincent's Hospital, UNSW, Sydney, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
| | - J R Center
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia
- Clinical School, Faculty of Medicine, St Vincent's Hospital, UNSW, Sydney, Australia
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Farrag K, Berger C, Armbruster F, Schulze H, Dignass A, Stein J. A75 COMPARISON OF TWO DIFFERENT ASSESSMENT TECHNIQUES FOR MEASUREMENT OF VEDOLIZUMAB TROUGH LEVELS IN ADULT PATIENTS WITH IBD. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- K Farrag
- DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
| | - C Berger
- Immundiagnostik AG, Bensheim, Germany
| | | | - H Schulze
- Agaplesion Markus Hospital, Frankfurt/Main, Germany
| | - A Dignass
- Agaplesion Markus Hospital, Frankfurt/Main, Germany
| | - J Stein
- Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
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Farrag K, Berger C, Pilch A, Ruppert J, Armbruster F, Stein J. A83 AN ENZYME-LINKED IMMUNOSORBENT ASSAY FOR THERAPEUTIC DRUG MONITORING OF GOLIMUMAB. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Farrag
- Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
| | - C Berger
- Immundiagnostik AG, Bensheim, Germany
| | - A Pilch
- Immundiagnostik AG, Bensheim, Germany
| | - J Ruppert
- Immundiagnostik AG, Bensheim, Germany
| | | | - J Stein
- Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
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Fuchs C, Brüggemann A, Weseloh MJ, Berger C, Möller C, Reinhard S, Hader J, Moloney JV, Bäumner A, Koch SW, Stolz W. Author Correction: High-temperature operation of electrical injection type-II (GaIn)As/Ga(AsSb)/(GaIn)As “W”-quantum well lasers emitting at 1.3 µm. Sci Rep 2018; 8:7891. [PMID: 29760512 PMCID: PMC5951860 DOI: 10.1038/s41598-018-25808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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MacLean CD, Berger C, Cangiano ML, Ziegelman D, Lidofsky SD. Impact of electronic reminder systems on hepatitis C screening in primary care. J Viral Hepat 2018; 25:939-944. [PMID: 29478306 DOI: 10.1111/jvh.12885] [Citation(s) in RCA: 18] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/02/2018] [Indexed: 01/27/2023]
Abstract
Screening for hepatitis C virus (HCV) was recommended in 2012 by the Centers for Disease Control (CDC) for the population born between 1946 and 1965. Reminder systems are effective at promoting HCV screening, but the yield of positive tests among various population subgroups and the linkage to specialty HCV treatment is not well understood. We sought to determine: (i) the effect of the CDC recommendation alone, and the effect of an electronic medical record (EMR) reminder on the proportion of the population screened; (ii) the yield of positive HCV tests as screening strategies have evolved, and according to a patient's history of serum aminotransferase testing; (iii) the proportion of positive cases followed up for HCV treatment. This retrospective cohort study included 60 000 primary care patients at a northeast US academic medical centre serving an urban and rural population in which an EMR reminder was instituted in 2014. Results demonstrated an increase in proportion tested for HCV from 12% prior to the CDC recommendation to 37% after the reminder system. The yield of positive HCV antibody (HCV Ab) tests decreased from 7% in the "case-finding" era to 1.6% after the EMR reminder prompted screening of a lower risk population (P < .001). Patients with a history of abnormal aminotransferase tests had a fivefold higher rate of positive HCV Ab testing (6.7% vs 1.5%, P < .001). Ninety per cent of patients with confirmed HCV infection were seen in specialty care.
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Affiliation(s)
- C D MacLean
- Division of General Internal Medicine, Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA
| | - C Berger
- Division of General Internal Medicine, Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA
| | - M L Cangiano
- Department of Family Medicine, Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA
| | - D Ziegelman
- Division of General Internal Medicine, Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA
| | - S D Lidofsky
- Division of Gastroenterology, Robert Larner, MD College of Medicine at the University of Vermont, Burlington, VT, USA
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Specht JM, Lee S, Turtle CJ, Berger C, Baladrishnan A, Srivastava S, Voillet V, Veatch J, Gooley T, Mullane E, Chaney C, Rader C, Pierce RH, Gottardo R, Maloney DG, Riddell SR. Abstract CT131: A phase I study of adoptive immunotherapy for advanced ROR1+ malignancies with defined subsets of autologous T cells expressing a ROR1-specific chimeric antigen receptor (ROR1-CAR). Clin Trials 2018. [DOI: 10.1158/1538-7445.am2018-ct131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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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Aparicio T, Ducreux M, Faroux R, Barbier E, Manfredi S, Lecomte T, Etienne PL, Bedenne L, Bennouna J, Phelip JM, François E, Michel P, Legoux JL, Gasmi M, Breysacher G, Rougier P, De Gramont A, Lepage C, Bouché O, Seitz JF, Adenis A, Alessio A, Aouakli A, Azzedine A, Bedjaoui A, Bidault A, Blanchi A, Botton A, Cadier-Lagnes A, Fatisse A, Gagnaire A, Gilbert A, Gueye A, Hollebecque A, Lemaire A, Mahamat A, Marre A, Patenotte A, Rotenberg A, Roussel A, Thirot-Bidault A, Votte A, Weber A, Zaanan A, Dupont-Gossart A, Villing A, Queuniet A, Coudert B, Denis B, Garcia B, Lafforgue B, Landi B, Leduc B, Linot B, Paillot B, Rhein B, Winkfield B, Barberis C, Becht C, Belletier C, Berger C, Bineau C, Borel C, Brezault C, Buffet C, Cornila C, Couffon C, De La Fouchardière C, Giraud C, Lecaille C, Lepere C, Lobry C, Locher C, Lombard-Bohas C, Paoletti C, Platini C, Rebischung C, Sarda C, Vilain C, Briac-Levaché C, Auby D, Baudet-Klepping D, Bechade D, Besson D, Cleau D, Festin D, Gargot D, Genet D, Goldfain D, Luet D, Malka D, Peré-Vergé D, Pillon D, Sevin-Robiche D, Smith D, Soubrane D, Tougeron D, Zylberait D, Carola E, Cuillerier E, Dorval Danquechin E, Echinard E, Janssen E, Maillard E, Mitry E, Norguet-Monnereau E, Suc E, Terrebonne E, Zrihen E, Pariente E, Almaric F, Audemar F, Bonnetain F, Desseigne F, Dewaele F, Di Fiore F, Ghiringhelli F, Husseini F, Khemissa F, Kikolski F, Morvan F, Petit-Laurent F, Riot F, Subtil F, Zerouala-Boussaha F, Caroli-Bosc F, Boilleau-Jolimoy G, Bordes G, Cavaglione G, Coulanjon G, Deplanque G, Gatineau-Saillant G, Goujon G, Medinger G, Roquin G, Brixi-Benmansour H, Castanie H, Lacroix H, Maechel H, Perrier H, Salloum H, Senellart H, Baumgaertner I, Cumin I, Graber I, Trouilloud I, Boutin J, Butel J, Charneau J, Cretin J, Dauba J, Deguiral J, Egreteau J, Ezenfis J, Forestier J, Goineau J, Lacourt J, Lafon J, Martin J, Meunier J, Moreau J, Provencal J, Taieb J, Thaury J, Tuaillon J, Vergniol J, Villand J, Vincent J, Volet J, Bachet J, Barbare J, Souquet J, Grangé J, Dor J, Paitel J, Jouve