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Eichhorst B, Niemann CU, Kater AP, Fürstenau M, von Tresckow J, Zhang C, Robrecht S, Gregor M, Juliusson G, Thornton P, Staber PB, Tadmor T, Lindström V, da Cunha-Bang C, Schneider C, Poulsen CB, Illmer T, Schöttker B, Nösslinger T, Janssens A, Christiansen I, Baumann M, Frederiksen H, van der Klift M, Jäger U, Leys MBL, Hoogendoorn M, Lotfi K, Hebart H, Gaska T, Koene H, Enggaard L, Goede J, Regelink JC, Widmer A, Simon F, De Silva N, Fink AM, Bahlo J, Fischer K, Wendtner CM, Kreuzer KA, Ritgen M, Brüggemann M, Tausch E, Levin MD, van Oers M, Geisler C, Stilgenbauer S, Hallek M. First-Line Venetoclax Combinations in Chronic Lymphocytic Leukemia. N Engl J Med 2023; 388:1739-1754. [PMID: 37163621 DOI: 10.1056/nejmoa2213093] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Randomized trials of venetoclax plus anti-CD20 antibodies as first-line treatment in fit patients (i.e., those with a low burden of coexisting conditions) with advanced chronic lymphocytic leukemia (CLL) have been lacking. METHODS In a phase 3, open-label trial, we randomly assigned, in a 1:1:1:1 ratio, fit patients with CLL who did not have TP53 aberrations to receive six cycles of chemoimmunotherapy (fludarabine-cyclophosphamide-rituximab or bendamustine-rituximab) or 12 cycles of venetoclax-rituximab, venetoclax-obinutuzumab, or venetoclax-obinutuzumab-ibrutinib. Ibrutinib was discontinued after two consecutive measurements of undetectable minimal residual disease or could be extended. The primary end points were undetectable minimal residual disease (sensitivity, <10-4 [i.e., <1 CLL cell in 10,000 leukocytes]) as assessed by flow cytometry in peripheral blood at month 15 and progression-free survival. RESULTS A total of 926 patients were assigned to one of the four treatment regimens (229 to chemoimmunotherapy, 237 to venetoclax-rituximab, 229 to venetoclax-obinutuzumab, and 231 to venetoclax-obinutuzumab-ibrutinib). At month 15, the percentage of patients with undetectable minimal residual disease was significantly higher in the venetoclax-obinutuzumab group (86.5%; 97.5% confidence interval [CI], 80.6 to 91.1) and the venetoclax-obinutuzumab-ibrutinib group (92.2%; 97.5% CI, 87.3 to 95.7) than in the chemoimmunotherapy group (52.0%; 97.5% CI, 44.4 to 59.5; P<0.001 for both comparisons), but it was not significantly higher in the venetoclax-rituximab group (57.0%; 97.5% CI, 49.5 to 64.2; P = 0.32). Three-year progression-free survival was 90.5% in the venetoclax-obinutuzumab-ibrutinib group and 75.5% in the chemoimmunotherapy group (hazard ratio for disease progression or death, 0.32; 97.5% CI, 0.19 to 0.54; P<0.001). Progression-free survival at 3 years was also higher with venetoclax-obinutuzumab (87.7%; hazard ratio for disease progression or death, 0.42; 97.5% CI, 0.26 to 0.68; P<0.001), but not with venetoclax-rituximab (80.8%; hazard ratio, 0.79; 97.5% CI, 0.53 to 1.18; P = 0.18). Grade 3 and grade 4 infections were more common with chemoimmunotherapy (18.5%) and venetoclax-obinutuzumab-ibrutinib (21.2%) than with venetoclax-rituximab (10.5%) or venetoclax-obinutuzumab (13.2%). CONCLUSIONS Venetoclax-obinutuzumab with or without ibrutinib was superior to chemoimmunotherapy as first-line treatment in fit patients with CLL. (Funded by AbbVie and others; GAIA-CLL13 ClinicalTrials.gov number, NCT02950051; EudraCT number, 2015-004936-36.).
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Affiliation(s)
- Barbara Eichhorst
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Carsten U Niemann
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Arnon P Kater
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Moritz Fürstenau
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Julia von Tresckow
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Can Zhang
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Sandra Robrecht
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Michael Gregor
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Gunnar Juliusson
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Patrick Thornton
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Philipp B Staber
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Tamar Tadmor
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Vesa Lindström
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Caspar da Cunha-Bang
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Christof Schneider
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Christian B Poulsen
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Thomas Illmer
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Björn Schöttker
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Thomas Nösslinger
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Ann Janssens
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Ilse Christiansen
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Michael Baumann
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Henrik Frederiksen
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Marjolein van der Klift
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Ulrich Jäger
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Maria B L Leys
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Mels Hoogendoorn
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Kourosh Lotfi
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Holger Hebart
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Tobias Gaska
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Harry Koene
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Lisbeth Enggaard
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Jereon Goede
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Josien C Regelink
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Anouk Widmer
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Florian Simon
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Nisha De Silva
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Anna-Maria Fink
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Jasmin Bahlo
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Kirsten Fischer
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Clemens-Martin Wendtner
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Karl A Kreuzer
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Matthias Ritgen
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Monika Brüggemann
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Eugen Tausch
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Mark-David Levin
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Marinus van Oers
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Christian Geisler
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Stephan Stilgenbauer
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
| | - Michael Hallek
- From the Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne (B.E., M.F., C.Z., S.R., F.S., A.-M.F., J.B., K.F., K.A.K., M. Hallek), the Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen (J.T.), the Division of Chronic Lymphocytic Leukemia, Department of Internal Medicine III, University of Ulm, Ulm (C.S., E.T., S.S.), Group Practice for Hematology and Oncology, Dresden (T.I.); the Hematology-Oncology Center, Würzburg (B.S.), Specialist Medical Practice of Hematology and Oncology, Mutlangen (H.H.), the Department of Hematology, Clinic for Hematology and Oncology, Centrum of Oncology, Brüderhospital St. Josef, Paderborn (T.G.), the Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig Maximilian University, Munich (C.-M.W.); and the Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel (M.R., M. Brüggemann), Kiel - all in Germany; the Department of Hematology, Odense Rigshospitalet, Copenhagen University Hospital (C.U.N., C.C.-B., C.G.), and the Department of Hematology, Center for Cancer and Organ Diseases, Rigshospitalet (L.E.),Copenhagen, the Department of Hematology, Faculty of Medicine, Aalborg University Hospital, Aalborg (I.C.), the Department of Hematology, Zealand University Hospital, Roskilde (C.B.P.), and the Department of Hematology, Odense University Hospital, Odense (H.F.) - all in Denmark; the Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam (A.P.K., M.O.), the Department of Internal Medicine, Amphia Hospital, Breda (M.K.), the Department of Hematology, Maasstad Ziekenhuis, Rotterdam (M.B.L.L.), the Department of Hematology and Oncology, Medical Center Leeuwarden, Leeuwarden (M. Hoogendoorn), the Department of Hematology, St. Antonius Hospital Utrecht, Utrecht (H.K.), the Department of Hematology, Meander Medical Center, Amersfoort (J.C.R.), and the Department of Hematology, Albert Schweitzer Hospital, Dordrecht (M.-D.L.) - all in the Netherlands; the Department of Hematology, Luzerner Kantonsspital, Lucerne (M.G.), the Department of Hematology, Kantonsspital St. Gallen, St. Gallen (M. Baumann), the Department of Hematology, Clinic for Medical Oncology and Hematology, Kantonsspital Hospital Winterthur, Winterthur (J.G.), and the Department of Medical Oncology and Hematology Clinic, University Hospital Zürich, Zürich (A.W.) - all in Switzerland; the Department of Hematology, Lund University Cancer Center, Lund (G.J.), and the Department of Hematology, Linköping University Hospital, Linköping (K.L.) - both in Sweden; the Department of Hematology, Blackrock Health Member Hospitals, Hermitage Clinic, Dublin (P.T.); the Department of Medicine I, Division of Hematology and Hemostaseology (P.B.S.), the Department of Internal Medicine, University Hospital for Internal Medicine, Clinical Department of Hematology and Hemostaseology (U.J.), and the Comprehensive Cancer Center Vienna, Vienna General Hospital (P.B.S.), Medical University of Vienna, and the Department of Hematology and Oncology, Hanusch Hospital (T.N.) - both in Vienna; the Department of Hematology and Blood Bank, Bnai Zion Medical Center, Haifa, Israel (T.T.); the Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki (V.L.); the Department of Oncology, Universitair Ziekenhuis Leuven, Leuven, Belgium (A.J.); and the Department of Hematology, University College London, London (N.D.S.)
