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Maier CP, Klose C, Seitz CM, Heubach F, Döring M, Meisel R, Schuster F, Gruhn B, Keller F, Rabsteyn A, Arendt AM, Amorelli G, Eichholz T, Feuchtinger T, Martinius H, Nierkens S, Teltschik R, Schulte JH, Lengerke C, Handgretinger R, Lang P. Influence of ATLG serum levels on CD3/CD19-depleted hematopoietic grafts and on immune recovery in pediatric haplo-HSCT. Blood Adv 2024; 8:2160-2171. [PMID: 38290133 PMCID: PMC11068504 DOI: 10.1182/bloodadvances.2023011016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/20/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024] Open
Abstract
ABSTRACT Anti-T lymphocyte globulin (ATLG) significantly reduces the risk of engraftment failure in allogeneic hematopoietic stem cell transplant (HSCT) but hampers posttransplant immune reconstitution. We hypothesized that in patients receiving haploidentical CD3/CD19-depleted grafts, these double-edged effects could be better balanced by attaining high ATLG serum concentrations before transplant but as low as possible on the day of transplant. Therefore, we moved the start of ATLG application to day -12 and determined serum concentrations of T-cell-specific ATLG in pediatric patients treated with 3 established dosing regimens (15, 30, or 60 mg/kg). Corresponding mean T-cell-specific ATLG serum concentrations at day 0 were 1.14, 2.99, or 12.10 μg/mL, respectively. Higher ATLG doses correlated with higher peak levels at days -8 and -7 and reduced graft rejection, whereas lower ATLG doses correlated with significantly faster posttransplant recovery of T and natural killer cells. The rate of graft-versus-host disease remained low, independent of ATLG doses. Moreover, in vitro assays showed that ATLG concentrations of 2.0 μg/mL and lower only slightly reduced the activity of natural killer cells, and therefore, the function of such effector cells might be preserved in the grafts. Pharmacokinetic analysis, compatible with linear first-order kinetics, revealed similar half-life values, independent of ATLG doses. Hence, the day on which a desired ATLG serum level is reached can be calculated before HSCT. Our retrospective study demonstrates the relevance of dosing and time of administration of ATLG on engraftment and immune recovery in ex vivo CD3/CD19-depleted haploidentical HSCT.
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Affiliation(s)
- Claus-Philipp Maier
- Department of General Pediatrics, Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, Center for Internal Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Chihab Klose
- Center for Clinical Transfusion Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Christian Martin Seitz
- Department of General Pediatrics, Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tuebingen, a partnership between DKFZ and University Hospital Tuebingen, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies,” University of Tuebingen, Tuebingen, Germany
| | - Florian Heubach
- Department of General Pediatrics, Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies,” University of Tuebingen, Tuebingen, Germany
| | - Michaela Döring
- Department of General Pediatrics, Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
| | - Roland Meisel
- Division of Pediatric Stem Cell Therapy, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Friedhelm Schuster
- Division of Pediatric Stem Cell Therapy, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - Frieder Keller
- Department of Nephrology, Center for Internal Medicine, University Hospital Ulm, Ulm, Germany
- Institute of Experimental and Clinical Pharmacology and Toxicology, University Hospital Ulm, Ulm, Germany
| | - Armin Rabsteyn
- Department of General Pediatrics, Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tuebingen, a partnership between DKFZ and University Hospital Tuebingen, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies,” University of Tuebingen, Tuebingen, Germany
| | - Anne-Marie Arendt
- Department of General Pediatrics, Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
| | - Germano Amorelli
- Department of General Pediatrics, Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tuebingen, a partnership between DKFZ and University Hospital Tuebingen, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies,” University of Tuebingen, Tuebingen, Germany
| | - Thomas Eichholz
- Department of General Pediatrics, Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
| | - Tobias Feuchtinger
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's University Hospital, Munich, Germany
| | | | - Stefan Nierkens
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Rouwen Teltschik
- Department of General Pediatrics, Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
| | - Johannes Hubertus Schulte
- Department of General Pediatrics, Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies,” University of Tuebingen, Tuebingen, Germany
| | - Claudia Lengerke
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, Center for Internal Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Rupert Handgretinger
- Department of General Pediatrics, Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
| | - Peter Lang
- Department of General Pediatrics, Hematology/Oncology, Children’s University Hospital Tuebingen, Tuebingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tuebingen, a partnership between DKFZ and University Hospital Tuebingen, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies,” University of Tuebingen, Tuebingen, Germany
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Bonig H, Verbeek M, Herhaus P, Braitssch K, Beutel G, Schmid C, Müller N, Bug G, Döring M, von Stackelberg A, Tischer J, Ayuk F, Wulf G, Holtick U, Pfeffermann LM, Jahrsdörfer B, Schrezenmeier H, Kuci S, Kuci Z, Zens A, Tribanek M, Zeiser R, Huenecke S, Bader P. Real-world data suggest effectiveness of the allogeneic mesenchymal stromal cells preparation MSC-FFM in ruxolitinib-refractory acute graft-versus-host disease. J Transl Med 2023; 21:837. [PMID: 37990219 PMCID: PMC10664468 DOI: 10.1186/s12967-023-04731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Patients with steroid-refractory acute graft-versus-host disease (aGvHD) not tolerating/responding to ruxolitinib (RR-aGvHD) have a dismal prognosis. METHODS We retrospectively assessed real-world outcomes of RR-aGvHD treated with the random-donor allogeneic MSC preparation MSC-FFM, available via Hospital Exemption in Germany. MSC-FFM is provided as frozen cell dispersion for administration as i.v. infusion immediately after thawing, at a recommended dose of 1-2 million MSCs/kg body weight in 4 once-weekly doses. 156 patients, 33 thereof children, received MSC-FFM; 5% had Grade II, 40% had Grade III, and 54% had Grade IV aGvHD. Median (range) number of prior therapies was 4 (1-10) in adults and 7 (2-11) in children. RESULTS The safety profile of MSC-FFM was consistent with previous reports for MSC therapies in general and MSC-FFM specifically. The overall response rate at Day 28 was 46% (95% confidence interval [CI] 36-55%) in adults and 64% (45-80%) in children; most responses were durable. Probability of overall survival at 6, 12 and 24 months was 47% (38-56%), 35% (27-44%) and 30% (22-39%) for adults, and 59% (40-74%), 42% (24-58%) and 35% (19-53%) for children, respectively (whole cohort: median OS 5.8 months). CONCLUSION A recent real-world analysis of outcomes for 64 adult RR-aGvHD patients not treated with MSCs reports survival of 20%, 16% and 10% beyond 6, 12 and 24 months, respectively (median 28 days). Our data thus suggest effectiveness of MSC-FFM in RR-aGvHD.
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Affiliation(s)
- Halvard Bonig
- Faculty of Medicine, Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
| | - Mareike Verbeek
- School of Medicine, Technical University Munich, Klinikum Rechts Der Isar, Clinic and Policlinic for Internal Medicine III, Munich, Germany
| | - Peter Herhaus
- School of Medicine, Technical University Munich, Klinikum Rechts Der Isar, Clinic and Policlinic for Internal Medicine III, Munich, Germany
| | - Krischan Braitssch
- School of Medicine, Technical University Munich, Klinikum Rechts Der Isar, Clinic and Policlinic for Internal Medicine III, Munich, Germany
| | - Gernot Beutel
- Hannover Medical School, Department of Hematology, and Stem Cell Transplantation, HemostasisHannover, Oncology, Germany
| | - Christoph Schmid
- Augsburg University Hospital and Medical Faculty, Augsburg, Germany
| | | | - Gesine Bug
- Department of Medicine 2, University Hospital, Goethe University, Frankfurt, Germany
| | - Michaela Döring
- Universitätsklinik Für Kinder Und Jugendmedizin, Tübingen, Germany
| | | | - Johanna Tischer
- Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Francis Ayuk
- Klinik Für Stammzelltransplantation, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Gerald Wulf
- Hämatologie Und Medizinische Onkologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | | | | | - Bernd Jahrsdörfer
- Institute for Clinical Transfusion Medicine and Immunogenetics, University of Ulm, Ulm, Germany
| | - Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics, University of Ulm, Ulm, Germany
| | - Selim Kuci
- Department of Pediatrics, Division for Stem Cell Transplantation and Immunology, Goethe University, Frankfurt, Germany
| | - Zyrafete Kuci
- Department of Pediatrics, Division for Stem Cell Transplantation and Immunology, Goethe University, Frankfurt, Germany
| | - Anke Zens
- Medac Gesellschaft Für Klinische Spezialpräparate mbH, Wedel, Germany
| | - Michael Tribanek
- Medac Gesellschaft Für Klinische Spezialpräparate mbH, Wedel, Germany
| | - Robert Zeiser
- Department Innere Medizin, Klinik Für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Sabine Huenecke
- Department of Pediatrics, Division of Stem Cell Transplantation and Immunology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Peter Bader
- Department of Pediatrics, Division of Stem Cell Transplantation and Immunology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Malaval CI, Cabanillas Stanchi KM, Werle D, Thiel S, Gansel M, Lang P, Handgretinger R, Svaldi J, Döring M. Application of the National Comprehensive Cancer Network-distress thermometer in pediatric patients during autologous and allogeneic hematopoietic stem cell transplantation and relationship to blood parameters of the stress axis. J Cancer Res Clin Oncol 2023; 149:15899-15909. [PMID: 37676266 PMCID: PMC10620269 DOI: 10.1007/s00432-023-05300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Hematopoietic stem cell transplantations (HSCT) are extremely stressful procedures for pediatric patients. The activation of the hypothalamic pituitary adrenocortical axis (HPA) can influence the immune system negatively and therefore the overall outcome. The distress thermometer (DT) is an easy to use tool for the self-assessment of perceived distress. METHODS In this prospective study, a DT with an attached problem list was used in 40 pediatric patients undergoing HSCT and in one parent of each patient. The patients were aged 10-18 years. The patients' cortisol, thyroid stimulating hormone, free triiodothyronine and thyroxine levels were measured regularly during the in-patient stay. RESULTS After admission to the hospital, the stress levels of the pediatric patients and their parents increased and reached their maximum on the day of HSCT. The overall stress values of the parents were higher than those of their children. There was a significant difference in the parents' stress levels on the day of HSCT, as compared to their stress levels on other days. The mean cortisol values of the pediatric patients also increased after admission, reaching significant elevated levels above the upper normal limit 1 week after HSCT and on discharge day. Although the pediatric patients experienced mainly exhaustion, especially on the day of transplantation, their parents mainly felt worry and anxiety. Interestingly, the rate of worry among children increased in the post-transplant period and reached its maximum on the day of discharge. CONCLUSIONS In summary, a significantly increased stress level is shown for both the patients and their parents. This is reflected for the patients both in the DT scores and in the increased cortisol values. For the parents, the focus is primarily on worry and anxiety, for the patients primarily on exhaustion and worry.
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Affiliation(s)
- Carmen Isolde Malaval
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Karin Melanie Cabanillas Stanchi
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Dustin Werle
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Stefanie Thiel
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Melanie Gansel
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Peter Lang
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Rupert Handgretinger
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Jennifer Svaldi
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Michaela Döring
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tübingen-Children's Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
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4
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Schober S, Huber S, Braun N, Döring M, Lang P, Hofbeck M, Neunhoeffer F, Renk H. Prognostic factors and predictive scores for 6-months mortality of hematopoietic stem cell transplantation recipients admitted to the pediatric intensive care unit. Front Oncol 2023; 13:1161573. [PMID: 37810960 PMCID: PMC10552149 DOI: 10.3389/fonc.2023.1161573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Despite advances in hematopoietic stem cell transplantation (HSCT), a considerable number of pediatric HSCT patients develops post-transplant complications requiring admission to the pediatric intensive care unit (PICU). The objective of this study was to evaluate clinical findings, PICU supportive therapy and outcome as well as predictive factors for 6-months survival after discharge of HSCT patients from PICU. Study design This retrospective single-center analysis investigated patient characteristics, microbiological findings, reasons for admission and death of 54 cases accounting for 94 admissions to the PICU of the University Children's Hospital Tuebingen from 2002 to 2017. We compared clinical characteristics between children with and without 6-months survival after discharge from PICU following HSCT. Finally, we assessed the potential prognostic value of the oncological Pediatric Risk of Mortality Score (O-PRISM), the Pediatric Sequential Organ Failure Assessment Score (pSOFA) and the pRIFLE Criteria for Acute Kidney Injury for 6-months survival using Generalized Estimating Equations (GEE) and Receiver Operating Characteristic curves. Results Respiratory insufficiency, gastroenterological problems and sepsis were the most common reasons for PICU admission. Out of 54 patients, 38 (70%) died during or after their last PICU admission, 30% survived for at least six months. When considering only first PICU admissions, we could not determine prognostic factors for 6-months mortality. In contrast, under consideration of all PICU admissions in the GEE model, ventilation (p=0.03) and dialysis (p=0.007) were prognostic factors for 6-months mortality. Furthermore, pSOFA (p=0.04) and O-PRISM (p=0.02) were independent risk factors for 6-months mortality considering all PICU admissions. Conclusion Admission of HSCT patients to PICU is still associated with poor outcome and 69% of patients died within 6 months. Need for respiratory support and dialysis are associated with poor outcome. Prediction of 6-months survival is difficult, especially during a first PICU admission. However, on subsequent PICU admissions pSOFA and O-PRISM scores might be useful to predict mortality. These scores should be prospectively evaluated in further studies to verify whether they can identify pediatric HSCT recipients profiting most from transferal to the PICU.
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Affiliation(s)
- Sarah Schober
- University Children’s Hospital Tuebingen, Department I – General Pediatrics, Hematology/Oncology, Tuebingen, Germany
| | - Silke Huber
- University Children’s Hospital Tuebingen, Department II – Pediatric Cardiology, Pulmonology and Intensive Care Medicine, Tuebingen, Germany
| | - Norbert Braun
- University Children’s Hospital Tuebingen, Department II – Pediatric Cardiology, Pulmonology and Intensive Care Medicine, Tuebingen, Germany
| | - Michaela Döring
- University Children’s Hospital Tuebingen, Department I – General Pediatrics, Hematology/Oncology, Tuebingen, Germany
| | - Peter Lang
- University Children’s Hospital Tuebingen, Department I – General Pediatrics, Hematology/Oncology, Tuebingen, Germany
| | - Michael Hofbeck
- University Children’s Hospital Tuebingen, Department II – Pediatric Cardiology, Pulmonology and Intensive Care Medicine, Tuebingen, Germany
| | - Felix Neunhoeffer
- University Children’s Hospital Tuebingen, Department II – Pediatric Cardiology, Pulmonology and Intensive Care Medicine, Tuebingen, Germany
| | - Hanna Renk
- University Children’s Hospital Tuebingen, Department I – General Pediatrics, Hematology/Oncology, Tuebingen, Germany
- University Children’s Hospital Tuebingen, Department II – Pediatric Cardiology, Pulmonology and Intensive Care Medicine, Tuebingen, Germany
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5
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Döring M, Xemaire J, Werle D, Thiel S, Schneider V, Michaelis S, Schlösser M, Lang P, Svaldi J, Cabanillas Stanchi KM. Impact of a mental training program for pediatric cancer patients after allogeneic hematopoietic stem cell transplantation or high-dose chemotherapy - Results of a randomized controlled trial. Palliat Support Care 2023:1-8. [PMID: 37681460 DOI: 10.1017/s1478951523000986] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Hematopoietic stem cell transplantation (HSCT) or intensive chemotherapy for the treatment of malignant diseases is a highly distressing experience. The affected person's resilience is crucial to coping with this challenging experience. Experience with resilience-enhancing interventions in children and young adults during cancer therapy is scarce. The major objective of this work was developing and evaluating an effective psycho-oncological mental training that complements the standard psychosocial care. METHODS In this prospective, randomized single-center study, a total of 30 patients (12 to 22 years of age) who underwent HSCT or high-dose chemotherapy received either the standard psychosocial care (control group [CG]) or additionally underwent a novel and specifically developed resilience-enhancing 14-session mental training (therapy group [TG]). The patients were observed over an 8-month period and were screened for distress, thyroid, and immune function parameters, as well as generalized anxiety, affect, and sports orientation. RESULTS Patients of the TG showed significantly greater improvements in all assessed mental aspects, including anxiety, affect, competitiveness, win orientation, goal orientation, self-optimization, self-blocking, and loss of focus, as well as cortisol levels within 8 months, as opposed to patients of the CG (effect size range ξ: 0.74-1.00). SIGNIFICANCE OF RESULTS Patients who underwent the mental training displayed less anxiety, better affect, and improved mental performance with less self-blocking. This resulted in improved goal orientation, competitiveness, self-optimization, and focus when compared to the CG patients. However, larger prospective trials are necessary to substantiate these findings.
