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Male C, Ay C, Crevenna R, Eichinger S, Feistritzer C, Füller R, Haushofer A, Kurringer A, Neumeister P, Puchner S, Rettl T, Schindl T, Schuster G, Schwarz G, Sohm M, Streif W, Thom K, Wagner B, Wissmann E, Zwiauer K, Pabinger I. [Treatment of haemophilia in Austria]. Wien Klin Wochenschr 2024; 136:75-102. [PMID: 38743098 DOI: 10.1007/s00508-024-02370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
This guideline is intended to provide practical guidance for the diagnosis and treatment of haemophilia in Austria. Few randomized controlled interventional trials are available addressing the treatment of haemophilia, therefore recommendations are usually based on low level of evidence and represent expert consensus.This guideline is based on the WFH guideline, published in 2020, and adapted according to the national circumstances and experience.It includes recommendations and suggestions for diagnosis and follow-up visits and pharmacological therapies for treatment and prophylaxis. Further topics comprise special aspects in children and adults with severe haemophilia, outcome measurement, and management of trauma, special bleedings and interventions, including dental procedures, inhibitors, management of haemophilia carriers, and psychosocial aspects.
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Affiliation(s)
- Christoph Male
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Cihan Ay
- Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
| | - Richard Crevenna
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Sabine Eichinger
- Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
| | - Clemens Feistritzer
- Abteilung für Innere Medizin V - Hämatologie und Onkologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Robert Füller
- Österreichische Hämophilie Gesellschaft, Wien, Österreich
| | - Alexander Haushofer
- Institut für Medizinische und Chemische Labordiagnostik, Klinikum Wels-Grieskirchen, Wels-Grieskirchen, Österreich
| | - Andreas Kurringer
- Abteilung für Kinder- und Jugendheilkunde, Landeskrankenhaus Bregenz, Bregenz, Österreich
| | - Peter Neumeister
- Klinische Abteilung für Hämatologie, Medizinische Universität Graz, Graz, Österreich
| | - Stephan Puchner
- Klinische Abteilung für Orthopädie, Universitätsklinik für Orthopädie und Unfallchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Thomas Rettl
- Abteilung für Innere Medizin und Hämatologie und internistische Onkologie, Klinikum Klagenfurt, Klagenfurt, Österreich
| | - Thomas Schindl
- Österreichische Hämophilie Gesellschaft, Wien, Österreich
| | | | - Gerhard Schwarz
- Abteilung für Kinder- und Jugendheilkunde, Landesklinikum Amstetten, Universität Wien, Wien, Österreich
| | - Michael Sohm
- Universitätsklinik für Kinder- und Jugendheilkunde, Universitätsklinikum St. Pölten, St. Pölten, Österreich
| | - Werner Streif
- Department Kinder- und Jugendheilkunde, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Katharina Thom
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Barbara Wagner
- Universitätsklinik für Physikalische Medizin, Rehabilitation und Arbeitsmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Eva Wissmann
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Karl Zwiauer
- Universitätsklinik für Kinder- und Jugendheilkunde, Universitätsklinikum St. Pölten, St. Pölten, Österreich
| | - Ingrid Pabinger
- Abteilung für Hämatologie und Hämostaseologie, Universitätsklinik für Innere Medizin I, Medizinische Universität Wien, Wien, Österreich
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2
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Sousa B, de Almeida CR, Barahona AF, Lopes R, Martins-Logrado A, Cavaco M, Neves V, Carvalho LA, Labão-Almeida C, Coelho AR, Leal Bento M, Lopes RMR, Oliveira BL, Castanho MARB, Neumeister P, Deutsch A, Vladimer GI, Krall N, João C, Corzana F, Seixas JD, Fior R, Bernardes GJL. Selective Inhibition of Bruton's Tyrosine Kinase by a Designed Covalent Ligand Leads to Potent Therapeutic Efficacy in Blood Cancers Relative to Clinically Used Inhibitors. ACS Pharmacol Transl Sci 2022; 5:1156-1168. [PMID: 36407952 PMCID: PMC9667546 DOI: 10.1021/acsptsci.2c00163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Indexed: 11/06/2022]
Abstract
Bruton's tyrosine kinase (BTK) is a member of the TEC-family kinases and crucial for the proliferation and differentiation of B-cells. We evaluated the therapeutic potential of a covalent inhibitor (JS25) with nanomolar potency against BTK and with a more desirable selectivity and inhibitory profile compared to the FDA-approved BTK inhibitors ibrutinib and acalabrutinib. Structural prediction of the BTK/JS25 complex revealed sequestration of Tyr551 that leads to BTK's inactivation. JS25 also inhibited the proliferation of myeloid and lymphoid B-cell cancer cell lines. Its therapeutic potential was further tested against ibrutinib in preclinical models of B-cell cancers. JS25 treatment induced a more pronounced cell death in a murine xenograft model of Burkitt's lymphoma, causing a 30-40% reduction of the subcutaneous tumor and an overall reduction in the percentage of metastasis and secondary tumor formation. In a patient model of diffuse large B-cell lymphoma, the drug response of JS25 was higher than that of ibrutinib, leading to a 64% "on-target" efficacy. Finally, in zebrafish patient-derived xenografts of chronic lymphocytic leukemia, JS25 was faster and more effective in decreasing tumor burden, producing superior therapeutic effects compared to ibrutinib. We expect JS25 to become therapeutically relevant as a BTK inhibitor and to find applications in the treatment of hematological cancers and other pathologies with unmet clinical treatment.
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Affiliation(s)
- Bárbara
B. Sousa
- Instituto
de Medicina Molecular João Lobo Antunes, Faculdade de Medicina,
Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | | | - Ana F. Barahona
- Champalimaud
Foundation, Avenida de Brasília, 1400-038, Lisbon, Portugal
| | - Raquel Lopes
- Champalimaud
Foundation, Avenida de Brasília, 1400-038, Lisbon, Portugal
| | | | - Marco Cavaco
- Instituto
de Medicina Molecular João Lobo Antunes, Faculdade de Medicina,
Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Vera Neves
- Instituto
de Medicina Molecular João Lobo Antunes, Faculdade de Medicina,
Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Luís A.
R. Carvalho
- Yusuf
Hamied Department of Chemistry, University
of Cambridge, Lensfield Road, Cambridge CB2 1EW, U.K.
| | - Carlos Labão-Almeida
- Instituto
de Medicina Molecular João Lobo Antunes, Faculdade de Medicina,
Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Ana R. Coelho
- Instituto
de Medicina Molecular João Lobo Antunes, Faculdade de Medicina,
Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Marta Leal Bento
- Instituto
de Medicina Molecular João Lobo Antunes, Faculdade de Medicina,
Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-028, Lisbon, Portugal
- Centro
Hospitalar Lisboa Norte, Department of Hematology and Bone Marrow
Transplantation, Avenida
Prof. Egas Moniz, 1649-035 Lisbon, Portugal
| | - Ricardo M. R.
M. Lopes
- Research
Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, 1600-277 Lisbon, Portugal
| | - Bruno L. Oliveira
- Instituto
de Medicina Molecular João Lobo Antunes, Faculdade de Medicina,
Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Miguel A. R. B. Castanho
- Instituto
de Medicina Molecular João Lobo Antunes, Faculdade de Medicina,
Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Peter Neumeister
- Division
of Hematology, Medical University of Graz, Auenbruggerplatz 38, 8036 Graz, Austria
| | - Alexander Deutsch
- Division
of Hematology, Medical University of Graz, Auenbruggerplatz 38, 8036 Graz, Austria
| | - Gregory I. Vladimer
- Exscientia, The Schrödinger Building,
Oxford Science Park, Oxford OX4 4GE, U.K.
| | - Nikolaus Krall
- Exscientia, The Schrödinger Building,
Oxford Science Park, Oxford OX4 4GE, U.K.
| | - Cristina João
- Champalimaud
Foundation, Avenida de Brasília, 1400-038, Lisbon, Portugal
| | - Francisco Corzana
- Centro
de Investigación en Síntesis Química, Departamento
de Química, Universidad de La Rioja, 26006 Logroño, Spain
| | - João D. Seixas
- Instituto
de Medicina Molecular João Lobo Antunes, Faculdade de Medicina,
Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-028, Lisbon, Portugal
- TARGTEX
S.A., Avenida Tenente
Valadim, N°17, 2F, 2560-275 Torres Vedras, Portugal
| | - Rita Fior
- Champalimaud
Foundation, Avenida de Brasília, 1400-038, Lisbon, Portugal
| | - Gonçalo J. L. Bernardes
- Instituto
de Medicina Molecular João Lobo Antunes, Faculdade de Medicina,
Universidade de Lisboa, Avenida Prof. Egas Moniz, 1649-028, Lisbon, Portugal
- Yusuf
Hamied Department of Chemistry, University
of Cambridge, Lensfield Road, Cambridge CB2 1EW, U.K.
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Schulz E, Grumaz S, Hatzl S, Gornicec M, Valentin T, Huber-Kraßnitzer B, Kriegl L, Uhl B, Deutsch A, Greinix H, Krause R, Neumeister P. Pathogen detection by metagenomic next generation sequencing during neutropenic fever in patients with hematological malignancies. Open Forum Infect Dis 2022; 9:ofac393. [PMID: 36004313 PMCID: PMC9394763 DOI: 10.1093/ofid/ofac393] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/29/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Febrile neutropenia (FN) following chemotherapy is a major cause of morbidity during cancer treatment. The performance of metagenomic next-generation sequencing (mNGS) of circulating cell-free DNA from plasma may be superior to blood culture (BC) diagnostics for identification of causative pathogens. The aim of this study was to validate mNGS (DISQVER test) for the detection of pathogens in hematologic patients with FN.
Methods
We collected paired whole blood specimens from central venous catheter and peripheral vein during FN for BC and mNGS testing. We repeated paired sampling at the earliest after 3 days of fever, which was defined as one FN episode. All clinical data were retrospectively reviewed by an infectious disease expert panel. We calculated percent positive agreement (PPA), percent negative agreement (PNA), percent overall agreement (POA), and sensitivity and specificity.
Results
We analyzed a total of 98 unselected FN episodes in 61 patients who developed predominantly FN after conditioning therapy for allogeneic (n = 22) or autologous (n = 21) hematopoietic stem cell transplantation. Success rate of mNGS was 99% (97/98). Positivity rate of mNGS was 43% (42/97) overall and 32% (31/97) excluding viruses compared to 14% (14/98) in BC. PPA, PNA and POA between mNGS and BC were 84.6% (95% CI, 54.6% to 98.1%), 63.1% (51.9% to 73.4%) and 66% (55.7% to 75.3%), respectively. Sensitivity for bacteria or fungi was 40% (28.0% to 52.9%) and 18.5% (9.9% to 30.0%), respectively.
Conclusion
Pathogen detection by mNGS (DISQVER) during unselected FN episodes shows twofold higher sensitivity and a broader pathogen spectrum than BC.
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Affiliation(s)
- Eduard Schulz
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
- Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda, Maryland , USA
| | | | - Stefan Hatzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Maximilian Gornicec
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Thomas Valentin
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Bianca Huber-Kraßnitzer
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Lisa Kriegl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Barbara Uhl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Alexander Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Hildegard Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz , Graz , Austria
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz , Graz , Austria
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4
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Uhl B, Prochazka KT, Pansy K, Wenzl K, Strobl J, Baumgartner C, Szmyra MM, Waha JE, Wolf A, Tomazic PV, Steinbauer E, Steinwender M, Friedl S, Weniger M, Küppers R, Pichler M, Greinix HT, Stary G, Ramsay AG, Apollonio B, Feichtinger J, Beham-Schmid C, Neumeister P, Deutsch AJ. Distinct Chemokine Receptor Expression Profiles in De Novo DLBCL, Transformed Follicular Lymphoma, Richter's Trans-Formed DLBCL and Germinal Center B-Cells. Int J Mol Sci 2022; 23:7874. [PMID: 35887224 PMCID: PMC9316992 DOI: 10.3390/ijms23147874] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Chemokine receptors and their ligands have been identified as playing an important role in the development of diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, and Richter syndrome (RS). Our aim was to investigate the different expression profiles in de novo DLBCL, transformed follicular lymphoma (tFL), and RS. Here, we profiled the mRNA expression levels of 18 chemokine receptors (CCR1-CCR9, CXCR1-CXCR7, CX3CR1 and XCR1) using RQ-PCR, as well as immunohistochemistry of seven chemokine receptors (CCR1, CCR4-CCR8 and CXCR2) in RS, de novo DLBCL, and tFL biopsy-derived tissues. Tonsil-derived germinal center B-cells (GC-B) served as non-neoplastic controls. The chemokine receptor expression profiles of de novo DLBCL and tFL substantially differed from those of GC-B, with at least 5-fold higher expression of 15 out of the 18 investigated chemokine receptors (CCR1-CCR9, CXCR1, CXCR2, CXCR6, CXCR7, CX3CR1 and XCR1) in these lymphoma subtypes. Interestingly, the de novo DLBCL and tFL exhibited at least 22-fold higher expression of CCR1, CCR5, CCR8, and CXCR6 compared with RS, whereas no significant difference in chemokine receptor expression profile was detected when comparing de novo DLBCL with tFL. Furthermore, in de novo DLBCL and tFLs, a high expression of CCR7 was associated with a poor overall survival in our study cohort, as well as in an independent patient cohort. Our data indicate that the chemokine receptor expression profile of RS differs substantially from that of de novo DLBCL and tFL. Thus, these multiple dysregulated chemokine receptors could represent novel clinical markers as diagnostic and prognostic tools. Moreover, this study highlights the relevance of chemokine signaling crosstalk in the tumor microenvironment of aggressive lymphomas.
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Affiliation(s)
- Barbara Uhl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
| | - Katharina T. Prochazka
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
| | - Katrin Pansy
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
| | - Kerstin Wenzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
- Division of Hematology, Mayo Clinic, Rochester, MN 55902, USA
| | - Johanna Strobl
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (J.S.); (G.S.)
| | - Claudia Baumgartner
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, 8036 Graz, Austria; (C.B.); (J.F.)
| | - Marta M. Szmyra
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
| | - James E. Waha
- General, Visceral and Transplant Surgery, Medical University of Graz, 8036 Graz, Austria;
| | - Axel Wolf
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, 8036 Graz, Austria; (A.W.); (P.V.T.)
| | - Peter V. Tomazic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, 8036 Graz, Austria; (A.W.); (P.V.T.)
| | - Elisabeth Steinbauer
- Institute of Pathology, Medical University of Graz, 8036 Graz, Austria; (E.S.); (M.S.); (S.F.); (C.B.-S.)
| | - Maria Steinwender
- Institute of Pathology, Medical University of Graz, 8036 Graz, Austria; (E.S.); (M.S.); (S.F.); (C.B.-S.)
| | - Sabine Friedl
- Institute of Pathology, Medical University of Graz, 8036 Graz, Austria; (E.S.); (M.S.); (S.F.); (C.B.-S.)
| | - Marc Weniger
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, 45122 Essen, Germany; (M.W.); (R.K.)
| | - Ralf Küppers
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, 45122 Essen, Germany; (M.W.); (R.K.)
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Hildegard T. Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria; (J.S.); (G.S.)