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2
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Brieghel C, Galle V, Agius R, da Cunha-Bang C, Andersen MA, Vlummens P, Mattsson M, Rosenquist R, Smedby KE, Herling CD, Bahlo J, Hallek M, Lundgren JD, Offner F, Niemann CU. Identifying patients with chronic lymphocytic leukemia without need of treatment: End of endless watch and wait? Eur J Haematol 2022; 108:369-378. [PMID: 35030282 DOI: 10.1111/ejh.13743] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Early-stage chronic lymphocytic leukemia (CLL) challenges specialized management and follow-up. METHODS We developed and validated a prognostic index to identify newly diagnosed patients without need of treatment (CLL-WONT) by a training/validation approach using data on 4708 patients. Composite scores derived from weighted hazards by multivariable analysis defined CLL-WONT risk groups. RESULTS Age (>65 years: 1 point), Binet stage (B: 2 points), lactate dehydrogenase (LDH) (>205 U/L: 1 point), absolute lymphocyte count (15-30 × 109 /L: 1 point; >30 × 109 /L; 2 points), β2-microglobulin (>4 mg/L: 1 point), IGHV mutation status (unmutated: 1 point), and 11q or 17p deletion (1 point) were independently associated with shorter time to first treatment (TTFT). Low-risk patients demonstrated 5-year TTFT of 2% by internal validation, but 7-19% by external validation. Including all patients with complete scores, the 5-year TTFT was 10% for the 756 (39%) CLL-WONT low-risk patients, and the 704 (37%) patients who were both CLL-WONT and CLL-IPI low risk demonstrated even lower 5-year TTFT (8%). CONCLUSION We have adopted the CLL-WONT at an institution covering 1 800 000 individuals to allow patients with both low-risk CLL-WONT and CLL-IPI to be managed by primary healthcare providers, thereby prioritizing specialized hematology services for patients in dire need.
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Affiliation(s)
| | - Veerle Galle
- Department of Clinical Hematology, Ghent University Hospital, Ghent, Belgium
| | - Rudi Agius
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Philip Vlummens
- Department of Clinical Hematology, Ghent University Hospital, Ghent, Belgium
| | - Mattias Mattsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Hematology, Uppsala University Hospital, Uppsala, Sweden
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Karin E Smedby
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carmen D Herling
- Department of Internal Medicine, Uniklinik Köln, Cologne, Germany
| | - Jasmin Bahlo
- Department of Internal Medicine, Uniklinik Köln, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine, Uniklinik Köln, Cologne, Germany
| | - Jens D Lundgren
- Centre for Health, Immunity and Infectious Diseases (CHIP), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Fritz Offner
- Department of Clinical Hematology, Ghent University Hospital, Ghent, Belgium
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3
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Bloehdorn J, Krzykalla J, Holzmann K, Gerhardinger A, Jebaraj BMC, Bahlo J, Humphrey K, Tausch E, Robrecht S, Mertens D, Schneider C, Fischer K, Hallek M, Döhner H, Benner A, Stilgenbauer S. Integrative prognostic models predict long-term survival after immunochemotherapy in chronic lymphocytic leukemia patients. Haematologica 2021; 107:615-624. [PMID: 33730841 PMCID: PMC8883563 DOI: 10.3324/haematol.2020.251561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/01/2020] [Indexed: 11/25/2022] Open
Abstract
Chemoimmunotherapy with fludarabine, cyclophosphamide and rituximab (FCR) can induce long-term remissions in patients with chronic lymphocytic leukemia. Treatment efficacy with Bruton's tyrosine kinase inhibitors was found similar to FCR in untreated chronic lymphocytic leukemia patients with a mutated immunoglobulin heavy chain variable (IGHV) gene. In order to identify patients who specifically benefit from FCR, we developed integrative models including established prognostic parameters and gene expression profiling (GEP). GEP was conducted on n=337 CLL8 trial samples, “core” probe sets were summarized on gene levels and RMA normalized. Prognostic models were built using penalized Cox proportional hazards models with the smoothly clipped absolute deviation penalty. We identified a prognostic signature of less than a dozen genes, which substituted for established prognostic factors, including TP53 and IGHV gene mutation status. Independent prognostic impact was confirmed for treatment, β2-microglobulin and del(17p) regarding overall survival and for treatment, del(11q), del(17p) and SF3B1 mutation for progression-free survival. The combination of independent prognostic and GEP variables performed equal to models including only established non-GEP variables. GEP variables showed higher prognostic accuracy for patients with long progression-free survival compared to categorical variables like the IGHV gene mutation status and reliably predicted overall survival in CLL8 and an independent cohort. GEP-based prognostic models can help to identify patients who specifically benefit from FCR treatment. The CLL8 trial is registered under EUDRACT-2004-004938-14 and clinicaltrials gov. Identifier: NCT00281918.
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Affiliation(s)
| | - Julia Krzykalla
- Division of Biostatistics, German Cancer Research Center, Heidelberg
| | | | | | | | - Jasmin Bahlo
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne
| | - Kathryn Humphrey
- Clinical Development Oncology, Roche Products Ltd, Welwyn Garden City
| | - Eugen Tausch
- Department of Internal Medicine III, University of Ulm, Ulm
| | - Sandra Robrecht
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne
| | - Daniel Mertens
- Department of Internal Medicine III, University of Ulm, Ulm, Germany; German Cancer Research Center (DKFZ), Heidelberg
| | | | - Kirsten Fischer
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne
| | - Michael Hallek
- Department I for Internal Medicine and Centre for Integrated Oncology, University of Cologne, Cologne
| | - Hartmut Döhner
- Department of Internal Medicine III, University of Ulm, Ulm
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg
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4
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Cramer P, Tresckow JV, Robrecht S, Bahlo J, Fürstenau M, Langerbeins P, Pflug N, Al-Sawaf O, Heinz WJ, Vehling-Kaiser U, Dürig J, Tausch E, Hensel M, Sasse S, Fink AM, Fischer K, Kreuzer KA, Böttcher S, Ritgen M, Kneba M, Wendtner CM, Stilgenbauer S, Eichhorst B, Hallek M. Bendamustine, followed by ofatumumab and ibrutinib in chronic lymphocytic leukemia (CLL2-BIO): primary endpoint analysis of a multicenter, open-label phase-II trial. Haematologica 2021; 106:543-554. [PMID: 32107341 PMCID: PMC7849583 DOI: 10.3324/haematol.2019.223693] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/09/2019] [Accepted: 02/25/2020] [Indexed: 12/12/2022] Open
Abstract
The introduction of targeted agents has revolutionized the treatment of chronic lymphocytic leukemia but only few patients achieve a complete remission and minimal residual disease negativity with ibrutinib monotherapy. This multicenter, investigator-initiated, phase II study is evaluating sequential treatment with two cycles of bendamustine debulking for patients with a higher tumor load, followed by ofatumumab and ibrutinib induction and maintenance treatment. An all-comer population, irrespective of prior treatment, physical fitness and genetic factors, was included. The primary endpoint was the investigator-assessed overall response rate at the end of induction treatment. Of 66 patients enrolled, one patient with early treatment discontinuation was excluded from the efficacy analysis as predefined by the protocol. Thirty-nine patients (60%) were treatment-naïve and 26 patients (40%) had relapsed/refractory chronic lymphocytic leukemia, 21 patients (32%) had a del(17p) and/or TP53 mutation and 45 patients (69%) had unmutated IGHV status. At the end of the induction, 60 of 65 patients (92%) responded and nine (14%) achieved minimal residual disease negativity (<10-4) in peripheral blood. No unexpected or cumulative toxicities occurred. The most common grade 3 or 4 adverse events, according to the Common Toxicity Criteria, were neutropenia, anemia, infusion-related reactions, and diarrhea. This sequential treatment of bendamustine debulking, followed by ofatumumab and ibrutinib was well tolerated without unexpected safety signals and showed a good efficacy with an overall response rate of 92%. Ongoing maintenance treatment aims at deeper responses with minimal residual disease negativity. However, ibrutinib should still be used as a single agent outside clinical trials. Clinicaltrials.gov number: NCT02689141.
