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Pötzsch C, Kurch L, Naumann S, Georgi TW, Sabri O, Stoevesandt D, Cepelova M, Körholz D, Mauz-Körholz C, Hasenclever D, Kluge R. Prevention of activated brown adipose tissue on 18F-FDG-PET scans of young lymphoma patients: results of an ancillary study within the EuroNet-PHL-C2 trial. Sci Rep 2023; 13:21944. [PMID: 38081864 PMCID: PMC10713612 DOI: 10.1038/s41598-023-48871-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Activated brown fat (aBAT) is known to affect the evaluation of 18F-FDG PET scans, especially in young patients. The aim of this study was to determine factors influencing the occurrence of aBAT, and to investigate the effectiveness of the two preventive measures, warming and beta-blocker (propranolol) administration. Five-hundred-twenty-eight 18F-FDG-PET scans of 241 EuroNet-PHL-C2 trial patients from 41 nuclear medicine departments in Germany and Czech Republic were screened for aBAT. The occurrence of aBAT was analyzed with patient characteristics (age, sex, body mass index, predisposition to aBAT), weather data at the day of 18F-FDG PET scanning as well as the preventive measures taken. Potentially important factors from univariate analyses were included into a logistic regression model. Warming as a preventive measure was used in 243 18F-FDG-PET scans, propranolol was administered in 36, warming and propranolol were combined in 84, and no preventive measures were taken in 165 scans. Whereas age, sex and body mass index had no clear impact, there was an individual predisposition to aBAT. Logistic regression model revealed that the frequency of aBAT mainly depends on the outside temperature (p = 0.005) and can be effectively reduced by warming (p = 0.004), the administration of unselective beta-blocker or the combination of both. Warming is a simple, cheap and non-invasive method to reduce the frequency of aBAT. However, the effect of warming decreases with increasing outside temperatures. Administration of propranolol seems to be equally effective and provides advantages whenever the positive effect of warming is compromised. The combination of both preventive measures could have an additive effect.
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Affiliation(s)
- C Pötzsch
- Department of Nuclear Medicine, University Hospital of Leipzig, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany.
| | - S Naumann
- Department of Nuclear Medicine, University Hospital of Leipzig, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - T W Georgi
- Department of Nuclear Medicine, University Hospital of Leipzig, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - O Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
| | - D Stoevesandt
- Department of Radiology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - M Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol and Second Medical Faculty of Charles University, Prague, Czech Republic
| | - D Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University Giessen, Giessen, Germany
| | - C Mauz-Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University Giessen, Giessen, Germany
| | - D Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - R Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
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2
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Lautenschlaeger S, Iancu G, Flatten V, Baumann K, Thiemer M, Dumke C, Zink K, Hauswald H, Vordermark D, Mauz-Körholz C, Engenhart-Cabillic R, Eberle F. Advantage of proton-radiotherapy for pediatric patients and adolescents with Hodgkin's disease. Radiat Oncol 2019; 14:157. [PMID: 31477141 PMCID: PMC6721251 DOI: 10.1186/s13014-019-1360-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/16/2019] [Indexed: 01/26/2023] Open
Abstract
Abstract Radiotherapy is frequently used in the therapy of lymphoma. Since lymphoma, for example Hodgkin’s disease, frequently affect rather young patients, the induction of secondary cancer or other long-term adverse effects after irradiation are important issues to deal with. Especially for mediastinal manifestations numerous organs and substructures at risk play a role. The heart, its coronary vessels and cardiac valves, the lungs, the thyroid and, for female patients, the breast tissue are only the most important organs at risk. In this study we investigated if proton-radiotherapy might reduce the dose delivered to the organs at risk and thus minimize the therapy-associated toxicity. Methods In this work we compared the dose delivered to the heart, its coronary vessels and valves, the lungs, the thyroid gland and the breast tissue by different volumetric photon plans and a proton plan, all calculated for a dose of 28.8 Gy (EURO-NET-PHL-C2). Target Volumes have been defined by F18-FDG PET-positive areas, following a modified involved node approach. Data from ten young female patients with mediastinal lymphoma have been evaluated. Three different modern volumetric IMRT (VMAT) photon plans have been benchmarked against each other and against proton-irradiation concepts. For plan-evaluation conformity- and homogeneity-indices have been calculated as suggested in ICRU 83. The target volume coverage as well as the dose to important organs at risk as the heart with its substructures, the lungs, the breast tissue, the thyroid and the spinal cord were calculated and compared. For statistical evaluation mean doses to organs at risk were evaluated by non- parametric Kruskal-Wallis calculations with pairwise comparisons. Results Proton-plans and three different volumetric photon-plans have been calculated. Proton irradiation results in significant lower doses delivered to organ at risk. The median doses and the mean doses could be decreased while PTV coverage is comparable. As well conformity as homogeneity are slightly better for proton plans. For several organs a risk reduction for secondary malignancies has been calculated using literature data as reference. According to the used data derived from literature especially the secondary breast cancer risk, the secondary lung cancer risk and the risk for ischemic cardiac insults can be reduced significantly by using protons for radiotherapy of mediastinal lymphomas. Conclusion Irradiation with protons for mediastinal Hodgkin-lymphoma results in significant lower doses for almost all organs at risk and is suitable to reduce long term side effects for pediatric and adolescent patients. Electronic supplementary material The online version of this article (10.1186/s13014-019-1360-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Lautenschlaeger
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.
| | - G Iancu
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany
| | - V Flatten
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Technische Hochschule Mittelhessen, Institut für Medizinische Physik und Strahlenschutz, Gießen, Germany
| | - K Baumann
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Technische Hochschule Mittelhessen, Institut für Medizinische Physik und Strahlenschutz, Gießen, Germany
| | - M Thiemer
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany
| | - C Dumke
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany
| | - K Zink
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Technische Hochschule Mittelhessen, Institut für Medizinische Physik und Strahlenschutz, Gießen, Germany
| | - H Hauswald
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Klinik für Radio-Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Marburg, Germany
| | - D Vordermark
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - C Mauz-Körholz
- Abteilung für Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Gießen, Gießen, Germany.,Department für operative und konservative Kinder- und Jugendmedizin, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - R Engenhart-Cabillic
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Marburg, Germany
| | - F Eberle
- Klinik für Strahlentherapie und Radioonkologie, Klinikum der Philipps Universität Marburg, Baldingerstr, 35043, Marburg, Germany.,Marburg Ion-Beam Therapy Center (MIT), Marburg, Germany
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3
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Flerlage J, Mauz-Körholz C, Kelly K, McCarten K, Punnett A, Kaste S, Dieckmann K, Marks L, Seelisch J, Drachtman R, Lewis J, Beishuzen A, Kluge R, Kurch L, Stroevesandt D, Metzger M. INCLUSION OF A PEDIATRIC PERSPECTIVE INTO RECOMMENDATIONS FOR THE INITIAL EVALUATION AND STAGING OF HODGKIN LYMPHOMA: A CALL TO ACTION FROM THE INTERNATIONAL SEARCH WORKING GROUP. Hematol Oncol 2019. [DOI: 10.1002/hon.24_2629] [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: 11/10/2022]
Affiliation(s)
- J. Flerlage
- Oncology; St. Jude Children's Research Hospital; Memphis United States
| | - C. Mauz-Körholz
- Pediatric Hematology and Oncology; Martin-Luther-University; Giessen Germany
| | - K. Kelly
- Hematology/Oncology; Roswell Park Comprehensive Cancer Center; Buffalo United States
| | - K. McCarten
- Diagnostic Imaging; 13Rhode Island Hospital/Warren Alpert Medical School at Brown University; Providence United States
| | - A. Punnett
- Pediatrics; Sickkids Hospital; Toronto Ontario Canada
| | - S. Kaste
- Oncology; St. Jude Children's Research Hospital; Memphis United States
| | - K. Dieckmann
- Radiotherapy; Medizinische Universität Wien; Vienna Austria
| | - L. Marks
- Pediatric Hematology/Oncology; Stanford; Palo Alto United States
| | - J. Seelisch
- Hematology/Oncology; Children's Hospital, London Health Sciences Centre; London Ontario Canada
| | - R. Drachtman
- Hematology/Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick United States
| | - J. Lewis
- Hematology/Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick United States
| | | | - R. Kluge
- Nuclear Medicine; University of Leipzig; Leipzig Germany
| | - L. Kurch
- Nuclear Medicine; University of Leipzig; Leipzig Germany
| | | | - M. Metzger
- Oncology; St. Jude Children's Research Hospital; Memphis United States
