1
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van Dam JL, Verkolf EMM, Dekker EN, Bonsing BA, Bratlie SO, Brosens LAA, Busch OR, van Driel LMJW, van Eijck CHJ, Feshtali S, Ghorbani P, de Groot DJA, de Groot JWB, Haberkorn BCM, de Hingh IH, van der Holt B, Karsten TM, van der Kolk MB, Labori KJ, Liem MSL, Loosveld OJL, Molenaar IQ, Polée MB, van Santvoort HC, de Vos-Geelen J, Wumkes ML, van Tienhoven G, Homs MYV, Besselink MG, Wilmink JW, Groot Koerkamp B. Perioperative or adjuvant mFOLFIRINOX for resectable pancreatic cancer (PREOPANC-3): study protocol for a multicenter randomized controlled trial. BMC Cancer 2023; 23:728. [PMID: 37550634 PMCID: PMC10405377 DOI: 10.1186/s12885-023-11141-5] [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: 01/12/2023] [Accepted: 06/30/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Surgical resection followed by adjuvant mFOLFIRINOX (5-fluorouracil with leucovorin, irinotecan, and oxaliplatin) is currently the standard of care for patients with resectable pancreatic cancer. The main concern regarding adjuvant chemotherapy is that only half of patients actually receive adjuvant treatment. Neoadjuvant chemotherapy, on the other hand, guarantees early systemic treatment and may increase chemotherapy use and thereby improve overall survival. Furthermore, it may prevent futile surgery in patients with rapidly progressive disease. However, some argue that neoadjuvant therapy delays surgery, which could lead to progression towards unresectable disease and thus offset the potential benefits. Comparison of perioperative (i.e., neoadjuvant and adjuvant) with (only) adjuvant administration of mFOLFIRINOX in a randomized controlled trial (RCT) is needed to determine the optimal approach. METHODS This multicenter, phase 3, RCT will include 378 patients with resectable pancreatic ductal adenocarcinoma with a WHO performance status of 0 or 1. Patients are recruited from 20 Dutch centers and three centers in Norway and Sweden. Resectable pancreatic cancer is defined as no arterial contact and ≤ 90 degrees venous contact. Patients in the intervention arm are scheduled for 8 cycles of neoadjuvant mFOLFIRINOX followed by surgery and 4 cycles of adjuvant mFOLFIRINOX (2-week cycle of oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, irinotecan 150 mg/m2 at day 1, followed by 46 h continuous infusion of 5-fluorouracil 2400 g/m2). Patients in the comparator arm start with surgery followed by 12 cycles of adjuvant mFOLFIRINOX. The primary outcome is overall survival by intention-to-treat. Secondary outcomes include progression-free survival, resection rate, quality of life, adverse events, and surgical complications. To detect a hazard ratio of 0.70 with 80% power, 252 events are needed. The number of events is expected to be reached after the inclusion of 378 patients in 36 months, with analysis planned 18 months after the last patient has been randomized. DISCUSSION The multicenter PREOPANC-3 trial compares perioperative mFOLFIRINOX with adjuvant mFOLFIRINOX in patients with resectable pancreatic cancer. TRIAL REGISTRATION Clinical Trials: NCT04927780. Registered June 16, 2021.
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Affiliation(s)
- J L van Dam
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - E M M Verkolf
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - E N Dekker
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - B A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - S O Bratlie
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L A A Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Pathology, Radboud UMC, Nijmegen, The Netherlands
| | - O R Busch
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - L M J W van Driel
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - C H J van Eijck
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Feshtali
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - P Ghorbani
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - D J A de Groot
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - J W B de Groot
- Department of Medical Oncology, Isala Oncology Center, Zwolle, The Netherlands
| | - B C M Haberkorn
- Department of Medical Oncology, Maasstad Hospital, Rotterdam, The Netherlands
| | - I H de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - B van der Holt
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - T M Karsten
- Department of Surgery, OLVG, Amsterdam, The Netherlands
| | - M B van der Kolk
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K J Labori
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M S L Liem
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - O J L Loosveld
- Department of Medical Oncology, Amphia Hospital, Breda, The Netherlands
| | - I Q Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital and University Medical Center Utrecht, Utrecht, The Netherlands
| | - M B Polée
- Department of Medical Oncology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - H C van Santvoort
- Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital and University Medical Center Utrecht, Utrecht, The Netherlands
| | - J de Vos-Geelen
- Division of Medical Oncology, Department of Internal Medicine, GROW, Maastricht UMC+, Maastricht, the Netherlands
| | - M L Wumkes
- Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - G van Tienhoven
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Radiation Oncology, Location University of Amsterdam, Amsterdam, The Netherlands
| | - M Y V Homs
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M G Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J W Wilmink
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - B Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
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2
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Bromberg JEC, Issa S, van der Holt B, Minnema MC, Seute T, Durian MF, Cull G, van der Poel MWM, Stevens WBC, Zijlstra JM, Nijland M, Mason KD, Beeker A, Brandsma D, van den Bent MJ, Gonzalez M, de Jong D, Doorduijn JK. OS03.6.A Rituximab in primary CNS lymphoma - long term follow-up of the phase III HOVON 105/ALLG NHL 24 Study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The efficacy of rituximab in Primary CNS Lymphoma (PCNSL) is still under debate. We performed an international randomized phase III study to investigate the efficacy of rituximab when added to methotrexate, BCNU, teniposide and prednisolone (MBVP) in PCNSL. The primary endpoint, event-free survival (EFS) at one year, was similar in both treatment groups and was previously reported (Bromberg et al, Lancet Oncology 2019; 20: 216-228). Here we present long-term follow up results after a median follow-up of 82 months.
Material and Methods
between August 2010 and May 2016 200 newly-diagnosed, non-immunocompromised patients with PCNSL aged 18-70 years and WHO performance status 0-3 were randomized between treatment with MBVP chemotherapy with (arm B) or without (arm A) rituximab. The rituximab was given weekly in the first MBVP cycle, fortnightly in the second (in total 6 rituximab administrations). Responsive patients received consolidation with high-dose cytarabine, and patients aged ≤ 60 were subsequently treated with low-dose WBRT if in CR/CRu; in case of PR with an additional boost on the tumor. Patients > 60 were not irradiated. All patients gave written informed consent.
Results
The modified intention-to-treat (m-ITT) population consisted of 199 eligible patients, 55% were men. The median age was 61 yrs (range 26-70), the median WHO performance status 1 (range 0-3). The primary endpoint EFS at one year was 49% (95% CI 39-58)(MBVP) vs 55% (95% CI 44-64) (R-MBVP). The EFS at 5 years was 25% (17-34) vs 36% (27-46) respectively, hazard ratio (HR) 0.85, 95% CI 0.61-1.18, p=0.33 (adjusted for age and WHO performance status). The progression-free survival (PFS) at one and 5 years were 58% (47-67) and 29% (21-39) (MBVP) and 65% (54-73) and 43% (33-53) (R-MBVP) ) (HR 0.73, 95% CI 0.52-1.02, p=0.07). 80 patients were still alive. Overall survival (OS) at 5 years for MBVP and R-MBVP was 49% (39-59) and 53% (43-63) respectively. A total of 111 patients had progression or relapse, 63 after MBVP and 48 after R-MBVP. 79% of these patients received further treatment. The median OS after progression/relapse was 9.7 months (5.9-19.9) in the MBVP arm, and 6.1 months (2.4-13.1) in the R-MBVP arm (HR 1.25, 95% CI 0.83-1.87, p=0.29). 119 patients died, 64 in the MBVP arm and 55 in the R-MBVP arm. Causes of death were PCNSL in 69% of the patients (both arms), complication of treatment (6% vs 5%), secondary malignancy (5% vs 2%) and other or unknown causes (20% vs 24%). Age was the strongest prognostic factor for EFS, PFS and OS in multivariate analysis.
Conclusion
in the modified-ITT population we found no statistically significant benefit of the addition of rituximab to MBVP on EFS, PFS and OS in patients with PCNSL, even after a long follow-up of median 82 months. Therefore, the results of this study do not support the use of rituximab with MBVP in the treatment of primary CNS lymphoma.
