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Rosar F, Ezziddin S, Bittenbring JT, Christofyllakis K, Burgard C. Mast Cell Sarcoma Mimicking Lymphoma or Metastatic Disease on 18 F-FDG PET/CT. Clin Nucl Med 2024; 49:464-465. [PMID: 38456450 DOI: 10.1097/rlu.0000000000005162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
ABSTRACT We report an 18 F-FDG PET/CT scan of a 47-year-old man diagnosed with diffuse mast cell sarcoma with lymph node, bone, liver, spleen, and lung involvement. This interesting image should remind colleagues to consider mast cell sarcoma as a rare differential diagnosis in patients with multiple, intensely hypermetabolic lesions in various organs and lymph nodes.
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Affiliation(s)
| | | | - Jörg Thomas Bittenbring
- Hematology, Oncology, Clinical Immunology, Rheumatology, Saarland University, Homburg, Germany
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Hoffmann MC, Cavalli G, Fadle N, Cantoni E, Regitz E, Fleser O, Klemm P, Zaks M, Stöger E, Campochiaro C, Tomelleri A, Baldissera E, Bittenbring JT, Zimmer V, Pfeifer J, Fischer Y, Preuss KD, Bewarder M, Thurner B, Fuehner S, Foell D, Dagna L, Kessel C, Thurner L. Autoantibody-Mediated Depletion of IL-1RA in Still's Disease and Potential Impact of IL-1 Targeting Therapies. J Clin Immunol 2024; 44:45. [PMID: 38231276 PMCID: PMC10794369 DOI: 10.1007/s10875-023-01642-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/17/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Adult-onset Still's disease (AOSD) and systemic juvenile idiopathic arthritis (sJIA) resemble a continuum of a rare, polygenic IL-1β-driven disease of unknown etiology. OBJECTIVE In the present study we sought to investigate a potential role of recently described autoantibodies neutralizing the interleukin-1(IL-1)-receptor antagonist (IL-1-Ra) in the pathogenesis of Still's disease. METHODS Serum or plasma samples from Still's disease patients (AOSD, n = 23; sJIA, n = 40) and autoimmune and/or inflammatory disease controls (n = 478) were analyzed for autoantibodies against progranulin (PGRN), IL-1Ra, IL-18 binding protein (IL-18BP), and IL-36Ra, as well as circulating IL-1Ra and IL-36Ra levels by ELISA. Biochemical analyses of plasma IL-1Ra were performed by native Western blots and isoelectric focusing. Functional activity of the autoantibodies was examined by an in vitro IL-1β-signaling reporter assay. RESULTS Anti-IL-1-Ra IgG were identified in 7 (27%) out of 29 Still's disease patients, including 4/23 with AOSD and 3/6 with sJIA and coincided with a hyperphosphorylated isoform of endogenous IL-1Ra. Anti-IL-36Ra antibodies were found in 2 AOSD patients. No anti-PGRN or anti-IL-18BP antibodies were detected. Selective testing for anti-IL-1Ra antibodies in an independent cohort (sJIA, n = 34) identified 5 of 34 (14.7%) as seropositive. Collectively, 8/12 antibody-positive Still's disease patients were either new-onset active disease or unresponsive to IL-1 blocking drugs. Autoantibody-seropositivity associated with decreased IL-1Ra plasma/serum levels. Seropositive plasma impaired in vitro IL-1Ra bioactivity, which could be reversed by anakinra or canakinumab treatment. CONCLUSION Autoantibodies neutralizing IL-1Ra may represent a novel patho-mechanism in a subgroup of Still's disease patients, which is sensitive to high-dose IL-1 blocking therapy.
