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van der Straten L, Hosnijeh F, van der Straten L, Kater A, van Oers M, Posthuma W, Chamuleau M, Nijland M, Hoogendoorn M, De Croon F, Wittebol S, Kerst J, Marijt E, Raymakers R, Koene H, Dobber J, Tonino S, Kersting S, Langerak A, Levin M. PROTEOMICS MARKERS PROGNOSTIC FOR OUTCOME OF CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS UNDER TREATMENT: RESULTS FROM THE HOVON-109 STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.25_2630] [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)
| | - F. Hosnijeh
- Immunology; Laboratory Medical Immunology, Erasmus MC, University Medical Center; Rotterdam Netherlands
| | | | - A.P. Kater
- Hematology and Lymphoma and Myeloma Center Amsterdam; Academic Medical Center; Amsterdam Netherlands
| | - M.H. van Oers
- Hematology and Lymphoma and Myeloma Center Amsterdam; Academic Medical Center; Amsterdam Netherlands
| | - W.F. Posthuma
- Internal Medicine; Reinier de Graaf Hospital; Delft Netherlands
| | - M.E. Chamuleau
- VU University Medical Center; Hematology; Amsterdam Netherlands
| | - M. Nijland
- Hematology; University Medical Center Groningen; Groningen Netherlands
| | - M. Hoogendoorn
- Internal Medicine; Medical Center Leeuwarden; Leeuwarden Netherlands
| | - F. De Croon
- Internal Medicine; Ikazia Hospital; Rotterdam Netherlands
| | - S. Wittebol
- Internal Medicine; Gelderland Valley Hospital; Ede Netherlands
| | - J. Kerst
- Medical Oncology; Antoni van Leeuwenhoek Hospital; Amsterdam Netherlands
| | - E.W. Marijt
- Hematology; Leiden University Medical Center; Leiden Netherlands
| | - R.A. Raymakers
- Hematology; University Medical Center Utrecht; Utrecht Netherlands
| | - H.R. Koene
- Hematology; St. Antonius Hospital; Nieuwegein Netherlands
| | - J.A. Dobber
- Laboratory Special Hematology; Academic Medical Center; Amsterdam Netherlands
| | - S.H. Tonino
- Hematology and Lymphoma and Myeloma Center Amsterdam; Academic Medical Center; Amsterdam Netherlands
| | | | - A.W. Langerak
- Immunology; Laboratory Medical Immunology, Erasmus MC, University Medical Center; Rotterdam Netherlands
| | - M. Levin
- Internal Medicine; Albert Schweitzer Hospital; Dordrecht Netherlands
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2
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Kater AP, van Oers MHJ, van Norden Y, van der Straten L, Driessen J, Posthuma WFM, Schipperus M, Chamuleau MED, Nijland M, Doorduijn JK, Van Gelder M, Hoogendoorn M, De Croon F, Wittebol S, Kerst JM, Marijt EWA, Raymakers RAP, Schaafsma MR, Dobber JA, Kersting S, Levin MD. Feasibility and efficacy of addition of individualized-dose lenalidomide to chlorambucil and rituximab as first-line treatment in elderly and FCR-unfit patients with advanced chronic lymphocytic leukemia. Haematologica 2018; 104:147-154. [PMID: 30115656 PMCID: PMC6312018 DOI: 10.3324/haematol.2018.193854] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/09/2018] [Indexed: 12/12/2022] Open
Abstract
Lenalidomide has been proven to be effective but with a distinct and difficult to manage toxicity profile in the context of chronic lymphocytic leukemia, potentially hampering combination treatment with this drug. We conducted a phase 1-2 study to evaluate the efficacy and safety of six cycles of chlorambucil (7 mg/m2 daily), rituximab (375 mg/m2 cycle 1 and 500 mg/m2 cycles 2-6) and individually-dosed lenalidomide (escalated from 2.5 mg to 10 mg) (induction-I) in first-line treatment of patients with chronic lymphocytic leukemia unfit for treatment with fludarabine, cyclophosphamide and rituximab. This was followed by 6 months of 10 mg lenalidomide monotherapy (induction-II). Of 53 evaluable patients in phase 2 of the study, 47 (89%) completed induction-I and 36 (68%) completed induction-II. In an intention-to-treat analysis, the overall response rate was 83%. The median progression-free survival was 49 months, after a median follow-up time of 27 months. The 2- and 3-year progression-free survival rates were 58% and 54%, respectively. The corresponding rates for overall survival were 98% and 95%. No tumor lysis syndrome was observed, while tumor flair reaction occurred in five patients (9%, 1 grade 3). The most common hematologic toxicity was grade 3-4 neutropenia, which occurred in 73% of the patients. In conclusion, addition of lenalidomide to a chemotherapy backbone followed by a fixed duration of lenalidomide monotherapy resulted in high remission rates and progression-free survival rates, which seem comparable to those observed with novel drug combinations including novel CD20 monoclonal antibodies or kinase inhibitors. Although lenalidomide-specific toxicity remains a concern, an individualized dose-escalation schedule is feasible and results in an acceptable toxicity profile. EuraCT number: 2010-022294-34.
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Affiliation(s)
- Arnon P Kater
- Department of Hematology and Lymphoma and Myeloma Center Amsterdam, Academic Medical Center, Amsterdam
| | - Marinus H J van Oers
- Department of Hematology and Lymphoma and Myeloma Center Amsterdam, Academic Medical Center, Amsterdam
| | - Yvette van Norden
- Department of Hematology - HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam
| | | | - Julia Driessen
- Department of Hematology and Lymphoma and Myeloma Center Amsterdam, Academic Medical Center, Amsterdam
| | - Ward F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft.,Department of Hematology, Leiden University Medical Center
| | | | | | - Marcel Nijland
- Department of Hematology, University Medical Center, Groningen
| | | | | | | | | | | | - J Martijn Kerst
- Department of Medical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam
| | | | | | | | - Johan A Dobber
- Laboratory Special Hematology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht
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3
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Vojdeman FJ, Herman SEM, Kirkby N, Wiestner A, van T' Veer MB, Tjønnfjord GE, Itälä-Remes MA, Kimby E, Farooqui MZ, Polliack A, Wu KL, Doorduijn JK, Alemayehu WG, Wittebol S, Kozak T, Walewski J, Abrahamse-Testroote MCJ, van Oers MHJ, Geisler CH, Niemann CU. Soluble CD52 is an indicator of disease activity in chronic lymphocytic leukemia. Leuk Lymphoma 2017; 58:2356-2362. [PMID: 28278728 DOI: 10.1080/10428194.2017.1285027] [Citation(s) in RCA: 5] [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] [Indexed: 10/20/2022]
Abstract
CD52 is a glycoprotein expressed on normal as well as leukemic immune cells and shed as soluble CD52 (sCD52). We studied sCD52 levels in three CLL cohorts: the 'early', the 'high-risk', and the 'ibrutinib-treated'. The 'high-risk' patients had significantly higher sCD52 levels than the 'early' patients. For the 'early' patients, high sCD52 levels were associated with a significantly shorter time to first treatment. Regarding prognostic factors, no clear correlations with stage, IGHV, or beta-2-microglobulin were found; in a cox multivariate analysis of the 'early' patients, sCD52 and IGHV both had independent prognostic value. Following chemo-immunotherapy, sCD52 decreased in parallel with leukocytes while during ibrutinib treatment and ibrutinib-induced ymphocytosis, sCD52 decreased along with lymph node reductions. In vitro IgM stimulation of CLL cells led to increased sCD52 levels in the medium. Our findings indicate that sCD52 reflects disease activity and potentially treatment efficacy in CLL.
