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Akil A, Müller MC, Ziegeler S, Dickgreber N, Fischer S. [Successful treatment of a geriatric COVID-19 patient with severe chest trauma : An interdisciplinary case report]. Unfallchirurg 2021; 124:358-361. [PMID: 33616681 PMCID: PMC7898493 DOI: 10.1007/s00113-021-00962-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
Die Coronaviruserkrankung 2019 (COVID-19) ist eine neu auftretende Infektionskrankheit, die sich weltweit rasch ausgebreitet hat und zu einer hohen Morbidität und Mortalität führt. Klinische Erfahrungen bezüglich des chirurgischen Managements bei COVID-19-Patienten mit schwerem Thoraxtrauma sind limitiert. Hier wird über das interdisziplinäre Management einer geriatrischen COVID-19-Patientin nach schwerem Thoraxtrauma mit pulmonaler Symptomatik bei traumatisch instabiler Rippenserienfraktur und begleitendem Hämatothorax berichtet.
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Affiliation(s)
- A Akil
- Klinik für Thoraxchirurgie und Lungenunterstützung, Klinikum Ibbenbüren, Grosse Straße 41, 49477, Ibbenbüren, Deutschland.
| | - M C Müller
- Klinik für Unfallchirurgie und Orthopädie, Klinikum Ibbenbüren, Ibbenbüren, Deutschland
| | - S Ziegeler
- Klinik für Anästhesie und Intensivmedizin, Klinikum Ibbenbüren, Ibbenbüren, Deutschland
| | - N Dickgreber
- Klinik für Pneumologie, Thoraxonkologie und Beatmungsmedizin, Klinikum Ibbenbüren, Ibbenbüren, Deutschland
| | - S Fischer
- Klinik für Thoraxchirurgie und Lungenunterstützung, Klinikum Ibbenbüren, Grosse Straße 41, 49477, Ibbenbüren, Deutschland
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2
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Barros VRP, Monte APO, Santos JMS, Lins TLBG, Cavalcante AYP, Gouveia BB, Müller MC, Oliveira Junior JL, Barberino RS, Donfack NJ, Araújo VR, Matos MHT. Effects of melatonin on the in vitro growth of early antral follicles and maturation of ovine oocytes. Domest Anim Endocrinol 2020; 71:106386. [PMID: 31809950 DOI: 10.1016/j.domaniend.2019.106386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/17/2019] [Accepted: 08/08/2019] [Indexed: 01/21/2023]
Abstract
This study aimed to evaluate the effect of melatonin on the in vitro culture and maturation of isolated sheep early antral follicles. Isolated early antral follicles were cultured for 12 d in α-minimum essential medium (MEM+) alone (control) or α-MEM+ added with fixed different concentrations (100, 500, or 1,000 pg/mL) or a sequential concentration of melatonin (MelSeq; day 6 = 100; day 12 = 500 pg/mL). The percentage of morphologically normal follicles was higher (P < 0.05) in 500 pg/mL melatonin than the other treatments at 6 d. Mel 500 also showed a higher rate of fully grown oocytes (P < 0.05) than other treatments. After in vitro culture, reactive oxygen species (ROS) levels in oocytes were similar between Mel 500 and MelSeq, with both being lower (P < 0.05) than other treatments. Oocytes cultured in both Mel 500 and Mel 1000 showed glutathione peroxidase levels similar (P > 0.05) to the control group and higher (P < 0.05) than other treatments. Mitochondrial activity was similar (P > 0.05) among control, Mel 500, and Mel 1000 treatments. Mel 500 treatment presented a higher percentage of germinal vesicle breakdown oocytes than the control group and similar percentages to the other treatments. Follicles cultured in melatonin followed by oocyte maturation with the addition of 500 pg/mL melatonin in maturation medium showed increased (P < 0.05) levels of mitochondrial activity compared to α-MEM+ alone. In conclusion, the concentration of 500 pg/mL of melatonin promotes development and decreases ROS levels of ovine oocytes from in vitro grown early antral follicles. Moreover, melatonin increases mitochondrial activity and promotes the acquisition of meiotic competence of these oocytes.
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Affiliation(s)
- V R P Barros
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - A P O Monte
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - J M S Santos
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - T L B G Lins
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - A Y P Cavalcante
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - B B Gouveia
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - M C Müller
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - J L Oliveira Junior
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - R S Barberino
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - N J Donfack
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil
| | - V R Araújo
- Health Center Science, State University of Ceará, Fortaleza, CE 60714-903, Brazil
| | - M H T Matos
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, Petrolina, PE 56300-990, Brazil.
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Schaefer LK, Parlange F, Buchmann G, Jung E, Wehrli A, Herren G, Müller MC, Stehlin J, Schmid R, Wicker T, Keller B, Bourras S. Cross-Kingdom RNAi of Pathogen Effectors Leads to Quantitative Adult Plant Resistance in Wheat. Front Plant Sci 2020; 11:253. [PMID: 32211008 PMCID: PMC7076181 DOI: 10.3389/fpls.2020.00253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/18/2020] [Indexed: 05/30/2023]
Abstract
Cross-kingdom RNA interference (RNAi) is a biological process allowing plants to transfer small regulatory RNAs to invading pathogens to trigger the silencing of target virulence genes. Transient assays in cereal powdery mildews suggest that silencing of one or two effectors could lead to near loss of virulence, but evidence from stable RNAi lines is lacking. We established transient host-induced gene silencing (HIGS) in wheat, and demonstrate that targeting an essential housekeeping gene in the wheat powdery mildew pathogen (Blumeria graminis f. sp. tritici) results in significant reduction of virulence at an early stage of infection. We generated stable transgenic RNAi wheat lines encoding a HIGS construct simultaneously silencing three B.g. tritici effectors including SvrPm3 a1/f1 , a virulence factor involved in the suppression of the Pm3 powdery mildew resistance gene. We show that all targeted effectors are effectively downregulated by HIGS, resulting in reduced fungal virulence on adult wheat plants. Our findings demonstrate that stable HIGS of effector genes can lead to quantitative gain of resistance without major pleiotropic effects in wheat.
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Affiliation(s)
| | - Francis Parlange
- Department of Plant and Microbial Biology, University of Zurich, Zurich, Switzerland
| | - Gabriele Buchmann
- Department of Plant and Microbial Biology, University of Zurich, Zurich, Switzerland
| | - Esther Jung
- Department of Plant and Microbial Biology, University of Zurich, Zurich, Switzerland
| | - Andreas Wehrli
- Department of Plant and Microbial Biology, University of Zurich, Zurich, Switzerland
| | - Gerhard Herren
- Department of Plant and Microbial Biology, University of Zurich, Zurich, Switzerland
| | - Marion Claudia Müller
- Department of Plant and Microbial Biology, University of Zurich, Zurich, Switzerland
| | - Jonas Stehlin
- Department of Plant and Microbial Biology, University of Zurich, Zurich, Switzerland
| | - Roman Schmid
- Department of Plant and Microbial Biology, University of Zurich, Zurich, Switzerland
| | - Thomas Wicker
- Department of Plant and Microbial Biology, University of Zurich, Zurich, Switzerland
| | - Beat Keller
- Department of Plant and Microbial Biology, University of Zurich, Zurich, Switzerland
| | - Salim Bourras
- Department of Plant and Microbial Biology, University of Zurich, Zurich, Switzerland
- Department of Forest Mycology and Plant Pathology, Division of Plant Pathology, Swedish University of Agricultural Sciences, Uppsala, Sweden
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4
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Barros VRP, Monte APO, Santos JMS, Lins TLBG, Cavalcante AYP, Gouveia BB, Müller MC, Oliveira JL, Donfack NJ, Araújo VR, Matos MHT. Melatonin improves development, mitochondrial function and promotes the meiotic resumption of sheep oocytes from in vitro grown secondary follicles. Theriogenology 2019; 144:67-73. [PMID: 31918071 DOI: 10.1016/j.theriogenology.2019.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 05/24/2019] [Revised: 12/07/2019] [Accepted: 12/08/2019] [Indexed: 12/24/2022]
Abstract
The aim of this study was to evaluate follicular survival and development of ovine isolated secondary follicles cultured in medium containing fixed or sequential concentrations of melatonin and further oocyte maturation. Isolated secondary follicles were cultured for 18 days in α-MEM+ alone (control) or with different concentrations of melatonin (100, 500 or 1000 pg/mL) or sequential concentrations of melatonin (Mel Seq: Day 6 = 100; Day 12 = 500; Day 18 = 1000 pg/mL). The percentages of morphologically normal follicles and antral cavity formation increased significantly in 1000 pg/mL melatonin compared to the other treatments. After 18 days, 1000 pg/mL melatonin (Mel 100) showed a greater (P < 0.05) follicular diameter than α-MEM+, 100 and 500 pg/mL melatonin. In addition, the concentration of 500 pg/mL melatonin showed a higher (P < 0.05) percentage of fully grown oocytes than α-MEM+, Mel 100 and Mel Seq treatments. After oocyte maturation, the levels of ROS were lower (P < 0.05) in 1000 pg/mL melatonin (Mel 1000) than in other treatments. Both Mel 1000 and Mel Seq treatments showed significantly higher levels of mitochondrial activity than other treatments. There were no significant differences between 500 and 1000 pg/mL melatonin regarding meiotic stages. In conclusion, the concentration of 1000 pg/mL melatonin maintains survival, promotes follicular development and increases the levels of active mitochondria after in vitro culture of sheep secondary follicles. Moreover, this concentration promotes the meiotic competence of oocytes and decreases the production of ROS during oocyte maturation.
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Affiliation(s)
- V R P Barros
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, 56300-990, Petrolina, PE, Brazil
| | - A P O Monte
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, 56300-990, Petrolina, PE, Brazil
| | - J M S Santos
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, 56300-990, Petrolina, PE, Brazil
| | - T L B G Lins
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, 56300-990, Petrolina, PE, Brazil
| | - A Y P Cavalcante
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, 56300-990, Petrolina, PE, Brazil
| | - B B Gouveia
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, 56300-990, Petrolina, PE, Brazil
| | - M C Müller
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, 56300-990, Petrolina, PE, Brazil
| | - J L Oliveira
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, 56300-990, Petrolina, PE, Brazil
| | - N J Donfack
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, 56300-990, Petrolina, PE, Brazil
| | - V R Araújo
- Health Center Science, State University of Ceará, 60714-903, Fortaleza, CE, Brazil
| | - M H T Matos
- Nucleus of Biotechnology Applied to Ovarian Follicle Development, Federal University of São Francisco Valley, 56300-990, Petrolina, PE, Brazil.
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Bourras S, Kunz L, Xue M, Praz CR, Müller MC, Kälin C, Schläfli M, Ackermann P, Flückiger S, Parlange F, Menardo F, Schaefer LK, Ben-David R, Roffler S, Oberhaensli S, Widrig V, Lindner S, Isaksson J, Wicker T, Yu D, Keller B. The AvrPm3-Pm3 effector-NLR interactions control both race-specific resistance and host-specificity of cereal mildews on wheat. Nat Commun 2019; 10:2292. [PMID: 31123263 PMCID: PMC6533294 DOI: 10.1038/s41467-019-10274-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/03/2019] [Indexed: 12/25/2022] Open
Abstract
The wheat Pm3 resistance gene against the powdery mildew pathogen occurs as an allelic series encoding functionally different immune receptors which induce resistance upon recognition of isolate-specific avirulence (AVR) effectors from the pathogen. Here, we describe the identification of five effector proteins from the mildew pathogens of wheat, rye, and the wild grass Dactylis glomerata, specifically recognized by the PM3B, PM3C and PM3D receptors. Together with the earlier identified AVRPM3A2/F2, the recognized AVRs of PM3B/C, (AVRPM3B2/C2), and PM3D (AVRPM3D3) belong to a large group of proteins with low sequence homology but predicted structural similarities. AvrPm3b2/c2 and AvrPm3d3 are conserved in all tested isolates of wheat and rye mildew, and non-host infection assays demonstrate that Pm3b, Pm3c, and Pm3d are also restricting the growth of rye mildew on wheat. Furthermore, divergent AVR homologues from non-adapted rye and Dactylis mildews are recognized by PM3B, PM3C, or PM3D, demonstrating their involvement in host specificity.
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Affiliation(s)
- Salim Bourras
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland.
- Department of Forest Mycology and Plant Pathology, Division of Plant Pathology, Swedish University of Agricultural Sciences, 750 07, Uppsala, Sweden.
| | - Lukas Kunz
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Minfeng Xue
- Institute of Plant Protection and Soil Science, Hubei Academy of Agricultural Sciences, Wuhan, 430064, China
- Ministry of Agriculture Key Laboratory of Integrated Pest Management in Crops in Central China, Wuhan, 430064, China
- College of Life Science, Wuhan University, Wuhan, 430072, China
| | - Coraline Rosalie Praz
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Marion Claudia Müller
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Carol Kälin
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Michael Schläfli
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Patrick Ackermann
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Simon Flückiger
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Francis Parlange
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Fabrizio Menardo
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | | | - Roi Ben-David
- Institute of Plant Science, ARO-Volcani Center, 50250, Bet Dagan, Israel
| | - Stefan Roffler
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Simone Oberhaensli
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Victoria Widrig
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Stefan Lindner
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Jonatan Isaksson
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Thomas Wicker
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland
| | - Dazhao Yu
- Institute of Plant Protection and Soil Science, Hubei Academy of Agricultural Sciences, Wuhan, 430064, China.
- Ministry of Agriculture Key Laboratory of Integrated Pest Management in Crops in Central China, Wuhan, 430064, China.
- College of Life Science, Wuhan University, Wuhan, 430072, China.
| | - Beat Keller
- Department of Plant and Microbial Biology, University of Zurich, 8008, Zurich, Switzerland.
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6
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McNally KE, Menardo F, Lüthi L, Praz CR, Müller MC, Kunz L, Ben‐David R, Chandrasekhar K, Dinoor A, Cowger C, Meyers E, Xue M, Zeng F, Gong S, Yu D, Bourras S, Keller B. Distinct domains of the AVRPM3 A2/F2 avirulence protein from wheat powdery mildew are involved in immune receptor recognition and putative effector function. New Phytol 2018; 218:681-695. [PMID: 29453934 PMCID: PMC6175116 DOI: 10.1111/nph.15026] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 01/05/2018] [Indexed: 05/22/2023]
Abstract
Recognition of the AVRPM3A2/F2 avirulence protein from powdery mildew by the wheat PM3A/F immune receptor induces a hypersensitive response after co-expression in Nicotiana benthamiana. The molecular determinants of this interaction and how they shape natural AvrPm3a2/f2 allelic diversity are unknown. We sequenced the AvrPm3a2/f2 gene in a worldwide collection of 272 mildew isolates. Using the natural polymorphisms of AvrPm3a2/f2 as well as sequence information from related gene family members, we tested 85 single-residue-altered AVRPM3A2/F2 variants with PM3A, PM3F and PM3FL456P/Y458H (modified for improved signaling) in Nicotiana benthamiana for effects on recognition. An intact AvrPm3a2/f2 gene was found in all analyzed isolates and the protein variant recognized by PM3A/F occurred globally at high frequencies. Single-residue alterations in AVRPM3A2/F2 mostly disrupted, but occasionally enhanced, the recognition response by PM3A, PM3F and PM3FL456P/Y458H . Residues enhancing hypersensitive responses constituted a protein domain separate from both naturally occurring polymorphisms and positively selected residues of the gene family. These results demonstrate the utility of using gene family sequence diversity to screen residues for their role in recognition. This approach identified a putative interaction surface in AVRPM3A2/F2 not polymorphic in natural alleles. We conclude that molecular mechanisms besides recognition drive AvrPm3a2/f2 diversification.