J, Raoul J, Cheula J, Gornet J, Sabate J, Vantelon J, Vaillant J, Aucouturier J, Barbieux J, Herr J, Lafargue J, Lagasse J, Latrive J, Plachot J, Ramain J, Robin J, Spano J, Douillard J, Beerblock K, Bouhier-Leporrier K, Slimane Fawzi K, Cany L, Chone L, Dahan L, Gasnault L, Rob L, Stefani L, Wander L, Baconnier M, Ben Abdelghani M, Benchalal M, Blasquez M, Carreiro M, Charbit M, Combe M, Duluc M, Fayolle M, Gignoux M, Giovannini M, Glikmanas M, Mabro M, Mignot M, Mornet M, Mousseau M, Mozer M, Pauwels M, Pelletier M, Porneuf M, Ramdani M, Schnee M, Tissot M, Zawadi M, Clavero-Fabri M, Gouttebel M, Kaminsky M, Galais M, Abdelli N, Barrière N, Bouaria N, Bouarioua N, Delas N, Gérardin N, Hess-Laurens N, Stremsdoerfer N, Berthelet O, Boulat O, Capitain O, Favre O, Amoyal P, Bergerault P, Burtin P, Cassan P, Chatrenet P, Chiappa P, Claudé P, Couzigou P, Feydy P, Follana P, Geoffroy P, Godeau P, Hammel P, Laplaige P, Lehair P, Martin P, Novello P, Pantioni P, Pienkowski P, Pouderoux P, Prost P, Ruszniewski P, Souillac P, Texereau P, Thévenet P, Haineaux P, Benoit R, Coriat R, Lamy R, Mackiewicz R, Beorchia S, Chaussade S, Hiret S, Jacquot S, Lavau Denes S, Montembault S, Nahon S, Nasca S, Nguyen S, Oddou-Lagraniere S, Pesque-Penaud S, Fratte S, Chatellier T, Mansourbakht T, Morin T, Walter T, Boige V, Bourgeois V, Derias V, Guérin-Meyer V, Hautefeuille V, Jestin Le Tallec V, Lorgis V, Quentin V, Sebbagh V, Veuillez V, Adhoute X, Coulaud X, Becouarn Y, Coscas Y, Courouble Y, Le Bricquir Y, Molin Y, Rinaldi Y, Lam Y, Ladhib Z. Overweight is associated to a better prognosis in metastatic colorectal cancer: A pooled analysis of FFCD trials. Eur J Cancer 2018; 98:1-9. [DOI: 10.1016/j.ejca.2018.03.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
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Cusini A, Béguelin C, Stampf S, Boggian K, Garzoni C, Koller M, Manuel O, Meylan P, Mueller NJ, Hirsch HH, Weisser M, Berger C, van Delden C. Clostridium difficile infection is associated with graft loss in solid organ transplant recipients. Am J Transplant 2018; 18:1745-1754. [PMID: 29349869 DOI: 10.1111/ajt.14640] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 12/10/2017] [Accepted: 12/12/2017] [Indexed: 01/25/2023]
Abstract
Clostridium difficile infection (CDI) is a leading cause of infectious diarrhea in solid organ transplant recipients (SOT). We aimed to assess incidence, risk factors, and outcome of CDI within the Swiss Transplant Cohort Study (STCS). We performed a case-control study of SOT recipients in the STCS diagnosed with CDI between May 2008 and August 2013. We matched 2 control subjects per case by age at transplantation, sex, and transplanted organ. A multivariable analysis was performed using conditional logistic regression to identify risk factors and evaluate outcome of CDI. Two thousand one hundred fifty-eight SOT recipients, comprising 87 cases of CDI and 174 matched controls were included. The overall CDI rate per 10 000 patient days was 0.47 (95% confidence interval ([CI] 0.38-0.58), with the highest rate in lung (1.48, 95% CI 0.93-2.24). In multivariable analysis, proven infections (hazard ratio [HR] 2.82, 95% CI 1.29-6.19) and antibiotic treatments (HR 4.51, 95% CI 2.03-10.0) during the preceding 3 months were independently associated with the development of CDI. Despite mild clinical presentations, recipients acquiring CDI posttransplantation had an increased risk of graft loss (HR 2.24, 95% CI 1.15-4.37; P = .02). These findings may help to improve the management of SOT recipients.
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Affiliation(s)
- A Cusini
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.,Division of Infectious Diseases, Cantonal Hospital Chur, Chur, Switzerland
| | - C Béguelin
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Stampf
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - K Boggian
- Division of Infectious Diseases & Hospital Hygiene, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - C Garzoni
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.,Clinic of Internal Medicine & Infectious Diseases, Clinica Luganese, Lugano, Switzerland
| | - M Koller
- Division of Infectious Diseases & Hospital Hygiene, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - O Manuel
- Infectious Diseases Service, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - P Meylan
- Infectious Diseases Service, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - N J Mueller
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital, University of Zürich, Zürich, Switzerland
| | - H H Hirsch
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - M Weisser
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - C Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zürich, Zürich, Switzerland
| | - C van Delden
- Transplant Infectious Diseases Unit, University Hospitals Geneva, Geneva, Switzerland
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Berger C, Boggavarapu N, Norlin E, Queckbörner S, Hörnaeus K, Falk A, Engman M, Ramström M, Lalitkumar PGL, Gemzell-Danielsson K. Molecular characterization of PRM-associated endometrial changes, PAEC, following mifepristone treatment. Contraception 2018; 98:317-322. [PMID: 29890128 DOI: 10.1016/j.contraception.2018.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/11/2018] [Accepted: 05/25/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The progesterone receptor modulator (PRM) mifepristone holds the potential to be developed for regular contraception. However, long-term treatment can cause thickening of the endometrium and PRM-associated endometrial changes (PAEC). The objective of this study was to explore the molecular expression of endometrium displaying PAEC after mifepristone treatment in order to understand the future implications of PAEC and safety of long-term use. STUDY DESIGN Endometrial biopsies were obtained from premenopausal women following 3 months of continuous mifepristone treatment. The biopsies were evaluated regarding occurrence of PAEC and followed up by a comparative analysis of gene expression in PAEC endometrium (n=7) with endometrium not displaying PAEC (n=4). Methods used included microarray analysis, Ingenuity Pathway Analysis (IPA) and real-time polymerase chain reaction. RESULTS Three genes relevant within endometrial function were up-regulated with PAEC: THY1 (p=.02), ADAM12 (p=.04) and TN-C (p=.04). The proliferation marker MKi67 was not altered (p=.31). None of the differentially regulated genes were involved in the endometrial cancer-signaling pathway (based on IPA knowledge database). CONCLUSION The genes altered in endometrium displaying PAEC after 3 months of mifepristone exposure are mainly involved in the structural architecture of tissue. IMPLICATIONS PAEC features may be explained by the altered genes and their networks affecting tissue architecture although not involved in endometrial cancer signaling pathways, and thus, treatment with mifepristone at this dosage does not show any adverse effect at endometrial level.