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4
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Metzger M, Mauz-Körholz C, Flerlage J, Bartelt J, Billett A, Choi J, Ehrhardt M, Georgi T, Hasenclever D, Wang F, Zhang H, Kaste S, Kluge R, Körholz D, Kurch L, Link M, Stoevesandt D, Hudson M, Krasin M. SAFETY AND RESPONSE AFTER 2 CYCLES OF BRENTUXIMAB VEDOTIN SUBSTITUTING VINCRISTINE IN THE OEPA/COPDAC REGIMEN FOR HIGH RISK PEDIATRIC HODGKIN LYMPHOMA (HL). Hematol Oncol 2019. [DOI: 10.1002/hon.25_2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M. Metzger
- Oncology; St Jude Children's Research Hospital; Memphis United States
| | - C. Mauz-Körholz
- Pediatric Hematology Oncology; Justus Liebig Universität; Giessen Germany
| | - J. Flerlage
- Oncology; St Jude Children's Research Hospital; Memphis United States
| | - J. Bartelt
- Clinic of Radiology; Martin Luther University; Halle (Saale) Germany
| | - A. Billett
- Blood Disorders Center; Dana-Farber/Boston Children's Hospital; Boston United States
| | - J.K. Choi
- Pathology; St Jude Children's Research Hospital; Memphis United States
| | - M. Ehrhardt
- Oncology; St Jude Children's Research Hospital; Memphis United States
| | - T. Georgi
- Nuclear Medicine; University of Leipzig; Leipzig Germany
| | - D. Hasenclever
- Institut for Medical Informatics; University of Leipzig; Leipzig Germany
| | - F. Wang
- Biostatistics; St Jude Children's Research Hospital; Memphis United States
| | - H. Zhang
- Biostatistics; St Jude Children's Research Hospital; Memphis United States
| | - S.C. Kaste
- Diagnostic Imaging; St Jude Children's Research Hospital; Memphis United States
| | - R. Kluge
- Nuclear Medicine; University of Leipzig; Leipzig Germany
| | - D. Körholz
- Pediatric Hematology Oncology; Justus Liebig Universität; Giessen Germany
| | - L. Kurch
- Nuclear Medicine; University of Leipzig; Leipzig Germany
| | - M. Link
- Pediatric Hematology Oncology; Stanford University Medical Center; Palo Alto United States
| | - D. Stoevesandt
- Clinic of Radiology; Martin Luther University; Halle (Saale) Germany
| | - M.M. Hudson
- Oncology; St Jude Children's Research Hospital; Memphis United States
| | - M. Krasin
- Radiation Oncology; St Jude Children's Research Hospital; Memphis United States
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5
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Kelly K, Daw S, Mauz-Körholz C, Mascarin M, Michel G, Cooper S, Beishuizen A, Leger K, Garaventa A, Buffardi S, Brugières L, Harker-Murray P, Cole P, Drachtman R, Manley T, Francis S, Sacchi M, Leblanc T. RESPONSE-ADAPTED TREATMENT WITH NIVOLUMAB AND BRENTUXIMAB VEDOTIN IN YOUNG PATIENTS WITH RELAPSED/REFRACTORY CLASSICAL HODGKIN LYMPHOMA: CHECKMATE 744 SUBGROUP ANALYSES. Hematol Oncol 2019. [DOI: 10.1002/hon.26_2629] [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: 11/12/2022]
Affiliation(s)
- K.M. Kelly
- Department of Pediatric Oncology; Roswell Park Comprehensive Cancer Center; Buffalo United States
| | - S. Daw
- Paediatric and Adolescent Haemato-Oncology; University College Hospital; London United Kingdom
| | - C. Mauz-Körholz
- Department of Pediatric Hematology and Oncology; University Hospital Justus Liebig University; Giessen Germany
| | - M. Mascarin
- AYA and Pediatric Radiotherapy Unit; IRCCS Centro di Riferimento Oncologico; Aviano Italy
| | - G. Michel
- Service d'Hématologie pédiatrique; CHU de Marseille - Hôpital de la Timone; Maresille France
| | - S. Cooper
- Pediatric Oncology; Johns Hopkins Hospital; Baltimore United States
| | - A. Beishuizen
- Pediatric Oncology/Hematology; Princess Máxima Center for Pediatric Oncology; Utrecht Netherlands
| | - K.J. Leger
- Hematology-Oncology; Seattle Children's Hospital; Seattle United States
| | - A. Garaventa
- UOC Oncologia; Ematologia e Trapianto di Midollo, IRCCS Istituto Giannina Gaslini; Genoa Italy
| | - S. Buffardi
- Paediatric Haemato-Oncology; Santobono-Pausilipon Hospital; Naples Italy
| | - L. Brugières
- Department of Paediatrics; Institut Gustave Roussy; Villejuif France
| | - P. Harker-Murray
- Pediatric Hematology-Oncology; Children's Hospital of Wisconsin; Milwaukee United States
| | - P.D. Cole
- Division of Pediatric Hematology/Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick United States
| | - R.A. Drachtman
- Division of Pediatric Hematology/Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick United States
| | - T. Manley
- Seattle Genetics; Bothell United States
| | - S. Francis
- Bristol-Myers Squibb; Princeton United States
| | - M. Sacchi
- Bristol-Myers Squibb; Princeton United States
| | - T. Leblanc
- Service d'Hématologie Pédiatrique; Hôpital Robert-Debré APHP; Paris France
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6
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Kurch L, Hasenclever D, Kluge R, Georgi T, Tchavdarova L, Golombeck M, Sabri O, Eggert A, Brenner W, Sykora KW, Bengel FM, Rossig C, Körholz D, Schäfers M, Feuchtinger T, Bartenstein P, Ammann RA, Krause T, Urban C, Aigner R, Gattenlöhner S, Klapper W, Mauz-Körholz C. Only strongly enhanced residual FDG uptake in early response PET (Deauville 5 or qPET ≥ 2) is prognostic in pediatric Hodgkin lymphoma: Results of the GPOH-HD2002 trial. Pediatr Blood Cancer 2019; 66:e27539. [PMID: 30426671 DOI: 10.1002/pbc.27539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 10/11/2018] [Accepted: 10/14/2018] [Indexed: 11/06/2022]
Abstract
PURPOSE In 2014, we published the qPET method to quantify fluorodeoxyglucose positron emission tomography (FDG-PET) responses. Analysis of the distribution of the quantified signals suggested that a clearly abnormal FDG-PET response corresponds to a visual Deauville score (vDS) of 5 and high qPET values ≥ 2. Evaluation in long-term outcome data is still pending. Therefore, we analyzed progression-free survival (PFS) by early FDG-PET response in a subset of the GPOH-HD2002 trial for pediatric Hodgkin lymphoma (PHL). PATIENTS/METHODS Pairwise FDG-PET scans for initial staging and early response assessment after two cycles of chemotherapy were available in 93 PHL patients. vDS and qPET measurement were performed and related to PFS. RESULTS Patients with a qPET value ≥ 2.0 or vDS of 5 had 5-year PFS rates of 44%, respectively 50%. Those with qPET values < 2.0 or vDS 1 to 4 had 5-year PFS rates of 90%, respectively 80%. The positive predictive value of FDG-PET response assessment increased from 18% (9%; 33%) using a qPET threshold of 0.95 (vDS ≤ 3) to 30% (13%; 54%) for a qPET threshold of 1.3 (vDS ≤ 4) and to 56% (23%; 85%) when the qPET threshold was ≥ 2.0 (vDS 5). The negative predictive values remained stable at ≥92% (CI: 82%; 98%). CONCLUSION Only strongly enhanced residual FDG uptake in early response PET (vDS 5 or qPET ≥ 2, respectively) seems to be markedly prognostic in PHL when treatment according to the GPOH-HD-2002 protocol is given.
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Affiliation(s)
- L Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - D Hasenclever
- Institute of Medical Statistics, Informatics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - R Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - T Georgi
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - L Tchavdarova
- Clinic of Nuclear Medicine, National Hospital for Active Treatment in Oncology, Sofia, Bulgaria
| | - M Golombeck
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - O Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - A Eggert
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Charité Berlin, Berlin, Germany
| | - W Brenner
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K W Sykora
- Department of Pediatric Hematology and Oncology, Medizinische Hochschule Hannover, Hannover, Germany
| | - F M Bengel
- Department of Nuclear Medicine, Medizinische Hochschule Hannover, Hannover, Germany
| | - C Rossig
- University Children's Hospital Münster, Pediatric Hematology and Oncology, Münster, Germany
| | - D Körholz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Giessen, Germany
| | - M Schäfers
- Department of Nuclear Medicine, University Hospital of Münster, Münster, Germany
| | - T Feuchtinger
- Dr. von Hauner University Children's Hospital, LMU Munich, Munich, Germany
| | - P Bartenstein
- Department of Nuclear Medicine, LMU Munich, Munich, Germany
| | - R A Ammann
- Division of Pediatric Hematology and Oncology, Department of Pediatrics (Inselspital) Bern University Hospital, University of Bern, Bern, Switzerland
| | - T Krause
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Urban
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Graz, Graz, Austria
| | - R Aigner
- Department of Radiology, Medical University Graz, Graz, Austria
| | - S Gattenlöhner
- Department of Pathology, Justus-Liebig University of Giessen, Giessen, Germany
| | - W Klapper
- Department of Pathology, University Hospital of Kiel, Kiel, Germany
| | - C Mauz-Körholz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Giessen, Germany.,Medical Faculty, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
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7
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Dietlein M, Mauz-Körholz C, Engert A, Borchmann P, Sabri O, Schober O, Schicha H, Kluge R, Kobe C. FDG-PET in Hodgkin lymphoma. Nuklearmedizin 2018; 47:235-8; quiz N75-6. [DOI: 10.3413/nukmed-0216] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SummaryThe high negative predictive value of FDG-PET in therapy control of Hodgkin lymphoma is proven by the data acquired up to now. Thus, the analysis of the HD15 trial has shown that consolidation radiotherapy might be omitted in PET negative patients after effective chemotherapy. Further response adapted therapy guided by PET seems to be a promising approach in reducing the toxicity for patients undergoing chemotherapy. The criteria used for the PET interpretation have been standardized by the German study groups for Hodgkin lymphoma patients and will be reevaluated in the current studies.