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, 1090 Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, 1090 Vienna, Austria
| | - Alan G. Ramsay
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London WC2R 2LS, UK; (A.G.R.); (B.A.)
| | - Benedetta Apollonio
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London WC2R 2LS, UK; (A.G.R.); (B.A.)
| | - Julia Feichtinger
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, 8036 Graz, Austria; (C.B.); (J.F.)
| | - Christine Beham-Schmid
- Institute of Pathology, Medical University of Graz, 8036 Graz, Austria; (E.S.); (M.S.); (S.F.); (C.B.-S.)
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
| | - Alexander J. Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.U.); (K.T.P.); (K.P.); (K.W.); (M.M.S.); (H.T.G.)
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Neumeister P, Schulz E, Pansy K, Szmyra M, Deutsch AJA. Targeting the Microenvironment for Treating Multiple Myeloma. Int J Mol Sci 2022; 23:ijms23147627. [PMID: 35886976 PMCID: PMC9317002 DOI: 10.3390/ijms23147627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 12/23/2022] Open
Abstract
Multiple myeloma (MM) is a malignant, incurable disease characterized by the expansion of monoclonal terminally differentiated plasma cells in the bone marrow. MM is consistently preceded by an asymptomatic monoclonal gammopathy of undetermined significance, and in the absence of myeloma defining events followed by a stage termed smoldering multiple myeloma (SMM), which finally progresses to active myeloma if signs of organ damage are present. The reciprocal interaction between tumor cells and the tumor microenvironment plays a crucial role in the development of MM and the establishment of a tumor-promoting stroma facilitates tumor growth and myeloma progression. Since myeloma cells depend on signals from the bone marrow microenvironment (BMME) for their survival, therapeutic interventions targeting the BMME are a novel and successful strategy for myeloma care. Here, we describe the complex interplay between myeloma cells and the cellular components of the BMME that is essential for MM development and progression. Finally, we present BMME modifying treatment options such as anti-CD38 based therapies, immunomodulatory drugs (IMiDs), CAR T-cell therapies, bispecific antibodies, and antibody-drug conjugates which have significantly improved the long-term outcome of myeloma patients, and thus represent novel therapeutic standards.
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Affiliation(s)
- Peter Neumeister
- Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, 8036 Graz, Austria; (E.S.); (K.P.); (M.S.); (A.J.D.)
- Correspondence:
| | - Eduard Schulz
- Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, 8036 Graz, Austria; (E.S.); (K.P.); (M.S.); (A.J.D.)
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Katrin Pansy
- Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, 8036 Graz, Austria; (E.S.); (K.P.); (M.S.); (A.J.D.)
| | - Marta Szmyra
- Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, 8036 Graz, Austria; (E.S.); (K.P.); (M.S.); (A.J.D.)
| | - Alexander JA Deutsch
- Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, 8036 Graz, Austria; (E.S.); (K.P.); (M.S.); (A.J.D.)
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6
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Pansy K, Fechter K, Arra A, Szmyra M, Haingartner S, Ramsay A, Greinix H, Beham-Schmid C, Neumeister P, Deutsch A. S226: LOSS OF NR4A1 IS ASSOCIATED WITH HIGHER EXPRESSION OF IMMUNE CHECKPOINT COMPONENTS AND REDUCED T CELL-MEDIATED LYMPHOMA CELL KILLING IN AGGRESSIVE LYMPHOMA. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000843796.36636.df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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7
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Kornauth C, Pemovska T, Vladimer GI, Bayer G, Bergmann M, Eder S, Eichner R, Erl M, Esterbauer H, Exner R, Felsleitner-Hauer V, Forte M, Gaiger A, Geissler K, Greinix HT, Gstöttner W, Hacker M, Hartmann BL, Hauswirth AW, Heinemann T, Heintel D, Hoda MA, Hopfinger G, Jaeger U, Kazianka L, Kenner L, Kiesewetter B, Krall N, Krajnik G, Kubicek S, Le T, Lubowitzki S, Mayerhoefer ME, Menschel E, Merkel O, Miura K, Müllauer L, Neumeister P, Noesslinger T, Ocko K, Öhler L, Panny M, Pichler A, Porpaczy E, Prager GW, Raderer M, Ristl R, Ruckser R, Salamon J, Schiefer AI, Schmolke AS, Schwarzinger I, Selzer E, Sillaber C, Skrabs C, Sperr WR, Srndic I, Thalhammer R, Valent P, van der Kouwe E, Vanura K, Vogt S, Waldstein C, Wolf D, Zielinski CC, Zojer N, Simonitsch-Klupp I, Superti-Furga G, Snijder B, Staber PB. Functional Precision Medicine Provides Clinical Benefit in Advanced Aggressive Hematologic Cancers and Identifies Exceptional Responders. Cancer Discov 2022; 12:372-387. [PMID: 34635570 PMCID: PMC9762339 DOI: 10.1158/2159-8290.cd-21-0538] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/22/2021] [Accepted: 09/24/2021] [Indexed: 01/07/2023]
Abstract
Personalized medicine aims to match the right drug with the right patient by using specific features of the individual patient's tumor. However, current strategies of personalized therapy matching provide treatment opportunities for less than 10% of patients with cancer. A promising method may be drug profiling of patient biopsy specimens with single-cell resolution to directly quantify drug effects. We prospectively tested an image-based single-cell functional precision medicine (scFPM) approach to guide treatments in 143 patients with advanced aggressive hematologic cancers. Fifty-six patients (39%) were treated according to scFPM results. At a median follow-up of 23.9 months, 30 patients (54%) demonstrated a clinical benefit of more than 1.3-fold enhanced progression-free survival compared with their previous therapy. Twelve patients (40% of responders) experienced exceptional responses lasting three times longer than expected for their respective disease. We conclude that therapy matching by scFPM is clinically feasible and effective in advanced aggressive hematologic cancers. SIGNIFICANCE: This is the first precision medicine trial using a functional assay to instruct n-of-one therapies in oncology. It illustrates that for patients lacking standard therapies, high-content assay-based scFPM can have a significant value in clinical therapy guidance based on functional dependencies of each patient's cancer.See related commentary by Letai, p. 290.This article is highlighted in the In This Issue feature, p. 275.
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Affiliation(s)
- Christoph Kornauth
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
| | - Tea Pemovska
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Gregory I Vladimer
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Exscientia GmbH, Vienna, Austria
| | - Günther Bayer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Michael Bergmann
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Sandra Eder
- Department of Internal Medicine and Hematology/Oncology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Ruth Eichner
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Martin Erl
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Austria
| | - Harald Esterbauer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Maurizio Forte
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Alexander Gaiger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
| | - Klaus Geissler
- Medical School, Sigmund Freud University, Vienna, Austria
| | - Hildegard T Greinix
- Department of Internal Medicine, Division of Hematology, Medical University of Graz, Graz, Austria
| | - Wolfgang Gstöttner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Alexander W Hauswirth
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Tim Heinemann
- Department of Biology, Institute of Molecular Systems Biology, ETH Zürich, Zürich, Switzerland
| | - Daniel Heintel
- Division of Medicine I, Klinik Ottakring, Vienna, Austria
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Georg Hopfinger
- Third Medical Department, Centre for Oncology and Haematology, Klinik Favoriten, Vienna, Austria
| | - Ulrich Jaeger
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
| | - Lukas Kazianka
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Lukas Kenner
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Krall
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Exscientia GmbH, Vienna, Austria
| | - Gerhard Krajnik
- Department of Medicine I, Universitätsklinikum St. Pölten, St. Pölten, Austria
| | - Stefan Kubicek
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Trang Le
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elisabeth Menschel
- Third Medical Department, Hematology & Oncology, Hanusch Hospital, Vienna, Austria
| | - Olaf Merkel
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Katsuhiro Miura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Peter Neumeister
- Department of Internal Medicine, Division of Hematology, Medical University of Graz, Graz, Austria
| | - Thomas Noesslinger
- Third Medical Department, Hematology & Oncology, Hanusch Hospital, Vienna, Austria
| | - Katharina Ocko
- Pharmacy Department, Vienna General Hospital, Vienna, Austria
| | - Leopold Öhler
- Internal Medicine I, Department of Oncology, St. Josef Hospital, Vienna, Austria
| | - Michael Panny
- Third Medical Department, Hematology & Oncology, Hanusch Hospital, Vienna, Austria
| | - Alexander Pichler
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Edit Porpaczy
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Gerald W Prager
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Robin Ristl
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Julius Salamon
- Department of Medicine, Landesklinikum Waidhofen a.d. Ybbs, Waidhofen-Ybbs, Austria
| | - Ana-Iris Schiefer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Ann-Sofie Schmolke
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Ilse Schwarzinger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Edgar Selzer
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Christian Sillaber
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Cathrin Skrabs
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang R Sperr
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Ismet Srndic
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Renate Thalhammer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Emiel van der Kouwe
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Katrina Vanura
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Stefan Vogt
- Department of Medicine and Oncology, LKH Wiener Neustadt, Wiener Neustadt, Austria
| | - Cora Waldstein
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Dominik Wolf
- Department of Internal Medicine V, Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Niklas Zojer
- Division of Medicine I, Klinik Ottakring, Vienna, Austria
| | | | - Giulio Superti-Furga
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Berend Snijder
- Department of Biology, Institute of Molecular Systems Biology, ETH Zürich, Zürich, Switzerland
| | - Philipp B Staber
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria.
- Comprehensive Cancer Center Vienna, Medical University of Vienna and Vienna General Hospital, Vienna, Austria
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Uhl B, Prochazka KT, Fechter K, Pansy K, Greinix HT, Neumeister P, Deutsch AJA. Impact of the microenvironment on the pathogenesis of mucosa-associated lymphoid tissue lymphomas. World J Gastrointest Oncol 2022; 14:153-162. [PMID: 35116108 PMCID: PMC8790412 DOI: 10.4251/wjgo.v14.i1.153] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/16/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Approximately 8% of all non-Hodgkin lymphomas are extranodal marginal zone B cell lymphomas of mucosa-associated lymphoid tissue (MALT), also known as MALT lymphomas. These arise at a wide range of different extranodal sites, with most cases affecting the stomach, the lung, the ocular adnexa and the thyroid. The small intestine is involved in a lower percentage of cases. Lymphoma growth in the early stages is associated with long-lasting chronic inflammation provoked by bacterial infections (e.g., Helicobacter pylori or Chlamydia psittaci infections) or autoimmune conditions (e.g., Sjögren’s syndrome or Hashimoto thyroiditis). While these inflammatory processes trigger lymphoma cell proliferation and/or survival, they also shape the microenvironment. Thus, activated immune cells are actively recruited to the lymphoma, resulting in either direct lymphoma cell stimulation via surface receptor interactions and/or indirect lymphoma cell stimulation via secretion of soluble factors like cytokines. In addition, chronic inflammatory conditions cause the acquisition of genetic alterations resulting in autonomous lymphoma cell growth. Recently, novel agents targeting the microenvironment have been developed and clinically tested in MALT lymphomas as well as other lymphoid malignancies. In this review, we aim to describe the composition of the microenvironment of MALT lymphoma, the interaction of activated immune cells with lymphoma cells and novel therapeutic approaches in MALT lymphomas using immunomodulatory and/or microenvironment-targeting agents.
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Affiliation(s)
- Barbara Uhl
- Division of Hematology, Medical University of Graz, Graz 8036, Austria
| | | | - Karoline Fechter
- Division of Hematology, Medical University of Graz, Graz 8036, Austria
| | - Katrin Pansy
- Division of Hematology, Medical University of Graz, Graz 8036, Austria
| | | | - Peter Neumeister
- Division of Hematology, Medical University of Graz, Graz 8036, Austria
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9
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Spindelboeck W, Halwachs B, Bayer N, Huber-Krassnitzer B, Schulz E, Uhl B, Gaksch L, Hatzl S, Bachmayr V, Kleissl L, Kump P, Deutsch A, Stary G, Greinix H, Gorkiewicz G, Högenauer C, Neumeister P. Antibiotic use and ileocolonic immune cells in patients receiving fecal microbiota transplantation for refractory intestinal GvHD: a prospective cohort study. Ther Adv Hematol 2022; 12:20406207211058333. [PMID: 34987741 PMCID: PMC8721365 DOI: 10.1177/20406207211058333] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023] Open
Abstract
Introduction Treatment-refractory, acute graft-versus-host disease (GvHD) of the lower gastrointestinal tract (GI) after allogeneic hematopoietic stem cell transplantation is life threatening and lacks effective treatment options. While fecal microbiota transplantation (FMT) was shown to ameliorate GI-GvHD, its mechanisms of action and the factors influencing the treatment response in humans remain unclear.The objective of this study is to assess response to FMT treatment, factors influencing response, and to study the mucosal immune cell composition in treatment-refractory GI-GvHD. Methods Consecutive patients with treatment-refractory GI-GvHD were treated with up to six endoscopically applied FMTs. Results We observed the response to FMT in four out of nine patients with severe, treatment refractory GI-GvHD, associated with a significant survival benefit (p = 0.017). The concomitant use of broad-spectrum antibiotics was the main factor associated with FMT failure (p = 0.048). In addition, antibiotic administration hindered the establishment of donor microbiota after FMT. Unlike in non-responders, the microbiota characteristics (e.g. α- and β-diversity, abundance of anaerobe butyrate-producers) in responders were more significantly similar to those of FMT donors. During active refractory GI-GvHD, an increased infiltrate of T cells, mainly Th17 and CD8+ T cells, was observed in the ileocolonic mucosa of patients, while the number of immunomodulatory cells such as regulatory T-cells and type 3 innate lymphoid cells decreased. After FMT, a change in immune cell patterns was induced, depending on the clinical response. Conclusion This study increases the knowledge about the crucial effects of antibiotics in patients given FMT for treatment refractory GI-GvHD and defines the characteristic alterations of ileocolonic mucosal immune cells in this setting.
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Affiliation(s)
- Walter Spindelboeck
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Bettina Halwachs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Nadine Bayer
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Bianca Huber-Krassnitzer
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Eduard Schulz
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Barbara Uhl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Lukas Gaksch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Stefan Hatzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Victoria Bachmayr
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Lisa Kleissl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Patrizia Kump
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Hildegard Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Christoph Högenauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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10
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Staber PB, Jurczak W, Greil R, Vucinic V, Middeke JM, Montillo M, Munir T, Neumeister P, Schetelig J, Stilgenbauer S, Striebel F, Dirnberger-Hertweck M, Weirather J, Brugger W, Kelemen P, Wendtner CM, Woyach JA. Tafasitamab combined with idelalisib or venetoclax in patients with CLL previously treated with a BTK inhibitor. Leuk Lymphoma 2021; 62:3440-3451. [PMID: 34414843 DOI: 10.1080/10428194.2021.1964020] [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] [Indexed: 10/20/2022]
Abstract
Patients with relapsed/refractory chronic lymphocytic leukemia (R/R CLL) whose treatment failed with a Bruton's tyrosine kinase inhibitor have poor outcomes. We investigated tafasitamab plus idelalisib (cohort A) or venetoclax (cohort B) in this patient population in a phase II study (NCT02639910). In total, 24 patients were enrolled (cohort A: n = 11, median time on study, 7.4 months; cohort B: n = 13, median time on study, 15.6 months). The most common treatment-emergent adverse event (TEAE) in cohort A was anemia (63.6%) and in cohort B was infusion-related reaction (53.8%). The most common severe TEAE was neutropenia (cohort A: 45.5%; cohort B: 46.2%). The best overall response rate was 90.9% (cohort A) and 76.9% (cohort B). Undetectable minimal residual disease in peripheral blood was achieved in 2/8 patients (cohort A) and 6/7 patients (cohort B). Overall, these results suggest that anti-CD19 antibody-based combinations may be important in the treatment of patients with CLL.