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Affiliation(s)
- C Berger
- Department of Women´s and Children´s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, S-171 76, Stockholm, Sweden.
| | - N Boggavarapu
- Department of Women´s and Children´s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - E Norlin
- Department of Women´s and Children´s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - S Queckbörner
- Department of Women´s and Children´s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - K Hörnaeus
- Analytical Chemistry, Department of Chemistry-BMC and Science for Life Laboratory, S-751 24, Uppsala, Sweden
| | - A Falk
- Analytical Chemistry, Department of Chemistry-BMC and Science for Life Laboratory, S-751 24, Uppsala, Sweden
| | - M Engman
- Department of Women´s and Children´s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - M Ramström
- Analytical Chemistry, Department of Chemistry-BMC and Science for Life Laboratory, S-751 24, Uppsala, Sweden
| | - P G L Lalitkumar
- Department of Women´s and Children´s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - K Gemzell-Danielsson
- Department of Women´s and Children´s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, S-171 76, Stockholm, Sweden
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Grange L, Guichard I, Berger C, Garçon L, Picard V, Cathébras P. Une nouvelle cause hématologique de surcharge martiale sévère. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Taraseviciute A, Tkachev V, Ponce R, Turtle CJ, Snyder JM, Liggitt HD, Myerson D, Gonzalez-Cuyar L, Baldessari A, English C, Yu A, Zheng H, Furlan SN, Hunt DJ, Hoglund V, Finney O, Brakke H, Blazar BR, Berger C, Riddell SR, Gardner R, Kean LS, Jensen MC. Chimeric Antigen Receptor T Cell-Mediated Neurotoxicity in Nonhuman Primates. Cancer Discov 2018; 8:750-763. [PMID: 29563103 PMCID: PMC6058704 DOI: 10.1158/2159-8290.cd-17-1368] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/03/2018] [Accepted: 03/12/2018] [Indexed: 12/22/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell immunotherapy has revolutionized the treatment of refractory leukemias and lymphomas, but is associated with significant toxicities, namely cytokine release syndrome (CRS) and neurotoxicity. A major barrier to developing therapeutics to prevent CAR T cell-mediated neurotoxicity is the lack of clinically relevant models. Accordingly, we developed a rhesus macaque (RM) model of neurotoxicity via adoptive transfer of autologous CD20-specific CAR T cells. Following cyclophosphamide lymphodepletion, CD20 CAR T cells expand to 272 to 4,450 cells/μL after 7 to 8 days and elicit CRS and neurotoxicity. Toxicities are associated with elevated serum IL6, IL8, IL1RA, MIG, and I-TAC levels, and disproportionately high cerebrospinal fluid (CSF) IL6, IL2, GM-CSF, and VEGF levels. During neurotoxicity, both CD20 CAR and non-CAR T cells accumulate in the CSF and in the brain parenchyma. This RM model demonstrates that CAR T cell-mediated neurotoxicity is associated with proinflammatory CSF cytokines and a pan-T cell encephalitis.Significance: We provide the first immunologically relevant, nonhuman primate model of B cell-directed CAR T-cell therapy-mediated CRS and neurotoxicity. We demonstrate CAR and non-CAR T-cell infiltration in the CSF and in the brain during neurotoxicity resulting in pan-encephalitis, accompanied by increased levels of proinflammatory cytokines in the CSF. Cancer Discov; 8(6); 750-63. ©2018 AACR.This article is highlighted in the In This Issue feature, p. 663.
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Affiliation(s)
- Agne Taraseviciute
- The Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
- The Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Victor Tkachev
- The Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
- The Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
| | | | | | - Jessica M Snyder
- Deparment of Comparative Medicine, University of Washington, Seattle, Washington
| | - H Denny Liggitt
- Deparment of Comparative Medicine, University of Washington, Seattle, Washington
| | - David Myerson
- The Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pathology, University of Washington, Seattle, Washington
| | | | - Audrey Baldessari
- Washington National Primate Research Center, University of Washington, Seattle, Washington
| | - Chris English
- Washington National Primate Research Center, University of Washington, Seattle, Washington
| | - Alison Yu
- The Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Hengqi Zheng
- The Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Scott N Furlan
- The Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
- The Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Daniel J Hunt
- The Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Virginia Hoglund
- The Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Olivia Finney
- The Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Hannah Brakke
- The Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Bruce R Blazar
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Carolina Berger
- The Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Rebecca Gardner
- The Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Leslie S Kean
- The Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington.
- The Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Michael C Jensen
- The Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington.
- The Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
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Neofytos D, Chatzis O, Nasioudis D, Boely Janke E, Doco Lecompte T, Garzoni C, Berger C, Cussini A, Boggian K, Khanna N, Manuel O, Mueller NJ, van Delden C. Epidemiology, risk factors and outcomes of invasive aspergillosis in solid organ transplant recipients in the Swiss Transplant Cohort Study. Transpl Infect Dis 2018; 20:e12898. [PMID: 29668068 DOI: 10.1111/tid.12898] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/07/2018] [Accepted: 03/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is lack of recent multicenter epidemiological data on invasive aspergillosis (IA) among solid organ transplant recipient (SOTr) in the mold-acting antifungal era. We describe the epidemiology and outcomes of IA in a contemporary cohort of SOTr using the Swiss Transplant Cohort Study. METHODS All consecutive SOTr with proven or probable IA between 01.05.2008 and 31.12.2014 were included. A case-control study to identify IA predictors was performed: 1-case was matched with 3-controls based on SOT type, transplant center, and time post-SOT. RESULTS Among 2868 SOTr, 70 (2.4%) patients were diagnosed with proven (N: 30/70, 42.9%) or probable (N: 40/70, 57.1%) IA. The incidence of IA was 8.3%, 7.1%, 2.6%, 1.3%, and 1.2% in lung, heart, combined, kidney, and liver transplant recipients, respectively, Galactomannan immunoassay was positive in 1/3 of patients tested. Only 33/63 (52.4%) of patients presented with typical pulmonary radiographic findings. Predictors of IA included: renal insufficiency, re-operation, and bacterial and viral infections. 12-week mortality was higher in liver (85.7%, 6/7) compared to other (15.9%, 10/63; P < .001) SOTr. CONCLUSIONS Invasive aspergillosis remains a rare complication post-SOT, with atypical radiographic presentations and low positivity rates of biomarkers posing significant diagnostic challenges. Although overall mortality has decreased in SOTr, it remains high in liver SOTr.
