1
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de Jonge AV, Duetz C, Bruins WSC, Korst CLBM, Rentenaar R, Cosovic M, Eken M, Twickler I, Nijland M, van der Poel MWM, de Heer K, Klerk CPW, Strobbe L, Oosterveld M, Boersma R, Koene HR, Roemer MGM, van Werkhoven E, Chamuleau MED, Mutis T. Distinct peripheral T-cell and NK-cell profiles in HGBL-MYC/BCL2 vs patients with DLBCL NOS. Blood Adv 2024; 8:1094-1104. [PMID: 38191686 PMCID: PMC10907399 DOI: 10.1182/bloodadvances.2023011687] [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] [Received: 09/14/2023] [Revised: 11/27/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024] Open
Abstract
ABSTRACT Patients with high-grade B-cell lymphoma with MYC and BCL2 rearrangements (HGBL-MYC/BCL2) respond poorly to immunochemotherapy compared with patients with diffuse large B-cell lymphoma not otherwise specified (DLBCL NOS) without a MYC rearrangement. This suggests a negative impact of lymphoma-intrinsic MYC on the immune system. To investigate this, we compared circulating T cells and natural killer (NK) cells of patients with HGBL-MYC/BCL2 (n = 66), patients with DLBCL NOS (n = 53), and age-matched healthy donors (HDs; n = 16) by flow cytometry and performed proliferation, cytokine production, and cytotoxicity assays. Compared with HDs, both lymphoma subtypes displayed similar frequencies of CD8+ T cells but decreased CD4+ T cells. Regulatory T-cell (Treg) frequencies were reduced only in patients with DLBCL NOS. Activated (HLA-DR+/CD38+) T cells, PD-1+CD4+ T cells, and PD-1+Tregs were increased in both lymphoma subtypes, but PD-1+CD8+ T cells were increased only in HGBL-MYC/BCL2. Patients with DLBCL NOS, but not patients with HGBL-MYC/BCL2, exhibited higher frequencies of senescent T cells than HDs. Functional assays showed no overt differences between both lymphoma groups and HDs. Deeper analyses revealed that PD-1+ T cells of patients with HGBL-MYC/BCL2 were exhausted with impaired cytokine production and degranulation. Patients with DLBCL NOS, but not patients with HGBL-MYC/BCL2, exhibited higher frequencies of NK cells expressing inhibiting receptor NKG2A. Both lymphoma subtypes exhibited lower TIM-3+- and DNAM-1+-expressing NK cells. Although NK cells of patients with HGBL-MYC/BCL2 showed less degranulation, they were not defective in cytotoxicity. In conclusion, our results demonstrate an increased exhaustion in circulating T cells of patients with HGBL-MYC/BCL2. Nonetheless, the overall intact peripheral T-cell and NK-cell functions in these patients emphasize the importance of investigating potential immune evasion in the microenvironment of MYC-rearranged lymphomas.
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Affiliation(s)
- A. Vera de Jonge
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Carolien Duetz
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Wassilis S. C. Bruins
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Charlotte L. B. M. Korst
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Rosa Rentenaar
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Meliha Cosovic
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Merve Eken
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Inoka Twickler
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Marcel Nijland
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein W. M. van der Poel
- Division of Hematology, Department of Internal Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Koen de Heer
- Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
| | - Clara P. W. Klerk
- Department of Internal Medicine, Dijklanderziekenhuis, Hoorn, The Netherlands
| | - Leonie Strobbe
- Department of Internal Medicine, Gelreziekenhuizen, Zutphen, The Netherlands
| | | | - Rinske Boersma
- Department of Internal Medicine, Amphia Ziekenhuis, Breda, The Netherlands
| | - Harry R. Koene
- Department of Hematology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Margaretha G. M. Roemer
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Erik van Werkhoven
- HOVON Foundation, Rotterdam, The Netherlands
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Martine E. D. Chamuleau
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Tuna Mutis
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
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2
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Groen K, Stege CA, Nasserinejad K, de Heer K, van Kampen RJ, Leys RB, Thielen N, Westerman M, Wu KL, Ludwig I, Issa DE, Velders GA, Vekemans MC, Timmers GJ, de Boer F, Tick LW, Verbrugge A, Buitenhuis D, Cunha SM, van der Spek E, de Waal EG, Sohne M, Sonneveld P, Nijhof IS, Klein SK, van de Donk NW, Levin MD, Ypma PF, Zweegman S. Ixazomib, daratumumab and low-dose dexamethasone in intermediate-fit patients with newly diagnosed multiple myeloma: an open-label phase 2 trial. EClinicalMedicine 2023; 63:102167. [PMID: 37680948 PMCID: PMC10481174 DOI: 10.1016/j.eclinm.2023.102167] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
