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Kühnl A, Peckitt C, Patel B, Ardeshna KM, Macheta MP, Radford J, Johnson R, Paneesha S, Barton S, Chau I, Begum R, Valeri N, Wotherspoon A, Du Y, Zerizer I, Cunningham D. R-GEM-Lenalidomide versus R-GEM-P as second-line treatment of diffuse large B-cell lymphoma: results of the UK NRCI phase II randomised LEGEND trial. Ann Hematol 2020; 99:105-112. [PMID: 31776726 DOI: 10.1007/s00277-019-03842-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/05/2019] [Indexed: 01/25/2023]
Abstract
Outcome of patients with relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL) remains poor, highlighting the need for novel treatment approaches. The multicentre randomised phase II LEGEND trial evaluated lenalidomide in combination with rituximab, methylprednisolone and gemcitabine (R-GEM-L) vs. standard R-GEM-P as second-line treatment of DLBCL. The study closed early to recruitment after the planned interim analysis failed to demonstrate a complete response (CR) rate of ≥ 40% in either arm. Among 34 evaluable patients, 7/18 (38.9%) achieved CR with R-GEM-L and 3/16 (18.8%) with R-GEM-P. Median event-free and overall survival was 3.5/3.8 months and 10.8/8.3 months for R-GEM-L and R-GEM-P, respectively. The incidence of grade ≥ 3 toxicities was 52% in R-GEM-L and 83% in R-GEM-P. Efficacy and tolerability of R-GEM-L seem comparable with R-GEM-P and other standard salvage therapies, but a stringent design led to early trial closure. Combination of lenalidomide with gemcitabine-based regimens should be further evaluated in r/r DLBCL.
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Affiliation(s)
- Andrea Kühnl
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, UK
| | - Clare Peckitt
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | - Bijal Patel
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | | | | | - John Radford
- University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | - Sarah Barton
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
- Wellington Blood and Cancer Centre, Wellington, New Zealand
| | - Ian Chau
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | - Ruwaida Begum
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | - Nicola Valeri
- Division of Molecular Pathology, The Institute of Cancer Research, Surrey, UK
| | - Andrew Wotherspoon
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | - Yong Du
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | - Imene Zerizer
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK
| | - David Cunningham
- Royal Marsden NHS Foundation Trust London and Surrey, Downs Road Sutton, Surrey, SM2 5PT, UK.
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Trenner M, Eckstein HH, Kallmayer MA, Reutersberg B, Kühnl A. Secondary analysis of statutorily collected routine data. Gefässchirurgie 2019. [DOI: 10.1007/s00772-019-0524-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kühnl A, Cunningham D, Hutka M, Peckitt C, Rozati H, Morano F, Chong I, Gillbanks A, Wotherspoon A, Harris M, Murray T, Chau I. Rapid access clinic for unexplained lymphadenopathy and suspected malignancy: prospective analysis of 1000 patients. BMC Hematol 2018; 18:19. [PMID: 30128155 PMCID: PMC6092787 DOI: 10.1186/s12878-018-0109-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 06/25/2018] [Indexed: 11/25/2022]
Abstract
Background In patients presenting with peripheral lymphadenopathy, it is critical to effectively identify those with underlying cancer who require urgent specialist care. Methods We analyzed a large dataset of 1000 consecutive patients with unexplained lymphadenopathy referred between 2001 and 2009 to the Royal Marsden Hospital (RMH) rapid access lymph node diagnostic clinic (LNDC). Results Cancer was diagnosed in 14% of patients. Factors predictive for malignant disease were male sex, age, supraclavicular and multiple site involvement. Cancer-associated symptoms were present for a median of 8 weeks. The median time from referral to start of cancer therapy was 53 days. Fine needle aspiration (FNA) was performed in 83% of patients with malignancies. Sensitivity and specificity of FNA were limited (50 and 87%, respectively for any malignancy; 30 and 79%, respectively for lymphoma). The vast majority of cancer patients received diagnostic biopsies on the basis of suspicious clinical and ultrasound findings; the FNA result contributed to establishing the diagnosis in only 4 cases. Conclusions In conclusion, we demonstrate that Oncologist-led rapid access clinics are successful concepts to assess patients with unexplained lymphadenopathy. Our data suggest that a routine use of FNA should be reconsidered in this setting. Electronic supplementary material The online version of this article (10.1186/s12878-018-0109-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Kühnl
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - David Cunningham
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Margaret Hutka
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Clare Peckitt