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Affiliation(s)
- Fie J Vojdeman
- a Department of Hematology , Rigshospitalet , Copenhagen , Denmark.,b Department of Clinical Biochemistry , Bispebjerg-Frederiksberg Hospital , Copenhagen , Denmark
| | - Sarah E M Herman
- c Hematology Branch, National Heart, Lung, and Blood Institute , National Institutes of Health , Bethesda , MD , USA
| | - Nikolai Kirkby
- d Department of Microbiology , Rigshospitalet , Copenhagen , Denmark
| | - Adrian Wiestner
- c Hematology Branch, National Heart, Lung, and Blood Institute , National Institutes of Health , Bethesda , MD , USA
| | - Mars B van T' Veer
- e Department of Hematology , Leiden University Medical Centre , Leiden , The Netherlands
| | - Geir E Tjønnfjord
- f Department of Hematology , Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Maija A Itälä-Remes
- g Department of Hematology , Turku Central University Hospital , Turku , Finland
| | - Eva Kimby
- h Division of Hematology, Department of Medicine at Huddinge , Karolinska Institute , Stockholm , Sweden
| | - Mohammed Z Farooqui
- c Hematology Branch, National Heart, Lung, and Blood Institute , National Institutes of Health , Bethesda , MD , USA
| | - Aaron Polliack
- i Department of Hematology , Hadassah University Hospital, Hebrew University Medical School , Jerusalem , Israel
| | - Ka Lung Wu
- j Department of Hematology , Stuivenberg Hospital , Antwerpen , Belgium
| | - Jeanette K Doorduijn
- k Department of Hematology , Erasmus MC Cancer Center , Rotterdam , The Netherlands
| | | | - Shulamiet Wittebol
- m Department of Internal Medicine , Gelderse Vallei Hospital , Amersfoort , The Netherlands
| | - Tomas Kozak
- n Department of Clinical Hematology, Third Faculty of Medicine , Charles University Hospital Kralovske Vinohrady , Prague , Czech Republic
| | - Jan Walewski
- o Lymphoid Malignancies , Maria Sklodowska - Curie Memorial Institute and Oncology Centre , Warszawa , Poland
| | | | - Marinus H J van Oers
- p Department of Hematology , Academisch Medisch Centrum , Amsterdam , The Netherlands
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Vojdeman FJ, Van't Veer MB, Tjønnfjord GE, Itälä-Remes M, Kimby E, Polliack A, Wu KL, Doorduijn JK, Alemayehu WG, Wittebol S, Kozak T, Walewski J, Abrahamse-Testroote MCJ, van Oers MHJ, Geisler CH. The HOVON68 CLL trial revisited: performance status and comorbidity affect survival in elderly patients with chronic lymphocytic leukemia. Leuk Lymphoma 2016; 58:594-600. [PMID: 27484290 DOI: 10.1080/10428194.2016.1213831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In the HOVON68 CLL trial, patients 65 to 75 years of age had no survival benefit from the addition of low-dose alemtuzumab to fludarabine and cyclophosphamide (FC) in contrast to younger patients. The reasons are explored in this 5-year trial update using both survival analysis and competing risk analysis on non-CLL-related mortality. Elderly FCA patients died more frequently from causes not related to CLL, and more often related to comorbidity (mostly cardiovascular) than to infection. In a Cox multivariate analysis, del(17p), performance status >0, and comorbidity were associated with a higher non-CLL-related mortality in the elderly independent of the treatment modality. Thus, while the 'fit' elderly with no comorbidity or performance status of 0 might potentially benefit from chemo-immunotherapy with FC, caution is warranted, when considering alemtuzumab treatment in elderly patients with cardiovascular comorbidity.
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Affiliation(s)
| | - Mars B Van't Veer
- b Department of Hematology , Leiden University Medical Centre , Leiden , The Netherlands
| | - Geir E Tjønnfjord
- c Department of Hematology , Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | | | - Eva Kimby
- e Division of Hematology, Department of Medicine at Huddinge , Karolinska Institute , Stockholm , Sweden
| | - Aaron Polliack
- f Department of Hematology , Hadassah University Hospital, Hebrew University Medical School , Jerusalem , Israel
| | - Ka L Wu
- g Department of Hematology , Stuivenberg Hospital , Antwerpen , Belgium
| | - Jeanette K Doorduijn
- h Department of Hematology , Erasmus MC Cancer Center , Rotterdam , The Netherlands
| | | | - Shulamiet Wittebol
- j Department of Internal Medicine , Gelderse Vallei, Amersfoot , The Netherlands
| | - Tomas Kozak
- k Department of Clinical Hematology, Third Faculty of Medicine , Charles University Hospital Kralovske Vinohrady , Prague , Czech Republic
| | - Jan Walewski
- l Lymphoid Malignancies , Maria Sklodowska-Curie Memorial Institute and Oncology Centre , Warszawa , Poland
| | | | - Marinus H J van Oers
- m Department of Hematology , Academisch Medisch Centrum , Amsterdam , The Netherlands
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5
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Lokhorst HM, van der Holt B, Cornelissen JJ, Kersten MJ, van Oers M, Raymakers R, Minnema MC, Zweegman S, Bos G, Schaap N, Wittebol S, de Weerdt O, Ammerlaan R, Sonneveld P. Reduced relapse rate in upfront tandem autologous/reduced-intensity allogeneic transplantation in multiple myeloma only results in borderline non-significant prolongation of progression-free but not overall survival. Haematologica 2015; 100:e508-10. [PMID: 26341740 DOI: 10.3324/haematol.2015.128728] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Henk M Lokhorst
- Department of Hematology, VU University Medical Center Amsterdam, The Netherlands
| | - Bronno van der Holt
- HOVON Data Center, Erasmus MC Cancer Center - Clinical Trial Center, Rotterdam, The Netherlands
| | - Jan J Cornelissen
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marinus van Oers
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | - Reinier Raymakers
- Department of Hematology, University Medical Center Utrecht, The Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, The Netherlands
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center Amsterdam, The Netherlands
| | - Gerard Bos
- Department of Hematology, Academic Hospital Maastricht, The Netherlands
| | - Nicolaas Schaap
- Radboud University Nijmegen Hospital, Nijmegen, The Netherlands
| | | | | | - Rianne Ammerlaan
- HOVON Data Center, Erasmus MC Cancer Center - Clinical Trial Center, Rotterdam, The Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands
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Holtzer-Goor KM, Schaafsma MR, Joosten P, Posthuma EFM, Wittebol S, Huijgens PC, Mattijssen EJM, Vreugdenhil G, Visser H, Peters WG, Erjavec Z, Wijermans PW, Daenen SMGJ, van der Hem KG, van Oers MHJ, Uyl-de Groot CA. Quality of life of patients with chronic lymphocytic leukaemia in the Netherlands: results of a longitudinal multicentre study. Qual Life Res 2015. [PMID: 26205768 PMCID: PMC4615661 DOI: 10.1007/s11136-015-1039-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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] [Indexed: 11/24/2022]
Abstract
Purpose To describe the health-related quality of life (HRQoL) of an unselected population of patients with chronic lymphocytic leukaemia (CLL) including untreated patients. Methods HRQoL was measured by the EORTC QLQ-C30 including the CLL16 module, EQ-5D, and VAS in an observational study over multiple years. All HRQoL measurements per patient were connected and analysed using area under the curve analysis over the entire study duration. The total patient group was compared with the general population, and three groups of CLL patients were described separately, i.e. patients without any active treatment (“watch and wait”), chlorambucil treatment only, and patients with other treatment(s). Results HRQoL in the total group of CLL patients was compromised when compared with age- and gender-matched norm scores of the general population. CLL patients scored statistically worse on the VAS and utility score of the EQ-5D, all functioning scales of the EORTC QLQ-C30, and the symptoms of fatigue, dyspnoea, sleeping disturbance, appetite loss, and financial difficulties. In untreated patients, the HRQoL was slightly reduced. In all treatment stages, HRQoL was compromised considerably. Patients treated with chlorambucil only scored worse on the EORTC QLQ-C30 than patients who were treated with other treatments with regard to emotional functioning, cognitive functioning, bruises, uncomfortable stomach, and apathy. Conclusions CLL patients differ most from the general population on role functioning, fatigue, concerns about future health, and having not enough energy. Once treatment is indicated, HRQoL becomes considerably compromised. This applies to all treatments, including chlorambucil, which is considered to be a mild treatment. Electronic supplementary material The online version of this article (doi:10.1007/s11136-015-1039-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K M Holtzer-Goor
- Department of Health Policy and Management, Erasmus University Rotterdam, Institute for Medical Technology Assessment, P.O. Box 1738, 3000DR, Rotterdam, The Netherlands.