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Affiliation(s)
- Michaela Döring
- General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Johanna Xemaire
- TAKT - Tübinger Akademie für Kinder- und Jugendlichenpsychotherapie GmbH, Tübingen, Germany
| | - Dustin Werle
- Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Stefanie Thiel
- General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Veronika Schneider
- General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Sebastian Michaelis
- General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Manuel Schlösser
- Psychosocial-Therapeutic Service, University Children's Hospital Tübingen, Tübingen, Germany
| | - Peter Lang
- General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Jennifer Svaldi
- Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
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Schneckmann R, Döring M, Gerfer S, Gorressen S, Heitmeier S, Helten C, Polzin A, Jung C, Kelm M, Fender AC, Flögel U, Grandoch M. Rivaroxaban attenuates neutrophil maturation in the bone marrow niche. Basic Res Cardiol 2023; 118:31. [PMID: 37580509 PMCID: PMC10425524 DOI: 10.1007/s00395-023-01001-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
Pharmacological inhibition of factor Xa by rivaroxaban has been shown to mediate cardioprotection and is frequently used in patients with, e.g., atrial fibrillation. Rivaroxaban's anti-inflammatory actions are well known, but the underlying mechanisms are still incompletely understood. To date, no study has focused on the effects of rivaroxaban on the bone marrow (BM), despite growing evidence that the BM and its activation are of major importance in the development/progression of cardiovascular disease. Thus, we examined the impact of rivaroxaban on BM composition under homeostatic conditions and in response to a major cardiovascular event. Rivaroxaban treatment of mice for 7 days markedly diminished mature leukocytes in the BM. While apoptosis of BM-derived mature myeloid leukocytes was unaffected, lineage-negative BM cells exhibited a differentiation arrest at the level of granulocyte-monocyte progenitors, specifically affecting neutrophil maturation via downregulation of the transcription factors Spi1 and Csfr1. To assess whether this persists also in situations of increased leukocyte demand, mice were subjected to cardiac ischemia/reperfusion injury (I/R): 7 d pretreatment with rivaroxaban led to reduced cardiac inflammation 72 h after I/R and lowered circulating leukocyte numbers. However, BM myelopoiesis showed a rescue of the leukocyte differentiation arrest, indicating that rivaroxaban's inhibitory effects are restricted to homeostatic conditions and are mainly abolished during emergency hematopoiesis. In translation, ST-elevation MI patients treated with rivaroxaban also exhibited reduced circulating leukocyte numbers. In conclusion, we demonstrate that rivaroxaban attenuates neutrophil maturation in the BM, which may offer a therapeutic option to limit overshooting of the immune response after I/R.
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Affiliation(s)
- R Schneckmann
- Institute for Translational Pharmacology Düsseldorf, Medical Faculty, University Hospital of the Heinrich Heine University, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - M Döring
- Institute for Translational Pharmacology Düsseldorf, Medical Faculty, University Hospital of the Heinrich Heine University, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - S Gerfer
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | - S Gorressen
- Institute for Pharmacology Düsseldorf, Medical Faculty, University Hospital and Heinrich Heine University, Düsseldorf, Germany
| | - S Heitmeier
- Research & Development Pharmaceuticals, Bayer AG, Acute Hospital Research, Wuppertal, Germany
| | - C Helten
- Department for Cardiology, Pneumology and Vascular Medicine, University Hospital and Heinrich Heine University, Düsseldorf, Germany
| | - A Polzin
- Department for Cardiology, Pneumology and Vascular Medicine, University Hospital and Heinrich Heine University, Düsseldorf, Germany
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - C Jung
- Department for Cardiology, Pneumology and Vascular Medicine, University Hospital and Heinrich Heine University, Düsseldorf, Germany
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - M Kelm
- Department for Cardiology, Pneumology and Vascular Medicine, University Hospital and Heinrich Heine University, Düsseldorf, Germany
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - A C Fender
- Institute of Pharmacology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - U Flögel
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Experimental Cardiovascular Imaging, Institute for Molecular Cardiology, University Hospital and Heinrich Heine University, Düsseldorf, Germany
| | - M Grandoch
- Institute for Translational Pharmacology Düsseldorf, Medical Faculty, University Hospital of the Heinrich Heine University, Universitätsstr. 1, 40225, Düsseldorf, Germany.
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
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Döring M, Dette AK, Werle D, Jendritza R, Malaval C, Thiel S, Michaelis S, Schlösser M, Lang P, Handgretinger R, Svaldi J, Cabanillas Stanchi KM. Screening for distress and quality of life in pediatric patients after allogeneic or autologous hematopoietic stem cell transplantation using a self-reporting instrument, blood stress biomarkers and an expert rating scale (PO-Bado). J Psychosom Res 2023; 170:111358. [PMID: 37196587 DOI: 10.1016/j.jpsychores.2023.111358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/07/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Hematopoietic stem cell transplantation (HSCT) is highly distressing and potentially traumatizing for pediatric and young adult patients (PYAP). At present, there is little evidence on their individual burdens. METHODS In this prospective cohort study, the course of the psychological and somatic distress was investigated on eight observation days (day -8/-12, -5, 0 (day of HSCT), +10, +20, and + 30 before/after HSCT), using the PO-Bado external rating scale and the EORTC-QLQ-C15-PAL self-assessment questionnaire. Stress-associated blood parameters were determined and correlated with the results of the questionnaires. RESULTS A total of 64 PYAP with a median age of 9.1 years (range 0-26 years) who underwent autologous (n = 20; 31%; autoHSCT) or allogeneic (n = 44; 69%; alloHSCT) HSCT were analyzed. Both were associated with a significant reduction in QOL. The reduction in self-assessed QOL correlated with somatic and psychological distress as assessed by medical staff. While somatic distress was similar in both groups with a maximum around day+10 (alloHSCT 8.9 ± 2.4 vs. autoHSCT 9.1 ± 2.6; p = 0.69), a significantly higher level of psychological distress was seen during alloHSCT (e.g. day0 alloHSCT 5.3 ± 2.6 vs. day0 autoHSCT 3.2 ± 1.0; p < 0.0001). CONCLUSIONS The maximum of psychological and somatic distress, as well as the lowest quality of life, ranges between day 0 and + 10 after both allogeneic and autologous pediatric HSCT. While somatic distress is similar during autologous and allogeneic HSCT, the allogeneic group seems to be affected by higher psychological distress. Larger prospective studies are needed to evaluate this observation.
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Affiliation(s)
- Michaela Döring
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Anna Karina Dette
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Dustin Werle
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076 Tübingen, Germany.
| | - Ricarda Jendritza
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Carmen Malaval
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Stefanie Thiel
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Sebastian Michaelis
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Manuel Schlösser
- University Children's Hospital Tübingen, Psychosocial-therapeutic service, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Peter Lang
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Rupert Handgretinger
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Jennifer Svaldi
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076 Tübingen, Germany.
| | - Karin Melanie Cabanillas Stanchi
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
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8
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Schneider V, Cabanillas Stanchi KM, Althaus K, Schober S, Michaelis S, Seitz C, Lang P, Handgretinger R, Bakchoul T, Hammer S, Döring M. Hypofibrinolysis in pediatric patients with veno-occlusive disease in hematopoietic stem cell transplantation. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04798-9. [PMID: 37086290 PMCID: PMC10374734 DOI: 10.1007/s00432-023-04798-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/15/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE Veno-occlusive disease (VOD) is a serious complication of hematopoietic stem cell transplantation (HSCT) with a high incidence in pediatric patients. This study aimed to detect signs of hypofibrinolysis using thrombelastography. METHODS In this prospective single-center study, thrombelastographic measurements (EX and TPA tests) were taken during HSCT to detect signs of impaired coagulation, clot formation, or hypofibrinolysis. RESULTS Of 51 patients undergoing allogeneic and autologous HSCT, five (9.8%) developed VOD and received defibrotide treatment. Thrombelastography measurements were also obtained from 55 healthy children as a control group. The results show that clot lysis was prolonged in VOD patients compared to other HSCT patients and control group (lysis time, TPA test: day + 14 to + 21: VOD: 330 ± 67 s vs. HSCT: 246 ± 53 s; p = 0.0106; control: 234 ± 50 s; control vs. VOD: p = 0.0299). The maximum lysis was reduced in HSCT patients compared to controls (EX test: control: 8.3 ± 3.2%; HSCT: day 0 to + 6: 5.3 ± 2.6%, p < 0.0001; day + 7 to + 13: 3.9 ± 2.1%, p < 0.0001; day + 14 to d + 21: 4.1 ± 2.3%, p < 0.0001). CONCLUSION These results suggest that HSCT patients exhibit reduced fibrinolytic capacities and patients diagnosed with VOD show signs of hypofibrinolysis. This prospective study shows that fibrinolysis can be assessed in a rapid and accessible way via thrombelastography. Thrombelastography might be a parameter to support the diagnosis of a VOD and to serve as a follow-up parameter after the diagnosis of a VOD.
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Affiliation(s)
- Veronika Schneider
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Karin M Cabanillas Stanchi
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Karina Althaus
- Center for Clinical Transfusion Medicine, University Hospital of Tübingen, Tübingen, Germany
- Institute for Clinical and Experimental Transfusion Medicine, Medical Faculty of Tübingen, Tübingen, Germany
| | - Sarah Schober
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Sebastian Michaelis
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Christian Seitz
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Peter Lang
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Rupert Handgretinger
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Tamam Bakchoul
- Center for Clinical Transfusion Medicine, University Hospital of Tübingen, Tübingen, Germany
- Institute for Clinical and Experimental Transfusion Medicine, Medical Faculty of Tübingen, Tübingen, Germany
| | - Stefanie Hammer
- Center for Clinical Transfusion Medicine, University Hospital of Tübingen, Tübingen, Germany
- Institute for Clinical and Experimental Transfusion Medicine, Medical Faculty of Tübingen, Tübingen, Germany
| | - Michaela Döring
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
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9
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Flaadt T, Ladenstein RL, Ebinger M, Lode HN, Arnardóttir HB, Poetschger U, Schwinger W, Meisel R, Schuster FR, Döring M, Ambros PF, Queudeville M, Fuchs J, Warmann SW, Schäfer J, Seitz C, Schlegel P, Brecht IB, Holzer U, Feuchtinger T, Simon T, Schulte JH, Eggert A, Teltschik HM, Illhardt T, Handgretinger R, Lang P. Anti-GD2 Antibody Dinutuximab Beta and Low-Dose Interleukin 2 After Haploidentical Stem-Cell Transplantation in Patients With Relapsed Neuroblastoma: A Multicenter, Phase I/II Trial. J Clin Oncol 2023:JCO2201630. [PMID: 36854071 DOI: 10.1200/jco.22.01630] [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: 03/02/2023] Open
Abstract
PURPOSE Patients with relapsed high-risk neuroblastoma (rHR-NB) have a poor prognosis. We hypothesized that graft-versus-neuroblastoma effects could be elicited by transplantation of haploidentical stem cells (haplo-SCT) exploiting cytotoxic functions of natural killer cells and their activation by the anti-GD2 antibody dinutuximab beta (DB). This phase I/II trial assessed safety, feasibility, and outcomes of immunotherapy with DB plus subcutaneous interleukin-2 (scIL2) after haplo-SCT in patients with rHR-NB. METHODS Patients age 1-21 years underwent T-/B-cell-depleted haplo-SCT followed by DB and scIL2. The primary end point 'success of treatment' encompassed patients receiving six cycles, being alive 180 days after end of trial treatment without progressive disease, unacceptable toxicity, acute graft-versus-host-disease (GvHD) ≥grade 3, or extensive chronic GvHD. RESULTS Seventy patients were screened, and 68 were eligible for immunotherapy. Median number of DB cycles was 6 (range, 1-9). Median number of scIL2 cycles was 3 (1-6). The primary end point was met by 37 patients (54.4%). Median observation time was 7.8 years. Five-year event-free survival (EFS) and overall survival from start of trial treatment were 43% (95% CI, 31 to 55) and 53% (95% CI, 41 to 65), respectively. Five-year EFS among patients in complete remission (CR; 52%; 95% CI, 31 to 69) or partial remission (44%; 95% CI, 27 to 60) before immunotherapy were significantly better compared with patients with nonresponse/mixed response/progressive disease (13%; 95% CI, 1 to 42; P = .026). Overall response rate in 43 patients with evidence of disease after haplo-SCT was 51% (22 patients), with 15 achieving CR (35%). Two patients developed GvHD grade 2 and 3 each. No unexpected adverse events occurred. CONCLUSION DB therapy after haplo-SCT in patients with rHR-NB is feasible, with low risk of inducing GvHD, and results in long-term remissions likely attributable to increased antineuroblastoma activity by donor-derived effector cells.
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Affiliation(s)
- Tim Flaadt
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ruth L Ladenstein
- St Anna Children's Hospital and Children's Cancer Research Institute, Department of Studies and Statistics for Integrated Research and Projects, Medical University of Vienna, Vienna, Austria.,Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Martin Ebinger
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Holger N Lode
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Helga Björk Arnardóttir
- Department for Studies and Statistics and Integrated Research, Children's Cancer Research Institute, Vienna, Austria
| | - Ulrike Poetschger
- Department for Studies and Statistics and Integrated Research, Children's Cancer Research Institute, Vienna, Austria
| | - Wolfgang Schwinger
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Roland Meisel
- Division of Pediatric Stem Cell Therapy, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - Friedhelm R Schuster
- Division of Pediatric Stem Cell Therapy, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - Michaela Döring
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Peter F Ambros
- CCRI, Children's Cancer Research Institute, Vienna, Department of Tumor Biology and Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Manon Queudeville
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Steven W Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Jürgen Schäfer
- Department for Diagnostic and Interventional Radiology, University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Christian Seitz
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Cluster of Excellence iFIT (Exc 2180) "Image-guided and Functionally Instructed Tumor Therapies," University of Tuebingen, Germany
| | - Patrick Schlegel
- Children's Medical Research Institute, The Cancer Centre for Children, The Children's Hospital Westmead, University of Sydney, Sydney, Australia
| | - Ines B Brecht
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ursula Holzer
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Tobias Feuchtinger
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Dr von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University Hospital, University of Cologne, Cologne, Germany
| | - Johannes H Schulte
- Department of Pediatric Oncology/Hematology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Angelika Eggert
- Department of Pediatric Oncology/Hematology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Heiko-Manuel Teltschik
- Department of Hematology and Oncology, Children's Hospital Stuttgart-Olgahospital, Stuttgart, Germany
| | - Toni Illhardt
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Rupert Handgretinger
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Peter Lang
- Department of Hematology and Oncology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany.,Cluster of Excellence iFIT (Exc 2180) "Image-guided and Functionally Instructed Tumor Therapies," University of Tuebingen, Germany
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10
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Eichholz T, Döring M, Giardino S, Gruhn B, Seitz C, Flaadt T, Schwinger W, Ebinger M, Holzer U, Mezger M, Teltschik HM, Sparber-Sauer M, Koscielniak E, Abele M, Handgretinger R, Lang P. Haploidentical hematopoietic stem cell transplantation as individual treatment option in pediatric patients with very high-risk sarcomas. Front Oncol 2023; 13:1064190. [PMID: 36895486 PMCID: PMC9990259 DOI: 10.3389/fonc.2023.1064190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
Background Prognosis of children with primary disseminated or metastatic relapsed sarcomas remains dismal despite intensification of conventional therapies including high-dose chemotherapy. Since haploidentical hematopoietic stem cell transplantation (haplo-HSCT) is effective in the treatment of hematological malignancies by mediating a graft versus leukemia effect, we evaluated this approach in pediatric sarcomas as well. Methods Patients with bone Ewing sarcoma or soft tissue sarcoma who received haplo-HSCT as part of clinical trials using CD3+ or TCRα/β+ and CD19+ depletion respectively were evaluated regarding feasibility of treatment and survival. Results We identified 15 patients with primary disseminated disease and 14 with metastatic relapse who were transplanted from a haploidentical donor to improve prognosis. Three-year event-free survival (EFS) was 18,1% and predominantly determined by disease relapse. Survival depended on response to pre-transplant therapy (3y-EFS of patients in complete or very good partial response: 36,4%). However, no patient with metastatic relapse could be rescued. Conclusion Haplo-HSCT for consolidation after conventional therapy seems to be of interest for some, but not for the majority of patients with high-risk pediatric sarcomas. Evaluation of its future use as basis for subsequent humoral or cellular immunotherapies is necessary.
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Affiliation(s)
- Thomas Eichholz
- University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Michaela Döring
- University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Stefano Giardino
- Hematopoietic Stem Cell Transplantation Unit, Department of Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - Christian Seitz
- University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Tim Flaadt
- University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Wolfgang Schwinger
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Martin Ebinger
- University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Ursula Holzer
- University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Markus Mezger
- University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Heiko-Manuel Teltschik
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart, Germany
| | - Monika Sparber-Sauer
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart, Germany.,University Tübingen, Medical Faculty, Tübingen, Germany
| | - Ewa Koscielniak
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart, Germany.,University Tübingen, Medical Faculty, Tübingen, Germany
| | - Michael Abele
- University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
| | | | - Peter Lang
- University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
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11
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Sperl D, Lang P, Benesch M, Bainschab A, Urban C, Wilfing R, Feuchtinger T, Döring M, Seitz C, Strenger V, Lackner H, Seidel MG, Perwein T, Handgretinger R, Sipurzynski S, Rosskopf K, Schwinger W. Immunological recovery following HLA-matched CD3+ TCR αß+/CD19+ depleted hematopoietic stem cell transplantation in children. Pediatr Transplant 2022; 26:e14285. [PMID: 35441401 DOI: 10.1111/petr.14285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 02/08/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative option for children with both malignant and nonmalignant diseases. T-cell depletion techniques may result in reduced transplant-related mortality compared with unmanipulated grafts due to a lower incidence of GvHD. METHODS Immune recovery and outcome were analyzed in a cohort of 23 patients with malignant and nonmalignant diseases who received CD3+TCRαβ+ T- and B-cell-depleted allografts from matched donors after reduced-intensity or myeloablative conditioning. The median number of CD34+, CD3+TCRαβ+, and CD19+B-cells infused was 12.7 × 106 /kg, 16.8 × 103 /kg, and 96 × 103 /kg bodyweight. RESULTS With a median follow-up of 36 (range 1-73) months, overall survival and disease-free survival at 3 years were 65.2% and 60.8%. Eight patients died, six due to the underlying disease and two of extended visceral cGvHD. Immune reconstitution, disease-free, and overall survivals were similar compared with a historical cohort of 23 patients transplanted with matched unmanipulated bone marrow. A significant lower rate of higher grade (III-IV) aGvHD was observed in the manipulated HSCT group (8.7% vs. 26%; p = 0.001), whereas the incidence of cGvHD was equal. CONCLUSIONS Our data suggest that this graft manipulation strategy could be a safe and effective alternative to conventional HSCT techniques in matched donors.