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Affiliation(s)
| | - S Issa
- Middlemore Hospital , Auckland , New Zealand
| | | | - M C Minnema
- University Medical Center Utrecht , Utrecht , Netherlands
| | - T Seute
- University Medical Center Utrecht , Utrecht , Netherlands
| | | | - G Cull
- Sir Charles Gairdner Hospital and PathWest Laboratory Medicine , nedlands , Australia
| | | | - W B C Stevens
- Radboud university medical center , Nijmegen , Netherlands
| | - J M Zijlstra
- Amsterdam Umc location VU MC , Amsterdam , Netherlands
| | - M Nijland
- University Medical Center , Groningen , Netherlands
| | - K D Mason
- Royal Melbourne Hospital , Melbourne , Australia
| | - A Beeker
- Spaarne gasthuis , Haarlem , Netherlands
| | - D Brandsma
- Netherlands Cancer Institute , Amsterdam , Netherlands
| | | | - M Gonzalez
- Royal Melbourne Hospital , Melbourne , Australia
| | - D de Jong
- Amsterdam Umc location VU MC , Amsterdam , Netherlands
| | - J K Doorduijn
- Erasmus MC Cancer Institute , Rotterdam , Netherlands
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3
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Groen K, Seefat MR, van der Holt B, Schjesvold FH, Stege CA, Levin MD, Hansson M, Leys RB, Regelink J, Waage A, Szatkowski D, Axelsson P, Do TH, Svirskaite A, van der Spek E, Haukas E, Knut-Bojanowska D, Ypma PF, Blimark C, Mellqvist UH, van de Donk NW, Sonneveld P, Klostergaard A, Vangsted AJ, Abdilgaard N, Zweegman S. P905: IXAZOMIB-THALIDOMIDE-DEXAMETHASONE INDUCTION FOLLOWED BY IXAZOMIB OR PLACEBO MAINTENANCE IN NON-TRANSPLANT ELIGIBLE NEWLY DIAGNOSED MULTIPLE MYELOMA PATIENTS; LONG-TERM RESULTS OF HOVON-126/NMSG 21.13. Hemasphere 2022. [PMCID: PMC9429083 DOI: 10.1097/01.hs9.0000846492.51234.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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4
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Lugtenburg P, de Nully Brown P, van der Holt B, d'Amore F, Koene H, de Jongh E, Fijnheer R, Loosveld O, Böhmer L, Pruijt H, Verhoef G, Hoogendoorn M, Bilgin Y, Nijland M, Lam K, de Keizer B, de Jong D, Zijlstra J. RITUXIMAB MAINTENANCE FOR PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA IN FIRST COMPLETE REMISSION: RESULTS FROM A RANDOMIZED HOVON-NORDIC LYMPHOMA GROUP PHASE III STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.49_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- P. Lugtenburg
- Hematology; Erasmus MC Cancer Institute; Rotterdam Netherlands
| | - P. de Nully Brown
- Hematology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - B. van der Holt
- Hematology; HOVON Data Center, Erasmus MC Cancer Institute; Rotterdam Netherlands
| | - F. d'Amore
- Hematology; Aarhus University Hospital; Aarhus Denmark
| | - H. Koene
- Internal Medicine; St. Antonius Hospital; Nieuwegein Netherlands
| | - E. de Jongh
- Internal Medicine; Albert Schweitzer Hospital; Dordrecht Netherlands
| | - R. Fijnheer
- Hematology; Meander MC; Amersfoort Netherlands
| | - O. Loosveld
- Hematology; Amphia Hospital; Breda Netherlands
| | - L. Böhmer
- Hematology; Haga Teaching Hospital; The Hague Netherlands
| | - H. Pruijt
- Internal Medicine; Jeroen Bosch Hospital's-Hertogenbosch; Netherlands
| | - G. Verhoef
- Hematology; University Hospitals Leuven; Leuven Belgium
| | - M. Hoogendoorn
- Internal Medicine; Medical Center Leeuwarden; Leeuwarden Netherlands
| | - Y. Bilgin
- Internal Medicine; Admiraal de Ruyter Hospital; Goes Netherlands
| | - M. Nijland
- Hematology; University Medical Center Groningen; Groningen Netherlands
| | - K. Lam
- Pathology; HOVON Pathology Facility and Biobank, Erasmus MC; Rotterdam Netherlands
| | - B. de Keizer
- Nuclear Medicine; UMC Utrecht; Utrecht Netherlands
| | - D. de Jong
- Pathology; HOVON Pathology Facility and Biobank, Amsterdam UMC, Location VUmc; Amsterdam Netherlands
| | - J. Zijlstra
- Hematology; Amsterdam UMC, Vrije Universiteit Cancer Center; Amsterdam Netherlands
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5
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Lugtenburg P, Brown P, van der Holt B, D’Amore F, Koene H, de Jongh E, Fijnheer R, Loosveld O, Böhmer L, Pruijt H, Verhoef G, Hoogendoorn M, Bilgin Y, Nijland M, Lam K, de Keizer B, de Jong D, Zijlstra J. S1599 RITUXIMAB MAINTENANCE FOR PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA IN FIRST COMPLETE REMISSION: RESULTS FROM A RANDOMIZED HOVON-NORDIC LYMPHOMA GROUP PHASE III STUDY. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000564644.71009.e6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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6
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Goldschmidt H, Lokhorst HM, Mai EK, van der Holt B, Blau IW, Zweegman S, Weisel KC, Vellenga E, Pfreundschuh M, Kersten MJ, Scheid C, Croockewit S, Raymakers R, Hose D, Potamianou A, Jauch A, Hillengass J, Stevens-Kroef M, Raab MS, Broijl A, Lindemann HW, Bos GMJ, Brossart P, van Marwijk Kooy M, Ypma P, Duehrsen U, Schaafsma RM, Bertsch U, Hielscher T, Jarari L, Salwender HJ, Sonneveld P. Bortezomib before and after high-dose therapy in myeloma: long-term results from the phase III HOVON-65/GMMG-HD4 trial. Leukemia 2017; 32:383-390. [PMID: 28761118 DOI: 10.1038/leu.2017.211] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/10/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022]
Abstract
The Dutch-Belgian Cooperative Trial Group for Hematology Oncology Group-65/German-speaking Myeloma Multicenter Group-HD4 (HOVON-65/GMMG-HD4) phase III trial compared bortezomib (BTZ) before and after high-dose melphalan and autologous stem cell transplantation (HDM, PAD arm) compared with classical cytotoxic agents prior and thalidomide after HDM (VAD arm) in multiple myeloma (MM) patients aged 18-65 years. Here, the long-term follow-up and data on second primary malignancies (SPM) are presented. After a median follow-up of 96 months, progression-free survival (censored at allogeneic transplantation, PFS) remained significantly prolonged in the PAD versus VAD arm (hazard ratio (HR)=0.76, 95% confidence interval (95% CI) of 0.65-0.89, P=0.001). Overall survival (OS) was similar in the PAD versus VAD arm (HR=0.89, 95% CI: 0.74-1.08, P=0.24). The incidence of SPM were similar between the two arms (7% each, P=0.73). The negative prognostic effects of the cytogenetic aberration deletion 17p13 (clone size ⩾10%) and renal impairment at baseline (serum creatinine >2 mg dl-1) on PFS and OS remained abrogated in the PAD but not VAD arm. OS from first relapse/progression was similar between the study arms (HR=1.02, P=0.85). In conclusion, the survival benefit with BTZ induction/maintenance compared with classical cytotoxic agents and thalidomide maintenance is maintained without an increased risk of SPM.
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Affiliation(s)
- H Goldschmidt
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Clinic Heidelberg, Heidelberg, Germany
| | - H M Lokhorst
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - E K Mai
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - B van der Holt
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Center, Rotterdam, The Netherlands
| | - I W Blau
- Internal Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - S Zweegman
- Department of Hematology, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - K C Weisel
- Department of Hematology, Oncology, Immunology, Rheumatology and Pulmonology, University Hospital of Tuebingen, Tuebingen, Germany
| | - E Vellenga
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - M Pfreundschuh
- Department of Hematology and Oncology, University Clinic of Saarland, Homburg, Germany
| | - M J Kersten
- Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | - C Scheid
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - S Croockewit
- Deptartment of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Raymakers
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D Hose
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | | | - A Jauch
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - J Hillengass
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - M Stevens-Kroef
- Laboratorium Tumor Genetica, Radboud University Medical Centre, Nijmegen,The Netherlands
| | - M S Raab
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - A Broijl
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - H W Lindemann
- Klinik für Hämatologie/Onkologie, Kath. Krankenhaus Hagen gem. GmbH - St-Marien-Hospital, Hagen, Germany
| | - G M J Bos
- Deptartment of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - P Brossart
- Internal Medicine III, Oncology, Hematology and Rheumatology, University Clinic Bonn, Bonn, Germany
| | | | - P Ypma
- Department of Hematology, Haga Hospital, The Hague, The Netherlands
| | - U Duehrsen
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - R M Schaafsma
- Department of Hematology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - U Bertsch
- Department of Internal Medicine V, University Clinic Heidelberg, Heidelberg, Germany
| | - T Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - Le Jarari
- HOVON Datacenter, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - H J Salwender
- Department of Hematology and Oncology, Asklepios Hospital Hamburg Altona, Hamburg, Germany
| | - P Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Burggraaff C, de Vet H, Hoekstra O, Arens A, de Keizer B, van der Holt B, Lugtenburg P, Zijlstra J. FDG-PET as a Biomarker of Response in DLBCL: the HOVON 84 Study Experience. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- C.N. Burggraaff
- Department of Hematology; VU University Medical Center; Amsterdam Netherlands
| | - H.C. de Vet
- Department of Epidemiology and Biostatistics; VU University Medical Center; Amsterdam Netherlands
| | - O.S. Hoekstra
- Department of Radiology and Nuclear Medicine; VU University Medical Center; Amsterdam Netherlands
| | - A.I. Arens
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen Netherlands
| | - B. de Keizer
- Department of Radiology and Nuclear Medicine; University Medical Center Utrecht; Utrecht Netherlands
| | - B. van der Holt
- HOVON Data Center - Department of Hematology; Erasmus MC Cancer Institute; Rotterdam Netherlands
| | - P.J. Lugtenburg
- Department of Hematology; Erasmus MC Cancer Institute; Rotterdam Netherlands
| | - J.M. Zijlstra
- Department of Hematology; VU University Medical Center; Amsterdam Netherlands
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Gahrmann R, Leemans A, van der Holt B, Vernhout RM, Taal W, Vos M, de Groot JC, Hanse M, van den Bent M, Smits M. P04.24 Apparent diffusion coefficient histogram analysis in recurrent glioblastoma predicts overall survival after the first course of bevacizumab and lomustine. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gahrmann R, van den Bent M, van der Holt B, Vernhout R, Taal W, Taphoorn M, de Groot J, Beerepoot L, Jasperse B, Smits M. OS4.2 Radiological response assessment in the era of bevacizumab: RANO or volumetry? A report from the BELOB trial. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Eraslan LE, van den Bent M, Kros J, Oosterkamp H, Walenkamp A, Beerepoot L, Hanse M, Buter J, Honkoop A, van der Holt B, Vernhout RM, Smitt PS, Taal W, French P. GE-10 * IDENTIFICATION OF PATIENTS WITH RECURRENT GBM THAT BENEFIT FROM BEVACIZUMAB. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou256.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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11
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French P, Erdem-Eraslan L, Kros JM, Oosterkamp HM, Walenkamp AME, Beerepoot L, Hanse M, Buter J, Honkoop A, van der Holt B, Vernhout RM, Sillevis Smitt PAE, Taal W, van den Bent MJ. IDENTIFICATION OF PATIENTS WITH RECURRENT GBM THAT BENEFIT FROM BEVACIZUMAB. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou206.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Jöris MM, Lankester AC, von dem Borne PA, Kuball J, Bierings M, Cornelissen JJ, Sijnke MEG, van der Holt B, van Rood JJ, Oudshoorn M, Claas FHJ. Translating in vitro prediction of cytotoxic T cell alloreactivity to hematopoietic stem cell transplantation outcome. Transpl Immunol 2014; 30:59-64. [PMID: 24440708 DOI: 10.1016/j.trim.2013.08.006] [Citation(s) in RCA: 12] [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: 03/21/2013] [Revised: 07/24/2013] [Accepted: 08/05/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previously we developed a weighted amino acid (AA) mismatch score predictive for cytotoxic T cell (CTL) alloreactivity (in vitro CTLp assay) based on the structure of the HLA class I molecule. The aim of this study is to confirm the clinical relevance of the CTLp assay and to validate the AA mismatch score as an alternative and easy to use tool to predict permissible mismatches in hematopoietic stem cell transplantation (HSCT). METHODS We selected patients transplanted with a 9/10 single HLA class I mismatched graft (n=171) at three Dutch HSCT centers. A CTLp assay was performed in 73 donor-recipient pairs. As a control we selected 168 10/10 HLA matched pairs that were matched to the 9/10 single HLA class I mismatched pairs for HSCT year, donor type, patient age and diagnosis. RESULTS We observed that pairs with negative a CTLp assay had statistically significant decreased incidence of mortality after HSCT comparable to that of 10/10 HLA matched pairs. However, the weighted AA mismatch score did not significantly predict any HSCT end point of interest. CONCLUSION Further investigation is needed to unravel the mechanisms involved in causing the beneficial effect of a negative CTLp assay, before other alternative tools to predict HSCT outcome may be developed.
