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Reifarth E, Naendrup JH, Garcia Borrega J, Altenrath L, Shimabukuro-Vornhagen A, Eichenauer DA, Kochanek M, Böll B. [Handoffs in the intensive care unit]. Med Klin Intensivmed Notfmed 2024; 119:253-259. [PMID: 38498181 DOI: 10.1007/s00063-024-01127-x] [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] [Received: 11/21/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Effective handoffs in the intensive care unit (ICU) are key to patient safety. PURPOSE This article aims to raise awareness of the significance of structured and thorough handoffs and highlights possible challenges as well as means for improvement. MATERIALS AND METHODS Based on the available literature, the evidence regarding handoffs in ICUs is summarized and suggestions for practical implementation are derived. RESULTS The quality of handoffs has an impact on patient safety. At the same time, communication in the intensive care setting is particularly challenging due to the complexity of cases, a disruptive work environment, and a multitude of inter- and intraprofessional interactions. Hierarchical team structures, deficiencies in feedback and error-management culture, (technical) language barriers in communication, as well as substantial physical and psychological stress may negatively influence the effectiveness of handoffs. Sets of interventions such as the implementation of checklists, mnemonics, and communication workshops contribute to a more structured and thorough handoff process and have the potential to significantly improve patient safety. CONCLUSION Effective handoffs are the cornerstone of high-quality and safe patient care but face particular challenges in ICUs. Interventional measures such as structuring handoff concepts and periodic communication trainings can help to improve handoffs and thus increase patient safety.
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Affiliation(s)
- Eyleen Reifarth
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Jan-Hendrik Naendrup
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jorge Garcia Borrega
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Lisa Altenrath
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | | | | | - Matthias Kochanek
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Boris Böll
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Neumann MAC, Nieper P, Simon F, Shimabukuro-Vornhagen A, Hallek M, Garcia Borrega J. A diagnostic challenge-First case of chronic lymphatic leukemia-associated necrotizing sweet syndrome. Eur J Haematol 2024; 112:650-653. [PMID: 38105522 DOI: 10.1111/ejh.14153] [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] [Received: 10/04/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Abstract
Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is a rare disorder typically characterized by the clinical triad including a sudden onset of fever, painful skin lesions, and neutrophilia. The histopathological findings are a dense neutrophilic infiltrate and oedema of the dermis and epidermis without evidence of a vasculitis. Besides treatment of the underlying cause, sweet syndrome is typically treated with high-dose corticosteroids leading to a relapse-free response in 70% of patients. However, if left unrecognized or untreated, the condition may lead to serious complications. Here, we report on the case of a 38-year-old patient in whom, under the assumption of the presence of necrotizing fasciitis, exarticulation of the right arm was performed. In the absence of pathogen detection and insufficient response to anti-infective therapies, the diagnosis of a sweet syndrome was assumed and, later, confirmed by an excellent response to high-dose administration of systematic glucocorticoids. The case emphasizes the need to be aware of this rare syndrome, which can be easily misdiagnosed due to its close resemblance to infection and stresses the need of further research to define distinct diagnostic tools.
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Affiliation(s)
- Marie Anne-Catherine Neumann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Pascal Nieper
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Florian Simon
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Jorge Garcia Borrega
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
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3
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Naendrup JH, Steinke J, Garcia Borrega J, Stoll SE, Michelsen PO, Assion Y, Shimabukuro-Vornhagen A, Eichenauer DA, Kochanek M, Böll B. Airway Pressure Release Ventilation in COVID-19-Associated Acute Respiratory Distress Syndrome-A Multicenter Propensity Score-Matched Analysis. J Intensive Care Med 2024; 39:84-93. [PMID: 37861125 DOI: 10.1177/08850666231207303] [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] [Indexed: 10/21/2023]
Abstract
Background: There are limited and partially contradictory data on the effects of airway pressure release ventilation (APRV) in COVID-19-associated acute respiratory distress syndrome (CARDS). Therefore, we analyzed the clinical outcome, complications, and longitudinal course of ventilation parameters and laboratory values in patients with CARDS, who were mechanically ventilated using APRV. Methods: Respective data from 4 intensive care units (ICUs) were collected and compared to a matched cohort of patients receiving conventional low tidal volume ventilation (LTV). Propensity score matching was performed based on age, sex, blood gas analysis, and APACHE II score at admission, as well as the implementation of prone positioning. Findings: Forty patients with CARDS, who were mechanically ventilated using APRV, and 40 patients receiving LTV were matched. No significant differences were detected for tidal volumes per predicted body weight, peak pressure values, and blood gas analyses on admission, 6 h post admission as well as on day 3 and day 7. Regarding ICU survival, no significant difference was identified between APRV patients (40%) and LTV patients (42%). Median duration of mechanical ventilation and duration of ICU treatment were comparable in both groups. Similar complication rates with respect to ventilator-associated pneumonia, septic shock, thromboembolic events, barotrauma, as well as the necessity for hemodialysis were detected for both groups. Clinical characteristics that were associated with increased mortality in a Cox proportional hazards regression analysis included age (hazard ratio [HR] 1.08, 95% confidence interval [CI] 1.04-1.1; P < .001), severe acute respiratory distress syndrome (HR 2.62, 95% CI 1.02-6.7; P = .046) and the occurrence of septic shock (HR 17.18, 95% CI 2.06-143.2; P = .009), but not the ventilation mode. Interpretation: Intensive care unit survival, duration of mechanical ventilation, and ICU treatment as well as ventilation-associated complication rates were equivalent using APRV compared to conventional LTV in patients with CARDS.
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Affiliation(s)
- Jan-Hendrik Naendrup
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Jonathan Steinke
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Jorge Garcia Borrega
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Sandra Emily Stoll
- Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany
| | - Per Ole Michelsen
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, St. Vinzenz Hospital Cologne, Cologne, Germany
| | - Yannick Assion
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Porz am Rhein Hospital Cologne, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Dennis Alexander Eichenauer
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Matthias Kochanek
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
| | - Boris Böll
- Faculty of Medicine and University Hospital Cologne, First Department of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany
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4
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Wolff J, Becker J, Naendrup JH, Borrega JG, Heger JM, Hamacher L, Böll B, Eichenauer DA, Shimabukuro-Vornhagen A, Kochanek M. [Team-specific impacts of the corona pandemic on intensive care medicine personnel of a maximum care hospital]. Med Klin Intensivmed Notfmed 2023; 118:556-563. [PMID: 36121481 PMCID: PMC9484350 DOI: 10.1007/s00063-022-00959-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/01/2022] [Accepted: 08/27/2022] [Indexed: 11/25/2022]
Abstract
The ongoing strain on personnel in the healthcare system during the COVID-19 pandemic is considerable and poses major emotional and psychological challenges for the personnel. In a team evaluation (physicians and nurses), team-specific stress, possible relief strategies, positive and negative experiences, and wishes for improvement of the situation in an intensive care unit were collected. While both occupational groups perceived equally high emotional stress intensities, nursing additionally perceived high stress intensities in the organizational and physical areas. Thus, the occupational group of nurses proves to be the most stressed by the COVID-19 pandemic. The findings presented here can be used to derive instructions for future actions.
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Affiliation(s)
- Jochen Wolff
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
- Seelsorge Uniklinik Köln, Universitätsklinik Köln, Köln, Deutschland
| | - Jürgen Becker
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jan-Hendrik Naendrup
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jorge Garcia Borrega
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Jan-Michel Heger
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Laura Hamacher
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Boris Böll
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Dennis A Eichenauer
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Alexander Shimabukuro-Vornhagen
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Matthias Kochanek
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Kerpener Str. 62, 50937, Köln, Deutschland.
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5
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Kochanek M, Grass G, Böll B, Eichenauer DA, Shimabukuro-Vornhagen A, Hallek M, Zander T, Mertens J, Voltz R. [Proposal for participation in intensive care and emergency medicine studies for patients unable to give informed consent (Cologne Model)]. Med Klin Intensivmed Notfmed 2023:10.1007/s00063-023-01063-2. [PMID: 37773455 DOI: 10.1007/s00063-023-01063-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/25/2023] [Accepted: 08/10/2023] [Indexed: 10/01/2023]
Abstract
When conducting clinical trials in intensive care and emergency medicine, physicians, ethics committees, and legal experts have differing views regarding the inclusion of patients who are incapable of giving consent. These different views on the participation of patients who are not capable of giving consent also complicate how clinical trials are prepared and conducted. Based on the results of a literature search, a consensus model (Cologne Model) was developed by physicians performing clinical research, ethics committees, and lawyers in order to provide patients, those scientifically responsible for the study, ethics committees, and probate (guardianship) judges with a maximum of patient safety and legal certainty, while simultaneously enabling scientific research.
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Affiliation(s)
- M Kochanek
- Medizinische Fakultät und Universitätsklinik Köln, Med. Klinik I für Innere Medizin, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - G Grass
- Ethikkommission der Medizinischen Fakultät, Universität zu Köln, Köln, Deutschland
| | - B Böll
- Medizinische Fakultät und Universitätsklinik Köln, Med. Klinik I für Innere Medizin, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - D A Eichenauer
- Medizinische Fakultät und Universitätsklinik Köln, Med. Klinik I für Innere Medizin, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - A Shimabukuro-Vornhagen
- Medizinische Fakultät und Universitätsklinik Köln, Med. Klinik I für Innere Medizin, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - M Hallek
- Medizinische Fakultät und Universitätsklinik Köln, Med. Klinik I für Innere Medizin, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - T Zander
- Medizinische Fakultät und Universitätsklinik Köln, Med. Klinik I für Innere Medizin, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO), Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | | | - R Voltz
- Ethikkommission der Medizinischen Fakultät, Universität zu Köln, Köln, Deutschland
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6
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Heger JM, Böll B, Naendrup JH, Simon F, Gräf CM, Hallek M, Shimabukuro-Vornhagen A, Kochanek M, Eichenauer DA, Garcia Borrega J. Hyperleukocytosis in patients with acute myeloid leukemia admitted to the intensive care unit: a single-center retrospective analysis. Leuk Res 2023; 132:107352. [PMID: 37423072 DOI: 10.1016/j.leukres.2023.107352] [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] [Received: 03/24/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
A relevant proportion of patients with acute myeloid leukemia (AML) presenting with hyperleukocytosis are admitted to the intensive care unit (ICU). However, data on characteristics and outcomes of these patients are limited. We therefore conducted a single-center retrospective analysis including 69 consecutive AML patients with a white blood cell (WBC) count > 100.000/µl who had been treated on the ICU between 2011 and 2020. The median age was 63 years (range: 14-87 years). Males accounted for the majority of cases (n = 43; 62.3%). Mechanical ventilation (MV), renal replacement therapy and the use of vasopressors were necessary in 34.8%, 8.7% and 40.6% of patients, respectively. Cardiopulmonary resuscitation was performed in 15.9% of patients. The ICU, hospital, 90-day and 1-year survival rates were 53.6%, 43.5%, 42% and 30.4%, respectively. Age (p = 0.002), SOFA score (p < 0.001) and MV (p < 0.001) were independently associated with a reduced survival probability. A score comprising the factors age > 70 years, lactate dehydrogenase level > 1500 U/l, WBC count > 150.000/µl, elevated lactate level and SOFA score > 7 allowed the discrimination of 3 distinct risk groups (low-risk: 0-1 points, intermediate-risk: 2 points, high-risk: 3-5 points) with regard to survival (p < 0.0001). Taken together, the present analysis indicates that more than two-thirds of AML patients with hyperleukocytosis treated on the ICU die within 1 year. However, outcomes vary considerably depending on the presence of risk factors.