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Affiliation(s)
- Daniela Sperl
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Peter Lang
- Children's University Hospital University of Tuebingen, Tuebingen, Germany
| | - Martin Benesch
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Antonia Bainschab
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Christian Urban
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Roland Wilfing
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Tobias Feuchtinger
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner University Children's Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Michaela Döring
- Children's University Hospital University of Tuebingen, Tuebingen, Germany
| | - Christian Seitz
- Children's University Hospital University of Tuebingen, Tuebingen, Germany
| | - Volker Strenger
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Herwig Lackner
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Markus G Seidel
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Perwein
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Sabine Sipurzynski
- Department of Blood Group Serology and Transfusion Medicine, Medical University Graz, Graz, Austria
| | - Konrad Rosskopf
- Department of Blood Group Serology and Transfusion Medicine, Medical University Graz, Graz, Austria
| | - Wolfgang Schwinger
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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12
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Betzmann D, Döring M, Blumenstock G, Erdmann F, Grabow D, Lang P, Binder G. Impact of serum insulin-like growth factor-1 on HSCT outcome in pediatric cancer patients. Transplant Cell Ther 2022; 28:355.e1-355.e9. [PMID: 35405367 DOI: 10.1016/j.jtct.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/20/2021] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is associated with severe medical complications and variable outcome depending on the recipient's disease stage and health condition. Biomarkers predicting outcome may have therapeutic relevance in pediatric cancer care. Insulin like growth factor 1 (IGF 1) is a mitogenic and anabolic peptide hormone that is expressed in almost all tissues. This hormone is the major growth factor in childhood. As IGF 1 is decreased in conditions that cause catabolic metabolism, it may reflect the degree of physical robustness of the patient and serve as predictive biomarker for transplant outcome. OBJECTIVES AND STUDY DESIGN We evaluated the impact of pre-transplant serum-IGF 1 on both survival and adverse events in 587 pediatric cancer patients, who underwent autologous or allogeneic HSCT between 1987 and 2014 at the University Children's Hospital Tübingen, Germany. Survival probabilities of the entire cohort and of defined subgroups according to pre-transplant serum-IGF-1 were estimated using the Kaplan-Meier method. RESULTS Mean pre-transplant IGF 1 (n = 498) was low: -1.67 SDS (SD, 1.54). Completeness of follow-up three and ten years post HSCT was 96 % and 83 %, respectively. The ten-year overall survival was 44.8 % (95 % confidence interval [CI], 40.6-48.9). With decreasing IGF-1 SDS, there was a significant increase of transplant-related mortality (p = 0.027), sinusoidal obstruction syndrome (quartiles 4 to 1: 3; 1; 12; 12%; p < 0.001) and thrombotic microangiopathy (quartiles 4 to 1: 0: 0: 2; 5%; p = 0.004). IGF 1 decile 1 showed a significantly poorer outcome (p=0.042) with lower median (12 versus 68 months) and ten-year overall survival (37 % versus 52 %) when compared to decile 2-10. CONCLUSIONS This retrospective study suggests pre-transplant serum-IGF 1 as a predictor of survival and selected vascular adverse events that may have diagnostic and therapeutic relevance in pediatric cancer care.
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Affiliation(s)
- Deborah Betzmann
- University Children's Hospital Tübingen, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Michaela Döring
- University Children's Hospital Tübingen, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Silcherstraße 5, 72076 Tübingen, Germany
| | - Friederike Erdmann
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | - Peter Lang
- University Children's Hospital Tübingen, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Gerhard Binder
- University Children's Hospital Tübingen, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany.
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Cabanillas Stanchi KM, Böhringer J, Strölin M, Groeschel S, Lenglinger K, Treuner C, Kehrer C, Laugwitz L, Bevot A, Kaiser N, Schumm M, Lang P, Handgretinger R, Krägeloh-Mann I, Müller I, Döring M. Hematopoietic stem cell transplantation with mesenchymal stromal cells in children with metachromatic leukodystrophy. Stem Cells Dev 2022; 31:163-175. [PMID: 35323019 DOI: 10.1089/scd.2021.0352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Metachromatic leukodystrophy (MLD) is a lysosomal storage disorder primarily affecting the white matter of the nervous system that results from a deficiency of the arylsulfatase A (ARSA). Mesenchymal stem cells (MSCs) are able to secrete ARSA and have shown beneficial effects in MLD patients. In this retrospective analysis, 10 pediatric MLD patients (MSCG) underwent allogeneic hematopoietic stem cell transplantation (HSCT) and received two applications of 2 x 106 MSCs/kg bodyweight at day +30 and +60 after HSCT between 2007 and 2018. MSC safety, occurrence of graft-versus-host disease (GvHD), blood ARSA levels, chimerism, cell regeneration and engraftment, MRI changes, and the gross motor function were assessed within the first year of HSCT. The long-term data included clinical outcomes and safety aspects of MSCs. Data were compared to a control cohort of seven pediatric MLD patients (CG) who underwent HSCT only. The application of MSC in pediatric MLD patients after allogeneic HSCT was safe and well tolerated and long-term potentially MSC-related adverse effects up to 13.5 years after HSCT were not observed. Patients achieved significantly higher ARSA levels (CG: median 1.03 nmol∙10-6, range 0.41-1.73 | MSCG: median 1.58 nmol∙10-6, range 0.44-2.6; p<0.05), as well as significantly higher leukocyte (p<0.05) and thrombocyte (p<0.001) levels within 365 days of MSC application compared to CG patients. Statistically significant effects on acute GvHD, regeneration of immune cells, engraftment, MRI changes, gross motor function, and clinical outcomes were not detected. In conclusion, the application of MSCs in pediatric MLD patients after allogeneic HSCT was safe and well tolerated. The two applications of 2 x 106/kg allogeneic MSCs were followed by improved engraftment and hematopoiesis within the first year after HSCT. Larger, prospective trials are necessary to evaluate the impact of MSC application on engraftment and hematopoietic recovery.
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Affiliation(s)
| | - Judith Böhringer
- University Children's Hospital Tübingen, Dpt. III - Neuropediatrics, Germany;
| | - Manuel Strölin
- University Children's Hospital Tübingen, Dpt. III - Neuropediatrics, Germany;
| | - Samuel Groeschel
- University Children's Hospital Tübingen, Dpt. III - Neuropediatrics, Germany;
| | - Katrin Lenglinger
- University Children's Hospital Tübingen, Dpt. I - General Pediatrics, Hematology and Oncology, Germany;
| | - Claudia Treuner
- University Children's Hospital Tübingen, Dpt. I - General Pediatrics, Hematology and Oncology, Germany;
| | - Christiane Kehrer
- University Children's Hospital Tübingen, Dpt. I - General Pediatrics, Hematology and Oncology, Germany;
| | - Lucia Laugwitz
- University Children's Hospital Tübingen, Dpt. III - Neuropediatrics, Germany;
| | - Andrea Bevot
- University Children's Hospital Tübingen, Dpt. III - Neuropediatrics, Germany;
| | - Nadja Kaiser
- University Children's Hospital Tübingen, Dpt. III - Neuropediatrics, Germany;
| | - Michael Schumm
- University Children's Hospital Tübingen, Dpt. I - General Pediatrics, Hematology and Oncology, Germany;
| | - Peter Lang
- University Children's Hospital Tübingen, Dpt. I - General Pediatrics, Hematology and Oncology, Germany;
| | - Rupert Handgretinger
- Children's University Hospital, Hematology/Oncology, Hoppe-Seyler-Str. 1, Tuebingen, Germany, 72076;
| | | | - Ingo Müller
- University Medical Center Hamburg-Eppendorf, 37734, Department of Pediatric Hematology and Oncology, Hamburg, Hamburg, Germany;
| | - Michaela Döring
- University Children's Hospital Tübingen, Dpt. I - General Pediatrics, Hematology and Oncology, Germany;
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14
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Stief TA, Kaeuferle T, Müller TR, Döring M, Jablonowski LM, Schober K, Feucht J, Dennehy KM, Willier S, Blaeschke F, Handgretinger R, Lang P, Busch DH, Feuchtinger T. Protective T cell receptor identification for orthotopic reprogramming of immunity in refractory virus infections. Mol Ther 2022; 30:198-208. [PMID: 34058386 PMCID: PMC8753271 DOI: 10.1016/j.ymthe.2021.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/30/2021] [Accepted: 05/25/2021] [Indexed: 01/07/2023] Open
Abstract
Viral infections cause life-threatening disease in immunocompromised patients and especially following transplantation. T cell receptor (TCR) engineering redirects specificity and can bring significant progress to emerging adoptive T cell transfer (ACT) approaches. T cell epitopes are well described, although knowledge is limited on which TCRs mediate protective immunity. In this study, refractory adenovirus (AdV) infection after hematopoietic stem cell transplantation (HSCT) was treated with ACT of highly purified Hexon5-specific T cells using peptide major histocompatibility complex (pMHC)-Streptamers against the immunodominant human leukocyte antigen (HLA)-A∗0101-restricted peptide LTDLGQNLLY. AdV was successfully controlled through this oligoclonal ACT. Novel protective TCRs were isolated ex vivo and preclinically engineered into the TCR locus of allogeneic third-party primary T cells by CRISPR-Cas9-mediated orthotopic TCR replacement. Both TCR knockout and targeted integration of the new TCR in one single engineering step led to physiological expression of the transgenic TCR. Reprogrammed TCR-edited T cells showed strong virus-specific functionality such as cytokine release, effector marker upregulation, and proliferation capacity, as well as cytotoxicity against LTDLGQNLLY-presenting and AdV-infected targets. In conclusion, ex vivo isolated TCRs with clinical proven protection through ACT could be redirected into T cells from naive third-party donors. This approach ensures that transgenic TCRs are protective with potential off-the-shelf use and widened applicability of ACT to various refractory emerging viral infections.
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Affiliation(s)
- Tanja A. Stief
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich Germany,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Theresa Kaeuferle
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich Germany,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Thomas R. Müller
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Michaela Döring
- Department I – General Pediatrics, Hematology/Oncology, University Hospital Tubingen, Children’s Hospital, Tubingen, Germany
| | - Lena M. Jablonowski
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich Germany
| | - Kilian Schober
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Judith Feucht
- Department I – General Pediatrics, Hematology/Oncology, University Hospital Tubingen, Children’s Hospital, Tubingen, Germany,Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin M. Dennehy
- German Center for Infection Research (DZIF), Partner Site Tubingen, Tubingen, Germany,Institute for Laboratory Medicine and Microbiology, University Hospital Augsburg, Germany
| | - Semjon Willier
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich Germany
| | - Franziska Blaeschke
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich Germany,Department I – General Pediatrics, Hematology/Oncology, University Hospital Tubingen, Children’s Hospital, Tubingen, Germany
| | - Rupert Handgretinger
- Department I – General Pediatrics, Hematology/Oncology, University Hospital Tubingen, Children’s Hospital, Tubingen, Germany
| | - Peter Lang
- Department I – General Pediatrics, Hematology/Oncology, University Hospital Tubingen, Children’s Hospital, Tubingen, Germany
| | - Dirk H. Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Tobias Feuchtinger
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich Germany,Department I – General Pediatrics, Hematology/Oncology, University Hospital Tubingen, Children’s Hospital, Tubingen, Germany,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany,Corresponding author: Tobias Feuchtinger, MD, Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children’s Hospital, LMU Munich, Lindwurmstrasse 4, 80337 Munich, Germany.
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15
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Wegener D, Lang P, Paulsen F, Weidner N, Zips D, Ebinger M, Holzer U, Döring M, Heinzelmann F. Primary immunosuppressive TNI-based conditioning regimens in pediatric patients treated with haploidentical hematopoietic cell transplantation. Strahlenther Onkol 2021; 198:66-72. [PMID: 34476532 PMCID: PMC8760200 DOI: 10.1007/s00066-021-01840-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This retrospective analysis aims to address the toxicity and efficacy of a modified total nodal irradiation (TNI)-based conditioning regimen before haploidentical hematopoietic cell transplantation (HCT) in pediatric patients. MATERIALS AND METHODS Patient data including long-term follow-up were evaluated of 7 pediatric patients with malignant (n = 2) and non-malignant diseases (n = 5) who were treated by a primary TNI-based conditioning regimen. TNI was performed using anterior/posterior opposing fields. All patients received 7 Gy single-dose TNI combined with systemic agents followed by an infusion of peripheral blood stem cells (n = 7). All children had haploidentical family donors. RESULTS Engraftment was reached in 6/7 children after a median time of 9.5 days; 1 child had primary graft failure but was successfully reconditioned shortly thereafter. After an average follow-up time of 103.5 months (range 8.8-138.5 months), event-free (EFS) and overall survival (OS) rates were 71.4% and 85.7%, respectively. One child with a non-malignant disease died 8.8 months after transplantation due to a relapse and a multiple organ failure. Follow-up data was available for 5/6 long-term survivors with a median follow-up (FU) of 106.2 months (range 54.5-138.5 months). Hypothyroidism and deficiency of sexual hormones was present in 3/5 patients each. Mean forced expiratory volume in 1 s (FEV1) after TNI was 71%; mean vital capacity (VC) was 78%. Growth failure (< 10th percentile) occurred in 2/5 patients (height) and 1/5 patient (weight). No secondary malignancies were reported. CONCLUSION In this group of patients, a primary single-dose 7 Gy TNI-based conditioning regimen before HCT in pediatric patients allowed sustained engraftment combined with a tolerable toxicity profile leading to long-term OS/EFS. Late toxicity after a median FU of over 9 years includes growth failure, manageable hormonal deficiencies, and acceptable decrease in lung function.
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Affiliation(s)
- D Wegener
- Department of Radiation Oncology, University Clinic of Tuebingen, Tuebingen, Germany.
| | - P Lang
- Department of Paediatrics I, Hematology and Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - F Paulsen
- Department of Radiation Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - N Weidner
- Department of Radiation Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - D Zips
- Department of Radiation Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - M Ebinger
- Department of Paediatrics I, Hematology and Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - U Holzer
- Department of Paediatrics I, Hematology and Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - M Döring
- Department of Paediatrics I, Hematology and Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - F Heinzelmann
- Department of Radiation Oncology, Clinic of Esslingen, Esslingen, Germany
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16
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Abele M, Müller SL, Schleicher S, Hartmann U, Döring M, Queudeville M, Lang P, Handgretinger R, Ebinger M. Arsenic trioxide in pediatric cancer - a case series and review of literature. Pediatr Hematol Oncol 2021; 38:471-485. [PMID: 33635158 DOI: 10.1080/08880018.2021.1872748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Arsenic trioxide (ATO) has become an established component of treatment protocols for acute promyelocytic leukemia (APL) with excellent efficacy and no relevant sustained toxicity. Part of its action has been attributed to the inhibition of Hedgehog signaling (Hh) which enables a possible therapeutic approach as many pediatric tumor entities have been associated with increased Hh activity. We retrospectively analyzed 31 patients with refractory and relapsed pediatric cancer who were treated with ATO at the University Children's Hospital of Tuebingen. Additionally a literature review on the clinical and preclinical use of ATO in pediatric cancer treatment was performed.ATO alone as well as combinations with other drugs have proven effective in vitro and in mouse models of various pediatric malignancies. However, only few data on the clinical use of ATO in pediatric patients besides APL exist. In our patient sample, ATO was overall well tolerated in the treatment of various pediatric cancers, even in combination with other cytostatic drugs. Due to distinct tumor entities, differently progressed disease stages and varying co-medication, no clear statement can be made regarding the efficacy of ATO treatment. However, patients with proven Hh activation in molecular tumor profiling surpassed all other patients, who received ATO in an experimental treatment setting, in terms of survival. As molecular profiling of tumors increases and enhanced Hh activity can be detected at an early stage, ATO might expand its clinical use to other pediatric malignancies beyond APL depending on further clinical studies.
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Affiliation(s)
- Michael Abele
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Sara-Lena Müller
- Clinic for Anaesthesiology, Critical Care, Emergency Medicine and Pain Management, Klinikum Ludwigsburg, Germany
| | - Sabine Schleicher
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Michaela Döring
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Manon Queudeville
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Peter Lang
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Rupert Handgretinger
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Ebinger
- Pediatric Hematology/Oncology, Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
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17
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Döring M, Cabanillas Stanchi KM, Lenglinger K, Treuner C, Gieseke F, Erbacher A, Mezger M, Vaegler M, Schlegel PG, Greil J, Bettoni da Cunha Riehm C, Faul C, Schumm M, Lang P, Handgretinger R, Müller I. Long-Term Follow-Up After the Application of Mesenchymal Stromal Cells in Children and Adolescents with Steroid-Refractory Graft-Versus-Host Disease. Stem Cells Dev 2021; 30:234-246. [PMID: 33446053 DOI: 10.1089/scd.2020.0191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Steroid-refractory graft-versus-host disease (GvHD) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation (alloHSCT). Alternative treatment options are often insufficient. Several studies have proven the efficacy of mesenchymal stromal cells (MSCs) in the treatment of therapy-refractory acute GvHD in adult and pediatric patients. Long-term data in pediatric patients are scarce. In this retrospective analysis, a total of 25 patients with a median age of 10.6 years (range 0.6-22.1 years) who received bone marrow-derived MSCs after alloHSCT for the treatment of steroid-refractory III and IV GvHD were analyzed. The median observation period of the surviving patients was 9.3 years (1.3-12.7 years) after HSCT. Among the 25 patients, 10 (40.0%) died [relapse (n = 3), multiorgan failure (n = 6), cardiorespiratory failure (n = 1)] at median 0.5 years (0.2-2.3 years) after HSCT. Partial response and complete remission (PR, CR) of the GvHD were achieved in 76.0% and 24.0% of the patients, respectively. Transplant-related mortality was 0% in the patients who achieved CR after MSC treatment and 26.3% for those with PR. A median improvement by one intestinal or liver GvHD stage (range 1-4) could be achieved after MSC application. No potentially MSC-related long-term adverse effects, for example, secondary malignancy, were identified. In conclusion, the intravenous application of allogeneic MSCs was safe and proved effective for the treatment of steroid-refractory GvHD. However, larger, prospective, and randomized trials are needed to evaluate these findings.