| | | | - P Joosten
- Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - E F M Posthuma
- Leiden University Medical Center, Leiden, The Netherlands.,Reinier de Graaf Groep, Delft, The Netherlands
| | - S Wittebol
- Meander Medisch Centrum, Amersfoort, The Netherlands
| | - P C Huijgens
- VU University Medical Center, Amsterdam, The Netherlands
| | | | - G Vreugdenhil
- Máxima Medisch Centrum, Veldhoven, The Netherlands.,MUMC+, Maastricht, The Netherlands
| | - H Visser
- Medisch Centrum Alkmaar, Alkmaar, The Netherlands
| | - W G Peters
- Catharina-ziekenhuis, Eindhoven, The Netherlands
| | - Z Erjavec
- Ommelander Ziekenhuis Groep, Delfzijl, The Netherlands
| | | | - S M G J Daenen
- UMCG, University of Groningen, Groningen, The Netherlands
| | | | - M H J van Oers
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C A Uyl-de Groot
- Department of Health Policy and Management, Erasmus University Rotterdam, Institute for Medical Technology Assessment, P.O. Box 1738, 3000DR, Rotterdam, The Netherlands
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7
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Zwaginga JJ, van der Holt B, Te Boekhorst PA, Biemond BJ, Levin MD, van der Griend R, Brand A, Zweegman S, Pruijt HFM, Novotny VMJ, Vreugdenhil A, de Groot MR, de Weerdt O, van Pampus ECM, van Maanen-Lamme TM, Wittebol S, Schipperus MR, Silbermann MH, Huijgens PC, Luten M, Hollestein R, Brakenhoff JAC, Schrama JG, Valster FAA, Velders GA, Koene HR. Multi-center randomized open label phase II trial on three rituximab dosing schemes in immune thrombocytopenia patients. Haematologica 2014; 100:e90-2. [PMID: 25425692 DOI: 10.3324/haematol.2014.110213] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Jaap J Zwaginga
- Dept. of Immunohematology and Blood Transfusion, Leiden University Medical Center and the Jon J van Rood Center for Clinical Transfusion Research, Sanquin-Leiden University Medical Center, The Netherlands
| | - Bronno van der Holt
- HOVON Data Center, Erasmus MC Cancer Institute - Clinical Trial Center, Rotterdam
| | | | - Bart J Biemond
- Dept. of Hematology, Academic Medical Center Amsterdam, The Netherlands
| | - Mark-David Levin
- Dept. of Internal Medicine, Albert Schweitzer Hospital, Dordrecht
| | | | - Anneke Brand
- Dept. of Immunohematology and Blood Transfusion, Leiden University Medical Center and the Jon J van Rood Center for Clinical Transfusion Research, Sanquin-Leiden University Medical Center, The Netherlands
| | - Sonja Zweegman
- Dept. of Hematology, VU University Medical Center, Amsterdam
| | - Hans F M Pruijt
- Dept. of Internal Medicine, Jeroen Bosch Hospital, Den Bosch
| | - Vera M J Novotny
- Dept. of Hematology, Radboud University Medical Centre, Nijmegen
| | | | | | - Okke de Weerdt
- Dept. of Internal Medicine, St. Antonius Hospital, Nieuwegein
| | | | | | | | | | | | | | - Marleen Luten
- HOVON Data Center, Erasmus MC Cancer Institute - Clinical Trial Center, Rotterdam
| | - Rene Hollestein
- HOVON Data Center, Erasmus MC Cancer Institute - Clinical Trial Center, Rotterdam
| | | | | | - Fransje A A Valster
- Dept. of Internal Medicine, Lievensberg Hospital, Bergen op Zoom, The Netherlands
| | - Gerjo A Velders
- Dept. of Internal Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Harry R Koene
- Dept. of Internal Medicine, St. Antonius Hospital, Nieuwegein
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8
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Holtzer-Goor KM, Bouwmans-Frijters CAM, Schaafsma MR, de Weerdt O, Joosten P, Posthuma EFM, Wittebol S, Huijgens PC, Mattijssen EJM, Vreugdenhil G, Visser H, Peters WG, Erjavec Z, Wijermans PW, Daenen SMGJ, van der Hem KG, van Oers MHJ, Groot CAUD. Real-world costs of chronic lymphocytic leukaemia in the Netherlands. Leuk Res 2013; 38:84-90. [PMID: 24268350 DOI: 10.1016/j.leukres.2013.10.029] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 10/31/2013] [Indexed: 11/25/2022]
Abstract
We performed a comprehensive cost calculation identifying the main cost drivers of treatment of chronic lymphocytic leukaemia in daily practice. In our observational study 160 patient charts were reviewed repeatedly to assess the treatment strategies from diagnosis till the study end. Ninety-seven patients (61%) received ≥1 treatment lines during an average follow-up time of 6.4 years. The average total costs per patient were €41,417 (€539 per month). The costs varied considerably between treatment groups and between treatment lines. Although patients were treated with expensive chemo(immuno-)therapy, the main cost driver was inpatient days for other reasons than administration of chemo(immuno-)therapy.
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Affiliation(s)
- K M Holtzer-Goor
- Department of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - C A M Bouwmans-Frijters
- Department of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M R Schaafsma
- Department of Haematology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - O de Weerdt
- Department of Haematology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - P Joosten
- Department of Haematology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - E F M Posthuma
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands; Department of Haematology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - S Wittebol
- Department of Haematology, Meander Medical Center, Amersfoort, The Netherlands
| | - P C Huijgens
- Department of Haematology, VU University Medical Center, Amsterdam, The Netherlands
| | - E J M Mattijssen
- Department of Haematology, Rijnstate Hospital, Arnhem, The Netherlands
| | - G Vreugdenhil
- Department of Haematology, Máxima Medical Center, Veldhoven, The Netherlands
| | - H Visser
- Department of Haematology, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - W G Peters
- Department of Haematology, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Z Erjavec
- Department of Haematology, OZG Delfzicht Ziekenhuis, Delfzijl, The Netherlands
| | - P W Wijermans
- Department of Haematology, Haga Hospital, Den Haag, The Netherlands
| | - S M G J Daenen
- Department of Haematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K G van der Hem
- Department of Haematology, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - M H J van Oers
- Department of Haematology, Academic Medical Center, Amsterdam, The Netherlands
| | - C A Uyl-de Groot
- Department of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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9
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Scheid C, Sonneveld P, Schmidt-Wolf IGH, van der Holt B, el Jarari L, Bertsch U, Salwender H, Zweegman S, Blau IW, Vellenga E, Weisel K, Pfreundschuh M, Jie KS, Neben K, van de Velde H, Duehrsen U, Schaafsma MR, Lindemann W, Kersten MJ, Peter N, Hänel M, Croockewit S, Martin H, Wittebol S, Bos GM, van Marwijk-Kooy M, Wijermans P, Goldschmidt H, Lokhorst HM. Bortezomib before and after autologous stem cell transplantation overcomes the negative prognostic impact of renal impairment in newly diagnosed multiple myeloma: a subgroup analysis from the HOVON-65/GMMG-HD4 trial. Haematologica 2013; 99:148-54. [PMID: 23996482 DOI: 10.3324/haematol.2013.087585] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Renal impairment is frequent in patients with multiple myeloma and is correlated with an inferior prognosis. This analysis evaluates the prognostic role of renal impairment in patients with myeloma treated with bortezomib before and after autologous stem cell transplantation within a prospective randomized phase III trial. Eight hundred and twenty-seven newly diagnosed myeloma patients in the HOVON-65/GMMG-HD4 trial were randomized to receive three cycles of vincristine, adriamycin, dexamethasone (VAD) or bortezomib, adriamycin, dexamethasone (PAD) followed by autologous stem cell transplantation and maintenance with thalidomide 50 mg daily (VAD-arm) or bortezomib 1.3 mg/m(2) every 2 weeks (PAD-arm). Baseline serum creatinine was less than 2 mg/dL (Durie-Salmon-stage A) in 746 patients and 2 mg/dL or higher (stage B) in 81. In myeloma patients with a baseline creatinine ≥ 2 mg/dL the renal response rate was 63% in the VAD-arm and 81% in the PAD-arm (P=0.31). The overall myeloma response rate was 64% in the VAD-arm versus 89% in the PAD-arm with 13% complete responses in the VAD-arm versus 36% in the PAD-arm (P=0.01). Overall survival at 3 years for patients with a baseline creatinine ≥ 2 mg/dL was 34% in the VAD-arm versus 74% in the PAD-arm (P<0.001) with a progression-free survival rate at 3 years of 16% in the VAD-arm versus 48% in the PAD-arm (P=0.004). Overall and progression-free survival rates in the PAD-arm were similar in patients with a baseline creatinine ≥ 2 mg/dL or <2 mg/dL. We conclude that a bortezomib-containing treatment before and after autologous stem cell transplantation overcomes the negative prognostic impact of renal impairment in patients with newly diagnosed multiple myeloma. The trial was registered at www.trialregister.nl as NTR213 and at www.controlled-trials.com as ISRCTN 64455289.
