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Nachtkamp K, Strupp C, Vukelja M, Kasprzak A, Haase D, Ganster C, Hildebrandt B, Betz B, Giagounidis A, Aul C, Blum S, Hofmann WK, Pfeilstöcker M, Valent P, Lübbert M, Seidl M, Rudelius M, Stauder R, Krieger O, Götze KS, Bobak J, Kündgen A, Schulz F, Dietrich S, Kobbe G, Gattermann N, Germing U. The new WHO 2022 and ICC proposals for the classification of myelodysplastic neoplasms. Validation based on the Düsseldorf MDS Registry and proposals for a merged classification. Leukemia 2024; 38:442-445. [PMID: 38263435 PMCID: PMC10844089 DOI: 10.1038/s41375-024-02157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/28/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Affiliation(s)
- K Nachtkamp
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany.
| | - C Strupp
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - M Vukelja
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - A Kasprzak
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - D Haase
- Department of Hematology and Medical Oncology, Georg August University, Göttingen, Germany
| | - C Ganster
- Department of Hematology and Medical Oncology, Georg August University, Göttingen, Germany
| | - B Hildebrandt
- Institute of Human Genetics, Heinrich Heine University, Düsseldorf, Germany
| | - B Betz
- Institute of Human Genetics, Heinrich Heine University, Düsseldorf, Germany
| | - A Giagounidis
- Department of Hematology, Oncology and Palliative Care, Marien Hospital, Duesseldorf, Germany
| | - C Aul
- Department of Hematology, Oncology and Clinical Immunology, Johannes Hospital, Duisburg, Germany
| | - S Blum
- Centre Hospitalier Universitaire Vaudois, Service d'hématologie, Département d'oncologie, and Lausanne University (UNIL), Lausanne, Switzerland
| | - W K Hofmann
- Department of Hematology and Oncology, University Hospital, Mannheim, Germany
| | - M Pfeilstöcker
- Medical Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Hanusch Hospital and Medical University of Vienna, Vienna, Austria
| | - P Valent
- Ludwig Boltzmann Institute for Hematology and Oncology, Hanusch Hospital and Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - M Lübbert
- Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany
| | - M Seidl
- Institute of Pathology, Heinrich Heine University, Düsseldorf, Germany
| | - M Rudelius
- Institute of Pathology, Heinrich Heine University, Düsseldorf, Germany
| | - R Stauder
- Department of Internal Medicine, Medical University, Innsbruck, Austria
| | - O Krieger
- Elisabethinen Hospital, Linz, Austria
| | - K S Götze
- Department of Medicine III, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - J Bobak
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - A Kündgen
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - F Schulz
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - S Dietrich
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - G Kobbe
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - N Gattermann
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - U Germing
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
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DeGutis J, Aul C, Barthelemy OJ, Davis BL, Alshuaib S, Marin A, Kinger SB, Ellis TD, Cronin-Golomb A. Side of motor symptom onset predicts sustained attention deficits and motor improvements after attention training in Parkinson's disease. Neuropsychologia 2023; 190:108698. [PMID: 37806442 DOI: 10.1016/j.neuropsychologia.2023.108698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/28/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Parkinson's disease (PD) side of motor symptom onset has been associated with distinct cognitive deficits; individuals with left-side onset (LPD) show more visuospatial impairments, whereas those with right-side onset (RPD) show more verbal impairments. Non-spatial attention is a critical cognitive ability associated with motor functioning that is right hemisphere lateralized but has not been characterized with regard to PD side of onset. We compared individuals with LPD and RPD on non-spatial attention tasks and examined differential responses to a 4-week sustained attention training program. METHOD Participants included 9 with LPD and 12 with RPD, who performed both brief and extended go/no-go continuous performance tasks and an attentional blink task. Participants also engaged in an at-home sustained attention training program, Tonic and Phasic Alertness Training (TAPAT), 5 days/week for 4 weeks. We assessed cognitive and motor symptoms before and after training, and after a 4-week no-contact period. RESULTS At baseline, participants with LPD exhibited worse performance than those with RPD on the extended continuous performance task, indicating specific deficits in sustaining attention. Poorer attention was associated with worse clinical motor scores. Notably, side of onset had a significant effect on clinical motor changes after sustained attention training, with only LPD participants improving after training, and 4/9 showing clinically meaningful improvements. CONCLUSIONS Compared to RPD, participants with LPD had poorer sustained attention pre-training and were more likely to improve on clinical motor functioning after sustained attention training. These findings support mechanistic differences between LPD and RPD and suggest potential differential treatment approaches.
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Affiliation(s)
- Joseph DeGutis
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA; Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Courtney Aul
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA; Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, USA
| | - Olivier J Barthelemy
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Breanna L Davis
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Shaikhah Alshuaib
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Anna Marin
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Shraddha B Kinger
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Terry D Ellis
- Department of Physical Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
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Kaplan RI, Mukadam N, Girnis J, Aul C, Sebastian A, Gao Y, Stuber A, Boas DA, Kiran S, Somers DC, Luhmann von A, Yucel MA, Ellis TD, Cronin-Golomb A. B - 61 Increased Cortical Efficiency in the Absence of Behavioral Improvement on Working Memory Task Revealed by Functional Near-Infrared Spectroscopy. Arch Clin Neuropsychol 2023; 38:1426. [PMID: 37807431 DOI: 10.1093/arclin/acad067.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Functional near-infrared spectroscopy (fNIRS) is a non-invasive functional neuroimaging method that indirectly measures cortical activation via task-related changes in oxygenated hemoglobin (HbO). We used fNIRS during a working memory task to assess learning effect over time by assessing brain activity (fNIRS signal) and task performance. We hypothesized that in later blocks of the task, learning (better accuracy) would be correlated to less increase in HbO in prefrontal regions, indicating improved cognitive efficiency. METHOD Eighteen healthy adults [mean age = 24.9 (SD = 4.2); 14 female] engaged in 8 blocks of serial-3 subtraction for 30 seconds each followed by 20 seconds of rest. fNIRS data were collected in 8 cortical regions of interest (ROI) broadly covering the frontal lobe. fNIRS signal in each ROI and task-performance data were compared for the first 4 and last 4 blocks to examine learning. RESULTS fNIRS signal was significantly greater for the first 4 than last 4 blocks (z = -2.1, p < 0.05) in only the right dorsolateral prefrontal cortex ROI. No learning effects appeared for any task-performance variables. CONCLUSIONS These results indicate a dissociation between brain activity and task performance during a working memory task in healthy adults. There was less activity in the right dorsolateral prefrontal cortex during later than earlier trials, indicating an increase in this region's efficiency, without a change in task performance. The results suggest that fNIRS may be sensitive to change in brain activity before it appears clinically, which may be useful in studying people with conditions such as preclinical Alzheimer's disease, and in assessing subtle effects of interventions.