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Affiliation(s)
- Jan-Michel Heger
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Boris Böll
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Jan-Hendrik Naendrup
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Florian Simon
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Claus Moritz Gräf
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Michael Hallek
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Matthias Kochanek
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Dennis A Eichenauer
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany.
| | - Jorge Garcia Borrega
- University of Cologne, First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
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7
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Garcia Borrega J, Böll B, Kochanek M, Naendrup JH, Simon F, Sieg N, Hallek M, Borchmann P, Holtick U, Shimabukuro-Vornhagen A, Eichenauer DA, Heger JM. Characteristics and outcomes of patients undergoing high-dose chemotherapy and autologous stem cell transplantation admitted to the intensive care unit: a single-center retrospective analysis. Ann Hematol 2023; 102:191-197. [PMID: 36394583 PMCID: PMC9807528 DOI: 10.1007/s00277-022-05028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
Abstract
High-dose chemotherapy and autologous stem cell transplantation (ASCT) can be associated with adverse events necessitating treatment on the intensive care unit (ICU). Data focusing on patients admitted to the ICU during hospitalization for high-dose chemotherapy and ASCT are scarce. We thus conducted a single-center retrospective analysis comprising 79 individuals who had high-dose chemotherapy and ASCT between 2014 and 2020 and were admitted to the ICU between the initiation of conditioning therapy and day 30 after ASCT. The median age was 57 years (range: 20-82 years); 38% of patients were female. B-cell non-Hodgkin lymphoma (34%) and plasma cell disorders (28%) were the most common indications for high-dose chemotherapy and ASCT. Sepsis represented the major cause for ICU admission (68%). Twenty-nine percent of patients required mechanical ventilation (MV), 5% had renal replacement therapy, and 44% needed vasopressors. The ICU, hospital, 90-day, and 1-year survival rates were 77.2%, 77.2%, 72.2%, and 60.3%, respectively. Stable disease or disease progression prior to the initiation of high-dose chemotherapy (p = 0.0028) and MV (p < 0.0001) were associated with an impaired survival. A total of 36 patients died during observation. The most frequent causes of death were the underlying malignancy (44%) and sepsis (39%). Taken together, the present analysis indicates a favorable overall outcome for patients admitted to the ICU during hospitalization for high-dose chemotherapy and ASCT. Thus, this patient group should not be denied admission and treatment on the ICU.
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Affiliation(s)
- Jorge Garcia Borrega
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Boris Böll
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Matthias Kochanek
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Jan-Hendrik Naendrup
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Florian Simon
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Noelle Sieg
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Michael Hallek
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Peter Borchmann
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Udo Holtick
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Dennis A. Eichenauer
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Jan-Michel Heger
- First Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
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8
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Böll B, Kochanek M, Eichenauer DA, Shimabukuro-Vornhagen A, von Bergwelt-Baildon M. [Intensive care management of cancer patients]. Dtsch Med Wochenschr 2022; 147:850-855. [PMID: 35785783 DOI: 10.1055/a-1696-9520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Cancer patients compromise about 15-20 % of all patients on the intensive Care Unit (ICU). Moreover, recent therapeutic developments in hematology oncology as chimeric T-cells (CAR T-cells) regularly require critical care and therefore the amount of cancer patients in the ICU is expected to grow in the coming years. Although their prognosis has dramatically improved over the past decades, the mortality on cancer patients on the ICU is still high compared to non-cancer patients. Therefore, the interdisciplinary management of these patients is crucial in order to accurately identify patients who benefit from transfer to the ICU and to optimize treatment of these vulnerable and often complex patients. Consequently, large cohort studies have shown a positive impact of daily interdisciplinary patient visits including hematology-oncology and critical care medicine on survival of cancer patients on the ICU. This short review summarizes current knowledge and open questions in the critical care management of cancer patients.
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Koehler P, von Stillfried S, Garcia Borrega J, Fuchs F, Salmanton-García J, Pult F, Böll B, Eichenauer DA, Shimabukuro-Vornhagen A, Kurzai O, Boor P, Kochanek M, Cornely OA. Aspergillus tracheobronchitis in COVID-19 ARDS patients - a cohort study. Eur Respir J 2022; 59:13993003.03142-2021. [PMID: 35144992 PMCID: PMC9068972 DOI: 10.1183/13993003.03142-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/02/2022] [Indexed: 11/15/2022]
Abstract
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, patients with acute respiratory distress syndrome (ARDS) due to SARS-CoV-2 showed a profoundly altered immune system and received immune-modulating therapeutic interventions. This enhanced the susceptibility for fungal superinfections [1, 2]. With the first reports of COVID-19-associated pulmonary aspergillosis (CAPA) the 2020 European Confederation of Medical Mycology (ECMM)/International Society for Human and Animal Mycology (ISHAM) consensus criteria were proposed [3, 4] and Aspergillus tracheobronchitis (ATB) was distinguished as a sub-entity in CAPA [4–6]. During bronchoscopy, ATB presents as ulcerations, pseudomembranes, plaques and eschars, possibly combined with tracheal stenosis [5]. Facing the risk of transmission and SARS-CoV-2 infection of examiners during bronchoscopy, blind suctioning of upper airway samples has been implemented with tracheal aspirates (TA) and non-bronchoscopic lavages. These techniques preclude inspection of the airways, so that ATB cannot be diagnosed beyond the level of suspicion. To study ATB in CAPA patients, we performed a retrospective, single-centre cohort study. Comprehensive work-up is needed for COVID-19 ARDS patients, especially when suspecting invasive fungal infections. Aspergillus tracheobronchitis has a substantial prevalence in patients with CAPA accounting for an overall mortality of 75% in this study.https://bit.ly/3uF3FZU
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Affiliation(s)
- Philipp Koehler
- Department I of Internal Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | | | - Jorge Garcia Borrega
- Department I of Internal Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Frieder Fuchs
- University of Cologne, Medical Faculty and University Hospital Cologne, Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Jon Salmanton-García
- Department I of Internal Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Fabian Pult
- Department I of Internal Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Boris Böll
- Department I of Internal Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- Department I of Internal Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | | | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany.,National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knoell-Institute, Jena, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany.,Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne, ZKS Köln, Cologne, Germany.,University of Cologne, Medical Faculty and University Hospital Cologne, German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,MK and OAC share last authorship
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10
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Shimabukuro-Vornhagen A, Böll B, Schellongowski P, Valade S, Metaxa V, Azoulay E, von Bergwelt-Baildon M. Critical care management of chimeric antigen receptor T-cell therapy recipients. CA Cancer J Clin 2022; 72:78-93. [PMID: 34613616 DOI: 10.3322/caac.21702] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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] [Received: 03/11/2021] [Revised: 06/30/2021] [Accepted: 07/21/2021] [Indexed: 12/30/2022] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a promising immunotherapeutic treatment concept that is changing the treatment approach to hematologic malignancies. The development of CAR T-cell therapy represents a prime example for the successful bench-to-bedside translation of advances in immunology and cellular therapy into clinical practice. The currently available CAR T-cell products have shown high response rates and long-term remissions in patients with relapsed/refractory acute lymphoblastic leukemia and relapsed/refractory lymphoma. However, CAR T-cell therapy can induce severe life-threatening toxicities such as cytokine release syndrome, neurotoxicity, or infection, which require rapid and aggressive medical treatment in the intensive care unit setting. In this review, the authors provide an overview of the state-of-the-art in the clinical management of severe life-threatening events in CAR T-cell recipients. Furthermore, key challenges that have to be overcome to maximize the safety of CAR T cells are discussed.
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Affiliation(s)
- Alexander Shimabukuro-Vornhagen
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
| | - Boris Böll
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
| | - Peter Schellongowski
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Medicine I, Intensive Care Unit 13i2, Comprehensive Cancer Center, Center of Excellence in Medical Intensive Care (CEMIC), Medical University of Vienna, Vienna, Austria
| | - Sandrine Valade
- Medical Intensive Care Unit, St Louis Teaching Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Elie Azoulay
- Medical Intensive Care Unit, St Louis Teaching Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Michael von Bergwelt-Baildon
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Medicine III, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
- Munich Comprehensive Cancer Center, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
- Bavarian Center for Cancer Research, Munich, Germany
- Nine-i Multinational Research Network, Service de Médecine Intensive et Réanimaton Médicale, Hôpital Saint-Louis, France
- German Cancer Consortium, Partner Site Munich, Munich, Germany
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11
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Naendrup JH, Garcia Borrega J, Eichenauer DA, Shimabukuro-Vornhagen A, Kochanek M, Böll B. Reactivation of EBV and CMV in Severe COVID-19-Epiphenomena or Trigger of Hyperinflammation in Need of Treatment? A Large Case Series of Critically ill Patients. J Intensive Care Med 2021; 37:1152-1158. [PMID: 34791940 PMCID: PMC9396115 DOI: 10.1177/08850666211053990] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Reactivation of viruses such as Epstein-Barr virus (EBV) and cytomegalovirus
(CMV) are common in critically ill patients and have been described in
patients with severe COVID-19. However, it is unclear whether these
reactivations are associated with increased mortality and whether targeted
treatments are beneficial. Methods In a retrospective single-center cohort study, patients with severe COVID-19
treated on our intensive care unit (ICU) were screened for EBV and CMV
reactivation as detected by polymerase chain reaction. If present, patient
characteristics, temporal connections to severe acute respiratory syndrome
coronavirus 2 diagnosis and corticosteroid use, the use of targeted
treatments as well as the course of disease and outcome were analyzed. As
control group, non-COVID-19 patients with sepsis, treated within the same
time period on our ICU, served as control group to compare incidences of
viral reactivation. Results In 19 (16%) of 117 patients with severe COVID-19 treated on our ICU EBV
reactivations were identified, comparable 18 (14%) of 126 in the
non-COVID-19 control group (P = .672). Similarly, in 11
(9%) of 117 patients CMV reactivations were identified, comparable to the 16
(13%) of 126 in the non-COVID-19 sepsis patients
(P = .296). The majority of EBV (58%) and CMV reactivations
(55%) were detected in patients under systemic corticosteroid treatment. 7
(37%) of 19 patients with EBV reactivation survived the ICU stay, 2 (29%) of
7 patients with rituximab treatment and 5 (42%) of 12 patients without
treatment (P = .568). Five (50%) of 10 patients with CMV
reactivation survived the ICU stay, 5 (83%) of 6 patients with ganciclovir
treatment and 0 of 4 patients without treatment (P = .048).
Follow-up analysis in these patients showed that the initiation of treatment
lead to decrease in viral load. Conclusion Critically ill patients with COVID-19 are at a high risk for EBV and CMV
reactivations. Whether these reactivations are a cause of hyperinflammation
and require targeted treatment remains uncertain. However, in patients with
clinical deterioration or signs of hyperinflammation targeted treatment
might be beneficial and warrants further studying.
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Affiliation(s)
| | | | | | | | | | - Boris Böll
- 27182University of Cologne, Cologne, Germany
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12
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Garcia Borrega J, Naendrup JH, Heindel K, Hamacher L, Heger E, Di Cristanziano V, Deppe AC, Dusse F, Wetsch WA, Eichenauer DA, Shimabukuro-Vornhagen A, Böll B, Kochanek M. Clinical Course and Outcome of Patients with SARS-CoV-2 Alpha Variant Infection Compared to Patients with SARS-CoV-2 Wild-Type Infection Admitted to the ICU. Microorganisms 2021; 9:1944. [PMID: 34576839 PMCID: PMC8470850 DOI: 10.3390/microorganisms9091944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/15/2022] Open
Abstract
The alpha variant of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is associated with higher transmissibility and possibly higher mortality compared with wild-type SARS-CoV-2. However, few data are available on the clinical course of infections with the alpha variant compared with wild-type SARS-CoV-2 in critically ill patients in intensive care units (ICUs). Therefore, we retrospectively analyzed patients admitted to our ICU due to SARS-CoV-2 Alpha variant infection and compared characteristics and course to patients with SARS-CoV-2 wild-type infection. The median age of patients with Alpha variant infections was 57 years compared to 62 years in the wild-type group. ICU survival was 41/80 (51%) in the Alpha variant group and 35/80 (44%) in the wild-type group (p = 0.429). Results of a matched-pair analysis based on age and sex illustrated that 45/58 patients (77.6%) in the Alpha variant group and 38/58 (65.5%) patients in the wild-type group required mechanical ventilation (p = 0.217). ICU survival was documented for 28/58 patients (48.3%) in the Alpha variant group and 27/58 patients (46.6%) in the wild-type group (p = 1). Thus, ICU mortality among patients with SARS-CoV-2 infections remains high. Although the Alpha variant group included younger patients requiring mechanical ventilation, no significant differences between patients with the SARS-CoV-2 Alpha variant and the SARS-CoV-2 wild-type, respectively, were detected with respect to clinical course and ICU mortality. For future VOCs, we believe it would be important to obtain valid and rapid data on the clinical course of critically ill patients who test positive for COVID-19 in order to perform appropriate epidemiological planning of intensive care capacity.