- 2Department of Computing, Royal Marsden NHS Foundation Trust, London, Surrey UK
| | - Hamoun Rozati
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Federica Morano
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Irene Chong
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Angela Gillbanks
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Andrew Wotherspoon
- 3Department of Histopathology, Royal Marsden NHS Foundation Trust, London, Surrey UK
| | - Michelle Harris
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Tracey Murray
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
| | - Ian Chau
- 1Department of Medicine, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT UK
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Kühnl A, Cunningham D, Chau I. Beyond genomics - Targeting the epigenome in diffuse large B-cell lymphoma. Cancer Treat Rev 2017; 59:132-137. [PMID: 28822237 DOI: 10.1016/j.ctrv.2017.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/15/2017] [Revised: 07/25/2017] [Accepted: 07/31/2017] [Indexed: 11/18/2022]
Abstract
After decades of intense research on genetic alterations in cancer and successful implementation of genetically-based targeted therapies, the field of cancer epigenetics is only beginning to be fully recognized. The discovery of frequent mutations in genes modifying the epigenome in diffuse large B-cell lymphoma (DLBCL) has highlighted the outstanding role of epigenetic deregulation in this disease. Identification of epigenetically-driven DLBCL subgroups and development of novel epigenetic drugs have rapidly advanced. However, further insights are needed into the biological consequences of epigenetic alterations and the possibility of restoring the aberrant epigenome with specific therapies to bring this treatment concept further into clinical practice. This review will summarize the main epigenetic changes found in DLBCL and their potential for precision medicine approaches.
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Affiliation(s)
- Andrea Kühnl
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - David Cunningham
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Ian Chau
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom.
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Kühnl A, Cunningham D, Counsell N, Hawkes EA, Qian W, Smith P, Chadwick N, Lawrie A, Mouncey P, Jack A, Pocock C, Ardeshna KM, Radford J, McMillan A, Davies J, Turner D, Kruger A, Johnson PW, Gambell J, Rosenwald A, Ott G, Horn H, Ziepert M, Pfreundschuh M, Linch D. Outcome of elderly patients with diffuse large B-cell lymphoma treated with R-CHOP: results from the UK NCRI R-CHOP14v21 trial with combined analysis of molecular characteristics with the DSHNHL RICOVER-60 trial. Ann Oncol 2017; 28:1540-1546. [PMID: 28398499 PMCID: PMC5815562 DOI: 10.1093/annonc/mdx128] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 12/09/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is an on-going debate whether 2- or 3-weekly administration of R-CHOP is the preferred first-line treatment for elderly patients with diffuse large B-cell lymphoma (DLBCL). The UK NCRI R-CHOP14v21 randomized phase 3 trial did not demonstrate a difference in outcomes between R-CHOP-14 and R-CHOP-21 in newly diagnosed DLBCL patients aged 19-88 years, but data on elderly patients have not been reported in detail so far. Here, we provide a subgroup analysis of patients ≥60 years treated on the R-CHOP14v21 trial with extended follow-up. PATIENTS AND METHODS Six hundred and four R-CHOP14v21 patients ≥60 years were included in this subgroup analysis, with a median follow-up of 77.7 months. To assess the impact of MYC rearrangements (MYC-R) and double-hit-lymphoma (DHL) on outcome in elderly patients, we performed a joint analysis of cases with available molecular data from the R-CHOP14v21 (N = 217) and RICOVER-60 (N = 204) trials. RESULTS Elderly DLBCL patients received high dose intensities with median total doses of ≥98% for all agents. Toxicities were similar in both arms with the exception of more grade ≥3 neutropenia (P < 0.0001) and fewer grade ≥3 thrombocytopenia (P = 0.05) in R-CHOP-21 versus R-CHOP-14. The elderly patient population had a favorable 5-year overall survival (OS) of 69% (95% CI: 65-73). We did not identify any subgroup of patients that showed differential response to either regimen. In multivariable analysis including individual factors of the IPI, gender, bulk, B2M and albumin levels, only age and B2M were of independent prognostic significance for OS. Molecular analyses demonstrated a significant impact of MYC-R (HR = 1.96; 95% CI: 1.22-3.16; P = 0.01) and DHL (HR = 2.21; 95% CI: 1.18-4.11; P = 0.01) on OS in the combined trial cohorts, independent of other prognostic factors. CONCLUSIONS Our data support equivalence of both R-CHOP application forms in elderly DLBCL patients. Elderly MYC-R and DHL patients have inferior prognosis and should be considered for alternative treatment approaches. TRIAL NUMBERS ISCRTN 16017947 (R-CHOP14v21); NCT00052936 (RICOVER-60).