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Affiliation(s)
- Kaitlin Elyse McNally
- Department of Plant and Microbial BiologyUniversity of ZürichZollikerstrasse 1078008ZürichSwitzerland
| | - Fabrizio Menardo
- Department of Plant and Microbial BiologyUniversity of ZürichZollikerstrasse 1078008ZürichSwitzerland
| | - Linda Lüthi
- Department of Plant and Microbial BiologyUniversity of ZürichZollikerstrasse 1078008ZürichSwitzerland
| | - Coraline Rosalie Praz
- Department of Plant and Microbial BiologyUniversity of ZürichZollikerstrasse 1078008ZürichSwitzerland
| | - Marion Claudia Müller
- Department of Plant and Microbial BiologyUniversity of ZürichZollikerstrasse 1078008ZürichSwitzerland
| | - Lukas Kunz
- Department of Plant and Microbial BiologyUniversity of ZürichZollikerstrasse 1078008ZürichSwitzerland
| | - Roi Ben‐David
- Institute of Plant ScienceARO‐Volcani Center50250Bet DaganIsrael
| | - Kottakota Chandrasekhar
- Department of Plant Pathology and MicrobiologyThe Robert H. Smith Faculty of Agriculture, Food and EnvironmentThe Hebrew University of JerusalemRehovot76100Israel
| | - Amos Dinoor
- Department of Plant Pathology and MicrobiologyThe Robert H. Smith Faculty of Agriculture, Food and EnvironmentThe Hebrew University of JerusalemRehovot76100Israel
| | - Christina Cowger
- United States Department of Agriculture‐Agricultural Research Service (USDA‐ARS)North Carolina State UniversityRaleighNC27695USA
- Department of Plant PathologyNorth Carolina State UniversityRaleighNC27695USA
| | - Emily Meyers
- Department of Plant PathologyNorth Carolina State UniversityRaleighNC27695USA
| | - Mingfeng Xue
- Institute of Plant Protection and Soil ScienceHubei Academy of Agricultural Sciences430064WuhanChina
- Ministry of AgricultureKey Laboratory of Integrated Pest Management in Crops in Central China430064WuhanChina
| | - Fangsong Zeng
- Institute of Plant Protection and Soil ScienceHubei Academy of Agricultural Sciences430064WuhanChina
- Ministry of AgricultureKey Laboratory of Integrated Pest Management in Crops in Central China430064WuhanChina
| | - Shuangjun Gong
- Institute of Plant Protection and Soil ScienceHubei Academy of Agricultural Sciences430064WuhanChina
- Ministry of AgricultureKey Laboratory of Integrated Pest Management in Crops in Central China430064WuhanChina
- College of Life ScienceWuhan University430072WuhanChina
| | - Dazhao Yu
- Institute of Plant Protection and Soil ScienceHubei Academy of Agricultural Sciences430064WuhanChina
- Ministry of AgricultureKey Laboratory of Integrated Pest Management in Crops in Central China430064WuhanChina
- College of Life ScienceWuhan University430072WuhanChina
| | - Salim Bourras
- Department of Plant and Microbial BiologyUniversity of ZürichZollikerstrasse 1078008ZürichSwitzerland
| | - Beat Keller
- Department of Plant and Microbial BiologyUniversity of ZürichZollikerstrasse 1078008ZürichSwitzerland
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7
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Hehlmann R, Lauseker M, Saußele S, Pfirrmann M, Krause S, Kolb HJ, Neubauer A, Hossfeld DK, Nerl C, Gratwohl A, Baerlocher GM, Heim D, Brümmendorf TH, Fabarius A, Haferlach C, Schlegelberger B, Müller MC, Jeromin S, Proetel U, Kohlbrenner K, Voskanyan A, Rinaldetti S, Seifarth W, Spieß B, Balleisen L, Goebeler MC, Hänel M, Ho A, Dengler J, Falge C, Kanz L, Kremers S, Burchert A, Kneba M, Stegelmann F, Köhne CA, Lindemann HW, Waller CF, Pfreundschuh M, Spiekermann K, Berdel WE, Müller L, Edinger M, Mayer J, Beelen DW, Bentz M, Link H, Hertenstein B, Fuchs R, Wernli M, Schlegel F, Schlag R, de Wit M, Trümper L, Hebart H, Hahn M, Thomalla J, Scheid C, Schafhausen P, Verbeek W, Eckart MJ, Gassmann W, Pezzutto A, Schenk M, Brossart P, Geer T, Bildat S, Schäfer E, Hochhaus A, Hasford J. Assessment of imatinib as first-line treatment of chronic myeloid leukemia: 10-year survival results of the randomized CML study IV and impact of non-CML determinants. Leukemia 2017; 31:2398-2406. [PMID: 28804124 PMCID: PMC5668495 DOI: 10.1038/leu.2017.253] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [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: 06/23/2017] [Accepted: 07/04/2017] [Indexed: 01/06/2023]
Abstract
Chronic myeloid leukemia (CML)-study IV was designed to explore whether treatment with imatinib (IM) at 400 mg/day (n=400) could be optimized by doubling the dose (n=420), adding interferon (IFN) (n=430) or cytarabine (n=158) or using IM after IFN-failure (n=128). From July 2002 to March 2012, 1551 newly diagnosed patients in chronic phase were randomized into a 5-arm study. The study was powered to detect a survival difference of 5% at 5 years. After a median observation time of 9.5 years, 10-year overall survival was 82%, 10-year progression-free survival was 80% and 10-year relative survival was 92%. Survival between IM400 mg and any experimental arm was not different. In a multivariate analysis, risk group, major-route chromosomal aberrations, comorbidities, smoking and treatment center (academic vs other) influenced survival significantly, but not any form of treatment optimization. Patients reaching the molecular response milestones at 3, 6 and 12 months had a significant survival advantage. For responders, monotherapy with IM400 mg provides a close to normal life expectancy independent of the time to response. Survival is more determined by patients' and disease factors than by initial treatment selection. Although improvements are also needed for refractory disease, more life-time can currently be gained by carefully addressing non-CML determinants of survival.
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Affiliation(s)
- R Hehlmann
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - M Lauseker
- IBE, Universität München, Munich, Germany
| | - S Saußele
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | | | - S Krause
- Medizinische Klinik 5, Universitätsklinikum, Erlangen, Germany
| | - H J Kolb
- Medizinische Klinik III, Universität München, Munich, Germany
| | - A Neubauer
- Klinik für innere Medizin, Universitätsklinikum, Marburg, Germany
| | - D K Hossfeld
- 2. Medizinische Klinik, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - C Nerl
- Klinikum Schwabing, Munich, Germany
| | | | | | - D Heim
- Universitätsspital, Basel, Switzerland
| | | | - A Fabarius
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | | | | | - M C Müller
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | | | - U Proetel
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - K Kohlbrenner
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - A Voskanyan
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - S Rinaldetti
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - W Seifarth
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - B Spieß
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | | | - M C Goebeler
- Medizinische Klinik und Poliklinik, Universitätsklinikum, Würzburg, Germany
| | - M Hänel
- Klinik für innere Medizin 3, Chemnitz, Germany
| | - A Ho
- Medizinische Klinik V, Universität Heidelberg, Heidelberg, Germany
| | - J Dengler
- Onkologische Schwerpunktpraxis, Heilbronn, Germany
| | - C Falge
- Medizinische Klinik 5, Klinikum Nürnberg-Nord, Nürnberg, Germany
| | - L Kanz
- Medizinische Abteilung 2, Universitätsklinikum, Tübingen, Germany
| | - S Kremers
- Caritas Krankenhaus, Lebach, Germany
| | - A Burchert
- Klinik für innere Medizin, Universitätsklinikum, Marburg, Germany
| | - M Kneba
- 2. Medizinische Klinik und Poliklinik, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - F Stegelmann
- Klinik für Innere Medizin 3, Universitätsklinikum, Ulm, Germany
| | - C A Köhne
- Klinik für Onkologie und Hämatologie, Oldenburg, Germany
| | | | - C F Waller
- Innere Medizin 1, Universitätsklinikum, Freiburg, Germany
| | - M Pfreundschuh
- Klinik für Innere Medizin 1, Universität des Saarlandes, Homburg, Germany
| | - K Spiekermann
- Medizinische Klinik III, Universität München, Munich, Germany
| | - W E Berdel
- Medizinische Klinik A, Universitätsklinikum, Münster, Germany
| | - L Müller
- Onkologie Leer UnterEms, Leer, Germany
| | - M Edinger
- Klinik und Poliklinik für Innere Medizin 3, Universitätsklinikum, Regensburg, Germany
| | - J Mayer
- Masaryk University Hospital, Brno, Czech Republic
| | - D W Beelen
- Klinik für Knochenmarktransplantation, Essen, Germany
| | - M Bentz
- Medizinische Klinik 3, Städtisches Klinikum, Karlsruhe, Germany
| | - H Link
- Klinik für Innere Medizin 3, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - B Hertenstein
- 1. Medizinische Klinik, Klinikum Bremen Mitte, Bremen, Germany
| | | | - M Wernli
- Kantonsspital, Aarau, Switzerland
| | - F Schlegel
- St Antonius-Hospital, Eschweiler, Germany
| | - R Schlag
- Hämatologische-Onkologische Schwerpunktpraxis, Würzburg, Germany
| | - M de Wit
- Vivantes Klinikum Neukölln, Berlin, Germany
| | - L Trümper
- Klinik für Hämatologie und medizinische Onkologie, Universitätsmedizin, Göttingen, Germany
| | - H Hebart
- Stauferklinikum Schwäbisch Gmünd, Mutlangen, Germany
| | - M Hahn
- Onkologie Zentrum, Ansbach, Germany
| | - J Thomalla
- Praxisklinik für Hämatologie und Onkologie, Koblenz, Germany
| | - C Scheid
- Klinik 1 für Innere Medizin, Universitätsklinikum, Köln, Germany
| | - P Schafhausen
- 2. Medizinische Klinik, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - W Verbeek
- Ambulante Hämatologie und Onkologie, Bonn, Germany
| | - M J Eckart
- Internistische Schwerpunktpraxis, Erlangen, Germany
| | | | | | - M Schenk
- Barmherzige Brüder, Regensburg, Germany
| | - P Brossart
- Medizinische Klinik 3, Universität, Bonn, Germany
| | - T Geer
- Diakonie, Schwäbisch Hall, Germany
| | - S Bildat
- Medizinische Klinik 2, Herford, Germany
| | - E Schäfer
- Onkologische Schwerpunktpraxis, Bielefeld, Germany
| | - A Hochhaus
- Klinik für Innere Medizin 2, Universitätsklinikum, Jena, Germany
| | - J Hasford
- IBE, Universität München, Munich, Germany
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8
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Schütz C, Inselmann S, Sausslele S, Dietz CT, Müller MC, Eigendorff E, Brendel CA, Metzelder SK, Brümmendorf TH, Waller C, Dengler J, Goebeler ME, Herbst R, Freunek G, Hanzel S, Illmer T, Wang Y, Lange T, Finkernagel F, Hehlmann R, Huber M, Neubauer A, Hochhaus A, Guilhot J, Xavier Mahon F, Pfirrmann M, Burchert A. Expression of the CTLA-4 ligand CD86 on plasmacytoid dendritic cells (pDC) predicts risk of disease recurrence after treatment discontinuation in CML. Leukemia 2017; 31:829-836. [DOI: 10.1038/leu.2017.9] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 12/23/2022]
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9
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Cross NCP, White HE, Ernst T, Welden L, Dietz C, Saglio G, Mahon FX, Wong CC, Zheng D, Wong S, Wang SS, Akiki S, Albano F, Andrikovics H, Anwar J, Balatzenko G, Bendit I, Beveridge J, Boeckx N, Cerveira N, Cheng SM, Colomer D, Czurda S, Daraio F, Dulucq S, Eggen L, El Housni H, Gerrard G, Gniot M, Izzo B, Jacquin D, Janssen JJWM, Jeromin S, Jurcek T, Kim DW, Machova-Polakova K, Martinez-Lopez J, McBean M, Mesanovic S, Mitterbauer-Hohendanner G, Mobtaker H, Mozziconacci MJ, Pajič T, Pallisgaard N, Panagiotidis P, Press RD, Qin YZ, Radich J, Sacha T, Touloumenidou T, Waits P, Wilkinson E, Zadro R, Müller MC, Hochhaus A, Branford S. Development and evaluation of a secondary reference panel for BCR-ABL1 quantification on the International Scale. Leukemia 2016; 30:1844-52. [PMID: 27109508 PMCID: PMC5240017 DOI: 10.1038/leu.2016.90] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/11/2016] [Indexed: 12/24/2022]
Abstract
Molecular monitoring of chronic myeloid leukemia patients using robust BCR-ABL1 tests standardized to the International Scale (IS) is key to proper disease management, especially when treatment cessation is considered. Most laboratories currently use a time-consuming sample exchange process with reference laboratories for IS calibration. A World Health Organization (WHO) BCR-ABL1 reference panel was developed (MR1–MR4), but access to the material is limited. In this study, we describe the development of the first cell-based secondary reference panel that is traceable to and faithfully replicates the WHO panel, with an additional MR4.5 level. The secondary panel was calibrated to IS using digital PCR with ABL1, BCR and GUSB as reference genes and evaluated by 44 laboratories worldwide. Interestingly, we found that >40% of BCR-ABL1 assays showed signs of inadequate optimization such as poor linearity and suboptimal PCR efficiency. Nonetheless, when optimized sample inputs were used, >60% demonstrated satisfactory IS accuracy, precision and/or MR4.5 sensitivity, and 58% obtained IS conversion factors from the secondary reference concordant with their current values. Correlation analysis indicated no significant alterations in %BCR-ABL1 results caused by different assay configurations. More assays achieved good precision and/or sensitivity than IS accuracy, indicating the need for better IS calibration mechanisms.