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8
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Pinkwart C, Haase R, Merkel N, Forsberg D, Mauz-Körholz C, Stiefel M. Immuntoleranzinduktion mit hoch dosiertem FVIII und intravenösen Immunglobulin-Pulsen. Hamostaseologie 2017. [DOI: 10.1055/s-0037-1619092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
SummaryThe development of neutralizing allo-antibodies against factor VIII (FVIII) or FVIII inhibitors is a severe complication in the treatment of haemophilia A. About 25% of the children with severe haemophilia A develop FVIII inhibitors. Here we report on a boy with severe haemophilia A and intron 22 inversion of the FVIII gene who was diagnosed at ten months of age. After 16 exposure days to FVIII (81 days after initial exposure) he developed a FVIII inhibitor (maximum: 9.76 BU/ml). Therapy: We started immune tolerance induction (ITI) according to the Bonn protocol with high dose plasma derived FVIII concentrate (100 IU per kg body weight) twice daily. For additional inhibitor elimination treatment the patient received intravenous immunoglobulin (ivIg) at a dose of 1–2 g/kg body weight every 4 to 6 weeks. After start of treatment a rapid decline of the inhibitor level was observed, nevertheless low FVIII inhibitor levels persisted (<5 BU/ ml). Furthermore, the FVIII half-life was still accelerated. However, after every course of ivIg the inhibitor level declined and FVIII half-life was prolonged. Currently, the FVIII half-life is approaching normal values after more than seven months of ITI duration. Conclusion: Additional application of immunoglobulin is beneficial for immune tolerance induction.
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9
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Körholz D, Schneider D, von Kries R, Mauz-Körholz C, Göbel U. How to Overcome Scientific Standstill for Very Rare Diseases: Clinical Trials or Clinical Registries? Klin Padiatr 2015; 227:303-4. [PMID: 26600174 DOI: 10.1055/s-0035-1565135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Mauz-Körholz C, Lange T, Hasenclever D, Burkhardt B, Feller A, Dörffel W, Kluge R, Vordermark D, Körholz D. Pediatric Nodular Lymphocyte-predominant Hodgkin Lymphoma: Treatment Recommendations of the GPOH-HD Study Group. Klin Padiatr 2015; 227:314-21. [DOI: 10.1055/s-0035-1559664] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Mauz-Körholz
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle/ Wittenberg, Halle/ Saale, Germany
| | - T. Lange
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle/ Wittenberg, Halle/ Saale, Germany
| | - D. Hasenclever
- Institut für Medizinische Informatik, Statistik & Epidemiologie (IMISE), Universität Leipzig, Leipzig, Germany
| | - B. Burkhardt
- Clinic for Pediatric Hematology and Oncology, University Hospital Münster, Münster, Germany
| | - A. Feller
- Institute for Pathology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - W. Dörffel
- Clinic for Pediatric and Youth Medicine, Helios Hospital Berlin-Buch, Berlin, Germany
| | - R. Kluge
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - D. Vordermark
- Clinic and Policlinic for Radiation Therapy, University Hospital Halle (Saale), Halle (Saale), Germany
| | - D. Körholz
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle/ Wittenberg, Halle/ Saale, Germany
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11
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Körholz D, Mauz-Körholz C, Vordermark D, Kluge R, Dieckmann K. Increased relapse rates in early stage hodgkin lymphoma (HL) patients without radiotherapy: the German Society of Radiooncology (DEGRO) advises to treat all early stage HL patients with radiotherapy. Klin Padiatr 2014; 226:307-8. [PMID: 25431863 DOI: 10.1055/s-0034-1389928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Clauß D, Deutsch J, Krol I, Haase R, Willard P, Müller-Bahlke T, Mauz-Körholz C, Körholz D. [Early childhood intervention - access to risk families and support through actors from the health-care sector]. Klin Padiatr 2014; 226:243-7. [PMID: 25010130 DOI: 10.1055/s-0034-1374603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Interdisciplinary cooperation and networking determine the success of activities for supporting families at risk for early childhood abuse. The integration of the healthcare sector might be important.The medical standard of perinatal care at the University hospital includes information exchange about family risk factors which may contribute to an increased risk of child abuse within the first year of life. As a result, the -pediatrician offered supporting services for the families at the time of the second examination during the official childhood health screening program (U2). A team of family-sponsorship was established and evaluated.In 281 of 1238 risk-factor questionnaires at least one stress factor was detected and 97 families had high-impact family stress. Families under the supervision of a family midwife or youth services had a significantly higher number of risk factors. The family-sponsorship program was institutionalized and positively evaluated by the families.The time of a hospital delivery is an excellent opportunity for the evaluation of familial risk factors and for the provision of supporting services. To increase the acceptance of such services by the families at risk repeated assessment of risk factors and support offers are required.
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Affiliation(s)
- D Clauß
- Universitätsklinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Halle, Halle (Saale)
| | - J Deutsch
- Franckesche Stiftungen zu Halle, Halle (Saale)
| | - I Krol
- Universitätsklinik und Poliklinik für Geburtshilfe, Universitätsklinikum Halle, Halle (Saale)
| | - R Haase
- Universitätsklinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Halle, Halle (Saale)
| | - P Willard
- Franckesche Stiftungen zu Halle, Halle (Saale)
| | | | - C Mauz-Körholz
- Universitätsklinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Halle, Halle (Saale)
| | - D Körholz
- Universitätsklinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Halle, Halle (Saale)
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13
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Burkhardt B, Körholz D, Klapper W, Woessmann W, Mauz-Körholz C. Grey Zone Lymphoma in Children and Adolescents: Experience of Pediatric Hodgkin and Non-Hodgkin Study Groups. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Conrad J, Stiefel M, Behre H, Jürgens H, Kramm C, Schneppenheim R, Attarbaschi A, Ebetsberger-Dachs G, Bergstraesser E, Körholz D, Mauz-Körholz C. Fertility Testing in Young Men After Successful Treatment of Hodgkin's Lymphoma with Procarbazine-Free Combination Regimen within the GPOH-HD 2002 Trial. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Kurch L, Hasenclever D, Tchavdarova L, Georgi T, Stoevesandt D, Pelz T, Vordermark D, Sabri O, Mauz-Körholz C, Körholz D, Kluge R. Impact of Non-FDG-Avid Areas Inside a Tumour Mass in Paediatric Hodgkin Lymphoma (PHL) Patients. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Locatelli F, Neville K, Rosolen A, Landman-Parker J, Aladjidi N, Beishuizen A, Daw S, Gore L, Franklin ARK, Fasanmade A, Wang J, Sachs J, Mauz-Körholz C. Phase 1/2 Study of Brentuximab Vedotin in Pediatric Pts with Relapsed/Refractory (R/R) Hodgkin Lymphoma (HL) or Systemic Anaplastic Large-Cell Lymphoma (sALCL): Preliminary Phase 2 HL Data. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Hartmann S, Mauz-Körholz C, Eichenauer D, Mottok A, Bob R, Koch K, Bernd HW, Cogliatti S, Hummel M, Feller A, Ott G, Möller P, Rosenwald A, Stein H, Hansmann ML, Körholz D, Klapper W. Variant Histological Patterns of Nodular Lymphocyte Predominant Hodgkin Lymphoma in Children Treated in Trials of the GPOH-HD. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Fink A, Mauz-Körholz C, Körholz D, Richter M. Social Inequalities in Participation and Activity in Children and Adolescents with Hodgkin's Lymphoma. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Mauz-Körholz C, Hasenclever D, Holzendorf V, Jürgens H, Burdach S, Eggert A, Berthold F, Müller H, Frühwald M, Klingebiel T, Metzler M, Körholz D. Feasibility of VECOPA a Dose-Intensive Regimen for Pediatric Intermediate and Advanced Stage Hodgkin's Lymphoma: Results of the GPOH-HD-2002/VECOPA-Pilot Study. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Kurch L, Mauz-Körholz C, Bertling S, Wallinder M, Kaminska M, Marwede D, Tchavdarova L, Georgi TW, Elsner A, Barthel A, Stoevesandt D, Hasenclever D, Sattler B, Sabri O, Körholz D, Kluge R. The EuroNet paediatric hodgkin network - modern imaging data management for real time central review in multicentre trials. Klin Padiatr 2013; 225:357-61. [PMID: 24166093 DOI: 10.1055/s-0033-1354416] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Since 2007, children and adolescents with Hodgkin lymphomas are treated in the Europe-wide EuroNet-PHL trials. A real time central review process for stratification of the patients enhances quality control and efficient therapy management. This process includes reading of all cross-sectional-images. Since reference evaluation is time critical, a fast, easy to handle and safe data transfer is important. In addition, immediate and constant access to all the data has to be guaranteed in case of queries and for regulatory reasons. To meet the mentioned requirements the EuroNet Paediatric Hodgkin Data Network (funded by the European Union - Project Number: 2007108) was established between 2008 and 2011. A respective tailored data protection plan was formulated. The aim of this article is to describe the networks' mode of operation and the advantages for multi-centre trials that include centralized image review.