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Affiliation(s)
- Paula Cramer
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Julia V Tresckow
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Sandra Robrecht
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Jasmin Bahlo
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Moritz Fürstenau
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Petra Langerbeins
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Natali Pflug
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Othman Al-Sawaf
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Werner J Heinz
- University of Würzburg, Medical Center, Medical Clinic II, Würzburg, Germany
| | | | - Jan Dürig
- University Hospital Essen, Department for Hematology, West German Cancer Center, Essen, Germany
| | - Eugen Tausch
- Department III of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | | | - Stephanie Sasse
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Anna-Maria Fink
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Kirsten Fischer
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Karl-Anton Kreuzer
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Sebastian Böttcher
- Department III of Internal Medicine, Rostock University Medical Center, Rostock, Germany
| | - Matthias Ritgen
- Department of Internal Medicine II, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Michael Kneba
- Department of Internal Medicine II, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | | | | | - Barbara Eichhorst
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
| | - Michael Hallek
- University of Cologne, Dept. of Internal Medic University Hospital of Cologne, Germany
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5
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Jaramillo S, Agathangelidis A, Schneider C, Bahlo J, Robrecht S, Tausch E, Bloehdorn J, Hoechstetter M, Fischer K, Eichhorst B, Goede V, Hallek M, Döhner H, Rosenquist R, Ghia P, Stamatopoulos K, Stilgenbauer S. Prognostic impact of prevalent chronic lymphocytic leukemia stereotyped subsets: analysis within prospective clinical trials of the German CLL Study Group (GCLLSG). Haematologica 2020; 105:2598-2607. [PMID: 33131249 PMCID: PMC7604575 DOI: 10.3324/haematol.2019.231027] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/18/2019] [Indexed: 11/25/2022] Open
Abstract
Almost one-third of all patients with chronic lymphocytic leukemia (CLL) express stereotyped B cell receptor immunoglobulins (BcR IG) and can be assigned to distinct subsets, each with a particular BcR IG. The largest stereotyped subsets are #1, #2, #4 and #8, associated with specific clinicobiological characteristics and outcomes in retrospective studies. We assessed the associations and prognostic value of these BcR IG in prospective multicenter clinical trials reflective of two different clinical situations: i) early-stage patients (watch-and-wait arm of the CLL1 trial) (n=592); ii) patients in need of treatment, enrolled in 3 phase III trials (CLL8, CLL10, CLL11), treated with different chemo-immunotherapies (n=1861). Subset #1 was associated with del(11q), higher CLL international prognostic index (CLL-IPI) scores and similar clinical course to CLL with unmutated immunoglobulin heavy variable (IGHV) genes (U-CLL) in both early and advanced stage groups. IGHV-mutated (M-CLL) subset #2 cases had shorter time-to-first-treatment (TTFT) versus other M-CLL cases in the early-stage cohort (HR: 4.2, CI: 2-8.6, p<0.001), and shorter time-to-next-treatment (TTNT) in the advanced-stage cohort (HR: 2, CI: 1.2-3.3, p=0.005). M-CLL subset #4 was associated with lower CLL-IPI scores and younger age at diagnosis; in both cohorts, these patients showed a trend towards better outcomes versus other M-CLL. U-CLL subset #8 was associated with trisomy 12. Overall, this study shows that major stereotyped subsets have distinctive characteristics. For the first time in prospective multicenter clinical trials, subset # 2 appeared as an independent prognostic factor for earlier TTFT and TTNT and should be proposed for risk stratification of patients.
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Affiliation(s)
- Sonia Jaramillo
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Andreas Agathangelidis
- Institute of Applied Biosciences, Centre for Research and Technology, Thessaloniki, Greece
| | | | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Eugen Tausch
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | | | - Manuela Hoechstetter
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Munchen Klinik Schwabing, Munich, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Valentin Goede
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Ghia
- Universita Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology, Thessaloniki, Greece
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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6
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Herling CD, Cymbalista F, Groß-Ophoff-Müller C, Bahlo J, Robrecht S, Langerbeins P, Fink AM, Al-Sawaf O, Busch R, Porcher R, Cazin B, Dreyfus B, Ibach S, Leprêtre S, Fischer K, Kaiser F, Eichhorst B, Wentner CM, Hoechstetter MA, Döhner H, Leblond V, Kneba M, Letestu R, Böttcher S, Stilgenbauer S, Hallek M, Levy V. Early treatment with FCR versus watch and wait in patients with stage Binet A high-risk chronic lymphocytic leukemia (CLL): a randomized phase 3 trial. Leukemia 2020; 34:2038-2050. [PMID: 32071431 PMCID: PMC7387319 DOI: 10.1038/s41375-020-0747-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 02/04/2023]
Abstract
We report a randomized prospective phase 3 study (CLL7), designed to evaluate the efficacy of fludarabine, cyclophosphamide, and rituximab (FCR) in patients with an early-stage high-risk chronic lymphocytic leukemia (CLL). Eight hundred patients with untreated-stage Binet A disease were enrolled as intent-to-treat population and assessed for four prognostic markers: lymphocyte doubling time <12 months, serum thymidine kinase >10 U/L, unmutated IGHV genes, and unfavorable cytogenetics (del(11q)/del(17p)/trisomy 12). Two hundred and one patients with ≥2 risk features were classified as high-risk CLL and 1:1 randomized to receive either immediate therapy with 6xFCR (Hi-FCR, 100 patients), or to be observed according to standard of care (Hi-W&W, 101 patients). The overall response rate after early FCR was 92.7%. Common adverse events were hematological toxicities and infections (61.0%/41.5% of patients, respectively). After median observation time of 55.6 (0-99.2) months, event-free survival was significantly prolonged in Hi-FCR compared with Hi-W&W patients (median not reached vs. 18.5 months, p < 0.001). There was no significant overall survival benefit for high-risk patients receiving early FCR therapy (5-year OS 82.9% in Hi-FCR vs. 79.9% in Hi-W&W, p = 0.864). In conclusion, although FCR is efficient to induce remissions in the Binet A high-risk CLL, our data do not provide evidence that alters the current standard of care "watch and wait" for these patients.