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10
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Sonneveld P, Schmidt-Wolf IGH, van der Holt B, El Jarari L, Bertsch U, Salwender H, Zweegman S, Vellenga E, Broyl A, Blau IW, Weisel KC, Wittebol S, Bos GMJ, Stevens-Kroef M, Scheid C, Pfreundschuh M, Hose D, Jauch A, van der Velde H, Raymakers R, Schaafsma MR, Kersten MJ, van Marwijk-Kooy M, Duehrsen U, Lindemann W, Wijermans PW, Lokhorst HM, Goldschmidt HM. Bortezomib induction and maintenance treatment in patients with newly diagnosed multiple myeloma: results of the randomized phase III HOVON-65/ GMMG-HD4 trial. J Clin Oncol 2012; 30:2946-55. [PMID: 22802322 DOI: 10.1200/jco.2011.39.6820] [Citation(s) in RCA: 601] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE We investigated whether bortezomib during induction and maintenance improves survival in newly diagnosed multiple myeloma (MM). PATIENTS AND METHODS In all, 827 eligible patients with newly diagnosed symptomatic MM were randomly assigned to receive induction therapy with vincristine, doxorubicin, and dexamethasone (VAD) or bortezomib, doxorubicin, and dexamethasone (PAD) followed by high-dose melphalan and autologous stem-cell transplantation. Maintenance consisted of thalidomide 50 mg (VAD) once per day or bortezomib 1.3 mg/m(2) (PAD) once every 2 weeks for 2 years. The primary analysis was progression-free survival (PFS) adjusted for International Staging System (ISS) stage. RESULTS Complete response (CR), including near CR, was superior after PAD induction (15% v 31%; P < .001) and bortezomib maintenance (34% v 49%; P < .001). After a median follow-up of 41 months, PFS was superior in the PAD arm (median of 28 months v 35 months; hazard ratio [HR], 0.75; 95% CI, 0.62 to 0.90; P = .002). In multivariate analysis, overall survival (OS) was better in the PAD arm (HR, 0.77; 95% CI, 0.60 to 1.00; P = .049). In high-risk patients presenting with increased creatinine more than 2 mg/dL, bortezomib significantly improved PFS from a median of 13 months to 30 months (HR, 0.45; 95% CI, 0.26 to 0.78; P = .004) and OS from a median of 21 months to 54 months (HR, 0.33; 95% CI, 0.16 to 0.65; P < .001). A benefit was also observed in patients with deletion 17p13 (median PFS, 12 v 22 months; HR, 0.47; 95% CI, 0.26 to 0.86; P = .01; median OS, 24 months v not reached at 54 months; HR, 0.36; 95% CI, 0.18 to 0.74; P = .003). CONCLUSION Bortezomib during induction and maintenance improves CR and achieves superior PFS and OS.
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11
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Daenen S, van der Holt B, Dekker AW, Willemze R, Rijneveld AW, Biemond BJ, Muus P, van de Loosdrecht AA, Schouten HC, van Marwijk Kooy M, Breems DA, Demuynck H, Maertens J, Wijermans PW, Wittebol S, de Klerk EW, Cornelissen JJ. Intensive chemotherapy to improve outcome in patients with acute lymphoblastic leukemia over the age of 40: a phase II study for efficacy and feasibility by HOVON. Leukemia 2012; 26:1726-9. [DOI: 10.1038/leu.2012.53] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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12
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Kater AP, Wittebol S, Chamuleau MED, van Gelder M, J van Oers MH. Dutch guidelines for diagnosis and treatment of chronic lymphocytic leukaemia 2011. Neth J Med 2011; 69:422-429. [PMID: 22058261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
One of the principal responsibilities of the Chronic Lymphocytic Leukaemia (CLL) Working Party of the Dutch/Belgium Haemato-Oncology Foundation for Adults in the Netherlands (HOVON) is to create up-to-date guidelines for CLL . In this article, the revised guidelines for diagnosis and treatment are summarised. Despite recent expansion in treatment options for patients with CLL , the disease remains incurable in most cases and the optimal treatment approach for several subgroups of patients is still unclear. Therefore, it remains highly important to treat patients within clinical studies as much as possible. In this article, the current studies initiated by the HOVON CLL working party are emphasised.
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Affiliation(s)
- A P Kater
- Department of Hematology, Academic Medical Center, Amsterdam, the Netherlands.
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13
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Rijneveld AW, van der Holt B, Daenen SMGJ, Biemond BJ, de Weerdt O, Muus P, Maertens J, Mattijssen V, Demuynck H, Legdeur MCJC, Wijermans PW, Wittebol S, Spoelstra FM, Dekker AW, Ossenkoppele GJ, Willemze R, Cornelissen JJ. Intensified chemotherapy inspired by a pediatric regimen combined with allogeneic transplantation in adult patients with acute lymphoblastic leukemia up to the age of 40. Leukemia 2011; 25:1697-703. [DOI: 10.1038/leu.2011.141] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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14
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Mutis T, de Weers M, van der Veer MS, Kessel BV, Bakker JM, Wittebol S, Parren P, Lokhorst HM. The potential of the human CD38-specific antibody daratumumab to improve the antimyeloma effect of novel multidrug therapies including patients refractory to lenalidomide or bortezomib. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Verelst SGR, Termorshuizen F, Uyl-de Groot CA, Schaafsma MR, Ammerlaan AHM, Wittebol S, Sinnige HAM, Zweegman S, van Marwijk Kooy M, van der Griend R, Lokhorst HM, Sonneveld P, Wijermans PW. Effect of thalidomide with melphalan and prednisone on health-related quality of life (HRQoL) in elderly patients with newly diagnosed multiple myeloma: a prospective analysis in a randomized trial. Ann Hematol 2011; 90:1427-39. [PMID: 21472373 DOI: 10.1007/s00277-011-1224-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 03/22/2011] [Indexed: 11/12/2022]
Abstract
Thalidomide with melphalan/prednisone (MPT) was defined as standard treatment in elderly patients with multiple myeloma (MM) based on five randomized trials. In one of these trials, HOVON49, a prospective health-related quality-of-life (HRQoL) study was initiated in order to assess the impact of thalidomide on QoL. Patients aged >65 years with newly diagnosed MM were randomized to receive melphalan plus prednisone (MP) or MPT, followed by thalidomide maintenance in the MPT arm. Two hundred eighty-four patients were included in this side study (MP, n=149; MPT n=135). HRQoL was assessed with the EORTC Core QoL Questionnaire (QLQ-C30) and the myeloma-specific module (QLQ-MY24) at baseline and at predetermined intervals during treatment. The QLQ-C30 subscales physical function (P=0.044) and constipation (P<0.001) showed an improvement during induction in favour of the MP arm. During thalidomide maintenance, the scores for the QLQ-MY24 paraesthesia became significantly higher in the MPT arm (P<0.001). The QLQ-C30 subscales pain (P=0.12), insomnia (P=0.068), appetite loss (P=0.074) and the QLQ-MY24 item sick (P=0.086) scored marginally better during thalidomide maintenance. The overall QoL-scale QLQ-C30-HRQoL showed a significant time trend towards more favourable mean values during protocol treatment without differences between MP and MPT. For the QLQ-C30 subscales emotional function and future perspectives, difference in favour of the MPT arm from the start of treatment was observed (P=0.018 and P=0.045, respectively) with no significant 'time × arm' interaction, indicating a persistent better patient perspective with MPT treatment. This study shows that the higher frequency of toxicity associated with MPT does not translate into a negative effect on HRQoL and that MPT holds a better patient perspective.
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Affiliation(s)
- Silvia G R Verelst
- Department of Hematology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
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16
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van der Veer MS, de Weers M, van Kessel B, Bakker JM, Wittebol S, Parren PWHI, Lokhorst HM, Mutis T. Towards effective immunotherapy of myeloma: enhanced elimination of myeloma cells by combination of lenalidomide with the human CD38 monoclonal antibody daratumumab. Haematologica 2010; 96:284-90. [PMID: 21109694 DOI: 10.3324/haematol.2010.030759] [Citation(s) in RCA: 169] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In our efforts to develop novel effective treatment regimens for multiple myeloma we evaluated the potential benefits of combining the immunomodulatory drug lenalidomide with daratumumab. Daratumumab is a novel human CD38 monoclonal antibody which kills CD38+ multiple myeloma cells via antibody-dependent cell-mediated cytotoxicity, complement-dependent cytotoxicity and apoptosis. DESIGN AND METHODS To explore the effect of lenalidomide combined with daratumumab, we first carried out standard antibody-dependent cell-mediated cytotoxicity and complement-dependent cytotoxicity assays in which the CD38+ multiple myeloma cell line UM-9 and primary multiple myeloma cells isolated from patients were used as target cells. We also tested the effect of lenalidomide on daratumumab-dependent cell-mediated-cytotoxicity and complement-dependent cytotoxicity of multiple myeloma cells directly in the bone marrow mononuclear cells of multiple myeloma patients. Finally, we determined the daratumumab-dependent cell-mediated cytotoxicity using peripheral blood mononuclear cells of multiple myeloma patients receiving lenalidomide treatment. RESULTS Daratumumab-dependent cell-mediated cytotoxicity of purified primary multiple myeloma cells, as well as of the UM-9 cell line, was significantly augmented by lenalidomide pre-treatment of the effector cells derived from peripheral blood mononuclear cells from healthy individuals. More importantly, we demonstrated a clear synergy between lenalidomide and daratumumab-induced antibody-dependent cell-mediated cytotoxicity directly in the bone marrow mononuclear cells of multiple myeloma patients, indicating that lenalidomide can also potentiate the daratumumab-dependent lysis of myeloma cells by activating the autologous effector cells within the natural environment of malignant cells. Finally, daratumumab-dependent cell-mediated cytotoxicity was significantly up-regulated in peripheral blood mononuclear cells derived from 3 multiple myeloma patients during lenalidomide treatment. CONCLUSIONS Our results indicate that powerful and complementary effects may be achieved by combining lenalidomide and daratumumab in the clinical management of multiple myeloma.