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Aul C, Brau JM, Sugarman A, DeGutis JM, Germine LT, Esterman M, McGlinchey RE, Fortenbaugh FC. The functional relevance of visuospatial processing speed across the lifespan. Cogn Res Princ Implic 2023; 8:51. [PMID: 37542181 PMCID: PMC10403489 DOI: 10.1186/s41235-023-00504-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/06/2023] [Indexed: 08/06/2023] Open
Abstract
Visuospatial processing speed underlies several cognitive functions critical for successful completion of everyday tasks, including driving and walking. While it is widely accepted that visuospatial processing speed peaks in early adulthood, performance across the lifespan remains incompletely characterized. Additionally, there remains a lack of paradigms available to assess visuospatial processing speed in unsupervised web-based testing environments. To address these gaps, we developed a novel visuospatial processing speed (VIPS) task adapted from two tests sensitive to visuospatial processing speed declines in older adults, the Useful Field of View paradigm and the PERformance CEntered Portable Test. The VIPS task requires participants to make a central orientation discrimination and complete a simultaneous peripheral visual search task. Data were collected from 86 in-lab volunteers (18-30 years) to compare performance to traditional neuropsychological measures. Consistent with previous literature, performance on the novel VIPS task significantly correlated with measures of selective attention, executive functioning, visual speed, and working memory. An additional 4395 volunteers (12-62 years) were recruited on TestMyBrain.org to establish lifespan trajectories of visuospatial processing speed and associations with functional disability. VIPS task performance peaked in the early 20's, and steadily decreased such that thresholds doubled in 60-year-olds relative to 20-year-olds (817 ms vs. 412 ms). VIPS task performance significantly correlated with self-reported cognitive functioning deficits broadly across the lifespan but was specifically related to mobility issues in middle-age. These findings have important implications for early detection of cognitive decline and provide insights into potential early intervention targets for younger and middle-aged adults.
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Affiliation(s)
- Courtney Aul
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Julia M Brau
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
| | - Alexander Sugarman
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
| | - Joseph M DeGutis
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Michael Esterman
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Francesca C Fortenbaugh
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Aul C, Park H, DeGutis J, Lo OY, Poole V, Bean J, Leritz E, Esterman M. Evidence for a Specific Association Between Sustained Attention and Gait Speed in Middle-to-Older-Aged Adults. Innov Aging 2021. [PMCID: PMC8681067 DOI: 10.1093/geroni/igab046.2647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Although cognitive decline has previously been associated with mobility limitations and frailty, the relationship between sustained attention and gait speed is incompletely characterized. To better quantify the specificity of the sustained attention and gait speed association, we examined the extent to which this relationship is unique rather than accounted for by executive functioning and physical health characteristics. 58 middle-to-older-aged community-dwelling adults without overt illness or diseases (45-90 years old, 21 females) participated in the study. Each participant completed a 4-meter gait speed assessment and validated neuropsychological tests to examine various domains of executive functions including working memory (i.e., Digit Span), inhibitory control (i.e., Stroop Color Word Test), and task switching (i.e., Trail Making Test). Multiple physical and vascular risk factors were also evaluated. Sustained attention was assessed using the gradual onset continuous performance task (gradCPT), a well validated go/no-go sustained attention task. A series of linear regression models were created to examine how different aspects of cognition, including sustained attention and traditional measures of executive functioning, related to gait speed while controlling for a variety of physical and vascular risk factors. Among all predictors, gradCPT accuracy explained the most variance in gait speed (R2 = 0.21, p < 0.001) and was the only significant predictor (β = 0.36, p = 0.01) when accounting for executive functioning and other physical and vascular risk factors. The present results indicate that sustained attention may be uniquely sensitive and mechanistically linked to mobility limitations in middle-to-older adults.
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Affiliation(s)
- Courtney Aul
- VA Boston Healthcare System, Boston, Massachusetts, United States
| | - Hannah Park
- Brandeis University, Waltham, Massachusetts, United States
| | - Joseph DeGutis
- VA Boston Healthcare System/Harvard Medical School, Boston, Massachusetts, United States
| | - On-Yee Lo
- Hebrew SeniorLife/Harvard Medical School, Boston, Massachusetts, United States
| | | | - Jonathan Bean
- VA Boston Healthcare System, VA Boston Healthcare System, Massachusetts, United States
| | - Elizabeth Leritz
- VA Boston Healthcare System, Boston, Massachusetts, United States
| | - Michael Esterman
- VA Boston Healthcare System/BU School of Medicine, Boston, Massachusetts, United States
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Park H, Aul C, DeGutis J, Lo OY, Poole VN, McGlinchey R, Bean JF, Leritz E, Esterman M. Evidence for a Specific Association Between Sustained Attention and Gait Speed in Middle-to-Older-Aged Adults. Front Aging Neurosci 2021; 13:703434. [PMID: 34290601 PMCID: PMC8289388 DOI: 10.3389/fnagi.2021.703434] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/26/2021] [Indexed: 01/14/2023] Open
Abstract
Although cognitive decline has previously been associated with mobility limitations and frailty, the relationship between sustained attention and gait speed is incompletely characterized. To better quantify the specificity of the sustained attention and gait speed association, we examined the extent to which this relationship is unique rather than accounted for by executive functioning and physical health characteristics. 58 middle-to-older-aged community-dwelling adults without overt evidence of cognitive impairment (45-90 years old; 21 females) participated in the study. Each participant completed a 4-meter gait speed assessment and validated neuropsychological tests to examine various domains of executive functioning including working memory (i.e., Digit Span), inhibitory control (i.e., D-KEFS Color-Word Interference), and task switching (i.e., D-KEFS Number/Letter Switching). Multiple physical and vascular risk factors were also evaluated. Sustained attention was assessed using the gradual onset continuous performance task (gradCPT), a well-validated go/no-go sustained attention task. A series of linear regression models were used to examine how different aspects of cognition, including sustained attention and traditional measures of executive functioning, related to gait speed while controlling for a variety of physical and vascular risk factors. Among all predictors, gradCPT accuracy explained the most variance in gait speed (R 2 = 0.19, p < 0.001) and was the only significant predictor (β = 0.35, p = 0.01) when accounting for executive functioning and other physical and vascular risk factors. The present results indicate that sustained attention may be uniquely sensitive and mechanistically linked to mobility limitations in middle-to-older adults.
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Affiliation(s)
- Hannah Park
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, United States
- Department of Psychology, Brandeis University, Waltham, MA, United States
| | - Courtney Aul
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, United States
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Joseph DeGutis
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, United States
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Victoria N. Poole
- Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Regina McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- New England Geriatric Research, Educational and Clinical Center (NEGRECC), VA Boston Healthcare System, Boston, MA, United States
| | - Jonathan F. Bean
- New England Geriatric Research, Educational and Clinical Center (NEGRECC), VA Boston Healthcare System, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Elizabeth Leritz
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- New England Geriatric Research, Educational and Clinical Center (NEGRECC), VA Boston Healthcare System, Boston, MA, United States
| | - Michael Esterman
- Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, United States
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
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Schuler E, Frank F, Hildebrandt B, Betz B, Strupp C, Rudelius M, Aul C, Schroeder T, Gattermann N, Haas R, Germing U. Myelodysplastic syndromes without peripheral monocytosis but with evidence of marrow monocytosis share clinical and molecular characteristics with CMML. Leuk Res 2017; 65:1-4. [PMID: 29216536 DOI: 10.1016/j.leukres.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/27/2017] [Accepted: 12/01/2017] [Indexed: 12/31/2022]
Abstract
MDS patients may present with monocytic marrow proliferation not fulfilling criteria for CMML. We analyzed MDS patients with or without a marrow monocytic proliferation by following up the amount of monocytic proliferation and characterizing their molecular profile. 315 MDS patients of Duesseldorf MDS registry were divided into two groups: A) 183 patients with monocytic esterase positive cells in marrow and monocytes between 101 and 900/μl in blood and B) 132 patients without monocytic esterase positive cells in marrow and monocytes in blood ≤100/μl. Twenty patients of each group were screened with regard to ASXL1, TET2, RUNX1, SETBP1, NRAS, and SRSF2 using Illumina myeloid panel. Group A patients were older, had significantly higher WBC, hemoglobin levels, neutrophils and platelets. CMML evolution rates were 4.9% and 1.5%, respectively (p=n.s.). TET2, NRAS and SRFS2 mutation frequencies were higher in group A and four patients had coexisting TET2 and SRFS2 mutation, which was shown to be characteristic but not specific for CMML. MDS patients with marrow monocytic proliferation have a more CMML-like pheno- and genotype and develop CMML more often. Those patients could potentially be very early stages of CMML or represent a CMML-like myeloid neoplasma with marrow adherence of the monocytic cell population.