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Biomarkers, Tumor/genetics
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Drug Administration Schedule
- Female
- Gene Rearrangement
- Humans
- Kaplan-Meier Estimate
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Multivariate Analysis
- Patient Selection
- Precision Medicine
- Prednisone/administration & dosage
- Prednisone/adverse effects
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-6/genetics
- Proto-Oncogene Proteins c-myc/genetics
- Risk Factors
- Rituximab
- Time Factors
- Treatment Outcome
- United Kingdom
- Vincristine/administration & dosage
- Vincristine/adverse effects
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Affiliation(s)
- A. Kühnl
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - D. Cunningham
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - N. Counsell
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - E. A. Hawkes
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
- Olivia-Newton John Cancer Research & Wellness Centre, Melbourne, Australia
| | - W. Qian
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - P. Smith
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - N. Chadwick
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - A. Lawrie
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - P. Mouncey
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - A. Jack
- HMDS, St James’s Institute of Oncology, Leeds
| | | | - K. M. Ardeshna
- Department of Hematology, University College London, London
- Mount Vernon Cancer Centre, Northwood
| | - J. Radford
- Department of Medical Oncology, University of Manchester and the Christie NHS Foundation Trust, Manchester
| | - A. McMillan
- Department of Hematology, Nottingham City Hospital, Nottingham
| | | | - D. Turner
- Department of Hematology, Torbay Hospital, Torquay
| | | | - P. W. Johnson
- Cancer Research UK Center, University of Southampton, Southampton, UK
| | - J. Gambell
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - A. Rosenwald
- Institute of Pathology, Würzburg University, Würzburg
| | - G. Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart
| | - H. Horn
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tübingen, Stuttgart
| | - M. Ziepert
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig
| | - M. Pfreundschuh
- Department of Medicine, Saarland University Medical School, Homburg/Saar, Germany
| | - D. Linch
- Department of Hematology, University College London, London
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Kallmayer MA, Tsantilas P, Knappich C, Haller B, Storck M, Stadlbauer T, Kühnl A, Zimmermann A, Eckstein HH. Patient characteristics and outcomes of carotid endarterectomy and carotid artery stenting: analysis of the German mandatory national quality assurance registry - 2003 to 2014. J Cardiovasc Surg (Torino) 2015; 56:827-836. [PMID: 26381216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM In Germany, every surgical or endovascular procedure on the extracranial carotid artery is documented in a mandatory quality assurance registry. The purpose of this study is to describe the patient characteristics, the indications for treatment, and the short-term outcomes as well as to analyse the corresponding trends from 2003 to 2014. METHODS Data on demographics, peri-procedural measures, and outcomes were extracted from the annual quality reports published by the Federal Agency for Quality Assurance and the Institute for Applied Quality Improvement and Research in Health Care. Data were available from 2003 to 2014 for carotid endarterectomy (CEA) and from 2012 to 2014 for carotid artery stenting (CAS). The primary outcome event of this study is any stroke or death until discharge from hospital. Temporal trends of categorical variables were statistically analysed using the Cochran-Armitage test for trend. RESULTS Between 2003 and 2014, 309,405 CEAs and 18,047 CAS procedures were documented in the database; 68.1% of all patients were male. The mean age of patients treated with CEA increased from 68.9 years in 2003 to 70.9 years in 2014. The proportion of patients with ASA stages III to V increased from 65% to 71% in CEA, whereas it decreased from 44% to 41% in CAS patients. 