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Affiliation(s)
- L Kurch
- Department of Nuclear Medicine, University Hospital of Leipzig, Germany
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21
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Haase R, Vilser C, Mauz-Körholz C, Hasenclever D, Kluge R, Ruschke K, Borkhardt A, Seeger K, Lehrnbecher T, Kulozik A, Rößler J, Burdach S, Jürgens H, Körholz D. Evaluation of the prognostic meaning of C-reactive protein (CRP) in children and adolescents with classical Hodgkin's lymphoma (HL). Klin Padiatr 2012; 224:377-81. [PMID: 23047832 DOI: 10.1055/s-0032-1323824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In adult cancer patients the negative predictive value of elevated CRP levels has been described for several malignancies. Only few studies have analyzed the prognostic role of CRP in children and adolescents with classical HL. In these studies elevated CRP levels correlate with the presence of classical risk factors and adverse outcome. PATIENTS AND METHODS The prognostic role of CRP for patients with classical HL admitted to the GPOH-HD-2002 study was analyzed retrospectively. RESULTS CRP levels were documented for 369 of 573 patients. Significant (p<0.05) increased median CRP levels were found in the presence of B-Symptoms (25.7 vs. 5.1 mg/l), extranodal involvement (21.5 vs. 7.5 mg/l), elevated erythrocyte sedimentation rate (ESR, 13.0 vs. 1.0 mg/l) and stage III/IV disease (15.5 vs. 5.3 mg/l). 83.9% of patients with elevated and 45.8% of patients with normal CRP had an ESR >30 mm/h. CONCLUSION Elevated CRP levels were associated with classical risk factors of HL. CRP and ESR may reflect different biological processes. CRP was prognostic within early stage TG-1 patients treated with reduced treatment, but not within advanced stage TG-2+3.
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Affiliation(s)
- R Haase
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle Wittenberg, Halle/Saale, Germany.
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22
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Thiel U, Wolf P, Wawer A, Blaeschke F, Grunewald TGP, von Lüttichau IT, Klingebiel T, Bader P, Borkhardt A, Laws HJ, Handgretinger R, Lang P, Schlegel PG, Eyrich M, Gruhn B, Ehninger G, Koscielniak E, Klein C, Sykora KW, Holler E, Mauz-Körholz C, Woessmann W, Richter GHS, Schmidt AH, Peters C, Dirksen U, Jürgens H, Bregni M, Burdach S. Human leukocyte antigen distribution in German Caucasians with advanced Ewing's sarcoma. Klin Padiatr 2012; 224:353-8. [PMID: 22821288 DOI: 10.1055/s-0032-1321730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Risk stratification criteria for patients with Ewing's sarcoma family of tumors (ESFT) are still limited. We hypothesized divergent human leukocyte antigen (HLA) patterns in ESFT patients and compared HLA-A, -B and -DR phenotype frequencies of patients with advanced ESFT with those of healthy controls. PATIENTS HLA types of all German Caucasian patients with advanced ESFT and available HLA-A, -B and -DR data registered in the European Group for Blood and Marrow Transplantation, Paediatric Registry for Stem Cell Transplantation and the MetaEICESS data bases (study group, n=30) were retrospectively compared with HLA types of healthy German stem cell donors (control group, n=8 862 for single HLA frequencies and n=8 839 for allele combinations). Study group patients had been immuno-typed due to eligibility for allogeneic stem cell transplantation for high risk of treatment failure, and thus constituted a selected subgroup of ESFT patients. RESULTS After Bonferroni correction for multiple testing (PC), phenotype frequencies of HLA-A24 remained significantly higher in the study group compared to controls (PC<0.05). Furthermore, several HLA combinations were significantly more frequent in the study group compared to controls (all PC<0.05). CONCLUSION We report an increased incidence of circumscribed HLA patterns in German Caucasians with advanced ESFT. The possible clinical significance of this observation has to be re-assessed in prospective trials comprising larger ESFT patient numbers of all risk groups.
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Affiliation(s)
- U Thiel
- Department of Pediatrics and Pediatric Oncology Center, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
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23
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Schlaf G, Mauz-Körholz C, Ott U, Leike S, Altermann W. General insufficiency of the classical CDC-based crossmatch to detect donor-specific anti-HLA antibodies leading to invalid results under recipients' medical treatment or underlying diseases. Histol Histopathol 2012; 27:31-8. [PMID: 22127594 DOI: 10.14670/hh-27.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Antibodies directed against HLA antigens of a given donor represent the most prominent cause for hyper-acute and acute rejections. In order to select recipients without donor-specific antibodies the complement-dependent cytotoxicity (CDC-) crossmatch as the standard procedure was established. As a functional assay it strongly depends on the availability of isolated donor lymphocytes and in particular on their vitality. However, due to several diseases or pharmacological treatment of a given recipient unexpected "false-positive" results of the CDC-crossmatch may arise. We here present three groups of patients which demonstrate the limits of the conventional crossmatch. 1) Kidney recipients before living donations exhibited positive CDC-reactions due to their conditioning using the therapeutical anti-CD20 mAb Rituximab (n=7), routinely used to deplete B-cells, or the anti-CD25 mAb basiliximab (n=2) to inhibit the proliferation of activated T-cells. 2) Recipients suffering from various leukaemias (n=5) exhibited "positive" CDC-crossmatches using PBL of the donors, although formerly these patients had never shown anti-HLA antibodies. Instead of donor-specific allo-antibodies, cytostatic agents such as 6-mercaptopurine led to an unspecific cell death. 3) Patients projected for post mortem or living kidney donations (n=44) exhibited "positive" CDC-crossmatch results which were not in accordance with their former antibody status and, partially, with high degrees of HLA-matching. These implausible results were due to underlying auto-immune diseases, mainly of the systemic immune complex type III such as lupus erythematosus, mainly leading to false-positive B-cell crossmatches by immune complexes binding to Fcγ-receptors. In all these 58 cases the alternatively performed ELISA-based "Antibody Monitoring System" (AMS-) crossmatch assay was not artifically affected, suggesting that this assay may be comprehensively established at least for the cases described.
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Affiliation(s)
- G Schlaf
- Tissue Typing Laboratory, University Hospital Halle, Germany.
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24
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Haase R, Elsner K, Merkel N, Stiefel M, Mauz-Körholz C, Kramm C, Körholz D. High Dose Methotrexate Treatment in Childhood ALL: Pilot Study on the Impact of the MTHFR 677C>T and 1298A>C Polymorphisms on MTX-related Toxicity. Klin Padiatr 2012; 224:156-9. [DOI: 10.1055/s-0032-1304623] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- R. Haase
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | - K. Elsner
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | - N. Merkel
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | - M. Stiefel
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | - C. Mauz-Körholz
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | - C. Kramm
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | - D. Körholz
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
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25
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Körholz D, Mauz-Körholz C, Kluge R, Bernig T, Staege MS, Vordermark D, Hasenclever D. Konzept der Langzeitnachsorge für in Deutschland behandelte Patienten der GPOH-HD2002 und EuroNet-PHL-C1 Studien. Klin Padiatr 2012. [DOI: 10.1055/s-0032-1306252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Pinkwart C, Stiefel M, Mauz-Körholz C, Körholz D. Acute Psychosis in an Adolescent Girl During Treatment for Advanced Nodular Lymphocyte-Predominant Hodgkin's Lymphom. Klin Padiatr 2011; 223:370-1. [DOI: 10.1055/s-0031-1279746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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27
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Haase R, Lieser U, Kramm C, Stiefel M, Vilser C, Bernig T, Merkel N, Mauz-Körholz C, Körholz D. Management of oncology patients admitted to the paediatric intensive care unit of a general children's hospital - a single center analysis. Klin Padiatr 2011; 223:142-6. [PMID: 21567369 DOI: 10.1055/s-0031-1275291] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The improving prognosis of children with cancer has partially been attributed to the increasing importance of pediatric intensive care units (PICU). We analyze whether outcome of these patients on a PICU improved during the last decade and which factors may influence the outcome in our hospital. PATIENTS AND METHODS The charts of all oncology patients admitted to the PICU between 1998 and 2009 have been reviewed retrospectively. The survival of patients admitted for life threatening complications has been correlated with basic data, organ failure and the PRISM score. The results of 2 consecutive treatment periods (1998-2003 and 2004-2009) were compared. RESULTS 644 admissions of 226 patients were recorded. 79 admissions were performed because of potentially life threatening complications (Group A), 236 for monitoring (B) and 329 admissions for interventions (C). 62% of Group A patients and all Group B and C patients were discharged alive. Poor outcome was associated with admission >28 days after initial diagnosis, PRISM >10, organ failure >2 organs, sepsis, allogeneic stem cell transplantation, need for mechanical ventilation or for catecholamines. The PICU survival rate of Group A patients admitted between 2004 and 2009 (78%) was higher than in the period between 1998 and 2003 (48%). CONCLUSIONS PICU provides essential services to support the pediatric oncology ward. Although children with cancer may have had benefit from advances in pediatric intensive care over the past decade, specific scoring systems for early identification of children with cancer needing PICU treatment are required. These systems might further improve PICU outcome in critical ill pediatric cancer patients.