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Affiliation(s)
- E Schuler
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany.
| | - F Frank
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany
| | - B Hildebrandt
- Institute of Human Genetics and Anthropology, Heinrich Heine-University, Duesseldorf, Germany
| | - B Betz
- Institute of Human Genetics and Anthropology, Heinrich Heine-University, Duesseldorf, Germany
| | - C Strupp
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany
| | - M Rudelius
- Institute of Pathology, Heinrich Heine-University, Duesseldorf, Germany
| | - C Aul
- Department of Hematology and Oncology, Johannes Hospital Duisburg, Germany
| | - T Schroeder
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany
| | - N Gattermann
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany
| | - R Haas
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany
| | - U Germing
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, Heinrich Heine-University, Duesseldorf, Germany
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Rautenberg C, Schuler E, Nachtkamp K, Schroeder T, Blum S, Aul C, Haas R, Germing U. Validation of a New Clinically Based Classification System for Stratification of Prognosis in Patients with CMML. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30372-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Schuler E, Frank F, Betz B, Hildebrandt B, Aul C, Strupp C, Schroeder T, Haas R, Germing U. Myelodysplastic Syndromes Showing Slight Monocytic Marrow Proliferation Are Prone to Progress to CMML. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Strupp C, Aul C, Germing U. Who Classification 2016 for the Myelodysplastic Syndromes (MDS): Main Changes. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30237-0] [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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Schanz J, Tüchler H, Solé F, Mallo M, Luño E, Cervera J, Grau J, Hildebrandt B, Slovak ML, Ohyashiki K, Steidl C, Fonatsch C, Pfeilstöcker M, Nösslinger T, Valent P, Giagounidis A, Aul C, Lübbert M, Stauder R, Krieger O, Le Beau MM, Bennett JM, Greenberg P, Germing U, Haase D. Monosomal karyotype in MDS: explaining the poor prognosis? Leukemia 2013; 27:1988-95. [PMID: 23787396 DOI: 10.1038/leu.2013.187] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/30/2013] [Accepted: 06/04/2013] [Indexed: 11/09/2022]
Abstract
Monosomal karyotype (MK) is associated with an adverse prognosis in patients in acute myeloid leukemia (AML). This study analyzes the prognostic impact of MK in a cohort of primary, untreated patients with myelodysplastic syndromes (MDS). A total of 431 patients were extracted from an international database. To analyze whether MK is an independent prognostic marker in MDS, cytogenetic and clinical data were explored in uni- and multivariate models regarding overall survival (OS) as well as AML-free survival. In all, 204/431 (47.3%) patients with MK were identified. Regarding OS, MK was prognostically significant in patients with ≤ 4 abnormalities only. In highly complex karyotypes (≥ 5 abnormalities), MK did not separate prognostic subgroups (median OS 4.9 months in MK+ vs 5.6 months in patients without MK, P=0.832). Based on the number of abnormalities, MK-positive karyotypes (MK+) split into different prognostic subgroups (MK+ and 2 abnormalities: OS 13.4 months, MK+ and 3 abnormalities: 8.0 months, MK+ and 4 abnormalities: 7.9 months and MK+ and ≥ 5 abnormalities: 4.9 months; P<0.01). In multivariate analyses, MK was not an independent prognostic factor. Our data support the hypothesis that a high number of complex abnormalities, associated with an instable clone, define the subgroup with the worst prognosis in MDS, independent of MK.
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Affiliation(s)
- J Schanz
- Department of Hematology and Oncology, University of Göttingen, Göttingen, Germany
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Neukirchen J, Nachtkamp K, Pfeilstöcker M, Valent P, Stauder R, Blum S, Lübbert M, Haase D, Götze K, Hofmann W, Schlenk R, Giagounidis A, Aul C, Schulte K, Lipke J, Nusch A, Krieger O, Hegener P, Weik C, Letsch A, Platzbecker U, Kreutzer K, Kobbe G, Germing U. O-023 Did the prognosis of MDS patients improve during the last 30 years? Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70045-6] [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: 10/26/2022]
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Lauseker M, Kuendgen A, Giagounidis A, Aul C, Haas R, Schlenk R, Haase D, Platzbecker U, Hasford J, Germing U. P-101 Influence of WHO categories and gender on the prognosis of MDS del(5q) patients. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Buesche G, Giagounidis A, Bock O, Teoman H, Göhring G, Schlegelberger B, Dieck S, Ganser A, List A, Bennett J, Aul C, Kreipe H. P-198 SPARC and TNF-α contribute significantly to erythroid failure in MDS with 5q deletion and influence considerably the efficacy of lenalidomide. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70245-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lübbert M, Suciu S, Hagemeijer A, Platzbecker U, Giagounidis A, Selleslag D, Germing U, Salih H, Muus P, Bogatyreva L, Aul C, De Witte T, Ganser A, Huls G, Marie J, Wijermans P. P-277 Decitabine vs. best supportive care in elderly higher-risk MDS patients with or without monosomal karyotypes: EORTC-LG/GMDS-SG phase III trial 06011. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70324-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Germing U, Lauseker M, Hildebrandt B, Symeonidis A, Cermak J, Fenaux P, Kelaidi C, Pfeilstöcker M, Nösslinger T, Sekeres M, Maciejewski J, Haase D, Schanz J, Seymour J, Kenealy M, Weide R, Lübbert M, Platzbecker U, Valent P, Götze K, Stauder R, Blum S, Kreuzer KA, Schlenk R, Ganser A, Hofmann WK, Aul C, Krieger O, Kündgen A, Haas R, Hasford J, Giagounidis A. Survival, prognostic factors and rates of leukemic transformation in 381 untreated patients with MDS and del(5q): A multicenter study. Leukemia 2012; 26:1286-92. [PMID: 22289990 DOI: 10.1038/leu.2011.391] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Giagounidis AAN, Kulasekararaj A, Germing U, Radkowski R, Haase S, Petersen P, Göhring G, Büsche G, Aul C, Mufti GJ, Platzbecker U. Long-term transfusion independence in del(5q) MDS patients who discontinue lenalidomide. Leukemia 2011; 26:855-8. [DOI: 10.1038/leu.2011.268] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Buesche G, Giagounidis A, Göhring G, Schlegelberger B, Dieck S, Knight R, Aul C, Kreipe H. 269 Mechanisms of action of lenalidomide on erythroblastic islands in patients with low- or intermediate-1-risk MDS with del(5q) chromosome abnormality. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70271-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Germing U, Neukirchen J, Strupp C, Bach K, Wulfert M, Haas R, Giagounidis A, Aul C, Gattermann N. 57 How to assess the medullary blast count in MDS? Pay attention to the proportion of erythroid cells! Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70059-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Germing U, Giagounidis A, Aul C, Kündgen A, Haase D, Schanz J, Pfeilstöcker M, Nosslinger T, Platzbecker U, Götze K, Lübbert M, Blum S, Hildebrandt B, Valent P, Krieger O, Stauder R, Hofmann W, Braess J, Schulte K, Kreutzer KA, Büsche G, Stadler M, Ganser A, Schlenk R, Bug G, Runde V, Gattermann N. 119 2011-update and overview of data in the German-Austrian-Suisse MDS registry (D-A-CH MDS registry). Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70121-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schroeder T, Ruf L, Bernhardt A, Hildebrandt B, Aivado M, Aul C, Gattermann N, Haas R, Germing U. Distinguishing myelodysplastic syndromes (MDS) from idiopathic cytopenia of undetermined significance (ICUS): HUMARA unravels clonality in a subgroup of patients. Ann Oncol 2010; 21:2267-2271. [PMID: 20439346 DOI: 10.1093/annonc/mdq233] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients not fulfilling minimal criteria for myelodysplastic syndromes (MDS) but presenting with persisting cytopenia(s) not attributable to a haematological or non-haematological disease are defined as 'idiopathic cytopenia of undetermined significance' (ICUS). DESIGN AND METHODS We retrospectively analysed 67 of 3504 patients from our MDS Registry fulfilling the criteria for ICUS. Furthermore, we used the human androgen receptor gene-based assay (HUMARA) to look for clonality. RESULTS Of all 67 patients, 66% had unilineage, 18% bilineage and 12% trilineage cytopenias. The majority of patients (67%) presented with anaemia. Median overall survival was 44 months (range: 1-199 months). In the entire group, eight patients (12%) developed acute myeloid leukaemia (AML). Of the 23 patients eligible for HUMARA, 17 had non-clonal X-chromosome inactivation patterns, while 6 patients showed clonal patterns. Two of these six patients developed AML indicating that a clonal stem cell disorder was the reason for the anteceding cytopenia, while there was no AML observed among the 17 patients with non-clonal patterns (P = 0.013). CONCLUSIONS Since some of the ICUS patients had a clonal bone marrow disease when presenting with cytopenia(s) and 8 of 67 patients with ICUS later developed AML, we recommend to follow these patients thoroughly. As demonstrated here, HUMARA can facilitate the discrimination between ICUS and a 'manifest' MDS.