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Affiliation(s)
- Michaela Döring
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | | | - Katrin Lenglinger
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Claudia Treuner
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Friederike Gieseke
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Annika Erbacher
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Markus Mezger
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Martin Vaegler
- Experimental and Clinical Research Center, GMP-Facility for Cellular Therapies, Charité Universitätsmedizin Berlin, Campus Berlin Buch, Berlin, Germany
| | - Paul-Gerhardt Schlegel
- Department of Pediatric Hematology and Oncology, University of Würzburg, Würzburg, Germany
| | - Johann Greil
- Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Christoph Faul
- University Hospital and Comprehensive Cancer Center Tübingen, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Michael Schumm
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Peter Lang
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Rupert Handgretinger
- Department I-General Pediatrics, Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Ingo Müller
- Division for Pediatric Stem Cell Transplantation and Immunology, Clinic for Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Queudeville M, Schlegel P, Heinz AT, Lenz T, Döring M, Holzer U, Hartmann U, Kreyenberg H, von Stackelberg A, Schrappe M, Zugmaier G, Feuchtinger T, Lang P, Handgretinger R, Ebinger M. Blinatumomab in pediatric patients with relapsed/refractory B-cell precursor acute lymphoblastic leukemia. Eur J Haematol 2021; 106:473-483. [PMID: 33320384 DOI: 10.1111/ejh.13569] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Pediatric patients with relapsed or refractory acute lymphoblastic leukemia have a poor prognosis. We here assess the response rates, adverse events, and long-term follow-up of pediatric patients with relapsed/refractory acute lymphoblastic leukemia receiving blinatumomab. METHODS Retrospective analysis of a single-center experience with blinatumomab in 38 patients over a period of 10 years. RESULTS The median age at onset of therapy was 10 years (1-21 years). Seventy-one percent of patients had undergone at least one hematopoietic stem cell transplantation (HSCT) prior to treatment with blinatumomab. We observed a response to blinatumomab in 13/38 patients (34%). The predominant side effect was febrile reactions, nearly half of the patients developed a cytokine release syndrome. Eight events of neurotoxicity were registered over the 78 cycles (15%). To date, nine patients (24%) are alive and in complete molecular remission. All survivors underwent haploidentical HSCT after treatment with blinatumomab. CONCLUSIONS Despite heavy pretreatment of most of our patients, severe adverse events were rare and response rates encouraging. Blinatumomab is a valuable bridging salvage therapy for relapsed or refractory patients to a second or even third HSCT.
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Affiliation(s)
- Manon Queudeville
- Department I - General Pediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Patrick Schlegel
- Department I - General Pediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Amadeus T Heinz
- Department I - General Pediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Teresa Lenz
- Department I - General Pediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Michaela Döring
- Department I - General Pediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Ursula Holzer
- Department I - General Pediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Ulrike Hartmann
- Department I - General Pediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | | | - Arend von Stackelberg
- Department of Pediatric Oncology/Hematology, Charité Medical Center, Humboldt University Berlin, Berlin, Germany
| | - Martin Schrappe
- Department of Pediatrics I, Christian-Albrechts-University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gerhard Zugmaier
- Research and Development, Amgen Research (Munich) GmbH, Munich, Germany
| | | | - Peter Lang
- Department I - General Pediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Rupert Handgretinger
- Department I - General Pediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Martin Ebinger
- Department I - General Pediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tübingen, Tübingen, Germany
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19
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Schober S, Cabanillas Stanchi KM, Riecker A, Pfeiffer M, Tsiflikas I, Wiegand G, Quintanilla-Martinez L, Haen S, Ebinger M, Lang P, Handgretinger R, Döring M. Fulminant Rhizomucor pusillus mucormycosis during anti-leukemic treatment with blinatumomab in a child: A case report and review of the literature. Med Mycol Case Rep 2020; 32:4-9. [PMID: 33489743 PMCID: PMC7806943 DOI: 10.1016/j.mmcr.2020.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/29/2022] Open
Abstract
This is the first published case report of a child with acute lymphatic leukemia developing a fatal mucormycosis during blinatumomab treatment. The patient showed multiple, systemic thromboembolic lesions with ischemia, bleeding and infarction in almost all organs. The child succumbed to increased brain pressure resulting in cerebral herniation. This case particularly illustrates the fulminant progression and huge challenges of diagnosing and treating mucormycosis in children with hemato-oncological diseases during treatment with targeted therapeutic antibodies (blinatumomab).
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Affiliation(s)
- Sarah Schober
- University Children's Hospital Tuebingen, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076, Tuebingen, Germany
| | - Karin Melanie Cabanillas Stanchi
- University Children's Hospital Tuebingen, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076, Tuebingen, Germany
| | - Anna Riecker
- University Children's Hospital Tuebingen, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076, Tuebingen, Germany
| | - Matthias Pfeiffer
- University Children's Hospital Tuebingen, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076, Tuebingen, Germany
| | - Ilias Tsiflikas
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Gesa Wiegand
- University Children's Hospital Tuebingen, Department II - Pediatric Cardiology, Intensive Care Medicine and Pulmonology, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology and Comprehensive Cancer Centre, University Hospital Tuebingen, Liebermeister-Str. 8, 72076, Tuebingen, Germany
| | - Susanne Haen
- Institute of Pathology and Neuropathology and Comprehensive Cancer Centre, University Hospital Tuebingen, Liebermeister-Str. 8, 72076, Tuebingen, Germany
| | - Martin Ebinger
- University Children's Hospital Tuebingen, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076, Tuebingen, Germany
| | - Peter Lang
- University Children's Hospital Tuebingen, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076, Tuebingen, Germany
| | - Rupert Handgretinger
- University Children's Hospital Tuebingen, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076, Tuebingen, Germany
| | - Michaela Döring
- University Children's Hospital Tuebingen, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076, Tuebingen, Germany
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20
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Cabanillas Stanchi KM, Willier S, Vek J, Schlegel P, Queudeville M, Rieflin N, Klaus V, Gansel M, Rupprecht JV, Flaadt T, Binder V, Feuchtinger T, Lang P, Handgretinger R, Döring M. Antiemetic Prophylaxis with Fosaprepitant and 5-HT 3-Receptor Antagonists in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation. Drug Des Devel Ther 2020; 14:3915-3927. [PMID: 33061297 PMCID: PMC7524181 DOI: 10.2147/dddt.s260887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/21/2020] [Indexed: 02/03/2023]
Abstract
Background High-dose myeloablative conditioning prior to autologous hematopoietic stem cell transplantation (autoHSCT) in pediatric patients is usually highly emetogenic. The antiemetic neurokinin-1 receptor antagonist fosaprepitant was safe and effective in children receiving highly emetogenic chemotherapy. Data on fosaprepitant during autoHSCT in children are currently not available. Methods A total of 35 consecutive pediatric patients, who received an antiemetic prophylaxis with fosaprepitant (4 mg/kg; single dose, max. 1 x 150 mg/kg BW) and ondansetron (24-hours continuous infusion; 8–32 mg/24h) or granisetron (2 x 40 µg/kg∙d−1) during highly emetogenic conditioning chemotherapy before autoHSCT were retrospectively analyzed, and their results were compared with a control group comprising 35 consecutive pediatric patients, who received granisetron or ondansetron only. The antiemetic efficacy and the safety of the two prophylaxis regimens were compared with respect to three time periods after the first chemotherapy administration (0–24h, >24–120h, >120–240h). Results Clinical adverse events and clinically relevant increases/decreases of laboratory markers were similarly low and did not significantly differ between the two study groups (p>0.05). The registered number of vomiting events was significantly higher in the control group in the time periods of 0–24h (64 vs 22 events; p<0.01), >24–120h (135 vs 78 events; p<0.0001), >120–240h (268 vs 105 events; p<0.0001), and the whole observation period 0–240h (467 vs 205 events; p<0.0001). The percentage of patients experiencing vomiting was higher in the control group during the time period of >24–120h (100% vs 74.3%) but not the other analyzed time periods (p>0.05). Conclusion The fosaprepitant-based antiemetic prophylaxis was safe, well tolerated and significantly reduced vomiting in children undergoing highly emetogenic chemotherapy prior to autoHSCT. Prospective randomized trials are necessary to confirm these results.
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Affiliation(s)
| | - Semjon Willier
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. Von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Julia Vek
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Patrick Schlegel
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Manon Queudeville
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Nora Rieflin
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Veronika Klaus
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Melanie Gansel
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Joachim Vincent Rupprecht
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Tim Flaadt
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Vera Binder
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. Von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Tobias Feuchtinger
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. Von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Peter Lang
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Rupert Handgretinger
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Michaela Döring
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen, Germany
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21
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Porto L, You SJ, Attarbaschi A, Cario G, Döring M, Moser O, Mücke U, Poyer F, Temme C, Voigt S, Groll AH, Lauten M, Hattingen E, Lehrnbecher T. Invasive Mold Infection of the Central Nervous System in Immunocompromised Children. J Fungi (Basel) 2020; 6:jof6040226. [PMID: 33081142 PMCID: PMC7711511 DOI: 10.3390/jof6040226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Due to the difficulties in the definite diagnosis, data on brain imaging in pediatric patients with central nervous system (CNS)-invasive mold infection (IMD) are scarce. Our aim was to describe brain imaging abnormalities seen in immunocompromised children with CNS-IMD, and to analyze retrospectively whether specific imaging findings and sequences have a prognostic value. Methods: In a retrospective study of 19 pediatric patients with proven or probable CNS-IMD, magnetic resonance imaging (MRI)-findings were described and analyzed. The results were correlated with outcome, namely death, severe sequelae, or no neurological sequelae. Results: 11 children and 8 adolescents (11/8 with proven/probable CNS-IMD) were included. Seven of the patients died and 12/19 children survived (63%): seven without major neurological sequelae and five with major neurological sequelae. Multifocal ring enhancement and diffusion restriction were the most common brain MRI changes. Diffusion restriction was mostly seen at the core of the lesion. No patient with disease limited to one lobe died. Perivascular microbleeding seen on susceptibility weighted imaging (SWI) and/or gradient-echo/T2* images, as well as infarction, were associated with poor prognosis. Conclusions: The presence of infarction was related to poor outcome. As early microbleeding seems to be associated with poor prognosis, we suggest including SWI in routine diagnostic evaluation of immunocompromised children with suspected CNS-IMD.
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Affiliation(s)
- Luciana Porto
- Department of Neuroradiology, University of Frankfurt, 60528 Frankfurt, Germany; (S.-J.Y.); (E.H.)
- Correspondence: ; Tel.: +49-696-301-5462; Fax: 49-696-301-7176
| | - Se-Jong You
- Department of Neuroradiology, University of Frankfurt, 60528 Frankfurt, Germany; (S.-J.Y.); (E.H.)
| | - Andishe Attarbaschi
- Department of Pediatrics and Adolescent Medicine, St. Anna Children’s Hospital, Medical University of Vienna, Pediatric Hematology and Oncology, 1090 Vienna, Austria; (A.A.); (F.P.)
| | - Gunnar Cario
- Department of Paediatrics, Pediatric Hematology and Oncology, Christian Albrechts University Kiel, 24118 Kiel, Germany;
| | - Michaela Döring
- Department of Paediatric Haematology and Oncology, University Children’s Hospital Tübingen, 53424 Tübingen, Germany;
| | - Olga Moser
- Department of Paediatrics, University Hospital Aachen, 52056 Aachen, Germany;
| | - Urs Mücke
- Department of Paediatric Haematology and Oncology, Hannover Medical School, 30625 Hannover, Germany;
| | - Fiona Poyer
- Department of Pediatrics and Adolescent Medicine, St. Anna Children’s Hospital, Medical University of Vienna, Pediatric Hematology and Oncology, 1090 Vienna, Austria; (A.A.); (F.P.)
| | - Christian Temme
- Department of Paediatric Haematology and Oncology, University Hospital Essen, 45147 Essen, Germany;
| | - Sebastian Voigt
- Department of Paediatric Haematology and Oncology, University Hospital Charité Berlin, 10117 Berlin, Germany;
| | - Andreas H. Groll
- Department of Infectious Disease Research, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, University Children’s Hospital Münster, 53424 Münster, Germany;
| | - Melchior Lauten
- Department of Paediatrics, Paediatric Haematology and Oncology, University of Lübeck, 23562 Lübeck, Germany;
| | - Elke Hattingen
- Department of Neuroradiology, University of Frankfurt, 60528 Frankfurt, Germany; (S.-J.Y.); (E.H.)
| | - Thomas Lehrnbecher
- Department of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University of Frankfurt, 60528 Frankfurt, Germany;
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22
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Löbe S, Paetsch I, Hilbert S, Spampinato R, Oebel S, Richter S, Döring M, Sommer P, Bollmann A, Hindricks G, Jahnke C. Evaluation of the right heart using cardiovascular magnetic resonance imaging in patients with cardiac devices. Int J Cardiol 2020; 316:266-271. [PMID: 32389768 DOI: 10.1016/j.ijcard.2020.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/08/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with cardiac implantable electronic devices (CIED) necessitate comprehensive cardiovascular magnetic resonance (CMR) examinations. The aim of this study was to provide data on CMR image quality and feasibility of functional assessment of the right heart in patients with CIED depending on the device type and imaging sequence used. METHODS 120 CIED carriers (Insertable cardiac monitoring system, n = 13; implantable loop-recorder, n = 22; pacemaker, n = 30; implantable cardioverter-defibrillator (ICD), n = 43; and cardiac resynchronization therapy defibrillator (CRT-D), n = 12) underwent clinically indicated CMR imaging using a 1.5 T. CMR protocols consisted of cine imaging and myocardial tissue characterization including T1-and T2-weighted blackblood imaging and late gadolinium enhancement (LGE) imaging. Image quality was evaluated with regard to device-related imaging artifacts per right-ventricular (RV) segment. RESULTS RV segmental evaluability was influenced by the device type and CMR imaging sequence: Cine steady-state-free-precision (SSFP) imaging was found to be non-diagnostic in patients with ICD/CRT-D and implantable loop recorders; a significant improvement of image quality was achieved when using cine turbo-field-echo (TFE) sequences with a further improvement on post-contrast TFE imaging. LGE scans were artifact-free in at least 91% of RV segments with best results in patients with a pacemaker or an insertable cardiac monitoring system. CONCLUSIONS In patients with CIED, artifact-free CMR imaging of the right ventricle was performed in the majority of patients and resulted in highly reproducible evaluability of RV functional parameters. This finding is of particular importance for the diagnosis and follow-up of right-ventricular diseases.
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Affiliation(s)
- S Löbe
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany.
| | - I Paetsch
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - S Hilbert
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - R Spampinato
- Department of Cardiac Surgery, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - S Oebel
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - S Richter
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - M Döring
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - P Sommer
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - A Bollmann
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - G Hindricks
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - C Jahnke
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
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23
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Holzer U, Döring M, Eichholz T, Ebinger M, Queudeville M, Turkiewicz D, Schwarz K, Handgretinger R, Lang P, Toporski J. Matched versus Haploidentical Hematopoietic Stem Cell Transplantation as Treatment Options for Primary Immunodeficiencies in Children. Transplant Cell Ther 2020; 27:71.e1-71.e12. [PMID: 32966882 DOI: 10.1016/j.bbmt.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/24/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
Primary immunodeficiencies (PIDs) are inherited disorders of the immune system with allogeneic hematopoietic stem cell transplantation (HSCT) as the only curative treatment in some of them. In case an HLA-matched donor is not available, HSCT from a haploidentical family donor may be considered. We compared the outcomes of HSCT from HLA-matched unrelated or related donors (MUDs or MRDs) and mismatched related haploidentical donors (MMRDs) in patients with a variety of PIDs in 2 centers. A total of 44 pediatric patients were evaluated. We reviewed the outcomes of 25 children who underwent transplantation with HLA-matched grafts (MRD, n = 13; MUD, n = 12) and 19 patients receiving haploidentical stem cells. Bone marrow (BM) was transplanted in 85% (MRD) and 75% (MUD) of the matched cohort and peripheral blood stem cells (PBSCs) in 15% (MRD), 25% (MUD), and 100% (MMRD). All but 9 patients (MRD, n = 6; MMRD, n = 3) with severe combined immunodeficiency (SCID) received a chemotherapy-based conditioning regimen. Immune reconstitution of T, B, and natural killer cells was comparable for all groups with an advantage of recipients of MRD grafts in early CD4 reconstitution. However, deaths due to viral infections occurred more often in the haploidentical cohort. The disease-free survival was 91.7% (MRD), 66.7% (MUD), and 62.7% (MMRD), respectively. Grade II to IV acute graft-versus-host disease (GVHD) occurred in 15% (MRD), 8% (MUD), and 21% (MMRD) of the patients. Only 1 patient had severe grade IV GVHD in the MRD group, whereas no grade >II GVHD was observed in the MUD or MMRD cohort. These data indicate that in the absence of a suitable HLA-identical family donor, haploidentical HSCT may be a viable option for patients with life-threatening disease and urgent need of HSCT.