53.1% of all CEAs were performed for asymptomatic patients (group A), 34.4% for symptomatic patients treated electively (group B), and 11.2% a in a collective group including other indications for CEA or CAS (such as recurrent stenosis, carotid aneurysms, emergency treatment due to stroke-in-evolution). The corresponding data for CAS are 49.3%, 26.1% and 26.3% respectively. In group B, the interval between the neurological index event and CEA decreased from 28 to 8 days (P<0.001). In patients treated with CAS, this interval was 9 days in 2012 (no further data available). On average, 67.1% and 48.2% of surgically treated patients as well as 77.8% and 69.8% of CAS patients were neurologically assessed before and after the procedure, respectively. From 2003 to 2014, CEA procedures were performed more frequently in locoregional anesthesia (10.1% to 29.1%, P<0.001). The same trend was observed for the application of the eversion technique (37.0% to 41.6%, P<0.001), the neurophysiological monitoring (49.8% to 61.8%, P<0.001), and the intra-procedural assessment of the treated artery (44.5% to 69.7%, P<0.001). In contrast, shunting was used less frequently (48.1% to 43.0%, P<0.001). Averagely 95.7% of all endovascular procedures were performed using stent-angioplasty. In 54.2% a protection device was used. Nitinol and bare metal stents were used in 74.1% and 21.4% of cases, respectively. The in-hospital rate of any stroke or death decreased from 2.0% to 1.1% in asymptomatic patients treated with CEA without a contralateral stenosis ≥75% or occlusion, P<0.001). In patients treated with CAS this rate did not increase (1.7% to 1.8%, p=0.909). The corresponding rates in CEA and CAS patients with severe contralateral stenosis or occlusion varied between 1.9%-3.1% and 2.2%-2.6%, respectively. In symptomatic patients (group B) with a stenosis of 50 percent or more, the rate of any stroke or death decreased significantly after CEA from 4.2% to 2.4% (P<0.001) and remained stable after CAS (3.9% to 3.5%, P=0.577). CONCLUSION This report on 327,452 carotid procedures analysed one of the largest quality registries on CEA and CAS worldwide. Data indicate that treated patients became older and sicker, whereas in contrast, the in-hospital rates of stroke or death are decreasing over time.
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Affiliation(s)
- M A Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der IsarTechnische Universität München, Munich, Germany -
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Tsantilas P, Kühnl A, Kallmayer M, Knappich C, Schmid S, Kuetchou A, Zimmermann A, Eckstein HH. Stroke risk in the early period after carotid related symptoms: a systematic review. J Cardiovasc Surg (Torino) 2015; 56:845-852. [PMID: 26399273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Current guidelines recommend performing carotid endarterectomy in patients with symptomatic carotid disease as soon as possible after the neurological index event. However, early stroke risk has not been well documented for this patient group. We therefore conducted a systematic analysis of the current literature on the recurrent risk of ischemic events in patients with symptomatic carotid stenosis. Systematic review was performed by searching the MEDLINE® database from 1950 until June 8, 2015 (key words: cerebral ischemia, transient ischemic attack, amaurosis fugax, stroke, symptomatic carotid stenosis, recurrent risk, outcome, prognosis, follow-up, cohort and natural history). All studies reporting stroke risks in patients with symptomatic carotid stenosis after neurologic index events within a period of 7 days were included. Cumulative stroke risks with 95% confidence intervals after a neurologic index event were recalculated at 2-3, 7, 14 and 30 days and a meta-analysis including an analysis of heterogeneity were performed using the statistical package R and Excel for Mac 2003. Ten studies with a total number of 2634 patients were included. Results of an overall stroke risk were as follows: 2.0-17.2% at 2-3 days, 0-22.1% at 7 days, 0-29.6% at 14 days and 0-11.1% at 30 days in patients with a symptomatic extracranial carotid stenosis. The pooled stroke risk in the six studies with active follow-up was 6.0% (95% CI 2.4-14.4) at 2-3 days, 10.9% (6.1-18.7) at 7 days and 17.6% (9.7-29.9) at 14 days. Pooled stroke risk in the three studies with uncensored populations was even higher with 6.4% (1.5-23.8%) at 2-3 days, 19.5% (12.7-28.7) at 7 days and 26.1% (20.6-32.5%) at 14 days. Significant heterogeneity (P<0.001) could be explained by the different inclusion criteria and the study's design. Retrospective studies with passive follow-up had the lowest stroke risk whereas prospective studies with active follow-up and without bias through early intervention by carotid endarterectomy or carotid stenting had the highest stroke risk. The risk of recurrence of cerebrovascular events in patients with symptomatic carotid stenosis within the first days after a neurologic index event is as high as 6.4% (1.5-23.8), 19.5% (12.7-28.7) and 26.1% (20.6-32.5) after 2-3, 7 and 14 days respectively. Patients with a symptomatic carotid stenosis are therefore at a very high risk of a definitive stroke. Recommendations by current guidelines to perform carotid endarterectomy as soon as possible after the neurologic index event are therefore justified.