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Affiliation(s)
- Michael S van der Veer
- Dept. of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
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17
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Kneppers E, Lokhorst HM, Eeltink CM, Huls G, Kersten MJ, Koedam J, Minnema MC, van Oers MHJ, Raymakers RAP, Schaafsma MR, Vellenga E, Wijermans PW, Wittebol S, Sonneveld P, Zweegman S. Analysis of efficacy and prognostic factors of lenalidomide treatment as part of a Dutch compassionate use program. Clin Lymphoma Myeloma Leuk 2010; 10:138-43. [PMID: 20371448 DOI: 10.3816/clml.2010.n.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND METHODS To obtain efficacy and safety data on lenalidomide treatment outside of clinical trials, we analyzed the clinical data of 114 patients with refractory or relapsed multiple myeloma treated with lenalidomide on a compassionate use basis. The recommended treatment consisted of lenalidomide 25 mg given on days 1-21 of a 28-day cycle, in combination with dexamethasone. A median of 3 previous lines of therapy were given, including thalidomide in 91%. Most patients were treated until progression or intolerable toxicity. RESULTS The median number of cycles was 7 (range, 1-21+ cycles) with a maximum response after a median of 3 cycles (range, 1-10 cycles). The overall response rate was 69%, including complete response in 6%, very good partial response in 19%, and partial response in 44%. The response rate was not influenced by previous thalidomide and/or bortezomib treatment. The median time to progression (TTP) was 9 months and the median overall survival (OS) was 22 months. A significantly longer TTP was observed in patients who previously underwent allogeneic stem cell transplantation (12.5 months vs. 8 months; P = .036). Overall survival was significantly affected by performance status (P < .0001). Lenalidomide toxicity was predominantly hematologic (37%; Common Toxicity Criteria > or = 3) and the incidence of venous thrombotic events was low (5%) using the recommended prophylaxis. CONCLUSION This analysis confirms that, outside clinical prospective trials, treatment with lenalidomide is highly effective and feasible in heavily pretreated patients with multiple myeloma.
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Affiliation(s)
- Evelien Kneppers
- Department of Haematology, University Medical Center, Utrecht, The Netherlands
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18
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Wijermans P, Schaafsma M, Termorshuizen F, Ammerlaan R, Wittebol S, Sinnige H, Zweegman S, van Marwijk Kooy M, van der Griend R, Lokhorst H, Sonneveld P. Phase III study of the value of thalidomide added to melphalan plus prednisone in elderly patients with newly diagnosed multiple myeloma: the HOVON 49 Study. J Clin Oncol 2010; 28:3160-6. [PMID: 20516439 DOI: 10.1200/jco.2009.26.1610] [Citation(s) in RCA: 227] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE For several decades, the treatment of elderly patients with multiple myeloma (MM) has consisted of melphalan and prednisone (MP). The Dutch-Belgium Hemato-Oncology Cooperative Group (HOVON) investigated the efficacy of thalidomide added to MP (MP-T) in a randomized phase III trial. The objective of this study was to investigate the efficacy, toxicity, and effects on quality of life of MP-T. PATIENTS AND METHODS A randomized phase III trial compared standard MP with MP-T (thalidomide 200 mg/d) in newly diagnosed patients with multiple myeloma older than age 65 years. Maintenance therapy with thalidomide 50 mg/d was administered to patients after MP-T until relapse. The primary end point was event-free survival (EFS); response rate, overall survival (OS), and progression-free survival (PFS) were secondary end points. RESULTS An intent-to-treat analysis of 333 evaluable patients showed significantly higher response rates in MP-T-treated patients compared with MP-treated patients a response (> or = partial response: 66% v 45%, respectively; P < .001; and > or = very good partial response [VGPR]: 27% v 10%, respectively; P < .001). EFS was 13 months with MP-T versus 9 months with MP (P < .001). OS was 40 months with MP-T versus 31 months with MP (P = .05). CONCLUSION This study demonstrates that thalidomide improves the response rate and VGPR in elderly patients with newly diagnosed MM. MP-T also results in a better EFS, PFS, and OS.
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Wittebol S, Ferrant A, Wickham NW, Fehrenbacher L, Durbin-Johnson B, Bray GL. Phase II study of PRO95780 plus rituximab in patients with relapsed follicular non-Hodgkin's lymphoma (NHL). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Quarles van Ufford H, Hoekstra O, de Haas M, Fijnheer R, Wittebol S, Tieks B, Kramer M, de Klerk J. On the added value of baseline FDG-PET in malignant lymphoma. Mol Imaging Biol 2009; 12:225-32. [PMID: 19809855 PMCID: PMC2844531 DOI: 10.1007/s11307-009-0259-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2009] [Accepted: 04/28/2009] [Indexed: 01/08/2023]
Abstract
Purpose The added value of baseline positron emission tomography (PET) scans in therapy evaluation in malignant lymphoma is unclear. In guidelines, baseline PET is recommended but not mandatory except in lymphoma types with variable fluoro-d-glucose uptake. The aim of the present study was to test the hypothesis that adding baseline PET information decreases false positive readings with posttreatment PET and improves observer agreement. Methods Forty-four patients (mean age 56 years, standard deviation 14) with malignant lymphoma were included. Two nuclear medicine physicians retrospectively and independently evaluated the posttreatment PET, 3 weeks later followed by paired reading of baseline and posttreatment PET. For each PET, 22 regions were classified as positive, negative, or equivocal, resulting in an overall PET score of positive, unclear, or negative. In case of discrepancies, consensus was reached. Results Addition of baseline to posttreatment PET evaluation affected the classification of metabolic response in 34% of malignant lymphoma patients treated with first-line chemotherapy. In one out of seven patients, addition of the baseline PET lead to opposite conclusions (95% confidence interval 4–14). False positivity was reduced by adding the baseline scan information, but the effect on false negativity was similar. In addition, the amount of unclear classifications halved after paired reading. Observer agreement did not improve upon adding the baseline PET data. Conclusion Without any other clinical information, pretreatment PET facilitates changes the interpretation of a posttreatment PET in a third of the patients, resulting in both upgrading and downgrading of the posttreatment situation of a malignant lymphoma patient. If these results are confirmed for PET–computed tomography systems, they favor the addition of baseline PET to the current work-up of patients with malignant lymphoma.
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21
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van Balen P, van Wijnen M, Hogeman PHG, Wittebol S. A dutch family with Hb Debrousse: severe anemia after parvovirus B19 infection. Hemoglobin 2009; 33:269-73. [PMID: 19657843 DOI: 10.1080/03630260903058784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hb Debrousse [beta96(FG3)Leu-->Pro] is an unstable hemoglobin (Hb) variant with high oxygen affinity. We describe a case of chronic compensated hemolysis in a 39-year-old woman in whom the variant was found. Soon after the diagnosis was made, she and her son were admitted to the hospital with severe anemia due to Parvovirus B19 infection. The son also appeared to have the Hb Debrousse variant. Parvovirus B19 infection is a life-threatening disease in patients with (compensated) hemolysis.
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Affiliation(s)
- Peter van Balen
- Department of Internal Medicine, Meander Medical Centre, Amersfoort, The Netherlands.
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22
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van Gent R, Kater AP, Otto SA, Jaspers A, Borghans JAM, Vrisekoop N, Ackermans MAT, Ruiter AFC, Wittebol S, Eldering E, van Oers MHJ, Tesselaar K, Kersten MJ, Miedema F. In vivo dynamics of stable chronic lymphocytic leukemia inversely correlate with somatic hypermutation levels and suggest no major leukemic turnover in bone marrow. Cancer Res 2009; 68:10137-44. [PMID: 19074880 DOI: 10.1158/0008-5472.can-08-2325] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although accumulating evidence indicates that chronic lymphocytic leukemia (CLL) is a disease with appreciable cell dynamics, it remains uncertain whether this also applies to patients with stable disease. In this study, (2)H(2)O was administered to a clinically homogeneous cohort of nine stable, untreated CLL patients. CLL dynamics in blood and bone marrow were determined and compared with normal B-cell dynamics in blood from five healthy individuals who underwent a similar (2)H(2)O labeling protocol. Average CLL turnover rates (0.08-0.35% of the clone per day) were approximately 2-fold lower than average B-cell turnover rates from healthy individuals (0.34-0.89%), whereas the rate at which labeled CLL cells in blood disappeared (0.00-0.39% of B cells per day) was approximately 10-fold lower compared with labeled B cells from healthy individuals (1.57-4.24% per day). Leukemic cell turnover variables inversely correlated with the level of somatic hypermutation of the CLL clone (IgVH mutations). Although CLL cells in bone marrow had a higher level of label enrichment than CLL cells in blood, no difference between proliferation rates and proapoptotic and antiapoptotic profiles of CLL cells from these compartments was observed. These data suggest that, in stable disease, there is a biological relationship between the degree of somatic hypermutation of the CLL clone and its dynamics in vivo. Furthermore, in contrast to lymph nodes, the bone marrow does not seem to be a major CLL proliferation site.