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Affiliation(s)
- Ursula Holzer
- Children's Hospital, University of Tübingen, Tübingen, Germany.
| | - Michaela Döring
- Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Thomas Eichholz
- Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Martin Ebinger
- Children's Hospital, University of Tübingen, Tübingen, Germany
| | | | | | - Klaus Schwarz
- Institute for Transfusion Medicine, University of Ulm, Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics, German Red Cross Blood Service Baden-Württemberg-Hessen, Ulm, Germany
| | | | - Peter Lang
- Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Jacek Toporski
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
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24
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Schlegel P, Jung G, Lang AM, Döring M, Schulte JH, Ebinger M, Holzer U, Heubach F, Seitz C, Lang B, Hundsdörfer P, Eggert A, Eichholz T, Kreyenberg H, Lang P, Handgretinger R. ADCC can improve graft vs leukemia effect after T- and B-cell depleted haploidentical stem cell transplantation in pediatric B-lineage ALL. Bone Marrow Transplant 2020; 54:689-693. [PMID: 31431707 DOI: 10.1038/s41409-019-0606-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Posttransplant relapsed B-cell precursor ALL can be cured by 2nd hematopoietic stem cell transplantation (HSCT) in 20% of patients. The major cause of death after second HSCT is leukemic relapse. One reliable predictor for survival after 2nd-HSCT are posttransplant MRD levels. Patients with detectable or increase of MRD are likely to relapse. Patients in complete molecular remission show the best leukemia-free survival and lowest cumulative incidence (CI) of relapse. As patients who undergo second or subsequent HSCT are high-risk patients, we evaluated the prophylactic use of the chimeric Fc-optimized CD19-4G7SDIE-mAb. Posttransplant relapsed CD19+ BCP-ALL patients, who underwent a second or subsequent haplo-HSCT from a T- and B-cell depleted graft received posttransplant prophylactic CD19-4G7SDIE-mAb treatment on compassionate use in complete molecular remission, to increase the antileukemic activity of the new reconstituting immune system by recruiting Fc-expressing effector cells. NK cells recovered early and robust. The 3 year overall survival in 15 evaluable patients was 56%, the 3 year event-free survival was 55% and the CI of relapse 38%. Compared to a historical control group, the CI of relapse was markedly lower and consecutively the EFS higher. Posttransplant-targeted therapy may overcome the need for unspecific GvL effect of undesired GvHD, that can cause severe morbidity and mortality. Due to a low adverse event profile the CD19-4G7SDIE-mAb may be suitable for broad administration to consolidate posttransplant MRD negativity.
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Affiliation(s)
- Patrick Schlegel
- Department of Pediatric Hematology and Oncology, University Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Gundram Jung
- Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, Tuebingen, Germany
| | - Anne-Marie Lang
- Department of Pediatric Hematology and Oncology, University Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Michaela Döring
- Department of Pediatric Hematology and Oncology, University Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Johannes H Schulte
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Charité Berlin, Germany
| | - Martin Ebinger
- Department of Pediatric Hematology and Oncology, University Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Ursula Holzer
- Department of Pediatric Hematology and Oncology, University Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Florian Heubach
- Department of Pediatric Hematology and Oncology, University Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Christian Seitz
- Department of Pediatric Hematology and Oncology, University Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Barbara Lang
- Department of Pediatric Hematology and Oncology, University Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Patrick Hundsdörfer
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Charité Berlin, Germany
| | - Angelika Eggert
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Charité Berlin, Germany
| | - Thomas Eichholz
- Department of Pediatric Hematology and Oncology, University Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Hermann Kreyenberg
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Frankfurt, Germany
| | - Peter Lang
- Department of Pediatric Hematology and Oncology, University Children's Hospital, University of Tuebingen, Tuebingen, Germany.
| | - Rupert Handgretinger
- Department of Pediatric Hematology and Oncology, University Children's Hospital, University of Tuebingen, Tuebingen, Germany
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25
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Beschle J, Döring M, Kehrer C, Raabe C, Bayha U, Strölin M, Böhringer J, Bevot A, Kaiser N, Bender B, Grimm A, Lang P, Müller I, Krägeloh-Mann I, Groeschel S. Early clinical course after hematopoietic stem cell transplantation in children with juvenile metachromatic leukodystrophy. Mol Cell Pediatr 2020; 7:12. [PMID: 32910272 PMCID: PMC7483683 DOI: 10.1186/s40348-020-00103-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Long-term outcomes of hematopoietic stem cell transplantation (HSCT) in children with juvenile metachromatic leukodystrophy (MLD) have been investigated systematically, while short-term effects of HSCT on the course of the disease remain to be elucidated. Results In this study, the clinical course was evaluated over the first 24 months following HSCT, conducted at our center in 12 children with juvenile MLD (mean follow-up 6.75 years, range 3–13.5) and compared with 35 non-transplanted children with juvenile MLD. Motor function (GMFM-88 and GMFC-MLD), cognitive function (FSIQ), peripheral neuropathy (tibial nerve conduction velocity), and cerebral changes (MLD-MR severity score) were tested prospectively. Seven children remained neurologically stable over a long period, five exhibited rapid disease progression over the first 12 to 18 months after transplantation. In the latter, time from first gross motor symptoms to loss of independent walking was significantly shorter compared with non-transplanted patients at the same stage of disease (p < 0.02). Positive prognostic factors were good motor function (GMFM = 100%, GMFC-MLD = 0) and a low MR severity score (≤ 17) at the time of HSCT. Conclusions Our results show that if disease progression occurs, this happens early on after HSCT and proceeds faster than in non-transplanted children with juvenile MLD, indicating that HSCT may trigger disease progression.
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Affiliation(s)
- Judith Beschle
- Department for Pediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Michaela Döring
- Department for General Pediatrics, Hematology/Oncology, University Children's Hospital, Tübingen, Germany
| | - Christiane Kehrer
- Department for Pediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Christa Raabe
- Department for Pediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Ute Bayha
- Department for Pediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Manuel Strölin
- Department for Pediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Judith Böhringer
- Department for Pediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Andrea Bevot
- Department for Pediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Nadja Kaiser
- Department for Pediatric Neurology, University Children's Hospital, Tübingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, Tübingen, Germany
| | | | - Peter Lang
- Department for General Pediatrics, Hematology/Oncology, University Children's Hospital, Tübingen, Germany
| | - Ingo Müller
- Department of Pediatric Hematology and Oncology, University Hospital Eppendorf, Hamburg, Germany
| | | | - Samuel Groeschel
- Department for Pediatric Neurology, University Children's Hospital, Tübingen, Germany.
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Döring M, Kluba T, Cabanillas Stanchi KM, Kahle P, Lenglinger K, Tsiflikas I, Treuner C, Vaegler M, Mezger M, Erbacher A, Schumm M, Lang P, Handgretinger R, Müller I. Longtime Outcome After Intraosseous Application of Autologous Mesenchymal Stromal Cells in Pediatric Patients and Young Adults with Avascular Necrosis After Steroid or Chemotherapy. Stem Cells Dev 2020; 29:811-822. [PMID: 32295491 DOI: 10.1089/scd.2020.0019] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Avascular necrosis (AVN) is a severe complication of immunosuppressant therapy or chemotherapy. A beneficial AVN therapy with core decompression (CD) and intraosseous infusion of mesenchymal stromal cells (MSCs) has been described in adult patients, but there are only few data on MSC applications in pediatric and young adult patients (PYAP). Between 2006 and 2015, 14 AVN lesions of 10 PYAP (6 females) with a median age of 16.9 years (range 8.5-25.8 years) received CD and intraosseous application of autologous MSCs. Data of these patients were analyzed regarding efficacy, safety, and feasibility of this procedure as AVN therapy and compared with a control group of 13 AVN lesions of 11 PYAP (5 females) with a median age of 17.9 years (range 13.5-27.5 years) who received CD only. During the follow-up analysis [MSC group: median 3.1 (1.6-5.8) years after CD; CD group: median 2.0 (1.5-8.5) years after CD], relative lesion sizes (as assessed by magnetic resonance imaging) compared with the initial lesion volume, were significantly lower (P < 0.05) in the MSC group (volume reduction to a median of 18.5%) when compared with the CD group (58.0%). One lesion in the MSC group comprised a complete remission. Size progression was not observed in either group. Clinical improvement (pain, mobility) was not significantly different between the two groups. None of the patients experienced treatment-related adverse effects. CD and additional MSC application was regarded safe, effective, feasible, and superior in reducing the lesion size when compared with CD only. Prospective, randomized clinical trials are needed to further evaluate these findings.
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Affiliation(s)
- Michaela Döring
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Torsten Kluba
- Department of Orthopedic Surgery, Städtisches Klinikum Dresden, Dresden, Germany
| | - Karin Melanie Cabanillas Stanchi
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Peter Kahle
- Department of Orthopedics, University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Lenglinger
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Ilias Tsiflikas
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Claudia Treuner
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Martin Vaegler
- Charité - Universitätsmedizin Berlin, Campus Berlin Buch, Experimental and Clinical Research Center, Zellkulturlabor für Klinische Prüfung ZKP, Berlin, Germany
| | - Markus Mezger
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Annika Erbacher
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Michael Schumm
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Peter Lang
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Rupert Handgretinger
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
| | - Ingo Müller
- Department I-General Pediatrics, Hematology and Oncology, University Hospital Tuebingen-Children's Hospital Tuebingen, Tuebingen, Germany
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28
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Ireland DG, Döring M, Glazier DI, Haidenbauer J, Mai M, Murray-Smith R, Rönchen D. Kaon Photoproduction and the Λ Decay Parameter α_{-}. Phys Rev Lett 2019; 123:182301. [PMID: 31763878 DOI: 10.1103/physrevlett.123.182301] [Citation(s) in RCA: 2] [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] [Received: 04/19/2019] [Revised: 09/09/2019] [Indexed: 06/10/2023]
Abstract
The weak decay parameter α_{-} of the Λ is an important quantity for the extraction of polarization observables in various experiments. Moreover, in combination with α_{+} from Λ[over ¯] decay it provides a measure for matter-antimatter asymmetry. The weak decay parameter also affects the decay parameters of the Ξ and Ω baryons and, in general, any quantity in which the polarization of the Λ is relevant. The recently reported value by the BESIII Collaboration of 0.750(9)(4) is significantly larger than the previous PDG value of 0.642(13) that had been accepted and used for over 40 years. In this work we make an independent estimate of α_{-}, using an extensive set of polarization data measured in kaon photoproduction in the baryon resonance region and constraints set by spin algebra. The obtained value is 0.721(6)(5). The result is corroborated by multiple statistical tests as well as a modern phenomenological model, showing that our new value yields the best description of the data in question. Our analysis supports the new BESIII finding that α_{-} is significantly larger than the previous PDG value. Any experimental quantity relying on the value of α_{-} should therefore be reconsidered.
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Affiliation(s)
- D G Ireland
- SUPA, School of Physics and Astronomy, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - M Döring
- Institute for Nuclear Studies and Department of Physics, The George Washington University, Washington, D.C. 20052, USA
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - D I Glazier
- SUPA, School of Physics and Astronomy, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - J Haidenbauer
- Institute for Advanced Simulation, Institut für Kernphysik (Theorie) and Jülich Center for Hadron Physics, Forschungszentrum Jülich, D-52425 Jülich, Germany
| | - M Mai
- Institute for Nuclear Studies and Department of Physics, The George Washington University, Washington, D.C. 20052, USA
| | - R Murray-Smith
- School of Computing Science, University of Glasgow, Glasgow G12 8RZ, United Kingdom
| | - D Rönchen
- Helmholtz-Institut für Strahlen- und Kernphysik (Theorie) and Bethe Center for Theoretical Physics, Universität Bonn, 53115 Bonn, Germany
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Cabanillas Stanchi KM, Ebinger M, Hartmann U, Queudeville M, Feucht J, Ost M, Koch MS, Malaval C, Mezger M, Schober S, Weber S, Michaelis S, Lange V, Lang P, Handgretinger R, Döring M. Efficacy, Safety And Feasibility Of Antiemetic Prophylaxis With Fosaprepitant, Granisetron And Dexamethasone In Pediatric Patients With Hemato-Oncological Malignancies. Drug Des Devel Ther 2019; 13:3439-3451. [PMID: 31686784 PMCID: PMC6777642 DOI: 10.2147/dddt.s214264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/29/2019] [Indexed: 01/18/2023]
Abstract
Background Chemotherapy-induced nausea and vomiting (CINV) are a major burden for patients undergoing emetogenic chemotherapy. International guidelines recommend an antiemetic prophylaxis with corticosteroids, 5-HT3R-antagonists and NK1R-antagonists. The NK1R-antagonist fosaprepitant has shown favorable results in pediatric and adult patients. There is little pediatric experience with fosaprepitant. Methods This non-interventional observation study analyzed 303 chemotherapy courses administered to 83 pediatric patients with a median age of 9 years (2-17 years), who received antiemetic prophylaxis either with fosaprepitant and granisetron with or without dexamethasone (fosaprepitant group/FG; n=41), or granisetron with or without dexamethasone (control group/CG; n=42), during moderately (CINV risk 30-90%) or highly (CINV risk>90%) emetogenic chemotherapy. The two groups' results were compared with respect to the safety and efficacy of the antiemetic prophylaxis during the acute (0-24hrs after chemotherapy), delayed (>24-120hrs after chemotherapy) and both CINV phases. Laboratory and clinical adverse events were compared between the two cohorts. Results Adverse events were not significantly different in the two groups (p>0.05). Significantly fewer vomiting events occurred during antiemetic prophylaxis with fosaprepitant in the acute (23 vs 142 events; p<0.0001) and the delayed (71 vs 255 events; p<0.0001) CINV phase. In the control group, the percentage of chemotherapy courses with vomiting was significantly higher during the acute (24%/FG vs 45%/CG; p<0.0001) and delayed CINV phase (28%/FG vs 47%/CG; p=0.0004). Dimenhydrinate (rescue medication) was administered significantly more often in the CG, compared to the FG (114/FG vs 320/CG doses; p<0.0001). Likewise, in the control group, dimenhydrinate was administered in significantly more (p<0.0001) chemotherapy courses during the acute and delayed CINV phases (79 of 150; 52.7%), compared to the fosaprepitant group (45 of 153; 29.4%). Conclusion Antiemetic prophylaxis with fosaprepitant and granisetron with or without dexamethasone was well tolerated, safe and effective in pediatric patients. However, larger prospective trials are needed to evaluate these findings.
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Affiliation(s)
| | - Martin Ebinger
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Ulrike Hartmann
- University Pharmacy, Eberhard-Karls-University of Tübingen, Tübingen 72076, Germany
| | - Manon Queudeville
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Judith Feucht
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Michael Ost
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Marie-Sarah Koch
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Carmen Malaval
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Markus Mezger
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Sarah Schober
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Simone Weber
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Sebastian Michaelis
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Veit Lange
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Peter Lang
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Rupert Handgretinger
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
| | - Michaela Döring
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Tübingen 72076, Germany
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Lehrnbecher T, Rath PM, Attarbaschi A, Cario G, Döring M, Moser O, Mücke U, Poyer F, Rieken S, Temme C, Voigt S, Groll AH, Lauten M. Galactomannan and PCR in the Central Nervous System to Detect Invasive Mold Disease - A Retrospective Analysis in Immunocompromised Children. Sci Rep 2019; 9:12950. [PMID: 31506548 PMCID: PMC6736859 DOI: 10.1038/s41598-019-49426-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/23/2019] [Indexed: 01/01/2023] Open
Abstract
Invasive mold disease (IMD) of the central nervous system (CNS) is a severe infectious complication in immunocompromised patients, but early microbiological diagnosis is difficult. As data on the value of biomarkers in the CNS are scarce, in particular in children, we retrospectively analyzed the performance of galactomannan (GM) and PCR assays in CNS samples of 15 children with proven and probable CNS IMD and of 32 immunocompromised children without fungal infection. Galactomannan in the cerebrospinal fluid (CSF) was assessed in nine of the 15 pediatric patients and was positive in five of them. Polymerase chain reaction (PCR) was performed in eight of the 15 patients and detected nucleic acids from molds in six patients. Galactomannan and PCR in CNS samples were the only positive microbiologic parameter in the CNS in three and two patients, respectively. In four patients, PCR specified the pathogen detected in microscopy. Galactomannan and PCR results remained negative in the CSF of all immunocompromised children without evidence for CNS IMD. Our data suggest that GM and PCR in CNS specimens are valuable additional tools in diagnosing CNS IMD and should be included in the work up of all pediatric patients with suspected mold disease of the CNS.
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Affiliation(s)
- Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University of Frankfurt, Frankfurt, Germany.
| | - Peter Michael Rath
- Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
| | - Andishe Attarbaschi
- St. Anna Children's Hospital, Medical University of Vienna, Pediatric Hematology and Oncology, Vienna, Austria
| | - Gunnar Cario
- Christian Albrechts University Kiel, Department of Pediatrics, Pediatric Hematology and Oncology, Kiel, Germany
| | - Michaela Döring
- University Children's Hospital Tübingen, Department of Paediatric Haematology and Oncology, Tübingen, Germany
| | - Olga Moser
- University Hospital Aachen, Division of Pediatric Hematology and Oncology, Aachen, Germany
| | - Urs Mücke
- Hannover Medical School, Department of Paediatric Haematology and Oncology, Hannover, Germany
| | - Fiona Poyer
- St. Anna Children's Hospital, Medical University of Vienna, Pediatric Hematology and Oncology, Vienna, Austria
| | - Sarah Rieken
- University of Lübeck, Department of Paediatrics, Paediatric Haematology and Oncology, Lübeck, Germany
| | - Christian Temme
- University Hospital Essen, Department of Paediatrics III, Essen, Germany
| | - Sebastian Voigt
- University Hospital Charité Berlin, Department of Paediatric Haematology and Oncology, Berlin, Germany
| | - Andreas H Groll
- University Children's Hospital Münster, Infectious Disease Research Program, Department of Paediatric Haematology and Oncology, Münster, Germany
| | - Melchior Lauten
- University of Lübeck, Department of Paediatrics, Paediatric Haematology and Oncology, Lübeck, Germany
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Fage J, Knoll K, Niessner N, Carstensen O, Schulz T, Malz F, Döring M, Schönberger F. Poly (Butyl Acrylate)-Graft-Polystyrene Synthesis by Free-Radical Polymerization: Interplay between Structure, Morphology, Mechanical, and Optical Properties. Polymers (Basel) 2019; 11:polym11081317. [PMID: 31394724 PMCID: PMC6722744 DOI: 10.3390/polym11081317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/29/2019] [Accepted: 08/03/2019] [Indexed: 11/16/2022] Open
Abstract
We report a new method of preparation of poly (butyl acrylate)-g-polystyrene/polystyrene blends by free-radical polymerization. Copolymerization of glycidyl (meth)acrylate with butyl acrylate is followed by a polymer analogous reaction of this copolymer with acrylic acid and subsequent copolymerization of the modified backbone with styrene. Investigation on the number of reactive groups per backbone chain and its molecular weight allows grafting efficiencies of about 35% to be reached, as well as low cross-linking. Blends of nanophase-separated copolymers having a backbone with Mn of around 50 kg/mol and 4 reactive groups per chain are transparent, with haze as low as 14%, tensile strength of around 22 MPa, and elongations at the break of around 3%. Correlation between morphology determined by transmission electron microscopy and properties of the blend is established.