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Affiliation(s)
- P Tsantilas
- Department of Vascular and Endovascular Surgery, Klinikum Rechts der Isar Technical University,Munich, Germany -
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Kallmayer M, Kühnl A, Haller B, Storck M, Zimmermann A, Eckstein H. Trends and Outcomes of Carotid Endarterectomy and Carotid Stenting in Germany Between 2003 and 2013 -– Results from the German Mandatory National Quality Assurance Registry. Eur J Vasc Endovasc Surg 2015. [DOI: 10.1016/j.ejvs.2015.06.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kallmayer M, Tsantilas P, Knappich C, Deutsch L, Haller B, Söllner H, Storck M, Kühnl A, Zimmermann A, Eckstein HH. Trends und Ergebnisse der Karotischirurgie in Deutschland 2003–2013. Gefässchirurgie 2015. [DOI: 10.1007/s00772-015-0040-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kühnl A, Valk PJM, Sanders MA, Ivey A, Hills RK, Mills KI, Gale RE, Kaiser MF, Dillon R, Joannides M, Gilkes A, Haferlach T, Schnittger S, Duprez E, Linch DC, Delwel R, Löwenberg B, Baldus CD, Solomon E, Burnett AK, Grimwade D. Downregulation of the Wnt inhibitor CXXC5 predicts a better prognosis in acute myeloid leukemia. Blood 2015; 125:2985-94. [PMID: 25805812 PMCID: PMC4463809 DOI: 10.1182/blood-2014-12-613703] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 03/11/2015] [Indexed: 12/13/2022] Open
Abstract
The gene CXXC5 on 5q31 is frequently deleted in acute myeloid leukemia (AML) with del(5q), suggesting that inactivation of CXXC5 might play a role in leukemogenesis. Here, we investigated the functional and prognostic implications of CXXC5 expression in AML. CXXC5 mRNA was downregulated in AML with MLL rearrangements, t(8;21) and GATA2 mutations. As a mechanism of CXXC5 inactivation, we found evidence for epigenetic silencing by promoter methylation. Patients with CXXC5 expression below the median level had a lower relapse rate (45% vs 59%; P = .007) and a better overall survival (OS, 46% vs 28%; P < .001) and event-free survival (EFS, 36% vs 21%; P < .001) at 5 years, independent of cytogenetic risk groups and known molecular risk factors. In gene-expression profiling, lower CXXC5 expression was associated with upregulation of cell-cycling genes and co-downregulation of genes implicated in leukemogenesis (WT1, GATA2, MLL, DNMT3B, RUNX1). Functional analyses demonstrated CXXC5 to inhibit leukemic cell proliferation and Wnt signaling and to affect the p53-dependent DNA damage response. In conclusion, our data suggest a tumor suppressor function of CXXC5 in AML. Inactivation of CXXC5 is associated with different leukemic pathways and defines an AML subgroup with better outcome.