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Affiliation(s)
- Jorge Garcia Borrega
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Jan-Hendrik Naendrup
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Katrin Heindel
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Laura Hamacher
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Eva Heger
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.H.); (V.D.C.)
| | - Veronica Di Cristanziano
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.H.); (V.D.C.)
| | - Antje-Christin Deppe
- Department of Cardiothoracic Surgery, ECMO Centre Cologne, Heart Centre, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Fabian Dusse
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (F.D.); (W.A.W.)
| | - Wolfgang Alois Wetsch
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (F.D.); (W.A.W.)
| | - Dennis Alexander Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Alexander Shimabukuro-Vornhagen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Boris Böll
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
| | - Matthias Kochanek
- First Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.G.B.); (J.-H.N.); (K.H.); (L.H.); (D.A.E.); (A.S.-V.); (B.B.)
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13
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Stecher SS, Stemmler HJ, Eichenauer DA, Kochanek M, Shimabukuro-Vornhagen A, von Bergwelt-Baildon M, Böll B. [Update 2021: COVID-19 from the perspective of intensive care]. Dtsch Med Wochenschr 2021; 146:908-910. [PMID: 34256406 DOI: 10.1055/a-1449-4995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
COVID-19 continues to challenge health-care systems and ICUs around the globe more than one year into the pandemic and in spite of all advances in diagnosis and treatment of the disease caused by the novel SARS-CoV-2. Many open questions remain concerning optimal medical therapy, respiratory management and resource allocation, particuly in times of limited available health care personell. In the following short article, we summarized current knowlegde on management of COVID-19 in the ICU.
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14
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Wennhold K, Thelen M, Lehmann J, Schran S, Preugszat E, Garcia-Marquez M, Lechner A, Shimabukuro-Vornhagen A, Ercanoglu MS, Klein F, Thangarajah F, Eidt S, Löser H, Bruns C, Quaas A, von Bergwelt-Baildon M, Schlößer HA. CD86 + Antigen-Presenting B Cells Are Increased in Cancer, Localize in Tertiary Lymphoid Structures, and Induce Specific T-cell Responses. Cancer Immunol Res 2021; 9:1098-1108. [PMID: 34155067 DOI: 10.1158/2326-6066.cir-20-0949] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/22/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
The role of B cells in antitumor immunity and their impact on emerging immunotherapies is increasingly gaining attention. B-cell effector functions include not only secretion of antibodies, but also presentation of antigens to T cells. A physiologic B-cell subset with immunostimulatory properties was described in humans, defined by a high expression of CD86 and downregulation of CD21. We used multicolor flow cytometry and IHC to elucidate abundance and spatial distribution of these antigen-presenting B cells (BAPC) in blood (peripheral blood mononuclear cells, PBMC) and tumor samples of 237 patients with cancer. Antigen-specific T-cell responses to cancer testis antigens were determined using tetramer staining and sorted BAPCs in FluoroSpot assays for selected patients. We found that BAPCs were increased in the tumor microenvironment of 9 of 10 analyzed cancer types with site-specific variation. BAPCs were not increased in renal cell carcinoma, whereas we found a systemic increase with elevated fractions in tumor-infiltrating lymphocytes (TIL) and PBMCs of patients with colorectal cancer and gastroesophageal adenocarcinoma. BAPCs were localized in lymphoid follicles of tertiary lymphoid structures (TLS) and were enriched in tumors with increased numbers of TLSs. BAPCs isolated from tumor-draining lymph nodes of patients with cancer showed increased percentages of tumor antigen-specific B cells and induced responses of autologous T cells in vitro. Our results highlight the relevance of BAPCs as professional antigen-presenting cells in tumor immunity and provide a mechanistic rationale for the observed correlation of B-cell abundance and response to immune checkpoint inhibition.
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Affiliation(s)
- Kerstin Wennhold
- Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin Thelen
- Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jonas Lehmann
- Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Simon Schran
- Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ella Preugszat
- Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Maria Garcia-Marquez
- Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Axel Lechner
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig Maximilians University, Munich, Germany.,Gene Center, Ludwig Maximilians University, Munich, Germany
| | - Alexander Shimabukuro-Vornhagen
- Department I for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Meryem S Ercanoglu
- Institute of Virology, Laboratory of Experimental Immunology, University of Cologne, Cologne, Germany
| | - Florian Klein
- Institute of Virology, Laboratory of Experimental Immunology, University of Cologne, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Gynecology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sebastian Eidt
- Institute of Pathology, St. Elisabeth Hospital, Cologne, Germany
| | - Heike Löser
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Christiane Bruns
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Alexander Quaas
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Michael von Bergwelt-Baildon
- Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Gene Center, Ludwig Maximilians University, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Hans A Schlößer
- Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany. .,Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
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15
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Shimabukuro-Vornhagen A. Intensive Care Unit Organization and Interdisciplinary Care for Critically Ill Patients with Cancer. Crit Care Clin 2020; 37:19-28. [PMID: 33190769 DOI: 10.1016/j.ccc.2020.09.003] [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] [Indexed: 11/19/2022]
Abstract
Patients with cancer are at high risk of developing acute critical illness requiring intensive care unit (ICU) admission. Critically ill patients with cancer have complex medical needs that can best be served by a multidisciplinary ICU care team. This article provides an overview of the current state-of-the-art in multidisciplinary care for critically ill patients with cancer. Better integration of multidisciplinary critical care into the continuum of care for patients with cancer offers the prospect of further improvements in the outcomes of patients with cancer.
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16
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17
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Stecher SS, Stemmler HJ, Eichenauer D, Kochanek M, Shimabukuro-Vornhagen A, von Bergwelt-Baildon M, Böll B. [COVID-19: The Intensive Care Point-of-View]. Dtsch Med Wochenschr 2020; 145:1057-1062. [PMID: 32731279 DOI: 10.1055/a-1164-4100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Approx. 93 % of COVID-19 infections are mild, and not all severely ill patients are transferred to the intensive care unit. But the Corona crisis implies high demands on intensive care medicine. Many treatment modalities of COVID patients are "best practice", but some aspects remain unclear at present. This article deals with diagnostics, monitoring and therapy with COVID-19 patients in intensive care units and with a suitable hygiene concepts.A hygiene concept is obligatory and must ensure - in addition to general measures - the training of employees and the hygienic discharge of material. Ideally, a cohort isolation is implemented.Monitoring of patients with COVID-19 is not different from other intensive care patients and should be adapted to the clinical situation of the individual patient. In laboratory analysis the typical abnormality of COVID-19 patients should be taken into account. In case of increasing inflammatory parameters, fungal infections should be tested.Due to the formation of aerosols, disconnection of the respiratory system must be avoided in invasive ventilation. If a disconnection from the respirator is necessary, the tube should be disconnected. After extubation, an intermittent NIV treatment for atelectase prophylaxis can be performed.
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18
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Koehler P, Cornely OA, Böttiger BW, Dusse F, Eichenauer DA, Fuchs F, Hallek M, Jung N, Klein F, Persigehl T, Rybniker J, Kochanek M, Böll B, Shimabukuro-Vornhagen A. COVID-19 associated pulmonary aspergillosis. Mycoses 2020; 63:528-534. [PMID: 32339350 PMCID: PMC7267243 DOI: 10.1111/myc.13096] [Citation(s) in RCA: 367] [Impact Index Per Article: 91.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications like invasive aspergillosis. Our study evaluates coronavirus disease 19 (COVID-19) associated invasive aspergillosis at a single centre in Cologne, Germany. METHODS A retrospective chart review of all patients with COVID-19 associated ARDS admitted to the medical or surgical intensive care unit at the University Hospital of Cologne, Cologne, Germany. RESULTS COVID-19 associated invasive pulmonary aspergillosis was found in five of 19 consecutive critically ill patients with moderate to severe ARDS. CONCLUSION Clinicians caring for patients with ARDS due to COVID-19 should consider invasive pulmonary aspergillosis and subject respiratory samples to comprehensive analysis to detect co-infection.
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Affiliation(s)
- Philipp Koehler
- Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,ZKS Köln, Clinical Trials Centre Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Fabian Dusse
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frieder Fuchs
- Faculty of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Florian Klein
- Institute of Virology, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Department of Radiology, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Rybniker
- Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Boris Böll
- Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
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19
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Kriege M, Dalberg J, McGrath BA, Shimabukuro-Vornhagen A, Billgren B, Lund TK, Thornberg K, Christophersen AV, Dunn MJ. Evaluation of intubation and intensive care use of the new Ambu® aScope™ 4 broncho and Ambu® aView™ compared to a customary flexible endoscope a multicentre prospective, non-interventional study. Trends in Anaesthesia and Critical Care 2020. [DOI: 10.1016/j.tacc.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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20
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Azoulay E, Shimabukuro-Vornhagen A, Darmon M, von Bergwelt-Baildon M. Critical Care Management of Chimeric Antigen Receptor T Cell-related Toxicity. Be Aware and Prepared. Am J Respir Crit Care Med 2020; 200:20-23. [PMID: 30676776 DOI: 10.1164/rccm.201810-1945ed] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 12/22/2022] Open
Abstract
CAR (chimeric antigen receptor) T cells (CARTs) are genetically engineered T cells that express CARs, with impressive clinical activity in relapsed and refractory hematologic malignancies, primarily acute lymphoblastic leukemia and diffuse large B-cell lymphoma. The most frequent life-threatening adverse events after CART infusion are cytokine release syndrome and CAR-related encephalopathy syndrome, which can occur within hours or days after administration. IL-6 released by macrophages and monocytes plays a major role in the pathogenesis of cytokine release syndrome and CAR-related encephalopathy syndrome, and IL-6 blockade and steroids contribute to fast resolution of symptoms. Critical care management plays an important role in patients receiving CARTs, as up to half of patients might need an admission to the ICU and lifesaving interventions. As new treatment indications and CART constructs enter the clinic, the number of patients requiring ICU admission will rapidly increase, with profound consequences for the use of ICU resources, training requirements, clinical expertise, multidisciplinary collaboration, and hospital organization. Research is also needed to validate at large scale biomarkers that allow doctors to risk-stratify patients for both their risk to develop severe toxicity and their likelihood to respond to therapy.