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Affiliation(s)
- D Neofytos
- Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - O Chatzis
- Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland.,Division of Pediatric Infectious Diseases, University Hospital of St Luc, Brussels, Belgium
| | - D Nasioudis
- Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - E Boely Janke
- Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - T Doco Lecompte
- Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - C Garzoni
- Department of Infectious Diseases, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Departments of Internal Medicine and Infectious Disease, Clinica Luganese, Lugano, Switzerland
| | - C Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zürich, Zürich, Switzerland
| | - A Cussini
- Department of Infectious Diseases, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - K Boggian
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - N Khanna
- Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel, Basel, Switzerland
| | - O Manuel
- Service of Infectious Diseases and Transplantation Center, University Hospital of Lausanne, Lausanne, Switzerland
| | - N J Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
| | - C van Delden
- Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland
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Specht JM, Lee S, Turtle C, Berger C, Veatch J, Gooley T, Mullane E, Chaney C, Riddell S, Maloney DG. Phase I study of immunotherapy for advanced ROR1+ malignancies with autologous ROR1-specific chimeric antigen receptor-modified (CAR)-T cells. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.5_suppl.tps79] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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
TPS79 Background: CAR-T cells have demonstrated marked tumor regression in patients (pts) with hematologic malignancies. ROR1, a tyrosine kinase orphan receptor, is expressed in triple negative breast cancers (TNBC) and non-small cell lung cancers (NSCLC) and is a novel candidate for CAR-T cell therapy. ROR1-specific CAR-T cells are engineered with lentiviral vector encoding ROR1 scFv/4-1BB/CD3ζ and a truncated EGFR molecule to permit elimination of ROR1 CAR-T cells in case of toxicity. Methods: NCT02706362 is a phase I study evaluating the safety and anti-tumor activity of adoptively transferred autologous ROR1 CAR-T cells in pts with advanced ROR1+ TNBC and NSCLC. Eligibility criteria include: metastatic TNBC or NSCLC; measurable disease; prior standard therapy with no maximum on number of prior regimens; tumor ROR1 expression > 20% by IHC; KPS > 70%; age ≥18; negative pregnancy test for women of childbearing potential; informed consent; adequate organ function. Exclusions are: active autoimmune disease or uncontrolled infection, HIV seropositive status, contraindication to cyclophosphamide, anticipated survival < 3 months, and/or untreated CNS metastases. After screening, leukapheresis is performed, CD8+ and CD4+ T cells are selected, then transduced with the ROR1+ CAR lentivirus and expanded. Lymphodepletion with cyclophosphamide and fludarabine is followed 36-96 hours later by infusion of ROR1 CAR-T cells in escalating doses (3.3 x 105/kg - 1 x 107/kg cells with defined CD8+ and CD4+ composition). Pts are treated in cohorts of 2 to determine cell dose associated with an estimated toxicity rate of < 25%. Primary aim is to determine the maximum tolerated dose (MTD) and safety of ex vivo expanded ROR1 CAR-T cells. Secondary aims include persistence and phenotype of transferred T cells, trafficking of T cells to tumor site, in vivo function, and preliminary antitumor activity of ROR1 CAR-T cells by RECIST 1.1. Dose escalation is determined by CRM algorithm with minimum of 21-day interval following infusion between pts. Preliminary estimates of efficacy will be obtained among all pts and those treated at estimated MTD. Six of 30 pts have been enrolled with no DLTs observed. Clinical trial information: NCT02706392.
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Affiliation(s)
| | | | | | | | - Josh Veatch
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ted Gooley
- Fred Hutchinson Cancer Research Center, Seattle, WA
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Fuchs C, Brüggemann A, Weseloh MJ, Berger C, Möller C, Reinhard S, Hader J, Moloney JV, Bäumner A, Koch SW, Stolz W. High-temperature operation of electrical injection type-II (GaIn)As/Ga(AsSb)/(GaIn)As "W"-quantum well lasers emitting at 1.3 µm. Sci Rep 2018; 8:1422. [PMID: 29362369 PMCID: PMC5780424 DOI: 10.1038/s41598-018-19189-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/02/2017] [Accepted: 12/22/2017] [Indexed: 11/29/2022] Open
Abstract
Electrical injection lasers emitting in the 1.3 μm wavelength regime based on (GaIn)As/Ga(AsSb)/(GaIn)As type-II double "W"-quantum well heterostructures grown on GaAs substrate are demonstrated. The structure is designed by applying a fully microscopic theory and fabricated using metal organic vapor phase epitaxy. Temperature-dependent electroluminescence measurements as well as broad-area edge-emitting laser studies are carried out in order to characterize the resulting devices. Laser emission based on the fundamental type-II transition is demonstrated for a 975 μm long laser bar in the temperature range between 10 °C and 100 °C. The device exhibits a differential efficiency of 41 % and a threshold current density of 1.0 kA/cm2 at room temperature. Temperature-dependent laser studies reveal characteristic temperatures of T0 = (132 ± 3) K over the whole temperature range and T1 = (159 ± 13) K between 10 °C and 70 °C and T1 = (40 ± 1) K between 80 °C and 100 °C.
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Affiliation(s)
- C Fuchs
- Materials Sciences Center and Department of Physics, Philipps-Universität Marburg, Renthof 5, 35032, Marburg, Germany.