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Affiliation(s)
- Marie-Christin Hoffmann
- José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Saarland University Medical School, 66421, Homburg, Saarland, Germany
| | - Giulio Cavalli
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Natalie Fadle
- José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Saarland University Medical School, 66421, Homburg, Saarland, Germany
| | | | - Evi Regitz
- José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Saarland University Medical School, 66421, Homburg, Saarland, Germany
| | - Octavian Fleser
- José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Saarland University Medical School, 66421, Homburg, Saarland, Germany
| | - Philipp Klemm
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Justus-Liebig-University Gießen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Marina Zaks
- Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Elisabeth Stöger
- Evangelische Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung Essen-Huttrop, Essen, Germany
| | | | | | | | - Jörg Thomas Bittenbring
- José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Saarland University Medical School, 66421, Homburg, Saarland, Germany
| | - Vincent Zimmer
- Department of Internal Medicine, Knappschaftsklinikum Saar, Püttlingen, Germany
| | - Jochen Pfeifer
- Department of Pediatric Cardiology, Saarland University, Homburg, Germany
| | - Yvan Fischer
- Institute of Physiology, Medical Faculty, RWTH Aachen, 52057, Aachen, Germany
| | - Klaus-Dieter Preuss
- José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Saarland University Medical School, 66421, Homburg, Saarland, Germany
| | - Moritz Bewarder
- José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Saarland University Medical School, 66421, Homburg, Saarland, Germany
| | | | - Sabrina Fuehner
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Münster, Germany
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Münster, Germany
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Christoph Kessel
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Münster, Germany
| | - Lorenz Thurner
- José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Saarland University Medical School, 66421, Homburg, Saarland, Germany.
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Sabet A, Mader N, Bittenbring JT, Khreish F, Grünwald F, Biersack HJ, Ezziddin S. Prophylactic Peripheral Blood Stem Cell Collection in Patients with Extensive Bone-Marrow Infiltration of Neuroendocrine Tumours Prior to Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE. Pharmaceuticals (Basel) 2021; 14:ph14101022. [PMID: 34681247 PMCID: PMC8539404 DOI: 10.3390/ph14101022] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
Peptide receptor radionuclide therapy (PRRT) of metastatic neuroendocrine tumors (NET) can be successfully repeated but may eventually be dose-limited. Since 177Lu-DOTATATE dose limitation may come from hematological rather than renal function, hematological peripheral blood stem cell backup might be desirable. Here, we report our initial experience of peripheral blood stem-cell collection (PBSC) in patients with treatment-related cytopenia and therefore high risk of bone-marrow failure. Five patients with diffuse bone-marrow infiltration of NET and relevant myelosuppression (≥grade 2) received PBSC before one PRRT cycle with 177Lu-DOTATATE (7.6 ± 0.8 GBq/cycle). Standard stem-cell mobilization with Granulocyte-colony stimulating factor (G-CSF) was applied, and successful PBSC was defined as a collection of >2 × 106/kg CD34+ cells. In case of initial failure, Plerixafor was administered in addition to G-CSF prior to apheresis. PBSC was successfully performed in all patients with no adverse events. Median cumulative activity was 44.8 GBq (range, 21.3-62.4). Three patients had been previously treated with PRRT, two of which needed the addition of Plerixafor for stem-cell mobilization. Only one of five patients required autologous peripheral blood stem-cell transplantation during the median follow up time of 28 months. PBSC collection seems to be feasible in NET with bone-marrow involvement and might be worth considering as a backup strategy prior to PRRT, in order to overcome dose-limiting bone-marrow toxicity.
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Affiliation(s)
- Amir Sabet
- Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (N.M.); (F.G.)
- Correspondence:
| | - Nicolai Mader
- Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (N.M.); (F.G.)
| | - Jörg Thomas Bittenbring
- Department of Haematology and Oncology, Caritas Hospital Saarbrücken, 66123 Saarbrücken, Germany;
| | - Fadi Khreish
- Department of Nuclear Medicine, Saarland University Medical Center, 66421 Homburg, Germany; (F.K.); (S.E.)
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany; (N.M.); (F.G.)
| | | | - Samer Ezziddin
- Department of Nuclear Medicine, Saarland University Medical Center, 66421 Homburg, Germany; (F.K.); (S.E.)