Background The outcome of non-transplant eligible newly diagnosed multiple myeloma (NDMM) patients is heterogeneous, partly depending on frailty level. The aim of this study was to prospectively investigate the efficacy and safety of Ixazomib-Daratumumab-low-dose dexamethasone (Ixa-Dara-dex) in NDMM intermediate-fit patients. Methods In this phase II multicenter HOVON-143 study, IMWG Frailty index based intermediate-fit patients, were treated with 9 induction cycles of Ixa-Dara-dex, followed by maintenance with ID for a maximum of 2 years. The primary endpoint was overall response rate on induction treatment. Patients were included from October 2017 until May 2019. Trial Registration Number: NTR6297. Findings Sixty-five patients were included. Induction therapy resulted in an overall response rate of 71%. Early mortality was 1.5%. At a median follow-up of 41.0 months, median progression-free survival (PFS) was 18.2 months and 3-year overall survival 83%. Discontinuation of therapy occurred in 77% of patients, 49% due to progression, 9% due to toxicity, 8% due to incompliance, 3% due to sudden death and 8% due to other reasons. Dose modifications of ixazomib were required frequently (37% and 53% of patients during induction and maintenance, respectively), mainly due to, often low grade, polyneuropathy. During maintenance 23% of patients received daratumumab alone. Global quality of life (QoL) improved significantly and was clinically relevant, which persisted during maintenance treatment. Interpretation Ixazomib-Daratumumab-low-dose dexamethasone as first line treatment in intermediate-fit NDMM patients is safe and improves global QoL. However, efficacy was limited, partly explained by ixazomib-induced toxicity, hampering long term tolerability of this 3-drug regimen. This highlights the need for more efficacious and tolerable regimens improving the outcome in vulnerable intermediate-fit patients. Funding Janssen Pharmaceuticals, Takeda Pharmaceutical Company Limited.
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Affiliation(s)
- Kaz Groen
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Claudia A.M. Stege
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Kazem Nasserinejad
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
- Innovative Statistical Consulting, Therapeutics Development Team, Cytel Inc., Massachusetts, USA
| | - Koen de Heer
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
| | - Roel J.W. van Kampen
- Department of Internal Medicine, Zuyderland Hospital, Sittard-Geleen, the Netherlands
| | - Rineke B.L. Leys
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Noortje Thielen
- Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | - Matthijs Westerman
- Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | - Ka-Lung Wu
- Department of Hematology, ZNA Stuivenberg, Antwerpen, Belgium
| | - Inge Ludwig
- Department of Internal Medicine, Ziekenhuis Bernhoven, Uden, the Netherlands
| | - Djamila E. Issa
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - Gerjo A. Velders
- Department of Internal Medicine, Gelderse Vallei, Ede, the Netherlands
| | | | - Gert-Jan Timmers
- Department of Internal Medicine, Amstelland Hospital, Amstelveen, the Netherlands
| | - Fransien de Boer
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands
| | - Lidwine W. Tick
- Department of Internal Medicine, Maxima Medical Center, Eindhoven, the Netherlands
| | - Annelies Verbrugge
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Danny Buitenhuis
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Sonia M. Cunha
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ellen van der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Esther G.M. de Waal
- Department of Internal Medicine, Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands
| | - Maaike Sohne
- Department of Internal Medicine, Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Inger S. Nijhof
- Department of Internal Medicine, Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Saskia K. Klein
- Department of Internal Medicine, Meander Medical Center, Amersfoort, the Netherlands
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | - Niels W.C.J. van de Donk
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Paula F. Ypma
- Department of Internal Medicine, Haga Hospital, Den Haag, the Netherlands
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
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3
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Jonker CAL, Pereverzeva L, de Stoppelaar SF, Heer KD. Diagnostic value of Chest X-Ray in Febrile Patients without Localizing Signs or Symptoms at the Emergency Department. Curr Med Imaging 2023:CMIR-EPUB-130113. [PMID: 36915992 DOI: 10.2174/1573405619666230313101934] [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: 11/29/2022] [Revised: 01/31/2023] [Accepted: 02/10/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND The chest X-ray (CXR) remains a widely used examination in the evaluation of patients with fever, to diagnose or rule out pneumonia. Recently, a study by our group suggested that it has no diagnostic value in patients with fever without respiratory signs and/or symptoms. OBJECTIVE The objective of this study is to validate the results of our previous study. Design A retrospective study was conducted in two hospitals in the Netherlands. Patients All patients that were referred to the internal medicine emergency department between May 2018 and May 2019 with a suspected infection defined as fever (temperature ≥38°C) or hypothermia (temperature <36°C) or CRP ≥100µg/mL. Main measures We defined our primary outcome as the number of newly diagnosed pneumonia by CXR in cases of suspected infection with no obvious site of infection and nor localizing symptoms or signs. Key results We included 1052 patients, of which 106 did not have respiratory signs or symptoms. In this group, none of the CXRs (95% CI 0-2.36%) showed an infiltrate. Combined with our previous study, 176 CXRs were performed in patients with no respiratory signs or symptoms. None (95% CI 0-1.42%) showed an infiltrate. Conclusion Our results confirm that a CXR has no diagnostic value in the workup of fever without localizing signs or symptoms.