| | - A Brüggemann
- Materials Sciences Center and Department of Physics, Philipps-Universität Marburg, Renthof 5, 35032, Marburg, Germany
| | - M J Weseloh
- Materials Sciences Center and Department of Physics, Philipps-Universität Marburg, Renthof 5, 35032, Marburg, Germany
| | - C Berger
- Materials Sciences Center and Department of Physics, Philipps-Universität Marburg, Renthof 5, 35032, Marburg, Germany
| | - C Möller
- Materials Sciences Center and Department of Physics, Philipps-Universität Marburg, Renthof 5, 35032, Marburg, Germany
| | - S Reinhard
- Materials Sciences Center and Department of Physics, Philipps-Universität Marburg, Renthof 5, 35032, Marburg, Germany
| | - J Hader
- Nonlinear Control Strategies Inc., 7040 N. Montecatina Dr., Tucson, AZ, 85704, USA
- College of Optical Sciences, University of Arizona, 1630 E. University Blvd., Tucson, AZ, 85721, USA
| | - J V Moloney
- Nonlinear Control Strategies Inc., 7040 N. Montecatina Dr., Tucson, AZ, 85704, USA
- College of Optical Sciences, University of Arizona, 1630 E. University Blvd., Tucson, AZ, 85721, USA
| | - A Bäumner
- Materials Sciences Center and Department of Physics, Philipps-Universität Marburg, Renthof 5, 35032, Marburg, Germany
| | - S W Koch
- Materials Sciences Center and Department of Physics, Philipps-Universität Marburg, Renthof 5, 35032, Marburg, Germany
| | - W Stolz
- Materials Sciences Center and Department of Physics, Philipps-Universität Marburg, Renthof 5, 35032, Marburg, Germany
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Turtle CJ, Hanafi LA, Berger C, Hudecek M, Pender B, Robinson E, Hawkins R, Chaney C, Cherian S, Chen X, Soma L, Wood B, Li D, Heimfeld S, Riddell SR, Maloney DG. Immunotherapy of non-Hodgkin's lymphoma with a defined ratio of CD8+ and CD4+ CD19-specific chimeric antigen receptor-modified T cells. Sci Transl Med 2017; 8:355ra116. [PMID: 27605551 DOI: 10.1126/scitranslmed.aaf8621] [Citation(s) in RCA: 728] [Impact Index Per Article: 104.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/21/2016] [Indexed: 12/20/2022]
Abstract
CD19-specific chimeric antigen receptor (CAR)-modified T cells have antitumor activity in B cell malignancies, but factors that affect toxicity and efficacy have been difficult to define because of differences in lymphodepletion and heterogeneity of CAR-T cells administered to individual patients. We conducted a clinical trial in which CD19 CAR-T cells were manufactured from defined T cell subsets and administered in a 1:1 CD4(+)/CD8(+) ratio of CAR-T cells to 32 adults with relapsed and/or refractory B cell non-Hodgkin's lymphoma after cyclophosphamide (Cy)-based lymphodepletion chemotherapy with or without fludarabine (Flu). Patients who received Cy/Flu lymphodepletion had increased CAR-T cell expansion and persistence, and higher response rates [50% complete remission (CR), 72% overall response rate (ORR)] than patients who received Cy-based lymphodepletion without Flu (8% CR, 50% ORR). The CR rate in patients treated with Cy/Flu at the maximally tolerated dose was 64% (82% ORR; n = 11). Cy/Flu minimized the effects of an immune response to the murine single-chain variable fragment component of the CAR, which limited CAR-T cell expansion and clinical efficacy in patients who received Cy-based lymphodepletion without Flu. Severe cytokine release syndrome (sCRS) and grade ≥3 neurotoxicity were observed in 13 and 28% of all patients, respectively. Serum biomarkers, one day after CAR-T cell infusion, correlated with subsequent sCRS and neurotoxicity. Immunotherapy with CD19 CAR-T cells in a defined CD4(+)/CD8(+) ratio allowed identification of correlative factors for CAR-T cell expansion, persistence, and toxicity, and facilitated optimization of lymphodepletion that improved disease response and overall and progression-free survival.
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Affiliation(s)
- Cameron J Turtle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. Department of Medicine, University of Washington, Seattle, WA 98109, USA.
| | - Laïla-Aïcha Hanafi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Carolina Berger
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. Department of Medicine, University of Washington, Seattle, WA 98109, USA
| | - Michael Hudecek
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Barbara Pender
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Emily Robinson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Reed Hawkins
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Colette Chaney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Sindhu Cherian
- Department of Laboratory Medicine, University of Washington, Seattle, WA 98109, USA
| | - Xueyan Chen
- Department of Laboratory Medicine, University of Washington, Seattle, WA 98109, USA
| | - Lorinda Soma
- Department of Laboratory Medicine, University of Washington, Seattle, WA 98109, USA
| | - Brent Wood
- Department of Laboratory Medicine, University of Washington, Seattle, WA 98109, USA
| | - Daniel Li
- Juno Therapeutics, Seattle, WA 98109, USA
| | - Shelly Heimfeld
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Stanley R Riddell
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. Department of Medicine, University of Washington, Seattle, WA 98109, USA
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. Department of Medicine, University of Washington, Seattle, WA 98109, USA
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Peralta Muniz Moreira RDF, Humeres E, Berger C, Isabel Fernández M, Santaballa JA, Canle M. Photolytic insertion of albumin on activated carbon modified with ozone. J Photochem Photobiol B 2017; 174:261-268. [PMID: 28806682 DOI: 10.1016/j.jphotobiol.2017.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/25/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
254nm photolyses of bovine serum albumin [BSA] in aqueous solutions, were carried out in the presence of activated carbons modified by reaction with ozone. The photolyses were monitored by fluorescence spectroscopy and UV spectrophotometry, and the products were characterized by elemental analysis, FTIR, TGA, total organic carbon analyses [TOC], and XPS. The ozonation reaction was carried out at room temperature with O3 under dry and wet conditions. The carbon characterization showed that the reaction increased the amount of epoxide and carbonyl groups on the carbon matrix. The activated carbon modified with dry O3 exhibited higher concentration of oxidized groups in its surface, smaller surface area and lower thermal stability. Characterization of the photolysis of ozonized carbons pointed to a small release of carbon organic groups during the reaction with elimination of epoxide groups and increase of carbonyl groups without change of thermal stability. Photolysis of BSA in aqueous solution occurred with fluorescence quenching due to changes of the local microenvironment and/or macromolecular conformational changes. Absorbance increase of the UV spectrum indicated a hyperchromic effect due to albumin structure modifications during photolysis. TGA analysis of the photolysed activated carbons in the presence of BSA suggested that ozonized carbon samples underwent insertion of BSA upon photolysis, in particular the sample ozonized under dry conditions. The changes observed for the FTIR and elemental analysis agreed with this conclusion, which was further supported by 13C SS-NMR, fluorescence emission and XPS.
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Affiliation(s)
| | - Eduardo Humeres
- Departamento de Química, Universidade Federal de Santa Catarina, 88040-900 Florianópolis, SC, Brazil
| | - Carolina Berger
- Departamento de Engenharia Química e Engenharia de Alimentos, Universidade Federal de Santa Catarina, 88040-900 Florianópolis, SC, Brazil
| | - M Isabel Fernández
- Universidade da Coruña, Grupo Reactividade Química e Fotorreactividade, Departamento de Química, Facultade de Ciencias & CICA, E-15071 A Coruña, Spain
| | - J A Santaballa
- Universidade da Coruña, Grupo Reactividade Química e Fotorreactividade, Departamento de Química, Facultade de Ciencias & CICA, E-15071 A Coruña, Spain
| | - Moisés Canle
- Universidade da Coruña, Grupo Reactividade Química e Fotorreactividade, Departamento de Química, Facultade de Ciencias & CICA, E-15071 A Coruña, Spain.