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Kaddu-Mulindwa D, Rosolowski M, Ziepert M, Regitz E, Assmann G, Bewarder M, Held G, Pfreundschuh M, Bittenbring JT. VEGFR2 and VEGFA polymorphisms are not associated with an inferior prognosis in Caucasian patients with aggressive B-cell lymphoma. Eur J Haematol 2020; 106:100-104. [PMID: 32997825 DOI: 10.1111/ejh.13526] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Previous published data showed an impact of single-nucleotide polymorphisms in the VEGF A and VEGFR2 genes on the survival of patients with various malignancies, among others diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS We investigated the role of four VEGF-A and two VEGFR-2 gene polymorphisms on the outcome of 273 patients with diffuse large B-cell lymphoma who were treated with R-CHOP within a prospective, randomized trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL). The genomic DNA samples were analyzed using commercial DNA Probes (Applied Biosystems, USA) to detect single-nucleotide polymorphisms in the VEGF A rs699947, rs1570360, rs2010963, rs3025039 and rs1870377, and rs2305948 in the VEGFR2 receptor. Hundred healthy blood donors served as a control. RESULTS There was no difference between the SNP allele frequencies in lymphoma patients compared to the control group for all investigated SNPs. None of the investigated SNPs was significantly associated with EFS or OS. After adjusting for the International Prognostic Index risk factors in a multivariate analysis, these results could be confirmed. CONCLUSION Single-nucleotide polymorphisms of the VEGF and VEGFR2 were not associated with a worse outcome in Caucasian patients with DLBCL.
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Affiliation(s)
- Dominic Kaddu-Mulindwa
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Maciej Rosolowski
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Marita Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Evi Regitz
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Gunter Assmann
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Moritz Bewarder
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Gerhard Held
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
| | - Michael Pfreundschuh
- Department of Hematology and Oncology, Saarland University Medical School, Homburg, Germany
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5
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Domingo-Domènech E, Boumendil A, Climent F, Socié G, Kroschinsky F, Finel H, Vandenbergue E, Nemet D, Stelljes M, Bittenbring JT, Robinson S, Montoto S, Sureda A, Dreger P. Allogeneic hematopoietic stem cell transplantation for patients with relapsed/refractory systemic anaplastic large cell lymphoma. A retrospective analysis of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2019; 55:633-640. [PMID: 31695173 DOI: 10.1038/s41409-019-0732-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/07/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022]
Abstract
Information regarding the curative role of allogeneic stem cell transplantation (allo-HCT) in systemic anaplastic large cell lymphoma (sALCL) is scarce. We analyzed the results of allo-HCT in patients with relapsed/refractory sALCL with special emphasis on the role of brentuximab vedotin (BV) as a bridge to allo-HCT. Forty-four patients (24 females, median age 38 years) with sALCL were included. Twenty-three patients (52%) received BV before allo-HCT; BV-treated patients were more heavily pretreated (≥3 lines of therapy in 74% vs. 38%, p = 0.04). Twenty-three patients (52%) were in complete remission (CR) at allo-HCT. Three-year nonrelapse mortality and incidence of relapse (IR) after allo-HCT were 7% and 40%, respectively. With a median follow-up of 39 (12-69) months for survivors, 3-year progression-free survival (PFS) and overall survival were 53% and 74%, respectively. Univariate analysis showed that heavily pretreated patients and those not in CR had a higher IR and a lower PFS. The use of BV before transplant did not impact on any of the outcomes. Allo-HCT is a curative therapeutic strategy in a significant proportion of patients with relapsed/refractory sALCL; BV does not seem to modify transplant-related outcomes but might be able to render more patients candidates for this curative treatment.