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Affiliation(s)
- Philipp Bernhard Staber
- Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Wojciech Jurczak
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | - Richard Greil
- Laboratory for Immunological and Molecular Cancer Research, Salzburg Cancer Research Institute, Salzburg, Austria
| | - Vladan Vucinic
- Department of Hematology and Internal Oncology, University Hospital Leipzig AöR, Leipzig, Germany
| | - Jan Moritz Middeke
- Medical Clinic 1, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Marco Montillo
- Hematology Department, Niguarda Cancer Center, Niguarda Hospital, Milan, Italy
| | - Talha Munir
- Clinical Hematology, The Leeds Teaching Hospital, Leeds, UK
| | - Peter Neumeister
- Clinical Department of Hematology, Medical University of Graz, Graz, Austria
| | - Johannes Schetelig
- Medical Clinic 1, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | | | | | | | | | | | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Medicine, Infectious Diseases, and Tropical Medicine, Munich Clinic Schwabing, Munich, Germany
| | - Jennifer Ann Woyach
- Division of Hematology, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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11
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Gressenberger P, Jud P, Kovacs G, Kreuzer S, Brezinsek HP, Guetl K, Muster V, Kolesnik E, Schmidt A, Odler B, Adelsmayr G, Neumeister P, Brcic L, Zenz S, Weber K, Gary T, Brodmann M, Graninger WB, Moazedi-Fürst FC. Rituximab as a Treatment Option after Autologous Hematopoietic Stem Cell Transplantation in a Patient with Systemic Sclerosis. J Pers Med 2021; 11:600. [PMID: 34201939 PMCID: PMC8305780 DOI: 10.3390/jpm11070600] [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: 05/03/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Systemic sclerosis (SSc) is an intractable autoimmune disease characterized by vasculopathy and organ fibrosis. Autologous hematopoietic stem cell transplantation (AHSCT) should be considered for the treatment of selected patients with rapid progressive SSc at high risk of organ failure. It, however, remains elusive whether immunosuppressive therapies such as rituximab (RTX) are still necessary for such patients after AHSCT, especially in those with bad outcomes. In the present report, a 43-year-old man with diffuse cutaneous SSc received AHSCT. Despite AHSCT, SSc further progressed with progressive symptomatic heart failure with newly developed concomitant mitral and tricuspid valve insufficiency, thus the patient started on RTX 8 months after AHSCT. Shortly after initiation of RTX, clinical symptoms and organ functions ameliorated subsequently. Heart valve regurgitations were reversible after initiation of RTX treatment. Currently, the patient remains in a stable condition with significant improvement of clinical symptoms and organ functions. Reporting about therapies after AHSCT in SSc is a very important issue, as randomized controlled trials are lacking, and therefore this report adds to evidence that RTX can be considered as a treatment option in patients with SSc that do not respond to AHSCT.
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Affiliation(s)
- Paul Gressenberger
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (P.J.); (K.G.); (V.M.); (T.G.); (M.B.)
| | - Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (P.J.); (K.G.); (V.M.); (T.G.); (M.B.)
| | - Gabor Kovacs
- Division of Pneumology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
- Ludwig Boltzmann Institute for Lung Vascular Research, 8010 Graz, Austria
| | - Sonja Kreuzer
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (S.K.); (H.-P.B.); (S.Z.); (K.W.); (W.B.G.); (F.C.M.-F.)
| | - Hans-Peter Brezinsek
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (S.K.); (H.-P.B.); (S.Z.); (K.W.); (W.B.G.); (F.C.M.-F.)
| | - Katharina Guetl
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (P.J.); (K.G.); (V.M.); (T.G.); (M.B.)
| | - Viktoria Muster
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (P.J.); (K.G.); (V.M.); (T.G.); (M.B.)
| | - Ewald Kolesnik
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (E.K.); (A.S.)
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (E.K.); (A.S.)
| | - Balazs Odler
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Gabriel Adelsmayr
- Division of General Radiology, Department of Radiology, Medical University of Graz, 8036 Graz, Austria;
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8036 Graz, Austria;
| | - Sabine Zenz
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (S.K.); (H.-P.B.); (S.Z.); (K.W.); (W.B.G.); (F.C.M.-F.)
| | - Kurt Weber
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (S.K.); (H.-P.B.); (S.Z.); (K.W.); (W.B.G.); (F.C.M.-F.)
| | - Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (P.J.); (K.G.); (V.M.); (T.G.); (M.B.)
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (P.J.); (K.G.); (V.M.); (T.G.); (M.B.)
| | - Winfried B. Graninger
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (S.K.); (H.-P.B.); (S.Z.); (K.W.); (W.B.G.); (F.C.M.-F.)
| | - Florentine C. Moazedi-Fürst
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (S.K.); (H.-P.B.); (S.Z.); (K.W.); (W.B.G.); (F.C.M.-F.)
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Prochazka KT, Neumeister P. Chronic lymphocytic leukaemia-what is new and notable in 2021, with a special focus on COVID-19. Memo 2021; 14:224-227. [PMID: 34394761 PMCID: PMC8356209 DOI: 10.1007/s12254-021-00735-z] [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] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/08/2021] [Indexed: 05/10/2023]
Abstract
In the last few years, treatment of patients exhibiting chronic lymphocytic leukaemia has changed extensively due to advances in the development of targeted therapies. The role of immunochemotherapy has been for the most part replace and the guidelines have been modified accordingly. Herein, we give an overview on updated onkopedia guidelines, studded with updates of the landmark studies of the latest American Society of Hematology (ASH) meeting. In addition, since still crucial, recommendations concerning coronavirus disease 2019 (COVID-19) in chronic lymphocytic leukaemia patients will be covered.
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Affiliation(s)
- Katharina T. Prochazka
- Division of Haematology, Department of Internal Medicine, Medical University Graz, Auenbruggerplatz 38, 8036 Graz, Austria
| | - Peter Neumeister
- Division of Haematology, Department of Internal Medicine, Medical University Graz, Auenbruggerplatz 38, 8036 Graz, Austria
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13
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Raufeisen S, Neumeister P, Buchheim JR, Stelter M, Braeutigam P. Pyrocatalytic oxidation - strong size-dependent poling effect on catalytic activity of pyroelectric BaTiO 3 nano- and microparticles. Phys Chem Chem Phys 2020; 22:23464-23473. [PMID: 32960200 DOI: 10.1039/d0cp03158e] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pyrocatalysis is an emerging advanced oxidation process for wastewater remediation with the potential for thermal energy harvesting and utilization. Although several studies explored the potential of new pyrocatalyst materials to degrade harmful organic water pollutants, the role of important material properties and electric poling procedures on the pyrocatalytic activity is still unclear. In this work, we investigate the interdependence between particle size, electric poling and pyrocatalytic activity of BaTiO3 powders with nominal particle sizes of 100, 200 and 500 nm by using the dichlorofluorescein redox assay. Depending on the particle size, the influence of surface area or phase composition on the pyrocatalytic activity predominates. Moreover, we demonstrate that poling of pyrocatalysts leads to a strong size-dependent increase of pyrocatalytic activity. This poling effect increases with particle size up to +247% and can be explained with size-dependent changes in phase composition and domain structure. Combining all results, the progression of the pyrocatalytic activity as a function of particle size was derived and a future strategy for maximizing the catalytic performance of pyrocatalysts was developed. This study greatly improves the understanding about the role of important material properties and electric poling on pyrocatalytic activity, thus enabling an effective catalyst design. With the help of highly active catalysts, the pyrocatalytic process can take the next step in its development into a new and energy-efficient advanced oxidation process for water remediation.
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Affiliation(s)
- Sascha Raufeisen
- Institute of Technical Chemistry and Environmental Chemistry, Friedrich Schiller University Jena, Philosophenweg 7a, 07743 Jena, Germany. and Center for Energy and Environmental Chemistry (CEEC Jena), Friedrich Schiller University Jena, Philosophenweg 7a, 07743 Jena, Germany
| | - Peter Neumeister
- Fraunhofer IKTS, Fraunhofer Institute for Ceramic Technologies and Systems, Winterbergstraße 28, 01277 Dresden, Germany
| | - Johannes R Buchheim
- Institute of Technical Chemistry and Environmental Chemistry, Friedrich Schiller University Jena, Philosophenweg 7a, 07743 Jena, Germany. and Center for Energy and Environmental Chemistry (CEEC Jena), Friedrich Schiller University Jena, Philosophenweg 7a, 07743 Jena, Germany
| | - Michael Stelter
- Institute of Technical Chemistry and Environmental Chemistry, Friedrich Schiller University Jena, Philosophenweg 7a, 07743 Jena, Germany. and Center for Energy and Environmental Chemistry (CEEC Jena), Friedrich Schiller University Jena, Philosophenweg 7a, 07743 Jena, Germany and Fraunhofer IKTS, Fraunhofer Institute for Ceramic Technologies and Systems, Michael-Faraday-Straße 1, 07629 Hermsdorf, Germany
| | - Patrick Braeutigam
- Institute of Technical Chemistry and Environmental Chemistry, Friedrich Schiller University Jena, Philosophenweg 7a, 07743 Jena, Germany. and Center for Energy and Environmental Chemistry (CEEC Jena), Friedrich Schiller University Jena, Philosophenweg 7a, 07743 Jena, Germany
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14
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Hatzl S, Posch F, Schulz E, Gornicec M, Deutsch A, Beham-Schmid C, Pichler M, Greinix H, Sill H, Zebisch A, Neumeister P, Prochazka KT. The Role of Immunohistochemical Overexpression of p53 as Adverse Prognostic Factor in Primary Testicular Diffuse Large B Cell Lymphoma. Pathol Oncol Res 2020; 26:2831-2833. [PMID: 32602002 DOI: 10.1007/s12253-020-00864-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Stefan Hatzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, A-8036, Graz, Austria.
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine (CBmed Ges.m.b.H.), Graz, Austria
| | - Eduard Schulz
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, A-8036, Graz, Austria
| | - Maximilian Gornicec
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, A-8036, Graz, Austria
| | - Alexander Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, A-8036, Graz, Austria
| | | | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine (CBmed Ges.m.b.H.), Graz, Austria.,Research Unit for Non-coding RNAs and Genome Editing, Medical University of Graz, Graz, Austria.,Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hildegard Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, A-8036, Graz, Austria
| | - Heinz Sill
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, A-8036, Graz, Austria
| | - Armin Zebisch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, A-8036, Graz, Austria.,Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, A-8036, Graz, Austria
| | - Katharina T Prochazka
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, A-8036, Graz, Austria
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15
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Hatzl S, Posch F, Deutsch A, Beham-Schmid C, Stöger H, Greinix H, Pichler M, Neumeister P, Prochazka KT. Immunohistochemistry for c-myc and bcl-2 overexpression improves risk stratification in primary central nervous system lymphoma. Hematol Oncol 2020; 38:277-283. [PMID: 32101329 PMCID: PMC7496545 DOI: 10.1002/hon.2727] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 11/11/2022]
Abstract
Overexpression of bcl‐2 and c‐myc are defining features of double‐expressor‐lymphoma (DEL) but may also occur separately in patients with primary central nervous system lymphoma (PCNSL). Despite all progress in optimizing treatment regimen, there is lack of sufficient risk stratification models. Here, we first describe the relationship between DEL biology, the National Comprehensive Cancer Network International Prognostic Index (NCCN‐IPI), treatment response, disease progression, and mortality in PCNSL. In this study, we determined c‐myc and bcl‐2 status immunohistochemically in samples of 48 patients with newly diagnosed PCNSL and followed these patients for a median interval of 6.2 years. Twelve, 18, and 17 patients harbored none, one, or both DEL features. Corresponding overall response rates after first‐line therapy were strongly associated with DEL biology (100%, 42%, and 44% in patients with 0, 1, or 2 DEL features). Patients with one or both DEL features had a 5‐fold and 13‐fold higher 5‐year risk of progression and/or death than patients without DEL features. These associations prevailed after adjusting for the NCCN‐IPI. DEL improved the discriminatory capability of the NCCN‐IPI (P = .0001). Furthermore, we could show that addition of DEL biology to the NCCN‐IPI significantly improved the score's discriminatory potential both toward progression‐free survival (increase in Harell's c = 0.15, P = .005) and overall survival (increase in Harell's c = 0.11, P = .029). In conclusion, DEL biology is a strong and simple‐to‐use predictor of adverse outcome in PCNSL. Addition of DEL to the NCCN‐IPI improves its prognostic potential. Disease progression from PCNSL harboring both DEL features is invariably fatal. This defines a novel PCNSL patient subset with a great unmet need for improved therapy.
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Affiliation(s)
- Stefan Hatzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Austria.,Center for Biomarker Research in Medicine (CBmed Ges.m.b.H.), Austria
| | - Alexander Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Austria
| | | | - Herbert Stöger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Austria
| | - Hildegard Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Austria.,Center for Biomarker Research in Medicine (CBmed Ges.m.b.H.), Austria.,Research Unit for non-coding RNAs and genome editing in cancer, Medical University of Graz, Austria.,Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA, USA
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Austria
| | - Katharina T Prochazka
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Austria
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16
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Ullrich E, Heidinger P, Soh J, Villanova L, Grabuschnig S, Bachler T, Hirschböck E, Sánchez-Heredero S, Ford B, Sensen M, Rosales Rodriguez I, Schwendenwein D, Neumeister P, Zurl CJ, Krause R, Lorenz Khol J, Sensen CW. Evaluation of host-based molecular markers for the early detection of human sepsis. J Biotechnol 2020; 310:80-88. [PMID: 32017954 DOI: 10.1016/j.jbiotec.2020.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/25/2019] [Revised: 01/18/2020] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
Abstract
We have identified 24 molecular markers, based on circulating nucleic acids (CNA) originating from the human genome, which in combination can be used in a quantitative real-time PCR (qPCR) assay to identify the presence of human sepsis, starting two to three days before the first clinical signs develop and including patients who meet the SEPSIS-3 criteria. The accuracy was more than 87 % inside of the same patient cohort for which the markers were developed and up to 81 % in blind studies of patient cohorts which were not included in the marker development. As our markers are host-based, they can be used to capture bacterial as well as fungal sepsis, unlike the current PCR-based tests, which require species-specific primer sets for each organism causing human sepsis. Our assay directly uses an aliquot of cell-free blood as the substrate for the PCR reaction, thus allowing to obtain the diagnostic results in three to four hours after the collection of the blood samples.