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MESH Headings
- Apoptosis/genetics
- Bone Marrow/pathology
- Child, Preschool
- Female
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Infant
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Mutation
- RNA, Neoplasm/genetics
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Affiliation(s)
- Rogier van Gent
- Department of Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
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23
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Lokhorst HM, Schmidt-Wolf I, Sonneveld P, van der Holt B, Martin H, Barge R, Bertsch U, Schlenzka J, Bos GMJ, Croockewit S, Zweegman S, Breitkreutz I, Joosten P, Scheid C, van Marwijk-Kooy M, Salwender HJ, van Oers MHJ, Schaafsma R, Naumann R, Sinnige H, Blau I, Delforge M, de Weerdt O, Wijermans P, Wittebol S, Duersen U, Vellenga E, Goldschmidt H. Thalidomide in induction treatment increases the very good partial response rate before and after high-dose therapy in previously untreated multiple myeloma. Haematologica 2008; 93:124-7. [PMID: 18166796 DOI: 10.3324/haematol.11644] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Henk M Lokhorst
- Department of Hematology, University Medical Center, Utrecht, The Netherlands.
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Abstract
OBJECTIVE Both carcinoma of the prostate and non-Hodgkin's lymphoma are common in elderly patients. Measurement of serum prostate-specific antigen (PSA) is a frequently used tool to diagnose and monitor prostate carcinoma and is generally specific for diseases of the prostate. CASE We describe a 68-yr-old patient with voiding difficulties and high PSA levels, but without inflammatory or malignant changes upon multiple transrectal ultrasound guided prostate biopsies. Digital rectal examination was normal. Laboratory showed a strongly elevated PSA level (62 microg/L, Immulight 2000); DPC, USA). A CT-scan showed a retroperitoneal process with mass in the right pelvis and infiltration of the bladder wall, suggestive for metastatic prostate carcinoma. Surgical excision of an axillary lymph node set the diagnosis at a stage IV follicular lymphoma, Berard grade I to II in which the majority of neoplastic cells expressed PSA. After lymphoma-specific treatment, there was a positron emission tomography (PET) confirmed complete remission with normal PSA levels (6 microg/L), which still persists. CONCLUSION Although rare, high PSA levels can be due to the presence of non-Hodgkin's lymphoma. Such a diagnosis should be considered when patients present with lymphadenopathy other than regional prostatic lymphadenopathy.
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25
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Affiliation(s)
- Leo E Weijs
- Department of Nuclear Medicine and Radiology, Meander Medical Center, Amersfoort, The Netherlands
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26
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Deenik W, van der Holt B, Verhoef GEG, Schattenberg AVMB, Verdonck LF, Daenen SMGJ, Zachée P, Westveer PHM, Smit WM, Wittebol S, Schouten HC, Löwenberg B, Ossenkoppele GJ, Cornelissen JJ. High-vs low-dose cytarabine combined with interferon alfa in patients with first chronic phase chronic myeloid leukemia. A prospective randomized phase III study. Ann Hematol 2006; 86:117-25. [PMID: 17031690 PMCID: PMC7101742 DOI: 10.1007/s00277-006-0186-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 06/06/2006] [Accepted: 08/03/2006] [Indexed: 11/26/2022]
Abstract
A prospective randomized phase III study was performed to evaluate whether intensified cytarabine would induce a higher response rate and longer event-free interval as compared to low-dose cytarabine in chronic myeloid leukemia (CML). One hundred and eighteen patients with CML in early chronic phase entered the study. Twenty-eight out of 32 patients assigned to group A received two cycles of a combination of intensified cytarabine and idarubicin followed by interferon alfa (IFN-α) maintenance, 28 patients in group B received standard treatment by a combination of low-dose cytarabine and IFN-α. Forty-nine patients with a human leukocyte antigen-identical sibling donor proceeded to allogeneic stem cell transplantation (allo-SCT) and nine patients were excluded from the analysis. Hematological response was observed in 97% of the patients in group A vs 86% of the patients in group B during the first year of treatment. In group A, 16 patients (50%) achieved a major cytogenetic response, which compared to seven patients (25%) with a major cytogenetic response in group B. With a median follow-up of 58 months (range 34–76), event-free survival was not significantly different between arms A and B. The estimated 5-year survival rate was 56% in the intensified arm and 77% in the low-dose arm (P = 0.05). Recipients of allo-SCT showed a 5-year estimated survival rate of 55%. Although intensified cytarabine induced a higher initial percentage of major and complete cytogenetic responses, responses were not sustained by IFN-α maintenance therapy.
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MESH Headings
- Adolescent
- Adult
- Aged
- Cytarabine/administration & dosage
- Cytarabine/therapeutic use
- Cytogenetics
- Disease-Free Survival
- Dose-Response Relationship, Drug
- Drug Therapy, Combination
- Female
- Humans
- Interferon-alpha/adverse effects
- Interferon-alpha/therapeutic use
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/genetics
- Leukemia, Myeloid, Chronic-Phase/pathology
- Leukemia, Myeloid, Chronic-Phase/surgery
- Male
- Middle Aged
- Stem Cell Transplantation
- Survival Rate
- Transplantation, Homologous
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Affiliation(s)
- W. Deenik
- Department of Hematology, Erasmus University Medical Center/Daniel den Hoed, Groene Hillendijk 301, 3008 AE Rotterdam, The Netherlands
| | | | | | | | - L. F. Verdonck
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - P. Zachée
- University Hospital Antwerp, Antwerp, Belgium
| | | | - W. M. Smit
- Medical Spectrum Twente, Enschede, The Netherlands
| | - S. Wittebol
- Meander Medical Center, Amersfoort, The Netherlands
| | - H. C. Schouten
- University Hospital Maastricht, Maastricht, The Netherlands
| | - B. Löwenberg
- Department of Hematology, Erasmus University Medical Center/Daniel den Hoed, Groene Hillendijk 301, 3008 AE Rotterdam, The Netherlands
| | | | - J. J. Cornelissen
- Department of Hematology, Erasmus University Medical Center/Daniel den Hoed, Groene Hillendijk 301, 3008 AE Rotterdam, The Netherlands
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van der Spek E, Bloem AC, van de Donk NWCJ, Bogers LH, van der Griend R, Kramer MH, de Weerdt O, Wittebol S, Lokhorst HM. Dose-finding study of high-dose simvastatin combined with standard chemotherapy in patients with relapsed or refractory myeloma or lymphoma. Haematologica 2006; 91:542-5. [PMID: 16585018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
In vitro statins induce apoptosis in myeloma and lymphoma cells in a dose-and time-dependent way. In combination with dexamethasone and doxorubicin, statins have a chemo-sensitizing effect. Twenty-eight patients with relapsed myeloma or lymphoma were treated with a dose-escalating regimen of simvastatin for 7 days followed by VAD in myeloma patients and CHOP in lymphoma patients. The maximum tolerated dose was 15 mg/kg/day simvastatin. The most frequently reported side-effects were fatigue, gastrointestinal CTC grade 1-2 and neutropenic fever. The dose-limiting toxicity was neutropenic sepsis and grade 3 gastrointestinal side effects. High-dose simvastatin given immediately prior to chemotherapy is safe and tolerable up to a dose of 15 mg/kg/day.
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Affiliation(s)
- Ellen van der Spek
- Department of Hematology and Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
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28
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van Agthoven M, Wittebol S, Budel LM, Uyl-de Groot CA, Kramer MH. [Survival of patients with aggressive non-hodgkin's lymphoma: no difference between first line treatment in a prospective randomised phase III clinical trial and first line treatment according to routine clinical practice]. Ned Tijdschr Geneeskd 2004; 148:88-93. [PMID: 14753131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To compare survival of patients with disseminated aggressive non-Hodgkin's lymphoma (NHL) who were treated either as part of a clinical trial or in routine clinical practice. DESIGN Retrospective. METHOD The survival was studied of patients with disseminated NHL of an intermediate or high degree of malignancy who were treated in the Meander Medical Centre, Amersfoort, the Netherlands, in the years 1994-2001 with chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP). This took place either in routine clinical practice (RCP) or as part of a clinical trial where patients < or = 60 years of age received intensified CHOP and patients > 60 years received CHOP with growth factors. Treatment data, the response to therapy, survival and prognostic factors according to the International Prognostic Index for aggressive NHL were collected by a review of the patient records. RESULTS Fifty-nine patients were eligible for this analysis: 32 men and 27 women with a median age of 63 years (range 30-83). Of these, 35 were treated within a clinical trial and 24 were treated in RCP. The patient characteristics in the two groups were comparable. There was no difference in median survival between the trial and RCP groups, this being 27 months for all patients, 34 months for the younger patients, 20 months for the elderly patients, and 42 months for patients who achieved complete remission following chemotherapy. CONCLUSION No difference in overall survival was found between patients with disseminated aggressive NHL who underwent treatment according to either RCP or as part of a clinical trial. It demonstrates that both patients in clinical trials and patients treated according to RCP received equally effective therapy. Recent developments in NHL treatments are promising, and therefore participation in clinical trials should be encouraged.