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Affiliation(s)
- Charlotte A L Jonker
- Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Liza Pereverzeva
- Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Sacha F de Stoppelaar
- Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Koen de Heer
- Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.,Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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4
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Raa DGT, van der Straten L, van Gelder M, Kersting S, Levin MD, Mous R, van der Straaten HM, Nijziel MR, van der Spek E, Posthuma EFM, Visser HP, van der Klift M, de Heer K, Bellido M, Doorduijn JK, Bruns AH, Raijmakers RAP, Kater AP. Diagnosis, treatment and supportive management of chronic lymphocytic leukemia: recommendations of the Dutch HOVON CLL working group. Leuk Lymphoma 2022; 63:2276-2289. [DOI: 10.1080/10428194.2022.2084731] [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]
Affiliation(s)
- Doreen G. Te Raa
- Department of Internal Medicine, Gelderse Vallei, Ede, the Netherlands
| | - Lina van der Straten
- Department of Internal Medicine, Albert Schweitzer hospital, Dordrecht, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Michel van Gelder
- Department of Hematology, Maastricht UMC, the Netherlands Maastricht
| | - Sabina Kersting
- Department of Internal Medicine, HAGA hospital, Den Haag, the Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer hospital, Dordrecht, the Netherlands
| | - Rogier Mous
- Department of Hematology, UMC Utrecht, the Netherlands Utrecht
| | | | - Marten R. Nijziel
- Department of Internal Medicine, Catharina hospital, Eindhoven, the Netherlands
| | | | - Eduardus F. M Posthuma
- Department of Internal Medicine, Reinier de Graaf hospital, Delft, the Netherlands
- Department of Hematology, Leiden Univerisity Medical Center, Leiden, the Netherlands
| | - Hein P.J Visser
- Department of Internal Medicine, Noordwest ziekenhuisgroep, Alkmaar, the Netherlands
| | | | - Koen de Heer
- Department of Internal Medicine, Flevo hospital, Almere, the Netherlands
| | - Mar Bellido
- Department of Hematology, Groningen University Medical Center, University of Groningen, Groningen, the Netherlands
| | - Jeanette K. Doorduijn
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anke H.W Bruns
- Department of Hematology, UMC Utrecht, the Netherlands Utrecht
| | | | - Arnon P. Kater
- Department of Hematology, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam UMC, Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
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5
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Martens AWJ, Rietveld JM, de Boer R, Peters FS, Ngo A, van Mil LWHG, de Heer K, Spaargaren M, Verkleij CPM, van de Donk NWCJ, Adams HC, Eldering E, van Noesel CJM, Verona R, Kater AP. Redirecting T-cell Activity with Anti-BCMA/Anti-CD3 Bispecific Antibodies in Chronic Lymphocytic Leukemia and Other B-cell Lymphomas. Cancer Res Commun 2022; 2:330-341. [PMID: 36875718 PMCID: PMC9981202 DOI: 10.1158/2767-9764.crc-22-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022]
Abstract
T-cell redirecting bispecific antibodies hold high promise for treatment of B-cell malignancies. B-cell maturation antigen (BCMA) exhibits high expression on normal and malignant mature B cells including plasma cells, which can be enhanced by inhibition of γ-secretase. BCMA is considered a validated target in multiple myeloma but whether mature B-cell lymphomas can be targeted by the BCMAxCD3 T-cell redirector teclistamab is currently unknown. BCMA expression on B-cell non-Hodgkin lymphoma and primary chronic lymphocytic leukemia (CLL) cells was assessed by flow cytometry and/or IHC. To assess teclistamab efficacy, cells were treated with teclistamab in presence of effector cells with/without γ-secretase inhibition. BCMA could be detected on all tested mature B-cell malignancy cell lines, while expression levels varied per tumor type. γ-secretase inhibition universally increased BCMA surface expression. These data were corroborated in primary samples from patients with Waldenstrom's macroglobulinemia, CLL, and diffuse large B-cell lymphoma. Functional studies with the B-cell lymphoma cell lines revealed teclistamab-mediated T-cell activation, proliferation, and cytotoxicity. This was independent of the level of BCMA expression, but generally lower in mature B-cell malignancies compared with multiple myeloma. Despite low BCMA levels, healthy donor T cells and CLL-derived T cells induced lysis of (autologous) CLL cells upon addition of teclistamab. These data show that BCMA is expressed on various B-cell malignancies and that lymphoma cell lines and primary CLL can be targeted using teclistamab. Further studies to understand the determinants of response to teclistamab are required to identify which other diseases might be suitable for teclistamab targeting. Significance Besides reported BCMA expression on multiple myeloma, we demonstrate BCMA can be detected and enhanced using γ-secretase inhibition on cell lines and primary material of various B-cell malignancies. Furthermore, using CLL we demonstrate that low BCMA-expressing tumors can be targeted efficiently using the BCMAxCD3 DuoBody teclistamab.