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Affiliation(s)
- Elisabeth Ullrich
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010, Graz, Austria
| | | | - Jung Soh
- CNA Diagnostics Inc., Suite 300, 4838 Richard Road SW, Calgary, Alberta, T3E 6L1, Canada
| | - Laura Villanova
- Institute of Computational Biotechnology, Graz University of Technology, Petersgasse 14/V, 8010, Graz, Styria, Austria
| | - Stefan Grabuschnig
- Institute of Computational Biotechnology, Graz University of Technology, Petersgasse 14/V, 8010, Graz, Styria, Austria
| | | | | | - Sara Sánchez-Heredero
- Institute of Computational Biotechnology, Graz University of Technology, Petersgasse 14/V, 8010, Graz, Styria, Austria
| | - Barry Ford
- Defence Research and Development Canada, Suffield Research Centre, Suffield, P.O. box 4000 Stn Main, T1A 8K6, Medicine Hat, Alberta, Canada
| | - Maria Sensen
- Hochstraße 12, 8076, Vasoldsberg, Styria, Austria
| | | | | | - Peter Neumeister
- Clinical Division for Hematology, Medical University of Graz, Auenbruggerplatz 38D, 8036 Graz, Styria, Austria
| | - Christoph J Zurl
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/II, 8036, Graz, Styria, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Styria, Austria; BioTechMed Graz, Mozartgasse 12/II, 8010, Graz, Styria, Austria
| | - Johannes Lorenz Khol
- Department for Farm Animals and Veterinary Public Health, University Clinic for Ruminants, University of Veterinary Medicine, Veterinärplatz 1, 1210, Vienna, Austria
| | - Christoph W Sensen
- Institute of Computational Biotechnology, Graz University of Technology, Petersgasse 14/V, 8010, Graz, Styria, Austria; CNA Diagnostics GmbH, Parkring 18, 8074, Grambach, Styria, Austria; BioTechMed Graz, Mozartgasse 12/II, 8010, Graz, Styria, Austria.
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17
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Pansy K, Feichtinger J, Ehall B, Uhl B, Sedej M, Roula D, Pursche B, Wolf A, Zoidl M, Steinbauer E, Gruber V, Greinix HT, Prochazka KT, Thallinger GG, Heinemann A, Beham-Schmid C, Neumeister P, Wrodnigg TM, Fechter K, Deutsch AJ. The CXCR4-CXCL12-Axis Is of Prognostic Relevance in DLBCL and Its Antagonists Exert Pro-Apoptotic Effects In Vitro. Int J Mol Sci 2019; 20:E4740. [PMID: 31554271 PMCID: PMC6801866 DOI: 10.3390/ijms20194740] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/19/2019] [Accepted: 09/21/2019] [Indexed: 12/13/2022] Open
Abstract
In tumor cells of more than 20 different cancer types, the CXCR4-CXCL12-axis is involved in multiple key processes including proliferation, survival, migration, invasion, and metastasis. Since data on this axis in diffuse large B cell lymphoma (DLBCL) are inconsistent and limited, we comprehensively studied the CXCR4-CXCL12-axis in our DLBCL cohort as well as the effects of CXCR4 antagonists on lymphoma cell lines in vitro. In DLBCL, we observed a 140-fold higher CXCR4 expression compared to non-neoplastic controls, which was associated with poor clinical outcome. In corresponding bone marrow biopsies, we observed a correlation of CXCL12 expression and lymphoma infiltration rate as well as a reduction of CXCR4 expression in remission of bone marrow involvement after treatment. Additionally, we investigated the effects of three CXCR4 antagonists in vitro. Therefore, we used AMD3100 (Plerixafor), AMD070 (Mavorixafor), and WKI, the niacin derivative of AMD070, which we synthesized. WK1 demonstrated stronger pro-apoptotic effects than AMD070 in vitro and induced expression of pro-apoptotic genes of the BCL2-family in CXCR4-positive lymphoma cell lines. Finally, WK1 treatment resulted in the reduced expression of JNK-, ERK1/2- and NF-κB/BCR-target genes. These data indicate that the CXCR4-CXCL12-axis impacts the pathogenesis of DLBCL and represents a potential therapeutic target in aggressive lymphomas.
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MESH Headings
- Aminoquinolines
- Antineoplastic Agents/pharmacology
- Apoptosis/drug effects
- Benzimidazoles
- Biomarkers
- Butylamines
- Cell Line, Tumor
- Cell Movement/drug effects
- Cell Proliferation/drug effects
- Chemokine CXCL12/genetics
- Chemokine CXCL12/metabolism
- Exons
- Female
- Gene Expression
- Heterocyclic Compounds, 1-Ring/pharmacology
- Humans
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Mutation
- Neoplasm Staging
- Prognosis
- Receptors, CXCR4/antagonists & inhibitors
- Receptors, CXCR4/genetics
- Receptors, CXCR4/metabolism
- Signal Transduction/drug effects
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Affiliation(s)
- Katrin Pansy
- Division of Hematology, Medical University Graz; Auenbruggerplatz 38, 8036 Graz, Austria.
| | - Julia Feichtinger
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Medical University of Graz, Neue Stiftingtalstraße 6/II, 8010 Graz, Austria.
| | - Barbara Ehall
- Division of Hematology, Medical University Graz; Auenbruggerplatz 38, 8036 Graz, Austria.
| | - Barbara Uhl
- Division of Hematology, Medical University Graz; Auenbruggerplatz 38, 8036 Graz, Austria.
| | - Miriam Sedej
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, Universitätsplatz 4/I, 8010 Graz, Austria.
| | - David Roula
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, Universitätsplatz 4/I, 8010 Graz, Austria.
| | - Beata Pursche
- Division of Hematology, Medical University Graz; Auenbruggerplatz 38, 8036 Graz, Austria.
| | - Axel Wolf
- Division of General Otorhinolaryngology, Medical University of Graz, Auenbruggerplatz 26, 8036 Graz, Austria.
| | - Manuel Zoidl
- Institute of Organic Chemistry, Graz University of Technology, Stremayrgasse 9/4, 8010 Graz, Austria.
| | - Elisabeth Steinbauer
- Diagnostic & Research Institute of Pathology, Medical University Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
| | - Verena Gruber
- Diagnostic & Research Institute of Pathology, Medical University Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
| | - Hildegard T Greinix
- Division of Hematology, Medical University Graz; Auenbruggerplatz 38, 8036 Graz, Austria.
| | - Katharina T Prochazka
- Division of Hematology, Medical University Graz; Auenbruggerplatz 38, 8036 Graz, Austria.
| | - Gerhard G Thallinger
- Institute of Computational Biotechnology, Graz University of Technology, Petersgasse 14/V, 8010 Graz, Austria.
- OMICS Center Graz, BioTechMed Graz, Stiftingtalstraße 24, 8010 Graz, Austria.
| | - Akos Heinemann
- Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Division of Pharmacology, Medical University of Graz, Universitätsplatz 4/I, 8010 Graz, Austria.
| | - Christine Beham-Schmid
- Diagnostic & Research Institute of Pathology, Medical University Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
| | - Peter Neumeister
- Division of Hematology, Medical University Graz; Auenbruggerplatz 38, 8036 Graz, Austria.
| | - Tanja M Wrodnigg
- Institute of Organic Chemistry, Graz University of Technology, Stremayrgasse 9/4, 8010 Graz, Austria.
| | - Karoline Fechter
- Division of Hematology, Medical University Graz; Auenbruggerplatz 38, 8036 Graz, Austria.
| | - Alexander Ja Deutsch
- Division of Hematology, Medical University Graz; Auenbruggerplatz 38, 8036 Graz, Austria.
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18
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Gunther PA, Neumeister P, Neubert H, Gebhardt S. Development of 40-MHz Ultrasonic Transducers via Soft Mold Process. IEEE Trans Ultrason Ferroelectr Freq Control 2019; 66:1497-1503. [PMID: 31217102 DOI: 10.1109/tuffc.2019.2923554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This paper reports on the fabrication of 1-3 piezocomposites for ultrasonic transducers with operating frequencies up to 40 MHz based on recent developments of the soft mold technique. Compared to the established dice-and-fill technique, the soft mold process allows for the manufacturing of 1-3 piezocomposites with higher variability of pillar design and distribution as well as smaller structural size. Consequently, spurious modes generated by the lateral composite layout can be pushed to higher frequencies, which allows for increased operating frequency. Different designs of circular piezoceramic pillars in hexagonal arrangement with decreasing diameters and spacings have been developed and characterized in order to shift spurious modes to frequencies approximately twice the desired working frequency. The influence of the lateral composite layout on resonance modes is investigated by analyzing the produced transducers with respect to their electrical impedance spectra. Experimental results are explained in detail and compared to modeled data. Results show that by downsizing pillar diameter from 30 to [Formula: see text] and pitch from 40 to [Formula: see text], the first spurious mode could be shifted from ~42 to ~78 MHz. Thereby, the soft mold process proves to be suitable for the fabrication of 40-MHz ultrasonic transducers based on 1-3 piezocomposites.
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19
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Rawlings SA, Heldt S, Prattes J, Eigl S, Jenks JD, Flick H, Rabensteiner J, Prüller F, Wölfler A, Neumeister P, Strohmaier H, Krause R, Hoenigl M. Using Interleukin 6 and 8 in Blood and Bronchoalveolar Lavage Fluid to Predict Survival in Hematological Malignancy Patients With Suspected Pulmonary Mold Infection. Front Immunol 2019; 10:1798. [PMID: 31428097 PMCID: PMC6687868 DOI: 10.3389/fimmu.2019.01798] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/17/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Molds and other pathogens induce elevated levels of several cytokines, including interleukin (IL)-6 and IL-8. The objective of this study was to investigate the prognostic value of IL-6 and IL-8 as well as fungal biomarkers in blood and bronchoalveolar lavage fluid (BAL) for overall survival in patients with underlying hematological malignancies and suspected mold infection. Methods: This cohort study included 106 prospectively enrolled adult cases undergoing bronchoscopy. Blood samples were collected within 24 h of BAL sampling and, in a subset of 62 patients, serial blood samples were collected up until 4 days after bronchoscopy. IL-6, IL-8, and other cytokines as well as galactomannan (GM) and β-D-glucan (BDG) were assayed in blood and BAL fluid and associations with overall mortality were assessed at the end of the study using receiver operating characteristic (ROC) curve analysis. Results: Both blood IL-8 (AUC 0.731) and blood IL-6 (AUC 0.699) as well as BAL IL-6 (AUC 0.763) and BAL IL-8 (AUC 0.700) levels at the time of bronchoscopy were predictors of 30-day all-cause mortality. Increasing blood IL-6 levels between bronchoscopy and day four after bronchoscopy were significantly associated with higher 90-day mortality, with similar findings for increasing IL-8 levels. In ROC analysis the difference of blood IL-8 levels between 4 days after bronchoscopy and the day of bronchoscopy had an AUC of 0.829 (95%CI 0.71-0.95; p < 0.001) for predicting 90-day mortality. Conclusions: Elevated levels of IL-6 and IL-8 in blood or BAL fluid at the time of bronchoscopy, and rising levels in blood 4 days following bronchoscopy were predictive of mortality in these patients with underlying hematological malignancy who underwent bronchoscopy for suspected mold infection.
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Affiliation(s)
- Stephen A Rawlings
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Sven Heldt
- Division of Pulmonology, Medical University of Graz, Graz, Austria.,Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Susanne Eigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Jeffrey D Jenks
- Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Holger Flick
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Albert Wölfler
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Heimo Strohmaier
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, Graz, Austria
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, San Diego, CA, United States.,Division of Pulmonology, Medical University of Graz, Graz, Austria.,Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
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20
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Panny M, Prochazka K, Neumeister P, Nösslinger T, Rathkolb V, Holzer K, Greinix H, Böhm A, Keil F. TREATMENT OF HIGH RISK AGGRESSIVE B CELL LYMPHOMAS WITH DA EPOCH R- THE AUSTRIAN EXPERIENCE. Hematol Oncol 2019. [DOI: 10.1002/hon.105_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M. Panny
- Department of Hematology and Oncology; Hanusch Hospital; Vienna Austria
| | - K. Prochazka
- Hematology; Medical University Graz; Graz Austria
| | | | - T. Nösslinger
- Department of Hematology and Oncology; Hanusch Hospital; Vienna Austria
| | - V. Rathkolb
- Department of Hematology and Oncology; Hanusch Hospital; Vienna Austria
| | - K. Holzer
- Department of Hematology and Oncology; Hanusch Hospital; Vienna Austria
| | - H. Greinix
- Hematology; Medical University Graz; Graz Austria
| | - A. Böhm
- Department of Hematology and Oncology; Hanusch Hospital; Vienna Austria
| | - F. Keil
- Department of Hematology and Oncology; Hanusch Hospital; Vienna Austria
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21
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Rejtő J, Reitter-Pfoertner S, Kepa S, Feistritzer C, Grundbichler M, Hörbst A, Jones N, Muntean W, Neumeister P, Oberbichler S, Schuster G, Schwarz R, Thom K, Zwiauer K, Streif W, Male C, Pabinger I. Epidemiology and Treatment of Patients with Haemophilia in Austria-Update from the Austrian Haemophilia Registry. Hamostaseologie 2018; 39:284-293. [PMID: 30419589 DOI: 10.1055/s-0038-1675354] [Citation(s) in RCA: 3] [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: 10/26/2022] Open
Abstract
The Austrian Haemophilia Registry collects epidemiological data on patients with haemophilia, on treatment modalities and potential side effects. The Registry covers more than 85% of the assumed total number of haemophilia patients in Austria. This report summarizes data on 753 patients: 84.3% (635) have haemophilia A and 15.7% (118) have haemophilia B. Patients' median age is 34 years (range: 1-93 years). Of the total cohort, 39.0% (294) patients have severe haemophilia, 11.3% (85) moderate haemophilia, and 49.4% (372) mild haemophilia. Of the patients with severe haemophilia, 38.4% (113) have been infected with hepatitis C virus (HCV) and 12.6% (37) are human immunodeficiency virus (HIV) positive. Overall, 10.6% (67) of patients with haemophilia A and 1.7% (2) of those with haemophilia B have had an inhibitor in their history. Among patients with severe haemophilia, 68.4% (201) receive prophylaxis and 28.6% (84) receive on-demand therapy. There are 65.0% (191) patients with severe haemophilia who are treated with recombinant products. In conclusion, most patients with severe haemophilia receive prophylactic treatment. HCV and HIV infections are still important issues in the Austrian haemophilia population.
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Affiliation(s)
- Judit Rejtő
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sylvia Reitter-Pfoertner
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sylvia Kepa
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Clemens Feistritzer
- Department of Internal Medicine V - Haematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grundbichler
- IIIrd Medical Department, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, Salzburg, Austria
| | - Alexander Hörbst
- eHealth Research and Innovation Unit, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Neil Jones
- Department of Pediatrics and Adolescent Medicine, Paracelsus Private Medical University, Salzburg, Austria
| | - Wolfgang Muntean
- Department of General Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Peter Neumeister
- Division of Haematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Stefan Oberbichler
- eHealth Research and Innovation Unit, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Gerhard Schuster
- Austrian Red Cross, Blood Transfusion Service for Upper Austria, Linz, Austria
| | - Rudolf Schwarz
- Department of Paediatric and Adolescent Medicine, Kepler University Hospital Linz, Linz, Austria
| | - Katharina Thom
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Karl Zwiauer
- Department of Paediatrics, Universitätsklinikum St. Pölten, Karl Landsteiner University of Health Sciences Austria, St. Pölten, Austria
| | - Werner Streif
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Male
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ingrid Pabinger
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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22
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Fechter K, Feichtinger J, Prochazka K, Unterluggauer JJ, Pansy K, Steinbauer E, Pichler M, Haybaeck J, Prokesch A, Greinix HT, Beham-Schmid C, Neumeister P, Thallinger GG, Deutsch AJA. Cytoplasmic location of NR4A1 in aggressive lymphomas is associated with a favourable cancer specific survival. Sci Rep 2018; 8:14528. [PMID: 30266952 PMCID: PMC6162226 DOI: 10.1038/s41598-018-32972-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023] Open
Abstract
The nuclear orphan receptor NR4A1 functions as tumour suppressor in aggressive lymphomas by pro-apoptotic genomic and non-genomic effects. Here, we immunohistochemically studied the clinico-pathological relevance of NR4A1 protein expression patterns in a cohort of 60 diffuse large B cell lymphoma (DLBCL) patients and non-neoplastic lymph nodes. We observed a significant association between high cytoplasmic NR4A1 and favourable cancer-specific survival and the germinal centre B cell-like subtype, respectively. Moreover, the percentage of lymphoma cells exhibiting cytoplasmic NR4A1 significantly correlated to those showing cleaved caspase 3. Complementary, functional profiling using gene set enrichment of Reactome pathways based on publicly available microarray data was applied to determine pathways potentially implicated in cytoplasmic localization of NR4A1 and validated by means of semi quantitative real-time PCR. The pathway analysis revealed changes in the ERK1/2 pathway, and this was corroborated by the finding that high cytoplasmic NR4A1 was associated with higher expression of ERK1/2 targets in our cohort. These data indicate that high cytoplasmic NR4A1 is associated with a favourable lymphoma-specific survival and highlights the importance of NR4A1 expression patterns as potential prognostic marker for risk assessment in aggressive lymphomas.