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Affiliation(s)
- T Schroeder
- Department of Haematology, Oncology and Clinical Immunology.
| | - L Ruf
- Department of Haematology, Oncology and Clinical Immunology
| | - A Bernhardt
- Department of Haematology, Oncology and Clinical Immunology
| | - B Hildebrandt
- Institute of Human Genetics and Anthropology, Heinrich-Heine University, Düsseldorf, Germany
| | - M Aivado
- Department of Haematology, Oncology and Clinical Immunology; Global Clinical Development Oncology GlaxoSmithKline, Collegeville, PA, USA
| | - C Aul
- Department of Haematology, Oncology and Clinical Immunology, St Johannes Hospital, Duisburg, Germany
| | - N Gattermann
- Department of Haematology, Oncology and Clinical Immunology
| | - R Haas
- Department of Haematology, Oncology and Clinical Immunology
| | - U Germing
- Department of Haematology, Oncology and Clinical Immunology
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Giagounidis A, Gohring G, Haase S, Heinsch M, Banisch S, Aul C, Schlegelberger B. P115 Long-term transfusion independence in del(5q) patients despite discontinuation of lenalidomide. Leuk Res 2009. [DOI: 10.1016/s0145-2126(09)70196-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Germing U, Strupp C, Giagounidis A, Starke C, Aul C, Gattermann N. C006 Detailed morphologic findings in 2773 patients with myelodysplastic syndromes. Leuk Res 2009. [DOI: 10.1016/s0145-2126(09)70044-x] [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: 10/20/2022]
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Tomonaga M, Matsuda A, Germing U, Jinnai I, Bessho M, Gattermann N, Aul C. C006 Improvement of criteria for refractory cytopenia with multilineage dysplasia according to the WHO classification based on prognostic significance of morphological features in patients with refractory anemia according to the FAB classification. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pellagatti A, Cazzola M, Giagounidis A, Malcovati L, Della Porta M, Jädersten M, Killick S, Fidler C, Cattan H, Bowen D, Aul C, Hellström-Lindberg E, Wainscoat J, Boultwood J. C023 Expression profiling of CD34+ cells in patients with myelodysplastic syndromes: differences between early and advanced cases and analysis of apoptosis-related genes. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70061-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wang L, Fidler C, Giagounidis A, Cazzola M, Malcovati L, Killick S, Aul C, Boultwood J, Wainscoat J. C019 Genome-wide analysis of copy number change and loss of heterozygosity in myelodysplastic syndrome with del (5q) using high-density SNP arrays. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70057-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Giagounidis A, Haase S, Lohrbacher V, Heinsch M, Schuran B, Aul C. P146 Disease progression in del (5q) MDS patients treated with lenalidomide: analysis of risk factors and long-term outcome in 44 patients. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70216-3] [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: 10/23/2022]
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Germing U, Strupp C, Aul C. 1 Epidemiologic features in myelodysplastic syndromes. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70002-4] [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: 10/23/2022]
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Matsuda A, Germing U, Jinnai I, Iwanaga M, Misumi M, Kuendgen A, Strupp C, Miyazaki Y, Tsushima H, Sakai M, Bessho M, Gattermann N, Aul C, Tomonaga M. Improvement of criteria for refractory cytopenia with multilineage dysplasia according to the WHO classification based on prognostic significance of morphological features in patients with refractory anemia according to the FAB classification. Leukemia 2007; 21:678-86. [PMID: 17268513 DOI: 10.1038/sj.leu.2404571] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the criteria of refractory cytopenia with multilineage dysplasia (RCMD) according to the WHO (World Health Organization) classification, the frequency threshold concerning dysplasia of each lineage was defined as 10%. To predict overall survival (OS) and leukemia-free survival (LFS) for patients with refractory anemia (RA) according to the French-American-British (FAB) classification, we investigated prognostic factors based on the morphological features of 100 Japanese and 87 German FAB-RA patients, excluding 5q-syndrome. In the univariate analysis of all patients, pseudo-Pelger-Huet anomalies >or=10% (Pelger+), micromegakaryocytes >or=10% (mMgk+), dysgranulopoiesis (dys G) >or=10% and dysmegakaryopoiesis (dys Mgk) >or=40% were unfavorable prognostic factors for OS and LFS (OS; P<0.001, LFS; P<0.001). The prognostic effects of the morphological features were similar in both Japanese and German patients. However, dys Mgk >or=10% was not correlated with OS and LFS. In the multivariate analysis, mMgk+ and dys Mgk>or=40% were adverse prognostic factors for OS for all patients, and dys G >or=10% and dys Mgk>or=40% were adverse prognostic factors for LFS for all patients. On the basis of the present analysis, we propose the following modified morphological criteria for RCMD. Modified RCMD should be defined as FAB-RA, excluding 5q-syndrome with dys G >or=10%, dys Mgk>or=40% or mMgk+.
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Affiliation(s)
- A Matsuda
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan.