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Affiliation(s)
- Elie Azoulay
- 1 Médecine Intensive et Réanimation, Assistance Publique des Hôpitaux de Paris, St-Louis Teaching Hospital and Paris 7 University, Paris, France.,2 Groupe de Recherche Respiratoire en Reanimation Onco-Hématologique, Paris, France
| | - Alexander Shimabukuro-Vornhagen
- 3 Intensive Care Program Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,4 Intensive Care in Hematologic and Oncologic Patients, Munich, Germany; and
| | - Michael Darmon
- 1 Médecine Intensive et Réanimation, Assistance Publique des Hôpitaux de Paris, St-Louis Teaching Hospital and Paris 7 University, Paris, France
| | - Michael von Bergwelt-Baildon
- 4 Intensive Care in Hematologic and Oncologic Patients, Munich, Germany; and.,5 Medizinische Klinik und Poliklinik III, Klinikum der Universität München, Munich, Germany
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21
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Koehler P, Bassetti M, Kochanek M, Shimabukuro-Vornhagen A, Cornely O. Intensive care management of influenza-associated pulmonary aspergillosis. Clin Microbiol Infect 2019; 25:1501-1509. [DOI: 10.1016/j.cmi.2019.04.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/21/2019] [Accepted: 04/27/2019] [Indexed: 12/15/2022]
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22
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Koliamitra C, Javelle F, Joisten N, Shimabukuro-Vornhagen A, Bloch W, Schenk A, Zimmer P. Do Acute Exercise-Induced Activations of the Kynurenine Pathway Induce Regulatory T-Cells on the Long-Term? - A Theoretical Frame Work Supported by Pilot Data. J Sports Sci Med 2019; 18:669-673. [PMID: 31827351 PMCID: PMC6873119] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/21/2019] [Indexed: 06/10/2023]
Abstract
Regular physical activity and exercise interventions are suspected to have anti-inflammatory effects depending on exercise modality, thereby potentially reducing the risk and progress of several chronic diseases. Alterations in the kynurenine pathway may represent a link between inflammatory responses following acute exercise and chronic anti-inflammatory properties, such as increased levels of regulatory T-cells (Treg). Here, we hypothesize that acute exercise activates the kynurenine pathway and physical fitness is associated with proportions of circulating anti-inflammatory Treg in older healthy women. Nineteen older healthy female participants (55 years (SD: ± 5.6)) completed a cardiopulmonary incremental exercise test (CPET) with spirometry on a bicycle ergometer until exhaustion with maximum oxygen uptake (VO2max) as outcome. Blood samples were taken before (T0) and one minute after (T1) the CPET. Levels of tryptophan, serotonin and kynurenine were determined by enzyme-linked immunosorbent assays. Flow cytometry was used to identify proportions of T-cell subsets. Both, kynurenine (p = 0.003, d = 0.40) and the kynurenine/tryptophan ratio (p = 0.034, d = 0.48) increased significantly after acute exercise. Moreover, participants` VO2max was strongly correlated with Treg levels (p < 0.001, r = 0.689). This is the first study indicating a kynurenine pathway activation following acute exercise in older healthy women. The observed correlation between Treg levels and VO2max emphasizes a potential link between short-term upregulated kynurenine levels and longer-term anti-inflammatory properties of exercise. Future research is needed to clarify to what extend acute exercise-induced activations of the kynurenine pathway contribute to Treg differentiation.
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Affiliation(s)
- Christina Koliamitra
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Florian Javelle
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Niklas Joisten
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany
- Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany
- Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany
| | - Wilhelm Bloch
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
- The German Research Centre of Elite Sport, German Sport University Cologne, Cologne, Germany
| | - Alexander Schenk
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Philipp Zimmer
- Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
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23
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Beutel G, Kiehl M, Stemmler J, Shimabukuro-Vornhagen A, Staudinger T. [Caring for The Critically Ill Cancer Patient in 2019]. Dtsch Med Wochenschr 2019; 144:1327-1332. [PMID: 31559613 DOI: 10.1055/a-0853-4804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In Europe, up to 25 % of the ICU patients suffer from malignant diseases. Recent studies have shown that the short term prognosis of critically ill cancer patients is determined by the severity of the acute complication leading to ICU admission, but not by the underlying malignancy. Long-term prognosis of cancer patients surviving the ICU however is given by the underlying disease and comparable to cancer patients never admitted to the ICU. In particular, survival rates of tumor patients admitted after surgery are equal to those from surgical non-tumor patients. Despite this favorable trend the ICU admission of patients suffering from malignancy is still debatable.To define admission criteria a triage system has been developed taking into account the prognosis of the underlying disease, the overall performance status, patient will and the severity of complications. Those criteria allow us to categorize patients and to grade the intensity of treatment into "full code" treatment, a limited "ICU trial", or palliative care without ICU intervention. In addition to those, additional factors of adverse prognosis as low performance status, number of comorbidities, admission due to cardiorespiratory arrest, organ failure due to malignancy, aspergillosis or admission after allogeneic stem cell transplantation have been identified.This complexity requires an interdisciplinary cooperation between oncologists/haematologists and intensive care specialists and seems to be an essential clue to successfully manage critically ill cancer patients. For the future the improvement of education and training, the development of individualized therapies, and to seize the opportunity to use modern tools of data analytics and machine learning are important goals in this field.
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24
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Probst L, Schalk E, Liebregts T, Zeremski V, Tzalavras A, von Bergwelt-Baildon M, Hesse N, Prinz J, Vehreschild JJ, Shimabukuro-Vornhagen A, Eichenauer DA, Garcia Borrega J, Kochanek M, Böll B. Prognostic accuracy of SOFA, qSOFA and SIRS criteria in hematological cancer patients: a retrospective multicenter study. J Intensive Care 2019; 7:41. [PMID: 31410290 PMCID: PMC6686367 DOI: 10.1186/s40560-019-0396-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 05/11/2019] [Accepted: 07/24/2019] [Indexed: 12/21/2022] Open
Abstract
Background With Sepsis-3, the increase in sequential organ failure assessment (SOFA) as a clinical score for the identification of patients with sepsis and quickSOFA (qSOFA) for the identification of patients at risk of sepsis outside the intensive care unit (ICU) were introduced in 2016. However, their validity has been questioned, and their applicability in different settings and subgroups, such as hematological cancer patients, remains unclear. We therefore assessed the validity of SOFA, qSOFA, and the systemic inflammatory response syndrome (SIRS) criteria regarding the diagnosis of sepsis and the prediction of in-hospital mortality in a multicenter cohort of hematological cancer patients treated on ICU and non-ICU settings. Methods We retrospectively calculated SIRS, SOFA, and qSOFA scores in our cohort and applied the definition of sepsis as "life-threatening organ dysfunction caused by dysregulated host response to infection" as reference. Discriminatory capacity was assessed using the area under the receiver operating characteristic curve (AUROC). Results Among 450 patients with hematological cancer (median age 58 years, 274 males [61%]), 180 (40%) had sepsis of which 101 (56%) were treated on ICU. For the diagnosis of sepsis, sensitivity was 86%, 64%, and 42% for SIRS, SOFA, and qSOFA, respectively. However, the AUROCs of SOFA and qSOFA indicated better discrimination for sepsis than SIRS (SOFA, 0.69 [95% CI, 0.64-0.73] p < 0.001; qSOFA, 0.67 [95% CI, 0.62-0.71] p < 0.001; SIRS, 0.57 [95% CI, 0.53-0.61] p < 0.001).In-hospital mortality was 40% and 14% in patients with and without sepsis, respectively (p < 0.001). Regarding patients with sepsis, mortality was similar in patients with positive and negative SIRS scores (39% vs. 40% (p = 0.899), respectively). For patients with qSOFA ≥ 2, mortality was 49% compared to 33% for those with qSOFA < 2 (p = 0.056), and for SOFA 56% vs. 11% (p < 0.001), respectively. SOFA allowed significantly better discrimination for in-hospital mortality (AUROC 0.74 [95% CI, 0.69-0.79] p < 0.001) than qSOFA (AUROC 0.65 [95% CI, 0.60-0.71] p < 0.001) or SIRS (AUROC 0.49 [95% CI, 0.44-0.54] p < 0.001). Conclusions An increase in SOFA score of ≥ 2 had better prognostic accuracy for both diagnosis of sepsis and in-hospital mortality in this setting, and especially on ICU, we observed limited validity of SIRS criteria and qSOFA in identifying hematological patients with sepsis and at high risk of death.
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Affiliation(s)
- Lucie Probst
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Enrico Schalk
- 2Department of Hematology and Oncology, Otto-von-Guericke University, Magdeburg, Germany
| | - Tobias Liebregts
- 3Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Vanja Zeremski
- 2Department of Hematology and Oncology, Otto-von-Guericke University, Magdeburg, Germany
| | - Asterios Tzalavras
- 3Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Nina Hesse
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Johanna Prinz
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Jörg Janne Vehreschild
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.,German Centre for Infection Research, partner-site Bonn-Cologne, Cologne, Germany.,6Medical Department 2, Hematology/Oncology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Alexander Shimabukuro-Vornhagen
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Dennis A Eichenauer
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Jorge Garcia Borrega
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Matthias Kochanek
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Boris Böll
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
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25
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Kochanek M, Shimabukuro-Vornhagen A, Rüß K, Beutel G, Lueck C, Kiehl M, Schneider R, Kroschinsky F, Liebregts T, Kluge S, Schellongowski P, von Bergwelt-Baildon M, Böll B. Prävalenz von Krebspatienten auf deutschen Intensivstationen. Med Klin Intensivmed Notfmed 2019; 115:312-319. [DOI: 10.1007/s00063-019-0594-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/14/2019] [Accepted: 06/01/2019] [Indexed: 01/07/2023]
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26
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Heger JM, Eichenauer DA, Kasper P, Böll B, Shimabukuro-Vornhagen A, Kochanek M. Fatal disseminated enterovirus infection in a patient with follicular lymphoma undergoing obinutuzumab maintenance therapy. Eur J Haematol 2019; 103:268-271. [PMID: 31211882 DOI: 10.1111/ejh.13278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/20/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/26/2023]
Abstract
Follicular lymphoma is the most common subtype of the indolent non-Hodgkin lymphomas. Treatment usually consists of immuno-chemotherapy and results in long-lasting remissions in most cases. Progression-free survival with the second-generation anti-CD20 antibody obinutuzumab was shown to be better than with rituximab when given in combination with either bendamustine or anthracycline-based chemotherapy. Although treatment is generally well tolerated without an excessive rate of toxicities, there appear to be slightly more adverse events with obinutuzumab than with rituximab. Here, we report the case of a 45-year-old female patient that was diagnosed with a disseminated enterovirus infection while undergoing maintenance therapy with obinutuzumab after induction treatment with the combination of bendamustine and rituximab. Enterovirus RNA was detected in the blood, the cerebrospinal fluid, and the colon. A therapy with intravenous immunoglobulins was initiated since the patient presented with a severe treatment-related immunosuppression indicated by hypogammaglobulinemia. Nonetheless, she eventually died from the enterovirus infection without evidence of lymphoma progression. This case underscores that clinicians should be aware of rare but potentially fatal infectious complications related to treatment protocols containing anti-CD20 antibodies.
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Affiliation(s)
- Jan-Michel Heger
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Critical Care Medicine, University of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Critical Care Medicine, University of Cologne, Cologne, Germany
| | - Philipp Kasper
- Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
| | - Boris Böll
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Critical Care Medicine, University of Cologne, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Critical Care Medicine, University of Cologne, Cologne, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Critical Care Medicine, University of Cologne, Cologne, Germany
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27
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Garcia Borrega J, Gödel P, Rüger MA, Onur ÖA, Shimabukuro-Vornhagen A, Kochanek M, Böll B. In the Eye of the Storm: Immune-mediated Toxicities Associated With CAR-T Cell Therapy. Hemasphere 2019; 3:e191. [PMID: 31723828 PMCID: PMC6746039 DOI: 10.1097/hs9.0000000000000191] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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: 12/15/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 12/16/2022] Open
Abstract
The success of chimeric antigen receptor (CAR)-T cell therapy with impressive response rates in hematologic malignancies but also promising data in solid tumors came along with the cognition of unexpected, potentially life-threatening immune-mediated toxicities, namely the cytokine release syndrome (CRS) and neurotoxicity recently referred to as "immune effector cell-associated neurotoxicity syndrome" (ICANS). These toxicities require urgent diagnostic and therapeutic interventions and targeted modulation of key cytokine pathways represents the mainstay of CRS treatment. However, as the underlying mechanisms of ICANS are not well understood, treatment options remain limited and further investigation is warranted. Importantly, after the recent market approval of 2 CAR-T cell constructs, the application of CAR-T cells will expand to nonacademic centers with limited experience in the management of CAR-T cell-associated toxicities. Here, we review the current evidence of CRS and ICANS pathophysiology, diagnostics, and treatment.