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Affiliation(s)
- N C P Cross
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - H E White
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - T Ernst
- Department of Hematology/Oncology, Universitätsklinikum Jena, Jena, Germany
| | - L Welden
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia
| | - C Dietz
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - G Saglio
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - F-X Mahon
- Bergonie Institute Cancer Center Bordeaux, INSERM U1218, University of Bordeaux, Bordeaux, France
| | - C C Wong
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - D Zheng
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Wong
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S-S Wang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Akiki
- West Midlands Regional Genetics Laboratory, Birmingham, UK
| | - F Albano
- Department of Hematology, University of Bari, Bari, Italy
| | - H Andrikovics
- Laboratory of Molecular Diagnostics, Hungarian National Blood Transfusion Service, Budapest, Hungary.,Department of Pathophysiology, Semmelweis University, Budapest, Hungary
| | - J Anwar
- King's College Hospital London, London, UK
| | - G Balatzenko
- National Specialized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria
| | - I Bendit
- Laboratorio de Biologia Tumoral, Disciplina de Hematologia do HC-FMUSP, São Paulo, Brazil
| | - J Beveridge
- PathWest Laboratory Medicine WA, Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia
| | - N Boeckx
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KUL, Leuven, Belgium
| | - N Cerveira
- Department of Genetics, Portuguese Oncology Institute, Porto, Portugal
| | - S-M Cheng
- Department of Hematology and Oncology, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
| | - D Colomer
- Hematopathology Unit, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - S Czurda
- Division of Molecular Microbiology, Children's Cancer Research Institute, Vienna, Austria
| | - F Daraio
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - S Dulucq
- Laboratoire Hematologie, Centre Hospitalier Universitaire de Bordeaux, Universite Bordeaux, Bordeaux, France
| | - L Eggen
- Laboratory of Molecular Pathology, Oslo University Hospital, Oslo, Norway
| | - H El Housni
- Clinique de Genetique Oncologique-Service de genetique, Hopital Erasme, Brussels, Belgium
| | - G Gerrard
- Imperial Molecular Pathology, Hammersmith Hospital, London, UK
| | - M Gniot
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - B Izzo
- Department of Clinical Medicine and Surgery, University 'Federico II' of Naples, Naples, Italy.,CEINGE - Biotecnologie Avanzate, Naples, Italy
| | | | - J J W M Janssen
- Department of Hematology and Molecular Diagnostics, VU University Medical Center, Amsterdam, The Netherlands
| | - S Jeromin
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - T Jurcek
- Center of Molecular Biology and Gene Therapy, Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - D-W Kim
- Seoul St Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea
| | - K Machova-Polakova
- Department of Molecular Genetics, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - J Martinez-Lopez
- Department of Hematology, Hospital Universitario 12 de Octubre, Universidad Complutense, CNIO, Madrid, Spain
| | - M McBean
- Division of Cancer Medicine, Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | - S Mesanovic
- Pathology Department, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - G Mitterbauer-Hohendanner
- Department of Laboratory Medicine, Division of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | | | - M-J Mozziconacci
- Departement de Biopathologie, Institut Paoli-Calmettes, Marseille, France
| | - T Pajič
- Specialized Haematology Laboratory, Department of Haematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - N Pallisgaard
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - P Panagiotidis
- Hematology Unit, First Department of Internal Medicine, Laiko Hospital, University of Athens, Athens, Greece
| | - R D Press
- Department of Pathology and Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Y-Z Qin
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - J Radich
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - T Sacha
- Chair and Department of Hematology, Jagiellonian University, Kraków, Poland
| | - T Touloumenidou
- Laboratory of Molecular Biology, Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - P Waits
- Bristol Genetics Laboratory, Bristol, UK
| | | | - R Zadro
- Faculty of Pharmacy and Biochemistry and University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - M C Müller
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - A Hochhaus
- Department of Hematology/Oncology, Universitätsklinikum Jena, Jena, Germany
| | - S Branford
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia.,School of Pharmacy and Medical Science, University of South Australia, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, SA, Adelaide, Australia.,School of Molecular and Biomedical Science, University of Adelaide, Adelaide, SA, Australia
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10
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Miranda MB, Lauseker M, Kraus MP, Proetel U, Hanfstein B, Fabarius A, Baerlocher GM, Heim D, Hossfeld DK, Kolb HJ, Krause SW, Nerl C, Brümmendorf TH, Verbeek W, Fauser AA, Prümmer O, Neben K, Hess U, Mahlberg R, Plöger C, Flasshove M, Rendenbach B, Hofmann WK, Müller MC, Pfirrmann M, Hochhaus A, Hasford J, Hehlmann R, Saußele S. Secondary malignancies in chronic myeloid leukemia patients after imatinib-based treatment: long-term observation in CML Study IV. Leukemia 2016; 30:1255-62. [PMID: 26859076 PMCID: PMC4895174 DOI: 10.1038/leu.2016.20] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/14/2015] [Accepted: 12/23/2015] [Indexed: 01/20/2023]
Abstract
Treatment of chronic myeloid leukemia (CML) has been profoundly improved by the introduction of tyrosine kinase inhibitors (TKIs). Long-term survival with imatinib is excellent with a 8-year survival rate of ∼88%. Long-term toxicity of TKI treatment, especially carcinogenicity, has become a concern. We analyzed data of the CML study IV for the development of secondary malignancies. In total, 67 secondary malignancies were found in 64 of 1525 CML patients in chronic phase treated with TKI (n=61) and interferon-α only (n=3). The most common malignancies (n⩾4) were prostate, colorectal and lung cancer, non-Hodgkin's lymphoma (NHL), malignant melanoma, non-melanoma skin tumors and breast cancer. The standardized incidence ratio (SIR) for all malignancies excluding non-melanoma skin tumors was 0.88 (95% confidence interval (0.63-1.20)) for men and 1.06 (95% CI 0.69-1.55) for women. SIRs were between 0.49 (95% CI 0.13-1.34) for colorectal cancer in men and 4.29 (95% CI 1.09-11.66) for NHL in women. The SIR for NHL was significantly increased for men and women. An increase in the incidence of secondary malignancies could not be ascertained. The increased SIR for NHL has to be considered and long-term follow-up of CML patients is warranted, as the rate of secondary malignancies may increase over time.
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Affiliation(s)
- M B Miranda
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - M Lauseker
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität, München, Germany
| | - M-P Kraus
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - U Proetel
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - B Hanfstein
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - A Fabarius
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - G M Baerlocher
- Universitätsklinik für Hämatologie und Hämatologisches Zentrallabor, Inselspital, Bern, Switzerland
| | - D Heim
- Klinik für Hämatologie, Universitätsspital, Basel, Switzerland
| | - D K Hossfeld
- II. Medizinische Klinik, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - H-J Kolb
- Medizinische Klinik und Poliklinik III, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - S W Krause
- Medizinische Klinik 5, Universitätsklinikum, Erlangen, Germany
| | - C Nerl
- Klinik für Hämatologie, Onkologie, Immunologie, Palliativmedizin, Infektiologie und Tropenmedizin, Klinikum Schwabing, München, Germany
| | | | - W Verbeek
- Zentrum für ambulante Hämatologie und Onkologie, Bonn, Germany
| | - A A Fauser
- Klinik für Knochenmarktransplantation und Hämatologie/Onkologie, Klinikum, Idar-Oberstein, Germany
| | - O Prümmer
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum, Kempten, Germany
| | - K Neben
- Medizinische Klinik 2, Klinikum Mittelbaden, Standort Balg, Baden-Baden, Germany
| | - U Hess
- Klinik für Onkologie/Hämatologie, Kantonsspital, St Gallen, Switzerland
| | - R Mahlberg
- Innere Medizin 1, Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - C Plöger
- Mannheimer Onkologie Praxis, Mannheim, Germany
| | - M Flasshove
- Medizinische Klinik III, Krankenhaus, Düren, Germany
| | - B Rendenbach
- Praxis für Innere Medizin, Nephrologie, Hämatologie und Onkologie, Trier, Germany
| | - W-K Hofmann
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - M C Müller
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - M Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität, München, Germany
| | - A Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum, Jena, Germany
| | - J Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität, München, Germany
| | - R Hehlmann
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - S Saußele
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
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11
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Hettchen M, Strauss AC, Pennekamp PH, Burger C, Weber O, Müller MC. [Elastic Stable Intramedullary Nailing (ESIN) of Metatarsal Fractures]. Z Orthop Unfall 2015; 154:148-56. [PMID: 26670302 DOI: 10.1055/s-0041-109773] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM In the treatment of metatarsal fractures, the objective is early restoration of the physiological painless function of the foot. While undisplaced metatarsal fractures can be treated non-surgically, displaced fractures are a valid indication for reduction and internal fixation. Whereas plate fixation may lead to soft tissue irritation involving tendon adhesions and scar formation, retrograde percutaneous pinning may harm the intact metatarsophalangeal joint and lead to joint stiffness. We have therefore used the technique of elastic stable intramedullary nailing (ESIN) with titanium elastic nails (TEN) to achieve minimally invasive, antegrade splinting of short metatarsal shaft and neck fractures. METHOD Within 7 years, ESIN was performed in 22 patients. The surgical technique is presented and the functional results and complications were retrospectively evaluated using the AOFAS Midfoot Score. RESULTS Nineteen patients were analysed after an average follow-up of 25.6 ± 21.3 months (range: 3-72 months). The mean AOFAS score was 93.9 ± 10.4 (range 62-100) points. One case of skin irritation required TEN shortening. Pseudarthrosis, secondary fracture dislocation and nail breakage were not observed. After TEN removal 13.4 ± 12.9 (range: 5-52) weeks after implantation, no refracture occurred. CONCLUSION Antegrade, minimally invasive, elastic stable intramedullary nailing of short metatarsal shaft and neck fractures using titanium nails (TEN) is a safe surgical procedure and achieves primary functional stability. It reliably leads to fracture healing and produces good functional results.
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Affiliation(s)
- M Hettchen
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Bonn
| | - A C Strauss
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Bonn
| | - P H Pennekamp
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Bonn
| | - C Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Bonn
| | - O Weber
- Chirurgische Klinik, St. Josefs Hospital Lennestadt
| | - M C Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Bonn
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12
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Wimmer MD, Philipps HM, Windemuth M, Burger C, Müller MC. [The "Muffplastik"--a Fasciocutaneous Reconstruction Technique in a Case of Extensive Soft Tissue Defect of the Distal Forearm--Historical Technique or Salvage Procedure?]. Z Orthop Unfall 2015; 154:77-9. [PMID: 26662368 DOI: 10.1055/s-0041-107986] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We present a case of a distant pedicled flap to reconstruct a defect at the distal upper extremity. We used this flap as a salvage procedure to treat a patient in the intensive care unit who was in a reduced general condition with numerous comorbidities that made regional or free microvascular flaps hazardous.
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Affiliation(s)
- M D Wimmer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - H M Philipps
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - M Windemuth
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - C Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - M C Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
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13
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Boch T, Reinwald M, Postina P, Cornely OA, Vehreschild JJ, Heußel CP, Heinz WJ, Hoenigl M, Eigl S, Lehrnbecher T, Hahn J, Claus B, Lauten M, Egerer G, Müller MC, Will S, Merker N, Hofmann WK, Buchheidt D, Spiess B. Identification of invasive fungal diseases in immunocompromised patients by combining an Aspergillus specific PCR with a multifungal DNA-microarray from primary clinical samples. Mycoses 2015; 58:735-45. [PMID: 26497302 DOI: 10.1111/myc.12424] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2015] [Indexed: 12/21/2022]
Abstract
The increasing incidence of invasive fungal diseases (IFD), most of all invasive aspergillosis (IA) in immunocompromised patients emphasises the need to improve the diagnostic tools for detection of fungal pathogens. We investigated the diagnostic performance of a multifungal DNA-microarray detecting 15 different fungi [Aspergillus, Candida, Fusarium, Mucor, Rhizopus, Scedosporium and Trichosporon species (spp.)] in addition to an Aspergillus specific polymerase chain reaction (PCR) assay. Biopsies, bronchoalveolar lavage and peripheral blood samples of 133 immunocompromised patients (pts) were investigated by a multifungal DNA-microarray as well as a nested Aspergillus specific PCR assay. Patients had proven (n = 18), probable (n = 29), possible (n = 48) and no IFD (n = 38) and were mostly under antifungal therapy at the time of sampling. The results were compared to culture, histopathology, imaging and serology, respectively. For the non-Aspergillus IFD the microarray analysis yielded in all samples a sensitivity of 64% and a specificity of 80%. Best results for the detection of all IFD were achieved by combining DNA-microarray and Aspergillus specific PCR in biopsy samples (sensitivity 79%; specificity 71%). The molecular assays in combination identify genomic DNA of fungal pathogens and may improve identification of causative pathogens of IFD and help overcoming the diagnostic uncertainty of culture and/or histopathology findings, even during antifungal therapy.
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Affiliation(s)
- T Boch
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - M Reinwald
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - P Postina
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - O A Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne, ZKS Köln, BMBF 01KN1106, Centre for Integrated Oncology CIO Köln Bonn, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - J J Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research, Partner site Bonn-Cologne, Cologne, Germany
| | - C P Heußel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - W J Heinz
- Department II of Internal Medicine, Würzburg University Hospital, Würzburg, Germany
| | - M Hoenigl
- Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - S Eigl
- Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - T Lehrnbecher
- Pediatric Hematology and Oncology, Children's Hospital, University of Frankfurt, Frankfurt, Germany
| | - J Hahn
- Regensburg University Hospital, Regensburg, Germany
| | - B Claus
- Ludwigshafen General Hospital, Ludwigshafen, Germany
| | - M Lauten
- Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - G Egerer
- Department V of Internal Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - M C Müller
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - S Will
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - N Merker
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - W-K Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - D Buchheidt
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - B Spiess
- Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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Ploeger MM, Pennekamp PH, Müller MC, Kabir K, Burger C, Wirtz DC, Schmolders J. [Bilateral Dislocation Fracture of the Humeral Head (Right AO 11C3.3; Left AO 11A1.3) without Direct Trauma Due to First Clinical Manifestation of Seizure - a Case Report and Review of the Literature]. Z Orthop Unfall 2015; 153:643-7. [PMID: 26468921 DOI: 10.1055/s-0035-1546265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The incidence of fractures among epileptics is frequent and mostly occurs by direct trauma due to falls caused by seizures. The risk of fractures is estimated to be 50 % higher in epileptics than in the general population. Most of the fractures affect the proximal femora and the hip joint. Dorsal shoulder dislocations occur frequently in epileptics. If they occur bilaterally, this is pathognomonic for seizuring. Besides this, shoulder dislocation and bilateral dislocation fractures of the humeral head, however, are far more rare even among epileptics but pathognomonic for seizure. In this case report we present a female patient with bilateral dislocation fracture of the humeral head due to first clinical manifestation of a tonic-clonic seizure without direct trauma.