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Germing U, Hildebrandt B, Pfeilstöcker M, Nösslinger T, Valent P, Fonatsch C, Lübbert M, Haase D, Steidl C, Krieger O, Stauder R, Giagounidis AAN, Strupp C, Kündgen A, Mueller T, Haas R, Gattermann N, Aul C. Refinement of the international prognostic scoring system (IPSS) by including LDH as an additional prognostic variable to improve risk assessment in patients with primary myelodysplastic syndromes (MDS). Leukemia 2005; 19:2223-31. [PMID: 16193087 DOI: 10.1038/sj.leu.2403963] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The international prognostic scoring system (IPSS) is considered the gold standard for risk assessment in primary myelodysplastic syndromes (MDS). This score includes several prognostic factors except serum lactate dehydrogenase (LDH). We evaluated the prognostic power of LDH as an additional variable in IPSS-based risk assessment. For this purpose, a total of 892 patients with primary MDS registered by the Austrian-German cooperative MDS study group was analyzed retrospectively. Multivariate analysis confirmed the value of established parameters such as medullary blasts, karyotype and peripheral cell counts and showed that elevated LDH was associated with decreased overall survival (P<0.00005) and increased risk of AML development (P<0.00005), independent of the system used to classify MDS (FAB or WHO). Moreover, elevated LDH was found to be a significant predictor of poor survival within each IPSS risk group and within each FAB group except RAEB-T. To exploit these results for refined prognostication, each IPSS risk group was split into two separate categories (A=normal LDH vs B=elevated LDH). Using this LDH-assisted approach, it was possible to identify MDS patients with unfavorable prognosis within the low and intermediate IPSS risk groups. We propose that the IPSS+LDH score should improve clinical decision-making and facilitate proper risk stratification in clinical trials.
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Affiliation(s)
- U Germing
- Department of Hematology, Oncology and Clinical Immunology , Heinrich-Heine-University, Germany.
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Abstract
INTRODUCTION Angiomyolipoma, although rare, belong together with oncocytomas to the most common benign renal neoplasms. Although angiomyolipoma is usually a non-invasive tumor that does not metastasize, chirurgical intervention, especially in case of large or enlarging tumors, is recommended due to their capacity to cause haemorrhage and other significant clinical complications. CASE REPORT We report the case of a renal angiomyolipoma in a female patient seriously disabled by multiple sclerosis with reduced physical and nutritional condition. The woman already underwent a nephrectomy 20 years ago due to an angiomyolipoma of the opposite kidney. The patient received oral gefitinib at a dose of 500 mg/day for 28 days. By a four-weekly course of EGFR-inhibitor gefitinib (Iressa), we achieved a control of the angiomyolipoma and were able to prevent nephrectomy. CONCLUSIONS The use of EGFR inhibitors, whose anti-proliferative activity in renal cell tumors derives not only from direct inhibition of cell proliferation, but also from the inhibition of angiogenesis, requires further investigation.
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Affiliation(s)
- M Schroeder
- Klinik für Hämatologie, Onkologie und Klinische Immunologie, Medizinische Klinik II, St. Johannes Hospital, Duisburg, Germany.
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Fenk R, Schneider P, Kropff M, Huenerlituerkoglu AN, Steidl U, Aul C, Hildebrandt B, Haas R, Heyll A, Kobbe G. High-dose idarubicin, cyclophosphamide and melphalan as conditioning for autologous stem cell transplantation increases treatment-related mortality in patients with multiple myeloma: results of a randomised study. Br J Haematol 2005; 130:588-94. [PMID: 16098074 DOI: 10.1111/j.1365-2141.2005.05641.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [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: 11/30/2022]
Abstract
We conducted a randomised trial comparing an intensified versus a standard conditioning regimen for high-dose chemotherapy followed by autologous stem-cell transplantation in patients with multiple myeloma. In this study, 56 patients were randomly assigned for high-dose therapy with melphalan 200 mg/m2 or with idarubicin 42 mg/m2, melphalan 200 mg/m2 and cyclophosphamide 120 mg/kg. The primary objective was response rate. Acute toxicity, mainly because of infections, was higher in the intensified treatment arm with a treatment-related mortality of 20% versus 0% in the standard arm. This lead to the early discontinuation of the study. Response rates did not differ significantly between both treatment arms {intensified versus standard: complete response+near complete remission 50% [95% confidence interval (CI) 26-74%] vs. 33% (95% CI 17-55%), partial remission 35% (95% CI 16-61%) vs. 50% (95% CI 30-70%)}. After a follow-up of 5 years, the median time-to-progression and overall survival were not significantly different between both patient groups. Analysis restricted to patients surviving the first 100 d after transplant showed a better outcome for patients with >or=2 bad prognostic risk factors in the intensified treatment arm, however all treatment-related deaths occurred within this group of patients. In conclusion, intensified conditioning for high-dose therapy had intolerably high toxicity without improving outcome in patients with multiple myeloma.
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Affiliation(s)
- R Fenk
- Department of Haematology, Oncology and Clinical Immunology, Heinrich-Heine University, Duesseldorf, Germany.
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Giagounidis AAN, Germing U, Strupp C, Hildebrandt B, Heinsch M, Aul C. Prognosis of patients with del(5q) MDS and complex karyotype and the possible role of lenalidomide in this patient subgroup. Ann Hematol 2005; 84:569-71. [PMID: 15891887 DOI: 10.1007/s00277-005-1054-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Accepted: 04/25/2005] [Indexed: 10/25/2022]
Abstract
The survival of patients with myelodysplastic syndromes is strongly affected by chromosomal abnormalities. Patients with an isolated del(5q31) have a favourable prognosis that worsens with the addition of another chromosomal abnormality. It has been reported that both patients with isolated del(5q31) and those with one single additional chromosomal abnormality achieve hematological and cytogenetic remissions with lenalidomide therapy. Whether this translates into improved overall survival of the patient population is unclear. We analysed data of 25 patients with myelodysplastic syndrome and complex chromosomal abnormalities including del(5q31) and show that their median survival is between 7 and 8 months, irrespective of the medullary blast count. Furthermore, we present data of a patient with complex karyotypic anomalies inclusive of del(5q31) treated with lenalidomide who achieved complete cytogenetic remission. This cytogenetic remission was diagnosed after 6 months, and the hematological response is ongoing at 9 months of therapy at a dose of 5 mg p.o. daily. We conclude that lenalidomide has the potential to induce sustained hematological and cytogenetic remissions in the poor prognosis MDS subgroup of del(5q31) patients with complex chromosomal anomalies and that this is likely to improve overall survival.
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Affiliation(s)
- A A N Giagounidis
- Medizinische Klinik II, St. Johannes Hospital, An der Abtei 7-11, 47166, Duisburg, and Klinik für Hämatologie, Onkologie und klinische Immunologie, Heinrich-Heine Universität Düsseldorf, Germany.
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Giagounidis AAN, Haase S, Germing U, Heinsch M, Aul C. Autoimmune disorders in two patients with myelodysplastic syndrome and 5q deletion. Acta Haematol 2005; 113:146-9. [PMID: 15802895 DOI: 10.1159/000083454] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Accepted: 06/30/2004] [Indexed: 11/19/2022]
Abstract
Autoimmune diseases occurring concurrently with myelodysplastic syndrome (MDS) with deletion del(5q) including band q31 are very rare and have only been reported twice in the medical literature. We present two additional cases, one patient with del(5q) and trisomy 21 who suffered from rheumatoid arthritis and one patient with isolated del(5q) and autoimmune hemolytic anemia. Both patients had mild leukopenia and severe transfusion-dependent anemia. The rheumatoid arthritis was treated with antirheumatics without additional immunosuppressive medication. Autoimmune hemolytic anemia was controlled with long-term steroid administration. This patient developed additional trisomy 21, 2 years after the initial diagnosis of del(5q). Contrary to previous reports on autoimmune disorders in MDS mentioning improvements of hematological function in response to steroid administration, neither of our patients had a hematological improvement under corticosteroids.
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Affiliation(s)
- A A N Giagounidis
- Medizinische Klinik II, St. Johannes Hospital, Duisburg, Deutschland.