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Affiliation(s)
- Jorge Garcia Borrega
- Department I of Internal Medicine, Hematology-Oncology, Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany
- Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Philipp Gödel
- Department I of Internal Medicine, Hematology-Oncology, Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany
- Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Cologne Translational Immunology, University Hospital of Cologne, Cologne, Germany
| | - Maria Adele Rüger
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Özgür A. Onur
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Department I of Internal Medicine, Hematology-Oncology, Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany
- Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Intensive Care in HematoOncologic Patients (iCHOP) Collaborative Group
| | - Matthias Kochanek
- Department I of Internal Medicine, Hematology-Oncology, Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany
- Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Intensive Care in HematoOncologic Patients (iCHOP) Collaborative Group
| | - Boris Böll
- Department I of Internal Medicine, Hematology-Oncology, Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany
- Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Intensive Care in HematoOncologic Patients (iCHOP) Collaborative Group
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28
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Wennhold K, Shimabukuro-Vornhagen A, von Bergwelt-Baildon M. B Cell-Based Cancer Immunotherapy. Transfus Med Hemother 2019; 46:36-46. [PMID: 31244580 PMCID: PMC6558332 DOI: 10.1159/000496166] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/10/2018] [Indexed: 12/13/2022] Open
Abstract
B cells are not only producers of antibodies, but also contribute to immune regulation or act as potent antigen-presenting cells. The potential of B cells for cellular therapy is still largely underestimated, despite their multiple diverse effector functions. The CD40L/CD40 signaling pathway is the most potent activator of antigen presentation capacity in B lymphocytes. CD40-activated B cells are potent antigen-presenting cells that induce specific T-cell responses in vitro and in vivo. In preclinical cancer models in mice and dogs, CD40-activated B cell-based cancer immunotherapy was able to induce effective antitumor immunity. So far, there have been only few early-stage clinical studies involving B cell-based cancer vaccines. These trials indicate that B cell-based immunotherapy is generally safe and associated with little toxicity. Furthermore, these studies suggest that B-cell immunotherapy can elicit antitumor T-cell responses. Alongside the recent advances in cellular therapies in general, major obstacles for generation of good manufacturing practice-manufactured B-cell immunotherapies have been overcome. Thus, a first clinical trial involving CD40-activated B cells might be in reach.
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Affiliation(s)
- Kerstin Wennhold
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | | | - Michael von Bergwelt-Baildon
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- Gene Center Munich, LMU Munich, Munich, Germany
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29
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Al-Sawaf O, Köhler P, Eichenauer DA, Böll B, Kochanek M, Shimabukuro-Vornhagen A. Management of an adult patient with sickle cell disease and acute chest syndrome by veno-venous extracorporeal membrane oxygenation. Ann Hematol 2019; 98:789-791. [PMID: 30643938 DOI: 10.1007/s00277-019-03596-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 01/02/2019] [Indexed: 01/06/2023]
Affiliation(s)
- O Al-Sawaf
- Department I of Internal Medicine, Critical Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - P Köhler
- Department I of Internal Medicine, Critical Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - D A Eichenauer
- Department I of Internal Medicine, Critical Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - B Böll
- Department I of Internal Medicine, Critical Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - M Kochanek
- Department I of Internal Medicine, Critical Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - A Shimabukuro-Vornhagen
- Department I of Internal Medicine, Critical Care Medicine, University Hospital of Cologne, Cologne, Germany.
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30
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Lechner A, Schlößer HA, Thelen M, Wennhold K, Rothschild SI, Gilles R, Quaas A, Siefer OG, Huebbers CU, Cukuroglu E, Göke J, Hillmer A, Gathof B, Meyer MF, Klussmann JP, Shimabukuro-Vornhagen A, Theurich S, Beutner D, von Bergwelt-Baildon M. Tumor-associated B cells and humoral immune response in head and neck squamous cell carcinoma. Oncoimmunology 2019; 8:1535293. [PMID: 30723574 PMCID: PMC6350680 DOI: 10.1080/2162402x.2018.1535293] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [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: 02/09/2018] [Revised: 10/07/2018] [Accepted: 10/09/2018] [Indexed: 01/04/2023] Open
Abstract
B lymphocytes are important players in immune responses to cancer. However, their composition and function in head and neck squamous cell carcinoma (HNSCC) has not been well described. Here, we analyzed B cell subsets in HNSCC (n = 38), non-cancerous mucosa (n = 14) and peripheral blood from HNSCC patients (n = 38) and healthy controls (n = 20) by flow cytometry. Intratumoral B cells contained high percentages of activated (CD86+), antigen-presenting (CD86+/CD21-) and memory B cells (IgD-/CD27+). T follicular helper cells (CD4+/CXCR5+/CD45RA-/CCR7-) as key components of tertiary lymphoid structures and plasma cells made up high percentages of the lymphocyte infiltrate. Percentages of regulatory B cell varied depending on the regulatory phenotype. Analysis of humoral immune responses against 23 tumor-associated antigens (TAA) showed reactivity against at least one antigen in 56% of HNSCC patients. Reactivity was less frequent in human papillomavirus associated (HPV+) patients and healthy controls compared to HPV negative (HPV-) HNSCC. Likewise, patients with early stage HNSCC or MHC-I loss on tumor cells had low TAA responses. Patients with TAA responses showed CD4+ dominated T cell infiltration compared to mainly CD8+ T cells in tumors without detected TAA response. To summarize, our data demonstrates different immune infiltration patterns in relation to serological TAA response detection and the presence of B cell subpopulations in HNSCC that can engage in tumor promoting and antitumor activity. In view of increasing use of immunotherapeutic approaches, it will be important to include B cells into comprehensive phenotypic and functional analyses of tumor-associated lymphocytes.
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Affiliation(s)
- Axel Lechner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Center, Ludwig Maximilians University, Munich, Germany
- Gene Center, Ludwig Maximilians University, Munich, Germany
| | - Hans A. Schlößer
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Martin Thelen
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
| | - Kerstin Wennhold
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
| | - Sacha I. Rothschild
- Department of Internal Medicine, Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Ramona Gilles
- Institute of Transfusion Medicine, University of Cologne, Cologne, Germany
| | - Alexander Quaas
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Oliver G. Siefer
- Jean-Uhrmacher-Institute for Clinical ENT Research, University of Cologne, Cologne, Germany
| | - Christian U. Huebbers
- Jean-Uhrmacher-Institute for Clinical ENT Research, University of Cologne, Cologne, Germany
| | - Engin Cukuroglu
- Computational and Systems Biology, Genome Institute of Singapore, Singapore
| | - Jonathan Göke
- Computational and Systems Biology, Genome Institute of Singapore, Singapore
- National Cancer Centre, Singapore
| | - Axel Hillmer
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Birgit Gathof
- Institute of Transfusion Medicine, University of Cologne, Cologne, Germany
| | - Moritz F. Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Jens P. Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
| | - Sebastian Theurich
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Gene Center, Ludwig Maximilians University, Munich, Germany
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
- Cancer- and Immunometabolism Research Group, Dept. I of Internal Medicine, University Hospital Cologne, Cologne, Germany
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Georg August University, Goettingen, Germany
| | - Michael von Bergwelt-Baildon
- Cologne Interventional Immunology, Department I of Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Georg August University, Goettingen, Germany
- Partner Site, German Cancer Consortium (DKTK), Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
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31
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d'Hargues Y, Prinz J, Gödel P, Shimabukuro-Vornhagen A, Kochanek M, Böll B. [Diagnosis and treatment of immune-related adverse events during checkpoint inhibitor therapy in intensive care medicine]. Med Klin Intensivmed Notfmed 2018; 115:281-285. [PMID: 30547224 DOI: 10.1007/s00063-018-0521-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/31/2018] [Accepted: 11/09/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Due to the use of checkpoint inhibitors, intensive care units will be confronted with an increasing number of patients with immune-related adverse events. A broad spectrum of symptoms and potentially lethal consequences make diagnosis and treatment challenging. OBJECTIVES Diagnosis and treatment of immune-related adverse events in the treatment with checkpoint inhibitors with a special focus on intensive care units. MATERIALS AND METHODS Review of current publications about incidence, symptoms and treatment of adverse events after the use of checkpoint inhibitors relevant for intensive care medicine. RESULTS Immune-related adverse events during therapy with checkpoint inhibitors are difficult to diagnose and present with various symptoms. Severe complications can often successfully be treated with early therapy. CONCLUSIONS The early treatment of immune-related adverse events according to their severity is needed to prevent a potentially life-threatening course.
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Affiliation(s)
- Y d'Hargues
- Klinik I für Innere Medizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - J Prinz
- Klinik I für Innere Medizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - P Gödel
- Klinik I für Innere Medizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | | | - M Kochanek
- Klinik I für Innere Medizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - B Böll
- Klinik I für Innere Medizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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32
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Schlößer HA, Thelen M, Lechner A, Wennhold K, Garcia-Marquez MA, Rothschild SI, Staib E, Zander T, Beutner D, Gathof B, Gilles R, Cukuroglu E, Göke J, Shimabukuro-Vornhagen A, Drebber U, Quaas A, Bruns CJ, Hölscher AH, Von Bergwelt-Baildon MS. B cells in esophago-gastric adenocarcinoma are highly differentiated, organize in tertiary lymphoid structures and produce tumor-specific antibodies. Oncoimmunology 2018; 8:e1512458. [PMID: 30546950 PMCID: PMC6287776 DOI: 10.1080/2162402x.2018.1512458] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 05/16/2018] [Revised: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 12/29/2022] Open
Abstract
Tumor-infiltrating lymphocytes (TILs) are correlated to prognosis of several kinds of cancer. Most studies focused on T cells, while the role of tumor-associated B cells (TABs) has only recently gained more attention. TABs contain subpopulations with distinct functions, potentially promoting or inhibiting immune responses. This study provides a detailed analysis of TABs in gastro-esophageal adenocarcinoma (EAC). Flow cytometric analyses of single cell suspensions of tumor samples, mucosa, lymph nodes and peripheral blood mononuclear cells (PBMC) of EAC patients and healthy controls revealed a distinct B cell compartment in cancer patients. B cells were increased in tumor samples and subset-analyses of TILs showed increased proportions of differentiated and activated B cells and an enrichment for follicular T helper cells. Confocal microscopy demonstrated that TABs were mainly organized in tertiary lymphoid structures (TLS), which resemble lymphoid follicles in secondary lymphoid organs. A panel of 34 tumor-associated antigens (TAAs) expressed in EAC was identified based on public databases and TCGA data to analyze tumor-specific B cell responses using a LUMINEXTM bead assay and flow cytometry. Structural analyses of TLS and the detection of tumor-specific antibodies against one or more TAAs in 48.1% of analyzed serum samples underline presence of anti-tumor B cell responses in EAC. Interestingly, B cells were decreased in tumors with expression of Programmed Death Ligand 1 or impaired HLA-I expression. These data demonstrate that anti-tumor B cell responses are an additional and underestimated aspect of EAC. Our results are of immediate translational relevance to emerging immunotherapies.
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Affiliation(s)
- Hans A. Schlößer
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Martin Thelen
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Axel Lechner
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
- Department of Head and Neck Surgery, University of Göttingen, Göttingen, Germany
| | - Kerstin Wennhold
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | | | | | - Elena Staib
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Thomas Zander
- Department I of Internal Medicine I, University of Cologne, Cologne, Germany
| | - Dirk Beutner
- Department of Head and Neck Surgery, University of Göttingen, Göttingen, Germany
| | - Birgit Gathof
- Institute of Transfusion Medicine, University of Cologne, Cologne, Germany
| | - Ramona Gilles
- Institute of Transfusion Medicine, University of Cologne, Cologne, Germany
| | | | | | | | - Uta Drebber
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Alexander Quaas
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Christiane J. Bruns
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Arnulf H. Hölscher
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Michael S. Von Bergwelt-Baildon
- German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Internal Medicine III, University Hospital, Munich, Germany
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33
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Al-Sawaf O, Garcia-Borrega J, Vehreschild JJ, Thelen P, Fätkenheuer G, Shimabukuro-Vornhagen A, Kochanek M, Böll B. Pelvic cellulitis caused by Raoultella planticola in a neutropenic patient. J Infect Chemother 2018; 25:298-301. [PMID: 30482700 DOI: 10.1016/j.jiac.2018.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/08/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022]
Abstract
Raoultella planticola is a gram-negative, encapsulated, aerobic bacterium within the Enterobacteriaceae family. It has been primarily described as pathogen in cases with pneumonia and gastrointestinal infections. Here we describe a case of severe pelvic cellulitis in a patient with neutropenia following induction therapy for myeloid sarcoma. The patient experienced a septic shock and was treated successfully with antibiotic therapy. A literature review is provided to put this case in context with previous reports on R. planticola. This report highlights that awareness for uncommon pathogens is crucial in the clinical management of infections in neutropenic patients.