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Affiliation(s)
- M M Ploeger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - P H Pennekamp
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - M C Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - K Kabir
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - C Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - D C Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - J Schmolders
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
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15
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Strauss AC, Pennekamp PH, Placzek R, Schmolders J, Friedrich MJ, Oldenburg J, Burger C, Müller MC. Perioperative management and outcome of fracture treatment in patients with haemophilia without inhibitors. Haemophilia 2015; 22:e30-5. [PMID: 26453567 DOI: 10.1111/hae.12803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Fractures in persons with haemophilia (PWH) are not uncommon and require an interdisciplinary approach to maintain haemostasis during surgical treatment. AIM The aim of this study was to evaluate the perioperative management and outcome in PWH following fracture fixation compared to a matched non-haemophilic control group. METHODS A cohort of 44 PWH who underwent 46 surgical fracture fixations was retrospectively compared to 46 non-haemophilic patients (matched-pair controls). Patients were classified according to the fracture localization: (i) proximal upper extremity (PrUEx; n = 7), (ii) distal upper extremity (DiUEx; n = 12), (iii) proximal lower extremity (PrLEx; n = 13) and (iv) distal lower extremity (DiLEx; n = 14). Both groups were assessed for length of hospital stay, duration of surgery, drainage use and complication rates. RESULTS There was no significant difference regarding the duration of the preoperative hospital stay between PWH and controls. Only PWH who were operated at the DiUEx stayed significantly longer in hospital (4.8 ± 3.7 days) than controls (2.2 ± 2.3 days; P = 0.039). Operation time was significantly longer in PWH with fractures treated at the DiLEx (64.9 ± 26.6 min) compared to the controls (49.8 ± 37.9 min; P = 0.035). Neither frequency nor duration of surgical drainage placement differed significantly between the two groups. The overall complication rate in both groups was low without a statistically significant difference. CONCLUSION An optimal interdisciplinary perioperative management provided the surgical treatment of fractures in PWH can be performed safely with a low complication rate.
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Affiliation(s)
- A C Strauss
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - P H Pennekamp
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - R Placzek
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - J Schmolders
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - M J Friedrich
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - J Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - C Burger
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - M C Müller
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
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16
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Strauss AC, Goldmann G, Schmolders J, Müller MC, Placzek R, Oldenburg J, Wirtz DC, Pennekamp PH. [Impact of Preoperative Knee Stiffness on the Postoperative Outcome after Total Knee Arthroplasty in Patients with Haemophilia]. Z Orthop Unfall 2015; 153:526-32. [PMID: 26451861 DOI: 10.1055/s-0035-1557768] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is an effective treatment option for patients with end-stage haemophilic arthropathy of the knee. However, the procedure is technically challenging, as knee motion is often restricted before the operation and complication rates are then thought to be higher than for patients with a normal range of motion (ROM). There is very limited information on the outcome of TKA in haemophilic patients presenting with stiff knees. The objective of the present study was to retrospectively analyse and compare the clinical results after TKA in haemophiliacs with stiff and non-stiff knees. PATIENTS AND METHODS The results of 50 TKA procedures in 41 haemophilic patients were retrospectively evaluated at a mean follow-up of 7.2 ± 4.9 years (range 2-25 years). 20 patients presenting with 23 stiff knees - defined by a preoperative ROM of 50° or less - were compared with 21 patients with 27 non-stiff knees. Knee motion (ROM, flexion, extension), Knee Society Score (KSS/KSS function), pain status (visual analogue scale, VAS), number of bleedings and patient satisfaction were evaluated. RESULTS The complication rate was 12 %, including two haematomas, one aseptic loosening, and three periprosthetic infections. The overall mean ROM increased from 58.6 ± 34.2° (range 0-120°) preoperatively to 85.9 ± 23.4 (35-130°) postoperatively (p < 0.005). Mean KSS and KSS function improved from 30.6 ± 11.0 points (range 10-49) and 43.4 ± 9.3 points (range 15-65) to 79.3 ± 9.6 points (range 49-95) and 68.9 ± 11.0 points (45-90), respectively (p < 0.005). The mean VAS score decreased significantly from 7.9 ± 0.8 points (range 6-9) to 1.8 ± 1.1 points (range 0-4; p < 0.005). In comparison to the non-stiff group, patients with stiff knees showed a significantly greater mean improvement in ROM (46.3 ± 21.8° [range - 10-85°] vs. 9.4 ± 16.9° [range - 30-35°]), flexion (32.8 ± 19.6° [range - 10-85°] vs. 5.2 ± 16.2° [range - 40-35°]), and flexion contracture (13.5 ± 9.6° [range 5-30°] vs. 5.9 ± 6.7° [range 5-20°]). Both KSS and KSS function were significantly inferior in stiff knees than with non-stiff knees. Nine patients with knee stiffness who underwent additional v-y quadricepsplasty to lengthen the extensor mechanism developed a mean extensor lag of 7-0° ± 4-8° (range 5-15°). At final follow-up, 37/41 patients were satisfied or very satisfied with the surgical result. CONCLUSION TKA in haemophilic patients presenting with haemophilic arthropathy of the knee results in significant improvements in function and reduced pain. Although the ultimate clinical outcome in stiff knees is inferior to that with non-stiff knees, joint replacement surgery can be successfully performed in patients with restricted preoperative range of motion. Vy-quadricepsplasty for to facilitate exposure is associated with the development of a postoperative extensor lag and should therefore be performed restrictively. Patient satisfaction after TKA was equally high in the two groups.
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Affiliation(s)
- A C Strauss
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - G Goldmann
- Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinikum Bonn
| | - J Schmolders
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - M C Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - R Placzek
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - J Oldenburg
- Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinikum Bonn
| | - D C Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - P H Pennekamp
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
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Wenn K, Tomala L, Wilop S, Vankann L, Hasenbank C, Frank O, Hochhaus A, Giles FJ, Lange T, Müller MC, Koschmieder S, Beier F, Ziegler P, Brümmendorf TH. Telomere length at diagnosis of chronic phase chronic myeloid leukemia (CML-CP) identifies a subgroup with favourable prognostic parameters and molecular response according to the ELN criteria after 12 months of treatment with nilotinib. Leukemia 2015; 29:2402-4. [PMID: 26369986 DOI: 10.1038/leu.2015.245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- K Wenn
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - L Tomala
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - S Wilop
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - L Vankann
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - C Hasenbank
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - O Frank
- Novartis Pharma GmbH, Nürnberg, Germany
| | - A Hochhaus
- Department of Hematology/Oncology, Universitätsklinikum Jena, Jena, Germany
| | - F J Giles
- Northwestern Medicine Developmental Therapeutics Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, USA
| | - T Lange
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - M C Müller
- Department of Hematology/Oncology, Universitätsmedizin Mannheim, Germany
| | - S Koschmieder
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - F Beier
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - P Ziegler
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Institute for Occupational and Social Medicine, Aachen University, Aachen, Germany
| | - T H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
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18
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Affiliation(s)
- N C P Cross
- 1] Faculty of Medicine, University of Southampton, Southampton, UK [2] National Genetics Reference Laboratory (Wessex), Salisbury, UK
| | - M C Müller
- Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany
| | - A Hochhaus
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
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19
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Strauss AC, Schmolders J, Friedrich MJ, Pflugmacher R, Müller MC, Goldmann G, Oldenburg J, Pennekamp PH. Outcome after total knee arthroplasty in haemophilic patients with stiff knees. Haemophilia 2015; 21:e300-5. [PMID: 25931189 DOI: 10.1111/hae.12698] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Advanced haemophilic arthropathy of the knee is associated with progressive joint stiffness. Results after total knee arthroplasty (TKA) in stiff knees are considered to be inferior compared to those with less restricted preoperative range of motion (ROM). There is only very limited data on the results of primary TKA in haemophilic patients with stiff knees. AIM The purpose of this retrospective study was to evaluate the clinical outcome after TKA performed in haemophilic patients with preoperative ROM of 50° or less. METHODS Twenty one patients (23 knees) undergoing TKA with stiff knees were retrospectively evaluated. Mean follow-up was 8.3 years (range, 2-25). Clinical assessment included ROM, degree of flexion contracture and complication rate. Functional evaluation and pain status were assessed using the Knee Society's Scoring System (KSS). RESULTS Range of motion improved from 26.7° preoperatively to 73.0° postoperatively. Flexion contracture decreased from 21.7° to 8.3°. KSS increased from 22.9 to 72.9 points. Evaluation of pain revealed a decrease from 8.4 points preoperatively to 2.1 points postoperatively. All these differences were statistically significant (P < 0.005). The complication rate was 8.7% including one late periprosthetic infection, and one aseptic implant loosening. Nine patients who required VY-quadricepsplasty for knee exposure developed a mean postoperative extensor lag of 7°. CONCLUSION Total knee arthroplasty in haemophilic patients presenting with stiff knees results in significant improvement of function and reduction in pain. Although the clinical outcome is inferior compared to nonstiff knees reported in the literature, joint replacement surgery can be successfully performed in this particular group of patients.
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Affiliation(s)
- A C Strauss
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - J Schmolders
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - M J Friedrich
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - R Pflugmacher
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - M C Müller
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - G Goldmann
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - J Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - P H Pennekamp
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
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20
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Burchert A, Saussele S, Eigendorff E, Müller MC, Sohlbach K, Inselmann S, Schütz C, Metzelder SK, Ziermann J, Kostrewa P, Hoffmann J, Hehlmann R, Neubauer A, Hochhaus A. Interferon alpha 2 maintenance therapy may enable high rates of treatment discontinuation in chronic myeloid leukemia. Leukemia 2015; 29:1331-5. [PMID: 25712735 DOI: 10.1038/leu.2015.45] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/14/2015] [Accepted: 01/20/2015] [Indexed: 01/06/2023]
Abstract
A minority of chronic myeloid leukemia (CML) patients is capable of successfully discontinuing imatinib. Treatment modalities to increase this proportion are currently unknown. Here, we assessed the role of interferon alpha 2a (IFN) on therapy discontinuation in a previously reported cohort of 20 chronic phase CML patients who were treated upfront with IFN alpha plus imatinib followed by IFN monotherapy to maintain cytogenetic or molecular remission (MR) after imatinib discontinuation. After a median follow-up of 7.9 years (range, 5.2-12.2), relapse-free survival was 73% (8/11 patients) and 84% (5/6 patients) for patients who discontinued imatinib in major MR (MMR) and MR4/MR4.5, respectively. Ten patients discontinued IFN after a median of 4.5 years (range, 0.24-9.3). After a median of 2.8 years (range, 0.7-5.1), nine of them remain in ongoing treatment-free remission with MR5 (n=6) and MR4.5 (n=3). The four patients who still administer IFN are in stable MR5, MR4.5, MR4, and MMR, respectively. In conclusion, an IFN/imatinib induction treatment followed by a temporary IFN maintenance therapy may enable a high rate of treatment discontinuation in CML patients in at least MMR when stopping imatinib.
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Affiliation(s)
- A Burchert
- Klinik für Hämatologie/Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps Universität Marburg, Marburg, Germany
| | - S Saussele
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - E Eigendorff
- Abt. f. Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - M C Müller
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - K Sohlbach
- Klinik für Hämatologie/Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps Universität Marburg, Marburg, Germany
| | - S Inselmann
- Klinik für Hämatologie/Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps Universität Marburg, Marburg, Germany
| | - C Schütz
- Klinik für Hämatologie/Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps Universität Marburg, Marburg, Germany
| | - S K Metzelder
- Klinik für Hämatologie/Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps Universität Marburg, Marburg, Germany
| | - J Ziermann
- Abt. f. Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - P Kostrewa
- Klinik für Hämatologie/Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps Universität Marburg, Marburg, Germany
| | - J Hoffmann
- Klinik für Hämatologie/Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps Universität Marburg, Marburg, Germany
| | - R Hehlmann
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - A Neubauer
- Klinik für Hämatologie/Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps Universität Marburg, Marburg, Germany
| | - A Hochhaus
- Abt. f. Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
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21
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Davies A, Giannoudis A, Zhang JE, Austin G, Wang L, Holyoake TL, Müller MC, Foroni L, Kottaridis PD, Pirmohamed M, Clark RE. Dual glutathione-S-transferase-θ1 and -μ1 gene deletions determine imatinib failure in chronic myeloid leukemia. Clin Pharmacol Ther 2014; 96:694-703. [PMID: 25188725 DOI: 10.1038/clpt.2014.176] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/13/2014] [Indexed: 01/16/2023]
Abstract
Approximately 40% of patients with chronic myeloid leukemia (CML) receiving imatinib fail treatment. There is an increased risk of CML in subjects with (i) deletions of genes encoding glutathione-S-transferase (GST)-θ1 (GSTT1) and -μ1, (GSTM1) and (ii) the GST-π1 (GSTP1) single-nucleotide polymorphism (SNP) Ile105Val (GSTP1*B; rs1695); however, their effects on imatinib treatment outcome are not known. Here, we assess the role of these GSTs in relation to imatinib treatment outcome in 193 CML patients. Deletion of GSTT1 alone, or in combination with deletion of the GSTM1 gene, significantly increased the likelihood of imatinib failure (P = 0.021 and P < 0.001, respectively). The GSTP1*B SNP was not associated with time to imatinib failure. Losses of the GSTT1 and GSTM1 genes are therefore important determinants of imatinib failure in CML. Screening for GSTT1 and GSTM1 gene deletions during diagnosis may identify patients who may be better treated using an alternative therapy.
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Affiliation(s)
- A Davies
- Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - A Giannoudis
- Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - J E Zhang
- The Wolfson Centre for Personalised Medicine, Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - G Austin
- Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - L Wang
- Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - T L Holyoake
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - M C Müller
- Faculty of Medicine, University of Heidelberg, Mannheim, Germany
| | - L Foroni
- Department of Haematology, Imperial College London, Hammersmith Hospital, London, UK
| | | | - M Pirmohamed
- The Wolfson Centre for Personalised Medicine, Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - R E Clark
- Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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22
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Müller MC, Strauss A, Pflugmacher R, Nähle CP, Pennekamp PH, Burger C, Wirtz DC. [Evaluation of radiation exposure of personnel in an orthopaedic and trauma operation theatre using the new real-time dosimetry system "dose aware"]. Z Orthop Unfall 2014; 152:381-8. [PMID: 25144849 DOI: 10.1055/s-0034-1368603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM There is a positive correlation between operation time and staff exposure to radiation during intraoperative use of C-arm fluoroscopy. Due to harmful effects of exposure to long-term low-dose radiation for both the patient and the operating team it should be kept to a minimum. AIM of this study was to evaluate a novel dosimeter system called Dose Aware® (DA) enabling radiation exposure feedback of the personal in an orthopaedic and trauma operation theatre in real-time. METHOD Within a prospective study over a period of four month, DA was applied by the operation team during 104 orthopaedic and trauma operations in which the C-arm fluoroscope was used in 2D-mode. During ten operation techniques, radiation exposure of the surgeon, the first assistant, the theatre nurse and the anaesthesiologist was evaluated. RESULTS Seventy-three operations were analysed. The surgeon achieved the highest radiation exposure during dorsolumbar spinal osteosynthesis, kyphoplasty and screw fixation of sacral fractures. The first assistant received a higher radiation exposure compared to the surgeon during plate osteosynthesis of distal radius fractures (157 %), intramedullary nailing of pertrochanteric fractures (143 %) and dorsolumbar spinal osteosynthesis (240 %). During external fixation of ankle fractures (68 %) and screw fixation of sacral fractures (66 %) radiation exposure of the theatre nurse exceeded 50 % of the surgeon's radiation exposure. During plate osteosynthesis of distal radius fractures (157 %) and intramedullary splinting of clavicular fractures (115 %), the anaesthesiologist received a higher radiation exposure than the surgeon. CONCLUSION The novel dosimeter system DA provides real-time radiation exposure feedback of the personnel in an orthopaedic and trauma operation theatre for the first time. Data of this study demonstrate that radiation exposure of the personnel depends on the operation type. The first assistant, the theatre nurse and the anaesthesiologist might be exposed to higher radiation doses than the surgeon. DA might help to increase awareness concerning irradiation in an orthopaedic and trauma operation theatre and might enhance staff compliance in using radiation protection techniques.