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MESH Headings
- Aged
- Cohort Studies
- Cytoplasm/genetics
- Cytoplasm/pathology
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Nuclear Receptor Subfamily 4, Group A, Member 1/analysis
- Nuclear Receptor Subfamily 4, Group A, Member 1/genetics
- Survival Analysis
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Affiliation(s)
- Karoline Fechter
- Division of Hematology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Julia Feichtinger
- Institute of Computational Biotechnology, Graz University of Technology, Graz, Austria
- BioTechMed Omics Center Graz, Graz, Austria
| | - Katharina Prochazka
- Division of Hematology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | - Katrin Pansy
- Division of Hematology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Johannes Haybaeck
- Institute of Pathology, Medical University Graz, Graz, Austria
- Department of Pathology, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Institute of Pathology, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Prokesch
- Institute of Cell Biology, Histology and Embryology, Medical University Graz, Graz, Austria
| | - Hildegard T Greinix
- Division of Hematology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Gerhard G Thallinger
- Institute of Computational Biotechnology, Graz University of Technology, Graz, Austria.
- BioTechMed Omics Center Graz, Graz, Austria.
| | - Alexander J A Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University Graz, Graz, Austria.
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23
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Neumeister P, Gathmann B, Hofmann D, Feldker K, Heitmann CY, Brinkmann L, Straube T. Neural correlates of trauma-related single word processing in posttraumatic stress disorder. Biol Psychol 2018; 138:172-178. [PMID: 30253231 DOI: 10.1016/j.biopsycho.2018.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/16/2017] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
Interpersonal violence (IPV) is one of the most frequent causes for the development of posttraumatic stress disorder (PTSD) in women. One key component in PTSD is altered processing of trauma-related cues, leading to emotional symptoms. In the everyday environment, words with trauma-associated semantic content represent typical, albeit abstract, trauma-related stimuli for patients suffering from PTSD. However, the functional neuroanatomy associated with processing single trauma-related words in IPV-PTSD is not understood. The present event-related functional magnetic resonance imaging study investigated the neural basis of trauma-related word processing in women with IPV-PTSD relative to healthy controls (HC) during a non-emotional vigilance task in which the emotional content of the words was task-irrelevant. On the behavioral level, trauma-related relative to neutral word stimuli evoked more unpleasant feelings, higher arousal as well as anxiety in IPV-PTSD patients as compared to HC. Functional imaging data showed hyperactivation to trauma-related versus neutral words in the basolateral amygdala (BLA) and cortical language-processing regions (inferior frontal gyrus, posterior cingulate cortex, angular/supramarginal gyrus) in IPV-PTSD compared to HC. These results propose a role of the BLA in hypervigilant responding to verbal trauma associated cues in IPV-PTSD. Furthermore, the particular involvement of cortical language-processing regions indicates enhanced processing of trauma-related words in brain regions associated with analysis and memory of verbal material. Taken together, our findings suggest that both subcortical and cortical mechanisms contribute to automatic responsivity to verbal trauma cues in PTSD.
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Affiliation(s)
- P Neumeister
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
| | - B Gathmann
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
| | - D Hofmann
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany.
| | - K Feldker
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
| | - C Y Heitmann
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
| | - L Brinkmann
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
| | - T Straube
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience, Muenster, Germany
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24
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Unterluggauer JJ, Prochazka K, Tomazic PV, Huber HJ, Seeboeck R, Fechter K, Steinbauer E, Gruber V, Feichtinger J, Pichler M, Weniger MA, Küppers R, Sill H, Schicho R, Neumeister P, Beham-Schmid C, Deutsch AJA, Haybaeck J. Expression profile of translation initiation factor eIF2B5 in diffuse large B-cell lymphoma and its correlation to clinical outcome. Blood Cancer J 2018; 8:79. [PMID: 30190479 PMCID: PMC6127263 DOI: 10.1038/s41408-018-0112-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/27/2018] [Accepted: 07/06/2018] [Indexed: 12/04/2022] Open
Affiliation(s)
- Julia J Unterluggauer
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center for Molecular BioMedicine, Medical University of Graz, Graz, Austria
| | | | - Peter V Tomazic
- Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - Heinrich J Huber
- Institute for Automation Engineering, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Rita Seeboeck
- Department Life Sciences, IMC University of Applied Sciences Krems, Krems, Austria
| | - Karoline Fechter
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Elisabeth Steinbauer
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center for Molecular BioMedicine, Medical University of Graz, Graz, Austria
| | - Verena Gruber
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center for Molecular BioMedicine, Medical University of Graz, Graz, Austria
| | - Julia Feichtinger
- Institute of Computational Biotechnology, Graz University of Technology, Graz, Austria
- BioTechMed Omics Center Graz, Graz, Austria
| | - Martin Pichler
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marc A Weniger
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, Essen, Germany
| | - Ralf Küppers
- Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Heinz Sill
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Rudolf Schicho
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Christine Beham-Schmid
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center for Molecular BioMedicine, Medical University of Graz, Graz, Austria
| | | | - Johannes Haybaeck
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center for Molecular BioMedicine, Medical University of Graz, Graz, Austria.
- Department of Pathology, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany.
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25
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Eigl S, Hoenigl M, Spiess B, Heldt S, Prattes J, Neumeister P, Wolfler A, Rabensteiner J, Prueller F, Krause R, Reinwald M, Flick H, Buchheidt D, Boch T. Galactomannan testing and Aspergillus PCR in same-day bronchoalveolar lavage and blood samples for diagnosis of invasive aspergillosis. Med Mycol 2018; 55:528-534. [PMID: 27744310 DOI: 10.1093/mmy/myw102] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 06/20/2016] [Accepted: 09/17/2016] [Indexed: 11/14/2022] Open
Abstract
In recent years galactomannan antigen testing (GM) and also Aspergillus PCR have become increasingly important for diagnosis of invasive aspergillosis (IA). Whether or not these tests need to be performed with bronchoalveolar lavage fluid (BALF; i.e., primary site of infection), or testing of blood samples is sufficient, remains, however, a matter of debate. We evaluated the diagnostic performance of GM ELISA, and Aspergillus PCR by using BALF samples and blood samples obtained at the same day from a total of 53 immunocompromised patients (16 with probable/proven IA and 37 with no evidence of IA according to the revised EORTC/MSG criteria; 38 patients with hematological malignancies were prospectively enrolled at the Medical University of Graz, Austria, 15 patients with mixed underlying diseases at the Mannheim University Hospital). Patients with possible IA were excluded from this analysis. A total of 34/53 (64%) of all patients and 12/16 (75%) of patients with probable/proven IA received mold-active antifungal prophylaxis/therapy at the time of the BALF procedure. Sensitivities of GM and Aspergillus PCR were 38% and 44% in BALF, and 31% and 0% in blood, respectively. Best sensitivity (75%) for detecting proven/probable IA was achieved when BALF Aspergillus PCR, BALF GM (>1.0 ODI), BALF-culture and serum-GM (>0.5 ODI) were combined (specificity 95%). In conclusion, sensitivities of the evaluated diagnostic tests-when interpreted on their own-were low in BALF and even lower in blood, sensitivities increased markedly when diagnostic tests were combined.
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Affiliation(s)
- Susanne Eigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Martin Hoenigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
- Division of Infectious Diseases, Department of Medicine, University of California-San Diego, San Diego, USA
- Center for Biomarker Research in Medicine, Graz, Austria
| | | | - Sven Heldt
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Albert Wolfler
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Florian Prueller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | | | - Holger Flick
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | | | - Tobias Boch
- Mannheim University Hospital, Mannheim, Germany
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26
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Heldt S, Prattes J, Eigl S, Spiess B, Flick H, Rabensteiner J, Johnson G, Prüller F, Wölfler A, Niedrist T, Boch T, Neumeister P, Strohmaier H, Krause R, Buchheidt D, Hoenigl M. Diagnosis of invasive aspergillosis in hematological malignancy patients: Performance of cytokines, Asp LFD, and Aspergillus PCR in same day blood and bronchoalveolar lavage samples. J Infect 2018; 77:235-241. [PMID: 29972764 DOI: 10.1016/j.jinf.2018.05.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Aspergillus spp. induce elevated levels of several cytokines. It remains unknown whether these cytokines hold value for clinical routine and enhance diagnostic performances of established and novel biomarkers/tests for invasive aspergillosis (IA). METHODS This cohort study included 106 prospectively enrolled (2014-2017) adult cases with underlying hematological malignancies and suspected pulmonary infection undergoing bronchoscopy. Serum samples were collected within 24 hours of bronchoalveolar lavage fluid (BALF) sampling. Both, serum and BALF samples were used to evaluate diagnostic performances of the Aspergillus-specific lateral-flow device test (LFD), Aspergillus PCR, β-D-glucan, and cytokines that have shown significant associations with IA before. RESULTS Among 106 cases, 11 had probable IA, and 32 possible IA; 80% received mold-active antifungals at the time of sampling. Diagnostic tests and biomarkers showed better performance in BALF versus blood, with the exception of serum interleukin (IL)-8 which was the most reliable blood biomarker. Combinations of serum IL-8 with either BALF LFD (sensitivity 100%, specificity 94%) or BALF PCR (sensitivity 91%, specificity 97%) showed promise for differentiating probable IA from no IA. CONCLUSIONS High serum IL-8 levels were highly specific, and when combined with either the BALF Aspergillus-specific LFD, or BALF Aspergillus PCR also highly sensitive for diagnosis of IA.
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Affiliation(s)
- Sven Heldt
- Division of Pulmonology, Medical University of Graz, Graz, Austria; Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, 8036 Graz, Austria; CBmed - Center for Biomarker Research in Medicine, Graz, Austria
| | - Susanne Eigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Birgit Spiess
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Holger Flick
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Gemma Johnson
- OLM Diagnostics, Newcastle-upon-Tyne, United Kingdom
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Albert Wölfler
- CBmed - Center for Biomarker Research in Medicine, Graz, Austria; Division of Hematology, Medical University of Graz, Graz, Austria
| | - Tobias Niedrist
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Tobias Boch
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Peter Neumeister
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Heimo Strohmaier
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, 8036 Graz, Austria; CBmed - Center for Biomarker Research in Medicine, Graz, Austria
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Martin Hoenigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria; Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, 8036 Graz, Austria; CBmed - Center for Biomarker Research in Medicine, Graz, Austria; Division of Infectious Diseases, Department of Medicine, University of California San Diego, San Diego, CA 92103, USA.
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27
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Neumeister P, Feldker K, Heitmann CY, Buff C, Brinkmann L, Bruchmann M, Straube T. Specific amygdala response to masked fearful faces in post-traumatic stress relative to other anxiety disorders. Psychol Med 2018; 48:1209-1217. [PMID: 28950918 DOI: 10.1017/s0033291717002513] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Altered amygdala activation to fear-related stimuli has been proposed to be a potential neural correlate of heightened threat sensitivity in anxiety- and stress-related disorders. However, the role of stimulus awareness and disorder specificity remains widely unclear. Here we investigated amygdala responses to conscious and unconscious fearful faces in patients suffering from panic disorder (PD), generalized anxiety disorder (GAD), or post-traumatic stress disorder (PTSD) and in a large sample of healthy controls (HC). METHODS During event-related functional magnetic resonance imaging participants (n = 120; 20 PD, 20 GAD, 20 PTSD, 60 HC) were confronted with briefly presented fearful faces, neutral faces, and non-faces in a backward masking paradigm. The design allowed for the analysis of trial-by-trial face detection performance and amygdala responses to fearful v. neutral faces. RESULTS All participants exhibited increased amygdala activation to fearful v. neutral faces during conscious trials. Specifically during unconscious face processing, the PTSD, compared with all other groups, showed higher right basolateral (BLA) amygdala activity to fearful v. neutral faces. CONCLUSIONS The present study shows that BLA amygdala hyperactivity during unconscious, but not conscious, processing of fearful faces differentiates PTSD from the investigated disorders. This finding suggests an automatic and specific neural hyper-responsivity to general fear cues in PTSD and supports the idea of categorical differences between PTSD and other anxiety-related disorders.
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Affiliation(s)
- P Neumeister
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
| | - K Feldker
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
| | - C Y Heitmann
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
| | - C Buff
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
| | - L Brinkmann
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
| | - M Bruchmann
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
| | - T Straube
- Institute of Medical Psychology and Systems Neuroscience,University Hospital Muenster,Muenster,Germany
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28
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Hoenigl M, Prattes J, Neumeister P, Wölfler A, Krause R. Real-world challenges and unmet needs in the diagnosis and treatment of suspected invasive pulmonary aspergillosis in patients with haematological diseases: An illustrative case study. Mycoses 2017; 61:201-205. [PMID: 29112326 DOI: 10.1111/myc.12727] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 12/25/2022]
Abstract
Recent years have seen important advances in the diagnosis of invasive pulmonary aspergillosis (IPA), complemented by the introduction of new therapies. Despite this, IPA remains a major cause of infection-related mortality in patients with haematological diseases. There are two main reasons for this. First, diagnosis of IPA remains a challenge, since risk factors and the clinical, radiological and mycological presentations vary not only by fungal disease stage, but also by patient group (eg neutropenic vs non-neutropenic patients). Diagnosis is particularly challenging in patients receiving mould-active prophylactic or empirical treatment, which reduces the sensitivity of all diagnostic tests for IPA. Second, treatment of IPA is complex due to unpredictable pharmacokinetic profiles of antifungal agents, small therapeutic window in terms of exposure and adverse events, and multiple drug-drug interactions through the CYP450 system. Here we report a case of a 23-year-old male with severe aplastic anaemia and subpleural nodules. Diagnostic tests for IPA obtained during ongoing mould-active empirical treatment were negative. Intravenous voriconazole was stopped after visual disturbances and hallucinations. The patient then had an anaphylactic reaction to liposomal amphotericin B and was switched to intravenous posaconazole, which had to be discontinued due to a significant increase in transaminase levels. He was treated with oral isavuconazole with reduced dosage, triggered by increasing transaminases under the standard dosage. Even under reduced dosage, blood concentrations of isavuconazole were high and treatment was successful. The case illustrates real-world challenges and unmet needs in the diagnosis and treatment of IPA in patients with haematological diseases.