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Affiliation(s)
- R Haase
- Department of Pediatrics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.
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28
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Stiefel M, Pinkwart C, Haase R, Merkel N, Forsberg D, Mauz-Körholz C. [Immune tolerance induction with high-dose FVIII and pulsed intravenous immunoglobulin]. Hamostaseologie 2010; 30 Suppl 1:S119-S121. [PMID: 21042665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
UNLABELLED The development of neutralizing allo-antibodies against factor VIII (FVIII) or FVIII inhibitors is a severe complication in the treatment of haemophilia A. About 25% of the children with severe haemophilia A develop FVIII inhibitors. Here we report on a boy with severe haemophilia A and intron 22 inversion of the FVIII gene who was diagnosed at ten months of age. After 16 exposure days to FVIII (81 days after initial exposure) he developed a FVIII inhibitor (maximum: 9.76 BU/ml). THERAPY We started immune tolerance induction (ITI) according to the Bonn protocol with high dose plasma derived FVIII concentrate (100 IU per kg body weight) twice daily. For additional inhibitor elimination treatment the patient received intravenous immunoglobulin (ivIg) at a dose of 1-2 g/kg body weight every 4 to 6 weeks. After start of treatment a rapid decline of the inhibitor level was observed, nevertheless low FVIII inhibitor levels persisted (<5 BU/ml). Furthermore, the FVIII half-life was still accelerated. However, after every course of ivIg the inhibitor level declined and FVIII half-life was prolonged. Currently, the FVIII half-life is approaching normal values after more than seven months of ITI duration. CONCLUSION Additional application of immunoglobulin is beneficial for immune tolerance induction.
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Affiliation(s)
- M Stiefel
- Universitätsklinik und Poliklinik für Kinder- und Jugendmedizin, Ernst-Grube Str. 40, 06120 Halle, Germany.
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29
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Krause C, Klüttermann K, Mauz-Körholz C. Molecular mechanisms and gene regulation of melphalan- and hyperthermia-induced apoptosis in Ewing sarcoma cells. Anticancer Res 2008; 28:2585-2593. [PMID: 19035282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The prognosis of high-risk Ewing tumours (HR-ET) remains poor. Melphalan-containing chemotherapy regimens are commonly applied for HR-ET patients. Moreover, melphalan (Mel) is a promising agent in thermochemotherapy. Therefore, we investigated the single effects, the synergism and the gene regulation of Mel and hyperthermia (HT) in an ET cell line (RD-ES). Dose-dependent cytotoxicity by Mel was demonstrated, which was enhanced by the concomitant application of HT (42 degrees C for 2 h). Mel, HT and their combination caused a significant activation of caspase-3. Using the pan-caspase inhibitor z-VAD-fmk, we demonstrated that both stimuli mediated predominantly caspase-dependent cytotoxicity. With cDNA array analysis, 20 out of 198 apoptosis-related genes were identified to be differentially expressed by Mel and/or HT. Although a significant enhancement of three selected genes could not be proven at the protein level in subsequent experiments, this study gives insight into the complex molecular and genetic response of tumour cells to cytotoxic stimulation.
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MESH Headings
- 4-1BB Ligand/antagonists & inhibitors
- 4-1BB Ligand/metabolism
- Antineoplastic Agents, Alkylating/pharmacology
- Apoptosis/drug effects
- Apoptosis/genetics
- Apoptosis/physiology
- Apoptosis Regulatory Proteins/antagonists & inhibitors
- Apoptosis Regulatory Proteins/biosynthesis
- Apoptosis Regulatory Proteins/genetics
- Caspase 3/metabolism
- Cell Line, Tumor
- Combined Modality Therapy
- Dose-Response Relationship, Drug
- Enzyme Activation
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Hyperthermia, Induced
- Male
- Melphalan/pharmacology
- Protein Serine-Threonine Kinases/antagonists & inhibitors
- Protein Serine-Threonine Kinases/biosynthesis
- Protein Serine-Threonine Kinases/genetics
- Receptors, TNF-Related Apoptosis-Inducing Ligand/antagonists & inhibitors
- Receptors, TNF-Related Apoptosis-Inducing Ligand/biosynthesis
- Receptors, TNF-Related Apoptosis-Inducing Ligand/genetics
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Sarcoma, Ewing/therapy
- Tumor Necrosis Factor Receptor Superfamily, Member 9/antagonists & inhibitors
- Tumor Necrosis Factor Receptor Superfamily, Member 9/metabolism
- Young Adult
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Affiliation(s)
- C Krause
- Division of Paediatric Haematology and Oncology, Department of Paediatrics, Martin Luther University of Halle, Germany
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30
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Baumann F, Mauz-Körholz C, Clauss D, Borrmann S, Giannis A, Merkel N, Körholz D, Preiss R. Determination of terephthalic acid isopropylamide in urine with a liquid chromatography/mass spectrometry (LC/MS) method. J Clin Lab Anal 2008; 22:21-8. [PMID: 18200575 DOI: 10.1002/jcla.20213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A sensitive and simple liquid chromatography/mass spectrometry (LC/MS) method was developed for the determination of terephthalic acid isopropylamide, the final metabolite of procarbazine in human urine. A solid-phase extraction with C(18) cartridges was used followed by LC/MS with a single mass spectrometer (SSQ 7000 from Finnigan). Terephthalic acid isobutylamide was the internal standard. The quantification limit was 30 ng/mL in urine (6 x noise). This assay was applied for drug monitoring of terephthalic acid isopropylamide in urine after oral administration of procarbazine in children and adolescents with Hodgkin lymphomas.
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Affiliation(s)
- F Baumann
- Institute of Clinical Pharmacology, University of Leipzig, Leipzig, Germany.
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31
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Klüttermann K, Banning U, Kachel M, Krause C, Körholz D, Mauz-Körholz C. TRAIL-induced cytotoxicity in a melphalan-resistant rhabdomyosarcoma cell line via activation of caspase-2. Anticancer Res 2006; 26:351-6. [PMID: 16475717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The prognosis for patients with chemo-refractory rhabdomyosarcoma remains poor. The tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) is a hopeful candidate for new strategies in chemotherapy. The effects of TRAIL and melphalan (Mel) in the rhabdomyosarcoma cell line TE-671 were investigated by colorimetric caspase assays and flow cytometry. TRAIL induced the activation of caspases-2, -3 and -8, but not the activation of caspase-9, in the Mel-resistant TE-671 cells. Inhibition of caspase-2 with the caspase-2 inhibitor z-VDVAD-fmk significantly down-regulated the TRAIL-induced caspase-3 activation, as well as the TRAIL-induced cytotoxicity. When TE-671 cells were treated with a combination of Mel and TRAIL, a significant synergism of drug-induced cytotoxicity was obtained. The inhibition of caspase-2 could completely abolish caspase-3 activation, suggesting that TRAIL sensitises TE-671 cells for Mel-induced cytotoxicity via a caspase-2- and -3-dependent mechanism. In conclusion, it was shown, for the first time, that TRAIL could sensitise Mel-resistant tumour cells to melphalan.
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Affiliation(s)
- K Klüttermann
- Division of Paediatric Haematology and Oncology, Department of Paediatrics, University of Leipzig, Germany
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Mauz-Körholz C, Banning U, Körholz D. Regulation of interleukin-2 induced soluble Fas ligand release from human peripheral blood mononuclear cells. Immunol Invest 2005; 33:251-60. [PMID: 15195700 DOI: 10.1081/imm-120030916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Adjuvant interleukin (IL)-2 immunotherapy has been used in the treatment of different malignant dieseases. However, clinical results have been rather disappointing. Therefore, further investigations on IL-2-induced mediators of cytotoxicity seem to be necessary in order to possibly create cytokine cocktails which could enhance the IL-2-induced cytotoxicity. We therefore investigated the regulation of IL-2-induced release of soluble Fas Ligand (sFasL), since this factor is known to possess anti-tumor activities. In CD3-stimulated peripheral blood mononuclear cells IL-2 induced sFasL in a dose-dependent fashion. Maximum sFasL concentrations were obtained after stimulation of MNC for 120 hrs. Inhibition of endogenous IL-12 production significantly reduced IL-2-mediated sFasL release by about 25%. In contrast, addition of IL-12 enhanced the IL-2-induced sFasL about 1,5-fold. IL-10 and IL-4 reduced the IL-2-stimulated sFasL by about 30%. Interestingly, these suppressive effects could be antagonized by the addition of IL-12. Not only exogenous IL-10 but also endogenously produced IL-10 decreased the sFasL release to that extent which had been stimulated by IL-12. Since IL-12 and IL-10 only marginally influenced the IL-2-mediated cell proliferation as well as the IL-2-induced cell death, the IL-12- and IL-10-controlled sFasL release seems to be based on an enhanced production per cell. However, the increase in cell numbers as well as the decrease of viability during cell culture might additionally contribute to the IL-2-induced increase of sFasL release. This secondary effect might explain why IL-2-mediated sFasL production is only partially controlled by regulatory cytokines such as IL-4, IL-10 or IL-12. In conclusion, addition of IL-12 might increase the efficacy of IL-2 immunotherapy by inhibition of the IL-10-mediated negative feed-back loop on IL-2-mediated sFasL release.