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Affiliation(s)
- Anne W J Martens
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Amsterdam, the Netherlands.,Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands
| | - Joanne M Rietveld
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Renate de Boer
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Fleur S Peters
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Amsterdam, the Netherlands.,Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands
| | - An Ngo
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lotte W H G van Mil
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Koen de Heer
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Hematology, Flevoziekenhuis, Almere, the Netherlands
| | - Marcel Spaargaren
- Cancer Center Amsterdam, Amsterdam, the Netherlands.,Department of Pathology, University of Amsterdam, the Netherlands.,Lymphoma and Myeloma Center Amsterdam, LYMMCARE, the Netherlands
| | - Christie P M Verkleij
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Niels W C J van de Donk
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Homer C Adams
- Janssen Pharmaceutical Companies of Johnson & Johnson, Philadelphia, Pennsylvania
| | - Eric Eldering
- Department of Experimental Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Amsterdam, the Netherlands.,Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands.,Lymphoma and Myeloma Center Amsterdam, LYMMCARE, the Netherlands
| | - Carel J M van Noesel
- Department of Pathology, University of Amsterdam, the Netherlands.,Lymphoma and Myeloma Center Amsterdam, LYMMCARE, the Netherlands
| | - Raluca Verona
- Janssen Pharmaceutical Companies of Johnson & Johnson, Philadelphia, Pennsylvania
| | - Arnon P Kater
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Amsterdam, the Netherlands.,Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands.,Lymphoma and Myeloma Center Amsterdam, LYMMCARE, the Netherlands
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6
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Amaador K, Wieske L, Koel-Simmelink MJA, Kamp A, Jongerius I, de Heer K, Teunissen CE, Minnema MC, Notermans NC, Eftimov F, Kersten MJ, Vos JMI. Serum neurofilament light chain, contactin-1 and complement activation in anti-MAG IgM paraprotein-related peripheral neuropathy. J Neurol 2022; 269:3700-3705. [PMID: 35157138 PMCID: PMC9217848 DOI: 10.1007/s00415-022-10993-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Abstract
Abstract
Introduction
In anti-myelin-associated glycoprotein IgM paraprotein-related peripheral neuropathy (anti-MAG PN), there is a lack of reliable biomarkers to select patients eligible for therapy and for evaluating treatment effects, both in routine practice and in clinical trials. Neurofilament light chain (NfL) and contactin-1 (CNTN1) can serve as markers of axonal and paranodal damage. Complement activation is involved in the pathogenesis in anti-MAG PN. We, therefore, hypothesized that serum NfL, CNTN1, C3b/c and C4b/c may function as biomarkers of disease activity in anti-MAG PN.
Methods
In this prospective cohort study, we included 24 treatment-naïve patients with anti-MAG PN (mean age 69 years, 57% male) that had IgM paraproteinemia, a high IgM MAG-antibody, and clinical diagnosis of anti-MAG PN by a neurologist specialized in peripheral nerve disorders. We measured serum NfL, CNTN1, C3b/c and C4b/c, reference values were based on healthy controls. As controls, 10 treatment-naïve patients with IgM Monoclonal gammopathy of undetermined significance (MGUS) or Waldenström’s Macroglobulinemia (mean age 69 years, 60% male) without signs of neuropathy were included (non-PN).