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Affiliation(s)
- Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University Graz, Graz, Austria.,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,CBmed - Center for Biomarker Research in Medicine, Graz, Austria.,Division of Infectious Diseases, Department of Medicine, University of California-San Diego, San Diego, CA, USA
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University Graz, Graz, Austria.,CBmed - Center for Biomarker Research in Medicine, Graz, Austria
| | - Peter Neumeister
- Division of Haematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Albert Wölfler
- Division of Haematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University Graz, Graz, Austria.,CBmed - Center for Biomarker Research in Medicine, Graz, Austria
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29
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Heldt S, Eigl S, Prattes J, Flick H, Rabensteiner J, Prüller F, Niedrist T, Neumeister P, Wölfler A, Strohmaier H, Krause R, Hoenigl M. Levels of interleukin (IL)-6 and IL-8 are elevated in serum and bronchoalveolar lavage fluid of haematological patients with invasive pulmonary aspergillosis. Mycoses 2017; 60:818-825. [PMID: 28877383 DOI: 10.1111/myc.12679] [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: 06/04/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 12/21/2022]
Abstract
Aspergillus spp. have been shown to induce T-helper cell (Th) 1 and Th17 subsets resulting in elevated levels of several cytokines. The objective of this study was to analyse a bundle of cytokines in serum and bronchoalveolar lavage fluid (BALF) in patients with and without invasive pulmonary aspergillosis (IPA). This nested case-control analysis included 10 patients with probable/proven IPA and 20 matched controls without evidence of IPA, out of a pool of prospectively enrolled (2014-2017) adult cases with underlying haematological malignancies and suspected pulmonary infection. Serum samples were collected within 24 hours of BALF sampling. All samples were stored at -70°C for retrospective determination of cytokines. IL-6 and IL-8 were significantly associated with IPA in both serum (P = .011 and P = .028) and BALF (P = .006 and P = .012, respectively), and a trend was observed for serum IL-10 (P = .059). In multivariate conditional logistic regression analysis, IL-10 remained a significant predictor of IPA in serum and IL-8 among BALF cytokines. In conclusion, levels of IL-6 and IL-8 were significantly associated with probable/proven IPA, and a similar trend was observed for serum IL-10. Future cohort studies should determine the diagnostic potential of these cytokines for IPA, and evaluate combinations with other IPA biomarkers/diagnostic tests.
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Affiliation(s)
- Sven Heldt
- Division of Pulmonology, Medical University of Graz, Graz, Austria.,Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Susanne Eigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,CBmed - Center for Biomarker Research in Medicine, Graz, Austria
| | - Holger Flick
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Tobias Niedrist
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Albert Wölfler
- CBmed - Center for Biomarker Research in Medicine, Graz, Austria.,Division of Hematology, Medical University of Graz, Graz, Austria
| | - Heimo Strohmaier
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,CBmed - Center for Biomarker Research in Medicine, Graz, Austria
| | - Martin Hoenigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria.,Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,CBmed - Center for Biomarker Research in Medicine, Graz, Austria.,Division of Infectious Diseases, Department of Medicine, University of California-San Diego, San Diego, USA
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30
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Prochazka KT, Posch F, Deutsch A, Beham-Schmid C, Stöger H, Abdyli L, Greinix H, Pichler M, Neumeister P. Immunohistochemical double hit score enhances NCCN-IPI and is associated with detrimental outcomes in refractory or relapsing patients with diffuse large B cell lymphoma. Br J Haematol 2017; 183:142-146. [PMID: 28875547 DOI: 10.1111/bjh.14912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Katharina T Prochazka
- Division of Haematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Alexander Deutsch
- Division of Haematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | | | - Herbert Stöger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Leke Abdyli
- Division of Haematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Hildegard Greinix
- Division of Haematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria.,Research Unit for non-coding RNAs and genome editing in cancer, Medical University of Graz, Graz, Austria.,Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Neumeister
- Division of Haematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
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31
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Neumeister P, Fechter K, Deutsch A, Pichler M, Prochazka K, Feichtinger J, Steinbauer E, Greinix H, Beham-Schmid C. Cytoplasmatic location of NR4A1 in aggressive lymphomas is associated with a favourable cancer specific survival. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- P. Neumeister
- Department of Internal Medicine; Division of Hematology; Graz Austria
| | - K. Fechter
- Department of Internal Medicine; Division of Hematology; Graz Austria
| | - A. Deutsch
- Department of Internal Medicine; Division of Hematology; Graz Austria
| | - M. Pichler
- Department of Internal Medicine; Division of Oncology; Graz Austria
| | - K. Prochazka
- Department of Internal Medicine; Division of Hematology; Graz Austria
| | - J. Feichtinger
- Institute of Molecular Biotechnology; University of Technology; Graz Austria
| | - E. Steinbauer
- Hematopathology; Institute of Pathology; Graz Austria
| | - H. Greinix
- Department of Internal Medicine; Division of Hematology; Graz Austria
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32
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Panny M, Prochazka K, Nösslinger T, Rathkolb V, Neumeister P, Greinix H, Keil F. Treatment of high risk aggressive B cell lymphomas with DA EPOCH R-A retrospective analysis. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M. Panny
- Department of Hematology and Oncology; Hanusch Hospital; Vienna Austria
| | - K. Prochazka
- Department of Hematology; Medical University of Graz; Graz Austria
| | - T. Nösslinger
- Department of Hematology and Oncology; Hanusch Hospital; Vienna Austria
| | - V. Rathkolb
- Department of Hematology and Oncology; Hanusch Hospital; Vienna Austria
| | - P. Neumeister
- Department of Hematology; Medical University of Graz; Graz Austria
| | - H. Greinix
- Department of Hematology; Medical University of Graz; Graz Austria
| | - F. Keil
- Department of Hematology and Oncology; Hanusch Hospital; Vienna Austria
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33
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Stauber MN, Aberer F, Oulhaj A, Mader JK, Zebisch A, Pieber TR, Neumeister P, Greinix HT, Sill H, Sourij H, Wölfler A. Early Hyperglycemia after Initiation of Glucocorticoid Therapy Predicts Adverse Outcome in Patients with Acute Graft-versus-Host Disease. Biol Blood Marrow Transplant 2017; 23:1186-1192. [PMID: 28285080 DOI: 10.1016/j.bbmt.2017.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/07/2017] [Indexed: 01/28/2023]
Abstract
Because of first-line treatment with high-dose glucocorticoids (GC), steroid-induced hyperglycemia develops frequently in patients with acute graft-versus-host disease (aGVHD), potentially affecting their outcome. We performed a retrospective analysis on 104 patients who received systemic GC for aGVHD and investigated the consequences of aberrant glucose metabolism. In particular, we focused on glucose parameters early after initiation of GC. With a median of 50 (range, 4 to 513) blood glucose measurements during GC treatment, increasing mean, median, and maximum glucose levels and the need for insulin treatment were associated with decreased overall survival (OS) in simple and multiple survival analysis. Early hyperglycemia, as defined by mean blood glucose levels >125 mg/dL during the first 3 days of GC therapy, was also found to be highly associated with adverse outcome (hazard ratio [HR], 2.5 for death; 95% confidence interval [CI], 1.3 to 4.8, and HR of 3.5 for death due to nonrelapse mortality, 95% CI, 1.7 to 7.5, in a competing risk analysis). A score based on early hyperglycemia and nonresponse to GC within 7 days allowed the identification of 3 risk groups: patients with both risk factors had an inferior OS at 5 years of 4.1% compared with 75.4% in patients with none. Patients with 1 risk factor had a 5-year OS rate of 32.0% (P = .0002 for trend). Early hyperglycemia after GC initiation is a prominent risk factor for adverse outcome in patients with aGVHD. A score based solely on early hyperglycemia and lack of response to GC can predict survival in these patients.
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Affiliation(s)
- Melanie N Stauber
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Abderrahim Oulhaj
- College of Medicine and Health Science, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Armin Zebisch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Center for Biomarker Research in Medicine, CBMed, Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hildegard T Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Heinz Sill
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Center for Biomarker Research in Medicine, CBMed, Graz, Austria
| | - Albert Wölfler
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Center for Biomarker Research in Medicine, CBMed, Graz, Austria.
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34
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Deutsch AJ, Rinner B, Pichler M, Prochazka K, Pansy K, Bischof M, Fechter K, Hatzl S, Feichtinger J, Wenzl K, Frisch MT, Stiegelbauer V, Prokesch A, Krogsdam A, Sill H, Thallinger GG, Greinix HT, Wang C, Beham-Schmid C, Neumeister P. NR4A3 Suppresses Lymphomagenesis through Induction of Proapoptotic Genes. Cancer Res 2017; 77:2375-2386. [DOI: 10.1158/0008-5472.can-16-2320] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/12/2016] [Accepted: 02/22/2017] [Indexed: 11/16/2022]
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35
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Feldker K, Heitmann CY, Neumeister P, Tupak SV, Schrammen E, Moeck R, Zwitserlood P, Bruchmann M, Straube T. Transdiagnostic brain responses to disorder-related threat across four psychiatric disorders. Psychol Med 2017; 47:730-743. [PMID: 27869064 DOI: 10.1017/s0033291716002634] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is an ongoing debate whether transdiagnostic neural mechanisms are shared by different anxiety-related disorders or whether different disorders show distinct neural correlates. To investigate this issue, studies controlling for design and stimuli across multiple anxiety-related disorders are needed. METHOD The present functional magnetic resonance imaging study investigated neural correlates of visual disorder-related threat processing across unmedicated patients suffering from panic disorder (n = 20), social anxiety disorder (n = 20), dental phobia (n = 16) and post-traumatic stress disorder (n = 11) relative to healthy controls (HC; n = 67). Each patient group and the corresponding HC group saw a tailor-made picture set with 50 disorder-related and 50 neutral scenes. RESULTS Across all patients, increased activation to disorder-related v. neutral scenes was found in subregions of the bilateral amygdala. In addition, activation of the lateral amygdala to disorder-related v. neutral scenes correlated positively with subjective anxiety ratings of scenes across patients. Furthermore, whole-brain analysis revealed increased responses to disorder-related threat across the four disorders in middle, medial and superior frontal regions, (para-)limbic regions, such as the insula and thalamus, as well as in the brainstem and occipital lobe. We found no disorder-specific brain responses. CONCLUSIONS The results suggest that pathologically heightened lateral amygdala activation is linked to experienced anxiety across anxiety disorders and trauma- and stressor-related disorders. Furthermore, the transdiagnostically shared activation network points to a common neural basis of abnormal responses to disorder-related threat stimuli across the four investigated disorders.
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Affiliation(s)
- K Feldker
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - C Y Heitmann
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - P Neumeister
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - S V Tupak
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - E Schrammen
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - R Moeck
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | | | - M Bruchmann
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
| | - T Straube
- University Hospital Muenster, Institute of Medical Psychology and Systems Neuroscience,Muenster,Germany
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36
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Spindelboeck W, Schulz E, Uhl B, Kashofer K, Aigelsreiter A, Zinke-Cerwenka W, Mulabecirovic A, Kump PK, Halwachs B, Gorkiewicz G, Sill H, Greinix H, Högenauer C, Neumeister P. Repeated fecal microbiota transplantations attenuate diarrhea and lead to sustained changes in the fecal microbiota in acute, refractory gastrointestinal graft- versus-host-disease. Haematologica 2017; 102:e210-e213. [PMID: 28154090 DOI: 10.3324/haematol.2016.154351] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Walter Spindelboeck
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria.,Theodor Escherich Laboratory for Microbiome Research, Medical University of Graz, Austria
| | - Eduard Schulz
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Barbara Uhl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Karl Kashofer
- Institute of Pathology, Medical University of Graz, Austria
| | | | - Wilma Zinke-Cerwenka
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Adnan Mulabecirovic
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Patrizia K Kump
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria.,Theodor Escherich Laboratory for Microbiome Research, Medical University of Graz, Austria
| | - Bettina Halwachs
- Theodor Escherich Laboratory for Microbiome Research, Medical University of Graz, Austria.,Division of Hematology, Department of Internal Medicine, Medical University of Graz, Austria.,Institute of Pathology, Medical University of Graz, Austria
| | - Gregor Gorkiewicz
- Theodor Escherich Laboratory for Microbiome Research, Medical University of Graz, Austria.,Division of Hematology, Department of Internal Medicine, Medical University of Graz, Austria.,Institute of Pathology, Medical University of Graz, Austria
| | - Heinz Sill
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Hildegard Greinix
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Christoph Högenauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria .,Theodor Escherich Laboratory for Microbiome Research, Medical University of Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Austria
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37
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Prochazka KT, Melchardt T, Posch F, Schlick K, Deutsch A, Beham-Schmid C, Weiss L, Gary T, Neureiter D, Klieser E, Greil R, Neumeister P, Egle A, Pichler M. NCCN-IPI score-independent prognostic potential of pretreatment uric acid levels for clinical outcome of diffuse large B-cell lymphoma patients. Br J Cancer 2016; 115:1264-1272. [PMID: 27764838 PMCID: PMC5104895 DOI: 10.1038/bjc.2016.325] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/12/2016] [Accepted: 09/19/2016] [Indexed: 12/22/2022] Open
Abstract
Background: Blood-based parameters are gaining increasing interest as potential prognostic biomarkers in patients with diffuse large B-cell lymphoma (DLBCL). The aim of this study was to comprehensively evaluate the prognostic significance of pretreatment plasma uric acid levels in patients with newly diagnosed DLBCL. Methods: The clinical course of 539 DLBCL patients, diagnosed and treated between 2004 and 2013 at two Austrian high-volume centres with rituximab-based immunochemotherapy was evaluated retrospectively. The prognostic influence of uric acid on overall survival (OS) and progression-free survival (PFS) were studied including multi-state modelling, and analysis of conditional survival. Results: Five-year OS and PFS were 50.4% (95% CI: 39.2–60.6) and 44.0% (33.4–54.0) in patients with uric acid levels above the 75th percentile of the uric acid distribution (Q3, cut-off: 6.8 mg dl−1), and 66.2% (60.4–71.5) and 59.6% (53.7–65.0%) in patients with lower levels (log-rank P=0.002 and P=0.0045, respectively). In univariable time-to-event analysis, elevated uric acid levels were associated with a worse PFS (hazard ratio (HR) per 1 log increase in uric acid 1.47, 95% CI: 1.10–1.97, P=0.009) and a worse OS (HR=1.60, 95% CI: 1.16–2.19, P=0.004). These associations prevailed upon multivariable adjustment for the NCCN-IPI score. Uric acid levels significantly improved the predictive performance of the R-IPI and NCCN-IPI scores, and in multi-state analysis, it emerged as a highly significant predictor of an increased risk of death without developing recurrence (transition-HR=4.47, 95% CI: 2.17–9.23, P<0.0001). Conclusions: We demonstrate that elevated uric acid levels predict poor long-term outcomes in DLBCL patients beyond the NCCN-IPI risk index.