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Affiliation(s)
- Carmen D Herling
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany.
| | - Florence Cymbalista
- Hopital Avicenne, Assistance Publique-Hopitaux de Paris (AP-HP), Service d'Hematologie Biologique, Bobigny, France
| | - Carolin Groß-Ophoff-Müller
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Raymonde Busch
- Institute for Medical Statistics and Epidemiology, Technical University, Munich, Germany
| | - Raphael Porcher
- Center of Clinical Epidemiology, Hopital Hotel-Dieu, Paris, France
| | - Bruno Cazin
- Service de Maladies du Sang, CHU Claude Huriez, Lille Cedex, France
| | | | - Stefan Ibach
- WiSP Wissenschaftlicher Service Pharma GmbH, Langenfeld, Germany
| | - Stéphane Leprêtre
- Inserm Unit U1245 and Department of Hematology, Cancer Centre Henri Becquerel and Normandie University Rouen, Rouen, France
| | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Florian Kaiser
- Day Clinic Hematology Oncology Palliative Care, Landshut, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Clemens-Martin Wentner
- Department of Hematology Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Manuela A Hoechstetter
- Department of Hematology Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Veronique Leblond
- Department of Haematology, Hopital de la Pitie-Salpetriere, Paris, France
| | - Michael Kneba
- Second Department of Medicine, University of Schleswig-Holstein, Kiel, Germany
| | - Remi Letestu
- Hopital Avicenne, Assistance Publique-Hopitaux de Paris (AP-HP), Service d'Hematologie Biologique, Bobigny, France
| | - Sebastian Böttcher
- Second Department of Medicine, University of Schleswig-Holstein, Kiel, Germany
- Department of Hematology, Oncology and Palliative Medicine, Center for Internal Medicine, University of Rostock, Rostock, Germany
| | | | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
- Cluster of Excellence on Cellular Stress Responses in Aging-associated Diseases (CECAD), Cologne, Germany
| | - Vincent Levy
- Unite de Recherche Clinique, Hopital Avicenne, Bobigny, France
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7
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Condoluci A, Terzi di Bergamo L, Langerbeins P, Hoechstetter MA, Herling CD, De Paoli L, Delgado J, Rabe KG, Gentile M, Doubek M, Mauro FR, Chiodin G, Mattsson M, Bahlo J, Cutrona G, Kotaskova J, Deambrogi C, Smedby KE, Spina V, Bruscaggin A, Wu W, Moia R, Bianchi E, Gerber B, Zucca E, Gillessen S, Ghielmini M, Cavalli F, Stussi G, Hess MA, Baumann TS, Neri A, Ferrarini M, Rosenquist R, Forconi F, Foà R, Pospisilova S, Morabito F, Stilgenbauer S, Döhner H, Parikh SA, Wierda WG, Montserrat E, Gaidano G, Hallek M, Rossi D. International prognostic score for asymptomatic early-stage chronic lymphocytic leukemia. Blood 2020; 135:1859-1869. [PMID: 32267500 DOI: 10.1182/blood.2019003453] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/12/2020] [Indexed: 02/08/2023] Open
Abstract
Most patients with chronic lymphocytic leukemia (CLL) are diagnosed with early-stage disease and managed with active surveillance. The individual course of patients with early-stage CLL is heterogeneous, and their probability of needing treatment is hardly anticipated at diagnosis. We aimed at developing an international prognostic score to predict time to first treatment (TTFT) in patients with CLL with early, asymptomatic disease (International Prognostic Score for Early-stage CLL [IPS-E]). Individual patient data from 11 international cohorts of patients with early-stage CLL (n = 4933) were analyzed to build and validate the prognostic score. Three covariates were consistently and independently correlated with TTFT: unmutated immunoglobulin heavy variable gene (IGHV), absolute lymphocyte count higher than 15 × 109/L, and presence of palpable lymph nodes. The IPS-E was the sum of the covariates (1 point each), and separated low-risk (score 0), intermediate-risk (score 1), and high-risk (score 2-3) patients showing a distinct TTFT. The score accuracy was validated in 9 cohorts staged by the Binet system and 1 cohort staged by the Rai system. The C-index was 0.74 in the training series and 0.70 in the aggregate of validation series. By meta-analysis of the training and validation cohorts, the 5-year cumulative risk for treatment start was 8.4%, 28.4%, and 61.2% among low-risk, intermediate-risk, and high-risk patients, respectively. The IPS-E is a simple and robust prognostic model that predicts the likelihood of treatment requirement in patients with early-stage CLL. The IPS-E can be useful in clinical management and in the design of early intervention clinical trials.
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MESH Headings
- Aged
- Biomarkers, Tumor/genetics
- Clinical Trials as Topic/statistics & numerical data
- Combined Modality Therapy
- Disease Progression
- Female
- Follow-Up Studies
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Mutation
- Nomograms
- Prognosis
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Adalgisa Condoluci
- Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Petra Langerbeins
- Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Cologne, Germany
| | | | - Carmen D Herling
- Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Cologne, Germany
| | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | | | | | - Michael Doubek
- Interní Hematologická a Onkologická Klinika (IHOK), University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | | | - Giorgia Chiodin
- Cancer Sciences Division, University of Southampton, Southampton, United Kingdom
| | | | - Jasmin Bahlo
- Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Cologne, Germany
| | | | - Jana Kotaskova
- Interní Hematologická a Onkologická Klinika (IHOK), University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Clara Deambrogi
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | - Valeria Spina
- Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Alessio Bruscaggin
- Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Wei Wu
- Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
- The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Elena Bianchi
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Bernhard Gerber
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Franco Cavalli
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Georg Stussi
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Mark A Hess
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Antonino Neri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Manlio Ferrarini
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | | | - Francesco Forconi
- Cancer Sciences Division, University of Southampton, Southampton, United Kingdom
- Southampton University Hospital Trust, Southampton, United Kingdom
| | - Robin Foà
- Division of Hematology, Sapienza University, Rome, Italy
| | - Sarka Pospisilova
- Interní Hematologická a Onkologická Klinika (IHOK), University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Fortunato Morabito
- Biotechnology Research Unit Aprigliano, Cosenza, Italy
- Augusta Victoria Hospital, Jerusalem, Israel
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany; and
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany; and
| | | | | | - Emili Montserrat
- Hospital Clinic, Barcelona, Spain
- Institute of Hematology and Oncology, University of Barcelona, Barcelona, Spain
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Michael Hallek
- Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Cologne, Germany
| | - Davide Rossi
- Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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8
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Kutsch N, Bahlo J, Robrecht S, Franklin J, Zhang C, Maurer C, De Silva N, Lange E, Weide R, Kiehl MG, Sökler M, Schlag R, Vehling-Kaiser U, Köchling G, Plöger C, Gregor M, Plesner T, Herling M, Fischer K, Döhner H, Kneba M, Wendtner CM, Klapper W, Kreuzer KA, Böttcher S, Stilgenbauer S, Fink AM, Hallek M, Eichhorst B. Long Term Follow-up Data and Health-Related Quality of Life in Frontline Therapy of Fit Patients Treated With FCR Versus BR (CLL10 Trial of the GCLLSG). Hemasphere 2020; 4:e336. [PMID: 32072150 PMCID: PMC7000471 DOI: 10.1097/hs9.0000000000000336] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 08/31/2019] [Revised: 11/26/2019] [Accepted: 12/18/2019] [Indexed: 11/26/2022] Open
Abstract
Fludarabine, cyclophosphamide and rituximab (FCR) was compared to bendamustine and rituximab (BR) in an international, randomized, open label, phase 3 trial in 561 previously untreated, fit patients with chronic lymphocytic leukemia (CLL) without del (17p). Primary endpoint was progression free survival (PFS). The final primary endpoint analysis after 37.1 months median follow up failed to show the non-inferiority of BR as compared with FCR. With extended median follow up of 58.2 months, median PFS was 42.3 months in BR-treated patients versus 57.6 months for FCR-treated patients (Hazard Ratio [HR] 1.593; 95% CI 1.271-1.996; p < 0.0001). For patients > 65 years, median PFS was 48.5 months with BR versus 57.9 months with FCR without reaching statistical significance (HR 1.352; 95% CI 0.912-2.006; p = 0.134). Median OS was not reached for both arms with 5-year OS rates of 80.1% vs 80.9%, respectively (HR 1.108; 95% CI 0.755-1.627; p = 0.599). No statistically significant difference was found in the time to secondary malignancy between the 2 groups (at 5 years, 86.6% free from secondary malignancies in the BR group vs 83.8% in the FCR group [HR 0.801; 95% CI 0.507-1.267; p = 0.344]). In patients >65 years secondary neoplasia occurred more frequently after FCR treatment [28 of 86 (32.6%) patients] as compared with BR [18 of 107 (16.8%) patients; p = 0.011]. Health-related quality of life was similar in both treatments. Despite the improved PFS for FCR, OS did not differ. These results also suggest an increase in secondary neoplasia associated with FCR in elderly fit CLL patients.