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Affiliation(s)
- C Mauz-Körholz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Leipzig Medical Center, Leipzig, Germany.
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Sorge I, Krausse A, Körholz D, Kluge R, Mauz-Körholz C, Hirsch W. Ist die Schnittbildgebung beim initialen Staging des Hodgkin-Lymphoms im Kindesalter ausreichend? ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Banning U, Lange T, Krahl R, Mauz-Körholz C, Krutmann J, Niederwieser D, Körholz D. Prognostic value of T-1 cell numbers prior to allogeneic stem cell transplantation in patients with severe graft-versus-host disease. Bone Marrow Transplant 2005; 35:691-7. [PMID: 15696178 DOI: 10.1038/sj.bmt.1704874] [Citation(s) in RCA: 1] [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: 11/09/2022]
Abstract
Assessment of risk factors for acute graft-versus-host disease (aGvHD) might help in tailoring the intensity of prophylactic immunosuppression after allogeneic stem cell transplantation (SCT), thereby decreasing the relapse rate in leukaemia patients. In this study, we analysed whether the number of recipient blood T cells and plasma levels of different cytokines were correlated with the risk of aGvHD after allogeneic SCT. Analyses were performed in 23 patients receiving pSCT immediately before or during the first 2 days of the conditioning regimen. In all, 40 or more Tc-1 cells/microl pretransplant were associated with a significantly increased risk of aGvHD (10/10 patients with GvHD>/=II; 4/13 patients without aGvHD with a Tc-1 number >40/microl, P<0.002, Fisher's exact test). In addition, 40 or more Th-1 cells/microl pretransplant were also associated with a significantly increased risk of aGvHD (P<0.04, Fisher's exact test). Furthermore, the number of Th-2 cells was significantly higher in patients with severe aGvHD even though the median absolute cell counts were very low. However, all other investigated parameters did not reveal predictive value. In conclusion, determination of T-1 cells prior to SCT might determine patients with high/low risk of aGvHD and could thus be used to control immunosuppression after SCT.
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Affiliation(s)
- U Banning
- Division of Paediatric Hematology, Oncology and Hemostaseology, Clinic for Children and Adolescents, University of Leipzig Medical Center, Leipzig, Germany.
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Körholz D, Claviez A, Hasenclever D, Kluge R, Hirsch W, Kamprad F, Dörffel W, Wickmann L, Papsdorf K, Dieckmann K, Kahn T, Mauz-Körholz C, Dannenberg C, Pötter R, Brosteanu O, Schellong G, Sabri O. The concept of the GPOH-HD 2003 therapy study for pediatric Hodgkin's disease: evolution in the tradition of the DAL/GPOH studies. Klin Padiatr 2004; 216:150-6. [PMID: 15175959 DOI: 10.1055/s-2004-822627] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Today it is possible to cure more than 90 % of children and adolescents with Hodgkin's disease with a combination of radiotherapy and chemotherapy. Since the DAL-HD 82 study, the main scientific focus has been on avoiding late effects such as the OPSI syndrome, late complications involving the heart, lungs, thyroid and/or gonads particularly sterility in men and premature onset of menopause in women, and the prevention of secondary malignancies. The GPOH-HD 2003 study will introduce FDG-PET to the initial diagnostic program and the assessment of response to therapy in order to evaluate further possibilities for reducing therapy. In this context, the central review of all clinical and radiological findings, systematically done since the DAL-HD 90 study, will be increasingly relevant in maintaining standardised stage classification and therapy group assignment which was established by the preceding studies. Continuing in the direction of the earlier studies, the indications for radiotherapy will be restricted even further. In the early stages (treatment group 1) patients with CR or a negative FDG-PET at the end of chemotherapy will receive no radiotherapy in order to reduce the risk of a secondary malignancy. In a randomized comparison, procarbazine will be replaced by dacarbazine in the COPP cycles to determine whether sterility in men and premature onset of menopause in women can be avoided by elimination of procarbazine while retaining the same clinical efficacy. Finally, relapse therapy is to be tailored according to the time of relapse, the initial therapy group, and the patient's response to the relapse therapy with more patients receiving autologous transplantation in order to further improve the results of relapse treatment.
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Affiliation(s)
- D Körholz
- Division of Pediatric Hematology and Oncology, Clinic and Policlinic for Children and Adolescents, University of Leipzig Medical Center, Germany.
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Krause C, Klüttermann K, Banning U, Körholz D, Mauz-Körholz C. Characterisation of apoptosis inductor and suppressor genes in thermochemotherapy treated Ewing tumor cells. Klin Padiatr 2004. [DOI: 10.1055/s-2004-828579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bernbeck B, Mauz-Körholz C, Zotz RB, Göbel U. Methylenetetrahydrofolate Reductase Gene Polymorphism and Glucocorticoid Intake in Children with ALL and Aseptic Osteonecrosis. Klin Padiatr 2003; 215:327-31. [PMID: 14677097 DOI: 10.1055/s-2003-45496] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Methotrexate is an essential part of the treatment of acute lymphoblastic leukaemia (ALL). Due to an increased survival of ALL patients, complications like BME (bone marrow edema) and AON (aseptic osteonecrosis) have become a matter of increasing importance. The aim of the study was to find out if a polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene predisposes to the development of BME and/or AON. Furthermore the cumulative prednisone equivalent dose per kilogram body weight was compared in a matched-pairs analysis. PATIENTS AND METHODS A retrospective analysis of the MTHFR polymorphism of 87 patients was performed (48 male, 43 female). 14/87 patients were diagnosed with BME and/or AON (16 %). RESULTS 42/73 patients without BME and/or AON (43 male, 34 female, median age 5.3 yrs) and 10/14 patients with BME/AON (5 male, 9 female, median age 10.2 years) presented with a MTHFR-polymorphism (p = 0.28). 14,3 % of the patients with MTHFR-polymorphism but without BME and/or AON (6/42) and 70 % of the patients with MTHFR-polymorphism and with BME and/or AON (7/10) were over 10 years of age at ALL diagnosis (p = 0.002). The mean cumulative prednisone equivalent dose per kilogram body weight was 98.0 mg, compared with 100.0 mg in the matched pairs group. CONCLUSIONS The age of the patients at diagnosis seems to be a risk factor for the development of BME and/or AON as also seen in previous studies. If MTHFR polymorphism is an additional risk factor it was not borne out by this study, possible due to the small number of patients analyzed. This aspect is worth to be proven with a large group of patients considering the MTX pharmacokinetic and leucovorine rescue.
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Affiliation(s)
- B Bernbeck
- Department of Paediatric Oncology, Haematology and Immunology, Heinrich Heine University Medical Center Düsseldorf, Germany.
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Schippel P, Lotz I, Rothe K, Greiner C, Mauz-Körholz C. Whole body thermochemotherapy in an infant with rhabdomyosarcoma and pulmonary metastases. ACTA ACUST UNITED AC 2003; 41:478-80. [PMID: 14515396 DOI: 10.1002/mpo.10390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- P Schippel
- Department of Anesthesiology, Leipzig University Medical Center, Germany
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Mauz-Körholz C, Dietzsch S, Banning U, Tröbs RB, Körholz D. Heat- and 4-hydroperoxy-ifosfamide-induced apoptosis in B cell precursor leukaemias. Int J Hyperthermia 2003; 19:444-60. [PMID: 12850929 DOI: 10.1080/0265673031000063864] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In the group of high risk childhood acute lymphoblastic leukaemia (ALL), very early and early relapses have a very poor prognosis with conventional chemotherapy alone. Remission induction in these patients is often hindered by drug resistance. Thus, intensifying chemotherapy strategies are required. Application of hyperthermia enhances efficacy of certain anti-neoplastic drugs such as ifosfamide. In this study, effects and molecular mechanisms of ifosfamide - and hyperthermia-induced apoptosis are investigated in a B cell precursor leukaemia cell line (REH) and in primary patient-derived B cell progenitor leukaemic blasts. Both 4OOH-IFA and hyperthermia are able to induce cell death in leukaemic cells, mainly by induction of caspase-dependent apoptosis. However, completely different kinetics of caspase-3, -8 and -9 activation are found for both stimuli. In addition, activation of caspase-1 is only observed following stimulation with hyperthermia. Combined application of ifosfamide and hyperthermia reveals increased cytotoxicity in both the leukaemia cell line and in 5/8 of the patient-derived leukaemic blast samples. In conclusion, hyperthermia and ifosfamide mediate cytotoxicity in B precursor leukaemic blasts by different kinetics of caspase activation. This might explain the additive effects of 4OOH-IFA and heat on leukaemic cell death. Therefore, whole body thermochemotherapy could be considered as a treatment option in relapsed leukaemic patients.
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Affiliation(s)
- C Mauz-Körholz
- Department of Pediatrics, University of Leipzig Medical Center, Oststr 21-25, D-04317 Leipzig, Germany.