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Affiliation(s)
- M M Jöris
- Europdonor Foundation, The Netherlands; Department of Immunohematology and Blood transfusion, LUMC, The Netherlands.
| | | | | | - J Kuball
- Department of Hematology and Immunology, UMCU, The Netherlands
| | - M Bierings
- Wilhelmina Children's Hospital, UMCU, The Netherlands
| | - J J Cornelissen
- Department of Hematology, Erasmus MC-Daniel den Hoed, The Netherlands
| | | | - B van der Holt
- HOVON Data Center, Erasmus MC-Daniel den Hoed, The Netherlands
| | - J J van Rood
- Europdonor Foundation, The Netherlands; Department of Immunohematology and Blood transfusion, LUMC, The Netherlands
| | - M Oudshoorn
- Europdonor Foundation, The Netherlands; Department of Immunohematology and Blood transfusion, LUMC, The Netherlands
| | - F H J Claas
- Department of Immunohematology and Blood transfusion, LUMC, The Netherlands
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Jöris MM, Lankester AC, von dem Borne PA, Kuball J, Bierings M, Cornelissen JJ, Groenendijk-Sijnke ME, van der Holt B, Haasnoot GW, van der Zanden HGM, van Walraven SM, van Rood JJ, Claas FHJ, Oudshoorn M. The impact of frequent HLA haplotypes in high linkage disequilibrium on donor search and clinical outcome after unrelated haematopoietic SCT. Bone Marrow Transplant 2012; 48:483-90. [PMID: 23064039 DOI: 10.1038/bmt.2012.189] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The MHC region on chromosome 6 contains a large number of non-HLA genes next to the HLA genes. Matching for HLA in unrelated hematopoietic SCT (HSCT) does not necessarily mean that these non-HLA genes are also matched. We selected 348 Northwest European patients transplanted with an HLA-A-, -B-, -C-, -DRB1-, -DQB1-matched unrelated donor (MUD) between 1987 and 2008. Patients' haplotypes were identified via descend. We were unable to determine the haplotypes of the donor; therefore we used frequent haplotypes (FH) in high linkage disequilibrium (LD) as a proxy for haplotype matching. Presence of a FH in a patient positively affected the probability and speed of identifying a matched unrelated donor. Competing risk survival analysis showed that patients with one or two FH have a statistically significantly decreased probability of developing ≥ grade II acute GVDH (aGVHD) without increased risk of relapse compared to patients without FH (HR (95% CI): 0.53 (0.31-0.91)). This association was strongest for those FH with the highest LD between both HLA-A and -C or -B, and HLA-C or -B and -DRB1 (HR (95% CI): 0.49 (0.26-0.92)). These results extend evidence that non-HLA allele coding regions have a significant impact on development of ≥ grade II aGVHD. We conclude that there is more to successful HSCT than matching for HLA genes.
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Affiliation(s)
- M M Jöris
- Europdonor Foundation, Leiden, The Netherlands.
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14
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Kim JH, Charkravarti A, Wang M, Aldape K, Sulman E, Bredel M, Hegi M, Gilbert M, Curran W, Werner-Wasik M, Mehta M, van den Bent MJ, Brandes AA, Taphoorn MJ, Kros JM, Kouwenhoven MC, Delattre JY, Bernsen HJ, Frenay M, Tijssen CC, Grisold W, Sipos L, Enting RH, French PJ, Dinjens WN, Vecht CJ, Allgeier A, Lacombe D, Gorlia T, Xuan KH, Chang JH, Oh MC, Kim EH, Kang SG, Cho J, Kim SH, Kim DS, Kim SH, Seo CO, Lee KS, Kim MM, Dabaja BS, Jeffrey Medeiros L, Allen P, Kim S, Fowler N, Peereboom DM, Seidman AD, Tabar V, Weil RJ, Thorsheim HR, Smith QR, Lockman PR, Steeg PS, Mallick S, Joshi N, Gandhi A, Jha P, Suri V, Julka PK, Sarkar C, Sharma D, Rath GK, Blumenthal DT, Talianski A, Fishniak L, Bokstein F, Taal W, Walenkamp AM, Taphoorn MJ, Beerepoot L, Hanse M, Buter J, Honkoop A, Groenewegen G, Boerman D, Jansen RL, van den Berkmortel FW, Brandsma D, Kros JM, Bromberg JE, van Heuvel I, Smits M, van der Holt B, Vernhout R, van den Bent M, Matienzo L, Batara J, Torcuator R, Yovino S, Balmanoukian A, Ye X, Campian J, Hess A, Fuchs E, Grossman SA, Leonard AK, Wolff J, Blanchard M, Laack N, Foote R, Brown P, Pan E, Yu D, Yue B, Potthast L, Smith P, Chowdhary S, Chamberlain M, Rockhill J, Sales L, Halasz L, Stewart R, Phillips M, Mathew M, Ott P, Rush S, Donahue B, Pavlick A, Golfinos J, Parker E, Huang P, Narayana A, Clark S, Carlson JA, Gaspar LE, Ney DE, Chen C, Kavanagh B, Damek DM, Martinez NL, DeAngelis LM, Abrey LE, Omuro A, Zhu JJ, Esquenazi-Levy Y, Friedman ER, Tandon N, Mathew M, Hitchen C, Dewyngaert K, Narayana A. CLIN-MEDICAL + RADIATION THERAPIES. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Daenen S, van der Holt B, Dekker AW, Willemze R, Rijneveld AW, Biemond BJ, Muus P, van de Loosdrecht AA, Schouten HC, van Marwijk Kooy M, Breems DA, Demuynck H, Maertens J, Wijermans PW, Wittebol S, de Klerk EW, Cornelissen JJ. Intensive chemotherapy to improve outcome in patients with acute lymphoblastic leukemia over the age of 40: a phase II study for efficacy and feasibility by HOVON. Leukemia 2012; 26:1726-9. [DOI: 10.1038/leu.2012.53] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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van der Biessen A, Cranendonk M, van der Holt B, Verweij J, de Jonge M, Mathijssen R. 1256 POSTER Evaluation of Enrollment in Oncology Phase I Clinical Trials. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70868-1] [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: 10/17/2022]
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17
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Corthals SL, Sun SM, Kuiper R, de Knegt Y, Broyl A, van der Holt B, Beverloo HB, Peeters JK, el Jarari L, Lokhorst HM, Zweegman S, Jongen-Lavrencic M, Sonneveld P. MicroRNA signatures characterize multiple myeloma patients. Leukemia 2011; 25:1784-9. [DOI: 10.1038/leu.2011.147] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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18
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Rijneveld AW, van der Holt B, Daenen SMGJ, Biemond BJ, de Weerdt O, Muus P, Maertens J, Mattijssen V, Demuynck H, Legdeur MCJC, Wijermans PW, Wittebol S, Spoelstra FM, Dekker AW, Ossenkoppele GJ, Willemze R, Cornelissen JJ. Intensified chemotherapy inspired by a pediatric regimen combined with allogeneic transplantation in adult patients with acute lymphoblastic leukemia up to the age of 40. Leukemia 2011; 25:1697-703. [DOI: 10.1038/leu.2011.141] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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19
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Van Gool AR, Verkerk R, Fekkes D, Sleijfer S, Bannink M, Kruit WHJ, van der Holt B, Scharpé S, Eggermont AMM, Stoter G, Hengeveld MW. Plasma activity of prolyl endopeptidase in relation to psychopathology during immunotherapy with IFN-alpha in patients with renal cell carcinoma. J Interferon Cytokine Res 2008; 28:283-6. [PMID: 18547158 DOI: 10.1089/jir.2007.0058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abnormal activity in peripheral blood of the cytosolic enzyme prolyl endopeptidase (PEP, EC 3.4.21.26, post prolyl cleaving enzyme, prolyl oligopeptidase) has been found in patients with a variety of psychiatric disorders, most consistently in mood disorders. Mood disturbance is a well-known side effect of immunotherapy with interferon-alpha (IFN-alpha). Earlier, we documented a decrease in serum PEP activity in the first 4 weeks of treatment with IFN-alpha. In 24 patients (16 men, 8 women, median age 60.5 years, range 47-72 years) with metastatic renal cell carcinoma (RCC), psychiatric assessment and blood sampling were performed before and at 4 and 8 weeks and at 6 months after initiation of treatment with IFN-alpha. No episodes of depression were observed, and the sum score and the scores on the subscales for depression and hostility of the Symptom Check List-90 (SCL-90) did not change during follow-up, whereas the anxiety scores were somewhat lower at 4 and 8 weeks compared with baseline. No change in plasma PEP activity and no relationships between change in psychiatric parameters and change in plasma PEP activity were found. As more subtle relationships between PEP activity and psychiatric status could have easily been obscured, a role for PEP in the pathophysiology of IFN-alpha-induced mood disturbance can neither be confirmed nor excluded.
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Affiliation(s)
- A R Van Gool
- Department of Psychiatry, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
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20
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Bromberg JEC, Breems DA, Kraan J, Bikker G, van der Holt B, Smitt PS, van den Bent MJ, van't Veer M, Gratama JW. CSF flow cytometry greatly improves diagnostic accuracy in CNS hematologic malignancies. Neurology 2007; 68:1674-9. [PMID: 17502548 DOI: 10.1212/01.wnl.0000261909.28915.83] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the diagnostic accuracy of flow cytometric immunophenotyping in comparison with classic cytomorphology for diagnosing CNS localizations of hematologic malignancies, and to evaluate the implications of CSF pleocytosis and protein content in this context. METHODS We reviewed the results of diagnostic evaluations of all CSF samples analyzed for localization of a hematologic malignancy between 2001 and 2004 at our center. RESULTS A total of 1,054 samples from 219 patients were available for analysis. Sixty patients had a CSF localization diagnosed by positive flow cytometry, cytomorphology, or both. The first sample was positive by flow cytometry in 44 (73%) patients, by cytomorphology in 19 (32%). Four first samples were positive by cytomorphology but negative by flow cytometry. Patients with positive cytomorphology had more frequent clinical symptomatology (95% vs 58%) and CSF pleocytosis (84% vs 25%), and tended to a poorer progression-free survival than patients with positive flow cytometry only. OR for CNS localization in case of CSF pleocytosis was 10.1 (95% CI 4.9 to 20.8); OR for CNS localization in case of elevated protein content was 2.9 (95% CI 1.5 to 5.4). Nevertheless, 26 of 137 (19%) patients with normal cell count and protein concentration had a CNS localization. CONCLUSIONS The diagnostic value of flow cytometry is more than twice that of cytomorphology. However, cytomorphologic examination of the CSF has additional diagnostic and possibly prognostic value, and should still be performed in conjunction with flow cytometry.