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Affiliation(s)
- Nadine Kutsch
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
| | - Jeremy Franklin
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
| | - Can Zhang
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
- Department of Hematology and Oncology, Evangelisches Krankenhaus Hamm, Hamm, Germany
- Praxis fuer Haematologie und Onkologie, Koblenz, Germany
- Department of Internal Medicine, Frankfurt (Oder) General Hospital, Frankfurt/Oder, Germany
- Department II of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
- Practice for Oncology, Würzburg, Germany
- Oncology and Palliative Care, Day clinic Landshut, Landshut, Germany
- Private Oncology Practice, Villingen-Schwenningen, Germany
- Private Oncology Practice, Mannheim, Germany
- Division of Hematology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- SAKK (Swiss Group for Clinical Cancer Research), Berne, Switzerland
- Department of Hematology, Vejle Hospital, Vejle, Denmark
- CECAD and Department of Medicine I, Cologne University, Cologne, Germany
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
- Department of Medicine II, University of Schleswig-Holstein, Kiel, Germany
- Department of Hematology, Oncology, Immunology, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
- Hematopathology Section, Christian-Albrechts-University Kiel, Kiel, Germany
- Clinic III, Hematology, Oncology and Palliative Medicine, University of Rostock, Rostock, Germany
| | - Christian Maurer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
| | - Nisha De Silva
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
| | - Elisabeth Lange
- Department of Hematology and Oncology, Evangelisches Krankenhaus Hamm, Hamm, Germany
| | - Rudolf Weide
- Praxis fuer Haematologie und Onkologie, Koblenz, Germany
| | - Michael G Kiehl
- Department of Internal Medicine, Frankfurt (Oder) General Hospital, Frankfurt/Oder, Germany
| | - Martin Sökler
- Department II of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | | | | | - Georg Köchling
- Private Oncology Practice, Villingen-Schwenningen, Germany
| | | | - Michael Gregor
- Division of Hematology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- SAKK (Swiss Group for Clinical Cancer Research), Berne, Switzerland
| | - Torben Plesner
- Department of Hematology, Vejle Hospital, Vejle, Denmark
| | - Marco Herling
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
- CECAD and Department of Medicine I, Cologne University, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Michael Kneba
- Department of Medicine II, University of Schleswig-Holstein, Kiel, Germany
| | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Wolfram Klapper
- Hematopathology Section, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
| | - Sebastian Böttcher
- Department of Medicine II, University of Schleswig-Holstein, Kiel, Germany
- Clinic III, Hematology, Oncology and Palliative Medicine, University of Rostock, Rostock, Germany
| | | | - Anna Maria Fink
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
- CECAD and Department of Medicine I, Cologne University, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and German CLL Study Group, University of Cologne, Germany
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9
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Fürstenau M, Bahlo J, Fink AM, Lange E, Dreger P, Dreyling M, Hess G, Ritgen M, Kneba M, Döhner H, Stilgenbauer S, Wendtner CM, Goede V, Fischer K, Böttcher S, Hallek M, Eichhorst B. Residual abdominal lymphadenopathy after intensive frontline chemoimmunotherapy is associated with inferior outcome independently of minimal residual disease status in chronic lymphocytic leukemia. Leukemia 2019; 34:924-928. [PMID: 31611627 DOI: 10.1038/s41375-019-0597-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/30/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022]
Affiliation(s)
- M Fürstenau
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - J Bahlo
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - A M Fink
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - E Lange
- Evangelisches Krankenhaus Hamm, Hamm, Germany
| | - P Dreger
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - M Dreyling
- Department of Internal Medicine III, University Hospital of the Ludwig Maximilians University Munich, Munich, Germany
| | - G Hess
- Department of Hematology, Medical Oncology and Pneumology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - M Ritgen
- Department II of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany
| | - M Kneba
- Department II of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany
| | - H Döhner
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - S Stilgenbauer
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany.,Department of Hematology, Oncology and Rheumatology and José Carreras Center for Immuno and Gene Therapy, Saarland University Medical School, Homburg/Saar, Germany
| | - C M Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, München Klinik Schwabing, Munich, Germany
| | - V Goede
- Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital, Cologne, Germany
| | - K Fischer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - S Böttcher
- Department II of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany.,Medical Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - M Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany.,Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Disease (CECAD), University of Cologne, Cologne, Germany
| | - B Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany.
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10
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Herling CD, Coombes KR, Benner A, Bloehdorn J, Barron LL, Abrams ZB, Majewski T, Bondaruk JE, Bahlo J, Fischer K, Hallek M, Stilgenbauer S, Czerniak BA, Oakes CC, Ferrajoli A, Keating MJ, Abruzzo LV. Time-to-progression after front-line fludarabine, cyclophosphamide, and rituximab chemoimmunotherapy for chronic lymphocytic leukaemia: a retrospective, multicohort study. Lancet Oncol 2019; 20:1576-1586. [PMID: 31582354 DOI: 10.1016/s1470-2045(19)30503-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/13/2019] [Accepted: 06/21/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fludarabine, cyclophosphamide, and rituximab (FCR) has become a gold-standard chemoimmunotherapy regimen for patients with chronic lymphocytic leukaemia. However, the question remains of how to treat treatment-naive patients with IGHV-unmutated chronic lymphocytic leukaemia. We therefore aimed to develop and validate a gene expression signature to identify which of these patients are likely to achieve durable remissions with FCR chemoimmunotherapy. METHODS We did a retrospective cohort study in two cohorts of treatment-naive patients (aged ≥18 years) with chronic lymphocytic leukaemia. The discovery and training cohort consisted of peripheral blood samples collected from patients treated at the University of Texas MD Anderson Cancer Center (Houston, TX, USA), who fulfilled the diagnostic criteria of the International Workshop on Chronic Lymphocytic Leukemia, had received at least three cycles of FCR chemoimmunotherapy, and had been treated between Oct 10, 2000, and Oct 26, 2006 (ie, the MDACC cohort). We did transcriptional profiling on samples obtained from the MDACC cohort to identify genes associated with time to progression. We did univariate Cox proportional hazards analyses and used significant genes to cluster IGHV-unmutated samples into two groups (intermediate prognosis and unfavourable prognosis). After using cross-validation to assess robustness, we applied the Lasso method to standardise the gene expression values to find a minimum gene signature. We validated this signature in an external cohort of treatment-naive patients with IGHV-unmutated chronic lymphocytic leukaemia enrolled on the CLL8 trial of the German Chronic Lymphocytic Leukaemia Study Group who were treated between July 21, 2003, and April 4, 2006 (ie, the CLL8 cohort). FINDINGS The MDACC cohort consisted of 101 patients and the CLL8 cohort consisted of 109 patients. Using the MDACC cohort, we identified and developed a 17-gene expression signature that distinguished IGHV-unmutated patients who were likely to achieve a long-term remission following front-line FCR chemoimmunotherapy from those who might benefit from alternative front-line regimens (hazard ratio 3·83, 95% CI 1·94-7·59; p<0·0001). We validated this gene signature in the CLL8 cohort; patients with an unfavourable prognosis versus those with an intermediate prognosis had a cause-specific hazard ratio of 1·90 (95% CI 1·18-3·06; p=0·008). Median time to progression was 39 months (IQR 22-69) for those with an unfavourable prognosis compared with 59 months (28-84) for those with an intermediate prognosis. INTERPRETATION We have developed a robust, reproducible 17-gene signature that identifies a subset of treatment-naive patients with IGHV-unmutated chronic lymphocytic leukaemia who might substantially benefit from treatment with FCR chemoimmunotherapy. We recommend testing the value of this gene signature in a prospective study that compares FCR treatment with newer alternative therapies as part of a randomised clinical trial. FUNDING Chronic Lymphocytic Leukaemia Global Research Foundation and the National Institutes of Health/National Cancer Institute.