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Affiliation(s)
- M C Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - A Strauss
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - R Pflugmacher
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - C P Nähle
- Klinik für Radiologie, Universitätsklinikum Bonn
| | - P H Pennekamp
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - C Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - D C Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
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White H, Deprez L, Corbisier P, Hall V, Lin F, Mazoua S, Trapmann S, Aggerholm A, Andrikovics H, Akiki S, Barbany G, Boeckx N, Bench A, Catherwood M, Cayuela JM, Chudleigh S, Clench T, Colomer D, Daraio F, Dulucq S, Farrugia J, Fletcher L, Foroni L, Ganderton R, Gerrard G, Gineikienė E, Hayette S, El Housni H, Izzo B, Jansson M, Johnels P, Jurcek T, Kairisto V, Kizilors A, Kim DW, Lange T, Lion T, Polakova KM, Martinelli G, McCarron S, Merle PA, Milner B, Mitterbauer-Hohendanner G, Nagar M, Nickless G, Nomdedéu J, Nymoen DA, Leibundgut EO, Ozbek U, Pajič T, Pfeifer H, Preudhomme C, Raudsepp K, Romeo G, Sacha T, Talmaci R, Touloumenidou T, Van der Velden VHJ, Waits P, Wang L, Wilkinson E, Wilson G, Wren D, Zadro R, Ziermann J, Zoi K, Müller MC, Hochhaus A, Schimmel H, Cross NCP, Emons H. A certified plasmid reference material for the standardisation of BCR-ABL1 mRNA quantification by real-time quantitative PCR. Leukemia 2014; 29:369-76. [PMID: 25036192 PMCID: PMC4320294 DOI: 10.1038/leu.2014.217] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [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: 03/31/2014] [Revised: 05/21/2014] [Accepted: 06/25/2014] [Indexed: 11/14/2022]
Abstract
Serial quantification of BCR–ABL1 mRNA is an important therapeutic indicator in chronic myeloid leukaemia, but there is a substantial variation in results reported by different laboratories. To improve comparability, an internationally accepted plasmid certified reference material (CRM) was developed according to ISO Guide 34:2009. Fragments of BCR–ABL1 (e14a2 mRNA fusion), BCR and GUSB transcripts were amplified and cloned into pUC18 to yield plasmid pIRMM0099. Six different linearised plasmid solutions were produced with the following copy number concentrations, assigned by digital PCR, and expanded uncertainties: 1.08±0.13 × 106, 1.08±0.11 × 105, 1.03±0.10 × 104, 1.02±0.09 × 103, 1.04±0.10 × 102 and 10.0±1.5 copies/μl. The certification of the material for the number of specific DNA fragments per plasmid, copy number concentration of the plasmid solutions and the assessment of inter-unit heterogeneity and stability were performed according to ISO Guide 35:2006. Two suitability studies performed by 63 BCR–ABL1 testing laboratories demonstrated that this set of 6 plasmid CRMs can help to standardise a number of measured transcripts of e14a2 BCR–ABL1 and three control genes (ABL1, BCR and GUSB). The set of six plasmid CRMs is distributed worldwide by the Institute for Reference Materials and Measurements (Belgium) and its authorised distributors (https://ec.europa.eu/jrc/en/reference-materials/catalogue/; CRM code ERM-AD623a-f).
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Affiliation(s)
- H White
- 1] National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, UK [2] Faculty of Medicine, University of Southampton, Southampton, UK
| | - L Deprez
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel, Belgium
| | - P Corbisier
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel, Belgium
| | - V Hall
- National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, UK
| | - F Lin
- 1] National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, UK [2] Faculty of Medicine, University of Southampton, Southampton, UK
| | - S Mazoua
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel, Belgium
| | - S Trapmann
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel, Belgium
| | - A Aggerholm
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - H Andrikovics
- Hungarian National Blood Transfusion Service, Budapest, Hungary
| | - S Akiki
- Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - G Barbany
- Department of Molecular Medicine and Surgery, Clinical Genetics Karolinska Institutet, Stockholm, Sweden
| | - N Boeckx
- 1] Department of Laboratory Medicine, UZ Leuven, Belgium [2] Department of Oncology, KU Leuven, Belgium
| | - A Bench
- Molecular Malignancy Laboratory and Haemato-Oncology Diagnostic Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Catherwood
- Haematology Department, Belfast City Hospital, Belfast, UK
| | - J-M Cayuela
- Haematology Laboratory and EA3518, University Hospital Saint-Louis, AP-HP, University Paris Diderot, Paris, France
| | - S Chudleigh
- Department of Molecular Haematology, Yorkhill NHS Trust, Glasgow, UK
| | - T Clench
- Molecular Haematology, Bristol Royal Infirmary, Bristol, UK
| | - D Colomer
- Hematopathology Unit, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - F Daraio
- Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - S Dulucq
- Laboratoire Hematologie, CHU Bordeaux, Hematopoiese Leucemique et Cibles Therapeutiques, INSERM U1035, Universite Bordeaux, Bordeaux, France
| | - J Farrugia
- Combined Laboratories, Derriford Hospital, Plymouth, UK
| | - L Fletcher
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - L Foroni
- Imperial Molecular Pathology, Centre for Haematology, Imperial College London, London, UK
| | - R Ganderton
- Molecular Pathology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - G Gerrard
- Imperial Molecular Pathology, Centre for Haematology, Imperial College London, London, UK
| | - E Gineikienė
- Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santariskiu Clinics, Vilnius, Lithuania
| | - S Hayette
- Laboratory of Molecular Biology and UMR5239, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - H El Housni
- Medical Genetics Department, Erasme Hospital, Brussels, Belgium
| | - B Izzo
- Department of Clinical Medicine and Surgery, University 'Federico II' of Naples, Naples, Italy
| | - M Jansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - P Johnels
- Department of Clinical Genetics, University and Regional Laboratories, Lund, Sweden
| | - T Jurcek
- Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - V Kairisto
- Turku University Hospital, TYKSLAB, Laboratory of Molecular Genetics, Turku, Finland
| | - A Kizilors
- Laboratory for Molecular Haemato-Oncology, Kings College Hospital, London, UK
| | - D-W Kim
- Cancer Research Institute, The Catholic University of Korea, Seoul, South Korea
| | - T Lange
- Abteilung für Hämatologie und internistische Onkologie, Universität Leipzig, Leipzig, Germany
| | - T Lion
- Children's Cancer Research Institute/LabDia Labordiagnostik and Medical University, Vienna, Austria
| | - K M Polakova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - G Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - S McCarron
- Cancer Molecular Diagnostics, St James's Hospital, Dublin, Ireland
| | - P A Merle
- VU Medical Centre, Department of Haematology, Amsterdam, The Netherlands
| | - B Milner
- Department of Medical Genetics, NHS-Grampian, Aberdeen, UK
| | | | - M Nagar
- Laboratory of Hematology, Sheba Medical Center, Tel Hashomer, Israel
| | - G Nickless
- Molecular Oncology Diagnostics Unit, Guy's Hospital, London, UK
| | - J Nomdedéu
- Lab Hematologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - D A Nymoen
- Division of Pathology, Rikshospital, Oslo University Hospital, Oslo, Norway
| | - E O Leibundgut
- Molecular Diagnostics Laboratory, Department of Hematology, University Hospital Bern, Bern, Switzerland
| | - U Ozbek
- Genetics Department, Institute of Experimental Medicine (DETAE), Istanbul University, Istanbul, Turkey
| | - T Pajič
- Specialized Haematology Laboratory, Division of Internal Medicine, Department of Haematology, University Medical Centre, Ljubljana, Slovenia
| | - H Pfeifer
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - C Preudhomme
- Laboratoire d'hématologie, CHU Lille, Lille, France
| | - K Raudsepp
- United Laboratories of Tartu University Hospitals, Tartu, Estonia
| | - G Romeo
- Molecular Haematology Laboratory, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - T Sacha
- Hematology Department, Jagiellonian University, Krakow, Poland
| | - R Talmaci
- Hematology Department, Fundeni Clinical Institute, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - T Touloumenidou
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - P Waits
- Bristol Genetics Laboratory, Southmead Hospital, Bristol, UK
| | - L Wang
- Department of Haematology, Royal Liverpool University Hospital, Liverpool, UK
| | - E Wilkinson
- HMDS, Leeds Institute of Oncology, St James's University Hospital, Leeds, UK
| | - G Wilson
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - D Wren
- Molecular Diagnostics, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - R Zadro
- Department of Laboratory Diagnostics, Clinical Hospital Center, Zagreb University School of Medicine, Zagreb, Croatia
| | - J Ziermann
- Department of Hematology/Oncology, Jena University Hospital, Jena, Germany
| | - K Zoi
- Haematology Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - M C Müller
- III. Medizinische Klinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - A Hochhaus
- Department of Hematology/Oncology, Jena University Hospital, Jena, Germany
| | - H Schimmel
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel, Belgium
| | - N C P Cross
- 1] National Genetics Reference Laboratory (Wessex), Salisbury District Hospital, Salisbury, UK [2] Faculty of Medicine, University of Southampton, Southampton, UK
| | - H Emons
- European Commission, Joint Research Centre, Institute for Reference Materials and Measurements, Geel, Belgium
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Hanfstein B, Shlyakhto V, Lauseker M, Hehlmann R, Saussele S, Dietz C, Erben P, Fabarius A, Proetel U, Schnittger S, Krause SW, Schubert J, Einsele H, Hänel M, Dengler J, Falge C, Kanz L, Neubauer A, Kneba M, Stegelmann F, Pfreundschuh M, Waller CF, Spiekermann K, Baerlocher GM, Pfirrmann M, Hasford J, Hofmann WK, Hochhaus A, Müller MC. Velocity of early BCR-ABL transcript elimination as an optimized predictor of outcome in chronic myeloid leukemia (CML) patients in chronic phase on treatment with imatinib. Leukemia 2014; 28:1988-92. [DOI: 10.1038/leu.2014.153] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 03/30/2014] [Accepted: 04/21/2014] [Indexed: 11/09/2022]
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Koob S, Weber O, Burger C, Müller MC. [Thromboembolic complications 6 months after plate osteosynthesis of a mid-clavicular fracture]. Z Orthop Unfall 2014; 152:177-81. [PMID: 24760458 DOI: 10.1055/s-0034-1368188] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 32-year-old patient suffered from progredient intermittent claudication of the left arm 6 months after plate fixation of a midshaft clavicular fracture (OTA classification type A). The radiological analysis revealed a subacute stenosis of the left subclavian artery, caused by a granuloma at the tip of a protruding screw, which triggered recurrent emboli and symptoms. Reperfusion was achieved by catheter embolectomy and complete removal of the plate. The case shows that, when performing plate osteosynthesis of clavicular fractures, special consideration has to be given to the length and protrusion of the applied screws. Due to the anatomic proximity not only acute, but also subsequent irritation of the subclavian vessels is possible.
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Affiliation(s)
- S Koob
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - O Weber
- Klinik für Orthopädie, Unfall- und Handchirurgie, St. Martinus Hospital, Olpe
| | - C Burger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
| | - M C Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
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26
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Agrawal M, Hanfstein B, Erben P, Wolf D, Ernst T, Fabarius A, Saussele S, Purkayastha D, Woodman RC, Hofmann WK, Hehlmann R, Hochhaus A, Müller MC. MDR1 expression predicts outcome of Ph+ chronic phase CML patients on second-line nilotinib therapy after imatinib failure. Leukemia 2014; 28:1478-85. [PMID: 24472814 DOI: 10.1038/leu.2014.6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 12/31/2013] [Indexed: 12/30/2022]
Abstract
In the face of competing tyrosine kinase inhibitors (TKIs), identification of chronic myeloid leukemia (CML) patients expecting favorable response to second-line treatment is warranted. At the time of imatinib resistance, the investigation of multidrug-resistance protein 1 (MDR1) and BCR-ABL yielded the following results: (i) Patients with high MDR1 transcript levels showed superior response at 48 months as compared with low-level MDR1 patients: major molecular response (MMR) in 41% vs 16% (P=0.014), complete cytogenetic response (CCyR) in 58% vs 39% (P=0.044), and progression-free survival (PFS) in 67% vs 46% (P=0.032). (ii) Patients with BCR-ABL(IS) <28% achieved higher MMR rates (48% vs 21%, P=0.009). (iii) PFS at 48 months was associated with in vitro resistance of BCR-ABL kinase domain mutations: 63% (no mutation) vs 61% (sensitive, intermediately sensitive or unknown IC50 (median inhibitory concentration)) vs 23% (resistant, P=0.01). (iv) Single-nucleotide polymorphisms (SNPs) at positions 1236 and 2677 were associated with higher MDR1 expression in comparison to wild type. (v) Nilotinib was able to impede proliferation of MDR1-overexpressing imatinib-resistant cells. High MDR1 gene expression might identify patients whose mode of imatinib resistance is essentially determined by increased efflux activity of MDR1 and therefore can be overcome by second-line nilotinib treatment.