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Affiliation(s)
- E Domingo-Domènech
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | | | - F Climent
- Pathology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - G Socié
- Hematology Department, Hopital St. Louis, Paris, France
| | | | - H Finel
- Lymphoma Working Party, EBMT, Paris, France
| | | | - D Nemet
- University Hospital Center Rebro, Zagreb, Croatia
| | - M Stelljes
- University of Münster, Muenster, Germany
| | - J T Bittenbring
- Department of Internal Medicine, University of Saarland, Homburg, Germany
| | - S Robinson
- Department of Hematology and Oncology, University Hospital Bristol, Bristol, UK
| | - S Montoto
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - A Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.
| | - P Dreger
- Medizinische Klinik u. Poliklinik V, University of Heidelberg, Heidelberg, Germany
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6
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Werner CM, Hecksteden A, Morsch A, Zundler J, Wegmann M, Kratzsch J, Thiery J, Hohl M, Bittenbring JT, Neumann F, Böhm M, Meyer T, Laufs U. Differential effects of endurance, interval, and resistance training on telomerase activity and telomere length in a randomized, controlled study. Eur Heart J 2019; 40:34-46. [PMID: 30496493 PMCID: PMC6312574 DOI: 10.1093/eurheartj/ehy585] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/26/2018] [Accepted: 09/21/2018] [Indexed: 02/07/2023] Open
Abstract
Aims It is unknown whether different training modalities exert differential cellular effects. Telomeres and telomere-associated proteins play a major role in cellular aging with implications for global health. This prospective training study examines the effects of endurance training, interval training (IT), and resistance training (RT) on telomerase activity and telomere length (TL). Methods and results One hundred and twenty-four healthy previously inactive individuals completed the 6 months study. Participants were randomized to three different interventions or the control condition (no change in lifestyle): aerobic endurance training (AET, continuous running), high-intensive IT (4 × 4 method), or RT (circle training on 8 devices), each intervention consisting of three 45 min training sessions per week. Maximum oxygen uptake (VO2max) was increased by all three training modalities. Telomerase activity in blood mononuclear cells was up-regulated by two- to three-fold in both endurance exercise groups (AET, IT), but not with RT. In parallel, lymphocyte, granulocyte, and leucocyte TL increased in the endurance-trained groups but not in the RT group. Magnet-activated cell sorting with telomerase repeat-ampliflication protocol (MACS-TRAP) assays revealed that a single bout of endurance training-but not RT-acutely increased telomerase activity in CD14+ and in CD34+ leucocytes. Conclusion This randomized controlled trial shows that endurance training, IT, and RT protocols induce specific cellular pathways in circulating leucocytes. Endurance training and IT, but not RT, increased telomerase activity and TL which are important for cellular senescence, regenerative capacity, and thus, healthy aging.
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Affiliation(s)
- Christian M Werner
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universität und Universitätsklinikum des Saarlandes, Geb. 41.1/IMED, Homburg/Saar, Germany
| | - Anne Hecksteden
- Institut für Sport und Präventivmedizin, Universität des Saarlandes, Campus, B8 2, Saarbrücken, Germany
| | - Arne Morsch
- Deutsche Hochschule für Prävention und Gesundheitsmanagement, Hermann-Neuberger-Sportschule 3, Saarbrücken, Germany
| | - Joachim Zundler
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universität und Universitätsklinikum des Saarlandes, Geb. 41.1/IMED, Homburg/Saar, Germany
| | - Melissa Wegmann
- Institut für Sport und Präventivmedizin, Universität des Saarlandes, Campus, B8 2, Saarbrücken, Germany
| | - Jürgen Kratzsch
- Institut für Labormedizin, Klinische Chemie und Molekulare Diagnostik, Universitätsklinikum, Liebigstr. 20, Leipzig, Germany