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Affiliation(s)
- Carmen D Herling
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Kevin R Coombes
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | | | - Lynn L Barron
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zachary B Abrams
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Tadeusz Majewski
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jolanta E Bondaruk
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jasmin Bahlo
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | | | - Bogdan A Czerniak
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher C Oakes
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael J Keating
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lynne V Abruzzo
- Department of Pathology, The Ohio State University, Columbus, OH, USA.
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11
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Al‐Sawaf O, Bazeos A, Robrecht S, Bahlo J, Gower C, Fink A, Tresckow J, Cramer P, Langerbeins P, Kutsch N, Humphrey K, Fingerle‐Rowson G, Stilgenbauer S, Wendtner C, Fischer K, Eichhorst B, Hallek M, Goede V. Mode of progression after first line treatment correlates with outcome of chronic lymphocytic leukemia (CLL). Am J Hematol 2019; 94:1002-1006. [PMID: 31222797 DOI: 10.1002/ajh.25561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 01/24/2023]
Abstract
In CLL, progressive disease (PD) following remission after first line treatment can present with varying phenotypes. We hypothesized that the mode of PD correlates with clinical outcomes. Data from three phase III trials of the German CLL Study Group (GCLLSG) (CLL8, CLL10, CLL11) including a total of 2159 patients receiving first line (immuno)-chemotherapy (FCR, FC, CLB, CLB-R, CLB-Ob) were analyzed. Patients were categorized as "ALC" if PD was due to increasing absolute lymphocyte count, or as "Ly" if due to lymphadenopathy. A group of 241 patients progressed with ALC, and 727 progressed with Ly, including 329 who progressed on both modalities. In fit patients, median TTNT after PD in the Ly group was 12.3 months vs 17.0 months in the ALC group (HR 1.299 [1.036-1.628]; P = .024). Median OS after PD was 45.1 months in the Ly group and 42.4 months in the ALC group (HR=1.023 [0.753-1.389]; P = .885). For unfit patients, median TTNT in the Ly group was 11.7 months vs 21.4 months in the ALC group (HR 1.357 [1.051-1.753]; P = .019). Median OS was 42.8 months in the Ly group and not reached in the ALC group (HR 1.851 [1.280-2.677]; P = .001). Patients in the Ly group more frequently showed impairment of quality of life (QoL). This analysis demonstrates that patients with progressive lymphadenopathy have a significantly shorter TTNT, OS and less favorable QoL. Our findings might help physicians to better estimate the clinical course of a progressing CLL patient.
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Affiliation(s)
- Othman Al‐Sawaf
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | | | - Sandra Robrecht
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Jasmin Bahlo
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | | | - Anna‐Maria Fink
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Julia Tresckow
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Paula Cramer
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Petra Langerbeins
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Nadine Kutsch
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | | | | | | | - Clemens‐Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, German CLL Study GroupHospital Munich‐Schwabing Munich Germany
| | - Kirsten Fischer
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Barbara Eichhorst
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Michael Hallek
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
| | - Valentin Goede
- University of Cologne, Department I of Internal MedicineCenter for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German CLL Study Group Cologne Germany
- Oncogeriatric Unit, Department of Geriatric MedicineSt. Marien Hospital Cologne Germany
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12
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Edelmann J, Holzmann K, Tausch E, Saunderson EA, Jebaraj BMC, Steinbrecher D, Dolnik A, Blätte TJ, Landau DA, Saub J, Estenfelder S, Ibach S, Cymbalista F, Leblond V, Delmer A, Bahlo J, Robrecht S, Fischer K, Goede V, Bullinger L, Wu CJ, Mertens D, Ficz G, Gribben JG, Hallek M, Döhner H, Stilgenbauer S. Genomic alterations in high-risk chronic lymphocytic leukemia frequently affect cell cycle key regulators and NOTCH1-regulated transcription. Haematologica 2019; 105:1379-1390. [PMID: 31467127 PMCID: PMC7193490 DOI: 10.3324/haematol.2019.217307] [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: 02/05/2019] [Accepted: 08/23/2019] [Indexed: 12/14/2022] Open
Abstract
To identify genomic alterations contributing to the pathogenesis of high-risk chronic lymphocytic leukemia (CLL) beyond the well-established role of TP53 aberrations, we comprehensively analyzed 75 relapsed/refractory and 71 treatment-naïve high-risk cases from prospective clinical trials by single nucleotide polymorphism arrays and targeted next-generation sequencing. Increased genomic complexity was a hallmark of relapsed/refractory and treatment-naïve high-risk CLL. In relapsed/refractory cases previously exposed to the selective pressure of chemo(immuno)therapy, gain(8)(q24.21) and del(9)(p21.3) were particularly enriched. Both alterations affect key regulators of cell-cycle progression, namely MYC and CDKN2A/B. While homozygous CDKN2A/B loss has been directly associated with Richter transformation, we did not find this association for heterozygous loss of CDKN2A/B. Gains in 8q24.21 were either focal gains in a MYC enhancer region or large gains affecting the MYC locus, but only the latter type was highly enriched in relapsed/refractory CLL (17%). In addition to a high frequency of NOTCH1 mutations (23%), we found recurrent genetic alterations in SPEN (4% mutated), RBPJ (8% deleted) and SNW1 (8% deleted), all affecting a protein complex that represses transcription of NOTCH1 target genes. We investigated the functional impact of these alterations on HES1, DTX1 and MYC gene transcription and found derepression of these NOTCH1 target genes particularly with SPEN mutations. In summary, we provide new insights into the genomic architecture of high-risk CLL, define novel recurrent DNA copy number alterations and refine knowledge on del(9p), gain(8q) and alterations affecting NOTCH1 signaling. This study was registered at ClinicalTrials.gov with number NCT01392079.