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Affiliation(s)
- M Agrawal
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - B Hanfstein
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - P Erben
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - D Wolf
- Medizinische Klinik III, Onkologie, Hämatologie und Rheumatologie, Universitätsklinikum Bonn (UKB), Bonn, Germany
| | - T Ernst
- Abteilung für Hämatologie/Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - A Fabarius
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - S Saussele
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - D Purkayastha
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - R C Woodman
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - W-K Hofmann
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - R Hehlmann
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - A Hochhaus
- Abteilung für Hämatologie/Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - M C Müller
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
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27
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Cortes JE, Kim DW, Pinilla-Ibarz J, le Coutre P, Paquette R, Chuah C, Nicolini FE, Apperley JF, Khoury HJ, Talpaz M, DiPersio J, DeAngelo DJ, Abruzzese E, Rea D, Baccarani M, Müller MC, Gambacorti-Passerini C, Wong S, Lustgarten S, Rivera VM, Clackson T, Turner CD, Haluska FG, Guilhot F, Deininger MW, Hochhaus A, Hughes T, Goldman JM, Shah NP, Kantarjian H. A phase 2 trial of ponatinib in Philadelphia chromosome-positive leukemias. N Engl J Med 2013; 369:1783-96. [PMID: 24180494 PMCID: PMC3886799 DOI: 10.1056/nejmoa1306494] [Citation(s) in RCA: 764] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ponatinib is a potent oral tyrosine kinase inhibitor of unmutated and mutated BCR-ABL, including BCR-ABL with the tyrosine kinase inhibitor-refractory threonine-to-isoleucine mutation at position 315 (T315I). We conducted a phase 2 trial of ponatinib in patients with chronic myeloid leukemia (CML) or Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL). METHODS We enrolled 449 heavily pretreated patients who had CML or Ph-positive ALL with resistance to or unacceptable side effects from dasatinib or nilotinib or who had the BCR-ABL T315I mutation. Ponatinib was administered at an initial dose of 45 mg once daily. The median follow-up was 15 months. RESULTS Among 267 patients with chronic-phase CML, 56% had a major cytogenetic response (51% of patients with resistance to or unacceptable side effects from dasatinib or nilotinib and 70% of patients with the T315I mutation), 46% had a complete cytogenetic response (40% and 66% in the two subgroups, respectively), and 34% had a major molecular response (27% and 56% in the two subgroups, respectively). Responses were observed regardless of the baseline BCR-ABL kinase domain mutation status and were durable; the estimated rate of a sustained major cytogenetic response of at least 12 months was 91%. No single BCR-ABL mutation conferring resistance to ponatinib was detected. Among 83 patients with accelerated-phase CML, 55% had a major hematologic response and 39% had a major cytogenetic response. Among 62 patients with blast-phase CML, 31% had a major hematologic response and 23% had a major cytogenetic response. Among 32 patients with Ph-positive ALL, 41% had a major hematologic response and 47% had a major cytogenetic response. Common adverse events were thrombocytopenia (in 37% of patients), rash (in 34%), dry skin (in 32%), and abdominal pain (in 22%). Serious arterial thrombotic events were observed in 9% of patients; these events were considered to be treatment-related in 3%. A total of 12% of patients discontinued treatment because of an adverse event. CONCLUSIONS Ponatinib had significant antileukemic activity across categories of disease stage and mutation status. (Funded by Ariad Pharmaceuticals and others; PACE ClinicalTrials.gov number, NCT01207440 .).
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Affiliation(s)
- J E Cortes
- The authors' full names, degrees, and affiliations are listed in the Appendix
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28
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Mayer K, Gielen GH, Willinek W, Müller MC, Wolf D. Fatal progressive cerebral ischemia in CML under third-line treatment with ponatinib. Leukemia 2013; 28:976-7. [PMID: 24170029 DOI: 10.1038/leu.2013.320] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- K Mayer
- Medical Clinic III for Oncology, Haematology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany
| | - G H Gielen
- Institute of Neuropathology, University Hospital Bonn (UKB), Bonn, Germany
| | - W Willinek
- Department of Radiology, University Hospital Bonn (UKB), Bonn, Germany
| | - M C Müller
- Medical Clinic III, University Hospital Mannheim, Mannheim, Germany
| | - D Wolf
- Medical Clinic III for Oncology, Haematology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany
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29
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Müller MC, Welle K, Windemuth M, Burger C, Pennekamp PH. [Elastic titanium nails for minimally invasive intramedullary splinting of metacarpal fractures]. Z Orthop Unfall 2013; 151:525-31. [PMID: 24129725 DOI: 10.1055/s-0033-1350875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM The goal in treatment of metacarpal fractures is to restore the normal function of the hand. Although a majority of these fractures can be treated non-operatively, surgery is recommended for displaced fractures and in case of a patient wish for primary stability for practise. A poor clinical outcome is described for metacarpal shortening of more than 5 millimeters and for rotational deformity. Whereas plate osteosynthesis may lead to soft tissue irritation involving tendon adhesions and scar formation, we have used the elastic stable intramedullary nailing [ESIN] technique using titanium elastic nails (TEN) for intramedullary splinting of short metacarpal shaft and neck fractures. METHOD Within 5 years, ESIN was performed in 95 patients. The operative technique was evaluated retrospectively concerning its functional results and complications. RESULTS Sixty-three patients were analysed after an average follow-up of 14.0 ± 5.2 weeks. The mean DASH-Score was 2.3 ± 3.9 points. We saw one implant out-of-position and three cases of skin irritation affording TEN shortening. Two superficial wound infections were treated conservatively. Pseudarthrosis and nail breakage were not observed. After TEN removal 9 ± 2.4 weeks post implantationem no refracture occurred. CONCLUSION Minimally invasive intramedullary stabilisation of short metacarpal shaft and neck fractures with a TEN is a safe surgical technique and achieves primary stability for practise. It reliably leads to fracture healing and produces excellent functional results.
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Affiliation(s)
- M C Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
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30
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Wessling M, Pflugmacher R, Müller MC, Kabir K, Pennekamp PH. [Basic principles of surgical treatment of bone metastases]. Z Orthop Unfall 2013; 151:303-14; quiz 315. [PMID: 23771334 DOI: 10.1055/s-0032-1328634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Due to an increased life expectancy and improved oncological treatment, the necessity for surgical treatment of bone metastases has increased as well. Ideally, therapy should concentrate on the improvement of the patient's quality of life while preferably being interdisciplinary. The type and extent of surgical therapy depend on the prognosis, tumor entity, localization of the tumor as well as on the patient's general condition. The main aims of surgical treatment is to reduce pain and preserve or restore function and mobility. After the contribution on spinal metastases in the last volume, this article focusses on metastases of the extremities and the pelvis. Pathologic fractures with an unclear oncological situation should be examined thoroughly before any surgical treatment is performed. In case of doubt, a biopsy should be performed. Depending on the individual prognosis, possible options for extremity surgery are (compound) osteosynthesis and implantation of a tumor endoprosthesis. The latter should be preferred for patients with a favorable prognosis and long life expectancy. To avoid revision surgery, the selected implant should outlast the patient's remaining life expectancy.
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Affiliation(s)
- M Wessling
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, Bonn
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31
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Hanfstein B, Müller MC, Hehlmann R, Erben P, Lauseker M, Fabarius A, Schnittger S, Haferlach C, Göhring G, Proetel U, Kolb HJ, Krause SW, Hofmann WK, Schubert J, Einsele H, Dengler J, Hänel M, Falge C, Kanz L, Neubauer A, Kneba M, Stegelmann F, Pfreundschuh M, Waller CF, Branford S, Hughes TP, Spiekermann K, Baerlocher GM, Pfirrmann M, Hasford J, Saußele S, Hochhaus A. Early molecular and cytogenetic response is predictive for long-term progression-free and overall survival in chronic myeloid leukemia (CML). Leukemia 2012; 26:2096-102. [PMID: 22446502 DOI: 10.1038/leu.2012.85] [Citation(s) in RCA: 335] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the face of competing first-line treatment options for CML, early prediction of prognosis on imatinib is desirable to assure favorable survival or otherwise consider the use of a second-generation tyrosine kinase inhibitor (TKI). A total of 1303 newly diagnosed imatinib-treated patients (pts) were investigated to correlate molecular and cytogenetic response at 3 and 6 months with progression-free and overall survival (PFS, OS). The persistence of BCR-ABL transcript levels >10% according to the international scale (BCR-ABL(IS)) at 3 months separated a high-risk group (28% of pts; 5-year OS: 87%) from a group with >1-10% BCR-ABL(IS) (41% of pts; 5-year OS: 94%; P=0.012) and from a group with ≤1% BCR-ABL(IS) (31% of pts; 5-year OS: 97%; P=0.004). Cytogenetics identified high-risk pts by >35% Philadelphia chromosome-positive metaphases (Ph+, 27% of pts; 5-year OS: 87%) compared with ≤35% Ph+ (73% of pts; 5-year OS: 95%; P=0.036). At 6 months, >1% BCR-ABL(IS) (37% of pts; 5-year OS: 89%) was associated with inferior survival compared with ≤1% (63% of pts; 5-year OS: 97%; P<0.001) and correspondingly >0% Ph+ (34% of pts; 5-year OS: 91%) compared with 0% Ph+ (66% of pts; 5-year OS: 97%; P=0.015). Treatment optimization is recommended for pts missing these landmarks.
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Affiliation(s)
- B Hanfstein
- III Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
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Müller MC, Burger C, Wirtz DC, Weber O. [Replacement of the comminuted radial head fracture by a bipolar radial head prosthesis]. Oper Orthop Traumatol 2011; 23:37-45. [PMID: 21327953 DOI: 10.1007/s00064-010-0004-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Radial head arthroplasty as a treatment of non-reconstructable, comminuted fractures of the radial head in order to achieve elbow stability and to prevent secondary complications, such as valgus elbow instability and radius proximalization. INDICATIONS In acute trauma, a radial head fracture not suitable for internal fixation without (Mason grade III) and with (Mason grade IV) concomitant destabilizing injury, Essex-Lopresti injury, sequelae following radial head resection (e.g., elbow instability or wrist pain), failed reconstruction of the radial head, and tumor-associated radial head or neck resection. CONTRAINDICATIONS General medical contraindications for surgical intervention, cobalt-chromium allergy, and osteoporosis of the proximal radius. SURGICAL TECHNIQUE In supine position, a lateral or posterolateral approach at the elbow was used. The annular ligament was exposed and the radial neck identified just above the bicipital tuberosity. In pronation of the forearm in order to protect the radial nerve, the medullary canal was prepared using rasps. The size of the implant was determined using trial stems. A distance of 0.5 mm between the head of the prosthesis and the capitulum humeri was recommended. After using a small bone plug, the prosthesis was cemented with respect to the anatomical radial curvature. After reconstruction of the annular ligament, the stability of the elbow was verified. In case of instability, the medial collateral ligament was reconstructed and afterwards the wound closed. POSTOPERATIVE MANAGEMENT Early mobilization begins the day after surgery. In case of additional injuries, the elbow was supported by an above-elbow cast for 3-4 weeks. To prevent heterotopic ossification, nonsteroidal antiinflammatory drugs were used for up to 4 weeks with gastric protection. RESULTS A total of 13 patients with 15 radial head prosthesis were analyzed at a mean follow-up of 29.5±20.8 months. In all patients, the elbow was stable. Subjectively, good and excellent results were found with one exception. Compared to the pretrauma status, the subjective rate was 78±12%. Based on the Radin and Riseborough score, 6 of the results were good and 9 were fair. According to the Broberg and Morrey score, 1 result was very good, 8 were good, and 6 were fair. The mean DASH score was 9.9±9.7 points. Two temporary nerve lesions were observed. Five patients were diagnosed with heterotopic ossification stage I, while 2 patients were classified with stage II on the Brooker scale.
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Affiliation(s)
- M C Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
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Müller MC, Belei P, de la Fuente M, Strake M, Kabir K, Weber O, Radermacher K, Wirtz DC. Evaluation of a new computer-assisted surgical planning and navigation system based on two-dimensional fluoroscopy for insertion of a proximal femoral nail: an experimental study. Proc Inst Mech Eng H 2011; 225:477-86. [PMID: 21755777 DOI: 10.1177/2041303310395073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pertrochanteric femoral fractures are common and intramedullary nailing is an accepted method for their surgical treatment. Accurate placement of the implant is essential to ensure fixation. The conventional technique can require multiple guide wire passes, and relies heavily on fluoroscopy. A computer-assisted planning and navigation system based on two-dimensional fluoroscopy for guide wire placement in the femoral neck has been developed, in order to perform intramedullary pertrochanteric fracture fixation using the proximal femoral nail (PFNA). The planning process was supported by a 'zero-dose C-arm navigation' system. The PFNA was inserted into 12, intact, femoral sawbones guided by the computer-based navigation, and into 12, intact, femoral sawbones using a conventional fluoroscopic-assisted technique. Guide wire and subsequent blade placement in the femoral neck was evaluated. The computer-assisted technique achieved a significant decrease in the number of required fluoroscopic images and in the number of guide wire passes. The obtained average blade placement accuracy in the femoral neck was equivalent to the conventional technique. The operation time was significantly longer in the navigation-assisted group. The addition of computer-assisted planning and surgical guidance to the intramedullary nailing of pertrochanteric femoral fractures offers a number of clinical benefits based on the results of this sawbone study. Further studies including fractured sawbones and cadaver models with extension of the navigation process to all steps of PFNA introduction and with the goal of reducing operation time are indispensable before integration of this navigation system into clinical practice.
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Affiliation(s)
- M C Müller
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
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Müller MC, Belei P, De La Fuente M, Strake M, Weber O, Burger C, Radermacher K, Wirtz DC. Evaluation of a fluoroscopy-based navigation system enabling a virtual radiation-free preview of X-ray images for placement of cannulated hip screws. A cadaver study. ACTA ACUST UNITED AC 2011; 16:22-31. [PMID: 21198425 DOI: 10.3109/10929088.2010.542694] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Accurate placement of cannulated screws is essential to ensure fixation of medial femoral neck fractures. The conventional technique may require multiple guide wire passes, and relies heavily on fluoroscopy. A computer-assisted planning and navigation system based on 2D fluoroscopy for guide wire placement in the femoral neck has been developed to improve screw placement. The planning process was supported by a tool that enables a virtual radiation-free preview of X-ray images. This is called "zero-dose C-arm navigation". For the evaluation of the system, six formalin-fixed cadaveric full-body specimens (12 femurs) were used. The evaluation demonstrated the feasibility of fluoroscopically navigated guide wire and implant placement. Use of the novel system resulted in a significant reduction in the number of fluoroscopic images and drilling attempts while achieving optimized accuracy by attaining better screw parallelism and enlarged neck-width coverage. Operation time was significantly longer in the navigation assisted group. The system has yielded promising initial results; however, additional studies using fractured bone models and with extension of the navigation process to track two bone fragments must be performed before integration of this navigation system into the clinical workflow is possible, and these studies should focus on reducing the operation time.
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Affiliation(s)
- M C Müller
- Department of Orthopaedics and Trauma Surgery, University Hospital of Bonn, Bonn, Germany.