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Affiliation(s)
- J Fage
- Fraunhofer Institute for Structural Durability and System Reliability, Plastics Division, Schlossgartenstrasse 6, 64289 Darmstadt, Germany
| | - K Knoll
- BASF SE, Carl-Bosch-Straße 38, 67063 Ludwigshafen am Rhein, Germany
| | - N Niessner
- INEOS Styrolution Group GmbH, Mainzer Landstrasse 50, 60325 Frankfurt am Main, Germany
| | - O Carstensen
- INEOS Styrolution Group GmbH, Mainzer Landstrasse 50, 60325 Frankfurt am Main, Germany
| | - T Schulz
- LANXESS Deutschland GmbH, Chempark Leverkusen, Gebäude R14, 51369 Leverkusen, Germany
| | - F Malz
- Fraunhofer Institute for Structural Durability and System Reliability, Plastics Division, Schlossgartenstrasse 6, 64289 Darmstadt, Germany
| | - M Döring
- Fraunhofer Institute for Structural Durability and System Reliability, Plastics Division, Schlossgartenstrasse 6, 64289 Darmstadt, Germany
| | - F Schönberger
- Fraunhofer Institute for Structural Durability and System Reliability, Plastics Division, Schlossgartenstrasse 6, 64289 Darmstadt, Germany.
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Lauten M, Attarbaschi A, Cario G, Döring M, Moser O, Mücke U, Poyer F, Rieken S, Temme C, Voigt S, Lehrnbecher T, Groll AH. Invasive mold disease of the central nervous system in children and adolescents with cancer or undergoing hematopoietic stem cell transplantation: Analysis of 29 contemporary patients. Pediatr Blood Cancer 2019; 66:e27806. [PMID: 31066209 DOI: 10.1002/pbc.27806] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/04/2019] [Accepted: 04/25/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Invasive mold disease (IMD) is a severe infectious complication in immunocompromised patients. The outcome of central nervous system (CNS) IMD is poor, but contemporary data, in particular in the pediatric setting, are lacking. PROCEDURE For this retrospective multicenter analysis, pediatric patients < 18 years with proven or probable CNS IMD receiving chemotherapy or undergoing allogeneic HSCT were reported by the local investigator. CNS IMD had to be diagnosed between 2007 and 2016. Proven CNS IMD was defined as compatible CNS imaging or macroscopic autopsy findings in conjunction with a positive microscopic or microbiological result in the brain tissue or cerebrospinal fluid. Probable CNS IMD was defined as compatible CNS imaging findings in combination with proven or probable IMD at a site outside the CNS. RESULTS AND CONCLUSIONS A total of 29 patients (median age, 14 years; 14 allogeneic HSCT recipients) were diagnosed with proven (n = 12) or probable (n = 17) CNS IMD. Aspergillus spp. was the most common fungal pathogen. All but one patient had IMD sites outside the CNS and eight patients (27.6%) were neurologically asymptomatic at diagnosis of CNS IMD. Forty-nine percent of the patients survived CNS IMD; however, 46.7% of the survivors suffered from severe long-term neurological sequelae. Our data suggest that (1) outcome of CNS IMD has improved in children as compared with previous series, (2) half of surviving patients suffer from severe neurological sequelae, and (3) imaging of the CNS should be performed in all children with IMD irrespective of neurological symptoms.
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Affiliation(s)
- Melchior Lauten
- Department of Pediatrics, University of Lübeck, Pediatric Hematology and Oncology, Lübeck, Germany
| | - Andishe Attarbaschi
- St. Anna Children's Hospital, Medical University of Vienna, Pediatric Hematology and Oncology, Vienna, Austria
| | - Gunnar Cario
- Department of Pediatrics, Pediatric Hematology and Oncology, Christian Albrechts University Kiel, Kiel, Germany
| | - Michaela Döring
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Olga Moser
- Department of Pediatrics, University Hospital Aachen, Aachen, Germany
| | - Urs Mücke
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Fiona Poyer
- St. Anna Children's Hospital, Medical University of Vienna, Pediatric Hematology and Oncology, Vienna, Austria
| | - Sarah Rieken
- Department of Pediatrics, University of Lübeck, Pediatric Hematology and Oncology, Lübeck, Germany
| | - Christian Temme
- Department of Pediatrics III, University Hospital Essen, Essen, Germany
| | - Sebastian Voigt
- Department of Pediatric Hematology and Oncology, University Hospital Charité Berlin, Berlin, Germany
| | - Thomas Lehrnbecher
- Johann Wolfgang von Goethe University, Pediatric Hematology and Oncology, Children's Hospital III, Frankfurt, Germany
| | - Andreas H Groll
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Infectious Disease Research Program, Münster, Germany
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Mai M, Döring M. Finite-Volume Spectrum of π^{+}π^{+} and π^{+}π^{+}π^{+} Systems. Phys Rev Lett 2019; 122:062503. [PMID: 30822051 DOI: 10.1103/physrevlett.122.062503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 01/14/2019] [Indexed: 06/09/2023]
Abstract
The ab initio understanding of hadronic three-body systems above threshold, such as exotic resonances or the baryon spectrum, requires the mapping of the finite-volume eigenvalue spectrum, produced in lattice QCD calculations, to the infinite volume. We present the first application of such a formalism to a physical system in form of three interacting positively charged pions. The results for the ground state energies agree with the available lattice QCD results by the NPLQCD collaboration at unphysical pion masses. Extrapolations to physical pion masses are performed using input from effective field theory. The excited energy spectrum is predicted. This demonstrates the feasibility to determine three-body amplitudes above threshold from lattice QCD, including resonance properties of axial mesons, exotics, and excited baryons.
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Affiliation(s)
- M Mai
- Institute for Nuclear Studies and Department of Physics, The George Washington University, Washington, DC 20052, USA
| | - M Döring
- Institute for Nuclear Studies and Department of Physics, The George Washington University, Washington, DC 20052, USA
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
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Blaeschke F, Stenger D, Kaeuferle T, Willier S, Lotfi R, Kaiser AD, Assenmacher M, Döring M, Feucht J, Feuchtinger T. Induction of a central memory and stem cell memory phenotype in functionally active CD4 + and CD8 + CAR T cells produced in an automated good manufacturing practice system for the treatment of CD19 + acute lymphoblastic leukemia. Cancer Immunol Immunother 2018; 67:1053-1066. [PMID: 29605883 PMCID: PMC11028239 DOI: 10.1007/s00262-018-2155-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/24/2018] [Indexed: 11/24/2022]
Abstract
Relapsed/refractory B-precursor acute lymphoblastic leukemia (pre-B ALL) remains a major therapeutic challenge. Chimeric antigen receptor (CAR) T cells are promising treatment options. Central memory T cells (Tcm) and stem cell-like memory T cells (Tscm) are known to promote sustained proliferation and persistence after T-cell therapy, constituting essential preconditions for treatment efficacy. Therefore, we set up a protocol for anti-CD19 CAR T-cell generation aiming at high Tcm/Tscm numbers. 100 ml peripheral blood from pediatric pre-B ALL patients was processed including CD4+/CD8+-separation, T-cell activation with modified anti-CD3/-CD28 reagents and transduction with a 4-1BB-based second generation CAR lentiviral vector. The process was performed on a closed, automated device requiring additional manual/open steps under clean room conditions. The clinical situation of these critically ill and refractory patients with leukemia leads to inconsistent cellular compositions at start of the procedure including high blast counts and low T-cell numbers with exhausted phenotype. Nevertheless, a robust T-cell product was achieved (mean CD4+ = 50%, CD8+ = 39%, transduction = 27%, Tcm = 50%, Tscm = 46%). Strong proliferative potential (up to > 100-fold), specific cytotoxicity and low expression of co-inhibitory molecules were documented. CAR T cells significantly released TH1 cytokines IFN-γ, TNF-α and IL-2 upon target-recognition. In conclusion, partly automated GMP-generation of CAR T cells from critically small blood samples was feasible with a new stimulation protocol that leads to high functionality and expansion potential, balanced CD4/CD8 ratios and a conversion to a Tcm/Tscm phenotype.
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Affiliation(s)
- Franziska Blaeschke
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner University Children's Hospital, Ludwig Maximilian University Munich, Lindwurmstrasse 4, 80337, Munich, Germany
| | - Dana Stenger
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner University Children's Hospital, Ludwig Maximilian University Munich, Lindwurmstrasse 4, 80337, Munich, Germany
| | - Theresa Kaeuferle
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner University Children's Hospital, Ludwig Maximilian University Munich, Lindwurmstrasse 4, 80337, Munich, Germany
| | - Semjon Willier
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner University Children's Hospital, Ludwig Maximilian University Munich, Lindwurmstrasse 4, 80337, Munich, Germany
| | - Ramin Lotfi
- Institute for Transfusion Medicine, University Hospital Ulm, Ulm, Germany
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Services Baden-Württemberg-Hessen, Ulm, Germany
| | | | | | - Michaela Döring
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner University Children's Hospital, Ludwig Maximilian University Munich, Lindwurmstrasse 4, 80337, Munich, Germany
- Department I - General Pediatrics, Hematology/Oncology, University Hospital Tübingen, Children's Hospital, Tübingen, Germany
| | - Judith Feucht
- Department I - General Pediatrics, Hematology/Oncology, University Hospital Tübingen, Children's Hospital, Tübingen, Germany
- Memorial Sloan Kettering Cancer Center, Center for Cell Engineering, New York, USA
| | - Tobias Feuchtinger
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner University Children's Hospital, Ludwig Maximilian University Munich, Lindwurmstrasse 4, 80337, Munich, Germany.
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Döring M, Cabanillas Stanchi KM, Klinker H, Eikemeier M, Feucht J, Blaeschke F, Schwarze CP, Ebinger M, Feuchtinger T, Handgretinger R, Heinz WJ. Posaconazole plasma concentrations in pediatric patients receiving antifungal prophylaxis during neutropenia. Med Mycol 2018; 55:375-384. [PMID: 27703016 DOI: 10.1093/mmy/myw091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/15/2016] [Indexed: 02/03/2023] Open
Abstract
Invasive fungal infections are one of the major complications in pediatric patients during prolonged neutropenia after chemotherapy. Evaluation of the efficacy and safety of the triazole posaconazole in these patients is missing. This multicenter survey analyzed trough concentrations of 33 pediatric patients with a median age of 8 years during 108 neutropenic episodes who received prophylactic posaconazole oral suspension. A total of 172 posaconazole trough levels were determined to median 438 ng/ml (range 111-2011 ng/ml; mean 468 ± 244 ng/ml). Age and gender had no influence on posaconazole plasma levels. Posaconazole was not discontinued due to adverse events in any of the patients. Only hepatic parameters significantly increased beyond the upper normal limit to median values of ALT of 87 U/l (P < .0001), and AST of 67 U/l (P < .0001). One patient with a median posaconazole trough concentration of 306 ng/ml experienced an invasive fungal infection. In conclusion, posaconazole was effective, safe and feasible in 33 pediatric patients with neutropenia ≥5 days after chemotherapy. Median posaconazole plasma concentrations were approximately 1.6-fold lower than the recommended plasma level of 700 ng/ml. Larger patient cohorts are needed to evaluate these findings.
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Affiliation(s)
- Michaela Döring
- University Hospital Tübingen, Children's Hospital, Department I - General Paediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Karin Melanie Cabanillas Stanchi
- University Hospital Tübingen, Children's Hospital, Department I - General Paediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Hartwig Klinker
- University Medical Center, Würzburg, Department of Infectiology, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Melinda Eikemeier
- University Hospital Tübingen, Children's Hospital, Department I - General Paediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Judith Feucht
- University Hospital Tübingen, Children's Hospital, Department I - General Paediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Franziska Blaeschke
- Ludwig-Maximilians-University München, Dr. von Hauner'sches Kinderspital, Pediatric Hematology, Oncology and Stem Cell Transplantation, Lindwurmstrasse 4, 80337 Munich, Germany
| | - Carl-Philipp Schwarze
- University Hospital Tübingen, Children's Hospital, Department I - General Paediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Martin Ebinger
- University Hospital Tübingen, Children's Hospital, Department I - General Paediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Tobias Feuchtinger
- Ludwig-Maximilians-University München, Dr. von Hauner'sches Kinderspital, Pediatric Hematology, Oncology and Stem Cell Transplantation, Lindwurmstrasse 4, 80337 Munich, Germany
| | - Rupert Handgretinger
- University Hospital Tübingen, Children's Hospital, Department I - General Paediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Werner J Heinz
- University Medical Center, Würzburg, Department of Infectiology, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
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Feucht J, Kayser S, Gorodezki D, Hamieh M, Döring M, Blaeschke F, Schlegel P, Bösmüller H, Quintanilla-Fend L, Ebinger M, Lang P, Handgretinger R, Feuchtinger T. T-cell responses against CD19+ pediatric acute lymphoblastic leukemia mediated by bispecific T-cell engager (BiTE) are regulated contrarily by PD-L1 and CD80/CD86 on leukemic blasts. Oncotarget 2018; 7:76902-76919. [PMID: 27708227 PMCID: PMC5363558 DOI: 10.18632/oncotarget.12357] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 09/02/2016] [Indexed: 01/22/2023] Open
Abstract
T-cell immunotherapies are promising options in relapsed/refractory B-precursor acute lymphoblastic leukemia (ALL). We investigated the effect of co-signaling molecules on T-cell attack against leukemia mediated by CD19/CD3-bispecific T-cell engager. Primary CD19+ ALL blasts (n≥10) and physiologic CD19+CD10+ bone marrow precursors were screened for 20 co-signaling molecules. PD-L1, PD-1, LAG-3, CD40, CD86, CD27, CD70 and HVEM revealed different stimulatory and inhibitory profiles of pediatric ALL compared to physiologic cells, with PD-L1 and CD86 as most prominent inhibitory and stimulatory markers. PD-L1 was increased in relapsed ALL patients (n=11) and in ALLs refractory to Blinatumomab (n=5). Exhaustion markers (PD-1, TIM-3) were significantly higher on patients' T cells compared to physiologic controls. T-cell proliferation and effector function was target-cell dependent and correlated to expression of co-signaling molecules. Blockade of inhibitory PD-1-PD-L and CTLA-4-CD80/86 pathways enhanced T-cell function whereas blockade of co-stimulatory CD28-CD80/86 interaction significantly reduced T-cell function. Combination of Blinatumomab and anti-PD-1 antibody was feasible and induced an anti-leukemic in vivo response in a 12-year-old patient with refractory ALL. In conclusion, ALL cells actively regulate T-cell function by expression of co-signaling molecules and modify efficacy of therapeutic T-cell attack against ALL. Inhibitory interactions of leukemia-induced checkpoint molecules can guide future T-cell therapies.