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Affiliation(s)
- M van Agthoven
- Erasmus Medisch Centrum, Institute for Medical Technology Assessment, Postbus 1738, 3000 DR Rotterdam
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29
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de Lange DW, Fijnheer R, Wittebol S. [Acquired von Willebrand syndrome]. Ned Tijdschr Geneeskd 2003; 147:1808-11. [PMID: 14526622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Two patients, a man aged 69 and a woman aged 64, were diagnosed with Von-Willebrand syndrome caused by monoclonal gammopathy. The man, who was admitted for hip surgery, had a history of long episodes of epistaxis. The patient was treated with immunoglobulin and the hip operation was carried out with no complications. The woman suffered from haemorrhagic diathesis. She was advised that should she undergo an invasive procedure then treatment with a prophylactic with intravenous immunoglobulin or Von-Willebrand factor (VWF)/factor-VIII-concentrates must be administered. Acquired Von-Willebrand syndrome is a rare condition with an estimated prevalence of 0.04-0.13%. It is linked to a large number of underlying diseases such as paraproteinaemia, multiple myeloma (Kahler's disease), myeloproliferative disease, lymphoproliferative disease, auto-immune disease, solid tumours and hypothyroidism. Recognition depends on a careful case-history and identification of the underlying disease. For its diagnosis VWF antigen. VWF propeptide, activated partial thromboplastin time and factor VIII are of importance. Technically, it is difficult to show the presence of VWF antibodies as it concerns a heterogeneous group of antibodies. There are two pillars of treatment: symptomatic treatment of the bleeding tendencies using desmopressin, VWF-concentrate or intravenous gammaglobulin, and treatment of the underlying disease. The latter form of treatment can lead to acquired Von-Willebrand-syndrome disappearing altogether.
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Affiliation(s)
- D W de Lange
- Universitair Medisch Centrum, afd. Interne Geneeskunde, F02.107, Heidelberglaan 100, 3508 GA Utrecht.
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30
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de Lange DW, Wittebol S, Meiss L. [Diagnostic image (89). A woman with dysphagia. Dysphagia lusoria]. Ned Tijdschr Geneeskd 2002; 146:941. [PMID: 12051062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
In a 49-year-old woman with dysphagia diagnostic endoscopy revealed a mass directly dorsal to the esophagus. CT showed an aberrant right subclavian artery being the cause of her swallowing problem: dysphagia lusoria.
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Affiliation(s)
- D W de Lange
- Afd. Inwendige Geneeskunde, Ziekenhuis Eemland, locatie Lichtenberg, Postbus 1502, 3800 BM Amersfoort
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31
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Vlot AJ, Wittebol S, Strengers PFW, Turenhout EAM, Voorberg J, van den Berg HM, Mauser-Bunschoten EP. Factor VIII inhibitor in a patient with mild haemophilia A and an Asn618-->Ser mutation responsive to immune tolerance induction and cyclophosphamide. Br J Haematol 2002; 117:136-40. [PMID: 11918545 DOI: 10.1046/j.1365-2141.2002.03383.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe a patient with mild haemophilia A (original value of factor VIII activity 0.30 U/ml) who developed an inhibitor (36.1 Bethesda U/ml) which cross-reacted with his endogenous factor VIII. This caused a decline in basal factor VIII level (< 0.01 U/ml) and severe haemorrhagic events. Treatment to induce immune tolerance was started with factor VIII/von Willebrand factor (VWF) concentrates, but inhibitor levels increased progressively and the patient suffered serious bleeding. Cyclophosphamide was administered and, after 8 months treatment, factor VIII levels increased to 0.20 U/ml and the inhibitor could no longer be detected. Screening of his factor VIII gene revealed a missense mutation in exon 13 that predicts substitution of Asn618-->Ser in the A2 domain of factor VIII. Immunoprecipitation analysis showed that the antibodies present in the patient's plasma reacted with metabolically labelled A2 domain and, to a lesser extent, with factor VIII light chain. Inhibitory antibodies were completely neutralized by recombinant A2 domain, whereas no neutralization was observed after the addition of factor VIII light chain (A3-C1-C2) and C2 domain. More detailed analysis showed that the majority of inhibitory antibodies were directed against residues Arg484-Ile508, a previously identified binding site for factor VIII inhibitors. Our findings suggest that immune tolerance therapy and cyclophosphamide were successful in eradicating inhibitory antibodies against a common epitope on factor VIII.
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Affiliation(s)
- André J Vlot
- Department of Internal Medicine, Eemland Hospital, Amersfoort, the Netherlands.
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33
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van Rijn RS, Wittebol S, Graafland AD, Kramer MH. [Immunologic phenomena as the first sign of myelodysplastic syndrome]. Ned Tijdschr Geneeskd 2001; 145:1529-33. [PMID: 11525083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Two patients, men aged 77 and 66 years, presented with a vasculitis. Due to an abnormal blood smear they were referred to the internist, who subsequently diagnosed a myelodysplastic syndrome (MDS). They were initially treated with a high dose of corticosteroids and this dosage later became a maintenance dose. Immunological phenomena occur in 10-14% of MDS patients and seem to have a poor prognosis. Most patients respond well to treatment with corticosteroids. Occasionally, favourable haematological responses to corticosteroid therapy are seen, although this was not the case in the two patients described. When patients present with an immunological disorder, such as a vasculitis or an autoimmune disease, it is important to be aware of the possibility of an underlying MDS.
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MESH Headings
- Aged
- Anemia, Refractory/immunology
- Biomarkers/blood
- Bone Marrow/pathology
- Diagnosis, Differential
- Glucocorticoids/therapeutic use
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Myelomonocytic, Chronic/diagnosis
- Male
- Myelodysplastic Syndromes/blood
- Myelodysplastic Syndromes/complications
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/immunology
- Prognosis
- Skin Diseases/immunology
- Vasculitis, Leukocytoclastic, Cutaneous/immunology
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Affiliation(s)
- R S van Rijn
- Ziekenhuis Eemland, locatie De Lichtenberg, afd. Interne Geneeskunde, Amersfoort.
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Segeren CM, Sonneveld P, van der Holt B, Baars JW, Biesma DH, Cornellissen JJ, Croockewit AJ, Dekker AW, Fibbe WE, Lowenberg B, van Marwijk Kooy M, van Oers MHJ, Richel DJ, Schouten HC, Vellenga E, Verhoef GEG, Wijermans PW, Wittebol S, Lokhorst HM. Vincristine, doxorubicin and dexamethasone (VAD) administered as rapid intravenous infusion for first-line treatment in untreated multiple myeloma. Br J Haematol 1999. [DOI: 10.1111/j.1365-2141.1999.01279.x] [Citation(s) in RCA: 65] [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] [Indexed: 11/25/2022]
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35
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Segeren CM, Sonneveld P, van der Holt B, Baars JW, Biesma DH, Cornellissen JJ, Croockewit AJ, Dekker AW, Fibbe WE, Löwenberg B, van Marwijk Kooy M, van Oers MH, Richel DJ, Schouten HC, Vellenga E, Verhoef GE, Wijermans PW, Wittebol S, Lokhorst HM. Vincristine, doxorubicin and dexamethasone (VAD) administered as rapid intravenous infusion for first-line treatment in untreated multiple myeloma. Br J Haematol 1999; 105:127-30. [PMID: 10233375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
We examined the feasibility of achieving a rapid response in patients with previously untreated multiple myeloma by administering vincristine 0.4 mg and doxorubicin 9 mg/m2 as a rapid intravenous infusion for 4 d together with intermittent high-dose dexamethasone 40 mg (VAD) for remission induction treatment in patients who were scheduled to receive high-dose therapy. 139 patients (86 male, 53 female; median age 53 years, range 32-65 years; Durie & Salmon stage IIA: 42, IIB: one, IIIA: 89, IIIB: seven) were included in a prospective multicentre study in which VAD was administered as remission induction treatment and was followed by intensified treatment. The response was evaluated according to the criteria of the Eastern Cooperative Oncology Group (ECOG). The results of treatment were evaluable in 134 patients. Five patients died before evaluation. 86 patients (62%) achieved a partial response (PR) and seven patients (5%) achieved a complete response (CR), which equates to a response rate of 67%. The main side-effect was mild neurotoxicity, which was observed in 18% of the patients. Fever or infections were reported in 27% of the patients. VAD administered as an outpatient regimen, based on rapid intravenous infusion, is an effective induction regimen for untreated myeloma with a 67% response rate and acceptable toxicity.
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Affiliation(s)
- C M Segeren
- University Hospital Rotterdam and University Hospital Utrecht for the Belgium-Dutch Haematology-Oncology Group (HOVON), The Netherlands.