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Berger C, Döbel V, Blüher M, Stumvoll M, Klöting N. Analyse der Funktion der humangenetischen Deletion von REPIN1 im HepG2-Zellmodell. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- C Berger
- Deutsche Zentrum für Diabetesforschung, Leipzig, Germany
| | - V Döbel
- IFB AdipositasErkrankungen, Leipzig, Germany
| | - M Blüher
- Deutsche Zentrum für Diabetesforschung, Leipzig, Germany
| | - M Stumvoll
- Deutsche Zentrum für Diabetesforschung, Leipzig, Germany
| | - N Klöting
- IFB AdipositasErkrankungen, Leipzig, Germany
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Roudil P, Vasselon C, Trombert-Paviot B, Berger C, Patural H. Blood parameters of preterm neonates: postnatal evolution according to gestational age. Int J Lab Hematol 2017; 39:317-328. [PMID: 28422440 DOI: 10.1111/ijlh.12629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/06/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The blood count provides qualitative and quantitative essential information on bloodlines. Reference hematologic parameters have been established in children and neonates, but few data are available regarding the premature population during the first month of life. The main objective of this study was to establish normative values for blood parameters for premature infants born between 26 and <37 weeks of gestation, during the first month of life, taking into account gestational and postnatal age and treatments that can impact the threshold values. METHODS A single-center retrospective study was conducted based on the clinical and laboratory data of preterm infants born between January 1, 2012 and December 31, 2013 and hospitalized in the intensive care, neonatal, and maternity units of University Hospital of Saint Etienne (France). Data were collected by crossing the PMSI database (date of birth and gestational age), the administrative patient database (IPP), and the pre-analytical laboratory database. Anthropometric and clinical data were extracted for both mother and child. The samples were all made from central or peripheral venous blood. All blood parameters were taken into account. RESULTS The degree of prematurity is a factor greatly influencing the values of the blood parameters at birth. All three blood lines increase in proportion to gestational age. We were able to highlight for some blood parameters specific kinetic profiles according to gestational age. CONCLUSION Blood parameters of preterm neonates depend on both the degree of prematurity, postnatal age, and perinatal treatments. A good knowledge of these physiological variations may help target transfusion or therapeutic indications in everyday practice.
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Affiliation(s)
- P Roudil
- Neonatal and Pediatric Critical Care, Mother and Baby Unit, North Hospital, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - C Vasselon
- Hematology Laboratory, North Hospital, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - B Trombert-Paviot
- Public Health Department, North Hospital, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - C Berger
- Pediatric Hematology Unit, North Hospital, Saint-Etienne University Hospital Center, Saint-Etienne, France
| | - H Patural
- Neonatal and Pediatric Critical Care, Mother and Baby Unit, North Hospital, Saint-Etienne University Hospital Center, Saint-Etienne, France.,EA SNA-Epis 4607, Jean Monnet University of Saint-Etienne, Saint-Etienne, France
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Philippeau C, Lettat A, Martin C, Silberberg M, Morgavi D, Ferlay A, Berger C, Nozière P. Effects of bacterial direct-fed microbials on ruminal characteristics, methane emission, and milk fatty acid composition in cows fed high- or low-starch diets. J Dairy Sci 2017; 100:2637-2650. [DOI: 10.3168/jds.2016-11663] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/14/2016] [Indexed: 11/19/2022]
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Yu OHY, Richards B, Berger C, Josse RG, Leslie WD, Goltzman D, Kaiser SM, Kovacs CS, Davison KS. The association between sclerostin and incident type 2 diabetes risk: a cohort study. Clin Endocrinol (Oxf) 2017; 86:520-525. [PMID: 28090669 DOI: 10.1111/cen.13300] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/19/2016] [Accepted: 12/28/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine whether sclerostin is associated with fasting glucose, insulin levels, insulin resistance or increased risk of incident type 2 diabetes. BACKGROUND Type 2 diabetic patients have a higher risk of fractures. Recent studies suggest sclerostin, a regulator of osteoblast activity, is associated with diabetes. MATERIALS AND METHODS Sclerostin levels were obtained from 1778 individuals with no history of type 2 diabetes participating in the population-based Canadian Multicentre Osteoporosis Study (CaMos) cohort. Participants were followed until diagnosis of type 2 diabetes, death or end of the study period (31 December 2013). The relationship of sclerostin with fasting glucose, insulin levels and homoeostatic model assessment-insulin resistance (HOMA-IR) was studied in linear regression models. Cox proportional hazards models were used to determine the association of sclerostin levels and the risk of incident type 2 diabetes during a mean 7·5 years of follow-up. RESULTS Fasting glucose, fasting insulin levels and HOMA-IR were weakly correlated with sclerostin levels (Spearman's correlation coefficient: 0·11, P < 0·05; -0·09, P < 0·05; and -0·07, P = 0·02, respectively). Multiple linear regression analyses confirmed a significant association between sclerostin and fasting insulin and HOMA-IR but no significant association with fasting glucose levels. Sclerostin levels were not found to be significantly associated with the risk of incident type 2 diabetes (HR: 1·30; 95% CI: 0·37-4·57). CONCLUSIONS We observed an association between sclerostin levels with fasting insulin levels and HOMA-IR, but there was no clear association with type 2 diabetes risk. Further studies are needed to understand the role of sclerostin in type 2 diabetes.
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Affiliation(s)
- O H Y Yu
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Division of Endocrinology, Jewish General Hospital, Montreal, QC, Canada
| | - B Richards
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Division of Endocrinology, Jewish General Hospital, Montreal, QC, Canada
| | - C Berger
- CaMos Coordinating Centre, McGill University, Montreal, QC, Canada
| | - R G Josse
- Division of Endocrinology & Metabolism, St Michael's University of Toronto, Toronto, ON, Canada
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - D Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, QC, Canada
| | - S M Kaiser
- Division of Endocrinology & Metabolism, Dalhousie University, Halifax, NS, Canada
| | - C S Kovacs
- Discipline of Medicine-Endocrinology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - K S Davison
- A Priori Medical Sciences Inc., Victoria, BC, Canada
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Balakrishnan A, Goodpaster T, Randolph-Habecker J, Hoffstrom BG, Jalikis FG, Koch LK, Berger C, Kosasih PL, Rajan A, Sommermeyer D, Porter PL, Riddell SR. Analysis of ROR1 Protein Expression in Human Cancer and Normal Tissues. Clin Cancer Res 2016; 23:3061-3071. [PMID: 27852699 DOI: 10.1158/1078-0432.ccr-16-2083] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 11/16/2022]
Abstract
Purpose: This study examines cell surface ROR1 expression in human tumors and normal tissues. ROR1 is considered a promising target for cancer therapy due to putative tumor-specific expression, and multiple groups are developing antibodies and/or chimeric antigen receptor-modified T cells to target ROR1. On-target, off-tumor toxicity is a challenge for most nonmutated tumor antigens; however, prior studies suggest that ROR1 is absent on most normal tissues.Experimental Design: Our studies show that published antibodies lack sensitivity to detect endogenous levels of cell surface ROR1 by immunohistochemistry (IHC) in formalin-fixed, paraffin-embedded tissues. We developed a ROR1-specific monoclonal antibody (mAb) targeting the carboxy-terminus of ROR1 and evaluated its specificity and sensitivity in IHC.Results: The 6D4 mAb is a sensitive and specific reagent to detect cell surface ROR1 by IHC. The data show that ROR1 is homogenously expressed on a subset of ovarian cancer, triple-negative breast cancer, and lung adenocarcinomas. Contrary to previous findings, we found ROR1 is expressed on several normal tissues, including parathyroid; pancreatic islets; and regions of the esophagus, stomach, and duodenum. The 6D4 mAb recognizes rhesus ROR1, and ROR1 expression was similar in human and macaque tissues, suggesting that the macaque is a suitable model to evaluate safety of ROR1-targeted therapies.Conclusions: ROR1 is a promising immunotherapeutic target in many epithelial tumors; however, high cell surface ROR1 expression in multiple normal tissues raises concerns for on-target off-tumor toxicities. Clinical translation of ROR1-targeted therapies warrants careful monitoring of toxicities to normal organs and may require strategies to ensure patient safety. Clin Cancer Res; 23(12); 3061-71. ©2016 AACR.