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Affiliation(s)
- O Al-Sawaf
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Department I of Internal Medicine, Critical Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - J Garcia-Borrega
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Department I of Internal Medicine, Critical Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - J J Vehreschild
- Department I of Internal Medicine, Division of Infectious Diseases, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn - Cologne, Cologne, Germany
| | - P Thelen
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - G Fätkenheuer
- Department I of Internal Medicine, Division of Infectious Diseases, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn - Cologne, Cologne, Germany
| | - A Shimabukuro-Vornhagen
- Department I of Internal Medicine, Critical Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - M Kochanek
- Department I of Internal Medicine, Critical Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - B Böll
- Department I of Internal Medicine, Critical Care Medicine, University Hospital of Cologne, Cologne, Germany.
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34
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Koehler P, Jung N, Kochanek M, Lohneis P, Shimabukuro-Vornhagen A, Böll B. 'Lost in Nasal Space': Staphylococcus aureus sepsis associated with Nasal Handkerchief Packing. Infection 2018; 47:307-311. [PMID: 30229470 DOI: 10.1007/s15010-018-1221-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/11/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Staphylococcus aureus frequently causes infections in outpatient and hospital settings and can present as a highly variable entity. Typical manifestations are endocarditis, osteoarticular infections or infection of implanted prostheses, intravascular devices or foreign bodies. A thorough diagnostic evaluation with early focus identification is mandatory to improve patient outcome. CASE REPORT We report a case of a 68-year old patient with a history of double allogeneic stem cell transplant for acute myeloid leukemia who developed a S. aureus bacteremia with dissemination, severe sepsis and lethal outcome due to nasal handkerchief packing after nose bleeding. CONCLUSION A thorough medical examination with further diagnostic work-up is most important in S. aureus blood stream infection to identify and eradicate the portal(s) of entry, to rule out endocarditis, to search for spinal abscesses, osteomyelitis or spondylodiscitis. Adherence to management guides for clinicians must be of major importance to achieve optimal quality of clinical care, and thus improve patient outcome.
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Affiliation(s)
- Philipp Koehler
- Department I of Internal Medicine, Intensive Care Unit, University Hospital of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, Intensive Care Unit, University Hospital of Cologne, Cologne, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Intensive Care Unit, University Hospital of Cologne, Cologne, Germany
| | - Philipp Lohneis
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | | | - Boris Böll
- Department I of Internal Medicine, Intensive Care Unit, University Hospital of Cologne, Cologne, Germany.
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35
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Shimabukuro-Vornhagen A, Subklewe M, von Bergwelt-Baildon M. [Challenges in Immuno-Oncology - Possibilities for Optimization]. Dtsch Med Wochenschr 2018; 143:1022-1029. [PMID: 30005436 DOI: 10.1055/a-0549-6987] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Immuno-oncology has undoubtedly started a new era in the treatment of malignant diseases. Within a short time immunotherapeutic therapy concepts have become part of the standard therapy for many tumors. Already, immunotherapy is one of the most potent therapeutic options for the treatment of many malignancies. Despite its impressive achievements, there is still a significant need for improvement and many aspects of the practical application of immunotherapeutic modalities of therapy are unclear. If it succeeds in solving the challenges discussed here, immuno-oncology will certainly be one of the most important pillars of successful tumor therapy in the future. Immunotherapeutic combination therapies offer the opportunity to improve treatment outcomes. The immunological side effects of immunotherapy may sometimes be life-threatening, but if adequately treated they may be associated with a good prognosis. The development of predictive biomarkers is indispensable for effective immunotherapy. The costs of immuno-oncological therapies are sometimes very high. Therefore reasonable solutions must be found.
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36
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Shimabukuro-Vornhagen A, Gödel P, Subklewe M, Stemmler HJ, Schlößer HA, Schlaak M, Kochanek M, Böll B, von Bergwelt-Baildon MS. Cytokine release syndrome. J Immunother Cancer 2018; 6:56. [PMID: 29907163 PMCID: PMC6003181 DOI: 10.1186/s40425-018-0343-9] [Citation(s) in RCA: 907] [Impact Index Per Article: 151.2] [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: 11/24/2017] [Accepted: 04/20/2018] [Indexed: 12/16/2022] Open
Abstract
During the last decade the field of cancer immunotherapy has witnessed impressive progress. Highly effective immunotherapies such as immune checkpoint inhibition, and T-cell engaging therapies like bispecific T-cell engaging (BiTE) single-chain antibody constructs and chimeric antigen receptor (CAR) T cells have shown remarkable efficacy in clinical trials and some of these agents have already received regulatory approval. However, along with growing experience in the clinical application of these potent immunotherapeutic agents comes the increasing awareness of their inherent and potentially fatal adverse effects, most notably the cytokine release syndrome (CRS). This review provides a comprehensive overview of the mechanisms underlying CRS pathophysiology, risk factors, clinical presentation, differential diagnoses, and prognostic factors. In addition, based on the current evidence we give practical guidance to the management of the cytokine release syndrome.
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Affiliation(s)
- Alexander Shimabukuro-Vornhagen
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany. .,Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany. .,Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany. .,Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany.
| | - Philipp Gödel
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany.,Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Translational Cancer Immunology, Gene Centre, University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Comprehensive Cancer Center Munich (CCCM), Munich, Germany
| | - Hans Joachim Stemmler
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Cancer Center Munich (CCCM), Munich, Germany
| | - Hans Anton Schlößer
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany.,Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Max Schlaak
- Department of Dermatology/Venereology, University Hospital of Cologne, Cologne, Germany
| | - Matthias Kochanek
- Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany.,Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany
| | - Boris Böll
- Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany.,Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany
| | - Michael S von Bergwelt-Baildon
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany.,Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Comprehensive Cancer Center Munich (CCCM), Munich, Germany
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37
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Abstract
During the last decade the field of cancer immunotherapy has witnessed impressive progress. Highly effective immunotherapies such as immune checkpoint inhibition, and T-cell engaging therapies like bispecific T-cell engaging (BiTE) single-chain antibody constructs and chimeric antigen receptor (CAR) T cells have shown remarkable efficacy in clinical trials and some of these agents have already received regulatory approval. However, along with growing experience in the clinical application of these potent immunotherapeutic agents comes the increasing awareness of their inherent and potentially fatal adverse effects, most notably the cytokine release syndrome (CRS). This review provides a comprehensive overview of the mechanisms underlying CRS pathophysiology, risk factors, clinical presentation, differential diagnoses, and prognostic factors. In addition, based on the current evidence we give practical guidance to the management of the cytokine release syndrome.
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Affiliation(s)
- Alexander Shimabukuro-Vornhagen
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany. .,Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany. .,Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany. .,Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany.
| | - Philipp Gödel
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany.,Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Translational Cancer Immunology, Gene Centre, University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Comprehensive Cancer Center Munich (CCCM), Munich, Germany
| | - Hans Joachim Stemmler
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Cancer Center Munich (CCCM), Munich, Germany
| | - Hans Anton Schlößer
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany.,Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Max Schlaak
- Department of Dermatology/Venereology, University Hospital of Cologne, Cologne, Germany
| | - Matthias Kochanek
- Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany.,Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany
| | - Boris Böll
- Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Center of Integrated Oncology Cologne-Bonn, University Hospital of Cologne, Cologne, Germany.,Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany
| | - Michael S von Bergwelt-Baildon
- Cologne Interventional Immunology, University Hospital of Cologne, Cologne, Germany.,Intensive Care in Hemato-Oncologic Patients (iCHOP), Cologne, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Comprehensive Cancer Center Munich (CCCM), Munich, Germany
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38
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Kiehl MG, Beutel G, Böll B, Buchheidt D, Forkert R, Fuhrmann V, Knöbl P, Kochanek M, Kroschinsky F, La Rosée P, Liebregts T, Lück C, Olgemoeller U, Schalk E, Shimabukuro-Vornhagen A, Sperr WR, Staudinger T, von Bergwelt Baildon M, Wohlfarth P, Zeremski V, Schellongowski P. Consensus statement for cancer patients requiring intensive care support. Ann Hematol 2018; 97:1271-1282. [PMID: 29704018 PMCID: PMC5973964 DOI: 10.1007/s00277-018-3312-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/19/2018] [Indexed: 02/06/2023]
Abstract
This consensus statement is directed to intensivists, hematologists, and oncologists caring for critically ill cancer patients and focuses on the management of these patients.
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Affiliation(s)
- M G Kiehl
- Department of Internal Medicine I, Clinic Frankfurt/Oder GmbH, Müllroser Chaussee 7, 15236, Frankfurt (Oder), Germany.
| | - G Beutel
- Hannover Medical School (MHH) Clinic for Hematology, Coagulation, Oncology and Stem Cell Transplantation, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - B Böll
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - D Buchheidt
- III. Medical Clinic, Medical Faculty Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - R Forkert
- Johanniter-Hospital, Johanniterstr. 3-5, 53113, Bonn, Germany
| | - V Fuhrmann
- Clinic for Intensive Care Medicine, University Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - P Knöbl
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Kochanek
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - F Kroschinsky
- Department of Internal Medicine I, University Hospital, Fetschertstr. 74, 01307, Dresden, Germany
| | - P La Rosée
- Department of Internal Medicine III, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen-Schwenningen, Germany
| | - T Liebregts
- Clinic for Stem Cell Transplantation, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - C Lück
- Hannover Medical School (MHH) Clinic for Hematology, Coagulation, Oncology and Stem Cell Transplantation, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - U Olgemoeller
- Department of Cardiology and Pulmonary Medicine, University Hospital, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - E Schalk
- Department of Hematology and Oncology, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - A Shimabukuro-Vornhagen
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - W R Sperr
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - T Staudinger
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M von Bergwelt Baildon
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - P Wohlfarth
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - V Zeremski
- Department of Hematology and Oncology, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - P Schellongowski
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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39
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Prinz J, Böll B, von Bergwelt-Baildon M, Burst V, Becker JU, Carvalho-Fiel D, Shimabukuro-Vornhagen A, Kochanek M. Intoxikation nach Frostschutzmittelaufnahme. Med Klin Intensivmed Notfmed 2018; 114:159-163. [DOI: 10.1007/s00063-018-0439-5] [Citation(s) in RCA: 1] [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] [Received: 01/13/2018] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
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40
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Wennhold K, Weber TM, Klein-Gonzalez N, Thelen M, Garcia-Marquez M, Chakupurakal G, Fiedler A, Schlösser HA, Fischer R, Theurich S, Shimabukuro-Vornhagen A, von Bergwelt-Baildon M. CD40-activated B cells induce anti-tumor immunity in vivo. Oncotarget 2018; 8:27740-27753. [PMID: 26934557 PMCID: PMC5438605 DOI: 10.18632/oncotarget.7720] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/26/2016] [Indexed: 01/04/2023] Open
Abstract
The introduction of checkpoint inhibitors represents a major advance in cancer immunotherapy. Some studies on checkpoint inhibition demonstrate that combinatorial immunotherapies with secondary drivers of anti-tumor immunity provide beneficial effects for patients that do not show a strong endogenous immune response. CD40-activated B cells (CD40B cells) are potent antigen presenting cells by activating and expanding naïve and memory CD4+ and CD8+ and homing to the secondary lymphoid organs. In contrast to dendritic cells, the generation of highly pure CD40B cells is simple and time efficient and they can be expanded almost limitlessly from small blood samples of cancer patients. Here, we show that the vaccination with antigen-loaded CD40B cells induces a specific T-cell response in vivo comparable to that of dendritic cells. Moreover, we identify vaccination parameters, including injection route, cell dose and vaccination repetitions to optimize immunization and demonstrate that application of CD40B cells is safe in terms of toxicity in the recipient. We furthermore show that preventive immunization of tumor-bearing mice with tumor antigen-pulsed CD40B cells induces a protective anti-tumor immunity against B16.F10 melanomas and E.G7 lymphomas leading to reduced tumor growth. These results and our straightforward method of CD40B-cell generation underline the potential of CD40B cells for cancer immunotherapy.