Results
NfL, CNTN1 levels in serum were mostly normal in anti-MAG PN patients and comparable to non-PN patients. C3b/c and C4b/c levels were normal in anti-MAG PN patients.
Conclusion
Our results do not support serum NfL, CNTN1, and C3b/c and C4b/c as potential biomarkers in anti-MAG PN, although we cannot exclude that subgroups or subtle abnormalities could be found in a much larger cohort with longitudinal follow-up.
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Affiliation(s)
- Karima Amaador
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, LYMMCARE, Amsterdam, The Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Marleen J A Koel-Simmelink
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - A Kamp
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, 1066CX, The Netherlands
| | - Ilse Jongerius
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, 1066CX, The Netherlands
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Koen de Heer
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, LYMMCARE, Amsterdam, The Netherlands
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Nicolette C Notermans
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, LYMMCARE, Amsterdam, The Netherlands
| | - Josephine M I Vos
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, LYMMCARE, Amsterdam, The Netherlands.
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7
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Gaartman AE, Sayedi AK, Gerritsma JJ, de Back TR, van Tuijn CF, Tang MW, Heijboer H, de Heer K, Biemond BJ, Nur E. Fluid overload due to intravenous fluid therapy for vaso-occlusive crisis in sickle cell disease: incidence and risk factors. Br J Haematol 2021; 194:899-907. [PMID: 34263922 PMCID: PMC8456906 DOI: 10.1111/bjh.17696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/11/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 02/02/2023]
Abstract
Intravenous fluid therapy (IV‐FT) is routinely used in the treatment of vaso‐occlusive crises (VOCs), as dehydration possibly promotes and sustains erythrocyte sickling. Patients with sickle cell disease (SCD) are at risk of developing diastolic dysfunction and fluid overload due to IV‐FT. However, data on the adverse effects of IV‐FT for VOC is sparse. We aimed to evaluate the incidence and risk factors of fluid overload due to IV‐FT in patients with SCD. Consecutive hospitalisations for VOC treated with IV‐FT between September 2016 and September 2018 were retrospectively analysed. The median (interquartile range) age was 25·0 (18·3–33·8) years and 65% had a severe genotype (HbSS/HbSβ0‐thal). Fluid overload occurred in 21% of 100 patients. Hospital stay was longer in patients with fluid overload (6·0 vs. 4·0 days, P = 0·037). A positive history of fluid overload (P = 0·017), lactate dehydrogenase level (P = 0·011), and top‐up transfusion during admission (P = 0·005) were independently associated with fluid overload occurrence. IV‐FT was not reduced in 86% of patients despite a previous history of fluid overload. Fluid overload is frequently encountered during IV‐FT for VOC. IV‐FT is often not adjusted despite a positive history of fluid overload or when top‐up transfusion is indicated, emphasising the need for more awareness of this complication and a personalised approach.
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Affiliation(s)
- Aafke E Gaartman
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ajab K Sayedi
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jorn J Gerritsma
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tim R de Back
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Man Wai Tang
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Harriët Heijboer
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Koen de Heer
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
| | - Bart J Biemond
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Erfan Nur
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
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8
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Kemps PG, Hebeda KM, Pals ST, Verdijk RM, Lam KH, Bruggink AH, de Lil HS, Ruiterkamp B, de Heer K, van Laar JAM, Valk PJM, Mutsaers P, Levin M, Hogendoorn PCW, van Halteren AGS. Spectrum of histiocytic neoplasms associated with diverse haematological malignancies bearing the same oncogenic mutation. J Pathol Clin Res 2021; 7:10-26. [PMID: 32852896 PMCID: PMC7737785 DOI: 10.1002/cjp2.177] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 05/08/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/14/2022]
Abstract