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Affiliation(s)
- Ashwini Balakrishnan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Tracy Goodpaster
- Experimental Histopathology Shared Resource, Fred Hutchinson Cancer Research Center, Seattle Washington
| | - Julie Randolph-Habecker
- Experimental Histopathology Shared Resource, Fred Hutchinson Cancer Research Center, Seattle Washington
| | - Benjamin G Hoffstrom
- Antibody Development Shared Resource, Fred Hutchinson Cancer Research Center, Seattle Washington
| | - Florencia G Jalikis
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Lisa K Koch
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Carolina Berger
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Medicine, University of Washington, Seattle, Washington
| | - Paula L Kosasih
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anusha Rajan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel Sommermeyer
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Peggy L Porter
- Department of Pathology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stanley R Riddell
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. .,Department of Medicine, University of Washington, Seattle, Washington.,Institute for Advanced Study, Technical University of Munich, Munich, Germany
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Casagranda L, Oriol M, Freycon F, Frappaz D, Bertrand Y, Bergeron C, Plantaz D, Stephan JL, Freycon C, Gomez F, Berger C, Trombert-Paviot B. Second malignant neoplasm following childhood cancer: A nested case-control study of a recent cohort (1987-2004) from the Childhood Cancer Registry of the Rhône-Alpes region in France. Pediatr Hematol Oncol 2016; 33:371-382. [PMID: 27687523 DOI: 10.1080/08880018.2016.1214653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
From a population-based cohort of cases of first cancers diagnosed between 1987 and 2004, before the patient's age of 15 years, the authors conducted a nested case-control study, matching 64 patients who experienced a second malignant neoplasm (SMN) with 190 controls. SMNs comprised 10 leukemia or myelodysplastic syndromes, 5 lymphomas induced by Epstein-Barr virus after allograft, and 49 solid tumors, including mainly 25 carcinomas (17 of the thyroid), 9 bone sarcomas, and 7 central nervous system (CNS) tumors. The median latency occurrence was 6.5 years, and that of thyroid carcinomas induced by 12 Gy fractioned total body irradiation (TBI) was 7.6 years. The relative risk (RR) of an SMN was increased by genetic and family factors and increased 17 to 69 times according to the dose of radiotherapy administered in the region for the first cancer. Age younger than 4 years at the time of radiotherapy increased the risk of SMN. Chemotherapy adjusted according to the dose of radiotherapy administered in the field yielded a greater RR of an SMN only for cumulative doses exceeding 2 g/m2 of epipodophyllotoxin but not for alkylating agents or platinum compounds. The RR of secondary leukemia increased 10-fold following high doses of epipodophyllotoxin >2 g/m2 but was not affected by alkylating agents or anthracyclines. The crude RR of a solid SMN developing after radiotherapy was very high at 18 and reached 90.7 for thyroid carcinoma after TBI, whereas the authors observed no increased risk associated with chemotherapy. These results confirm the risk of secondary leukemia after epipodophyllotoxin and of solid tumor after radiotherapy.
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Affiliation(s)
- L Casagranda
- a Pediatric Hematology and Oncology Unit, University Hospital of Saint-Etienne , Saint-Etienne , France.,b Laboratory EA4607 SNA-EPIS (Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health) , Jean Monnet University of Saint-Étienne , COMUE (Education and Research Cluster) Lyon , Saint-Étienne , France.,c Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France
| | - M Oriol
- d Department of Public Health and Medical Informatics , University Hospital of Saint-Étienne , Saint-Étienne , France
| | - F Freycon
- c Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France
| | - D Frappaz
- e Institute of Pediatric Hematology and Oncology , Lyon , France
| | - Y Bertrand
- e Institute of Pediatric Hematology and Oncology , Lyon , France
| | - C Bergeron
- e Institute of Pediatric Hematology and Oncology , Lyon , France
| | - D Plantaz
- f Pediatric Hematology and Oncology Unit, University Hospital of Grenoble , Grenoble , France
| | - J L Stephan
- a Pediatric Hematology and Oncology Unit, University Hospital of Saint-Etienne , Saint-Etienne , France
| | - C Freycon
- f Pediatric Hematology and Oncology Unit, University Hospital of Grenoble , Grenoble , France
| | - F Gomez
- g Centre Léon Bérard , Lyon , France
| | - C Berger
- a Pediatric Hematology and Oncology Unit, University Hospital of Saint-Etienne , Saint-Etienne , France.,b Laboratory EA4607 SNA-EPIS (Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health) , Jean Monnet University of Saint-Étienne , COMUE (Education and Research Cluster) Lyon , Saint-Étienne , France.,c Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France
| | - B Trombert-Paviot
- b Laboratory EA4607 SNA-EPIS (Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health) , Jean Monnet University of Saint-Étienne , COMUE (Education and Research Cluster) Lyon , Saint-Étienne , France.,c Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne , Saint-Etienne , France.,d Department of Public Health and Medical Informatics , University Hospital of Saint-Étienne , Saint-Étienne , France
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König-Otto JC, Mittendorff M, Winzer T, Kadi F, Malic E, Knorr A, Berger C, de Heer WA, Pashkin A, Schneider H, Helm M, Winnerl S. Slow Noncollinear Coulomb Scattering in the Vicinity of the Dirac Point in Graphene. Phys Rev Lett 2016; 117:087401. [PMID: 27588881 DOI: 10.1103/physrevlett.117.087401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Indexed: 06/06/2023]
Abstract
The Coulomb scattering dynamics in graphene in energetic proximity to the Dirac point is investigated by polarization resolved pump-probe spectroscopy and microscopic theory. Collinear Coulomb scattering rapidly thermalizes the carrier distribution in k directions pointing radially away from the Dirac point. Our study reveals, however, that, in almost intrinsic graphene, full thermalization in all directions relying on noncollinear scattering is much slower. For low photon energies, carrier-optical-phonon processes are strongly suppressed and Coulomb mediated noncollinear scattering is remarkably slow, namely on a ps time scale. This effect is very promising for infrared and THz devices based on hot carrier effects.