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Affiliation(s)
- J E C Bromberg
- Department of Neuro-Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
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21
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Breitkreutz I, Lokhorst HM, Raab MS, Holt BVD, Cremer FW, Herrmann D, Glasmacher A, Schmidt-Wolf IGH, Blau IW, Martin H, Salwender H, Haenel A, Sonneveld P, Goldschmidt H. Thalidomide in newly diagnosed multiple myeloma: influence of thalidomide treatment on peripheral blood stem cell collection yield. Leukemia 2007; 21:1294-9. [PMID: 17377586 DOI: 10.1038/sj.leu.2404661] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In a phase III randomized, multicenter study, the German-speaking Myeloma-Multicenter Group (GMMG) and the Dutch-Belgian Hemato-Oncology Cooperative Group (HOVON) group investigated the influence of thalidomide (Thal) on the outcome of peripheral blood stem cell (PBSC) collection in multiple myeloma (MM) before peripheral autologous blood stem cell transplantation (ABSCT). We analyzed the data of 398 myeloma patients after induction with Thal, doxorubicin and dexamethasone (TAD) in comparison with vincristine, doxorubicin and dexamethasone (VAD) followed by mobilization with cyclophosphamide, doxorubicin, dexamethasone (CAD) and PBSC collection. Within both the study groups, patients treated with TAD showed to collect significantly fewer CD34(+) cells compared with VAD (GMMG, TAD: median 9.8 x 10(6)/kg; range 2.0-33.6; VAD: median 10.9 x 10(6)/kg range 3.0-36.0; P=0.02) (HOVON, TAD: median 7.4 x 10(6)/kg; range 2.0-33.0; VAD: median 9.4 x 10(6)/kg; range 0.0-48.7; P=0.009). However, engraftment after peripheral autologous stem cell transplantation showed no difference between Thal and VAD groups. We conclude that Thal as a part of induction regimen is associated with better response rates (GMMG-HD3: CR/PR 79%, VAD: CR/PR 58%; HOVON-50: TAD: CR/PR 81%, VAD: CR/PR 61%), but significantly affects the yield of PBSC collection. Nevertheless, the number of total CD34(+) cells collected was sufficient for double autologous transplantation in 82% of the Thal patients, with at least 2.5 x 10(6)/kg CD34(+) cells.
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Affiliation(s)
- I Breitkreutz
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.
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22
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Deenik W, van der Holt B, Verhoef GEG, Schattenberg AVMB, Verdonck LF, Daenen SMGJ, Zachée P, Westveer PHM, Smit WM, Wittebol S, Schouten HC, Löwenberg B, Ossenkoppele GJ, Cornelissen JJ. High-vs low-dose cytarabine combined with interferon alfa in patients with first chronic phase chronic myeloid leukemia. A prospective randomized phase III study. Ann Hematol 2006; 86:117-25. [PMID: 17031690 PMCID: PMC7101742 DOI: 10.1007/s00277-006-0186-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 08/03/2006] [Indexed: 11/26/2022]
Abstract
A prospective randomized phase III study was performed to evaluate whether intensified cytarabine would induce a higher response rate and longer event-free interval as compared to low-dose cytarabine in chronic myeloid leukemia (CML). One hundred and eighteen patients with CML in early chronic phase entered the study. Twenty-eight out of 32 patients assigned to group A received two cycles of a combination of intensified cytarabine and idarubicin followed by interferon alfa (IFN-α) maintenance, 28 patients in group B received standard treatment by a combination of low-dose cytarabine and IFN-α. Forty-nine patients with a human leukocyte antigen-identical sibling donor proceeded to allogeneic stem cell transplantation (allo-SCT) and nine patients were excluded from the analysis. Hematological response was observed in 97% of the patients in group A vs 86% of the patients in group B during the first year of treatment. In group A, 16 patients (50%) achieved a major cytogenetic response, which compared to seven patients (25%) with a major cytogenetic response in group B. With a median follow-up of 58 months (range 34–76), event-free survival was not significantly different between arms A and B. The estimated 5-year survival rate was 56% in the intensified arm and 77% in the low-dose arm (P = 0.05). Recipients of allo-SCT showed a 5-year estimated survival rate of 55%. Although intensified cytarabine induced a higher initial percentage of major and complete cytogenetic responses, responses were not sustained by IFN-α maintenance therapy.
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MESH Headings
- Adolescent
- Adult
- Aged
- Cytarabine/administration & dosage
- Cytarabine/therapeutic use
- Cytogenetics
- Disease-Free Survival
- Dose-Response Relationship, Drug
- Drug Therapy, Combination
- Female
- Humans
- Interferon-alpha/adverse effects
- Interferon-alpha/therapeutic use
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/genetics
- Leukemia, Myeloid, Chronic-Phase/pathology
- Leukemia, Myeloid, Chronic-Phase/surgery
- Male
- Middle Aged
- Stem Cell Transplantation
- Survival Rate
- Transplantation, Homologous
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Affiliation(s)
- W. Deenik
- Department of Hematology, Erasmus University Medical Center/Daniel den Hoed, Groene Hillendijk 301, 3008 AE Rotterdam, The Netherlands
| | | | | | | | - L. F. Verdonck
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - P. Zachée
- University Hospital Antwerp, Antwerp, Belgium
| | | | - W. M. Smit
- Medical Spectrum Twente, Enschede, The Netherlands
| | - S. Wittebol
- Meander Medical Center, Amersfoort, The Netherlands
| | - H. C. Schouten
- University Hospital Maastricht, Maastricht, The Netherlands
| | - B. Löwenberg
- Department of Hematology, Erasmus University Medical Center/Daniel den Hoed, Groene Hillendijk 301, 3008 AE Rotterdam, The Netherlands
| | | | - J. J. Cornelissen
- Department of Hematology, Erasmus University Medical Center/Daniel den Hoed, Groene Hillendijk 301, 3008 AE Rotterdam, The Netherlands
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23
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Te Boekhorst PAW, Lamers CHJ, Schipperus MR, Hintzen RQ, van der Holt B, Cornelissen JJ, Löwenberg B, Gratama JW. T-lymphocyte reconstitution following rigorously T-cell-depleted versus unmodified autologous stem cell transplants. Bone Marrow Transplant 2006; 37:763-72. [PMID: 16518423 DOI: 10.1038/sj.bmt.1705333] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We compared the kinetics of T-cell recovery after extensive ex vivo and in vivo T-cell depleted autologous stem cell transplantation (SCT) for multiple sclerosis (MS; n=8) with unmodified SCT for hematological malignancies (HM; n=39). Both patient group showed a very protracted recovery of 'naive' CD4(+), 45R0(-) ( approximately CD45RA(+)) T-cells. Within the 'primed' CD4(+), 45R0(+) T-cells, the 'central memory' cells expressing the CD62L and CD27 markers were the slowest to recover. The repopulating T-cells were highly activated, as shown by increased expression of HLA-DR and the apoptosis marker CD95. The capability of CD4(+) and CD8(+) T-cells to produce IFN-gamma, IL-2 and TNF-alpha had reached normal ranges from 2 months post SCT onwards. Unexpectedly, the kinetics of T-cell recovery between 3 and 12 months post transplant was similar in T-depleted and unmodified SCT. Before SCT, the HM patients showed lymphopenia of all T-cell subsets, upregulated HLA-DR and CD95 expression and increased cytokine responses. We suggest that the similar kinetics of T-cell recovery in the two patient groups may be explained by the susceptibility to apoptosis of the activated CD4(+) T-cells in the autografts of the HM patients. This susceptibility to apoptosis would interfere with a swift and sustained CD4(+) T-cell regeneration post SCT.
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Affiliation(s)
- P A W Te Boekhorst
- Department of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands.
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24
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Kappers-Klunne MC, Wijermans P, Fijnheer R, Croockewit AJ, van der Holt B, de Wolf JTM, Löwenberg B, Brand A. Splenectomy for the treatment of thrombotic thrombocytopenic purpura. Br J Haematol 2005; 130:768-76. [PMID: 16115135 DOI: 10.1111/j.1365-2141.2005.05681.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Plasma exchange is the treatment of choice for patients with thrombotic thrombocytopenic purpura (TTP) and results in remission in >80% of the cases. Treatment of patients who are refractory to plasma therapy or have relapsing disease is difficult. Splenectomy has been a therapeutic option in these conditions but its value remains controversial. We report on a series of 33 patients with TTP who were splenectomised because they were plasma refractory (n = 9) or for relapsed disease (n = 24). Splenectomy generated prompt and unmaintained remissions in all except five patients, in whom remission was delayed (n = 4) or who died with progressive disease (n = 1). Four postoperative complications occurred: one pulmonary embolism and three surgical complications. Median follow-up after splenectomy was 109 months (range 28-230 months). The overall postsplenectomy relapse rate was 0.09 relapses/patient-year and the 10-year relapse-free survival (RFS) was 70% (95% CI 50-83%). In the patients with relapsing TTP, relapse rate fell from 0.74 relapses/patient-year before splenectomy to 0.10 after splenectomy (P < 0.00001). Two patients died from first postsplenectomy relapse. Although these results are based on retrospective data and that the relapse rate may spontaneously decrease with time, we conclude that splenectomy, when performed during stable disease, has an acceptable safety profile and should be considered in cases of plasma refractoriness or relapsing TTP to reach durable remissions and to reduce or prevent future relapses.
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Affiliation(s)
- M C Kappers-Klunne
- Department of Haematology, Erasmus Medical Centre, Centre Location, Rotterdam, The Netherlands.
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25
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van Imhoff GW, van der Holt B, MacKenzie MA, Ossenkoppele GJ, Wijermans PW, Kramer MHH, van 't Veer MB, Schouten HC, van Marwijk Kooy M, van Oers MHJ, Raemaekers JMM, Sonneveld P, Meulendijks LAMH, Kluin PM, Kluin-Nelemans HC, Verdonck LF. Short intensive sequential therapy followed by autologous stem cell transplantation in adult Burkitt, Burkitt-like and lymphoblastic lymphoma. Leukemia 2005; 19:945-52. [PMID: 15800666 DOI: 10.1038/sj.leu.2403733] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The feasibility and efficacy of up-front high-dose sequential chemotherapy followed by autologous stem cell transplantation (ASCT) in previously untreated adults (median age 33 years; range 15-64) with Burkitt lymphoma (BL), Burkitt-like lymphoma (BLL) or lymphoblastic lymphoma (LyLy), both without central nervous system or extensive bone marrow involvement was investigated in a multicenter phase II study. Treatment consisted of two sequential high-dose chemotherapy induction courses incorporating prednisone, cyclophosphamide, doxorubicin, etoposide and mitoxantrone, without high-dose methotrexate or high-dose cytarabine. Patients with at least PR went on with BEAM and ASCT. Protocol treatment was completed by 23/27 (85%) BL/BLL and 13/15 (87%) LyLy patients. Median treatment duration until BEAM was 70 (range: 50-116) days. No toxic deaths occurred. Response to treatment was complete response (CR) 81% and partial response (PR) 11% for BL/BLL, CR 73% and PR 20% for LyLy. At a median follow-up of 61 months of patients still alive, six BL/BLL and eight LyLy patients have died. The actuarial 5-year overall and event-free survival estimates are 81 and 73% for BL/BLL vs 46 and 40% for LyLy patients. In conclusion, this short up-front high-dose sequential chemotherapy regimen, followed by ASCT is highly effective in adults with BL/BLL with limited bone marrow involvement, but less so in patients with LyLy.
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Affiliation(s)
- G W van Imhoff
- Department of Hematology, University Medical Center Groningen, 97 RB Groningen, The Netherlands.