Histiocytic disorders are a spectrum of rare diseases characterised by the accumulation of macrophage-, dendritic cell-, or monocyte-differentiated cells in various tissues and organs. The discovery of recurrent genetic alterations in many of these histiocytoses has led to their recognition as clonal neoplastic diseases. Moreover, the identification of the same somatic mutation in histiocytic lesions and peripheral blood and/or bone marrow cells from histiocytosis patients has provided evidence for systemic histiocytic neoplasms to originate from haematopoietic stem/progenitor cells (HSPCs). Here, we investigated associations between histiocytic disorders and additional haematological malignancies bearing the same genetic alteration(s) using the nationwide Dutch Pathology Registry. By searching on pathologist-assigned diagnostic terms for the various histiocytic disorders, we identified 4602 patients with a putative histopathological diagnosis of a histiocytic disorder between 1971 and 2019. Histiocytosis-affected tissue samples of 187 patients had been analysed for genetic alterations as part of routine molecular diagnostics, including from nine patients with an additional haematological malignancy. Among these patients, we discovered three cases with different histiocytic neoplasms and additional haematological malignancies bearing identical oncogenic mutations, including one patient with concomitant KRAS p.A59E mutated histiocytic sarcoma and chronic myelomonocytic leukaemia (CMML), one patient with synchronous NRAS p.G12V mutated indeterminate cell histiocytosis and CMML, and one patient with subsequent NRAS p.Q61R mutated Erdheim-Chester disease and acute myeloid leukaemia. These cases support the existence of a common haematopoietic cell-of-origin in at least a proportion of patients with a histiocytic neoplasm and additional haematological malignancy. In addition, they suggest that driver mutations in particular genes (e.g. N/KRAS) may specifically predispose to the development of an additional clonally related haematological malignancy or secondary histiocytic neoplasm. Finally, the putative existence of derailed multipotent HSPCs in these patients emphasises the importance of adequate (bone marrow) staging, molecular analysis and long-term follow-up of all histiocytosis patients.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/genetics
- Erdheim-Chester Disease/genetics
- Erdheim-Chester Disease/pathology
- Erdheim-Chester Disease/therapy
- Fatal Outcome
- GTP Phosphohydrolases/genetics
- Genetic Predisposition to Disease
- Histiocytic Sarcoma/genetics
- Histiocytic Sarcoma/pathology
- Histiocytic Sarcoma/therapy
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Leukemia, Myelomonocytic, Chronic/genetics
- Leukemia, Myelomonocytic, Chronic/pathology
- Leukemia, Myelomonocytic, Chronic/therapy
- Male
- Membrane Proteins/genetics
- Middle Aged
- Mutation
- Phenotype
- Proto-Oncogene Proteins p21(ras)/genetics
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- Paul G Kemps
- Department of PaediatricsLeiden University Medical CenterLeidenThe Netherlands
| | - Konnie M Hebeda
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Steven T Pals
- Department of PathologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Robert M Verdijk
- Department of PathologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of PathologyLeiden University Medical CenterLeidenThe Netherlands
| | - King H Lam
- Department of PathologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Annette H Bruggink
- PALGA Foundation (Nationwide Network and Registry of Histopathology and Cytopathology)HoutenThe Netherlands
| | - Heleen S de Lil
- Department of HaematologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Bart Ruiterkamp
- Department of HaematologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Koen de Heer
- Department of HaematologyAmsterdam University Medical CentersAmsterdamThe Netherlands
- Department of HaematologyFlevoziekenhuisAlmereThe Netherlands
| | - Jan AM van Laar
- Department of Internal MedicineErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of ImmunologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Peter JM Valk
- Department of HaematologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Pim Mutsaers
- Department of HaematologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Mark‐David Levin
- Department of Internal MedicineAlbert Schweitzer ZiekenhuisDordrechtThe Netherlands
| | | | - Astrid GS van Halteren
- Department of PaediatricsLeiden University Medical CenterLeidenThe Netherlands
- Princess Máxima Center for Paediatric OncologyUtrechtThe Netherlands
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9
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de Stoppelaar SF, Pereverzeva L, Hafkamp B, Lips N, Tielbeke F, Rustenburg L, Hoogerheide-Wiegerinck C, de Heer K. Diagnostic Value of Chest X-Ray in Patients With Suspected Infection and No Respiratory Signs or Symptoms. Open Forum Infect Dis 2020; 7:ofaa221. [PMID: 32617380 PMCID: PMC7314582 DOI: 10.1093/ofid/ofaa221] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/03/2020] [Indexed: 11/16/2022] Open
Abstract
Suspicion of an infection without localizing signs or symptoms is a common problem. A chest x-ray (CXR) is often performed to rule out pneumonia. Our prospective cross-sectional study suggests that a CXR has no diagnostic value in patients without respiratory signs or symptoms, if a reliable medical history can be obtained.