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Affiliation(s)
- Judith Feucht
- Department of General Pediatrics, Hematology and Oncology, Children's University Hospital Tübingen, Tübingen, Germany.,Memorial Sloan Kettering Cancer Center, Center for Cell Engineering, New York, NY, USA
| | - Simone Kayser
- Department of General Pediatrics, Hematology and Oncology, Children's University Hospital Tübingen, Tübingen, Germany
| | - David Gorodezki
- Department of General Pediatrics, Hematology and Oncology, Children's University Hospital Tübingen, Tübingen, Germany
| | - Mohamad Hamieh
- Memorial Sloan Kettering Cancer Center, Center for Cell Engineering, New York, NY, USA
| | - Michaela Döring
- Department of General Pediatrics, Hematology and Oncology, Children's University Hospital Tübingen, Tübingen, Germany.,Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Franziska Blaeschke
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Patrick Schlegel
- Department of General Pediatrics, Hematology and Oncology, Children's University Hospital Tübingen, Tübingen, Germany
| | - Hans Bösmüller
- Institute of Pathology, University Hospital Tübingen, Tübingen, Germany
| | | | - Martin Ebinger
- Department of General Pediatrics, Hematology and Oncology, Children's University Hospital Tübingen, Tübingen, Germany
| | - Peter Lang
- Department of General Pediatrics, Hematology and Oncology, Children's University Hospital Tübingen, Tübingen, Germany
| | - Rupert Handgretinger
- Department of General Pediatrics, Hematology and Oncology, Children's University Hospital Tübingen, Tübingen, Germany
| | - Tobias Feuchtinger
- Department of General Pediatrics, Hematology and Oncology, Children's University Hospital Tübingen, Tübingen, Germany.,Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
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Mainardi C, Ebinger M, Enkel S, Feuchtinger T, Teltschik HM, Eyrich M, Schumm M, Rabsteyn A, Schlegel P, Seitz C, Schwarze CP, Müller I, Greil J, Bader P, Schlegel PG, Martin D, Holzer U, Döring M, Handgretinger R, Lang P. CD34 + selected stem cell boosts can improve poor graft function after paediatric allogeneic stem cell transplantation. Br J Haematol 2017; 180:90-99. [PMID: 29205259 DOI: 10.1111/bjh.15012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/19/2017] [Indexed: 12/13/2022]
Abstract
Poor graft function (PGF) is a severe complication of haematopoietic stem cell transplantation (HSCT) and administration of donor stem cell boosts (SCBs) represents a therapeutic option. We report 50 paediatric patients with PGF who received 61 boosts with CD34+ selected peripheral blood stem cells (PBSC) after transplantation from matched unrelated (n = 25) or mismatched related (n = 25) donors. Within 8 weeks, a significant increase in median neutrophil counts (0·6 vs. 1·516 × 109 /l, P < 0·05) and a decrease in red blood cell and platelet transfusion requirement (median frequencies 1 and 7 vs. 0, P < 0·0001 and <0·001), were observed, and 78·8% of patients resolved one or two of their cytopenias. 36·5% had a complete haematological response. Median lymphocyte counts for CD3+ , CD3+ CD4+ , CD19+ and CD56+ increased 8·3-, 14·2-, 22.- and 1·6-fold. The rate of de novo acute graft-versus-host disease (GvHD) grade I-III was only 6% and resolved completely. No GvHD grade IV or chronic GvHD occurred. Patients who responded to SCB displayed a trend toward better overall survival (OS) (P = 0·07). Thus, administration of CD34+ selected SCBs from alternative donors is safe and effective. Further studies are warranted to clarify the impact on immune reconstitution and survival.
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Affiliation(s)
- Chiara Mainardi
- Department of Paediatric Oncology, Children's University Hospital, University of Padova, Padova, Italy.,Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany
| | - Martin Ebinger
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany
| | - Sigrid Enkel
- Transfusion Medicine Department, Tübingen University Hospital, University of Tübingen, Tübingen, Germany
| | - Tobias Feuchtinger
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Heiko-Manuel Teltschik
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany
| | - Matthias Eyrich
- Department of Paediatric Oncology, University Children's Hospital, University of Würzburg, Würzburg, Germany
| | - Michael Schumm
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany
| | - Armin Rabsteyn
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany
| | - Patrick Schlegel
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany
| | - Christian Seitz
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany
| | - Carl-Phillip Schwarze
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany
| | - Ingo Müller
- Department of Paediatric Haematology and Oncology, University Hospital Eppendorf, Hamburg, Germany
| | - Johann Greil
- Department of Paediatric Oncology, Haematology and Immunology, University of Heidelberg, Heidelberg, Germany
| | - Peter Bader
- Clinic for Paediatric and Adolescent Medicine, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Paul-Gerhardt Schlegel
- Department of Paediatric Oncology, University Children's Hospital, University of Würzburg, Würzburg, Germany
| | - David Martin
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany.,Filderklinik, Filderstadt-Bonlanden, Germany
| | - Ursula Holzer
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany
| | - Michaela Döring
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany
| | - Rupert Handgretinger
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany
| | - Peter Lang
- Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany
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38
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Dörschner M, Bollmann A, Dinov B, Richter S, Döring M, Arya A, Müssigbrodt A, Kircher S, Dagres N, Sommer P, Hindricks G, Bode K. Structured pain management reduces patient discomfort after catheter ablation and rhythm device surgery. Eur J Pain 2017; 21:1723-1731. [DOI: 10.1002/ejp.1084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 01/23/2023]
Affiliation(s)
| | - A. Bollmann
- Department of Electrophysiology; Heart Center Leipzig; University of Leipzig; Germany
| | - B. Dinov
- Department of Electrophysiology; Heart Center Leipzig; University of Leipzig; Germany
| | - S. Richter
- Department of Electrophysiology; Heart Center Leipzig; University of Leipzig; Germany
| | - M. Döring
- Department of Electrophysiology; Heart Center Leipzig; University of Leipzig; Germany
| | - A. Arya
- Department of Electrophysiology; Heart Center Leipzig; University of Leipzig; Germany
| | - A. Müssigbrodt
- Department of Electrophysiology; Heart Center Leipzig; University of Leipzig; Germany
| | - S. Kircher
- Department of Electrophysiology; Heart Center Leipzig; University of Leipzig; Germany
| | - N. Dagres
- Department of Electrophysiology; Heart Center Leipzig; University of Leipzig; Germany
| | - P. Sommer
- Department of Electrophysiology; Heart Center Leipzig; University of Leipzig; Germany
| | - G. Hindricks
- Department of Electrophysiology; Heart Center Leipzig; University of Leipzig; Germany
| | - K. Bode
- Department of Electrophysiology; Heart Center Leipzig; University of Leipzig; Germany
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Döring M, Cabanillas Stanchi KM, Queudeville M, Feucht J, Blaeschke F, Schlegel P, Feuchtinger T, Lang P, Müller I, Handgretinger R, Heinz WJ. Efficacy, safety and feasibility of antifungal prophylaxis with posaconazole tablet in paediatric patients after haematopoietic stem cell transplantation. J Cancer Res Clin Oncol 2017; 143:1281-1292. [PMID: 28258343 DOI: 10.1007/s00432-017-2369-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Paediatric recipients of haematopoietic stem cell transplantation (HSCT) have a high risk for invasive fungal infections. Posaconazole oral suspension has proven to be effective in antifungal prophylaxis in adult and paediatric patients. A new posaconazole tablet formulation with absorption independent of the gastric conditions was approved by the FDA in 2013. This is the first report on the use of posaconazole tablets in paediatric patients. METHODS This single-centre study included 63 paediatric patients with haemato-oncological malignancies who received posaconazole for antifungal prophylaxis after HSCT. They were analysed for efficacy, feasibility and the safety of posaconazole. Out of 63 patients, 31 received posaconazole oral suspension and 32 received posaconazole tablets up to 200 days after transplantation. Analyses of the posaconazole trough levels were determined. RESULTS No possible, probable or proven invasive fungal infection was observed in either group. Posaconazole trough levels were significantly higher in the tablet group than in the suspension group at all analysed time points. Drug-related adverse events were similarly low in both groups. CONCLUSIONS Posaconazole tablets are effective in preventing invasive fungal infections in paediatric patients. As early as day 3 after starting posaconazole tablets, over 50% of the posaconazole trough levels were >500 ng/mL, while this was observed on day 14 after start with posaconazole suspension. The administration of posaconazole tablets was safe, effective and feasible as antifungal prophylaxis in paediatric patients after HSCT.
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Affiliation(s)
- Michaela Döring
- Department I - General Paediatrics, Haematology/Oncology, Children's Hospital, University Hospital Tübingen, Hoppe-Seyler-Str.1, 72076, Tübingen, Germany.
| | - Karin Melanie Cabanillas Stanchi
- Department I - General Paediatrics, Haematology/Oncology, Children's Hospital, University Hospital Tübingen, Hoppe-Seyler-Str.1, 72076, Tübingen, Germany
| | - Manon Queudeville
- Department I - General Paediatrics, Haematology/Oncology, Children's Hospital, University Hospital Tübingen, Hoppe-Seyler-Str.1, 72076, Tübingen, Germany
| | - Judith Feucht
- Department I - General Paediatrics, Haematology/Oncology, Children's Hospital, University Hospital Tübingen, Hoppe-Seyler-Str.1, 72076, Tübingen, Germany
| | - Franziska Blaeschke
- Ludwig-Maximilians-University München, Dr. von Hauner'sches Kinderspital, Paediatric Haematology, Oncology and Stem Cell Transplantation, Lindwurmstrasse 4, 80337, Munich, Germany
| | - Patrick Schlegel
- Department I - General Paediatrics, Haematology/Oncology, Children's Hospital, University Hospital Tübingen, Hoppe-Seyler-Str.1, 72076, Tübingen, Germany
| | - Tobias Feuchtinger
- Ludwig-Maximilians-University München, Dr. von Hauner'sches Kinderspital, Paediatric Haematology, Oncology and Stem Cell Transplantation, Lindwurmstrasse 4, 80337, Munich, Germany
| | - Peter Lang
- Department I - General Paediatrics, Haematology/Oncology, Children's Hospital, University Hospital Tübingen, Hoppe-Seyler-Str.1, 72076, Tübingen, Germany
| | - Ingo Müller
- Department of Paediatrics Haematology and Oncology, University Hospital Hamburg-Eppendorf, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Rupert Handgretinger
- Department I - General Paediatrics, Haematology/Oncology, Children's Hospital, University Hospital Tübingen, Hoppe-Seyler-Str.1, 72076, Tübingen, Germany
| | - Werner J Heinz
- Division of Infectious Diseases, Department of Internal Medicine II, University Medical Centre Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
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40
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Müssigbrodt A, Weber A, Mandrola J, van Belle Y, Richter S, Döring M, Arya A, Sommer P, Bollmann A, Hindricks G. Excess of exercise increases the risk of atrial fibrillation. Scand J Med Sci Sports 2017; 27:910-917. [PMID: 28090681 DOI: 10.1111/sms.12830] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 12/05/2016] [Indexed: 01/02/2023]
Abstract
An interesting and still not well-understood example for old medical wisdom "Sola dosis facit venenum" is the increased prevalence of atrial fibrillation (AF) in athletes. Numerous studies have shown a fourfold to eightfold increased risk of AF in athletes compared to the normal population. Analysis of the existing data suggests a dose-dependent effect of exercise. Moderate exercise seems to have a protective effect and decreases the risk of AF, whereas excessive exercise seems to increase the risk of AF. The described cases illustrate clinical manifestations within the spectrum of AF in elderly athletes, that is, exercise-induced AF, vagal AF, chronic AF, and atrial flutter. As the arrhythmia worsened quality of life and exercise capacity in all patients, recovery of sinus rhythm was desired in all described cases. As the atrial disease was advanced on different levels, different treatment regimes were applied. Lifestyle modification and temporary anti-arrhythmic drug therapy could stabilize sinus rhythm in one patient, whereas others needed radiofrequency ablation to achieve a stable sinus rhythm. The patient with the most advanced atrial disease necessitated anti-arrhythmic drug therapy and another left atrial ablation. All described patients remained in sinus rhythm during the long-term follow-up.
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Affiliation(s)
- A Müssigbrodt
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - A Weber
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - J Mandrola
- Baptist Health Louisville, Louisville, KY, USA
| | - Y van Belle
- Centre Hospitalier Universitaire, Liège, Belgium
| | - S Richter
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - M Döring
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - A Arya
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - P Sommer
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - A Bollmann
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
| | - G Hindricks
- Department of Electrophysiology, University of Leipzig, Heart Centre, Leipzig, Germany
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41
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Droege G, Barker K, Seberg O, Coddington J, Benson E, Berendsohn WG, Bunk B, Butler C, Cawsey EM, Deck J, Döring M, Flemons P, Gemeinholzer B, Güntsch A, Hollowell T, Kelbert P, Kostadinov I, Kottmann R, Lawlor RT, Lyal C, Mackenzie-Dodds J, Meyer C, Mulcahy D, Nussbeck SY, O'Tuama É, Orrell T, Petersen G, Robertson T, Söhngen C, Whitacre J, Wieczorek J, Yilmaz P, Zetzsche H, Zhang Y, Zhou X. The Global Genome Biodiversity Network (GGBN) Data Standard specification. Database (Oxford) 2016; 2016:baw125. [PMID: 27694206 PMCID: PMC5045859 DOI: 10.1093/database/baw125] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 08/09/2016] [Indexed: 11/24/2022]
Abstract
Genomic samples of non-model organisms are becoming increasingly important in a broad range of studies from developmental biology, biodiversity analyses, to conservation. Genomic sample definition, description, quality, voucher information and metadata all need to be digitized and disseminated across scientific communities. This information needs to be concise and consistent in today’s ever-increasing bioinformatic era, for complementary data aggregators to easily map databases to one another. In order to facilitate exchange of information on genomic samples and their derived data, the Global Genome Biodiversity Network (GGBN) Data Standard is intended to provide a platform based on a documented agreement to promote the efficient sharing and usage of genomic sample material and associated specimen information in a consistent way. The new data standard presented here build upon existing standards commonly used within the community extending them with the capability to exchange data on tissue, environmental and DNA sample as well as sequences. The GGBN Data Standard will reveal and democratize the hidden contents of biodiversity biobanks, for the convenience of everyone in the wider biobanking community. Technical tools exist for data providers to easily map their databases to the standard. Database URL:http://terms.tdwg.org/wiki/GGBN_Data_Standard
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Affiliation(s)
- G Droege
- Botanic Garden and Botanical Museum Berlin-Dahlem, Freie Universität Berlin, Königin-Luise-Str. 6-8, Berlin 14195, Germany
| | - K Barker
- National Museum of Natural History, Smithsonian Institution, Washington, DC 20560, USA
| | - O Seberg
- Natural History Museum of Denmark, University of Copenhagen, Sølvgade 83, opg. S, Copenhagen DK-1307, Denmark
| | - J Coddington
- National Museum of Natural History, Smithsonian Institution, Washington, DC 20560, USA
| | - E Benson
- Damar Research Scientists, Damar, Drum Road, Cuparmuir, Fife KY15 5RJ, UK
| | - W G Berendsohn
- Botanic Garden and Botanical Museum Berlin-Dahlem, Freie Universität Berlin, Königin-Luise-Str. 6-8, Berlin 14195, Germany
| | - B Bunk
- Leibniz Institute DSMZ - German Collection of Microorganisms and Cell Cultures, Inhoffenstr. 7B, Braunschweig 38124, Germany
| | - C Butler
- National Museum of Natural History, Smithsonian Institution, Washington, DC 20560, USA
| | - E M Cawsey
- Australian National Wildlife Collection, CSIRO National Research Collections Australia, Canberra, Australia
| | - J Deck
- Berkeley Natural History Museums, University of California at Berkeley, Berkeley, CA 94720, USA
| | - M Döring
- Global Biodiversity Information Facility Secretariat, Universitetsparken 15, Copenhagen DK-2100, Denmark
| | - P Flemons
- Australian Museum, Sydney 2010, NSW, Australia
| | - B Gemeinholzer
- Systematic Botany, Justus Liebig University, Giessen 35392, Germany
| | - A Güntsch
- Botanic Garden and Botanical Museum Berlin-Dahlem, Freie Universität Berlin, Königin-Luise-Str. 6-8, Berlin 14195, Germany
| | - T Hollowell
- National Museum of Natural History, Smithsonian Institution, Washington, DC 20560, USA
| | - P Kelbert
- Botanic Garden and Botanical Museum Berlin-Dahlem, Freie Universität Berlin, Königin-Luise-Str. 6-8, Berlin 14195, Germany
| | - I Kostadinov
- Department of Life Sciences & Chemistry, Jacobs University Bremen gGmbH, Campus Ring 1, Bremen 28759, Germany
| | - R Kottmann
- Microbial Genomics and Bioinformatics Research Group, Max Planck Institute for Marine Microbiology, Celsiusstrasse 1, Bremen 28359, Germany
| | - R T Lawlor
- ARC-Net Applied Research on Cancer Centre, Department of Pathology and Diagnostics, University of Verona, Verona 37134, Italy
| | - C Lyal
- Natural History Museum, Cromwell Road, London SW7 5BD, UK
| | | | - C Meyer
- National Museum of Natural History, Smithsonian Institution, Washington, DC 20560, USA
| | - D Mulcahy
- National Museum of Natural History, Smithsonian Institution, Washington, DC 20560, USA
| | - S Y Nussbeck
- Department of Medical Informatics and UMG Biobank, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen 37075, Germany
| | - É O'Tuama
- Global Biodiversity Information Facility Secretariat, Universitetsparken 15, Copenhagen DK-2100, Denmark
| | - T Orrell
- National Museum of Natural History, Smithsonian Institution, Washington, DC 20560, USA
| | - G Petersen
- Natural History Museum of Denmark, University of Copenhagen, Sølvgade 83, opg. S, Copenhagen DK-1307, Denmark
| | - T Robertson
- Global Biodiversity Information Facility Secretariat, Universitetsparken 15, Copenhagen DK-2100, Denmark
| | - C Söhngen
- Leibniz Institute DSMZ - German Collection of Microorganisms and Cell Cultures, Inhoffenstr. 7B, Braunschweig 38124, Germany
| | - J Whitacre
- National Museum of Natural History, Smithsonian Institution, Washington, DC 20560, USA
| | - J Wieczorek
- Museum of Vertebrate Zoology, University of California at Berkeley, Berkeley, CA 94720, USA
| | - P Yilmaz
- Microbial Genomics and Bioinformatics Research Group, Max Planck Institute for Marine Microbiology, Celsiusstrasse 1, Bremen 28359, Germany
| | - H Zetzsche
- Julius Kuehn-Institute (JKI), Federal Research Centre for Cultivated Plants, Institute for Resistance Research and Stress Tolerance, Erwin-Baur-Str. 27, Quedlinburg 06484, Germany
| | - Y Zhang
- China National GeneBank, BGI-Shenzhen, Shenzhen, Guangdong 518083, China
| | - X Zhou
- China National GeneBank, BGI-Shenzhen, Shenzhen, Guangdong 518083, China
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Hu B, Molina R, Döring M, Alexandru A. Two-Flavor Simulations of ρ(770) and the Role of the KK[over ¯] Channel. Phys Rev Lett 2016; 117:122001. [PMID: 27689266 DOI: 10.1103/physrevlett.117.122001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Indexed: 06/06/2023]
Abstract
The ρ(770) meson is the most extensively studied resonance in lattice QCD simulations in two (N_{f}=2) and three (N_{f}=2+1) flavor formulations. We analyze N_{f}=2 lattice scattering data using unitarized chiral perturbation theory, allowing not only for the extrapolation in mass but also in flavor, N_{f}=2→N_{f}=2+1. The flavor extrapolation requires information from a global fit to ππ and πK phase shifts from experiment. While the chiral extrapolation of N_{f}=2 lattice data leads to masses of the ρ(770) meson far below the experimental one, we find that the missing KK[over ¯] channel is able to explain this discrepancy.