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26
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de Bont JM, van der Holt B, Dekker AW, van der Does-van den Berg A, Sonneveld P, Pieters R. [Adolescents with acute lymphatic leukaemia achieve significantly better results when treated following Dutch paediatric oncology protocols than with adult protocols]. Ned Tijdschr Geneeskd 2005; 149:400-6. [PMID: 15751319] [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: 05/02/2023]
Abstract
OBJECTIVE To compare the results, in adolescents with acute lymphatic leukaemia (ALL), of treatment according to the protocols of the Netherlands Foundation for Paediatric Oncology (DCOG) or according to the protocols for adults of the Dutch Foundation for Adult Haemato-Oncology (HOVON). DESIGN Retrospective. METHOD During the period from May 1985 to November 1999, 120 15-20-year-old adolescents with ALL were treated: 47 according to a DCOG protocol and 73 according to a HOVON protocol. The records of the integrated cancer centres indicate that this represented about two-thirds of all known adolescents with ALL in the Netherlands. RESULTS Adolescents with ALL treated according to the DCOG protocols had significantly better 5-year survival rates (79% versus 38%), a significantly lower probability of relapse (27% versus 55%) and a lower treatment-related mortality (4% versus 25%) than the adolescents treated according to the HOVON protocols. CONCLUSION This difference in outcome was most likely related to differences in structure and content between the DCOG and HOVON protocols. The HOVON protocols consisted of relatively short, intensive chemotherapy, often followed by autologous or allogeneic bone-marrow transplantation. Several treatment elements present in the DCOG protocols, such as high-dose methotrexate, reinduction therapy and maintenance therapy were absent in the HOVON protocols. Moreover, the cumulative dosages of dexamethasone, mercaptopurine, asparaginase and vincristine were lower in the HOVON protocols.
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Affiliation(s)
- J M de Bont
- Locatie Sophia Kinderziekenhuis, afd. Kinderoncologie en -hematologie, Erasmus Medisch Centrum, Rotterdam
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de Bont JM, Holt BVD, Dekker AW, van der Does-van den Berg A, Sonneveld P, Pieters R. Significant difference in outcome for adolescents with acute lymphoblastic leukemia treated on pediatric vs adult protocols in the Netherlands. Leukemia 2004; 18:2032-5. [PMID: 15483674 DOI: 10.1038/sj.leu.2403538] [Citation(s) in RCA: 233] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Levin MD, van der Holt B, de Veld JC, Gratama JW, de Vries W, van't Veer MB. The value of crossmatch tests and panel tests as a screening tool to predict the outcome of platelet transfusion in a non-selected haematological population of patients. Vox Sang 2004; 87:291-8. [PMID: 15585026 DOI: 10.1111/j.1423-0410.2004.00582.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Alloantibodies against platelets can be detected by using different laboratory tests. Most of these tests, which use panel cells or antigens as a target, perform poorly in non-selected haematological patients. In relation to these tests, a crossmatch test of transfused platelets and patient's serum may be viewed as the standard and may be superior in predicting donor platelet destruction by alloimmunization. MATERIALS AND METHODS In 95 randomly selected thrombocytopenic patients with haematological malignancies, who were receiving leucodepleted blood products, 184 serum samples were studied in an in vitro crossmatch test by using the technique of the platelet immunofluorescence test (crossmatch-PIFT), in an in vivo crossmatch test detecting in vivo binding of immunoglobulins to transfused platelets according to the PIFT technique (in vivo-PIFT), in the indirect PIFT using five random donors as a target (panel-PIFT) and in an enzyme linked immunosorbent assay using immobilized human leucocyte antigens (HLAs) of 100 standardized donors (ELIHLA). The results of all these methods were related to the recovery at 1 and 16 h post-transfusion. RESULTS The results of the crossmatch-PIFT were not associated with platelet recovery at 1 and 16 h after transfusion. Even in a subgroup of patients, in whom predefined clinical factors were excluded, no association with platelet recovery was found. The results of the crossmatch-PIFT correlated with those of the in vivo-PIFT (P = 0.02); however, 35 (19%) discrepant results were identified between these tests. The results of the crossmatch-PIFT were not related to the panel-PIFT (P = 0.25), but did relate to those of the ELIHLA (P = 0.02), still revealing 36 (20%) discrepant results. None of the in vivo-PIFT, the panel-PIFT or the ELIHLA was associated with platelet recovery after 1 h, whilst only a positive panel-PIFT was associated with poor platelet recovery at 16 h after transfusion (P = 0.03). CONCLUSIONS In a population at low risk for alloimmunization, the correlation of test outcome and platelet recovery is poor. None of these crossmatch tests or screening tests was identified as superior to any other in this population.
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Affiliation(s)
- M-D Levin
- Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands.
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Wu KL, Helgason HH, van der Holt B, Wijermans PW, Lokhorst HM, Smit WM, Sonneveld P. Analysis of efficacy and toxicity of thalidomide in 122 patients with multiple myeloma: response of soft-tissue plasmacytomas. Leukemia 2004; 19:143-5. [PMID: 15510202 DOI: 10.1038/sj.leu.2403568] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Minnema MC, Breitkreutz I, Auwerda JJA, van der Holt B, Cremer FW, van Marion AMW, Westveer PHM, Sonneveld P, Goldschmidt H, Lokhorst HM. Prevention of venous thromboembolism with low molecular-weight heparin in patients with multiple myeloma treated with thalidomide and chemotherapy. Leukemia 2004; 18:2044-6. [PMID: 15470485 DOI: 10.1038/sj.leu.2403533] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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van Agthoven M, Segeren CM, Buijt I, Uyl-de Groot CA, van der Holt B, Lokhorst HM, Sonneveld P. A cost-utility analysis comparing intensive chemotherapy alone to intensive chemotherapy followed by myeloablative chemotherapy with autologous stem-cell rescue in newly diagnosed patients with stage II/III multiple myeloma. Eur J Cancer 2004; 40:1159-69. [PMID: 15110879 DOI: 10.1016/j.ejca.2004.01.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Revised: 01/19/2004] [Accepted: 01/21/2004] [Indexed: 10/26/2022]
Abstract
A prospective randomised phase III study in patients < or =65 years old with previously untreated multiple myeloma (MM), intensive chemotherapy followed by myeloablative chemotherapy and autologous stem-cell rescue was compared with intensive chemotherapy alone. This economic evaluation was based on detailed data from patient charts and hospital information systems. In the intention-to-treat analysis, mean total treatment and follow-up costs of the myeloablative treatment arm were 81,643 euros compared to 68,802 euros for the chemotherapy arm (P=0.09). Costs per quality-adjusted life year were 51,357 euros versus 37,328 euros. In the clinical study, no significant differences were found in overall survival after a median follow-up of 33 months from randomisation. Intensive chemotherapy is regarded as standard therapy for younger patients with previously untreated MM. Cost-effectiveness of myeloma therapy after 3 years of follow up seems not to be favoured by myeloablative treatment with autologous stem-cell rescue.
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Affiliation(s)
- M van Agthoven
- Institute for Medical Technology Assessment, Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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Goldschmidt H, Sonneveld P, Cremer FW, van der Holt B, Westveer P, Breitkreutz I, Benner A, Glasmacher A, Schmidt-Wolf IGD, Martin H, Hoelzer D, Ho AD, Lokhorst HM. Joint HOVON-50/GMMG-HD3 randomized trial on the effect of thalidomide as part of a high-dose therapy regimen and as maintenance treatment for newly diagnosed myeloma patients. Ann Hematol 2003; 82:654-9. [PMID: 12845480 DOI: 10.1007/s00277-003-0685-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2003] [Accepted: 04/28/2003] [Indexed: 10/26/2022]
Affiliation(s)
- H Goldschmidt
- Medizinische Klinik und Poliklinik V, Universität Heidelberg, Hospitalstrasse 3, 69115 Heidelberg, Germany.
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Doorduijn JK, van der Holt B, van Imhoff GW, van der Hem KG, Kramer MHH, van Oers MHJ, Ossenkoppele GJ, Schaafsma MR, Verdonck LF, Verhoef GEG, Steijaert MMC, Buijt I, Uyl-de Groot CA, van Agthoven M, Mulder AH, Sonneveld P. CHOP compared with CHOP plus granulocyte colony-stimulating factor in elderly patients with aggressive non-Hodgkin's lymphoma. J Clin Oncol 2003; 21:3041-50. [PMID: 12915593 DOI: 10.1200/jco.2003.01.076] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate whether the relative dose-intensity of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy could be improved by prophylactic administration of granulocyte colony-stimulating factor (G-CSF) in elderly patients with aggressive non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS Patients aged 65 to 90 years (median, 72 years) with stage II to IV aggressive NHL were randomly assigned to receive standard CHOP every 3 weeks or CHOP plus G-CSF every 3 weeks on days 2 to 11 of each cycle. RESULTS In 389 eligible patients, the relative dose intensities (RDIs) of cyclophosphamide (median, 96.3% v 93.9%; P =.01) and doxorubicin (median, 95.4% v 93.3%; P =.04) were higher in patients treated with CHOP plus G-CSF. The complete response rates were 55% and 52% for CHOP and CHOP plus G-CSF, respectively (P =.63). The actuarial overall survival at 5 years was 22% with CHOP alone, compared with 24% with CHOP plus G-CSF (P =.76), with a median follow-up of 33 months. Patients treated with CHOP plus G-CSF had an identical incidence of infections, with World Health Organization grade 3 to 4 (34 of 1,191 cycles v 36 of 1,195 cycles). Only the cumulative days with antibiotics were fewer with CHOP plus G-CSF (median, 0 v 6 days; P =.006) than with CHOP alone. The number of hospital admissions and the number of days in hospital were not different. CONCLUSION In elderly patients, G-CSF improved the RDI of CHOP, but this did not lead to a higher complete response rate or better overall survival. G-CSF did not prevent serious infections.
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Affiliation(s)
- J K Doorduijn
- Department of Hematology, Erasmus Medisch Centrum Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
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Levin MD, de Veld JC, van der Holt B, van 't Veer MB. Immune and nonimmune causes of low recovery from leukodepleted platelet transfusions: a prospective study. Ann Hematol 2003; 82:357-62. [PMID: 12719885 DOI: 10.1007/s00277-003-0648-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2003] [Accepted: 03/21/2003] [Indexed: 10/26/2022]
Abstract
Alloantibodies against HLA antigens can be reduced by applying leukodepletion to transfusions. Because the importance of immunological and nonimmunological causes of poor platelet transfusion results using leukodepleted transfusions is not clear, we conducted a prospective study in an unselected patient population receiving leukodepleted transfusions. In 97 patients with hematological malignancies, 181 random leukodepleted platelet transfusions were studied for immunological causes of poor platelet transfusion results by calculating the odds ratio of four different screening tests for a low platelet recovery. Nonimmune causes were also studied by calculating the odds ratio of the most prevalent nonimmune causes for a low platelet recovery. No single screening test showed an association with recovery after 1 and 16 h following a platelet transfusion. The combination of a positive enzyme-linked immunosorbent assay (ELISA) and platelet immunofluorescence test (PIFT) or a combination of a positive lymphocyte immunofluorescence test (LIFT) and PIFT, demonstrating an association with a low platelet recovery after 16 h, was present in 2% of all platelet transfusions. Of nonimmune causes, splenomegaly and storage time of platelets for more than 3 days were associated with low platelet recovery after 1 h and 16 h of being present in 29% and 47% of all platelet transfusions, respectively. Immunological causes account for a small proportion of poor platelet transfusion results compared to nonimmunological causes in a nonselected patient population receiving leukodepleted transfusions.