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Abstract
The 5q- syndrome is a distinct hematological disorder with typical laboratory, morphological, cytogenetic, molecular, and prognostic features. It is defined as a myelodysplastic syndrome with a medullary blast count <5% and an isolated interstitial deletion of the long arm of chromosome 5, including bands q31-q33. The molecular basis of this disease has not yet been fully elucidated, but there is evidence that a commonly deleted region of 1.5 Mb harbors one or several tumor suppressor genes, the loss of which being the basic event leading to disease activity. The 5q- deletion has been demonstrated in very early hematopoietic precursors, including CD34+CD133+ and CD34+CD38-Thyl+ cells. Analysing data of 60 patients with the 5q- syndrome that were followed over a period of up to 28 years, we found a median age at diagnosis of 66.8 years and a female preponderance with a male to female ratio of 1:1.5. Anemia is usually macrocytic and combined with low reticulocyte counts and high erythropoetin levels. Three types of cytogenetic deletion are most prevalent: del(5)(q13q33), del(5)(q13q31) and del(5)(q22q33). The 5q- syndrome has a good prognosis with a median overall survival of 107 months at a median follow-up of 53 months, and a low probability of transformation to AML. An increase of the medullary blast count to > or =5% or the addition of one karyotypic anomaly severely reduces median overall survival. The most promising therapeutic approach is the novel thalidomide analogue CC5013 that is currently evaluated in an international phase II study.
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Knipp S, Aul C, Giagounidis A, Haas R, Gattermann N, Germing U. P-5 Presence of peripheral blasts in RAand RARS predicts an unfavourable outcome. Leuk Res 2005. [DOI: 10.1016/s0145-2126(05)80069-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pfeilstocker M, Nosslinger M, Tuchler H, Strupp C, Valent P, Haase D, Lubbert M, Giagounidis A, Krieger O, Aul C, Germing U. P-10 Influence of age and gender on survival in MDS: Importance of an IPSS*gender interaction — A multicenter analysis on 1159 patients. Leuk Res 2005. [DOI: 10.1016/s0145-2126(05)80074-8] [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: 10/25/2022]
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Kuendgen A, Knipp S, Aivado M, Lara M, Isa S, Giagounides A, Aul C, Haas R, Gattermann N, Germing U. P-30 Prospective validation of the WHO classification of primary myelodysplastic syndromes. Leuk Res 2005. [DOI: 10.1016/s0145-2126(05)80094-3] [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: 10/25/2022]
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Hehlmann R, Berger U, Aul C, Büchner T, Döhner H, Ehninger G, Ganser A, Gökbuget N, Hoelzer D, Uberla K. [The competence network "acute and chronic leukemias"]. Dtsch Med Wochenschr 2004; 129:2660-5. [PMID: 15578322 DOI: 10.1055/s-2004-836093] [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: 10/26/2022]
Abstract
Leukemias are a challenge and a cost factor to society because of their frequency in all age groups. They also serve as a model for a variety of diseases and possess exemplary relevance for basic research and patient care. Leukemia research and therapy have achieved high standards and even a leading position in Germany with regard to clinical trials, standardization of diagnostics and molecular studies of prognostic factors, signal transduction and gene expression. Progress is hampered, however, by fragmentation of leukemia trial groups, diagnostic approaches and treatment research activities. A network was therefore created to integrate the leading leukemia trial groups on chronic myeloid leukemia (CML), acute myeloid leukemia (AML), acute lymphatic leukemia (ALL), myelodysplastic syndromes (MDS) and chronic myeloproliferative diseases (CMPD) and their interdisciplinary partners (diagnostics, treatment research, biometry) in cooperation with basic research and pharmaceutical industry to foster advancements in leukemia-related research and health care through clinical trials, promotion of translational research, introduction of standards for diagnostics and therapy, and development of evidence-based guidelines. Achievements include establishment of central information, communication and management structures, creation of an AML intergroup comprising five study groups, formation of a myelodysplastic syndromes study group and establishment of platforms for diagnostics, genomics and proteomics, and medical informatics. Exchange of scientific progress is mediated by intra- and internet, bi-annual newsletters, regular project group meetings and annual network symposia. Already now, the network structures leukemia therapy and research in Germany and supports the spread of scientific excellence in the field of leukemias.
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Affiliation(s)
- R Hehlmann
- Netzwerkzentrale des Kompetenznetzes "Akute und chronische Leukämien", III. Medizinische Universitätsklinik, Klinikum Mannheim der Universität Heidelberg.
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41
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Giagounidis AAN, Heinsch M, Haase S, Aul C. Early plasmacytoid dendritic cell leukemia/lymphoma coexpressing myeloid antigenes. Ann Hematol 2004; 83:716-21. [PMID: 15316755 DOI: 10.1007/s00277-004-0913-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2003] [Accepted: 11/03/2003] [Indexed: 11/27/2022]
Abstract
Early plasmacytoid dendritic cell (pDC) leukemia/lymphoma has recently been described as a CD4(+)CD56(+) lineage negative malignancy with characteristic clinical, morphologic, immunophenotypic, and biological features. We present a case of a 72-year-old man who was diagnosed with isolated skin involvement 30 months ago and received numerous chemotherapy cycles that did not prevent three relapses of the disease, the last two involving the bone marrow. The bone marrow was nearly completely infiltrated with small- to medium-sized blasts displaying a high nuclear to cytoplasmic ratio, a cytoplasm with faint basophilia lacking granulations or Auer rods. Small vacuoles surrounding the nucleus were frequently observed. Flow cytometry showed CD4(+), CD56(+), CD45(+), CD38(+), HLA-DR(+), CD33(+), CD123(+), CD2(-), cyCD3(-), CD7(-), CD10(-), CD11b(-), CD13(-), CD14(-), CD16(-), CD19(-), cyCD22(-), CD24(-), CD34(-), CD57(-), CD61(-), CD64(-), CD65(-), cyCD79a(-), CD117(-), MPO(-), and TdT(-) population. At the second bone marrow relapse, CD117 was also positive. Our patient was initially treated with acute myeloid leukemia-type chemotherapy, later he was given acute lymphoblastic leukemia-type treatment, and at the last relapse he received CHOP chemotherapy. Each treatment led to rapid response of tumor manifestations with disease-free intervals of 7 months, 9 months, and 8 months, respectively. Although patients usually have an ominous prognosis, with only 25% living more than 24 months, our patient is alive after 30+ months and has again achieved complete remission after the last chemotherapy.
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Affiliation(s)
- A A N Giagounidis
- St Johannes Hospital, Medizinische Klinik II, An der Abtei 7-11, 47166, Duisburg, Germany.
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42
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Hehlmann R, Berger U, Aul C, Büchner T, Döhner H, Ehninger G, Ganser A, Hoelzer D, Gökbuget N, Uberla K. [Clinical research in the "acute and chronic leukemias"competence network ]. Internist (Berl) 2004; 45:384-92. [PMID: 15004683 DOI: 10.1007/s00108-004-1151-5] [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: 11/24/2022]
Abstract
Goal of the network is the construction of an exemplary cooperative leukemia network for the improvement of medical care and of health related research in acute and chronic leukemias. This is achieved by improved mechanisms of cooperation among all major groups in Germany that deal with the leukemias in research and in patient care. In practice, cooperation between clinical groups and scientists in research institutes is mediated by various instruments that improve communication, flow of information and interdisciplinary cooperation and also increase information transfer from top research institutions to clinical translation. The network comprises more than 1400 participants in about 400 university centers, large community hospitals and specialty practices with functional communication structures, interdisciplinary cooperation and nation-wide logistics. The improved cooperation and the accelerated information transfer from the bench to the "bedside" results in an added value that ultimately results in improved survival results of patients and in superior competitiveness of involved research workers and clinicians. Sustainability is addressed by establishing a leukemia foundation to support long term financial coverage of the network and by negotiating a proposal for a European Network of Excellence against leukemia within the Sixth Framework Programme of the European Union.