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Müller MC, Belei P, de la Fuente M, Strake M, Weber O, Burger C, Radermacher K, Wirtz DC. [Evaluation of a 2D fluoroscopy-based navigation system for insertion of the dynamic hip screw (DHS): an experimental study]. ROFO-FORTSCHR RONTG 2011; 183:536-42. [PMID: 21506071 DOI: 10.1055/s-0031-1273329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Dynamic hip screw (DHS) insertion for the fixation of lateral femoral neck fractures is an accepted surgical treatment method. A computer-assisted planning and navigation system based on 2D fluoroscopy has been developed for guidewire insertion in order to perform screw placement. The image acquisition process was supported by a radiation-saving procedure called "zero-dose C-arm navigation". The aim of this study was to evaluate this new system. MATERIALS AND METHODS In the context of a sawbone study, we inserted dynamic hip screws. The procedure was performed under navigation control and in the conventional technique in 12 sawbones. Both procedures were performed in an open and closed technique. RESULTS The computer-assisted technique significantly reduced the number of intraoperative fluoroscopic images (open technique: -8.1 ± 0.5; p < 0.001 - closed technique: -12.3 ± 3.7; p < 0.001) and the number of guidewire passes (open technique: -1.3 ± 1.2; p < 0.05 - closed technique: -1.5 ± 1.2; p < 0,05). There was no difference with respect to precision in both groups. The operation time was significantly longer in the navigation-assisted groups (open technique: + 14.6 ± 5.4 min; p < 0.001 - closed technique: + 13 ± 3 min; p < 0.001). CONCLUSION The addition of computer-assisted planning and surgical guidance supported by "zero-dose C-arm navigation" may be useful for the fixation of lateral femoral neck fractures by the DHS as it reduces the amount of fluoroscopic images and requires fewer drill tracks. Further studies with the goal of reducing the operation time are necessary.
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Affiliation(s)
- M C Müller
- Department of Orthopaedics and Trauma Surgery, University of Bonn.
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Müller MC, Belei P, de la Fuente M, Strake M, Kabir K, Weber O, Burger C, Radermacher K, Wirtz DC. [Evaluation of a 2D fluoroscopy-based navigation system for insertion of femoral neck screws. An experimental study]. Unfallchirurg 2011; 115:802-10. [PMID: 21327810 DOI: 10.1007/s00113-010-1915-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The aim of this study was the evaluation of a new computer-assisted planning and navigation system based on 2D-fluoroscopy for guidewire insertion in order to perform cannulated screw placement into the femoral neck. The image acquisition process was supported by a radiation-saving procedure called Zero-dose C-arm navigation. MATERIAL AND METHODS In the context of a sawbone study, we performed insertion of 3 cannulated screws positioned under navigation control as well as using the conventional technique in 12 sawbones. Both procedures were performed using open and closed techniques. RESULTS The computer-assisted technique significantly reduced the amount of intraoperative fluoroscopic images (open technique: -14±3 images, closed technique: -29.4±6 images). Drilling attempts were reduced in the computer-assisted groups (open technique: -1.2±1 attempts, closed technique: -1.7±1.5 attempts) and the femoral neck area covered by the screws was greater in the navigation-assisted groups (open technique: +32.1±16.3 mm(2), closed technique: +32.6±14.9 mm(2)), There was no difference concerning parallelism of the screws or perforation of femoral neck or head. The operation time was significantly longer in the navigation-assisted groups (open technique: +24.2±2.1 min, closed technique: +22.8±5.8 min). CONCLUSION The addition of computer-assisted planning and surgical guidance supported by Zero-dose C-arm navigation can be useful for the fixation of medial femoral neck fractures with cannulated screws. Further studies with the goal of reducing the operation time are indispensable before integrating this navigation system into the clinical workflow.
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Affiliation(s)
- M C Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
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Grossmann V, Kohlmann A, Zenger M, Schindela S, Eder C, Weissmann S, Schnittger S, Kern W, Müller MC, Hochhaus A, Haferlach T, Haferlach C. A deep-sequencing study of chronic myeloid leukemia patients in blast crisis (BC-CML) detects mutations in 76.9% of cases. Leukemia 2011; 25:557-60. [PMID: 21274004 DOI: 10.1038/leu.2010.298] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hochhaus A, O'Brien SG, Guilhot F, Druker BJ, Branford S, Foroni L, Goldman JM, Müller MC, Radich JP, Rudoltz M, Mone M, Gathmann I, Hughes TP, Larson RA. Erratum: Six-year follow-up of patients receiving imatinib for the first-line treatment of chronic myeloid leukemia. Leukemia 2010. [DOI: 10.1038/leu.2010.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Müller MC, Burger C, Striepens N, Wirtz CD, Weber O. [Clinical results after replacement of comminuted radial head fractures (Mason III and IV) by the bipolar radial head prosthesis of Judet]. Z Orthop Unfall 2008; 146:218-26. [PMID: 18404586 DOI: 10.1055/s-2008-1038333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM Long-term results after resection of comminuted fractures of the radial head (Mason III and IV) may lead to valgus elbow instability, radius proximalisation and rotatory instability. Radial head replacement has been used to prevent and treat these complications. The aim of this study was to define the value of the bipolar radial head prosthesis of Judet for treating comminuted fractures of the radial head. METHOD Over a 5-year period, 14 radial head prosthesis were implanted in 12 patients. Retrospectively, we studied the clinical and radiological results. RESULTS Eleven patients with thirteen implants were analysed at a mean follow-up of 33.4 +/- 20.4 months. In all patients, the elbow was stable. Subjectively, we found good and excellent results with one exception. Compared to the pre-trauma status, the subjective rate was 78 +/- 12 %. According to the score of Radin and Riseborough, five of the results were found to be good and eight to be fair. According to the Broberg and Morrey score, one result was found to be very good, seven to be good and five to be fair. The mean DASH score was 10.2 +/- 10.1 points. Two temporary nerve lesions were observed. CONCLUSION In comminuted fractures of the radial head (Mason III and IV), bipolar radial head replacement with the Judet prosthesis leads subjectively to very good and good and functionally to good and fair results on the medium-term view. Joint stability is achieved and secondary complications like valgus elbow deformity and proximal radial migration are prevented. Patients must be informed about the possibility of temporary nerve lesions, heterotopic ossification causing limitation of motion and the lack of long-term results.
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Affiliation(s)
- M C Müller
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn.
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Müller MC, Jüptner U, Wüllner U, Wirz S, Türler A, Wirtz DC, Hirner A, Standop J. [Parkinson's disease influences the perioperative risk profile in trauma patients]. Z Orthop Unfall 2008; 146:227-30. [PMID: 18404587 DOI: 10.1055/s-2008-1038330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM Parkinson's disease (PD) is one of the most common degenerative diseases of the central nervous system affecting elderly patients with increasing demographic prevalence. The aim of this study was to define the perioperative risk profile in trauma patients suffering from Parkinson's disease in order to improve treatment options in these patients. METHOD Over a period of 13 years, 16 patients suffering from Parkinson's disease treated in the department of trauma surgery were retrospectively compared using matched-pair analysis with 16 controls not affected by PD. Both groups of patients were assessed regarding morbidity, length of treatment and rehabilitation. RESULTS Trauma patients suffering from Parkinson's disease showed an increase in morbidity risk. Postoperative falls occurred significantly, infections of the urinary tract and pneumonia tendentiously more often in PD patients. Postoperative stay and length of treatment were significantly longer in patients with PD. These patients also tended to stay longer preoperatively and remained longer in intensive care. PD patients required on-ward rehabilitation significantly more often. CONCLUSION Concomitant Parkinson's disease is a significant factor of perioperative morbidity in trauma patients. Perioperative morbidity in PD patients may be influenced by early diagnostic and therapeutic measures.
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Affiliation(s)
- M C Müller
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn
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Abstract
BACKGROUND In up to 31% of cases, conservative treatment of mid-clavicular fractures leads to unsatisfactory results. The aim of this study was to define the value of minimally invasive elastic stable intramedullary nailing (ESIN) of mid-clavicular fractures with titanium elastic nails. MATERIAL AND METHODS Within 5 years, ESIN was performed in 45 patients. We studied the functional results and complications. RESULTS Retrospectively we analysed the results of all patients at a mean follow-up of 24.7+/-2.4 months. Iatrogenic perforation of the lateral cortex occurred twice and medial migration in eight patients. Superficial skin infection developed in one. Nail breakage after fracture healing was observed twice. Twelve patients sustained clavicular shortening of > or =5 mm in relation to the intact contralateral side. After 6 months the mean constant score was 94.3+/-2 points, and the mean DASH score was 5.4+/-2.2 points. CONCLUSION Intramedullary stabilisation of mid-clavicular fractures with titanium elastic nails is a minimally invasive technique with good functional results. Patients must be informed about the possibility of open reduction in about half of the cases as well as shoulder asymmetry, migration of the nail, and iatrogenic nerve and vessel injury.
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Affiliation(s)
- M C Müller
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn.
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Metzgeroth G, Walz C, Score J, Siebert R, Schnittger S, Haferlach C, Popp H, Haferlach T, Erben P, Mix J, Müller MC, Beneke H, Müller L, Del Valle F, Aulitzky WE, Wittkowsky G, Schmitz N, Schulte C, Müller-Hermelink K, Hodges E, Whittaker SJ, Diecker F, Döhner H, Schuld P, Hehlmann R, Hochhaus A, Cross NCP, Reiter A. Recurrent finding of the FIP1L1-PDGFRA fusion gene in eosinophilia-associated acute myeloid leukemia and lymphoblastic T-cell lymphoma. Leukemia 2007; 21:1183-8. [PMID: 17377585 DOI: 10.1038/sj.leu.2404662] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The FIP1L1-PDGFRA fusion gene has been described in patients with eosinophilia-associated myeloproliferative disorders (Eos-MPD). Here, we report on seven FIP1L1-PDGFRA-positive patients who presented with acute myeloid leukemia (AML, n=5) or lymphoblastic T-cell non-Hodgkin-lymphoma (n=2) in conjunction with AML or Eos-MPD. All patients were male, the median age was 58 years (range, 40-66). AML patients were negative for common mutations of FLT3, NRAS, NPM1, KIT, MLL and JAK2; one patient revealed a splice mutation of RUNX1 exon 7. Patients were treated with imatinib (100 mg, n=5; 400 mg, n=2) either as monotherapy (n=2), as maintenance treatment after intensive chemotherapy (n=3) or in overt relapse 43 and 72 months, respectively, after primary diagnosis and treatment of FIP1L1-PDGFRA-positive disease (n=2). All patients are alive, disease-free and in complete hematologic and complete molecular remission after a median time of 20 months (range, 9-36) on imatinib. The median time to achievement of complete molecular remission was 6 months (range, 1-14). We conclude that all eosinophilia-associated hematological malignancies should be screened for the presence of the FIP1L1-PDGFRA fusion gene as they are excellent candidates for treatment with tyrosine kinase inhibitors even if they present with an aggressive phenotype such as AML.
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Affiliation(s)
- G Metzgeroth
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
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Frank O, Brors B, Fabarius A, Li L, Haak M, Merk S, Schwindel U, Zheng C, Müller MC, Gretz N, Hehlmann R, Hochhaus A, Seifarth W. Gene expression signature of primary imatinib-resistant chronic myeloid leukemia patients. Leukemia 2006; 20:1400-7. [PMID: 16728981 DOI: 10.1038/sj.leu.2404270] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Although the selective tyrosine kinase inhibitor imatinib is successfully used in the treatment of chronic myeloid leukemia (CML), inherent mechanisms confer primary resistance to leukemic patients. In order to search for potentially useful genes in predicting cytogenetic response, a retrospective gene expression study was performed. Leukocyte RNA isolated before imatinib from interferon-alpha-pretreated chronic phase CML patients (n=34) with or without major cytogenetic remission (< or =35% Philadelphia (Ph)+ metaphases) during the first year of treatment was comparatively analyzed using Affymetrix U133A chips. Using support vector machines for gene classification, an outcome-specific gene expression signature consisting of 128 genes was identified. Comparative expression data of specific genes point to changes in apoptosis (e.g. casp9, tumor necrosis factor receptor-associated protein 1, hras), DNA repair (msh3, ddb2), oxidative stress protection (glutathione synthetase, paraoxonase 2, vanin 1) and centrosomes (inhibitor of differentiation-1) within primary resistant patients. Independent statistical approaches and quantitative real-time reverse transcriptase-polymerase chain reaction studies support the clinical relevance of gene profiling. In conclusion, this study establishes a candidate predictor of imatinib resistance in interferon-alpha-pretreated CML patients to be subjected to future investigation in a larger independent patient cohort. The resulting expression signature point to involvement of BCR-ABL-independent mechanisms of resistance.
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Affiliation(s)
- O Frank
- III. Medizinische Klinik, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Universitätsklinikum Mannheim der Ruprecht-Karls-Universität Heidelberg, Mannheim, Germany.
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Müller MC, Gattermann N, Lahaye T, Deininger MWN, Berndt A, Fruehauf S, Neubauer A, Fischer T, Hossfeld DK, Schneller F, Krause SW, Nerl C, Sayer HG, Ottmann OG, Waller C, Aulitzky W, le Coutre P, Freund M, Merx K, Paschka P, König H, Kreil S, Berger U, Gschaidmeier H, Hehlmann R, Hochhaus A. Dynamics of BCR-ABL mRNA expression in first-line therapy of chronic myelogenous leukemia patients with imatinib or interferon α/ara-C. Leukemia 2003; 17:2392-400. [PMID: 14523462 DOI: 10.1038/sj.leu.2403157] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We sought to determine dynamics of BCR-ABL mRNA expression levels in 139 patients with chronic myelogenous leukemia (CML) in early chronic phase, randomized to receive imatinib (n=69) or interferon (IFN)/Ara-C (n=70). The response was sequentially monitored by cytogenetics from bone marrow metaphases (n=803) and qualitative and quantitative RT-PCR from peripheral blood samples (n=1117). Complete cytogenetic response (CCR) was achieved in 60 (imatinib, 87%) vs 10 patients (IFN/Ara-C, 14%) after a median observation time of 24 months. Within the first year after CCR, best median ratio BCR-ABL/ABL was 0.087%, (imatinib, n=48) vs 0.27% (IFN/Ara-C, n=9, P=0.025). BCR-ABL was undetectable in 25 cases by real-time PCR, but in only four patients by nested PCR. Median best response in patients with relapse after CCR was 0.24% (n=3) as compared to 0.029% in patients with continuous remission (n=52, P=0.029). We conclude that (i) treatment with imatinib in newly diagnosed CML patients is associated with a rapid decrease of BCR-ABL transcript levels; (ii) nested PCR may reveal residual BCR-ABL transcripts in samples that are negative by real-time PCR; (iii) BCR-ABL transcript levels parallel cytogenetic response, and (iv) imatinib is superior to IFN/Ara-C in terms of the speed and degree of molecular responses, but residual disease is rarely eliminated.