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Mauz-Körholz C, Dietzsch S, Schippel P, Banning U, Körholz D. Molecular mechanisms of hyperthermia- and cisplatin-induced cytotoxicity in T cell leukemia. Anticancer Res 2003; 23:2643-7. [PMID: 12894552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND The prognosis of early and very early relapse in acute lymphoblastic leukemia of childhood is still very poor unless a hematopoietic stem cell transplant is performed if a second remission can be achieved by induction chemotherapy. Therefore an intensification of chemotherapy is required. MATERIALS AND METHODS In the present study the molecular mechanisms of cisplatin- and/or hyperthermia-mediated cytotoxicity in CEM cells, a human T leukemia cell line, were investigated. RESULTS Both hyperthermia and cisplatin induced the activation of the effector caspases-3 and -6. However, caspase activation followed different time kinetics. While hyperthermia exerted maximum caspase activation immediately after application, cisplatin activated caspase-3 and -6 after 24 hours. At both time-points significant caspase-3 and -6 activation was observed when the cells were stimulated by a combination of heat and cisplatin. The application of z-VAD-fmk, a general caspase inhibitor, showed that hyperthermia mediated cytotoxicity mainly via caspase-dependent mechanisms, while cisplatin induced both caspase-dependent and -independent cytotoxicity. Time kinetic experiments revealed that hyperthermia induced cell death immediately after the heating pulse. In contrast, cisplatin-induced cell death had its maximum between 6 hours and 12 hours after the heating pulse. The combined application of heat and cisplatin induced two peaks of cytotoxicity, one immediately after the heating pulse and the other between 6 hours and 12 hours. CONCLUSION Hyperthermia and cisplatin induced cell death in T leukemic cells by different molecular mechanisms, which might explain the enhanced cisplatin-induced cytotoxicity by hyperthermia.
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Affiliation(s)
- C Mauz-Körholz
- Department of Pediatrics, University of Leipzig Medical Center, Oststr. 21-25, D-04317 Leipzig, Germany.
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Banning U, Mauz-Körholz C, Muhammad Q, Kösser A, Müller AE, Tunn U, Rieske K, Bönig H, Körholz D. Endogenous pro-inflammatory cytokines in children and adolescents during chemotherapy-induced neutropenia. Pediatr Hematol Oncol 2002; 19:561-8. [PMID: 12487831 DOI: 10.1080/08880010290097413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Monocyte-derived pro-inflammatory cytokines such as GM-CSF, IL-12, and IP-10 might protect patients with chemotherapy-induced neutropenia against infections. In settings with abundant neutrophils, G-CSF has been described as a suppressor of IL-12, but also as an inducer of GM-CSF. In 25 pediatric patients with chemotherapy-induced neutropenia the authors measured plasma levels of these four cytokines. GM-CSF was detectable in only a minority of patients (6/25). It was, however, positively correlated with high plasma levels of IL-12 and IP-10. G-CSF levels, however, were in no way correlated with the levels of any of these three cytokines.
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Affiliation(s)
- U Banning
- University of Leipzig Medical Center, Department of Pediatrics, Leipzig, Germany.
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Mauz-Körholz C, Dietzsch S, Banning U, Tröbs RB, Körholz D. Mechanisms of hyperthermia- and 4-hydroperoxy-ifosfamide-induced cytotoxicity in T cell leukemia. Anticancer Res 2002; 22:4243-7. [PMID: 12553065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The prognosis of patients with early ALL (acute lymphoblastic leukaemia) relapse is poor with conventional chemotherapy alone. Thus, intensified chemotherapy strategies are required. The application of hyperthermia enhances the efficacy of certain antineoplastic drugs such as ifosfamide. In this study, the effects and molecular mechanisms of ifosfamide (4hydroperoxy-ifosfamide = 4OOH-IFA)- and/or hyperthermia-induced cell death are investigated in CEM cells. Hyperthermia enhanced the efficacy of 4OOH-IFA in a subaddictive manner. Analysis of caspase activation revealed an early hyperthermia-induced stimulation of caspase-3 and -6 directly after the heating pulse, while maximum activation following stimulation with 4OOH-IFA was obtained after 24 hours of culture. The combination of 4OOH-IFA and hyperthermia mediated an overaddictive caspase stimulation directly following the heating phase. At this time also an overaddictive cytotoxic effect was noticed, being mainly responsible for the enhancing effects of hyperthermia on 4OOH-IFA cytotoxicity. In conclusion, hyperthermia enhanced the cytotoxic effect of 4OOH-IFA on CEM cells by stimulation of an early 4OOH-IFA effect. Thus, thermochemotherapy might be considered as an intensifying treatment option in relapsed T cell leukemias.
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Affiliation(s)
- C Mauz-Körholz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Leipzig Medical Center, Leipzig, Germany.
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Verheyen J, Bonig H, Banning U, Shin DI, Mauz-Körholz C, Körholz D. Co-operation of IL-1 and IL-2 on T-cell activation in mononuclear cell cultures. Immunol Invest 2001; 30:289-302. [PMID: 11777281 DOI: 10.1081/imm-100108164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/03/2022]
Abstract
In search of an optimized anti-cancer immunotherapy, the combination of IL-2 and IL-1 has been tried. In an in-vitro LAK model, this cytokine cocktail seemed to be quite promising. In our in-vitro model of IL-2 induced T-cell activation we have therefore investigated the co-operation of these two potent immunostimulators. Mononuclear cells were stimulated with CD3 activating antibody in the presence of different cytokines and blocking or neutralizing antibodies. Cytokine concentrations were detected in the supernatants with ELISA. Intracellular IFN-gamma and IL-4 in the different T-cell subsets was measured by flow cytometry. IL-1 and IL-1 receptor antagonist (IL-1Ra) were up-regulated by IL-2, this was achieved independently of IL-12 or CD40/CD40L interaction. As a negative feedback mechanism, IL-1beta induced its natural antagonist, IL-1Ra. Both endogenous and exogenous IL-10 suppressed IL-1beta and induced IL-1Ra, thus markedly decreased the amount of functional IL-1. The combination of IL-2 and IL-1beta lead to a mildly increased Interferon-gamma (IFN-gamma) secretion (+20%, p < 0.05), however, this appeared to be the result of an increased IFN-gamma production per secreting cell, rather than of an increased recruitment of non-secreting cells. Similarly, IL-6 was also induced in an additive fashion (+30%, p < 0.05). For both cytokines, this effect could be significantly augmented by neutralizing IL-1Ra. Concentrations of IL-2 induced IL-10 and soluble Fas ligand (sFasL) were not affected by IL-1beta. We were thus able to demonstrate that IL-1 relays its activity through different pathways than IL-2. Furthermore, we could show that the potentially synergistic action of IL-2 and IL-1 was hindered by the simultaneous induction of signficant amounts of IL-1Ra. From the latter findings we conclude that the combination of IL-2 and IL-1 for cytokine-induced anti-tumor activity may not, but a combination of IL-2 and anti-IL-1Ra might prove beneficial.
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Affiliation(s)
- J Verheyen
- Heinrich-Heine University, Center of Child Health, Department of Pediatric Hematology and Oncology, Düsseldorf, Germany
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Herrmann FH, Wulff K, Auberger K, Aumann V, Bergmann F, Bergmann K, Bratanoff E, Franke D, Grundeis M, Kreuz W, Lenk H, Losonczy H, Maak B, Marx G, Mauz-Körholz C, Pollmann H, Serban M, Sutor A, Syrbe G, Vogel G, Weinstock N, Wenzel E, Wolf K. Molecular biology and clinical manifestation of hereditary factor VII deficiency. Semin Thromb Hemost 2001; 26:393-400. [PMID: 11092214 DOI: 10.1055/s-2000-8458] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Inherited factor VII (FVII) deficiency is a rare autosomal recessive disorder. Mutations and polymorphisms of the FVII gene were characterized in more than 40 unrelated patients with FVII deficiency. Among the 29 different mutations, the most frequent were Ala294 Val, Ala294Val;404delC, IVS7+7, and Val281 Phe. Four novel mutations (IVS2+1G>C, Arg247 Cys, Glu265 Lys, Asp343 His) were detected. The relationships between genotypes of mutations and polymorphisms of the FVII gene, FVII deficiency, and clinical phenotype were investigated. Homozygosity of the Phe4 Leu, IVS4+1G>A, Cys135 Arg, Ala244 Val, and Ala294 Val;404delC and the double heterozygosity of Tyr68 Cys / IVS3-1G>A, Val252 Met / IVS2+5G>T, Val281 Phe / Cys135 Arg, Ala294 Val / Val281 Phe, Ala294 Val;404delC / Val281Phe, Ala294 Val;404delC / Arg152 stop, Ala294Val;404delC / Gln(-35) stop, Ala294 Val / Val252 Met, Ala294 Val / Gly156 Asp, and Thr359 Met / Asp242 His were related to clinical symptoms. Double heterozygotes for Arg247 Cys / IVS2+1G>C, Ala206 Thr / Pro303 Arg, Leu(-20) Pro / Val252 Met as well as IVS7+7 /Ala294 Val, IVS7+7 /Ala206 Thr, and IVS7+7 / Met298 Ile were asymptomatic. The clinical symptomatology is rather poor in correlation with the FVII activity. Concerning the clinical phanotype, a correlation seems to exist between specific mutations and clinical symptoms.
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Affiliation(s)
- F H Herrmann
- Institute of Human Genetics, Ernst-Moritz-Arndt-University Greifswald, Germany.