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Affiliation(s)
- Sacha F de Stoppelaar
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Liza Pereverzeva
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Bram Hafkamp
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Nikki Lips
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Department of Clinical Geriatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Floor Tielbeke
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Department of Emergency Medicine, Deventer Ziekenhuis, Deventer, the Netherlands
| | - Linde Rustenburg
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Department of General Practice, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Caroline Hoogerheide-Wiegerinck
- Department of Emergency Medicine, Flevoziekenhuis, Almere, the Netherlands
- Department of Emergency Medicine, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Koen de Heer
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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10
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van der Hout A, van Uden-Kraan CF, Holtmaat K, Jansen F, Lissenberg-Witte BI, Nieuwenhuijzen GAP, Hardillo JA, Baatenburg de Jong RJ, Tiren-Verbeet NL, Sommeijer DW, de Heer K, Schaar CG, Sedee RJE, Bosscha K, van den Brekel MWM, Petersen JF, Westerman M, Honings J, Takes RP, Houtenbos I, van den Broek WT, de Bree R, Jansen P, Eerenstein SEJ, Leemans CR, Zijlstra JM, Cuijpers P, van de Poll-Franse LV, Verdonck-de Leeuw IM. Role of eHealth application Oncokompas in supporting self-management of symptoms and health-related quality of life in cancer survivors: a randomised, controlled trial. Lancet Oncol 2020; 21:80-94. [DOI: 10.1016/s1470-2045(19)30675-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 12/27/2022]
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11
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Pereverzeva E, de Stoppelaar SF, de Heer K. [Chest X-ray in patients with fever and no localizing symptoms?]. Ned Tijdschr Geneeskd 2019; 163:D3780. [PMID: 31361410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Fever without localizing symptoms is a clinical problem that is frequently encountered on the emergency department. According to the NICE sepsis guideline, a chest X-ray should be considered in such patients. However, the evidence supporting this recommendation is limited to patients with neutropenic fever. We performed a telephone survey among the internists and residents at every Dutch hospital. Of the 141 physicians that responded, 88% considered a chest X-ray a valuable diagnostic tool and one that is indicated in patients with fever without localizing symptoms. In view of rising health costs, diagnostics should be chosen wisely. A clinical study on the diagnostic value of a chest X-ray in patients with fever without localizing symptoms is needed.
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Affiliation(s)
- E Pereverzeva
- Flevoziekenhuis, afd. Inwendige Geneeskunde, Almere
- Contact: E. Pereverzeva
| | | | - Koen de Heer
- Flevoziekenhuis, afd. Inwendige Geneeskunde, Almere
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12
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de Heer K, Gerritsen MG, Visser CE, Leeflang MMG. Galactomannan detection in broncho-alveolar lavage fluid for invasive aspergillosis in immunocompromised patients. Cochrane Database Syst Rev 2019; 5:CD012399. [PMID: 31107543 PMCID: PMC6526785 DOI: 10.1002/14651858.cd012399.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Invasive aspergillosis (IA) is a life-threatening opportunistic mycosis that occurs in some people with a compromised immune system. The serum galactomannan enzyme-linked immunosorbent assay (ELISA) rapidly gained widespread acceptance as part of the diagnostic work-up of a patient suspected of IA. Due to its non-invasive nature, it can be used as a routine screening test. The ELISA can also be performed on bronchoalveolar lavage (BAL), allowing sampling of the immediate vicinity of the infection. The invasive nature of acquiring BAL, however, changes the role of the galactomannan test significantly, for example by precluding its use as a routine screening test. OBJECTIVES To assess the diagnostic accuracy of galactomannan detection in BAL for the diagnosis of IA in people who are immunocompromised, at different cut-off values for test positivity, in accordance with the Cochrane Diagnostic Test Accuracy Handbook. SEARCH METHODS We searched three bibliographic databases including MEDLINE on 9 September 2016 for aspergillosis and galactomannan as text words and subject headings where appropriate. We checked reference lists of included studies for additional studies. SELECTION CRITERIA We included cohort studies that examined the accuracy of BAL galactomannan for the diagnosis of IA in immunocompromised patients if they used the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) classification as reference standard. DATA COLLECTION AND ANALYSIS Two review authors assessed study quality and extracted data. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used for quality assessment. MAIN RESULTS We included 17 studies in our review. All studies except one had a high risk of bias in two or more domains. The diagnostic performance of an optical density index (ODI) of 0.5 as cut-off value was reported in 12 studies (with 1123 patients). The estimated sensitivity was 0.88 (95% confidence interval (CI) 0.75 to 1.00) and specificity 0.81 (95% CI 0.71 to 0.91). The performance of an ODI of 1.0 as cut-off value could be determined in 11 studies (with 648 patients). The sensitivity was 0.78 (95% CI 0.61 to 0.95) and specificity 0.93 (95% CI 0.87 to 0.98). At a cut-off ODI of 1.5 or higher, the heterogeneity in specificity decreased significantly and was invariably >90%. AUTHORS' CONCLUSIONS The optimal cut-off value depends on the local incidence and clinical pathway. At a prevalence of 12% a hypothetical population of 1000 patients will consist of 120 patients with IA. At a cut-off value of 0.5 14 patients with IA will be missed and there will be 167 patients incorrectly diagnosed with IA. If we use the test at a cut-off value of 1.0, we will miss 26 patients with IA. And there will be 62 patients incorrectly diagnosed with invasive aspergillosis. The populations and results were very heterogeneous. Therefore, interpretation and extrapolation of these results has to be performed with caution. A test result of 1.5 ODI or higher appears a strong indicator of IA.