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Affiliation(s)
- Kerstin Wennhold
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Tanja M Weber
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Nela Klein-Gonzalez
- Department of Hematology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Martin Thelen
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Maria Garcia-Marquez
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Geothy Chakupurakal
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Anne Fiedler
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Hans A Schlösser
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Rieke Fischer
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Theurich
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Laboratory for Neuronal Control of Metabolism, Max Planck Institute for Metabolism Research Cologne, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Michael von Bergwelt-Baildon
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
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41
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Lehmann C, Kochanek M, Abdulla D, Becker S, Böll B, Bunte A, Cadar D, Dormann A, Eickmann M, Emmerich P, Feldt T, Frank C, Fries J, Gabriel M, Goetsch U, Gottschalk R, Günther S, Hallek M, Häussinger D, Herzog C, Jensen B, Kolibay F, Krakau M, Langebartels G, Rieger T, Schaade L, Schmidt-Chanasit J, Schömig E, Schüttfort G, Shimabukuro-Vornhagen A, von Bergwelt-Baildon M, Wieland U, Wiesmüller G, Wolf T, Fätkenheuer G. Control measures following a case of imported Lassa fever from Togo, North Rhine Westphalia, Germany, 2016. ACTA ACUST UNITED AC 2018; 22. [PMID: 29019307 PMCID: PMC5709954 DOI: 10.2807/1560-7917.es.2017.22.39.17-00088] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In a patient transferred from Togo to Cologne, Germany, Lassa fever was diagnosed 12 days post mortem. Sixty-two contacts in Cologne were categorised according to the level of exposure, and gradual infection control measures were applied. No clinical signs of Lassa virus infection or Lassa specific antibodies were observed in the 62 contacts. Thirty-three individuals had direct contact to blood, other body fluids or tissue of the patients. Notably, with standard precautions, no transmission occurred between the index patient and healthcare workers. However, one secondary infection occurred in an undertaker exposed to the corpse in Rhineland-Palatinate, who was treated on the isolation unit at the University Hospital of Frankfurt. After German authorities raised an alert regarding the imported Lassa fever case, an American healthcare worker who had cared for the index patient in Togo, and who presented with diarrhoea, vomiting and fever, was placed in isolation and medevacked to the United States. The event and the transmission of Lassa virus infection outside of Africa underlines the need for early diagnosis and use of adequate personal protection equipment (PPE), when highly contagious infections cannot be excluded. It also demonstrates that larger outbreaks can be prevented by infection control measures, including standard PPE.
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Affiliation(s)
- Clara Lehmann
- Department I of Internal Medicine, University of Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - Matthias Kochanek
- Centre of Integrated Oncology Köln, University of Cologne, Germany.,Department I of Internal Medicine, University of Cologne, Germany
| | - Diana Abdulla
- Centre of Integrated Oncology Köln, University of Cologne, Germany.,Department I of Internal Medicine, University of Cologne, Germany
| | - Stephan Becker
- German Center for Infection Research (DZIF), Gießen-Marburg-Langen, Germany.,Institute for Virology, Universität Marburg, Germany
| | - Boris Böll
- Centre of Integrated Oncology Köln, University of Cologne, Germany.,Department I of Internal Medicine, University of Cologne, Germany
| | - Anne Bunte
- Public Health Department Cologne, Germany
| | - Daniel Cadar
- German Centre for Infection Research (DZIF), Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Arno Dormann
- Municipal Hospital of Cologne, Medical Department Holweide, Germany
| | - Markus Eickmann
- German Center for Infection Research (DZIF), Gießen-Marburg-Langen, Germany.,Institute for Virology, Universität Marburg, Germany
| | - Petra Emmerich
- Department of Tropical Medicine and Infectious Diseases, Center of Internal Medicine II, University of Rostock, Rostock, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Torsten Feldt
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | - Christina Frank
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Jochen Fries
- Department of Pathology, University of Cologne, Germany
| | - Martin Gabriel
- German Centre for Infection Research (DZIF), Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Udo Goetsch
- Health Protection Authority City of Frankfurt am Main, Germany
| | - René Gottschalk
- University Hospital Frankfurt, Institute of Medical Virology, Germany.,Health Protection Authority City of Frankfurt am Main, Germany
| | - Stephan Günther
- German Centre for Infection Research (DZIF), Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Michael Hallek
- Centre of Integrated Oncology Köln, University of Cologne, Germany.,Department I of Internal Medicine, University of Cologne, Germany
| | - Dieter Häussinger
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herzog
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Björn Jensen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany
| | - Felix Kolibay
- Department for Clinical Affairs, University of Cologne, Germany
| | - Michael Krakau
- Municipal Hospital of Cologne, Medical Department Holweide, Germany
| | | | - Toni Rieger
- German Centre for Infection Research (DZIF), Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Lars Schaade
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Jonas Schmidt-Chanasit
- German Centre for Infection Research (DZIF), Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Gundolf Schüttfort
- University Hospital Frankfurt, Department of Infectious Diseases, Germany
| | - Alexander Shimabukuro-Vornhagen
- Centre of Integrated Oncology Köln, University of Cologne, Germany.,Department I of Internal Medicine, University of Cologne, Germany
| | - Michael von Bergwelt-Baildon
- Centre of Integrated Oncology Köln, University of Cologne, Germany.,Department I of Internal Medicine, University of Cologne, Germany
| | | | | | - Timo Wolf
- University Hospital Frankfurt, Department of Infectious Diseases, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, University of Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
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42
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Abstract
Fever is a symptom of a wide range of diseases. Its diagnostic management is of crucial importance, whereby the interface between general practitioner and hospital plays an important role. The family practitioner is of particular importance in the detection of life-threatening or complex situations involving fever. The diagnostic algorithm presented here can serve as the basis for rapid and targeted diagnostics. Good communication between the doctor and the hospital doctor is mandatory.
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Affiliation(s)
- M Kochanek
- Medizinische Klinik I für Innere Medizin, Klinikum der Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - A Piepereit
- Hausarztpraxis am Hansaring, Köln, Deutschland
| | - B Böll
- Medizinische Klinik I für Innere Medizin, Klinikum der Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - A Shimabukuro-Vornhagen
- Medizinische Klinik I für Innere Medizin, Klinikum der Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - M Hallek
- Medizinische Klinik I für Innere Medizin, Klinikum der Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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43
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Wennhold K, Thelen M, Schlößer HA, Haustein N, Reuter S, Garcia-Marquez M, Lechner A, Kobold S, Rataj F, Utermöhlen O, Chakupurakal G, Theurich S, Hallek M, Abken H, Shimabukuro-Vornhagen A, von Bergwelt-Baildon M. Using Antigen-Specific B Cells to Combine Antibody and T Cell-Based Cancer Immunotherapy. Cancer Immunol Res 2017; 5:730-743. [PMID: 28778961 DOI: 10.1158/2326-6066.cir-16-0236] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 05/30/2017] [Accepted: 07/27/2017] [Indexed: 11/16/2022]
Abstract
Cancer immunotherapy by therapeutic activation of T cells has demonstrated clinical potential. Approaches include checkpoint inhibitors and chimeric antigen receptor T cells. Here, we report the development of an alternative strategy for cellular immunotherapy that combines induction of a tumor-directed T-cell response and antibody secretion without the need for genetic engineering. CD40 ligand stimulation of murine tumor antigen-specific B cells, isolated by antigen-biotin tetramers, resulted in the development of an antigen-presenting phenotype and the induction of a tumor antigen-specific T-cell response. Differentiation of antigen-specific B cells into antibody-secreting plasma cells was achieved by stimulation with IL21, IL4, anti-CD40, and the specific antigen. Combined treatment of tumor-bearing mice with antigen-specific CD40-activated B cells and antigen-specific plasma cells induced a therapeutic antitumor immune response resulting in remission of established tumors. Human CEA or NY-ESO-1-specific B cells were detected in tumor-draining lymph nodes and were able to induce antigen-specific T-cell responses in vitro, indicating that this approach could be translated into clinical applications. Our results describe a technique for the exploitation of B-cell effector functions and provide the rationale for their use in combinatorial cancer immunotherapy. Cancer Immunol Res; 5(9); 730-43. ©2017 AACR.
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Affiliation(s)
- Kerstin Wennhold
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Martin Thelen
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Hans Anton Schlößer
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Natalie Haustein
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Sabrina Reuter
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Maria Garcia-Marquez
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Axel Lechner
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Cologne, Germany
| | - Sebastian Kobold
- Center of Integrated Protein Science Munich (CIPSM) and Division of Clinical Pharmacology, Medical Clinic and Policlinic IV, University Hospital Munich, Munich, Germany, Member of the German Center for Lung Research
| | - Felicitas Rataj
- Center of Integrated Protein Science Munich (CIPSM) and Division of Clinical Pharmacology, Medical Clinic and Policlinic IV, University Hospital Munich, Munich, Germany, Member of the German Center for Lung Research
| | - Olaf Utermöhlen
- Department for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Geothy Chakupurakal
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Theurich
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Laboratory for Cancer-Immuno-Metabolism, Department I of Internal Medicine, University Hospital of Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Hinrich Abken
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Michael von Bergwelt-Baildon
- Cologne Interventional Immunology (CII), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
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44
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Lechner A, Schlößer H, Rothschild SI, Thelen M, Reuter S, Zentis P, Shimabukuro-Vornhagen A, Theurich S, Wennhold K, Garcia-Marquez M, Tharun L, Quaas A, Schauss A, Isensee J, Hucho T, Huebbers C, von Bergwelt-Baildon M, Beutner D. Characterization of tumor-associated T-lymphocyte subsets and immune checkpoint molecules in head and neck squamous cell carcinoma. Oncotarget 2017; 8:44418-44433. [PMID: 28574843 PMCID: PMC5546490 DOI: 10.18632/oncotarget.17901] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [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: 01/10/2017] [Accepted: 04/25/2017] [Indexed: 01/10/2023] Open
Abstract
The composition of tumor-infiltrating lymphocytes (TIL) reflects biology and immunogenicity of cancer. Here, we characterize T-cell subsets and expression of immune checkpoint molecules in head and neck squamous cell carcinoma (HNSCC). We analyzed TIL subsets in primary tumors (n = 34), blood (peripheral blood mononuclear cells (PBMC); n = 34) and non-cancerous mucosa (n = 7) of 34 treatment-naïve HNSCC patients and PBMC of 15 healthy controls. Flow cytometry analyses revealed a highly variable T-cell infiltration mainly of an effector memory phenotype (CD45RA-/CCR7-). Naïve T cells (CD45RA+/CCR7+) were decreased in the microenvironment compared to PBMC of patients, while regulatory T cells (CD4+/CD25+/CD127low and CD4+/CD39+) were elevated. Furthermore, we performed digital image analyses of entire cross sections of HNSCC to define the 'Immunoscore' (CD3+ and CD8+ cell infiltration in tumor core and invasive margin) and quantified MHC class I expression on tumor cells by immunohistochemistry. Immune checkpoint molecules cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death 1 (PD-1) and programmed cell death 1 ligand 1 (PD-L1) were increased in TILs compared to peripheral T cells in flow-cytometric analysis. Human papillomavirus (HPV) positive tumors showed higher numbers of TILs, but a similar composition of T-cell subsets and checkpoint molecule expression compared to HPV negative tumors. Taken together, the tumor microenvironment of HNSCC is characterized by a strong infiltration of regulatory T cells and high checkpoint molecule expression on T-cell subsets. In view of increasingly used immunotherapies, a detailed knowledge of TILs and checkpoint molecule expression on TILs is of high translational relevance.