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MESH Headings
- Adolescent
- Adult
- Aged
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Carrier Proteins/antagonists & inhibitors
- Carrier Proteins/genetics
- Carrier Proteins/metabolism
- Cell Cycle
- Cohort Studies
- DNA Methylation
- DNA-Binding Proteins
- Down-Regulation
- Female
- Follow-Up Studies
- Gene Expression Profiling
- Gene Expression Regulation, Leukemic
- Humans
- Immunoenzyme Techniques
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/pathology
- Male
- Middle Aged
- Mutation/genetics
- Oligonucleotide Array Sequence Analysis
- Prognosis
- Promoter Regions, Genetic/genetics
- RNA, Messenger/genetics
- Real-Time Polymerase Chain Reaction
- Reverse Transcriptase Polymerase Chain Reaction
- Signal Transduction
- Survival Rate
- Transcription Factors
- Tumor Cells, Cultured
- Wnt Proteins/antagonists & inhibitors
- Young Adult
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Affiliation(s)
- Andrea Kühnl
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom; Department of Hematology and Oncology, Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Peter J M Valk
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mathijs A Sanders
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Adam Ivey
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Robert K Hills
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Ken I Mills
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, United Kingdom
| | - Rosemary E Gale
- Department of Haematology, University College London, London, United Kingdom
| | - Martin F Kaiser
- Department of Hematology and Oncology, Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Melanie Joannides
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Amanda Gilkes
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | | | | | - Estelle Duprez
- Centre de Recherche en Cancérologie de Marseille, INSERM U1068, Centre National de la Recherche Scientifique UMR7258, Institut Paoli-Calmettes, Aix Marseille University, Marseille, France
| | - David C Linch
- Department of Haematology, University College London, London, United Kingdom
| | - Ruud Delwel
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bob Löwenberg
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Claudia D Baldus
- Department of Hematology and Oncology, Charité University Hospital Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Ellen Solomon
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Alan K Burnett
- Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - David Grimwade
- Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
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Eckstein HH, Knipfer E, Trenner M, Kühnl A, Söllner H. Epidemiologie und Behandlung der PAVK und der akuten Extremitätenischämie in deutschen Krankenhäusern von 2005 bis 2012. Gefässchirurgie 2014. [DOI: 10.1007/s00772-013-1267-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ringleb P, Görtler M, Nabavi D, Arning C, Sander D, Eckstein HH, Kühnl A, Berkefeld J, Diel R, Dörfler A, Kopp I, Langhoff R, Lawall H, Storck M. S3-Leitlinie Extracranielle Carotisstenose. Gefässchirurgie 2012. [DOI: 10.1007/s00772-012-1052-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
An increasing number of cytogenetic and molecular genetic aberrations have been identified in acute myeloid leukaemia (AML), highlighting the biological heterogeneity of the disease. Moreover, the characterisation of specific molecular abnormalities provides the basis for targeted therapies, such as all trans retinoic acid (ATRA) and arsenic trioxide treatment in acute promyelocytic leukaemia or tyrosine kinase inhibitors in AML with FLT3 mutations. Several cytogenetic and molecular genetic changes have been shown to be prognostically relevant and have been acknowledged in the latest WHO classification of AML as separate entities. A detailed marker assessment at diagnosis is crucial for risk-stratification of AML patients, allowing the identification of those at high risk of relapse, who may benefit from early allogeneic stem cell transplantation. Finally, molecular markers are important for the detection of minimal residual disease after initial therapy and during long-term follow-up, which enables a more tailored treatment approach for individual AML patients.
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Affiliation(s)
- Andrea Kühnl
- Department of Medical and Molecular Genetics, King's College London School of Medicine, London, UK
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Kühnl A, Kaiser M, Neumann M, Fransecky L, Heesch S, Radmacher M, Marcucci G, Bloomfield CD, Hofmann WK, Thiel E, Baldus CD. High expression of IGFBP2 is associated with chemoresistance in adult acute myeloid leukemia. Leuk Res 2011; 35:1585-90. [PMID: 21899885 DOI: 10.1016/j.leukres.2011.08.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 08/08/2011] [Accepted: 08/09/2011] [Indexed: 12/22/2022]
Abstract
Insulin-like growth factor (IGF) signaling plays an important role in many tumors and overexpression of IGF Binding Protein (IGFBP) 2 has been associated with adverse outcome in childhood leukemia. Here, we evaluated IGFBP2 mRNA expression and its prognostic implications in 99 adult acute myeloid leukemia (AML) patients by quantitative real-time RT-PCR. High IGFBP2 was associated with a high incidence of primary resistant disease (IGFBP2 high 65%, IGFBP2 low 32%; P=0.02) and was independently predictive for therapy resistance [OR 3.6 (95% CI 1.2-11); P=0.02] in multivariate analyses. Gene-expression profiling revealed an up-regulation of genes implicated in leukemogenesis (MYB, MEIS1, HOXB3, HOXA9) and genes associated with adverse outcome (ERG, WT1) in patients with high IGFBP2 expression. Thus, our data suggest a role of IGFBP2 and IGF signaling in chemoresistance of AML. Patients with high IGFBP2 expression might benefit from molecular therapies targeting the IGF pathway.