| | - Joachim Thiery
- Institut für Labormedizin, Klinische Chemie und Molekulare Diagnostik, Universitätsklinikum, Liebigstr. 20, Leipzig, Germany
| | - Mathias Hohl
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universität und Universitätsklinikum des Saarlandes, Geb. 41.1/IMED, Homburg/Saar, Germany
| | - Jörg Thomas Bittenbring
- Klinik für Innere Medizin I, Onkologie, Hämatologie, Klinische Immunologie und Rheumatologie, Universitätsklinikum des Saarlandes, Geb. 41.1/IMED, Homburg/Saar, Germany
| | - Frank Neumann
- Klinik für Innere Medizin I, Onkologie, Hämatologie, Klinische Immunologie und Rheumatologie, Universitätsklinikum des Saarlandes, Geb. 41.1/IMED, Homburg/Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universität und Universitätsklinikum des Saarlandes, Geb. 41.1/IMED, Homburg/Saar, Germany
| | - Tim Meyer
- Institut für Sport und Präventivmedizin, Universität des Saarlandes, Campus, B8 2, Saarbrücken, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, Leipzig, Germany
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Kaddu-Mulindwa D, Bittenbring JT, Müller CSL, Altmeyer S. [61-Year-Old Man with Suddenly Appearing Painful Gluteal Purpura]. Dtsch Med Wochenschr 2018; 143:1225-1226. [PMID: 30134453 DOI: 10.1055/a-0659-3281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Dominic Kaddu-Mulindwa
- Klinik für Hämatologie, Onkologie, klinische Immunologie, Innere Medizin I, Universitätsklinikum des Saarlandes
| | - Jörg Thomas Bittenbring
- Klinik für Hämatologie, Onkologie, klinische Immunologie, Innere Medizin I, Universitätsklinikum des Saarlandes
| | - Cornelia S L Müller
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum des Saarlandes
| | - Sarah Altmeyer
- Klinik für Hämatologie, Onkologie, klinische Immunologie, Innere Medizin I, Universitätsklinikum des Saarlandes
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Bewarder M, Klostermann A, Ahlgrimm M, Bittenbring JT, Pfreundschuh M, Wagenpfeil S, Kaddu-Mulindwa D. Safety and feasibility of electrical muscle stimulation in patients undergoing autologous and allogeneic stem cell transplantation or intensive chemotherapy. Support Care Cancer 2018; 27:1013-1020. [PMID: 30094730 DOI: 10.1007/s00520-018-4390-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/11/2018] [Accepted: 07/31/2018] [Indexed: 02/04/2023]
Abstract
Intensive chemotherapy, with or without following autologous or allogeneic stem cell transplantation (HSCT), is often the only curative treatment option for patients with hematological malignancies and leave many survivors physically and psychologically impaired. Electrical muscle stimulation (EMS) is a proven tool to improve physical performance in seniors and patients with chronic diseases. We therefore investigated the safety and feasibility of EMS in 45 patients undergoing autologous HSCT (n = 13), allogeneic HSCT (n = 11) and intensive chemotherapy (n = 21). Furthermore, physical (assessed by 6-min walking distance (6MWD) and short physical performance battery (SPPB)) and psychological performance (assessed by multidimensional fatigue inventory (MFI) and the EORTC QOL-C30 questionnaire) were measured before chemotherapy (T1) and at discharge from hospital (T2). Four patients died due to septic shock, two withdrew consent before the start of EMS training and five stopped EMS training during the study because of chemotherapy-related complications, loss of motivation or loss of ability to use EMS autonomously. Thirty-four out of 45 (76%) patients used EMS throughout the study period and participated in physical and psychological tests at time points 1 and 2. EMS-related adverse events were hematoma (n = 1) and muscle pain (n = 2). No bleeding events > 1 according to the WHO bleeding scale occurred. Decline in 6MWD from T1 to T2 was 24 m. The SPPB score stayed the same with 11 points at T1 and T2. Most MFI subscales showed stable fatigue levels and quality of life (QoL) did not decrease significantly throughout therapy. EMS is feasible and safe in patients undergoing intensive chemotherapy. Trial registration: NCT03467087.