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Affiliation(s)
- Katharina T Prochazka
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz 8036, Austria
| | - Thomas Melchardt
- Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University Salzburg, Salzburg 5020, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz 8036, Austria
| | - Konstantin Schlick
- Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University Salzburg, Salzburg 5020, Austria
| | - Alexander Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz 8036, Austria
| | | | - Lukas Weiss
- Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University Salzburg, Salzburg 5020, Austria
| | - Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University of Graz (MUG), Graz 8036, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg 5020, Austria
| | - Eckhard Klieser
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg 5020, Austria
| | - Richard Greil
- Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University Salzburg, Salzburg 5020, Austria
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz 8036, Austria
| | - Alexander Egle
- Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University Salzburg, Salzburg 5020, Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz 8036, Austria.,Research Unit for non-coding RNAs and genome editing in cancer, Graz 8036, Austria.,Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
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38
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Melchardt T, Troppan K, Weiss L, Hufnagl C, Neureiter D, Tränkenschuh W, Schlick K, Huemer F, Deutsch A, Neumeister P, Greil R, Pichler M, Egle A. Independent Prognostic Value of Serum Markers in Diffuse Large B-Cell Lymphoma in the Era of the NCCN-IPI. J Natl Compr Canc Netw 2016; 13:1501-8. [PMID: 26656519 DOI: 10.6004/jnccn.2015.0178] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several serum parameters have been evaluated for adding prognostic value to clinical scoring systems in diffuse large B-cell lymphoma (DLBCL), but none of the reports used multivariate testing of more than one parameter at a time. The goal of this study was to validate widely available serum parameters for their independent prognostic impact in the era of the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI) score to determine which were the most useful. PATIENTS AND METHODS This retrospective bicenter analysis includes 515 unselected patients with DLBCL who were treated with rituximab and anthracycline-based chemoimmunotherapy between 2004 and January 2014. RESULTS Anemia, high C-reactive protein, and high bilirubin levels had an independent prognostic value for survival in multivariate analyses in addition to the NCCN-IPI, whereas neutrophil-to-lymphocyte ratio, high gamma-glutamyl transferase levels, and platelets-to-lymphocyte ratio did not. CONCLUSIONS In our cohort, we describe the most promising markers to improve the NCCN-IPI. Anemia and high C-reactive protein levels retain their power in multivariate testing even in the era of the NCCN-IPI. The negative role of high bilirubin levels may be associated as a marker of liver function. Further studies are warranted to incorporate these markers into prognostic models and define their role opposite novel molecular markers.
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Affiliation(s)
- Thomas Melchardt
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
| | - Katharina Troppan
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
| | - Lukas Weiss
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
| | - Clemens Hufnagl
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
| | - Daniel Neureiter
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
| | - Wolfgang Tränkenschuh
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
| | - Konstantin Schlick
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
| | - Florian Huemer
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
| | - Alexander Deutsch
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
| | - Peter Neumeister
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
| | - Richard Greil
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
| | - Martin Pichler
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
| | - Alexander Egle
- From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas
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Klamroth R, Simpson M, von Depka-Prondzinski M, Gill JC, Morfini M, Powell JS, Santagostino E, Davis J, Huth-Kühne A, Leissinger C, Neumeister P, Bensen-Kennedy D, Feussner A, Limsakun T, Zhou M, Veldman A, St Ledger K, Blackman N, Pabinger I. Comparative pharmacokinetics of rVIII-SingleChain and octocog alfa (Advate(®) ) in patients with severe haemophilia A. Haemophilia 2016; 22:730-8. [PMID: 27434619 DOI: 10.1111/hae.12985] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND rVIII-SingleChain, a novel recombinant factor VIII (rFVIII), has been designed as a B-domain truncated construct with covalently bonded heavy and light chains, aiming to increase binding affinity to von Willebrand factor (VWF). Preclinical studies confirmed greater affinity for VWF, giving improved pharmacokinetic and pharmacodynamic properties compared with full-length rFVIII. AIM To investigate the pharmacokinetics of rVIII-SingleChain and compare them against those of full-length rFVIII. METHODS This study enrolled 27 patients with severe haemophilia A in the AFFINITY clinical trial programme. After a 4-day washout period, all patients received a single infusion of 50 IU kg(-1) octocog alfa (Advate(®) ); after a ≥4-day postinfusion washout period, they received a single infusion of 50 IU kg(-1) rVIII-SingleChain. Blood samples for pharmacokinetic assessments of each product were collected before infusion (predose) and at 0.5, 1, 4, 8, 10, 24, 32, 48 and 72 h postinfusion for both products. RESULTS rVIII-SingleChain had a longer mean half-life (t1/2 ) (14.5 vs. 13.3 h), lower mean clearance (CL) (2.64 vs. 3.68 mL h(-1) kg(-1) ), higher mean residence time (20.4 vs. 17.1 h) and larger mean AUCinf (2090 vs. 1550 IU?h dL(-1) ) than octocog alfa, respectively. The mean AUCinf after rVIII-SingleChain infusion was ~35% larger than after octocog alfa. A similar pattern was observed for AUC0-last . No serious adverse events or inhibitors were reported. CONCLUSIONS rVIII-SingleChain has a favourable pharmacokinetic profile compared with octocog alfa and was well tolerated. The prolonged t1/2 , larger AUC and reduced CL of rVIII-SingleChain may permit longer dosing intervals, thereby improving patient adherence to prophylactic treatment.
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Affiliation(s)
- R Klamroth
- Department for Internal Medicine, Vascular Medicine and Haemostaseology, Vivantes Klinikum, Berlin Friedrichshain, Germany
| | - M Simpson
- Rush University Medical Center, Chicago, IL, USA
| | | | - J C Gill
- Medical College of Wisconsin and Blood Center of Wisconsin, Milwaukee, WI, USA
| | - M Morfini
- Ospedaliero Universitaria Careggi, Firenze, Italy
| | - J S Powell
- Hemophilia Treatment Center, UC Davis, Sacramento, CA, USA
| | - E Santagostino
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - J Davis
- University of Miami Hemophilia Treatment Center, Miami, FL, USA
| | - A Huth-Kühne
- Hämophiliezentrum und Gerinnungsambulanz SRH Kurpfalzkrankenhaus, Heidelberg, Germany
| | - C Leissinger
- Louisiana Center for Bleeding and Clotting Disorders, New Orleans, LA, USA
| | - P Neumeister
- Klinische Abteilung für Hämatologie, Medizinische Universität of Graz, Graz, Austria
| | | | - A Feussner
- Clinical R&D, CSL Behring, Marburg, Germany
| | - T Limsakun
- Clinical R&D, CSL Behring, King of Prussia, PA, USA
| | - M Zhou
- Clinical R&D, CSL Behring, King of Prussia, PA, USA
| | - A Veldman
- Clinical R&D, CSL Behring, Marburg, Germany
| | - K St Ledger
- Clinical R&D, CSL Behring, King of Prussia, PA, USA
| | - N Blackman
- Clinical R&D, CSL Behring, King of Prussia, PA, USA
| | - I Pabinger
- Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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Troppan KT, Melchardt T, Wenzl K, Schlick K, Deutsch A, Bullock MD, Reitz D, Beham-Schmid C, Weiss L, Neureiter D, Tränkenschuh W, Greil R, Neumeister P, Egle A, Pichler M. The clinical significance of fibrinogen plasma levels in patients with diffuse large B cell lymphoma. J Clin Pathol 2015; 69:326-30. [PMID: 26644520 DOI: 10.1136/jclinpath-2015-203356] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/17/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fibrinogen plays a crucial role in the pathophysiology of tumour cell growth, invasion and metastasis. The aim of this study was to evaluate the prognostic significance of pretreatment plasma fibrinogen levels in patients with diffuse large B cell lymphoma (DLBCL) METHODS: Data from 372 patients with DLBCL, diagnosed and treated between 2004 and 2013 at two Austrian centres, were evaluated retrospectively. The prognostic influences of plasma fibrinogen levels and other factors, including age, tumour stage and the National Comprehensive Cancer Network-International Prognostic Index, on 5-year overall survival (OS) and 5-year disease-free survival (DFS) were studied using Kaplan-Meier curves as well as univariate and multivariate Cox regression models. RESULTS Kaplan-Meier analysis revealed that a high fibrinogen plasma level is associated with decreased 5-year OS and 5-year DFS in patients with DLBCL (p<0.001, log-rank test). Furthermore, in multivariate analysis, elevated serum fibrinogen was found to be an independent marker of poor clinical outcome: 5-year OS (HR=1.69, 95% CI 1.06 to 2.72, p=0.029) and 5-year DFS (HR=1.68, 95% CI 1.08 to 2.61, p=0.021). CONCLUSIONS In the current study, we demonstrate that high plasma fibrinogen levels at diagnosis predict poor outcome in patients with DLBCL. TRIAL REGISTRATION NUMBER 25-434 ex 12713 and 415-EP/73/127-2012.
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Affiliation(s)
- Katharina T Troppan
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Thomas Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Graz, Austria
| | - Kerstin Wenzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Konstantin Schlick
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Graz, Austria
| | - Alexander Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Marc D Bullock
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel Reitz
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | | | - Lukas Weiss
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Graz, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Richard Greil
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Alexander Egle
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Graz, Austria
| | - Martin Pichler
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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41
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Rabensteiner J, Theiler G, Duettmann W, Zollner-Schwetz I, Hoenigl M, Valentin T, Leitner E, Luxner J, Grisold A, Valentin A, Neumeister P, Krause R. Detection of central venous catheter-related bloodstream infections in haematooncological patients. Eur J Clin Invest 2015; 45:824-32. [PMID: 26058473 DOI: 10.1111/eci.12477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 06/03/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Catheter-related bloodstream infections (CRBSIs) are currently detected in patients with clinically suspicion. The aim of our study was to evaluate whether CRBSIs could be anticipated and detected in a subclinical stage by peptide nucleic acid fluorescence in situ hybridization (PNA FISH) using universal hybridization probes or acridine orange leucocyte cytospin (AOLC) tests in haematooncological patients with central venous catheters (CVCs) in situ. MATERIALS AND METHODS Peptide nucleic acid fluorescence in situ hybridization and AOLC tests using blood samples from one CVC lumen/port chamber in haematooncological patients were continuously performed. These results were compared to those obtained from routinely performed CRBSI diagnostic tests. RESULTS One hundred and eighty-two patients with 342 catheter periods were investigated. Seventeen CRBSI cases were detected in 6466 CVC days by routine measures resulting in a CRBSI rate of 2.6/1000 catheter days. Two of 17 showed positive PNA FISH tests, and five positive AOLC test results before the diagnosis were established with routine measures. The screening revealed further seven patients with positive universal PNA FISH tests and 10 positive AOLC tests without symptoms indicative for infection and were therefore considered not to have CRBSI. CONCLUSIONS Sampling of only one CVC lumen/port chamber screening for CRBSI in haematooncological patients seems not to be a useful tool for anticipative diagnosis of CRBSI. Reasons for false-negative results might include origin of CRBSIs from the other CVC lumina not sampled for screening, and false-positive results might origin from catheter colonization without subsequent spread of micro-organisms into the peripheral bloodstream.
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Affiliation(s)
- Jasmin Rabensteiner
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Georg Theiler
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Wiebke Duettmann
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Eva Leitner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Josefa Luxner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Andrea Grisold
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Angelika Valentin
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Lin AP, Abbas S, Kim SW, Ortega M, Bouamar H, Escobedo Y, Varadarajan P, Qin Y, Sudderth J, Schulz E, Deutsch A, Mohan S, Ulz P, Neumeister P, Rakheja D, Gao X, Hinck A, Weintraub ST, DeBerardinis RJ, Sill H, Dahia PLM, Aguiar RCT. D2HGDH regulates alpha-ketoglutarate levels and dioxygenase function by modulating IDH2. Nat Commun 2015; 6:7768. [PMID: 26178471 PMCID: PMC4515030 DOI: 10.1038/ncomms8768] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 05/12/2015] [Accepted: 06/08/2015] [Indexed: 12/19/2022] Open
Abstract
Isocitrate dehydrogenases (IDH) convert isocitrate to alpha-ketoglutarate (α-KG). In cancer, mutant IDH1/2 reduces α-KG to D2-hydroxyglutarate (D2-HG) disrupting α-KG-dependent dioxygenases. However, the physiological relevance of controlling the interconversion of D2-HG into α-KG, mediated by D2-hydroxyglutarate dehydrogenase (D2HGDH), remains obscure. Here we show that wild-type D2HGDH elevates α-KG levels, influencing histone and DNA methylation, and HIF1α hydroxylation. Conversely, the D2HGDH mutants that we find in diffuse large B-cell lymphoma are enzymatically inert. D2-HG is a low-abundance metabolite, but we show that it can meaningfully elevate α-KG levels by positively modulating mitochondrial IDH activity and inducing IDH2 expression. Accordingly, genetic depletion of IDH2 abrogates D2HGDH effects, whereas ectopic IDH2 rescues D2HGDH-deficient cells. Our data link D2HGDH to cancer and describe an additional role for the enzyme: the regulation of IDH2 activity and α-KG-mediated epigenetic remodelling. These data further expose the intricacies of mitochondrial metabolism and inform on the pathogenesis of D2HGDH-deficient diseases.
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Affiliation(s)
- An-Ping Lin
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Saman Abbas
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Sang-Woo Kim
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Manoela Ortega
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Hakim Bouamar
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Yissela Escobedo
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Prakash Varadarajan
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Yuejuan Qin
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Jessica Sudderth
- Department of Pediatrics, Children's Medical Center Research Institute, University of Texas Southwestern, Dallas, Texas 75390, USA
| | - Eduard Schulz
- Division of Hematology, Medical University of Graz, A-8036 Graz, Austria
| | - Alexander Deutsch
- Division of Hematology, Medical University of Graz, A-8036 Graz, Austria
| | - Sumitra Mohan
- Institute of Human Genetics, Medical University of Graz, A-8036 Graz, Austria
| | - Peter Ulz
- Institute of Human Genetics, Medical University of Graz, A-8036 Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Medical University of Graz, A-8036 Graz, Austria
| | - Dinesh Rakheja
- 1] Department of Pediatrics, Children's Medical Center Research Institute, University of Texas Southwestern, Dallas, Texas 75390, USA [2] Department of Pathology and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Xiaoli Gao
- Department of Biochemistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Andrew Hinck
- Department of Biochemistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Susan T Weintraub
- Department of Biochemistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Ralph J DeBerardinis
- Department of Pediatrics, Children's Medical Center Research Institute, University of Texas Southwestern, Dallas, Texas 75390, USA
| | - Heinz Sill
- Division of Hematology, Medical University of Graz, A-8036 Graz, Austria
| | - Patricia L M Dahia
- 1] Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA [2] Greehey Children's Cancer Research Institute, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas 78229, USA [3] Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Ricardo C T Aguiar
- 1] Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA [2] Greehey Children's Cancer Research Institute, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas 78229, USA [3] Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA [4] South Texas Veterans Health Care System, Audie Murphy VA Hospital, San Antonio, Texas 78229, USA
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Wenzl K, Troppan K, Neumeister P, Deutsch AJA. The nuclear orphan receptor NR4A1 and NR4A3 as tumor suppressors in hematologic neoplasms. Curr Drug Targets 2015; 16:38-46. [PMID: 25410408 DOI: 10.2174/1389450115666141120112818] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 11/22/2022]
Abstract
NR4A1 (Nur77) belongs together with NR4A2 (Nurr1) and NR4A3 (NOR-1) to the nuclear orphan receptors of the NR4A-family. Their activation is generally short lived, the cellular outcome is a stimulus- and cell context-dependent differential activation of NR4A target genes that regulate cell cycle, apoptosis, inflammation, atherogenesis, metabolism, DNA repair and tumorigenesis. NR4A1 and NR4A3 were identified to function as tumor suppressors in acute myeloid leukemia (AML). Deletion of both nuclear receptors led to rapid development of AML in mice. Loss of NR4A1 and NR4A3 was a common feature in human AML patients. Additionally, NR4A1 and NR4A3 hypoallelic mice - mice with a reduced NR4A1 and NR4A3 expression - develop a chronic myeloid malignancy that recapitulates the pathological features of myelodysplastic/ myeloproliferative neoplasms with progression to AML in rare cases. Recently, a reduced NR4A1 and NR4A3 expression was described in aggressive lymphomas and low NR4A1 expression was associated with poor overall survival. Overexpression of NR4A1 in aggressive lymphoma cells led to induction of apoptosis and abrogated tumor growth in a xenograft mouse model. Recently, it was shown that NR4A inducing agents or NR4A agonist possess/induce apoptotic effects in AML and lymphoma cells. Due to this fact and the growing number of NR4A1 and NR4A3 inducing agents and NR4A agonists, both receptors represent new targets for anti tumor therapy.