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Affiliation(s)
- R Hehlmann
- III. Medizinische Universitätsklinik, Klinikum Mannheim der Universität Heidelberg.
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43
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Hehlmann R, Berger U, Aul C, Büchner T, Döhner H, Ehninger G, Ganser A, Gökbuget N, Hoelzer D, Uberla K, Gassmann W, Ludwig WD, Rieder H, Kneba M, Hochhaus A, Reiter A, Hiddemann W, Ottmann OG, Germing U, Adelhard K, Dugas M, Dirschedl P, Messerer D, Böhme A, Harrison-Neu E, Griesshammer M, Kienast J, Kolb HJ, Ho AD, Hallek M, Neubauer A, Schlegelberger B, Niederwieser D, Heil G, Müller T, Hasford J. The German competence network ‘Acute and chronic leukemias’. Leukemia 2004; 18:665-9. [PMID: 15044925 DOI: 10.1038/sj.leu.2403317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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44
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Giagounidis AAN, Germing U, Haase S, Hildebrandt B, Schlegelberger B, Schoch C, Wilkens L, Heinsch M, Willems H, Aivado M, Aul C. Clinical, morphological, cytogenetic, and prognostic features of patients with myelodysplastic syndromes and del(5q) including band q31. Leukemia 2004; 18:113-9. [PMID: 14586479 DOI: 10.1038/sj.leu.2403189] [Citation(s) in RCA: 163] [Impact Index Per Article: 8.2] [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: 01/16/2023]
Abstract
We analyzed data of 76 consecutive patients with myelodysplastic syndrome (MDS) and isolated del(5q) (n=66) or del(5q) plus one additional chromosomal abnormality (n=10) included in our MDS database over the last 26 years. The median age of our patient population was 66.8 years. The male to female ratio was 1:1.7. In all, 14 patients (18%) had advanced MDS with an increased medullary blast count. A total of 17 patients (22%) had significant dysplasia in the nonmegakaryocytic cell lines. Nearly half of the study population showed erythroid hypoplasia in the bone marrow. The projected median survival of patients with isolated del(5q) is 146 months for a median follow-up of 67 months. Patients with an increased medullary blast count and those with an additional chromosomal abnormality have a significantly shorter overall survival (24 and 45 months, respectively) than patients with isolated del(5q). We did not find survival differences for different cytogenetic breakpoints, nor did the amount of dysplasia have an impact on survival in our population. In total, 29 patients have died. Deaths occurred primarily due to transformation into acute leukemia, infection, or cardiac failure. Our data support the current definition of a separate entity of MDS with del(5q) that has been suggested by the World Health Organization.
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45
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Stadler M, Germing U, Kliche KO, Josten KM, Kuse R, Hofmann WK, Schrezenmeier H, Novotny J, Anders O, Eimermacher H, Verbeek W, Kreipe HH, Heimpel H, Aul C, Ganser A. A prospective, randomised, phase II study of horse antithymocyte globulin vs rabbit antithymocyte globulin as immune-modulating therapy in patients with low-risk myelodysplastic syndromes. Leukemia 2004; 18:460-5. [PMID: 14712285 DOI: 10.1038/sj.leu.2403239] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Immunosuppression has recently been proposed for low-risk myelodysplastic syndromes (MDS) to reverse bone marrow failure by inhibiting intramedullary secretion of proapoptotic cytokines. We treated 35 MDS patients (24 refractory anaemia (RA), 10 RA with excess blasts and one chronic myelomonocytic leukaemia) with either horse antithymocyte globulin 15 mg/kg/day or rabbit antithymocyte globulin 3.75 mg/kg/day, each for 5 days. Median age was 63 years (range: 41-75). After 1 to 34+ months of follow-up (mean: 15+), four patients experienced complete haematological responses (CR), six good responses (GR) and two minor responses. All CRs and GRs occurred in patients with RA, in whom both horse and rabbit ATG yielded five responses out of 12 (42%). Time to response varied between 1 and 10 (mean: 3) months. The median duration of response was 9+ (1-17+) months; five patients are in continuing response. In all, 23 patients suffered side effects > degrees II WHO (the degree of toxicity encountered according to the internationally accepted WHO toxicity grading); one patient died 2 weeks after rabbit ATG from rhinocerebral mucormycosis. Parameters that correlated with response were duration of disease and RA subgroup. In our experience, immune-modulating therapy with either horse or rabbit ATG is feasible in patients with RA and short duration of disease.
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Affiliation(s)
- M Stadler
- Department of Haematology and Oncology, Medizinische Hochschule, Hannover, Germany
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46
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Hehlmann R, Berger U, Pfirrmann M, Hochhaus A, Metzgeroth G, Maywald O, Hasford J, Reiter A, Hossfeld DK, Kolb HJ, Löffler H, Pralle H, Queisser W, Griesshammer M, Nerl C, Kuse R, Tobler A, Eimermacher H, Tichelli A, Aul C, Wilhelm M, Fischer JT, Perker M, Scheid C, Schenk M, Weiss J, Meier CR, Kremers S, Labedzki L, Schmeiser T, Lohrmann HP, Heimpel H. Randomized comparison of interferon alpha and hydroxyurea with hydroxyurea monotherapy in chronic myeloid leukemia (CML-study II): prolongation of survival by the combination of interferon alpha and hydroxyurea. Leukemia 2003; 17:1529-37. [PMID: 12886239 DOI: 10.1038/sj.leu.2403006] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The optimum treatment conditions of interferon (IFN) alpha therapy in chronic myeloid leukemia (CML) are still controversial. To evaluate the role of hydroxyurea (HU) for the outcome of IFN therapy, we conducted a randomized trial to compare the combination of IFN and HU vs HU monotherapy (CML-study II). From February 1991 to December 1994, 376 patients with newly diagnosed CML in chronic phase were randomized. In all, 340 patients were Ph/BCR-ABL positive and evaluable. Randomization was unbalanced 1:2 in favor of the combination therapy, since study conditions were identical to the previous CML-study I and it had been planned in advance to add the HU patients of study I (n=194) to the HU control group. Therefore, a total of 534 patients were evaluable (226 patients with IFN/HU and 308 patients with HU). Analyses were according to intention-to-treat. Median observation time of nontransplanted living patients was 7.6 years (7.9 years for IFN/HU and 7.3 years for HU). The risk profile (new CML score) was available for 532 patients: 200 patients (38%) were low, 239 patients (45%) intermediate, and 93 patients (17%) high risk. Complete hematologic response rates were higher in IFN/HU-treated patients (59 vs 32%). Of 169 evaluable IFN/HU-treated patients (75%), 104 patients (62%) achieved a cytogenetic response that was complete in 12% (n=21), major in 14% (n=24), and at least minimal in 35% (n=59). Of the 534 patients, 105 (20%) underwent allogeneic stem cell transplantation in first chronic phase. In the low-risk group, 65 of 200 patients were transplanted (33%), 30 (13%) in the intermediate-risk group, and nine (10%) in the high-risk group. Duration of chronic phase was 55 months for IFN/HU and 41 months for HU (P<0.0001). Median survival was 64 months for IFN/HU and 53 months for HU-treated patients (P=0.0063). We conclude that IFN in combination with HU achieves a significant long-term survival advantage over HU monotherapy. In view of the data of CML-study I, these results suggest that IFN/HU is also superior to IFN alone. HU should be combined with IFN in IFN-based therapies and for comparisons with new therapies.