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Affiliation(s)
- J C König-Otto
- Helmholtz-Zentrum Dresden-Rossendorf, P.O. Box 510119, 01314 Dresden, Germany
- Technische Universität Dresden, 01062 Dresden, Germany
| | - M Mittendorff
- University of Maryland, College Park, Maryland 20742, USA
| | - T Winzer
- Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - F Kadi
- Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - E Malic
- Chalmers University of Technology, SE-41296 Göteborg, Sweden
| | - A Knorr
- Technische Universität Berlin, Hardenbergstraße 36, 10623 Berlin, Germany
| | - C Berger
- Georgia Institute of Technology, Atlanta, Georgia 30332, USA
- Institut Néel, CNRS-Université Alpes, 38042 Grenoble, France
| | - W A de Heer
- Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - A Pashkin
- Helmholtz-Zentrum Dresden-Rossendorf, P.O. Box 510119, 01314 Dresden, Germany
| | - H Schneider
- Helmholtz-Zentrum Dresden-Rossendorf, P.O. Box 510119, 01314 Dresden, Germany
| | - M Helm
- Helmholtz-Zentrum Dresden-Rossendorf, P.O. Box 510119, 01314 Dresden, Germany
- Technische Universität Dresden, 01062 Dresden, Germany
| | - S Winnerl
- Helmholtz-Zentrum Dresden-Rossendorf, P.O. Box 510119, 01314 Dresden, Germany
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Blumröder R, Glunz A, Dunkelberger BS, Serway CN, Berger C, Mentzel B, de Belle JS, Raabe T. Mcm3 replicative helicase mutation impairs neuroblast proliferation and memory in Drosophila. Genes Brain Behav 2016; 15:647-59. [PMID: 27283469 DOI: 10.1111/gbb.12304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 01/03/2023]
Abstract
In the developing Drosophila brain, a small number of neural progenitor cells (neuroblasts) generate in a co-ordinated manner a high variety of neuronal cells by integration of temporal, spatial and cell-intrinsic information. In this study, we performed the molecular and phenotypic characterization of a structural brain mutant called small mushroom bodies (smu), which was isolated in a screen for mutants with altered brain structure. Focusing on the mushroom body neuroblast lineages we show that failure of neuroblasts to generate the normal number of mushroom body neurons (Kenyon cells) is the major cause of the smu phenotype. In particular, the premature loss of mushroom body neuroblasts caused a pronounced effect on the number of late-born Kenyon cells. Neuroblasts showed no obvious defects in processes controlling asymmetric cell division, but generated less ganglion mother cells. Cloning of smu uncovered a single amino acid substitution in an evolutionarily conserved protein interaction domain of the Minichromosome maintenance 3 (Mcm3) protein. Mcm3 is part of the multimeric Cdc45/Mcm/GINS (CMG) complex, which functions as a helicase during DNA replication. We propose that at least in the case of mushroom body neuroblasts, timely replication is not only required for continuous proliferation but also for their survival. The absence of Kenyon cells in smu reduced learning and early phases of conditioned olfactory memory. Corresponding to the absence of late-born Kenyon cells projecting to α'/β' and α/β lobes, smu is profoundly defective in later phases of persistent memory.
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Affiliation(s)
- R Blumröder
- Institute of Medical Radiation and Cell Research, University of Würzburg, Germany
| | - A Glunz
- Institute of Medical Radiation and Cell Research, University of Würzburg, Germany
| | - B S Dunkelberger
- School of Life Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA.,Present address: Las Vegas High School, Las Vegas, NV, USA
| | - C N Serway
- School of Life Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA.,Present address: UNM Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - C Berger
- Institute of Medical Radiation and Cell Research, University of Würzburg, Germany
| | - B Mentzel
- Institute of Medical Radiation and Cell Research, University of Würzburg, Germany.,Present address: State of Lower Saxony, Ministry of the Environment, Energy and Climate Protection, Hannover, Germany
| | - J S de Belle
- School of Life Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA.,Present address: Dart Neuroscience LLC, San Diego, CA, USA
| | - T Raabe
- Institute of Medical Radiation and Cell Research, University of Würzburg, Germany.
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Künkele A, Taraseviciute A, Finn LS, Johnson AJ, Berger C, Finney O, Chang CA, Rolczynski LS, Brown C, Mgebroff S, Berger M, Park JR, Jensen MC. Preclinical Assessment of CD171-Directed CAR T-cell Adoptive Therapy for Childhood Neuroblastoma: CE7 Epitope Target Safety and Product Manufacturing Feasibility. Clin Cancer Res 2016; 23:466-477. [PMID: 27390347 DOI: 10.1158/1078-0432.ccr-16-0354] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 06/13/2016] [Accepted: 06/28/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE The identification and vetting of cell surface tumor-restricted epitopes for chimeric antigen receptor (CAR)-redirected T-cell immunotherapy is the subject of intensive investigation. We have focused on CD171 (L1-CAM), an abundant cell surface molecule on neuroblastomas and, specifically, on the glycosylation-dependent tumor-specific epitope recognized by the CE7 monoclonal antibody. EXPERIMENTAL DESIGN CD171 expression was assessed by IHC using CE7 mAb in tumor microarrays of primary, metastatic, and recurrent neuroblastoma, as well as human and rhesus macaque tissue arrays. The safety of targeting the CE7 epitope of CD171 with CE7-CAR T cells was evaluated in a preclinical rhesus macaque trial on the basis of CD171 homology and CE7 cross reactivity. The feasibility of generating bioactive CAR T cells from heavily pretreated pediatric patients with recurrent/refractory disease was assessed. RESULTS CD171 is uniformly and abundantly expressed by neuroblastoma tumor specimens obtained at diagnoses and relapse independent of patient clinical risk group. CD171 expression in normal tissues is similar in humans and rhesus macaques. Infusion of up to 1 × 108/kg CE7-CAR+ CTLs in rhesus macaques revealed no signs of specific on-target off-tumor toxicity. Manufacturing of lentivirally transduced CD4+ and CD8+ CE7-CAR T-cell products under GMP was successful in 4 out of 5 consecutively enrolled neuroblastoma patients in a phase I study. All four CE7-CAR T-cell products demonstrated in vitro and in vivo antitumor activity. CONCLUSIONS Our preclinical assessment of the CE7 epitope on CD171 supports its utility and safety as a CAR T-cell target for neuroblastoma immunotherapy. Clin Cancer Res; 23(2); 466-77. ©2016 AACR.
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Affiliation(s)
- Annette Künkele
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Agne Taraseviciute
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington.,Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Laura S Finn
- Seattle Children's Hospital, Department of Pathology, University of Washington, Seattle, Washington
| | - Adam J Johnson
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Carolina Berger
- Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Medicine, University of Washington, Seattle, Washington
| | - Olivia Finney
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Cindy A Chang
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Lisa S Rolczynski
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Christopher Brown
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Stephanie Mgebroff
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Michael Berger
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Julie R Park
- Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Michael C Jensen
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington. .,Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, Washington.,University of Washington, Department of Bioengineering, Seattle, Washington
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