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Affiliation(s)
- M-D Levin
- Department of Hematology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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Levin MD, van der Holt B, de Veld JC, Gratama JW, de Vries W, van't Veer MB. Visual scoring versus histogram subtraction of in vivo binding of immunoglobulins against platelets after transfusion. ACTA ACUST UNITED AC 2003; 57:40-6. [PMID: 14696062 DOI: 10.1002/cyto.b.10067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND We developed a technique, in vivo binding of immunoglobulins in the platelet immunofluorescence test (IVBI-PIFT), that detects immunoglobulins bound in vivo to transfused platelets. The visually scored results of this technique, however, are susceptible to interobserver variation. We describe a more objective method to generate results in IVBI-PIFT. METHODS We studied 201 samples in 120 patients with hematologic malignancies in the IVBI-PIFT. Histogram subtraction, i.e., fluorescence (anti-immunoglobulin G and fluorescein isothiocyanate) histogram before platelet transfusion subtracted from the histogram after platelet transfusion, was compared with visual scoring (pattern 1: no enhanced fluorescence before and after transfusion; pattern 2: enhanced fluorescence before and after platelet transfusion; pattern 3: enhanced fluorescence before transfusion; pattern 4: enhanced fluorescence after transfusion, interpreted as alloimmunization). After histogram subtraction, the number of remaining events (events post substraction, EPS) and the mean amount of fluorescence of these remaining events (mean channel post substraction, MCPS) were used and compared with the visual scoring and with platelet survival after transfusion. RESULTS In 26 (13%) of the 201 samples studied in the IVBI-PIFT, fewer than three of five observers agreed on the visually scored pattern. In the 175 (87%) remaining samples, histogram subtraction showed a significant differentiation between pattern 4 and patterns 1 and 2 by using EPS, whereas patterns 4 and 3 were distinguished by using MCPS. The combination of EPS and MCPS differentiated best between pattern 4 and patterns 1, 2, and 3 (73% sensitivity, 96% specificity, 79% positive predictive value, and 95% negative predictive value). In contrast, the predictive value for platelet recovery after 1 and 16 h of pattern 4 from the visual scoring method and the results of histogram subtraction were poor. CONCLUSION This objective method of histogram subtraction correlated well with the visual scoring method of IVBI-PIFT.
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Affiliation(s)
- M-D Levin
- Department of Hematology, Erasmus Medical Center, Daniel den Hoed, Rotterdam, The Netherlands.
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van Etten B, van der Sijp J, Kruyt R, Oudkerk M, van der Holt B, Wiggers T. Ferumoxide-enhanced magnetic resonance imaging techniques in pre-operative assessment for colorectal liver metastases. Eur J Surg Oncol 2002; 28:645-51. [PMID: 12359202 DOI: 10.1053/ejso.2001.1251] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The objective was to evaluate whether contrast-enhanced magnetic resonance imaging (MRI) techniques used in a pre-operative assessment protocol for colorectal liver metastases are as accurate as spiral computer tomography during arterial portography (CTAP). Pre-operative accuracy and clinical consequences of MRI are described and compared with CTAP. Moreover, post-operative survival rate and tumour recurrence were studied. METHODS The study group comprised 84 patients which were possible candidates for a partial hepatectomy for colorectal liver metastases. Patients were pre-operatively evaluated by CT of the abdomen, CT of the thorax and spiral CTAP and ferumoxide-enhanced MRI was performed in routine way for all patients. Following this selection, 35 patients underwent a partial hepatectomy with curative intent. All patients were retrospectively evaluated. RESULTS Ferumoxide-enhanced MRI proved to be at least as accurate as spiral CTAP in 81% of patients. In nine patients (11%) spiral CTAP revealed more intrahepatic lesions than MRI; in only two patients (2%) did these foundings influenced the clinical decision. These patients were considered to have irresectable disease. In seven patients (8%) MRI detected more lesions than spiral CTAP and influenced the clinical decision in three patients (4%) and these did not undergo a laparotomy. The actuarial 3 year overall survival of operated patients was 41% and the actuarial 3 year disease-free survival was 19%. CONCLUSION Evaluation of the clinical impact of a pre-operative assessment protocol extended with ferumoxide MRI techniques demonstrated that this non-invasive MRI technique is safe and at least as accurate as spiral CTAP. This MRI technique results in comparable clinical decisions and outcome after hepatectomy. We suggest that the performance of routine contrast-enhanced MRI should instead be used in the pre-operative evaluation of colorectal liver metastases.
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Affiliation(s)
- B van Etten
- Department of Surgical Oncology, University Hospital Rotterdam-Daniel den Hoed Cancer Centre, The Netherlands
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Wu KL, Schaafsma MR, Lokhorst HM, Wijermans PW, van der Holt B, Sonneveld P. [Thalidomide in the treatment of refractory multiple myeloma: a Dutch study of 72 patients: an antitumor effect in 45%]. Ned Tijdschr Geneeskd 2002; 146:1445-8. [PMID: 12190011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE To determine the efficacy and side effects of thalidomide in the treatment of refractory multiple myeloma. DESIGN Retrospective, descriptive. METHOD Data were obtained by means of case research on patients with refractory multiple myeloma who were treated with thalidomide at four regional hematological centres in the period from 1 May 1999 to 31 May 2001. The patients had previously been treated with one, two or three schedules of chemotherapy. The starting dose of thalidomide was 200 mg per day and the dose was increased gradually to a maximum of 800 mg per day depending on the tolerance. RESULTS The 72 patients included 43 men and 29 women with an average age of 62 years (range: 38-82 years). The median follow-up was 13 months (range: 2-25). Thalidomide as a single agent was prescribed for 64 patients, of whom 29 (45%) responded; a complete response was achieved in 3 patients, a partial response in 18, and a minor response in 8. In 4 of 11 patients with an extramedullary plasmacytoma a decrease in size was observed. The median duration of the response was 9 months (range: from 2 till > 24). The median overall survival from the start of thalidomide treatment was 9 months. Thalidomide plus dexamethasone was given to 9 patients who did not respond to thalidomide alone, and in 6 of them a reduction of M-protein was then observed. The most frequent adverse effects were constipation, drowsiness, somnolence, dizziness, venous thrombosis and polyneuropathy. Doses of up to 400 mg per day were generally well tolerated. CONCLUSION Thalidomide has antitumour activity in refractory multiple myeloma.
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Affiliation(s)
- K L Wu
- Erasmus Medisch Centrum, locatie Dijkzigt, afd. Hematologie, Postbus 2040, 3000 CA Rotterdam
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Contant CME, Swaak AJG, Obdeijn AIM, van der Holt B, Tjong Joe Wai R, van Geel AN, Eggermont AMM. A prospective study on silicone breast implants and the silicone-related symptom complex. Clin Rheumatol 2002; 21:215-9. [PMID: 12111627 DOI: 10.1007/pl00011221] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This cohort study prospectively evaluated the prevalence of the silicone-related symptom complex (SRSC) in relation to antinuclear antibodies (ANA) and magnetic resonance imaging (MRI) of silicone breast implants (SBI) 1 year after implantation. A total of 57 women undergoing mastectomy followed by immediate breast reconstruction (IBR) and SBI between March 1995 and March 1997 at the University Hospital Rotterdam/Daniel den Hoed Cancer Centre, were prospectively evaluated. Just before and 1 year after IBR the sera of these women were tested for the presence of ANA and they were screened for the prevalence of SRSC-related symptoms by questionnaire. All prostheses were evaluated by MRI 1 month and 1 year after IBR. Just before operation 11% of the women had a Sjögren score of more than 2, whereas 30% had such a score 1 year after IBR ( P = 0.01). One year postoperatively women had significantly more RA/Raynaud-related complaints: 21% preoperatively versus 40% 1 year after IBR ( P = 0.03). Within the undefined complaints-related group 19% had a score of 2 or more preoperatively and 33% 1 year after IBR ( P = 0.09). There were no new cases of ANA positivity 1 year after IBR. The linguine sign was seen by MRI in three implants: one 1 month after IBR and two 1 year after IBR. There was no relation to changes in SRSC expression and these MRI findings. In conclusion, 1 year after SBI implantation women had more SRSC-related complaints, especially Sjögren's and RA/Raynaud's. Moreover there was no correlation between elevated SRSC expression and changes in the presence of ANA or changes in MRI of the SBI 1 year after IBR.