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Affiliation(s)
- Andrea Kühnl
- Department of Hematology and Oncology, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany.
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16
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Kaiser M, Kühnl A, Reins J, Fischer S, Ortiz-Tanchez J, Schlee C, Mochmann LH, Heesch S, Benlasfer O, Hofmann WK, Thiel E, Baldus CD. Antileukemic activity of the HSP70 inhibitor pifithrin-μ in acute leukemia. Blood Cancer J 2011; 1:e28. [PMID: 22829184 PMCID: PMC3255249 DOI: 10.1038/bcj.2011.28] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 04/26/2011] [Accepted: 05/12/2011] [Indexed: 01/14/2023] Open
Abstract
Heat shock protein (HSP) 70 is aberrantly expressed in different malignancies and has emerged as a promising new target for anticancer therapy. Here, we analyzed the in vitro antileukemic effects of pifithrin-μ (PFT-μ), an inhibitor of inducible HSP70, in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) cell lines, as well as in primary AML blasts. PFT-μ significantly inhibited cell viability at low micromolar concentrations in all cell lines tested, with IC50 values ranging from 2.5 to 12.7 μ, and was highly active in primary AML blasts with a median IC50 of 8.9 μ (range 5.7–37.2). Importantly, higher IC50 values were seen in normal hematopoietic cells. In AML and ALL, PFT-μ induced apoptosis and cell cycle arrest in a dose-dependent fashion. PFT-μ also led to an increase of the active form of caspase-3 and reduced the intracellular concentrations of AKT and ERK1/2 in NALM-6 cells. Moreover, PFT-μ enhanced cytotoxicity of cytarabine, 17-(allylamino)-17-desmethoxygeldanamycin, suberoylanilide hydroxamic acid, and sorafenib in NALM-6, TOM-1 and KG-1a cells. This is the first study demonstrating significant antileukemic effects of the HSP70 inhibitor PFT-μ, alone and in combination with different antineoplastic drugs in both AML and ALL. Our results suggest a potential therapeutic role for PFT-μ in acute leukemias.
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Heesch S, Schlee C, Neumann M, Stroux A, Kühnl A, Schwartz S, Haferlach T, Goekbuget N, Hoelzer D, Thiel E, Hofmann WK, Baldus CD. BAALC-associated gene expression profiles define IGFBP7 as a novel molecular marker in acute leukemia. Leukemia 2010; 24:1429-36. [PMID: 20535151 DOI: 10.1038/leu.2010.130] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Over expression of BAALC (brain and acute leukemia, cytoplasmic) predicts an inferior outcome in acute myeloid leukemia (AML) and acute lymphoblastic leukemia patients. To identify BAALC-associated genes that give insights into its functional role in chemotherapy resistance, gene expression signatures differentiating high from low BAALC expressers were generated from normal CD34(+) progenitors, T-acute lymphoblastic leukemia (T-ALL) and AML samples. The insulin-like growth factor binding protein 7 (IGFBP7) was one of the four genes (CD34, CD133, natriuretic peptide receptor C (NPR3), IGFBP7) coexpressed with BAALC and common to the three entities. In T-ALL, high IGFBP7-expression was associated with an immature phenotype of early T-ALL (P<0.001), expression of CD34 (P<0.001) and CD33 (P<0.001). Moreover, high IGFBP7-expression predicted primary therapy resistance (P=0.03) and inferior survival in T-ALL (P=0.03). In vitro studies revealed that IGFBP7 protein significantly inhibited the proliferation of leukemia cell lines (Jurkat cells: 42% reduction, P=0.002; KG1a cells: 65% reduction, P<0.001). In conclusion, IGFBP7 was identified as a BAALC coexpressed gene. Furthermore, high IGFBP7 was associated with stem cell features and treatment failure in T-ALL. In contrast to BAALC, which likely represents only a surrogate marker of treatment failure in acute leukemia, IGFBP7 regulates the proliferation of leukemic cells and might be involved in chemotherapy resistance.