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Affiliation(s)
- R Hehlmann
- Klinikum Mannheim, Universität Heidelberg, Mannheim, Germany
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47
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Giagounidis AAN, Heinsch M, Kasperk R, Aul C. Fournier's gangrene. Ann Hematol 2003; 82:531-532. [PMID: 12811517 DOI: 10.1007/s00277-003-0688-z] [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] [Received: 03/08/2003] [Accepted: 05/02/2003] [Indexed: 10/26/2022]
Affiliation(s)
- A A N Giagounidis
- Medizinische Klinik II, St. Johannes Hospital, An der Abtei 7-11, 47166, Duisburg, Germany.
| | - M Heinsch
- Medizinische Klinik II, St. Johannes Hospital, An der Abtei 7-11, 47166, Duisburg, Germany
| | - R Kasperk
- Klinik für Chirurgie, St. Johannes Hospital, An der Abtei 7-11, 47166, Duisburg, Germany
| | - C Aul
- Medizinische Klinik II, St. Johannes Hospital, An der Abtei 7-11, 47166, Duisburg, Germany
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48
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Oosterveld M, Suciu S, Verhoef G, Labar B, Belhabri A, Aul C, Selleslag D, Ferrant A, Wijermans P, Mandelli F, Amadori S, Jehn U, Muus P, Zittoun R, Hess U, Anak O, Beeldens F, Willemze R, de Witte T. The presence of an HLA-identical sibling donor has no impact on outcome of patients with high-risk MDS or secondary AML (sAML) treated with intensive chemotherapy followed by transplantation: results of a prospective study of the EORTC, EBMT, SAKK and GIMEMA Leukemia Groups (EORTC study 06921). Leukemia 2003; 17:859-68. [PMID: 12750698 DOI: 10.1038/sj.leu.2402897] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This report used the framework of a large European study to investigate the outcome of patients with and without an HLA-identical sibling donor on an intention-to-treat basis. After a common remission-induction and consolidation course, patients with an HLA-identical sibling donor were scheduled for allogeneic transplantation and patients lacking a donor for autologous transplantation. In all, 159 patients alive at 8 weeks from the start of treatment were included in the present analysis. In total, 52 patients had a donor, 65 patients did not have a donor and in 42 patients the availability of a donor was not assessed. Out of 52 patients, 36 (69%) with a donor underwent allogeneic transplantation (28 in CR1). Out of 65 patients, 33 (49%) received an autograft (27 in CR1). The actuarial survival rates at 4 years were 33.3% (s.e. = 6.7%) for patients with a donor and 39.0% (s.e. = 6.5%) for patients without a donor (P = 0.18). Event-free survival rates were 23.1% (s.e. = 6.2%) and 21.5% (s.e. = 5.3%), respectively (P = 0.66). Correction for alternative donor transplants did not substantially alter the survival of the group without a donor. Also, the survival in the various cytogenetic risk groups was not significantly different when comparing the donor vs the no-donor group. This analysis shows that patients with high-risk myelodysplastic syndrome and secondary acute myeloid leukemia may benefit from both allogeneic and autologous transplantation. We were unable to demonstrate a survival advantage for patients with a donor compared to patients without a donor.
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Affiliation(s)
- M Oosterveld
- 1University Medical Centre, Nijmegen, The Netherlands
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49
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Aul C, Schroeder M, Giagounidis A. [Medicinal therapy of malignant lymphomas]. Radiologe 2002; 42:943-53. [PMID: 12486548 DOI: 10.1007/s00117-002-0821-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Chemotherapy represents the most important therapeutic option in malignant lymphomas. Low to intermediate risk Hodgkin's disease is treated by a combination of chemotherapy and radiation. The new chemotherapy protocol BEACOPP has improved the outcome of advanced stages in comparison with the internationally accepted standard protocol COPP/ABVD. Dependent on the initial staging, cure rates between 50 and 95% can be achieved.Indolent non-Hodgkin's lymphomas usually present in advanced stages of disease. Chemotherapy in these cases has palliative character and aims at improving patients'quality of life and at avoiding complications due to the disease. In aggressive and very aggressive non-Hodgkin's lymphoma chemotherapy is curative and must be initiated immediately irrespective of the staging results. The efficacy of the standard protocol CHOP (cyclophosphamide,doxorubicin, vincristine and prednisone), that was established in the 1970s, has recently been improved by shortening of the therapy interval (CHOP-14 vs.CHOP-21),addition of etoposide (CHOEP) and combination with the monoclonal antibody rituximab (R-CHOP). The value of high dose chemotherapy with stem cell transplantation has been shown unequivocally only for aggressive non-Hodgkin lymphoma and relapsed Hodgkin's disease responsive to chemotherapy. The therapeutic strategy of malignant lymphomas is likely to be improved within the next years due to the introduction of novel cytostatic agents, the broadening application of monoclonal antibodies,upcoming new transplantation procedures and the development of substances with molecular targets. To rapidly increase our current knowledge on the topic it is mandatory to include patients into the large national and international multicenter studies.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Clinical Trials as Topic
- Combined Modality Therapy
- Drug Administration Schedule
- Hodgkin Disease/drug therapy
- Hodgkin Disease/mortality
- Hodgkin Disease/pathology
- Hodgkin Disease/radiotherapy
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/radiotherapy
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/radiotherapy
- Neoplasm Staging
- Radiotherapy, Adjuvant
- Retreatment
- Survival Rate
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Affiliation(s)
- C Aul
- Medizinische Klinik II, St.-Johannes-Hospital Duisburg
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50
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Oosterveld M, Muus P, Suciu S, Koller C, Verhoef G, Labar B, Wijermans P, Aul C, Fière D, Selleslag D, Willemze R, Gratwohl A, Ferrant A, Mandelli F, Cortes J, de Witte T, Estey E. Chemotherapy only compared to chemotherapy followed by transplantation in high risk myelodysplastic syndrome and secondary acute myeloid leukemia; two parallel studies adjusted for various prognostic factors. Leukemia 2002; 16:1615-21. [PMID: 12200672 DOI: 10.1038/sj.leu.2402591] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2001] [Accepted: 04/11/2002] [Indexed: 11/09/2022]
Abstract
Comparisons of the effectiveness of chemotherapy and transplantation in AML in first complete remission (CR) have focused almost exclusively on patients with de novo disease. Here we used Cox modelling to compare these strategies in patients with MDS and s-AML treated by the Leukemia Group of the EORTC or at the MD Anderson Cancer Center. All patients were aged 15-60. The 184 EORTC patients received conventional dose ara-C + idarubicin + etoposide for remission induction, and after one consolidation course, were scheduled to receive an allograft, or an autograft if a sibling donor was unavailable. The 215 MDA patients received various high-dose ara-C containing induction regimens, and in CR, continued to receive these regimens at reduced dose for 6-12 months. CR rates were 54% EORTC and 63% MDA (P = 0.09). Sixty-five of the 100 EORTC patients who entered CR received a transplant in first CR. Disease-free survival in patients achieving CR was superior in the EORTC cohort, the 4-years DFS rates were 28.9% (s.e. = 4.8%) EORTC vs 17.3% (s.e. = 3.7%) MDA (P = 0.017). Survival from CR was not significantly different in the EORTC and MDA groups, as was survival from start of treatment. After accounting for prognostic factors the conclusions were unchanged. Despite various problems with the analysis discussed below, the data suggest that neither transplantation nor chemotherapy, as currently practised, can be unequivocally recommended for these patients in first CR and that questions as to the superior modality may be less important than the need to improve results with both.
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Affiliation(s)
- M Oosterveld
- University Medical Centre Nijmegen, The Netherlands
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