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Affiliation(s)
- Axel Lechner
- Cologne Interventional Immunology, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Hans Schlößer
- Cologne Interventional Immunology, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Sacha I. Rothschild
- Cologne Interventional Immunology, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- University Hospital Basel, Department of Internal Medicine, Medical Oncology, Basel, Switzerland
| | - Martin Thelen
- Cologne Interventional Immunology, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Sabrina Reuter
- Cologne Interventional Immunology, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Peter Zentis
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Cologne Interventional Immunology, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
| | - Sebastian Theurich
- Cologne Interventional Immunology, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
- Max-Planck-Institute for Metabolism Research, Cologne, Germany
| | - Kerstin Wennhold
- Cologne Interventional Immunology, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Maria Garcia-Marquez
- Cologne Interventional Immunology, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Lars Tharun
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Alexander Quaas
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Astrid Schauss
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Jörg Isensee
- Department of Anesthesiology and Intensive Care Medicine, Experimental Anesthesiology and Pain Research, University Hospital of Cologne, University of Cologne, Germany
| | - Tim Hucho
- Department of Anesthesiology and Intensive Care Medicine, Experimental Anesthesiology and Pain Research, University Hospital of Cologne, University of Cologne, Germany
| | - Christian Huebbers
- Jean-Uhrmacher Institute for Clinical ENT Research, University of Cologne, Cologne, Germany
| | - Michael von Bergwelt-Baildon
- Cologne Interventional Immunology, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
| | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
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45
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Schlößer HA, Thelen M, Dieplinger G, von Bergwelt-Baildon A, Garcia-Marquez M, Reuter S, Shimabukuro-Vornhagen A, Wennhold K, Haustein N, Buchner D, Heiermann N, Kleinert R, Wahba R, Ditt V, Kurschat C, Cingöz T, Becker J, Stippel DL, von Bergwelt-Baildon M. Prospective Analyses of Circulating B Cell Subsets in ABO-Compatible and ABO-Incompatible Kidney Transplant Recipients. Am J Transplant 2017; 17:542-550. [PMID: 27529836 DOI: 10.1111/ajt.14013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 06/16/2016] [Revised: 07/24/2016] [Accepted: 08/09/2016] [Indexed: 01/25/2023]
Abstract
Immunosuppressive strategies applied in renal transplantation traditionally focus on T cell inhibition. B cells were mainly examined in the context of antibody-mediated rejection, whereas the impact of antibody-independent B cell functions has only recently entered the field of transplantation. Similar to T cells, distinct B cell subsets can enhance or inhibit immune responses. In this study, we prospectively analyzed the evolution of B cell subsets in the peripheral blood of AB0-compatible (n = 27) and AB0-incompatible (n = 10) renal transplant recipients. Activated B cells were transiently decreased and plasmablasts were permanently decreased in patients without signs of rejection throughout the first year. In patients with histologically confirmed renal allograft rejection, activated B cells and plasmablasts were significantly elevated on day 365. Rituximab treatment in AB0-incompatible patients resulted in long-lasting B cell depletion and in a naïve phenotype of repopulating B cells 1 year following transplantation. Acute allograft rejection was correlated with an increase of activated B cells and plasmablasts and with a significant reduction of regulatory B cell subsets. Our study demonstrates the remarkable effects of standard immunosuppression on circulating B cell subsets. Furthermore, the B cell compartment was significantly altered in rejecting patients. A specific targeting of deleterious B cell subsets could be of clinical benefit in renal transplantation.
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Affiliation(s)
- H A Schlößer
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Interventional Immunology, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - M Thelen
- Cologne Interventional Immunology, University of Cologne, Köln, Germany
| | - G Dieplinger
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - A von Bergwelt-Baildon
- Cologne Transplant Center, University of Cologne, Köln, Germany.,Department of Internal Medicine II, University of Cologne, Köln, Germany
| | - M Garcia-Marquez
- Cologne Interventional Immunology, University of Cologne, Köln, Germany
| | - S Reuter
- Cologne Interventional Immunology, University of Cologne, Köln, Germany
| | - A Shimabukuro-Vornhagen
- Cologne Interventional Immunology, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - K Wennhold
- Cologne Interventional Immunology, University of Cologne, Köln, Germany
| | - N Haustein
- Cologne Interventional Immunology, University of Cologne, Köln, Germany
| | - D Buchner
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - N Heiermann
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - R Kleinert
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - R Wahba
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - V Ditt
- Institute for Clinical Transfusion Medicine, Merheim Medical Center Cologne, Köln, Germany
| | - C Kurschat
- Cologne Transplant Center, University of Cologne, Köln, Germany.,Department of Internal Medicine II, University of Cologne, Köln, Germany
| | - T Cingöz
- Cologne Transplant Center, University of Cologne, Köln, Germany.,Department of Internal Medicine II, University of Cologne, Köln, Germany
| | - J Becker
- Cologne Transplant Center, University of Cologne, Köln, Germany.,Institute of Pathology, University of Cologne, Köln, Germany
| | - D L Stippel
- Department of General, Visceral and Cancer Surgery, University of Cologne, Köln, Germany.,Cologne Transplant Center, University of Cologne, Köln, Germany
| | - M von Bergwelt-Baildon
- Cologne Interventional Immunology, University of Cologne, Köln, Germany.,Department of Internal Medicine I, University of Cologne, Köln, Germany
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46
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Michels G, Ruhparwar A, Pfister R, Welte T, Gottlieb J, Andriopoulos N, Teschner S, Burst V, Mertens J, Stippel D, Herter-Sprie G, Shimabukuro-Vornhagen A, Böll B, von Bergwelt-Baildon M, Theurich S, Vehreschild J, Scheid C, Chemnitz J, Kochanek M. Transplantationsmedizin in der Intensivmedizin. Repetitorium Internistische Intensivmedizin 2017. [PMCID: PMC7193715 DOI: 10.1007/978-3-662-53182-2_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Die Betreuung von Patienten vor und nach einer Organtransplantation gehört zum Gebiet der „speziellen Intensivmedizin“ des jeweiligen Fachbereichs. Die transplantationsspezifische Intensivmedizin setzt daher ein interdisziplinäres Management voraus. Neben der Organprotektion bzw. dem Monitoring von speziellen transplantationsrelevanten Problemen steht die Immunsuppression. Auf das Management mit Immunsuppressiva und von transplantationsassoziierten, intensivmedizinisch relevanten Problemen wird in diesem Kapitel eingegangen. Speziell werden Herz-, Lungen-, Leber-, Nieren- und Stammzelltransplantationen dargestellt.
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47
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Abstract
Answer questions and earn CME/CNE The increasing prevalence of patients living with cancer in conjunction with the rapid progress in cancer therapy will lead to a growing number of patients with cancer who will require intensive care treatment. Fortunately, the development of more effective oncologic therapies, advances in critical care, and improvements in patient selection have led to an increased survival of critically ill patients with cancer. As a consequence, critical care has become an important cornerstone in the continuum of modern cancer care. Although, in many aspects, critical care for patients with cancer does not differ from intensive care for other seriously ill patients, there are several challenging issues that are unique to this patient population and require special knowledge and skills. The optimal management of critically ill patients with cancer necessitates expertise in oncology, critical care, and palliative medicine. Cancer specialists therefore have to be familiar with key principles of intensive care for critically ill patients with cancer. This review provides an overview of the state-of-the-art in the individualized management of critically ill patients with cancer. CA Cancer J Clin 2016;66:496-517. © 2016 American Cancer Society.
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Affiliation(s)
- Alexander Shimabukuro-Vornhagen
- Consultant, Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Member, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Boris Böll
- Member, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Head of Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Matthias Kochanek
- Member, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Program Director, Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Éli Azoulay
- Director, Medical Intensive Care Unit, St. Louis Hospital, Paris, France
- Professor of Medicine, Teaching and Research Unit, Department of Medicine, Paris Diderot University, Paris, France
- Chair, Study Group for Respiratory Intensive Care in Malignancies, St. Louis Hospital, Paris, France
| | - Michael S von Bergwelt-Baildon
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Program Director, Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Professor, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
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48
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Chakupurakal G, Garcia-Marquez MA, Shimabukuro-Vornhagen A, Kluth S, Schlosser H, Theurich S, Scheid C, Hallek M, Holtick U, von Bergwelt-Baildon M. Regulatory B10 cells display an altered homoeostasis in acute graft-versus-host disease. Eur J Haematol 2016; 98:128-133. [PMID: 27717015 DOI: 10.1111/ejh.12810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The role of B cells and the subgroup of IL-10 producing B cells, known to have a regulatory function, in patients following a haematopoietic stem cell transplant (alloSCT) has not been clearly understood to date. METHODS We prospectively recruited 95 patients following an alloSCT and studied the B-cell reconstitution on days 30, 90 and 150. Regulatory B10 cells could be analysed in 22 consecutively recruited patients on day 30 post-transplant. RESULTS The total B-cell percentages in transplant recipients (median 0.33; range 0.01-5.9) were significantly reduced than the controls (P = 0.0001) and constituted predominantly of transitional CD24high CD38high B cells. Regulatory B10 cells could be analysed in 22 consecutively recruited patients on day 30 post-transplant. The percentages of B10 cells (median 1.35; 0.0-4.5) were significantly reduced in the transplant recipients in comparison with the control cohort (P < 0.0001). Interestingly, the percentages of B10 cells in patients with acute GvHD (median 1.7; 0.33-4.5) were significantly higher than those without GvHD (median 0.7; 0-1.9) (P = 0.0003). CONCLUSION This is the first report demonstrating B10 cells in stem cell transplant recipients in the early post-alloSCT (30 d) period. Our data suggest a possible role for B10 cells in the pathophysiology of acute GvHD. Further longitudinal studies are warranted to understand the implications of our findings.
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Affiliation(s)
- Geothy Chakupurakal
- Department I of Internal Medicine, Interventional Immunology Group, University of Cologne, Cologne, Germany.,Praxis Klinik for Haematology and Oncology, Koblenz, Germany.,Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - María Alejandra Garcia-Marquez
- Department I of Internal Medicine, Interventional Immunology Group, University of Cologne, Cologne, Germany.,Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Alexander Shimabukuro-Vornhagen
- Department I of Internal Medicine, Interventional Immunology Group, University of Cologne, Cologne, Germany.,Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Sandra Kluth
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Hans Schlosser
- Department of General, Visceral and Cancer Surgery, Interventional Immunology Group, University of Cologne, Cologne, Germany
| | - Sebastian Theurich
- Department I of Internal Medicine, Interventional Immunology Group, University of Cologne, Cologne, Germany.,Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany.,Max-Planck-Institute for Metabolism Research, Cologne, Germany
| | - Christof Scheid
- Department I of Internal Medicine, Interventional Immunology Group, University of Cologne, Cologne, Germany.,Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Udo Holtick
- Department I of Internal Medicine, Interventional Immunology Group, University of Cologne, Cologne, Germany.,Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Michael von Bergwelt-Baildon
- Department I of Internal Medicine, Interventional Immunology Group, University of Cologne, Cologne, Germany.,Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
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49
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Kochanek M, Shimabukuro-Vornhagen A, von Bergwelt-Baildon M, Böll B. [Sepsis: new findings and developments. Update 2016]. Dtsch Med Wochenschr 2016; 141:1455-1458. [PMID: 27701690 DOI: 10.1055/s-0042-112089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The incidence of sepsis increases in Germany from latest DRG evaluations and also the mortality is still at a high level. The aim of the new Sepsis - 3 definition is to optimize the identification and initiation of therapy. The treatment algorithms by Rivers (EGDT) are getting old. Rapid identification of septic patients, rapid administration of antibiotics and rapid therapy management are crucial.
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50
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Shimabukuro-Vornhagen A, García-Márquez M, Fischer RN, Iltgen-Breburda J, Fiedler A, Wennhold K, Rappl G, Abken H, Lehmann C, Herling M, Wolf D, Fätkenheuer G, Rubbert-Roth A, Hallek M, Theurich S, von Bergwelt-Baildon M. Antigen-presenting human B cells are expanded in inflammatory conditions. J Leukoc Biol 2016; 101:577-587. [DOI: 10.1189/jlb.5a0416-182r] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/16/2016] [Accepted: 07/21/2016] [Indexed: 11/24/2022] Open
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