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Affiliation(s)
- M Bewarder
- Clinic for Hematology and Oncology, University Hospital Saarland, Homburg, Germany.
| | - A Klostermann
- Clinic for Hematology and Oncology, University Hospital Saarland, Homburg, Germany
| | - M Ahlgrimm
- Clinic for Hematology and Oncology, University Hospital Saarland, Homburg, Germany
| | - J T Bittenbring
- Clinic for Hematology and Oncology, University Hospital Saarland, Homburg, Germany
| | - M Pfreundschuh
- Clinic for Hematology and Oncology, University Hospital Saarland, Homburg, Germany
| | - S Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Homburg, Germany
| | - D Kaddu-Mulindwa
- Clinic for Hematology and Oncology, University Hospital Saarland, Homburg, Germany
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9
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Bochen F, Balensiefer B, Körner S, Bittenbring JT, Neumann F, Koch A, Bumm K, Marx A, Wemmert S, Papaspyrou G, Zuschlag D, Kühn JP, Al Kadah B, Schick B, Linxweiler M. Vitamin D deficiency in head and neck cancer patients - prevalence, prognostic value and impact on immune function. Oncoimmunology 2018; 7:e1476817. [PMID: 30228945 PMCID: PMC6140588 DOI: 10.1080/2162402x.2018.1476817] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 03/26/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 01/17/2023] Open
Abstract
Vitamin D deficiency is frequently observed in human cancer patients and a prognostic relevance could be shown for some entities. Additionally, it is known that vitamin D can stimulate the patients' antitumor immunity. However, valid epidemiological data for head and neck squamous cell carcinoma (HNSCC) patients are sparse and functional studies on a possible connection between vitamin D and the patients' immune system are missing. 25-OH vitamin D serum levels were analyzed in 231 HNSCC patients and 232 healthy controls and correlated with clinical data and patient survival. Intra- and peritumoral infiltration with T-cell, NK-cell and macrophage populations was analyzed in 102 HNSCC patients by immunohistochemistry. In 11 HNSCC patients, NK-cells were isolated before and after vitamin D substitution and analyzed for their cytotoxic activity directed against a HNSCC cell line. Vitamin D serum levels were significantly lower in HNSCC patients compared with healthy controls. Low vitamin D levels were associated with lymphatic metastasis and a negative HPV status and were a significant predictor of poor overall survival. HNSCC patients with severe vitamin D deficiency showed significantly altered intra- and peritumoral immune cell infiltrate levels. After vitamin D substitution, the patients' NK cells showed a significant rise in cytotoxic activity. Taken together, we could show that Vitamin D deficiency is highly prevalent in HNSCC patients and is a predictor of poor survival. Vitamin D substitution used as an adjuvant in immune therapies such as cetuximab and nivolumab treatment could support antitumorigenic immune responses, thus contributing to the improvement of the patients' prognosis in the context of a multimodal therapy.
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Affiliation(s)
- Florian Bochen
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Homburg, Germany
| | - Benedikt Balensiefer
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Homburg, Germany
| | - Sandrina Körner
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Homburg, Germany
| | - Jörg Thomas Bittenbring
- Department of Hematology, Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Frank Neumann
- Department of Hematology, Oncology, Rheumatology and Clinical Immunology, Saarland University Medical Center, Homburg, Germany
| | - Armand Koch
- Department of Otorhinolaryngology, Zitha Hospital, Luxemburg-City, Luxemburg
| | - Klaus Bumm
- Department of Otorhinolaryngology, Head and Neck Surgery, Caritas Hospital, Saarbrücken, Germany
| | - Anke Marx
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Homburg, Germany
| | - Silke Wemmert
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Homburg, Germany
| | - Georgios Papaspyrou
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Homburg, Germany
| | - David Zuschlag