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MESH Headings
- Adult
- Aged
- Antimetabolites, Antineoplastic/administration & dosage
- Antineoplastic Agents/administration & dosage
- Benzamides
- Cross-Over Studies
- Cytarabine/administration & dosage
- Cytogenetics
- Female
- Fusion Proteins, bcr-abl/genetics
- Humans
- Imatinib Mesylate
- Interferon-alpha/administration & dosage
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Piperazines/administration & dosage
- Prognosis
- Prospective Studies
- Pyrimidines/administration & dosage
- RNA, Messenger/metabolism
- Recurrence
- Risk Factors
- Treatment Outcome
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Affiliation(s)
- M C Müller
- III. Medizinische Universitätsklinik, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim, Germany
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Paschka P, Müller MC, Merx K, Kreil S, Schoch C, Lahaye T, Weisser A, Petzold A, König H, Berger U, Gschaidmeier H, Hehlmann R, Hochhaus A. Molecular monitoring of response to imatinib (Glivec) in CML patients pretreated with interferon alpha. Low levels of residual disease are associated with continuous remission. Leukemia 2003; 17:1687-94. [PMID: 12970765 DOI: 10.1038/sj.leu.2403033] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A significant proportion of chronic myeloid leukemia (CML) patients achieve a major cytogenetic remission (MCR) to imatinib therapy after failing interferon (IFN) alpha-based protocols. We sought to determine levels of residual disease in patients with MCR using various molecular methods and to establish a relation between residual BCR-ABL transcript levels and rate of relapse in complete cytogenetic remission (CCR). Response was measured by conventional cytogenetic analysis, hypermetaphase and interphase fluorescence in situ hybridization (HM-FISH, IP-FISH) of bone marrow (BM) cells, qualitative nested and quantitative reverse transcriptase polymerase chain reaction (RT-PCR) for BCR-ABL transcripts. We investigated 323 peripheral blood (PB) and BM samples from 48 CML patients who achieved a complete (Ph+ 0%; n=41) or partial (Ph+ 1-34%; n=7) cytogenetic remission after 3-20 months of imatinib therapy. Prior to imatinib, 35 patients were in chronic phase (CP), eight in accelerated phase (AP), four in myeloid and one in lymphoid blast crisis. HM-FISH results correlated with ratios BCR-ABL/ABL in PB and BM. In patients with CCR, residual disease was detectable by HM-FISH (31%), IP-FISH (18%), and RT-PCR (100%). During follow-up, BCR-ABL became undetectable in two patients (one CP, one AP) by both nested and quantitative RT-PCR. CCR is ongoing in 30 evaluable patients, 11 patients have relapsed. At the time of best response, median ratios BCR-ABL/ABL were 2.1% (range 0.82-7.8) in patients with subsequent relapse and 0.075% (range 0-3.9) in patients with ongoing remission (P=0.0011). All 16 CP patients, who achieved ratios BCR-ABL/ABL <0.1% as best molecular response are in continuous remission, while 6/13 patients (46%) with ratios >/=0.1% have relapsed (P=0.0036). We conclude that: (i) in patients with CCR to imatinib, HM-FISH and RT-PCR usually reveal residual BCR-ABL+ cells; (ii) RT-PCR results derived from PB and BM are comparable in CP CML; and (iii) low levels of residual disease with ratios BCR-ABL/ABL &<0.1% are associated with continuous remission.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Benzamides
- Bone Marrow/metabolism
- Bone Marrow/pathology
- Drug Resistance, Neoplasm
- Female
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Humans
- Imatinib Mesylate
- In Situ Hybridization, Fluorescence
- Interferon-alpha/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Neoplasm, Residual/diagnosis
- Piperazines/therapeutic use
- Prognosis
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Pyrimidines/therapeutic use
- RNA, Messenger/analysis
- RNA, Neoplasm/genetics
- Remission Induction
- Reverse Transcriptase Polymerase Chain Reaction
- Sensitivity and Specificity
- Survival Rate
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Affiliation(s)
- P Paschka
- III. Medizinische Klinik, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim, Germany
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Müller MC, Merx K, Weisser A, Kreil S, Lahaye T, Hehlmann R, Hochhaus A. Improvement of molecular monitoring of residual disease in leukemias by bedside RNA stabilization. Leukemia 2002; 16:2395-9. [PMID: 12454744 DOI: 10.1038/sj.leu.2402734] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2002] [Accepted: 07/09/2002] [Indexed: 11/09/2022]
Abstract
The sensitivity of assays designed to monitor minimal residual disease (MRD) by RT-PCR in leukemia depend on quality and quantity of RNA derived from peripheral blood (PB) and bone marrow (BM) leukocytes. Shipment of material may lead to RNA degradation resulting in a loss of sensitivity and, potentially, false negative results. Furthermore, degradation may lead to inaccurate estimates of MRD in positive specimens. We sought to determine feasibility and efficacy of a novel blood collection and processing system which is based on integrated RNA stabilization at the time of phlebotomy (PAXgene Blood RNA Kit) by comparison with standard methods of RNA extraction (cesium chloride gradient ultracentrifugation and RNeasy Mini Kit) using unstabilized EDTA anticoagulated PB. In 26 patients with chronic myelogenous leukemia (CML) on therapy, PB was processed after a storage time at room temperature of 2 and 72 h according to these protocols. BCR-ABL, total ABL and glucose-6-phosphate dehydrogenase (G6PD) mRNA transcripts of PB samples were quantified as a measure for response to therapy and RNA integrity. RNA yield expressed as the ratio of ABL transcripts after a storage time of 72 h/ABL transcripts after a storage time of 2 h at room temperature was significantly higher with the stabilizing method (median 0.40) compared to the RNeasy method using unstabilized PB (median 0.13, P = 0.01). Furthermore, ratios BCR-ABL/ABL after 72 vs 2 h still correlated well using the PAXgene method (r = 0.99, P < 0.0001) in contrast to the standard method which did not (r = 0.65, P = 0.03). Even investigation of complete cytogenetic responders with very low tumor burden showed a good correlation of ratios BCR-ABL/ABL compared to the reference method. Comparable results were achieved using G6PD transcripts as standard. We conclude that the new PAXgene stabilization method could improve RNA quality and the comparability of molecular monitoring within and between multicenter trials.
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Affiliation(s)
- M C Müller
- III. Medizinische Klinik, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim, Germany
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47
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Hochhaus A, Kreil S, Corbin AS, La Rosée P, Müller MC, Lahaye T, Hanfstein B, Schoch C, Cross NCP, Berger U, Gschaidmeier H, Druker BJ, Hehlmann R. Molecular and chromosomal mechanisms of resistance to imatinib (STI571) therapy. Leukemia 2002; 16:2190-6. [PMID: 12399961 DOI: 10.1038/sj.leu.2402741] [Citation(s) in RCA: 622] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2002] [Accepted: 07/23/2002] [Indexed: 11/08/2022]
Abstract
Selective inhibition of the BCR-ABL tyrosine kinase by imatinib (STI571, Glivec/Gleevec) is a promising new therapeutic strategy in patients with chronic myelogenous leukemia (CML). Despite significant hematologic and cytogenetic responses, resistance occurs, particularly in patients with advanced disease. We sought to determine the underlying mechanisms. Sixty-six patients with CML in myeloid blast crisis (n = 33), lymphoid blast crisis (n = 2), accelerated phase (n = 16), chronic phase (n = 13), and BCR-ABL-positive acute lymphoblastic leukemia (n = 2) resistant to imatinib were investigated. Median duration of imatinib therapy was 148 days (range 6-882). Patients were evaluated for genomic amplification of BCR-ABL, overexpression of BCR-ABL transcripts, clonal karyotypic evolution, and mutations of the imatinib binding site in the BCR-ABL tyrosine kinase domain. Results were as follows: (1) Median levels of BCR-ABL transcripts, were not significantly changed at the time of resistance but 7/55 patients showed a >10-fold increase in BCR-ABL levels; (2) genomic amplification of BCR-ABL was found in 2/32 patients evaluated by fluorescence in situ hybridization; (3) additional chromosomal aberrations were observed in 19/36 patients; (4) point mutations of the ABL tyrosine kinase domain resulting in reactivation of the BCR-ABL tyrosine kinase were detected in 23/66 patients. In conclusion, although the heterogeneous development of imatinib resistance is challenging, the fact that BCR-ABL is active in many resistant patients suggests that the chimeric oncoprotein remains a good therapeutic target. However, patients with clonal evolution are more likely to have BCR-ABL-independent mechanisms of resistance. The observations warrant trials combining imatinib with other agents.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Benzamides
- Chromosome Aberrations/drug effects
- DNA Mutational Analysis
- DNA Primers/chemistry
- DNA, Neoplasm/metabolism
- Drug Resistance, Neoplasm/genetics
- Enzyme Inhibitors/therapeutic use
- Fusion Proteins, bcr-abl/genetics
- Genes, abl/genetics
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Mutation
- Neoplasm Recurrence, Local/genetics
- Piperazines/therapeutic use
- Polymerase Chain Reaction
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Protein-Tyrosine Kinases/genetics
- Pyrimidines/therapeutic use
- Treatment Outcome
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Affiliation(s)
- A Hochhaus
- III. Medizinische Universitätsklinik, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Germany
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Abstract
HISTORY AND CLINICAL FINDINGS A 60-year-old woman presented with night-sweats and increasing weakness. Physical examination revealed no abnormalities. For 27 years she had been treated for Philadelphia-positive chronic myeloid leukemia (CML). Because of progressive disease treatment with the tyrosine kinase inhibitor imatinib (STI571, Glivec (R)) had been started 9 months before. She had achieved complete hematological remission within 8 weeks, but not a cytogenetic response. INVESTIGATIONS Elevated WBC count (26.7/nl) with a differential displaying typical features of acceleration in bone marrow aspirate confirmed CML in accelerated phase. Sequencing of the ATP binding site of the BCR-ABL gene, which - at protein level - is the target for imatinib, revealed the clonal selection of cells harboring a point mutation leading to the exchange of amino acid 253 from tyrosine to histidine. This was considered to be the cause of resistance to imatinib. TREATMENT AND COURSE Dose increase of imatinib up to 600 mg daily and administration of cytarabine did not overcome resistance. Imatinib therapy was discontinued; hematologic remission was induced by oral therapy with hydroxyurea and mercaptopurine. In the course of the following 6 months a gradual decrease of the resistant clone from 100 % down to lower than the detection limit of the method was demonstrated. CONCLUSIONS Clonal mutations are often the cause of resistance to imatinib therapy. They can be detected by sequencing of the ATP binding site of BCR-ABL in specialized laboratories. This case shows that discontinuation of imatinib therapy can significantly reduce the mutated (resistant) clone and thereby restore sensitivity to imatinib.
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MESH Headings
- Amino Acid Substitution/genetics
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Benzamides
- Clone Cells/drug effects
- Drug Resistance, Neoplasm/genetics
- Female
- Fusion Proteins, bcr-abl
- Histidine/genetics
- Humans
- Hydroxyurea/administration & dosage
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Mercaptopurine/administration & dosage
- Middle Aged
- Oncogene Proteins, Fusion/drug effects
- Oncogene Proteins, Fusion/genetics
- Piperazines/adverse effects
- Piperazines/therapeutic use
- Point Mutation/genetics
- Pyrimidines/adverse effects
- Pyrimidines/therapeutic use
- Selection, Genetic
- Tyrosine/genetics
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Affiliation(s)
- M C Müller
- III. Medizinische Klinik, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim.
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Hochhaus A, Berger U, Reiter A, Engelich G, Lahaye T, Kreil S, Merx K, Müller MC, Hehlmann R. [Current therapy concepts in chronic myeloid leukemia. Study IV of the German CML Study Group]. Internist (Berl) 2002; 43:1228, 1231-8, 1241-4. [PMID: 12524904 DOI: 10.1007/s00108-002-0706-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Benzamides
- Chromosome Aberrations
- Fusion Proteins, bcr-abl/genetics
- Humans
- Hydroxyurea/administration & dosage
- Imatinib Mesylate
- Interferon-alpha/administration & dosage
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/classification
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Piperazines/administration & dosage
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Pyrimidines/administration & dosage
- Randomized Controlled Trials as Topic
- Stem Cell Transplantation
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Affiliation(s)
- A Hochhaus
- III. Medizinische Universitätsklinik, Klinikum Mannheim, Universität Heidelberg, Wiesbadener Strasse 7-11, 68305 Mannheim.
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50
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Merx K, Müller MC, Kreil S, Lahaye T, Paschka P, Schoch C, Weisser A, Kuhn C, Berger U, Gschaidmeier H, Hehlmann R, Hochhaus A. Early reduction of BCR-ABL mRNA transcript levels predicts cytogenetic response in chronic phase CML patients treated with imatinib after failure of interferon alpha. Leukemia 2002; 16:1579-83. [PMID: 12200666 DOI: 10.1038/sj.leu.2402680] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2002] [Accepted: 05/30/2002] [Indexed: 11/08/2022]
Abstract
The degree of tumor load reduction as measured by cytogenetic response is an important prognostic factor for chronic myelogenous leukemia (CML) patients on therapy. We sought to determine whether BCR-ABL transcript levels can predict chromosomal response. Residual disease was evaluated in 120 CML patients in chronic phase (CP) treated with the selective tyrosine kinase inhibitor imatinib after resistance or intolerance to interferon alpha (IFN). Median time of therapy was 401 days (range 111-704). BCR-ABL and total ABL transcripts were measured in 486 peripheral blood (PB) specimens with a real time RT-PCR approach using fluorescent-labeled hybridization probes (LightCycler technology) and results were expressed as the ratio BCR-ABL/ABL. Cytogenetic response was determined in 3-monthly intervals: From 101 evaluable patients, 42 achieved a complete (CR, 0% Philadelphia chromosome (Ph)- positive metaphases), 18 a partial (PR, 1-34% Ph+), 13 a minor (MR, 35-94% Ph+), and 26 no response (NR, >94% Ph+). All PB samples were RT-PCR positive. The proportion of Ph+ metaphases and simultaneous BCR-ABL/ABL ratios correlated with r = 0.74, P < 0.0001. In order to investigate whether early molecular analysis may predict cytogenetic response, quantitative RT-PCR data obtained after 1 and 2 months of therapy were compared with cytogenetic response at 6 months. BCR-ABL/ABL ratios after 1 month were not predictive, but results after 2 months correlated with the consecutive cytogenetic response (P = 0.0008). The probability for a major cytogenetic response was significantly higher in patients with a BCR-ABL/ABL ratio <20% after 2 months of imatinib therapy. We conclude that: (1) quantitative determination of residual disease with real time RT-PCR is a reliable and sensitive method to monitor CML patients on imatinib therapy; (2) BCR-ABL/ABL ratios correlate well with cytogenetic response; (3) in IFN-pretreated patients all complete responders to imatinib have evidence of residual disease with the limited follow-up available; and (4) cytogenetic response at 6 months of therapy in CP patients is predictable with real time RT-PCR at 2 months.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Benzamides
- Bone Marrow/metabolism
- Bone Marrow/pathology
- Drug Resistance, Neoplasm
- Female
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Humans
- Imatinib Mesylate
- Interferon-alpha/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Neoplasm, Residual
- Piperazines/therapeutic use
- Prognosis
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Pyrimidines/therapeutic use
- RNA, Messenger/analysis
- RNA, Neoplasm/genetics
- Recurrence
- Reverse Transcriptase Polymerase Chain Reaction
- Sensitivity and Specificity
- Survival Rate
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Affiliation(s)
- K Merx
- III. Medizinische Klinik, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim, Germany
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