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Affiliation(s)
- B Hu
- The George Washington University, Washington, D.C. 20052, USA
| | - R Molina
- The George Washington University, Washington, D.C. 20052, USA
| | - M Döring
- The George Washington University, Washington, D.C. 20052, USA
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Alexandru
- The George Washington University, Washington, D.C. 20052, USA
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43
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Groeschel S, Kühl JS, Bley AE, Kehrer C, Weschke B, Döring M, Böhringer J, Schrum J, Santer R, Kohlschütter A, Krägeloh-Mann I, Müller I. Long-term Outcome of Allogeneic Hematopoietic Stem Cell Transplantation in Patients With Juvenile Metachromatic Leukodystrophy Compared With Nontransplanted Control Patients. JAMA Neurol 2016; 73:1133-40. [DOI: 10.1001/jamaneurol.2016.2067] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Samuel Groeschel
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital of Tübingen, Tübingen, Germany
| | - Jörn-Sven Kühl
- Department of Pediatric Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - Annette E. Bley
- Department of Pediatrics, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Kehrer
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital of Tübingen, Tübingen, Germany
| | - Bernhard Weschke
- Department of Neuropediatrics, Charité University Medicine Berlin, Berlin, Germany
| | - Michaela Döring
- Department of Pediatric Hematology and Oncology, University Children’s Hospital of Tübingen, Tübingen, Germany
| | - Judith Böhringer
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital of Tübingen, Tübingen, Germany
| | - Johanna Schrum
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - René Santer
- Department of Pediatrics, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alfried Kohlschütter
- Department of Pediatrics, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ingeborg Krägeloh-Mann
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital of Tübingen, Tübingen, Germany
| | - Ingo Müller
- Department of Pediatric Hematology and Oncology, University Children’s Hospital of Tübingen, Tübingen, Germany6Department of Pediatric Hematology and Oncology, University Children’s Hospital Hamburg-Eppendorf, Hamburg, Germany
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Döring M, Cabanillas Stanchi KM, Feucht J, Queudeville M, Teltschik HM, Lang P, Feuchtinger T, Handgretinger R, Müller I. Ferritin as an early marker of graft rejection after allogeneic hematopoietic stem cell transplantation in pediatric patients. Ann Hematol 2015; 95:311-23. [PMID: 26611853 DOI: 10.1007/s00277-015-2560-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/17/2015] [Indexed: 01/22/2023]
Abstract
Diagnosis of adverse events following hematopoietic stem cell transplantation (HSCT) is mainly assigned to clinical symptoms or biopsies and thus rather unspecific and/or invasive. Studies indicate a distinct role of serum ferritin in HSCT and its correlation with adverse events such as graft-versus-host disease (GvHD), veno-occlusive disease (VOD), or infections. However, published data on the relevance of ferritin as a prognostic marker for post-transplant adverse events is rare, especially in pediatric patients. The present study analyzes ferritin plasma concentrations of 138 pediatric patients after HSCT between 2007 and 2010 including the control group (n = 21). Given the initial results regarding ferritin as a significant predictor for acute graft rejection after allogeneic HSCT in 9 of the 138 pediatric patients, serum ferritin of all pediatric patients (n = 27) who experienced graft rejection between 2007 and 2014 was analyzed. In addition, laboratory parameters including C-reactive protein (CRP), lactate dehydrogenase (LDH), fibrinogen, and D-dimer as possible differentiation markers for graft rejection were determined. In 24 (88.9 %) of the 27 pediatric patients with graft rejection, a significant increase of ferritin levels was observed 1 to 7 days prior to (P < 0.0001) and at the time of graft rejection (P < 0.0001). Moreover, there was an increase of D-dimer, CRP, LDH, and fibrinogen 1-7 days before graft rejection. Ferritin increased significantly at time of VOD (P = 0.0067), at time of intestinal (P < 0.0001) and skin GvHD (P < 0.0001), and at time of sepsis (P = 0.0005) and bacteremia (P = 0.0029). Ferritin might serve as a readily available identification marker for differentiation and identification of adverse events after HSCT in combination with other laboratory markers.
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Affiliation(s)
- Michaela Döring
- Department I - General Paediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany. .,Dr. von Hauner'sches Kinderspital, Pediatric Hematology, Oncology and Stem Cell Transplantation, Ludwig-Maximilians-University München, Lindwurmstrasse 4, 80337, Munich, Germany.
| | - Karin Melanie Cabanillas Stanchi
- Department I - General Paediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.
| | - Judith Feucht
- Department I - General Paediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.
| | - Manon Queudeville
- Department I - General Paediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.
| | - Heiko-Manuel Teltschik
- Department I - General Paediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.
| | - Peter Lang
- Department I - General Paediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.
| | - Tobias Feuchtinger
- Department I - General Paediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany. .,Dr. von Hauner'sches Kinderspital, Pediatric Hematology, Oncology and Stem Cell Transplantation, Ludwig-Maximilians-University München, Lindwurmstrasse 4, 80337, Munich, Germany.
| | - Rupert Handgretinger
- Department I - General Paediatrics, Hematology/Oncology, Children's Hospital, University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.
| | - Ingo Müller
- Department of Paediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Heinz WJ, Cabanillas Stanchi KM, Klinker H, Blume O, Feucht J, Hartmann U, Feuchtinger T, Lang P, Handgretinger R, Döring M. Posaconazole plasma concentration in pediatric patients receiving antifungal prophylaxis after allogeneic hematopoietic stem cell transplantation. Med Mycol 2015; 54:128-37. [PMID: 26483433 DOI: 10.1093/mmy/myv087] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/08/2015] [Indexed: 11/14/2022] Open
Abstract
Posaconazole has been proven to be effective for antifungal prophylaxis in adults after hematopoietic stem cell transplantation (HSCT). Due to low gastrointestinal resorption of posaconazole suspension, bioavailability is impaired. Fatty food improves the uptake of posaconazole, but insufficient data on the pharmacokinetics of posaconazole in pediatric patients are available so far. The single-center analysis investigated 161 posaconazole serum concentrations in 27 pediatric patients after HSCT receiving 12 mg·kg BW(-1)·d(-1) posaconazole suspension depending on age, gender, and intestinal graft-versus-host (iGvHD) disease, and the influence of posaconazole on cyclosporine A plasma concentrations. To improve the uptake of posaconazole, one patient cohort received higher fat nutrition with the drug administration. A comparison of the regular nutrition and higher-fat nutrition groups revealed the following values: 31 (27.4%) versus 8 (16.7%) < 500 ng/ml; 12 (10.6%) versus 7 (14.6%) 500-700 ng/ml; 8 (7.1%) versus 6 (12.5%) 700-1000 ng/ml; 51 (45.1%) versus 21 (43.8%) 1000-2000 ng/ml; and 11 (9.7%) versus 6 (12.5%) > 2000 ng/ml. The mean posaconazole concentrations in patients with regular nutrition was 1123 ± 811 ng/ml and with higher-fat nutrition was 1191 ± 673 ng/ml. Posaconazole levels in patients with iGvHD were significantly lower (P = 0.0003) than in patients without GvHD. The majority of samples showed a sufficient posaconazole concentration above 700 ng/ml. Posaconazole levels were slightly higher in patients with higher-fat nutrition and significantly lower in patients with iGvHD. Cyclosporine A levels were not significantly higher during posaconazole administration.
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Affiliation(s)
- Werner J Heinz
- University of Würzburg Medical Center, Department of Internal Medicine II, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Karin M Cabanillas Stanchi
- University Hospital Tübingen, Children's Hospital, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Hartwig Klinker
- University of Würzburg Medical Center, Department of Internal Medicine II, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Olivia Blume
- University Hospital Tübingen, Children's Hospital, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Judith Feucht
- University Hospital Tübingen, Children's Hospital, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Ulrike Hartmann
- University Hospital Tübingen, University Pharmacy, Röntgenweg 9, 72076 Tübingen, Germany
| | - Tobias Feuchtinger
- Ludwig-Maximilians-University München, Dr. von Hauner'sches Kinderspital, Pediatric Hematology, Oncology and Stem Cell Transplantation, Lindwurmstrasse 4, 80337 Munich
| | - Peter Lang
- University Hospital Tübingen, Children's Hospital, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Rupert Handgretinger
- University Hospital Tübingen, Children's Hospital, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany
| | - Michaela Döring
- University Hospital Tübingen, Children's Hospital, Department I - General Pediatrics, Hematology/Oncology, Hoppe-Seyler-Str.1, 72076 Tübingen, Germany Ludwig-Maximilians-University München, Dr. von Hauner'sches Kinderspital, Pediatric Hematology, Oncology and Stem Cell Transplantation, Lindwurmstrasse 4, 80337 Munich
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Urschel C, Döring M, Strecker W. [Cement-free and cemented Excia hip shaft prosthesis: comparison of intermediate term results]. Orthopade 2014; 43:815-24. [PMID: 25118680 DOI: 10.1007/s00132-014-3003-x] [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: 11/29/2022]
Abstract
AIM OF THE STUDY For fixation of total hip prostheses, cemented and cement-free techniques are available. Normally, anchoring techniques and the definitive endoprosthesis model are determined preoperatively based on the available information, such as the quality of bone. Some newer endoprosthesis models utilize the same instruments for both implantation techniques. In this way it is possible to decide on the final anchoring technique intraoperatively. Because such a combined endoprosthesis system has been used in our clinic for 10 years, we were interested in the clinical results at the intermediate stage. MATERIAL AND METHODS In a prospective, non-randomized study 105 pairs from a continuing series were formed from 105 cases treated with cement-free prostheses and the latest cemented shaft implants from the same year. In this way a total of 210 hip shaft endoprostheses from the years 2002 to 2006 were included in the study. After an average time period of 6.3 years (range 4.5-8.2 years) the patients were recalled for a follow-up examination. The clinical results, early and late complications were analyzed. The immediately postoperative X-ray images and those from the follow-up examination were evaluated by an independent external expert with respect to primary positioning, migration and any signs of loosening. RESULTS At the follow-up examination at an average of 6.3 years the quota was 73%. The indications for cement-free/cemented total hip endoprosthesis were: primary arthritis 87%/98%, secondary arthritis 10%/2% and others 3%/0%. At the time of the last follow-up examination 4 and 14 patients, respectively, had died. The visual analog scale (VAS) for pain was given as 0.72/0.78. The Harris hip score improved from 54/48 to 93/90 points. The implant-related survival rate was 99.5%. Due to a periprosthetic fracture one of the cemented shafts had to be removed. Luxation occurred in 3/2 cases, respectively, of which 4 could be conservatively treated. In one cement-free case a head elongation and a change to an inlay with an anti-luxation shoulder was necessary. A fracture of the trochanter major was conservatively treated and an intraoperative shaft fissure was stabilized with wire cerclage and titan banding. The radiological evaluation showed no implant loosening or statistically significant differences in the shaft positioning. DISCUSSION Short and intermediate clinical and radiological results showed no differences in patients of similar average age in the sixth decade of life. The significant improvements in the Harris hip score and the range of movement could be confirmed in the intermediate term and are comparable to other current implants. It can be concluded that an intraoperative decision on the fixation technique based on the macroscopically visible bone quality supports the reliably good results of both methods.
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Affiliation(s)
- C Urschel
- Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Klinikum am Bruderwald, Buger Straße 80, 96049, Bamberg, Deutschland,
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Döring M, Rohrer KM, Erbacher A, Gieseke F, Schwarze CP, Bader P, Handgretinger R, Hofbeck M, Kerst G. Human leukocyte antigen DR surface expression on CD14+ monocytes during adverse events after hematopoietic stem cell transplantation. Ann Hematol 2014; 94:265-73. [PMID: 25113134 DOI: 10.1007/s00277-014-2185-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 08/04/2014] [Indexed: 11/28/2022]
Abstract
The human leukocyte antigen DR surface expression on CD14+ monocytes reflects the degree to which these cells have been activated. Given the central role monocytes and macrophages play in the immune system, a decreased human leukocyte antigen DR expression on CD14+ monocytes results in a hallmark of altered immune status during systemic inflammatory response syndrome. We hypothesize that human leukocyte antigen DR expression might be similarly altered after hematopoietic stem cell transplantation and during post-transplant complications. Using flow cytometry, this study investigates the human leukocyte antigen DR surface expression of CD14+ monocytes in 30 pediatric and young adult patients up to 1 year after hematopoietic stem cell transplantation. Normal values were derived from a control group of healthy children, adolescents, and young adults. Human leukocyte antigen DR expression decreased significantly prior and during bacterial infection or sepsis. By contrast, human leukocyte antigen DR expression levels were elevated before and at the time of viremia. Human leukocyte antigen DR expression was also elevated during acute graft-versus-host disease. In contrast, the expression was reduced when patients had hepatic veno-occlusive disease. A significant decrease of human leukocyte antigen DR expression was associated with a relapse of the underlying disease and before death. Human leukocyte antigen DR expression on CD14+ monocytes appears to be a promising parameter that might allow identification of patients at risk after hematopoietic stem cell transplantation.
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Affiliation(s)
- Michaela Döring
- Department I - General Paediatrics, Hematology/Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany,
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Döring M, Rohrer KM, Tsiflikas I, Buchenau W, Wilke M, Handgretinger R, Poets CF, Goelz R. A newborn with grouped facial skin lesions and subsequent seizures. BMC Pediatr 2014; 14:126. [PMID: 24884686 PMCID: PMC4041904 DOI: 10.1186/1471-2431-14-126] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/19/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Congenital grouped skin lesions are alarming signs of a variety of threatening diagnoses of quite different origin. The present case report shows an impressive clinical pattern of a neonate and illustrates the difficulty in differential diagnosis of mixed connective tissue disease and neonatal lupus erythematosus in newborns. This reported case is to our knowledge the first description of an unrecognized mixed connective tissue disease in the mother with an unusual clinical manifestation in the newborn, comprising skin lesions, neurological damage and non-typical antibody constellation. CASE PRESENTATION We report on a Caucasian female neonate from a perinatally asymptomatic mother, who presented with grouped facial pustular-like skin lesions, followed by focal clonic seizures caused by multiple ischemic brain lesions. Herpes simplex virus infection was excluded and both the mother and her infant had the antibody pattern of systemic lupus erythematosus and neonatal lupus erythematosus, respectively. However, clinical signs in the mother showed overlapping features of mixed connective tissue disease. CONCLUSION This case report emphasizes congenital Lupus erythematosus and mixed connective tissue disease as important differential diagnoses of grouped skin lesions in addition to Herpes simplex virus-infection. The coexistence of different criteria for mixed connective tissue disease makes it difficult to allocate precisely maternal and congenital infantile disease.
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Affiliation(s)
- Michaela Döring
- Department I - General Paediatrics, Hematology/Oncology, University Hospital Tuebingen, Children's Hospital, Hoppe-Seyler-Str,1, Tuebingen 72076, Germany.
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Döring M, Brenner B, Handgretinger R, Hofbeck M, Kerst G. Inadvertent intravenous administration of maternal breast milk in a six-week-old infant: a case report and review of the literature. BMC Res Notes 2014; 7:17. [PMID: 24401324 PMCID: PMC3895754 DOI: 10.1186/1756-0500-7-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 08/07/2013] [Accepted: 01/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accidental intravenous administration of an enteral feeding can be fatal or cause complications such as sepsis, acute respiratory and circulatory failure, acute renal failure, hepatic insufficiency, coagulation disorders and severe permanent neurological sequelae. These "wrong route" errors are possible due to compatible connections between enteral feeding systems and intravascular infusion catheters. CASE PRESENTATION We report a six-week-old male infant who received a 5 ml intravenous infusion of breast milk. Within five minutes of administration the child developed tachycardia and tachypnea, accompanied by a sudden decrease in oxygen saturation on pulse oximetry to 69%. The infant received supplemental oxygen via nasal cannula and was transferred to the pediatric intensive care unit. Broad-spectrum antibiotics were administered for 48 hours. Vital signs returned to normal within a few hours. Neurological follow-up through 3 years did not reveal any neurodevelopmental abnormalities. CONCLUSION Development of specific enteral feeding connections, which are incompatible with intravascular catheter connections, is needed urgently to prevent a misconnection with potential morbidity or mortality of children.
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Affiliation(s)
- Michaela Döring
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tübingen, Hoppe-Seyler-Str,1, 72076 Tübingen, Germany.
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Fuchs MA, Zevaco TA, Ember E, Walter O, Held I, Dinjus E, Döring M. Synthesis of cyclic carbonates from epoxides and carbon dioxide catalyzed by an easy-to-handle ionic iron(III) complex. Dalton Trans 2013; 42:5322-9. [PMID: 23403909 DOI: 10.1039/c3dt32961e] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report the successful utilization of monometallic, ionic iron(II)- and iron(III)-N2O2-ligand-systems as highly active homogeneous catalysts for the conversion of CO2 with different epoxides to cyclic carbonates. The catalytic tests were performed using propylene oxide (PO) and a range of nine substituted epoxides. Terminal monosubstituted oxides react quantitatively.
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Affiliation(s)
- M A Fuchs
- Institut für Katalyseforschung und -Technologie (IKFT), Karlsruher Institut für Technologie (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
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