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Affiliation(s)
- S Heesch
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Medizinische Klinik III, Berlin, Germany
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Kühnl A, Eckstein HH. Gefäßchirurgische Eingriffe am Venensystem des Körperstammes: Indikationen, Techniken, Ergebnisse. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Liu H, Zang C, Emde A, Planas-Silva MD, Rosche M, Kühnl A, Schulz CO, Elstner E, Possinger K, Eucker J. Anti-tumor effect of honokiol alone and in combination with other anti-cancer agents in breast cancer. Eur J Pharmacol 2008; 591:43-51. [DOI: 10.1016/j.ejphar.2008.06.026] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 05/26/2008] [Accepted: 06/05/2008] [Indexed: 11/28/2022]
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Abstract
Due to its low incidence there is only few information on optimal systemic therapy of male breast cancer. There are no prospective randomized trials, neither for early breast cancer nor for advanced stages. Retrospective analyses mostly comprise long-term-data from a small number of patients. In terms of epidemiology, cellular receptors or genetics there exist some significant differences between male and female breast cancer. Therefore, the possibility to extrapolate treatment recommendation for male patients from female breast cancer-trials is limited. Despite a high rate of receptor positivity, hormonal therapy seems to be less efficient in men, possibly due to different biological factors. The current standard in endocrine therapy is tamoxifen. It is not known whether tamoxifen therapy is as effective as orchiectomy, but tamoxifen is favoured because of its low side effects. The use of aromatase inhibitors needs to be considered carefully, since aromatization is blocked, but 5-alpha-reductase increases estrogen-like androstanediole. There might be a benefit from additional therapy with GnRH-analoga respectively 5-alpha-reductase inhibitors, but data is not available yet. Combination of GnRH-analoga and antiandrogens does induce tumor remission, but comparison to other endocrine therapies is still lacking. Currently, the efficiency of fulvestrant, an estrogen receptor destructor, is being examined. Cytostatic therapy seems to be as effective as in female breast cancer patients. Nevertheless, convincing prospective trials for the management of early and advanced male breast cancer need to be performed.
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Affiliation(s)
- J Eucker
- Med Universitätsklinik und Poliklinik mit Schwerpunkt Onkologie und Hämatologie, Universitätsmedizin Berlin, Charite Campus Mitte, Berlin, Germany.
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Kühnl A, Fichter MM, Lörsch B. [Dental and periodontal sequelae of bulimia nervosa]. Dtsch Zahnarztl Z 1990; 45:716-8. [PMID: 2269089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Twenty-eight women with established bulimia nervosa according to the US psychiatric diagnostic criteria DSM III R with periods of morbidly increased appetite and vomiting, as well as 35 psychically and somatically healthy women were subjected to dental examination. The bulimic patients revealed a significantly poorer dental status (DMFS rate) than the control group. Within the patient group a deterioration of the DMFS rate was observed parallel with an increase in the frequency of vomiting and bulimic attacks, in sugar consumption and duration of the disease, as well as a decrease in salivary flow. Causes and implications for treatment and prevention are discussed.
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Affiliation(s)
- A Kühnl
- Psychosomatische Klinik Roseneck, Prien
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Kühnl A. John R. Hardy, Arnold M. Karo: The Lattice Dynamics and Statics of Alkali Halide Crystals. Plenum Press, New York und London 1979 IX, 314 Seiten, 58 Abbildungen, 11 Tabellen. Preis: US $ 32,50. Krist Techn 1980. [DOI: 10.1002/crat.19800150712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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