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Affiliation(s)
- Jennifer Edelmann
- Department of Internal Medicine III, Ulm University, Ulm, Germany .,Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Eugen Tausch
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Emily A Saunderson
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | | | - Anna Dolnik
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Tamara J Blätte
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Dan A Landau
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA.,New York Genome Center, New York, NY, USA
| | - Jenny Saub
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Sven Estenfelder
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Stefan Ibach
- Wissenschaftlicher Service Pharma GmbH (WiSP), Langenfeld, Germany
| | | | | | - Alain Delmer
- Service d'Hématologie Clinique, CHU de Reims, Reims, France
| | - Jasmin Bahlo
- Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - Valentin Goede
- Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - Lars Bullinger
- Department of Internal Medicine III, Ulm University, Ulm, Germany.,Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Catherine J Wu
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Daniel Mertens
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Gabriella Ficz
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - John G Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Michael Hallek
- Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, Ulm University, Ulm, Germany
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13
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Kurtz DM, Esfahani MS, Scherer F, Soo J, Jin MC, Liu CL, Newman AM, Dührsen U, Hüttmann A, Casasnovas O, Westin JR, Ritgen M, Böttcher S, Langerak AW, Roschewski M, Wilson WH, Gaidano G, Rossi D, Bahlo J, Hallek M, Tibshirani R, Diehn M, Alizadeh AA. Dynamic Risk Profiling Using Serial Tumor Biomarkers for Personalized Outcome Prediction. Cell 2019; 178:699-713.e19. [PMID: 31280963 DOI: 10.1016/j.cell.2019.06.011] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/19/2019] [Accepted: 06/04/2019] [Indexed: 12/18/2022]
Abstract
Accurate prediction of long-term outcomes remains a challenge in the care of cancer patients. Due to the difficulty of serial tumor sampling, previous prediction tools have focused on pretreatment factors. However, emerging non-invasive diagnostics have increased opportunities for serial tumor assessments. We describe the Continuous Individualized Risk Index (CIRI), a method to dynamically determine outcome probabilities for individual patients utilizing risk predictors acquired over time. Similar to "win probability" models in other fields, CIRI provides a real-time probability by integrating risk assessments throughout a patient's course. Applying CIRI to patients with diffuse large B cell lymphoma, we demonstrate improved outcome prediction compared to conventional risk models. We demonstrate CIRI's broader utility in analogous models of chronic lymphocytic leukemia and breast adenocarcinoma and perform a proof-of-concept analysis demonstrating how CIRI could be used to develop predictive biomarkers for therapy selection. We envision that dynamic risk assessment will facilitate personalized medicine and enable innovative therapeutic paradigms.
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Affiliation(s)
- David M Kurtz
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA; Division of Hematology, Department of Medicine, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Mohammad S Esfahani
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Florian Scherer
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Joanne Soo
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Michael C Jin
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Chih Long Liu
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Aaron M Newman
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA
| | - Ulrich Dührsen
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - Andreas Hüttmann
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - Olivier Casasnovas
- Department of Hematology, Hopital F. Mitterrand, CHU Dijon and INSERM 1231, Dijon, France
| | - Jason R Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthais Ritgen
- Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Sebastian Böttcher
- Department III of Internal Medicine, University Hospital Rostock, Rostock, Germany
| | - Anton W Langerak
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Davide Rossi
- Hematology, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Jasmin Bahlo
- German CLL Study Group, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- German CLL Study Group, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany; Cologne Cluster of Excellence on Cellular Stress Responses in Aging-Related Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Robert Tibshirani
- Department Statistics, Stanford University, Stanford, CA, USA; Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Maximilian Diehn
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA; Stanford Cancer Institute, Stanford University, Stanford, CA, USA; Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
| | - Ash A Alizadeh
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA, USA; Division of Hematology, Department of Medicine, Stanford University, Stanford, CA, USA; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA; Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
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14
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Tausch E, Bahlo J, Robrecht S, Schneider C, Bloehdorn J, Schrell S, Galler C, Al-Sawaf O, Fink A, Eichhorst B, Kreuzer K, Tandon M, Humphrey K, Jiang Y, Schary W, Porro Lurà M, Döhner H, Fischer K, Hallek M, Stilgenbauer S. GENETIC MARKERS AND OUTCOME IN THE CLL14 TRIAL OF THE GCLLSG COMPARING FRONT LINE OBINUTUZUMAB PLUS CHLORABMUCIL OR VENETOCLAX IN PATIENTS WITH COMORBIDITY Best abstract submitted by a young investigator / travel grant recipient. Hematol Oncol 2019. [DOI: 10.1002/hon.53_2629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- E. Tausch
- Department of Internal Medicine 3; Ulm University; Ulm Germany
| | - J. Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - S. Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - C. Schneider
- Department of Internal Medicine 3; Ulm University; Ulm Germany
| | - J. Bloehdorn
- Department of Internal Medicine 3; Ulm University; Ulm Germany
| | - S. Schrell
- Department of Internal Medicine 3; Ulm University; Ulm Germany
| | - C. Galler
- Department of Internal Medicine 3; Ulm University; Ulm Germany
| | - O. Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - A. Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - B. Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - K. Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - M. Tandon
- Clinical Development Oncology; Roche; Welwyn Garden City United Kingdom
| | - K. Humphrey
- Clinical Development Oncology; Roche; Welwyn Garden City United Kingdom
| | - Y. Jiang
- Oncology Biomarker Development; Genentech; South San Francisco United States
| | - W. Schary
- Oncology; Abbvie Inc; North Chicago United States
| | - M. Porro Lurà
- Pharmaceuticals Division; F. Hoffmann - La Roche Ltd; Basel Switzerland
| | - H. Döhner
- Department of Internal Medicine 3; Ulm University; Ulm Germany
| | - K. Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - M. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital Cologne; Cologne Germany
| | - S. Stilgenbauer
- Department of Internal Medicine 3; Ulm University; Ulm Germany
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15
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Langerbeins P, Bahlo J, Rhein C, Gerwin H, Cramer P, Fürstenau M, Al-Sawaf O, von Tresckow J, Fink A, Kreuzer K, Vehling-Kaiser U, Tausch E, Müller L, Eckart M, Schlag R, Freier W, Gaska T, Balser C, Reiser M, Stauch M, Wendtner C, Fischer K, Stilgenbauer S, Eichhorst B, Hallek M. IBRUTINIB VERSUS PLACEBO IN PATIENTS WITH ASYMPTOMATIC, TREATMENT-NAÏVE EARLY STAGE CLL: PRIMARY ENDPOINT RESULTS OF THE PHASE 3 DOUBLE-BLIND RANDOMIZED CLL12 TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.7_2629] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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)
- P. Langerbeins
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - J. Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - C. Rhein
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - H. Gerwin
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - P. Cramer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - M. Fürstenau
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - O. Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - J. von Tresckow
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - A.M. Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - K. Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | | | - E. Tausch
- Internal Medicine III; University Hospital; Ulm Germany
| | - L. Müller
- Hämatologie und Onkologie; Studienzentrum UnterEms; Leer Germany
| | - M. Eckart
- Hämatologie und Onkologie; Onkologische Schwerpunktpraxis; Erlangen Germany
| | - R. Schlag
- Hämatologie und Onkologie; Gemeinschaftspraxis; Würzburg Germany
| | - W. Freier
- Hämatologie und Onkologie; Medicinum; Hildesheim Germany
| | - T. Gaska
- Klinik für Hämatologie und Onkologie; Brüderkrankenhaus St. Josef; Paderborn Germany
| | - C. Balser