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Affiliation(s)
- C M E Contant
- University Hospital Rotterdam/Daniel den Hoed Cancer Centre, Rotterdam, the Netherlands
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van den Heuvel-Eibrink MM, Wiemer EAC, Prins A, Meijerink JPP, Vossebeld PJM, van der Holt B, Pieters R, Sonneveld P. Increased expression of the breast cancer resistance protein (BCRP) in relapsed or refractory acute myeloid leukemia (AML). Leukemia 2002; 16:833-9. [PMID: 11986944 DOI: 10.1038/sj.leu.2402496] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2001] [Accepted: 01/28/2002] [Indexed: 11/08/2022]
Abstract
Expression of the multidrug resistance proteins P-glycoprotein, encoded by the MDR1 gene, multidrug resistance-associated protein (MRP1) and the lung resistance-related protein or major vault protein (LRP/MVP) is associated with clinical resistance to chemotherapy in acute myeloid leukemia (AML). Recently, the breast cancer-resistant protein (BCRP), the equivalent of mitoxantrone-resistant protein (MXR) or placental ABC transporter (ABCP), was described in AML. We investigated MDR1, MRP1, LRP/MVP and BCRP mRNA expression simultaneously in 20 paired clinical AML samples from diagnosis and relapse or refractory disease, using quantitative Taqman analysis. In addition, standard assays for P-glycoprotein expression and function were performed. BCRP was the only resistance protein that was expressed at a significantly higher RNA level (median 1.7-fold, P = 0.04) at relapsed/refractory state as compared to diagnosis. In contrast, LRP/MVP mRNA expression decreased as disease evolved (P = 0.02), whereas MDR1 and MRP1 mRNA levels were not different at relapse as compared to diagnosis. Also, at the protein level no difference of MDR1 between diagnosis and relapse was found. A significant co-expression of BCRP and MDR1 was found at diagnosis (r = 0.47, P = 0.04). The present results suggest that BCRP, but not MDR1, MRP1 or LRP/MVP is associated with clinical resistant disease in AML.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism
- ATP Binding Cassette Transporter, Subfamily G, Member 2
- ATP-Binding Cassette Transporters/genetics
- ATP-Binding Cassette Transporters/metabolism
- ATP-Binding Cassette Transporters/physiology
- Acute Disease
- Adolescent
- Adult
- Aged
- Bone Marrow Cells/pathology
- Child
- Child, Preschool
- Disease Progression
- Drug Resistance, Neoplasm
- Humans
- Infant
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/metabolism
- Leukemia, Myeloid/pathology
- Middle Aged
- Multidrug Resistance-Associated Proteins/genetics
- Multidrug Resistance-Associated Proteins/metabolism
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Neoplasm Proteins/physiology
- Polymerase Chain Reaction
- RNA, Messenger/metabolism
- Recurrence
- Up-Regulation
- Vault Ribonucleoprotein Particles/genetics
- Vault Ribonucleoprotein Particles/metabolism
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van Esser JW, van der Holt B, Meijer E, Niesters HG, Trenschel R, Thijsen SF, van Loon AM, Frassoni F, Bacigalupo A, Schaefer UW, Osterhaus AD, Gratama JW, Löwenberg B, Verdonck LF, Cornelissen JJ. Epstein-Barr virus (EBV) reactivation is a frequent event after allogeneic stem cell transplantation (SCT) and quantitatively predicts EBV-lymphoproliferative disease following T-cell--depleted SCT. Blood 2001; 98:972-8. [PMID: 11493441 DOI: 10.1182/blood.v98.4.972] [Citation(s) in RCA: 271] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Reactivation of the Epstein-Barr virus (EBV) after allogeneic stem cell transplantation (allo-SCT) may evoke a protective cellular immune response or may be complicated by the development of EBV-lymphoproliferative disease (EBV-LPD). So far, very little is known about the incidence, recurrence, and sequelae of EBV reactivation following allo-SCT. EBV reactivation was retrospectively monitored in 85 EBV-seropositive recipients of a T-cell--depleted (TCD) allo-SCT and 65 EBV-seropositive recipients of an unmanipulated allo-SCT. Viral reactivation (more than 50 EBV genome equivalents [gEq]/mL) was monitored frequently by quantitative real-time plasma polymerase chain reaction until day 180 after SCT. Probabilities of developing viral reactivation were high after both unmanipulated and TCD-allogeneic SCT (31% +/- 6% versus 65% +/- 7%, respectively). A high CD34(+) cell number of the graft appeared as a novel significant predictor (P =.001) for EBV reactivation. Recurrent reactivation was observed more frequently in recipients of a TCD graft, and EBV-LPD occurred only after TCD-SCT. High-risk status, TCD, and use of antithymocyte globulin were predictive for developing EBV-LPD. Plasma EBV DNA quantitatively predicted EBV-LPD. The positive and negative predictive values of a viral load of 1000 gEq/mL were, respectively, 39% and 100% after TCD. Treatment-related mortality did not differ significantly between TCD and non-TCD transplants, but the incidence of chronic graft-versus-host disease was significantly less in TCD patients. It is concluded that EBV reactivation occurs frequently after TCD and unmanipulated allo-SCT, especially in recipients of grafts with high CD34(+) cell counts. EBV-LPD, however, occurred only after TCD, and EBV load quantitatively predicted EBV-LPD in recipients of a TCD graft. (Blood. 2001;98:972-978)
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Affiliation(s)
- J W van Esser
- Department of Hematology, University Hospital Rotterdam/Daniel den Hoed Cancer Center, The Netherlands
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van den Heuvel-Eibrink MM, Wiemer EA, de Boevere MJ, van der Holt B, Vossebeld PJ, Pieters R, Sonneveld P. MDR1 gene-related clonal selection and P-glycoprotein function and expression in relapsed or refractory acute myeloid leukemia. Blood 2001; 97:3605-11. [PMID: 11369657 DOI: 10.1182/blood.v97.11.3605] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The expression of P-glycoprotein (P-gp), encoded by the MDR1 gene, is an independent adverse prognostic factor for response and survival in de novo acute myeloid leukemia (AML). Little is known about MDR1 expression during the development of disease. The present study investigated whether MDR1 gene- related clonal selection occurs in the development from diagnosis to relapsed AML, using a genetic polymorphism of the MDR1 gene at position 2677. Expression and function of P-gp were studied using monoclonal antibodies MRK16 and UIC2 and the Rhodamine 123 retention assay with or without PSC 833. No difference was found in the levels of P-gp function and expression between diagnosis and relapse in purified paired blast samples from 30 patients with AML. Thirteen patients were homozygous for the genetic polymorphism of MDR1 (n = 7 for guanine, n = 6 for thymidine), whereas 17 patients were heterozygous (GT). In the heterozygous patients, no selective loss of one allele was observed at relapse. Homozygosity for the MDR1 gene (GG or TT) was associated with shorter relapse-free intervals (P =.002) and poor survival rates (P =.02), compared with heterozygous patients. No difference was found in P-gp expression or function in patients with AML with either of the allelic variants of the MDR1 gene. It was concluded that P-gp function or expression is not upregulated at relapse/refractory disease and expression of one of the allelic variants is not associated with altered P-gp expression or function in AML, consistent with the fact that MDR1 gene-related clonal selection does not occur when AML evolves to recurrent disease. (Blood. 2001;97:3605-3611)
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- ATP Binding Cassette Transporter, Subfamily B, Member 1/physiology
- Adolescent
- Adult
- Aged
- Alleles
- Antibodies, Monoclonal
- Child
- Child, Preschool
- Gene Expression
- Genes, MDR/genetics
- Heterozygote
- Homozygote
- Humans
- Infant
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Middle Aged
- Nucleic Acid Hybridization
- Polymorphism, Genetic
- Prognosis
- Recurrence
- Survival Rate
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43
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Béné MC, Bernier M, Casasnovas RO, Castoldi G, Doekharan D, van der Holt B, Knapp W, Lemez P, Ludwig WD, Matutes E, Orfao A, Schoch C, Sperling C, van't Veer MB. Acute myeloid leukaemia M0: haematological, immunophenotypic and cytogenetic characteristics and their prognostic significance: an analysis in 241 patients. Br J Haematol 2001; 113:737-45. [PMID: 11380465 DOI: 10.1046/j.1365-2141.2001.02801.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Haematological, immunophenotypic and cytogenetic characteristics were analysed in 241 patients with acute myeloid leukaemia (AML) M0, including 58 children. Children < 3 years and adults between 60 and 70 years of age were most frequently affected. Immunophenotyping showed a heterogeneous phenotype. Anti-myeloperoxidase was positive in about half of the patients. Cytogenetic data were available from 129 (54%) patients. A normal karyotype was found in only 24%. Most of the abnormalities were unbalanced and the chromosomes 5, 7, 8 and 11 were the most frequently affected. Survival data were available from 152 treated patients (63%). The median overall survival for all patients was 10 months, 20 months for children (n = 36), 10 months for the young adult group (n = 50) and 7 months for the elderly patients (n = 66) (P = 0.09). Karyotype was not a prognostic factor influencing survival. AML M0 shows the immunological characteristics of early progenitor cells, but the expression of the different markers and cytogenetic abnormalities is heterogeneous. The prognosis is poor compared with other de novo AML and similar to that of AML with multilineage dysplasia or AML following myelodysplastic syndromes.
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Affiliation(s)
- M C Béné
- GEIL-laboratoire d'Immunologie, Faculté de Medicine, Nancy, France
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44
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van Esser JW, Niesters HG, Thijsen SF, Meijer E, Osterhaus AD, Wolthers KC, Boucher CA, Gratama JW, Budel LM, van der Holt B, van Loon AM, Löwenberg B, Verdonck LF, Cornelissen JJ. Molecular quantification of viral load in plasma allows for fast and accurate prediction of response to therapy of Epstein-Barr virus-associated lymphoproliferative disease after allogeneic stem cell transplantation. Br J Haematol 2001; 113:814-21. [PMID: 11380475 DOI: 10.1046/j.1365-2141.2001.02789.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Epstein-Barr virus lymphoproliferative disease (EBV-LPD) following allogeneic stem cell transplantation (allo-SCT) has a poor prognosis. We used a sensitive real-time polymerase chain reaction (PCR) assay for quantitative detection of EBV-DNA in plasma and serially measured EBV-DNA levels to assess the response to treatment in allo-SCT recipients with EBV-LPD. Fourteen allo-SCT recipients with EBV-LPD who received a T cell-depleted (TCD) sibling (n = 5) or matched unrelated donor (n = 9) graft were monitored from the time of EBV-LPD diagnosis, during therapy and assessment of clinical response. Seven patients had complete responses of EBV-LPD to therapy, of whom 21% (3 out of 14) survived beyond 6 months from EBV-LPD diagnosis. Clinically responding patients showed a rapid decline of EBV-DNA plasma levels within 72 h from the start of therapy. In contrast, all clinical non-responders showed an increase of EBV-DNA levels. Absolute EBV-DNA levels at the time of EBV-LPD diagnosis did not predict for response, but the pattern of EBV-DNA levels within 72 h from the start of therapy (> 50% decrease versus increase) strongly predicted for clinical response (P = 0.001). Quantitative monitoring of EBV-DNA levels from the start of and during therapy for EBV-LPD rapidly and accurately predicts for response to therapy as early as within 72 h. It may thus provide a powerful tool to adjust and select treatment in individuals with EBV-LPD following allo-SCT.
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MESH Headings
- Acute Disease
- Adult
- Anemia, Aplastic/mortality
- Anemia, Aplastic/surgery
- Anemia, Aplastic/virology
- DNA, Viral/blood
- Female
- Follow-Up Studies
- Hematopoietic Stem Cell Transplantation
- Herpesvirus 4, Human/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/virology
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid/surgery
- Leukemia, Myeloid/virology
- Leukemia, Myelomonocytic, Chronic/mortality
- Leukemia, Myelomonocytic, Chronic/surgery
- Leukemia, Myelomonocytic, Chronic/virology
- Lymphoproliferative Disorders/mortality
- Lymphoproliferative Disorders/surgery
- Lymphoproliferative Disorders/virology
- Male
- Middle Aged
- Multiple Myeloma/mortality
- Multiple Myeloma/surgery
- Multiple Myeloma/virology
- Polymerase Chain Reaction/methods
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/surgery
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/virology
- Prognosis
- Survival Rate
- Transplantation, Homologous
- Viral Load
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Affiliation(s)
- J W van Esser
- Department of Haematology, University Hospital Rotterdam/Daniel den Hoed Cancer Centre, The Netherlands.