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Eigl S, Prattes J, Reinwald M, Thornton CR, Reischies F, Spiess B, Neumeister P, Zollner-Schwetz I, Raggam RB, Flick H, Buchheidt D, Krause R, Hoenigl M. Influence of mould-active antifungal treatment on the performance of the Aspergillus-specific bronchoalveolar lavage fluid lateral-flow device test. Int J Antimicrob Agents 2015; 46:401-5. [PMID: 26187363 DOI: 10.1016/j.ijantimicag.2015.05.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/02/2015] [Accepted: 05/15/2015] [Indexed: 11/28/2022]
Abstract
The effect of mould-active antifungal (AF) therapy/prophylaxis on the performance of the Aspergillus-specific lateral-flow device (LFD) test for diagnosing invasive pulmonary aspergillosis (IPA) was evaluated. This was a retrospective analysis of patients diagnosed with probable or proven IPA (according to revised EORTC/MSG criteria) at the Medical University of Graz (Austria) and the University Hospital of Mannheim (Germany) between February 2011 and December 2014. In total, 60 patients with 63 bronchoalveolar lavage fluid (BALF) samples were included in the analysis. Patient charts were reviewed regarding AF treatment at the time of bronchoscopy, and the influence of AFs on the performance of the LFD and BALF galactomannan (GM) ELISA results was calculated. Overall, 54 patients (57 BALF samples) had probable IPA and 6 patients (6 samples) had proven IPA. In 21/63 samples (33%) (from 19 patients), systemic mould-active AFs had been initiated before bronchoscopy. Of 63 BALF samples, 16 (25%) yielded a false-negative LFD result. The sensitivity of the LFD for probable/proven IPA was significantly lower in those receiving mould-active AFs compared with those without (52% vs. 86%; P=0.006). Similar results were found for BALF GM, with sensitivities decreasing under systemic AFs (71% vs. 95%, P=0.013 with the 0.5 ODI cut-off; 52% vs. 81%, P=0.036 with the 1.0 cut-off). These results suggest that the sensitivity of the BALF LFD and BALF GM assays may be reduced in the presence of mould-active AF treatment. Negative results in patients on AFs should therefore be interpreted with caution.
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Affiliation(s)
- Susanne Eigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 20, 8036 Graz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Mark Reinwald
- Department of Haematology and Oncology, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | | | - Frederike Reischies
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Birgit Spiess
- Department of Haematology and Oncology, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Peter Neumeister
- Division of Haematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Reinhard B Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 20, 8036 Graz, Austria
| | - Dieter Buchheidt
- Department of Haematology and Oncology, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 20, 8036 Graz, Austria; Division of Infectious Diseases, Department of Medicine, University of California-San Diego, 200 West Arbor Drive 8208, San Diego, 92103 CA, USA.
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45
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Prattes J, Lackner M, Eigl S, Reischies F, Raggam RB, Koidl C, Flick H, Wurm R, Palfner M, Wölfler A, Neumeister P, Thornton CR, Krause R, Lass-Flörl C, Hoenigl M. Diagnostic accuracy of theAspergillus-specific bronchoalveolar lavage lateral-flow assay in haematological malignancy patients. Mycoses 2015; 58:461-9. [DOI: 10.1111/myc.12343] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/21/2015] [Accepted: 05/23/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology; Innsbruck Medical University; Innsbruck Austria
| | - Susanne Eigl
- Section of Infectious Diseases and Tropical Medicine; Department of Internal Medicine; Medical University of Graz; Graz Austria
- Division of Pulmonology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Frederike Reischies
- Section of Infectious Diseases and Tropical Medicine; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Reinhard B. Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics; Medical University of Graz; Graz Austria
| | - Christoph Koidl
- Institute of Hygiene, Microbiology and Environmental Medicine; Medical University of Graz; Graz Austria
| | - Holger Flick
- Division of Pulmonology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Robert Wurm
- Division of Pulmonology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Michael Palfner
- Division of Pulmonology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Albert Wölfler
- Division of Hematology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Peter Neumeister
- Division of Hematology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | | | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology; Innsbruck Medical University; Innsbruck Austria
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine; Department of Internal Medicine; Medical University of Graz; Graz Austria
- Division of Pulmonology; Department of Internal Medicine; Medical University of Graz; Graz Austria
- Division of Infectious Diseases; Department of Medicine; University of California; San Diego USA
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46
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Eigl S, Prattes J, Lackner M, Willinger B, Spiess B, Reinwald M, Selitsch B, Meilinger M, Neumeister P, Reischies F, Wölfler A, Raggam RB, Flick H, Eschertzhuber S, Krause R, Buchheidt D, Thornton CR, Lass-Flörl C, Hoenigl M. Multicenter evaluation of a lateral-flow device test for diagnosing invasive pulmonary aspergillosis in ICU patients. Crit Care 2015; 19:178. [PMID: 25927915 PMCID: PMC4421996 DOI: 10.1186/s13054-015-0905-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/30/2015] [Indexed: 12/20/2022]
Abstract
Introduction The incidence of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU) patients is increasing, and early diagnosis of the disease and treatment with antifungal drugs is critical for patient survival. Serum biomarker tests for IPA typically give false-negative results in non-neutropenic patients, and galactomannan (GM) detection, the preferred diagnostic test for IPA using bronchoalveolar lavage (BAL), is often not readily available. Novel approaches to IPA detection in ICU patients are needed. In this multicenter study, we evaluated the performance of an Aspergillus lateral-flow device (LFD) test for BAL IPA detection in critically ill patients. Methods A total of 149 BAL samples from 133 ICU patients were included in this semiprospective study. Participating centers were the medical university hospitals of Graz, Vienna and Innsbruck in Austria and the University Hospital of Mannheim, Germany. Fungal infections were classified according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Results Two patients (four BALs) had proven IPA, fourteen patients (sixteen BALs) had probable IPA, twenty patients (twenty-one BALs) had possible IPA and ninety-seven patients (one hundred eight BALs) did not fulfill IPA criteria. Sensitivity, specificity, negative predictive value, positive predictive value and diagnostic odds ratios for diagnosing proven and probable IPA using LFD tests of BAL were 80%, 81%, 96%, 44% and 17.6, respectively. Fungal BAL culture exhibited a sensitivity of 50% and a specificity of 85%. Conclusion LFD tests of BAL showed promising results for IPA diagnosis in ICU patients. Furthermore, the LFD test can be performed easily and provides rapid results. Therefore, it may be a reliable alternative for IPA diagnosis in ICU patients if GM results are not rapidly available. Trial registration ClinicalTrials.gov NCT02058316. Registered 20 January 2014.
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Affiliation(s)
- Susanne Eigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A- 8036, Graz, Austria. .,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A- 8036, Graz, Austria.
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schoepfstraße 41/III, 6020, Innsbruck, Austria.
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Birgit Spiess
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany.
| | - Mark Reinwald
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany.
| | - Brigitte Selitsch
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Michael Meilinger
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, 8036, Graz, Austria.
| | - Frederike Reischies
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A- 8036, Graz, Austria.
| | - Albert Wölfler
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, 8036, Graz, Austria.
| | - Reinhard B Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Stephan Eschertzhuber
- Department of Anesthesia and Intensive Care Medicine, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A- 8036, Graz, Austria.
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany.
| | - Christopher R Thornton
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Stocker Road, EX4 4QD, Exeter, UK.
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schoepfstraße 41/III, 6020, Innsbruck, Austria.
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A- 8036, Graz, Austria. .,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. .,Division of Infectious Diseases, Department of Medicine, University of California, 200 West Arbor Drive #8208, San Diego, CA, 92103, USA.
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47
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Troppan K, Hofer S, Wenzl K, Lassnig M, Pursche B, Steinbauer E, Wiltgen M, Zulus B, Renner W, Beham-Schmid C, Deutsch A, Neumeister P. Frequent down regulation of the tumor suppressor gene a20 in multiple myeloma. PLoS One 2015; 10:e0123922. [PMID: 25856582 PMCID: PMC4391781 DOI: 10.1371/journal.pone.0123922] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/09/2015] [Indexed: 11/18/2022] Open
Abstract
Multiple myeloma (MM) is a malignant clonal expansion of plasma cells in the bone marrow and belongs to the mature B-cell neoplams. The pathogenesis of MM is associated with constitutive NF-κB activation. However, genetic alterations causing constitutive NF-κB activation are still incompletely understood. Since A20 (TNFAIP3) is a suppressor of the NF-κB pathway and is frequently inactivated in various lymphoid malignancies, we investigated the genetic and epigenetic properties of A20 in MM. In total, of 46 patient specimens analyzed, 3 single base pair exchanges, 2 synonymous mutations and one missense mutation were detected by direct sequencing. Gene copy number analysis revealed a reduced A20 gene copy number in 8 of 45 (17.7%) patients. Furthermore, immunohistochemical staining confirmed that A20 expression correlates with the reduction of A20 gene copy number. These data suggest that A20 contributes to tumor formation in a significant fraction of myeloma patients.
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Affiliation(s)
- Katharina Troppan
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sybille Hofer
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Kerstin Wenzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Markus Lassnig
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Beata Pursche
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Marco Wiltgen
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Barbara Zulus
- Division of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Wilfried Renner
- Division of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | | | - Alexander Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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48
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Troppan KT, Melchardt T, Deutsch A, Schlick K, Stojakovic T, Bullock MD, Reitz D, Beham-Schmid C, Weiss L, Neureiter D, Wenzl K, Greil R, Neumeister P, Egle A, Pichler M. The significance of pretreatment anemia in the era of R-IPI and NCCN-IPI prognostic risk assessment tools: a dual-center study in diffuse large B-cell lymphoma patients. Eur J Haematol 2015; 95:538-44. [PMID: 25677782 DOI: 10.1111/ejh.12529] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anemia is frequently identified at the time of diagnosis in patients with diffuse large B-cell lymphoma (DLBCL); however, studies addressing the prognostic significance of this important clinical parameter are lacking. METHODS In this dual-center study of patients with DLBCL (n = 556) treated with rituximab-containing regimens, we evaluated the prognostic relevance of anemia at diagnosis in a training set (n = 211) and validated our findings in a second independent patient cohort (n = 345). Using Kaplan-Meier curves as well as univariate and multivariate Cox regression models, we analyzed the impact of anemia on 5-year overall survival (OS) and 5-year disease-free survival (DFS) alongside established prognostic indicators including age, tumor stage, the revised International Prognostic Index (R-IPI), and the recently published NCCN-IPI. The influence of anemia on the predictive accuracy of IPI, R-IPI, and NCCN-IPI prognosis scores was subsequently determined using the Harrell's concordance index. RESULTS Anemia was an independent predictor of impaired OS and DFS at 5 years in both DLBCL patient cohorts (P < 0.001, log-rank test). In multivariate analysis, hemoglobin level was also a strong and independent prognostic indicator in patients stratified according to R-IPI or NCCN-IPI score. In survival analysis, the estimated concordance index, using IPI, R-IPI, and NCCN-IPI stratification measures (0.69, 0.64, and 0.70, respectively), improved to 0.70, 0.68, and 0.73, respectively, when anemia was also considered. CONCLUSION In this study, we have demonstrated that anemia at the time of diagnosis is an independent predictor of impaired clinical outcome in DLBCL. Furthermore, consideration of hemoglobin levels may improve the accuracy of recently established prognostic tools in lymphoma. Our data encourage further evaluation of the prognostic utility of this readily accessible biological parameter in prospective clinical trials.
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Affiliation(s)
| | - Thomas Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Alexander Deutsch
- Division of Hematology, Medical University of Graz (MUG), Graz, Austria
| | - Konstantin Schlick
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz (MUG), Graz, Austria
| | - Marc D Bullock
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel Reitz
- Division of Oncology, Medical University of Graz (MUG), Graz, Austria
| | | | - Lukas Weiss
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Kerstin Wenzl
- Division of Hematology, Medical University of Graz (MUG), Graz, Austria
| | - Richard Greil
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Peter Neumeister
- Division of Hematology, Medical University of Graz (MUG), Graz, Austria
| | - Alexander Egle
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Martin Pichler
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Oncology, Medical University of Graz (MUG), Graz, Austria
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Kepa S, Horvath B, Reitter-Pfoertner S, Schemper M, Quehenberger P, Grundbichler M, Heistinger M, Neumeister P, Mannhalter C, Pabinger I. Parameters influencing FVIII pharmacokinetics in patients with severe and moderate haemophilia A. Haemophilia 2015; 21:343-350. [DOI: 10.1111/hae.12592] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 02/03/2023]
Affiliation(s)
- S. Kepa
- Clinical Division of Haematology and Haemostaseology; Department of Medicine I; Medical University of Vienna; Vienna Austria
| | - B. Horvath
- Department of Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - S. Reitter-Pfoertner
- Clinical Division of Haematology and Haemostaseology; Department of Medicine I; Medical University of Vienna; Vienna Austria
| | - M. Schemper
- Center for Medical Statistics, Informatics and Intelligent Systems; Medical University of Vienna; Vienna Austria
| | - P. Quehenberger
- Department of Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - M. Grundbichler
- Division of Haematology and Oncology; Department of Internal Medicine III; Medical University of Salzburg; Salzburg Austria
| | - M. Heistinger
- Department of Internal Medicine I; Clinical Centre of Klagenfurt am Woerthersee; Klagenfurt am Woerthersee Austria
| | - P. Neumeister
- Division of Haematology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - C. Mannhalter
- Department of Laboratory Medicine; Medical University of Vienna; Vienna Austria
| | - I. Pabinger
- Clinical Division of Haematology and Haemostaseology; Department of Medicine I; Medical University of Vienna; Vienna Austria
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50
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Abstract
Extranodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT) type represent 7-8% of all B cell lymphomas and up to 50% of primary gastric lymphomas and can arise at any extranodal site. The most common manifestation is the stomach, which is almost invariably associated with a chronic Helicobacter pylori infection. The diagnosis is based on the histopathological evaluation of multiple gastric biopsies in accordance with the current WHO classification. The mainstay of therapy is H. pylori eradication, which must be delivered to all gastric MALT lymphoma patients, independent of stage. In patients who do not achieve lymphoma regression following antibiotic therapy, irradiation and/or systemic oncological therapies should be applied, depending on the stage of the disease. Radiotherapy might be the preferred option for localized stage. However, in the presence of disseminated or advanced disease, chemotherapy and/or immunotherapy with the anti-CD 20 antibody rituximab is the treatment of choice, but no standard chemotherapy has been defined so far. Gastric MALT lymphomas have a limited tendency to distant spreading and to histological transformation and thus MALT lymphoma usually has a favorable outcome, with an overall survival rate at 5 years of more than 85%.
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Affiliation(s)
- Peter Neumeister
- Division of Hematology, Medical University of Graz, Graz, Austria
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