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Affiliation(s)
- Koen de Heer
- FlevoziekenhuisDepartment of Internal MedicineAlmereNetherlands
- Academic Medical CenterDepartment of HematologyAmsterdamNetherlands
| | | | - Caroline E Visser
- Academic Medical CentreDepartment of Medical MicrobiologyAmsterdamNetherlands
| | - Mariska MG Leeflang
- Amsterdam University Medical Centers, University of AmsterdamDepartment of Clinical Epidemiology, Biostatistics and BioinformaticsP.O. Box 22700AmsterdamNetherlands1100 DE
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13
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de Heer K, Gerritsen MG, Visser CE, Leeflang MMG. Galactomannan detection in broncho-alveolar lavage fluid for invasive aspergillosis in immunocompromised patients. Hippokratia 2016. [DOI: 10.1002/14651858.cd012399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Koen de Heer
- Flevoziekenhuis; Department of Internal Medicine; Almere Netherlands
- Academic Medical Center; Department of Hematology; Amsterdam Netherlands
| | - Marije G Gerritsen
- Academic Medical Center; Department of Hematology; Amsterdam Netherlands
| | - Caroline E Visser
- Academic Medical Centre; Department of Medical Microbiology; Amsterdam Netherlands
| | - Mariska MG Leeflang
- Academic Medical Center, University of Amsterdam; Department of Clinical Epidemiology, Biostatistics and Bioinformatics; P.O. Box 22700 Amsterdam Netherlands 1100 DE
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14
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Mank APM, Schoonenberg C, Bleeker K, Heijmenberg S, Heer KD, van Oers MHJ, Kersten MJ. Early discharge after high dose chemotherapy is safe and feasible: a prospective evaluation of 6 years of home care. Leuk Lymphoma 2014; 56:2098-104. [PMID: 25330445 DOI: 10.3109/10428194.2014.974039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A single-center, prospective, non-randomized clinical study was performed to examine the safety and feasibility of early discharge in patients undergoing consolidation chemotherapy for acute leukemia, or autologous stem cell transplant for lymphoma or multiple myeloma. Patients were discharged into ambulatory care the day after the last chemotherapy administration and were subsequently seen at the ambulatory care unit three times a week. One hundred and one of 224 patients were ineligible for the program, mostly because of their medical situation, the lack of a caregiver or the travel time to the hospital. The remaining 123 patients were able to spend more than 70% of the time at home. In 44% of cycles they were never readmitted. This study demonstrates the safety, feasibility and benefits of managing carefully selected patients. Patients and their caregivers felt safe and comfortable at home, and the vast majority preferred home care to in-hospital treatment.
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Affiliation(s)
- Arno P M Mank
- Department of Hematology, Academic Medical Center , Amsterdam , The Netherlands
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15
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Melenhorst M, Hehenkamp W, de Heer K, Ferco HB. CT features in uterine necrosis of unknown cause: a case report. Clin Imaging 2014; 38:543-546. [PMID: 24735683 DOI: 10.1016/j.clinimag.2014.02.009] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
Abstract
Uterine necrosis is a rare life-threatening condition known to be related to cesarean section, endometritis or uterine artery embolization. We present a case of uterine necrosis not preceded by common causative factors, diagnosed by computed tomography (CT) in a 64-year-old woman with myelodysplastic syndrome. A gas-filled, nonenhancing uterus was noted, diagnostic of uterine necrosis. At laparotomy, a nonvital uterus was removed. Imaging findings of uterine necrosis have sparsely been reported and mostly focus on magnetic resonance imaging technique. In this report, we describe the CT findings of uterine necrosis.
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Affiliation(s)
- Marleen Melenhorst
- Department of Radiology, VU University Medical Centre, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands.
| | - Wouter Hehenkamp
- Department of Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Koen de Heer
- Department of Hematology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Herger B Ferco
- Department of Radiology, VU University Medical Centre, Amsterdam, The Netherlands
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