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45
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van den Heuvel-Eibrink MM, Wiemer EA, de Boevere MJ, Slater RM, Smit EM, van Noesel MM, van der Holt B, Schoester M, Pieters R, Sonneveld P. MDR1 expression in poor-risk acute myeloid leukemia with partial or complete monosomy 7. Leukemia 2001; 15:398-405. [PMID: 11237063 DOI: 10.1038/sj.leu.2402027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Expression of the multidrug resistance (MDR1) phenotype, encoded by the MDR1 gene, is an adverse prognostic factor for CR and survival in acute myeloid leukemia (AML). Other prognostic factors, such as specific cytogenetic abnormalities, have been identified in AML. We have investigated the expression of the MDR1 gene in untreated AML patients with monosomy 7 (n = 12), and partial deletions (n = 7) of the long arm of chromosome 7 (respectively -7/7q-), because of the extremely bad prognosis associated with these cytogenetic abnormalities and because of the fact that the MDR1 gene is located on chromosome 7q21.1. The findings were compared with the level of MDR1 expression in a group of 42 other AML patients, matched for age with favourable, neutral or complex cytogenetic abberations. MDR1 mRNA expression, as measured by the RNase protection assay was significantly higher in the -7/7q- group vs other AML patients (median 1.3 vs 0.1 arbitrary units, P = 0.02). Protein expression of MDR1 in the -7/7q- group, as determined with the monoclonal antibody MRK16, was found to be similar to the levels found in the control group. With a functional rhodamine retention assay using the modulator PSC833, increased MDR1 activity was observed in the -7/7q- group as compared to the control group of patients (P = 0.05). Considering the higher MDR1 mRNA expression and equal or slightly elevated level of protein expression of MDR1, we studied the presence of MDR1 genes in this group of -7/7q- patients. Fluorescence in situ hybridization (FISH) studies, using a specific MDR1 probe revealed no loss of an MDR1 allele in any of the deleted q- arms of the seven patients with 7q-, whereas all monosomy 7 patients lacked one MDR1 gene homologue. To determine whether there was selective loss of the MDR1 gene in the -7/7q- patients, the genetic polymorphism of the MDR1 gene was used. Both allelic variants (G and T) were represented in the -7/7q- and in the control group, showing a predominance for GT at position 2677 of the MDR1 gene in the control group. In the 12 monosomy 7 patients loss of the MDR1 allele was random. Methylation studies of the CpG island of the MDR1 gene revealed no hypermethylation in any of the -7/7q- patients. We conclude that MDR1 expression in -7/7q- AML patients is upregulated at transcriptional, but not at translational level, suggesting that mechanisms other than MDR1 are responsible for the poor prognosis in these patients.
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Krol AD, Berenschot HW, Doekharan D, Henzen-Logmans S, van der Holt B, van 't Veer MB. Cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy and radiotherapy for stage I intermediate or high grade non-Hodgkin's lymphomas: results of a strategy that adapts radiotherapy dose to the response after chemotherapy. Radiother Oncol 2001; 58:251-5. [PMID: 11230885 DOI: 10.1016/s0167-8140(00)00272-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND A limited number cycles of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy followed by involved field radiotherapy is the treatment of choice for Ann Arbor stage I intermediate or high grade non-Hodgkin's lymphomas (NHL). The optimal radiotherapy dose in this combined modality setting, resulting in maximal disease control with minimal toxicity is unknown. In this retrospective single-center study we evaluated the results of a combined modality treatment strategy that adapts the radiotherapy dose to the response after chemotherapy, and focus on the influence of radiotherapy dose on local control and survival. PATIENTS AND METHODS One hundred and forty patients with NHL Ann Arbor stages I/IE of intermediate or high grade malignancy received four cycles of CHOP chemotherapy followed by involved field radiotherapy (IF-RT). The radiotherapy dose for patients in complete response (CR) after CHOP was either 26 or 40 Gy. Patients in partial response (PR) after CHOP always received 40 Gy. The influence of the radiotherapy dose on treatment outcome was evaluated for patients in CR at the end of treatment (n=128). RESULTS CR rates after chemotherapy and after radiotherapy were 67 and 91%, respectively. Seventy-four of the patients in CR after CHOP received 26 Gy, 20 patients in CR after CHOP 40 Gy. All patients in PR after CHOP (n=34) received 40 Gy. The localization of relapse (within or outside the radiation field) did not differ between patients receiving 26 or 40 Gy. Overall survival (OS) at 5 years for patients in CR after CHOP who received 26 and 40 Gy and for patients in PR after CHOP but CR after 40 Gy IF-RT was 76, 100 and 75%, respectively, (P=0.16), disease free survival (DFS) at 5 years 69, 90 and 75%, respectively, (P=0.52). CONCLUSIONS No statistically significant differences in patterns of relapse or survival were found between patients receiving 26 or 40 Gy IF-RT, however the number of events in all subgroups was small.
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Affiliation(s)
- A D Krol
- Department of Hematology, University Hospital Rotterdam/Daniel den Hoed Cancer Center, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands
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47
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Janssen JJ, van Rijn RS, van der Holt B, Schuurhuis GJ, Vellenga E, Verhoef GE, Ossenkoppele GJ, van den Berg E, Hagemeijer A, Släter R, Nieuwint AW, Cornelissen JJ. Mobilisation of haemopoietic progenitors in CML: a second course of intensive chemotherapy does not improve Ph-negativity in stem cell harvests. Bone Marrow Transplant 2000; 25:1147-55. [PMID: 10849527 DOI: 10.1038/sj.bmt.1702420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We collected peripheral blood stem cells (PBSC) in 19 early chronic phase CML patients following each of two consecutive cycles of intensive chemotherapy (CT) to evaluate whether an additional cycle of CT would increase Philadelphia (Ph)-negativity of the PBSC harvest. Autologous SCT (autoSCT) was performed if a major cytogenetic response (MCR) of the PBSC harvest was obtained. CT consisted of cytarabine 200 mg/ m2/day (days 1-7)/idarubicin 12 mg/m2/day (days 1-2) (cycle one) and cytarabine 2000 mg/m2/day (days 1-6)/amsacrine 120 mg/m2/day (days 1-3) (cycle two). One patient died of fungal pneumonia after the first cycle. Stem cells were harvested in 18 patients after cycle one and in 16 patients after cycle two. After the first cycle, all patients showed a cytogenetic response of their graft (MCR in eight patients: three complete, five partial), after cycle two, seven patients obtained an MCR (one complete, six partial). Seven patients became eligible for autoSCT. All patients proceeded with IFNalpha maintenance. Currently, 16 patients are alive. At the latest cytogenetic examination of bone marrow, four patients showed an MCR and four a minor response. In conclusion, although a second cycle of CT may contribute to elimination of leukemia residing in the patient, it appeared to be ineffective in improving the Ph-negativity of the PBSC graft.
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Affiliation(s)
- J J Janssen
- Department of Haematology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands
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48
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Contant CM, van Geel AN, van der Holt B, Griep C, Tjong Joe Wai R, Wiggers T. Morbidity of immediate breast reconstruction (IBR) after mastectomy by a subpectorally placed silicone prosthesis: the adverse effect of radiotherapy. Eur J Surg Oncol 2000; 26:344-50. [PMID: 10873353 DOI: 10.1053/ejso.1999.0896] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS This study evaluates the incidence of local complications after immediate breast reconstruction (IBR) following mastectomy with a subpectorally placed silicone prosthesis, with emphasis on the effect of radiation treatment on IBR. METHODS The medical records of 100 women, who underwent a mastectomy followed by IBR with a subpectorally placed silicone prosthesis at the University Hospital Rotterdam/Daniel den Hoed Cancer Center, between March 1990 and March 1995, were reviewed. Thirteen prostheses were implanted prior to radiation treatment, and 15 prostheses were implanted after irradiation of the chest wall. RESULTS Early complications were seen in 15% of the IBR and were more often in irradiated women. At long-term follow-up, the most common complication was capsular contracture (21%). This occurred significantly more around prostheses placed in a previously irradiated area (P<0.0005), or which were irradiated after IBR (P=0.001). Loss of prosthesis was seen in 11 cases, and was significantly (P<0.005) more in irradiated women (n=5; 18%) compared to women who were not irradiated (n=6; 7%). CONCLUSIONS Complications after IBR with a silicone prosthesis were more common in women who were treated with radiotherapy prior to or after IBR following mastectomy than in women who were not irradiated. In particular, capsular contracture around a prosthesis placed in a previously irradiated area was significantly increased. The use of musculocutaneous flaps, such as the transverse rectus abdominis muscle or latissimus dorsi flap, is preferable for reconstruction of previously irradiated breasts. There is no indication to remove the prosthesis before radiation therapy of the chest wall.
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Affiliation(s)
- C M Contant
- Department of Surgical Oncology, University Hospital Rotterdam/Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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49
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Ossenkoppele GJ, van der Holt B, Verhoef GE, Daenen SM, Verdonck LF, Sonneveld P, Wijermans PW, van der Lelie J, van Putten WL, Löwenberg B. A randomized study of granulocyte colony-stimulating factor applied during and after chemotherapy in patients with poor risk myelodysplastic syndromes: a report from the HOVON Cooperative Group. Dutch-Belgian Hemato-Oncology Cooperative Group. Leukemia 1999; 13:1207-13. [PMID: 10450748 DOI: 10.1038/sj.leu.2401478] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to determine the safety and efficacy of filgrastim as an adjunct to induction and consolidation chemotherapy in poor risk patients with myelodysplastic syndrome (MDS). Filgrastim was given both during and after chemotherapy with the objective to accelerate hematopoietic repopulation and enhance the efficacy of chemotherapy. In a prospective randomized multicentre phase II trial, a total of 64 patients with poor risk primary MDS were randomized to receive either granulocyte colony-stimulating factor (G-CSF, filgrastim, AMGEN, Breda, The Netherlands) 5 microg/kg/day subcutaneously or no G-CSF in addition to daunomycin (30 mg/m2/days 1, 2 and 3 intravenous bolus) and cytarabine (200 mg/m2 days 1-7, continuous infusion). The overall complete response rate was 63%: 73% for patients receiving filgrastim as compared to 52% in the standard arm (P = 0.08). Overall survival at 2 years was estimated at 29% for patients assigned to the filgrastim arm and 16% for control patients (P = 0.22). The median time for recovery of granulocytes towards 1.0 x 10(9)/l post-chemotherapy was 23 days in the filgrastim-treated patients vs 35 days in the standard arm (P = 0.015). There were no differences in time of platelet recovery, length of hospital stay, duration of antibiotic use or infectious complications between the two treatment groups. However the earlier recovery of neutrophils in the filgrastim group was associated with a reduced interval of 9 days between the induction and consolidation cycle. In patients with poor risk MDS the use of filgrastim during and after induction therapy results in a significantly reduced neutrophil recovery time. Further study may be warranted to see if the apparent trend of the improved response to chemotherapy in combination with filgrastim can be confirmed in greater number of patients and to assess the effect of the addition of filgrastim on survival.
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Affiliation(s)
- G J Ossenkoppele
- University Hospital Vrije Universiteit Amsterdam, The Netherlands
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50
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Segeren CM, Sonneveld P, van der Holt B, Baars JW, Biesma DH, Cornellissen JJ, Croockewit AJ, Dekker AW, Fibbe WE, Lowenberg B, van Marwijk Kooy M, van Oers MHJ, Richel DJ, Schouten HC, Vellenga E, Verhoef GEG, Wijermans PW, Wittebol S, Lokhorst HM. Vincristine, doxorubicin and dexamethasone (VAD) administered as rapid intravenous infusion for first-line treatment in untreated multiple myeloma. Br J Haematol 1999. [DOI: 10.1111/j.1365-2141.1999.01279.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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