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Homburg, Germany
| | - Jan Philipp Kühn
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Homburg, Germany
| | - Basel Al Kadah
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Homburg, Germany
| | - Bernhard Schick
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Homburg, Germany
| | - Maximilian Linxweiler
- Department of Otorhinolaryngology, Head and Neck Surgery, Saarland University Medical Center, Homburg, Germany
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Bittenbring JT, Neumann F, Altmann B, Achenbach M, Reichrath J, Ziepert M, Geisel J, Regitz E, Held G, Pfreundschuh M. Vitamin D Deficiency Impairs Rituximab-Mediated Cellular Cytotoxicity and Outcome of Patients With Diffuse Large B-Cell Lymphoma Treated With but Not Without Rituximab. J Clin Oncol 2014; 32:3242-8. [DOI: 10.1200/jco.2013.53.4537] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To investigate the impact and mechanisms of vitamin D deficiency (VDD) on the outcome of elderly patients with diffuse large B-cell lymphoma (DLBCL). Patients and Methods Three hundred fifty-nine pretreatment 25-hydroxyvitamin D3 (25[OH]D3) serum levels from the RICOVER-60 study (Six Versus Eight Cycles of Biweekly CHOP-14 With or Without Rituximab in Elderly Patients With Aggressive CD20+ B-Cell Lymphomas) and 63 from the RICOVER-noRTh study (an amendment to the RICOVER-60 study in which patients received six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone administered at an interval of 2 weeks plus two cycles of rituximab [R-CHOP-14], but without radiotherapy) were determined by chemoluminescent immunoassay. Rituximab-mediated cellular cytotoxicity (RMCC) was assessed by lactate dehydrogenase release assay of CD20+ Daudi cells. Results RICOVER-60 patients with VDD (≤ 8 ng/mL) and vitamin D levels more than 8 ng/mL treated with rituximab had 3-year event-free survival (EFS) of 59% and 79% and 3-year overall survival (OS) of 70% and 82%, respectively. These differences were significant in a multivariable analysis adjusting for International Prognostic Index risk factors with a hazard ratio (HR) of 2.1 (P = .008) for EFS and 1.9 (P = .040) for OS. EFS was not significantly different in patients with vitamin D levels ≤ 8 or more than 8 ng/mL (HR, 1.2; P = .388) treated without rituximab. This was confirmed in an independent validation set of 63 RICOVER-noRTh patients. RMCC increased significantly (P < .001) in seven of seven individuals with VDD after substitution and normalization of their vitamin D levels. Conclusion VDD is a risk factor for elderly patients with DLBCL treated with R-CHOP. That VDD impairs RMCC and substitution improves RMCC strongly suggests that vitamin D substitution enhances rituximab efficacy, which must be confirmed in appropriately designed prospective trials addressing VDD and substitution not only in DLBCL, but also in malignancies treated with other antibodies, of which the major mechanism of action is antibody-dependent cellular cytotoxicity (eg, trastuzumab in breast cancer and cetuximab in colorectal cancer).
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Affiliation(s)
- Jörg Thomas Bittenbring
- Jörg Thomas Bittenbring, Frank Neumann, Marina Achenbach, Jörg Reichrath, Jürgen Geisel, Evi Regitz, Gerhard Held, and Michael Pfreundschuh, Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg; and Bettina Altmann and Marita Ziepert, University Leipzig, Leipzig, Germany
| | - Frank Neumann
- Jörg Thomas Bittenbring, Frank Neumann, Marina Achenbach, Jörg Reichrath, Jürgen Geisel, Evi Regitz, Gerhard Held, and Michael Pfreundschuh, Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg; and Bettina Altmann and Marita Ziepert, University Leipzig, Leipzig, Germany
| | - Bettina Altmann
- Jörg Thomas Bittenbring, Frank Neumann, Marina Achenbach, Jörg Reichrath, Jürgen Geisel, Evi Regitz, Gerhard Held, and Michael Pfreundschuh, Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg; and Bettina Altmann and Marita Ziepert, University Leipzig, Leipzig, Germany
| | - Marina Achenbach
- Jörg Thomas Bittenbring, Frank Neumann, Marina Achenbach, Jörg Reichrath, Jürgen Geisel, Evi Regitz, Gerhard Held, and Michael Pfreundschuh, Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg; and Bettina Altmann and Marita Ziepert, University Leipzig, Leipzig, Germany