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Wittebol S, Raymakers R, van de Locht L, Mensink E, de Witte T. In AML t(8;21) colony growth of both leukemic and residual normal progenitors is restricted to the CD34+, lineage-negative fraction. Leukemia 1998; 12:1782-8. [PMID: 9823954 DOI: 10.1038/sj.leu.2401178] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In an earlier study we observed residual normal colonies in the CD34+, lineage-negative fraction in AML with a differentiated phenotype. The phenotype of both normal and leukemic progenitors in AML M2, t(8;21) was the subject of this study. The specific translocation enabled discrimination of normal and leukemic cells. Bone marrow samples from eight patients were evaluated for CD34 and the differentiation markers CD33, CD19 and CD56. Growth in all phenotypic fractions was measured in a single cell assay, which enabled quantification of plating efficiency, colony size and determination of progenitor cell origin. No growth was observed in the CD34-negative fraction. In the CD34+, lineage-positive fraction only clusters up to 20 cells were found in 6/8 samples. In 7/8 samples highly proliferative myeloid, erythroid and mixed colonies were cloned from the CD34+/CD56-CD19-CD33- fraction with a frequency between 1 and 12%. Such large colonies grew at a lower frequency (1-6%) from the CD34+/CD56 fraction (4/8 samples), the CD34+/CD56-CD19- fraction (5/8 samples) and from the CD34+/CD19- fraction (1/8 samples), respectively. Among the colonies consisting of more than 150 cells, only 3/45 evaluated were positive for the AML1/ETO fusion transcript. On the other hand, 8/19 colonies with less than 150 cells were AML1/ETO positive. This study shows that like normal progenitors leukemic progenitors are also present exclusively in the lineage-negative fraction in AML M2 t(8;21). A similar hierarchy of proliferation and differentiation was found for these leukemic progenitors, the smaller colony size fitting with their limited proliferation capacity. The frequency of leukemic progenitors was in the same range as their normal counterparts and detectable only after enrichment for the CD34+, lineage-negative population.
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MESH Headings
- Antigens, CD34/immunology
- Base Sequence
- Cell Division
- Cell Separation
- Chromosomes, Human, Pair 21
- Chromosomes, Human, Pair 8
- DNA Primers
- Hematopoietic Stem Cells/immunology
- Hematopoietic Stem Cells/pathology
- Humans
- Immunophenotyping
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Reverse Transcriptase Polymerase Chain Reaction
- Translocation, Genetic
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Affiliation(s)
- S Wittebol
- Division of Hematology, University Hospital Nijmegen, The Netherlands
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Galama JM, de Leeuw N, Wittebol S, Peters H, Melchers WJ. Prolonged enteroviral infection in a patient who developed pericarditis and heart failure after bone marrow transplantation. Clin Infect Dis 1996; 22:1004-8. [PMID: 8783701 DOI: 10.1093/clinids/22.6.1004] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We described a patient who developed heart failure and pericarditis after bone marrow transplantation for a hematologic malignancy. The patient died of heart failure complicated by pneumonia. Despite extensive surveillance, an infectious cause for the heart failure was not found while he was alive. In addition, cultures of specimens obtained at autopsy did not reveal a cause for the heart failure. Enterovirus was detected by the polymerase chain reaction (PCR) in two samples of pleural fluid that were obtained 21 days apart while he was alive. After the patient died, enteroviral RNA was also detected in his lungs, liver, and spleen, indicating a generalized infection. Analysis of the PCR products revealed sequences sharing close homology with the coxsackie B-like group of enteroviruses. In addition to reporting this case, we review the literature regarding enteroviral infections after transplantation.
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Affiliation(s)
- J M Galama
- Institute of Medical Microbiology, University Hospital Nijmegen, The Netherlands
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Raymakers R, Wittebol S, Pennings A, Linders E, Poddighe P, De Witte T. Residual normal, highly proliferative progenitors can be isolated from the CD34+/33- fraction of AML with a more differentiated phenotype (CD33+). Leukemia 1995; 9:450-7. [PMID: 7533867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Since in AML differentiation is abnormal but not absent, a hierarchy of stem cells, progenitor cells and more differentiated cells is postulated. The leukemic stem cell might also be characterized by the expression of CD34 and the absence of differentiation markers. Bone marrow samples of 33 AML patients, including 10 patients both at presentation and after relapse, were double labeled for CD34 and CD33. In 14/33 AML less than 1% of the labeled cells were found in the CD34+/33- fraction. After relapse a certain shift towards a more primitive phenotype was observed, but in 4/5 relapsed AML the CD34+/33- fraction remained below 1%. Single cells from the different subfractions were cultured and showed heterogeneous cluster and colony growth in both the CD34-/33+ and CD34+/33+ fraction. More colonies were observed in the CD34+/33- fraction. In AML with a more 'mature' phenotype (low number of CD34+/CD33- cells), highly proliferative myeloid, erythroid and mixed colonies could be cloned exclusively from this small CD34+/33- fraction. In five patients with numerical chromosomal abnormalities all these highly proliferative colonies appeared disomic using in situ hybridization (ISH) with centromeric probes. Based on these data we conclude that the CD34+/33- cell fraction in AML with a more mature immunophenotype (small fraction of cells CD34+/33-) comprise residual normal progenitors, while no primitive leukemic progenitors could be identified.
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Affiliation(s)
- R Raymakers
- Department of Medicine, University Hospital Nijmegen, The Netherlands
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van de Locht LT, Smetsers TF, Wittebol S, Raymakers RA, Mensink EJ. Molecular diversity in AML1/ETO fusion transcripts in patients with t(8;21) positive acute myeloid leukaemia. Leukemia 1994; 8:1780-4. [PMID: 7523801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patients with acute myeloid leukaemia with maturation (AML-M2) that carried the t(8;21) were tested for the presence of chimeric AML1/ETO mRNA. After RT-PCR, an expected band of 208 bp was observed on gel, as well as some slower migrating bands. The base composition of one of the additional products was determined and was found to contain a new 68-bp ETO sequence present at the fusion of AML1 and ETO genes. The derived protein sequence results in a truncated AML1 gene still containing the putative DNA binding domain. Molecular diversity in the AML1-ETO transcripts will have consequences for the detection of minimal residual disease and antisense studies.
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Affiliation(s)
- L T van de Locht
- Central Hematology Laboratory, University Hospital Nijmegen, The Netherlands
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40
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te Boekhorst PA, de Leeuw K, Schoester M, Wittebol S, Nooter K, Hagemeijer A, Löwenberg B, Sonneveld P. Predominance of functional multidrug resistance (MDR-1) phenotype in CD34+ acute myeloid leukemia cells. Blood 1993; 82:3157-62. [PMID: 7693039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The expression of the MDR-1-encoded P-170 glycoprotein (P-170) associated with clinical multidrug resistance (MDR) was investigated in 52 consecutive patients with untreated acute myeloid leukemia (AML). P-170 expression was analyzed in correlation with CD34 expression and clinical response. Thirty of 52 patients expressed P-170 (58%). Eight of 30 P-170+ as compared with 16 of 22 P-170- patients achieved a complete remission (CR) (27% v 73%, P = .003). In 21 of 30 P-170+ patients, expression of the CD34 antigen was observed in greater than 10% of the blast cells, as compared with 14 of 22 P-170- patients (70% v 64%, P > .05). The CR rate of CD34+ and CD34- patients was 31% and 76%, respectively (P = .006). In AMLs that simultaneously expressed both P-170 and CD34, the CR rate was worse as compared with those negative for P-170 and CD34 (5% v 63%, P = .004). In 12 patients (8 P-170+, 4 P-170-) CD34 and P-170 expression were further characterized by double fluorescence studies. It was shown that P-170+ cells were largely, but not exclusively, restricted to the CD34+ cell population. For the 8 P-170+ AML samples, the median ratio of P-170+/P-170- in CD34+ cells was 4.845 (range, 0.60 to 25.00) as compared with 0.135 (range, 0.02 to 0.67) in CD34- cells. In these 12 AML samples, the presence of functional resistance as defined by reduced daunorubicin accumulation was evaluated in CD34+ and CD34- AML cells. In 8 of 8 P-170+ patients, intracellular daunorubicin accumulation in CD34+ AML blast cells was lower than in CD34- cells, and it increased after cyclosporin addition. No difference of intracellular daunorubicin accumulation was observed between CD34+ and CD34- AML cells of 4 P-170- patients. These data indicate that P-170 expression in AML with a heterogeneous CD34+ phenotype seems predominantly present in CD34+ AML blast cells.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1
- Antigens, CD/analysis
- Antigens, CD34
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carrier Proteins/analysis
- Daunorubicin/administration & dosage
- Daunorubicin/metabolism
- Drug Resistance
- Flow Cytometry
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/metabolism
- Membrane Glycoproteins/analysis
- Phenotype
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Affiliation(s)
- P A te Boekhorst
- Department of Hematology, Erasmus University, Rotterdam, The Netherlands
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