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45
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Mauz-Körholz C, Junker R, Göbel U, Nowak-Göttl U. Prothrombotic risk factors in children with acute lymphoblastic leukemia treated with delayed E. coli asparaginase (COALL-92 and 97 protocols). Thromb Haemost 2000; 83:840-3. [PMID: 10896235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Hereditary prothrombotic risk factors have been shown to increase the risk of venous thrombosis in children treated with the combination of E. coli asparaginase and steroids. In the present study the role of prothrombotic risk factors in children with ALL treated according to the COALL study protocol was investigated in 108 consecutively recruited childhood patients. The prevalence rates of prothrombotic risk factors [factor V G1691A mutation, the prothrombin G20210A variant, the TT677 methylenetetrahydrofolate reductase genotype, deficiencies of protein C, protein S, antithrombin, elevated lipoprotein (a)] in this cohort were within the range reported for healthy Caucasians, and comparable to previously reported data for other leukemic patients. Venous thromboembolism occurred in 3 of the 108 children (induction n = 1; reinduction n = 2: 2.8%), and none of these children carried a prothrombotic risk factor. The results of the present study, suggest that the role of hereditary and acquired disturbances of coagulation in the development of thromboses might depend on the treatment regimen.
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Affiliation(s)
- C Mauz-Körholz
- Department of Paediatric Haematology and Oncology, Heinrich-Heine University Medical Centre, Düsseldorf, Germany
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Abstract
Vaginal yolk-sec tumours are usually incurable unless radical surgery is done. We have shown, however, that, neoadjuvant cisplatin-based chemotherapy with conservative surgery is effective in the management of these tumours, and results in a good survival rate, unlike germ-cell tumours of other origin.
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Verheyen J, Bönig H, Kim YM, Banning U, Mauz-Körholz C, Kramm C, Körholz D. Regulation of interleukin-2 induced interleukin-5 and interleukin-13 production in human peripheral blood mononuclear cells. Scand J Immunol 2000; 51:45-53. [PMID: 10632975 DOI: 10.1046/j.1365-3083.2000.00643.x] [Citation(s) in RCA: 9] [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: 11/20/2022]
Abstract
Adjuvant interleukin (IL)-2 immunotherapy has been used for many years for a variety of malignant and nonmalignant entities. In many cases, a dose escalation might have seemed desirable, but was prevented by the rather severe adverse effects of systemic IL-2 application. Only recently has the regulation of IL-2 induced cytotoxicity been understood better, so that now efforts can be aimed at the design of cytokine cocktails that would selectively induce cytotoxicity but result in as few adverse effects as possible. Previously, induction of IL-5 under systemic IL-2 therapy has been described, and a number of the side-effects have been attributed to this event. We therefore investigated the regulation of IL-2 induced production of IL-5 and IL-13 (which, similarly to IL-5, is a mediator of allergy-like symptoms). At the same time, the effects of regulatory cytokines, such as IL-4, IL-10 and IL-12, on interferon-gamma (IFN-gamma), the major cytotoxic mediator of IL-2 therapy, were studied. All three have been discussed as antitumour immunotherapeutics, either alone or in combination with IL-2. In anti-CD3-treated peripheral blood mononuclear cells, IL-2 induced IL-5 and IL-13 alongside IFN-gamma, IL-10 and IL-12. In the presence of IL-2, inhibition of endogenous IL-12 production further enhanced the IL-5 and IL-13 responses, while IFN-gamma and IL-10 were markedly suppressed. Co-incubation with IL-2 and IL-12 suppressed IL-5/IL-13 below, but enhanced IFN-gamma and IL-10 above, levels induced by IL-2 alone. IL-10 was suppressive on all the investigated cytokines, while IL-4 interfered with IL-2 induced IFN-gamma and IL-12 production, but was additive to IL-2 in its effect on IL-5 and IL-13. These data suggest that the combination of IL-12 with IL-2 would enhance the cytotoxic activity of this regimen, but might reduce its adverse effects.
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Affiliation(s)
- J Verheyen
- Department of Pediatric Hematology and Oncology, Center of Child Health, Heinrich-Heine University Medical Center, Düsseldorf, Germany
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Abstract
UNLABELLED von Willebrand disease (vWD) type 2M is characterized by the decreased platelet-dependent function of the von Willebrand factor (vWF) that is not caused by the absence of HMW vWF multimers. We report here on a 4-year-old boy with vWD type 2M, who underwent adenotomy and paracentesis after correction of his hemostatic defect by stimulation with DDAVP. The decreased basal levels of vWF Antigen (Ag), ristocetin cofactor activity (RiCoF) and collagen binding activity (CBA) (32%, 14% and 9% respectively) could be stimulated to maximum levels of 69%, 70% and 95% 2 h post DDAVP administration. DDAVP was administered in a dosage of 0.4 microg/kg BW intravenously 30 min prior to surgery. No bleeding occurred intra- and perioperatively. vWF multimer analysis revealed supranormal multimers with an abnormal satellite banding pattern. The typical separation by gel electrophoresis into oligomers with a triplet structure was missing even after stimulation with DDAVP. Thus, the functional hemostatic defect was corrected in this patient after DDAVP administration, although the structural abnormalities of the vWF multimers were still persisting. CONCLUSION In conclusion, type 2M vWD might be effectively treated with DDAVP administration in cases of elective surgery, dispensing with vWF replacement by pooled blood products.
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Affiliation(s)
- C Mauz-Körholz
- Department of Pediatric Hematology and Oncology, Heinrich-Heine-University Medical Center, Düsseldorf
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Bönig H, Banning U, Hannen M, Kim YM, Verheyen J, Mauz-Körholz C, Körholz D. Transforming growth factor-beta1 suppresses interleukin-15-mediated interferon-gamma production in human T lymphocytes. Scand J Immunol 1999; 50:612-8. [PMID: 10607309 DOI: 10.1046/j.1365-3083.1999.00635.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
One of the most remarkable means by which tumour cells manage to evade recognition and elimination by the immune system is the release of immunosuppressive mediators, such as interleukin (IL)-10 or transforming growth factor-beta (TGF-beta). For antitumour immunotherapies to reach their full potential, cytokine cocktails will have to be custom-tailored to the tumour's individual cytokine microenvironment. One of the components of such a cytokine cocktail may be interleukin (IL)-15, which has demonstrated an excellent stimulatory potential of antitumour immunity. In an in vitro model, we have previously been able to show that the negative effects of IL-10 on IL-15-mediated cytotoxic T-cell activation can be outweighed by the addition of interleukin (IL)-12. The mechanism by which TGF-beta may influence the effect of IL-15 remains poorly understood, however. We have therefore taken our T-cell model further and have studied the effect of TGF-beta on IL-15-mediated interferon-gamma (IFN-gamma) production. In activated, IL-15-stimulated peripheral blood T lymphocytes, TGF-beta suppressed IFN-gamma mRNA and protein levels by approximately 75%. This effect was likewise observed on both CD4+ and CD8+ T cells and, in contrast to the effect of IL-10 in this system, could not be neutralized by the addition of IL-12. Thus, immunotherapy for TGF-beta-producing tumours may benefit from the addition of TGF-neutralizing activity rather than IL-12.
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Affiliation(s)
- H Bönig
- Laboratory of Experimental Hematology and Stem Cell Transplantation, Department of Pediatric Hematology and Oncology, Heinrich-Heine-University Medical Center, Düsseldorf, Germany
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50
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Klinge J, Auberger K, Auerswald G, Brackmann HH, Mauz-Körholz C, Kreuz W. Prevalence and outcome of intracranial haemorrhage in haemophiliacs--a survey of the paediatric group of the German Society of Thrombosis and Haemostasis (GTH). Eur J Pediatr 1999; 158 Suppl 3:S162-5. [PMID: 10650860 DOI: 10.1007/pl00014346] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED A survey among centres of the paediatric group of the GTH was performed to evaluate the prevalence and outcome of haemophiliacs with intracerebral haemorrhage. A questionnaire sent to the centres covered the following points: number of patients with severe, moderate and mild haemophilia A and B; for each patient with ICH: birth date, age at bleeding, aetiology and neurological sequelae. Overall, 30 ICH in 744 haemophiliacs (4.0%) were reported by 17/40 centres (42.5%). There was no significant difference between the prevalence of patients with haemophilia A and B (3.5% vs. 6.3%) and among the age groups. Bleeding was diagnosed within 1 week of birth in 11/27 patients (41%). For 3 patients, no age-related information was given. The most important factor was trauma (17/30 = 57%), either during birth (9/30 = 30%) or later in life (8/30 = 27%). Seizures were common, occurring in 19/30 patients (63%). As 1 patient died after posttraumatic ICH, the neurological outcome of 29 patients could be evaluated. Psychomotor and statomotor retardation and cerebral palsy were reported in 17/29 (59%), 15/29 (51%) and 13/29 (45%) patients respectively. Only 7/29 (24%) showed no neurological sequelae. Severity of deficits was not correlated with birth date but to age at bleeding. Older children showed a better neurological outcome than neonates. CONCLUSION The frequency and outcome of ICH in haemophiliacs have not changed in our cohort over the past 20 years. Trauma at birth is an important risk factor for ICH in patients with haemophilia A or B. Intracranial haemorrhages in older children are rare, and a better outcome may be expected.
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Affiliation(s)
- J Klinge
- Paediatric Department of the University of Erlangen
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