| | - Jörg Reichrath
- Jörg Thomas Bittenbring, Frank Neumann, Marina Achenbach, Jörg Reichrath, Jürgen Geisel, Evi Regitz, Gerhard Held, and Michael Pfreundschuh, Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg; and Bettina Altmann and Marita Ziepert, University Leipzig, Leipzig, Germany
| | - Marita Ziepert
- Jörg Thomas Bittenbring, Frank Neumann, Marina Achenbach, Jörg Reichrath, Jürgen Geisel, Evi Regitz, Gerhard Held, and Michael Pfreundschuh, Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg; and Bettina Altmann and Marita Ziepert, University Leipzig, Leipzig, Germany
| | - Jürgen Geisel
- Jörg Thomas Bittenbring, Frank Neumann, Marina Achenbach, Jörg Reichrath, Jürgen Geisel, Evi Regitz, Gerhard Held, and Michael Pfreundschuh, Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg; and Bettina Altmann and Marita Ziepert, University Leipzig, Leipzig, Germany
| | - Evi Regitz
- Jörg Thomas Bittenbring, Frank Neumann, Marina Achenbach, Jörg Reichrath, Jürgen Geisel, Evi Regitz, Gerhard Held, and Michael Pfreundschuh, Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg; and Bettina Altmann and Marita Ziepert, University Leipzig, Leipzig, Germany
| | - Gerhard Held
- Jörg Thomas Bittenbring, Frank Neumann, Marina Achenbach, Jörg Reichrath, Jürgen Geisel, Evi Regitz, Gerhard Held, and Michael Pfreundschuh, Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg; and Bettina Altmann and Marita Ziepert, University Leipzig, Leipzig, Germany
| | - Michael Pfreundschuh
- Jörg Thomas Bittenbring, Frank Neumann, Marina Achenbach, Jörg Reichrath, Jürgen Geisel, Evi Regitz, Gerhard Held, and Michael Pfreundschuh, Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg; and Bettina Altmann and Marita Ziepert, University Leipzig, Leipzig, Germany
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Bittenbring JT. [22-year-old patient in critical care after central venous catheter insertion. Suspected pneumothorax right after insertion of a central venous catheter]. Dtsch Med Wochenschr 2012; 137:265-7. [PMID: 22294111 DOI: 10.1055/s-0032-1301846] [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: 10/14/2022]
Affiliation(s)
- J T Bittenbring
- Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
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Bittenbring JT, Achenbach M. [38-year-old patient with weight loss and night sweat. Hairy cell leukemia]. Dtsch Med Wochenschr 2011; 136:2089-90. [PMID: 21971884 DOI: 10.1055/s-0031-1292018] [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: 10/17/2022]
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Bittenbring JT, Chen CH, Fries P, Böhm M, Kilter H. [Typical laboratory constellation of a non-ST-segment elevation myocardial infarction in polymyositis]. Dtsch Med Wochenschr 2010; 135:2456-8. [PMID: 21120785 DOI: 10.1055/s-0030-1269416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
HISTORY AND ADMISSION FINDINGS a 80-year-old women was admitted with a hypertensive crisis. Laboratory tests showed elevated cardiac enzymes (CK, CK-MB and troponin T). She was treated for suspected non-ST segment elevation myocardial infarction. INVESTIGATIONS a cardiovascular examination, which included echocardiography, coronary angiography and magnetic resonance imaging, excluded a cardiac cause of the laboratory reults. After complete assessment the patient was found to have long-standing polymyosits positive for Mi-2 antibodies. This had caused troponin T elevation from the release of regenerating muscles after chronic inflammatory damage. Troponin I, however, is truly cardiomyocyte specific and distinguishes between cardiac and non cardiac origin of CK, CK-MB and troponin T. TREATMENT AND COURSE prednisone medication was started with a single dose of 50mg, then gradually reduced. Follow-up examination merely revealed minimally active polymyositis. CONCLUSION troponin I should be measured in patients with inflammatory myositis/myopathies in order to diagnose and assess cardiac involvement.
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Affiliation(s)
- J T Bittenbring
- Innere Medizin der Universitätskliniken des Saarlandes Homburg/Saar.
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