- Hämatologie und Onkologie; Internistische Praxis; Marburg Germany
| | - M. Reiser
- PIOH; Praxis Internistischer Onkologie und Hämatologie; Köln Germany
| | - M. Stauch
- Hämatologie; Onkologie, Gerinnung; Ambulantes Zentrum Kronach Germany
| | - C. Wendtner
- Department I of Internal Medicine, Munich Clinic Schwabing; Academic Teaching Hospital of University of Munich; Munich Germany
| | - K. Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - S. Stilgenbauer
- Internal Medicine I; University of Saarland; Homburg Germany
| | - B. Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
| | - M. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn; University Hospital; Cologne Germany
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16
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Condoluci A, Terzi di Bergamo L, Langerbeins P, Hoechstetter M, Herling C, De Paoli L, Delgado J, Gentile M, Doubek M, Mauro F, Chiodin G, Mattsson M, Bahlo J, Cutrona G, Kotaskova J, Deambrogi C, Moia R, Gerber B, Zucca E, Ghielmini M, Cavalli F, Stüssi G, Neri A, Ferrarini M, Rosenquist R, Forconi F, Foà R, Pospisilova S, Morabito F, Wierda W, Montserrat E, Gaidano G, Hallek M, Rossi D. INTERNATIONAL PROGNOSTIC SCORE FOR EARLY STAGE CHRONIC LYMPHOCYTIC LEUKEMIA (IPS-A). Hematol Oncol 2019. [DOI: 10.1002/hon.51_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- A. Condoluci
- Experimental Hematology; Institute of Oncology Research; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - L. Terzi di Bergamo
- Experimental Hematology; Institute of Oncology Research; Bellinzona Switzerland
| | - P. Langerbeins
- University of Cologne; Center of Integrated Oncology Cologne-Bonn, German CLL Study Group; Köln Germany
| | - M. Hoechstetter
- University of Cologne; Center of Integrated Oncology Cologne-Bonn, German CLL Study Group; Köln Germany
| | - C. Herling
- University of Cologne; Center of Integrated Oncology Cologne-Bonn, German CLL Study Group; Köln Germany
| | - L. De Paoli
- Translational Medicine; University of Eastern Piedmont; Novara Italy
| | - J. Delgado
- Hematology; Hospital Clínic de Barcelona; Barcelona Spain
| | - M. Gentile
- Hematology; Azienda Ospedaliera (AO) of Cosenza; Cosenza Italy
| | - M. Doubek
- Hematology and Oncology; University Hospital of Brno; Brno Czech Republic
| | - F.R. Mauro
- Hematology; Sapienza University; Rome Italy
| | - G. Chiodin
- Hematology; Southampton University; Southampton United Kingdom
| | - M. Mattsson
- Immunology; Genetics and Pathology, Uppsala University; Uppsala Sweden
| | - J. Bahlo
- University of Cologne; Center of Integrated Oncology Cologne-Bonn, German CLL Study Group; Köln Germany
| | - G. Cutrona
- Hematology; IRCCS Ospedale Policlinico San Martino; Genoa Italy
| | - J. Kotaskova
- Hematology and Oncology; University Hospital of Brno; Brno Czech Republic
| | - C. Deambrogi
- Translational Medicine; University of Eastern Piedmont; Novara Italy
| | - R. Moia
- Translational Medicine; University of Eastern Piedmont; Novara Italy
| | - B. Gerber
- Onco-hematology; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - E. Zucca
- Onco-hematology; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - M. Ghielmini
- Onco-hematology; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - F. Cavalli
- Onco-hematology; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - G. Stüssi
- Onco-hematology; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - A. Neri
- Hematology; University of Milan; Milan Italy
| | | | - R. Rosenquist
- Immunology; Genetics and Pathology, Uppsala University; Uppsala Sweden
| | - F. Forconi
- Hematology; Southampton University; Southampton United Kingdom
| | - R. Foà
- Hematology; Sapienza University; Rome Italy
| | - S. Pospisilova
- Hematology and Oncology; University Hospital of Brno; Brno Czech Republic
| | - F. Morabito
- Hematology; Augusta Victoria Hospital; Jerusalem Israel
| | - W.G. Wierda
- MD Anderson Cancer Center; University of Texas; Houston United States
| | - E. Montserrat
- Hematology; Hospital Clínic de Barcelona; Barcelona Spain
| | - G. Gaidano
- Translational Medicine; University of Eastern Piedmont; Novara Italy
| | - M. Hallek
- University of Cologne; Center of Integrated Oncology Cologne-Bonn, German CLL Study Group; Köln Germany
| | - D. Rossi
- Experimental Hematology; Institute of Oncology Research; Oncology Institute of Southern Switzerland; Bellinzona Switzerland
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Fischer K, Al-Sawaf O, Bahlo J, Fink AM, Tandon M, Dixon M, Robrecht S, Warburton S, Humphrey K, Samoylova O, Liberati AM, Pinilla-Ibarz J, Opat S, Sivcheva L, Le Dû K, Fogliatto LM, Niemann CU, Weinkove R, Robinson S, Kipps TJ, Boettcher S, Tausch E, Humerickhouse R, Eichhorst B, Wendtner CM, Langerak AW, Kreuzer KA, Ritgen M, Goede V, Stilgenbauer S, Mobasher M, Hallek M. Venetoclax and Obinutuzumab in Patients with CLL and Coexisting Conditions. N Engl J Med 2019; 380:2225-2236. [PMID: 31166681 DOI: 10.1056/nejmoa1815281] [Citation(s) in RCA: 512] [Impact Index Per Article: 102.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The BCL2 inhibitor venetoclax has shown activity in patients with chronic lymphocytic leukemia (CLL), but its efficacy in combination with other agents in patients with CLL and coexisting conditions is not known. METHODS In this open-label, phase 3 trial, we investigated fixed-duration treatment with venetoclax and obinutuzumab in patients with previously untreated CLL and coexisting conditions. Patients with a score of greater than 6 on the Cumulative Illness Rating Scale (scores range from 0 to 56, with higher scores indicating more impaired function of organ systems) or a calculated creatinine clearance of less than 70 ml per minute were randomly assigned to receive venetoclax-obinutuzumab or chlorambucil-obinutuzumab. The primary end point was investigator-assessed progression-free survival. The safety of each regimen was also evaluated. RESULTS In total, 432 patients (median age, 72 years; median Cumulative Illness Rating Scale score, 8; median creatinine clearance, 66.4 ml per minute) underwent randomization, with 216 assigned to each group. After a median follow-up of 28.1 months, 30 primary end-point events (disease progression or death) had occurred in the venetoclax-obinutuzumab group and 77 had occurred in the chlorambucil-obinutuzumab group (hazard ratio, 0.35; 95% confidence interval [CI], 0.23 to 0.53; P<0.001). The Kaplan-Meier estimate of the percentage of patients with progression-free survival at 24 months was significantly higher in the venetoclax-obinutuzumab group than in the chlorambucil-obinutuzumab group: 88.2% (95% CI, 83.7 to 92.6) as compared with 64.1% (95% CI, 57.4 to 70.8). This benefit was also observed in patients with TP53 deletion, mutation, or both and in patients with unmutated immunoglobulin heavy-chain genes. Grade 3 or 4 neutropenia occurred in 52.8% of patients in the venetoclax-obinutuzumab group and in 48.1% of patients in the chlorambucil-obinutuzumab group, and grade 3 or 4 infections occurred in 17.5% and 15.0%, respectively. All-cause mortality was 9.3% in the venetoclax-obinutuzumab group and 7.9% in the chlorambucil-obinutuzumab group. These differences were not significant. CONCLUSIONS Among patients with untreated CLL and coexisting conditions, venetoclax-obinutuzumab was associated with longer progression-free survival than chlorambucil-obinutuzumab. (Funded by F. Hoffmann-La Roche and AbbVie; ClinicalTrials.gov number, NCT02242942.).
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MESH Headings
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/administration & dosage
- Bridged Bicyclo Compounds, Heterocyclic/adverse effects
- Chlorambucil/administration & dosage
- Chlorambucil/adverse effects
- Comorbidity
- Female
- Humans
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Progression-Free Survival
- Sulfonamides/administration & dosage
- Sulfonamides/adverse effects
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Affiliation(s)
- Kirsten Fischer
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Othman Al-Sawaf
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Jasmin Bahlo
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Anna-Maria Fink
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Maneesh Tandon
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Mark Dixon
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Sandra Robrecht
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Simon Warburton
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Kathryn Humphrey
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Olga Samoylova
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Anna M Liberati
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Javier Pinilla-Ibarz
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Stephen Opat
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Liliya Sivcheva
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Katell Le Dû
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Laura M Fogliatto
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Carsten U Niemann
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Robert Weinkove
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Sue Robinson
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Thomas J Kipps
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Sebastian Boettcher
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Eugen Tausch
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Rod Humerickhouse
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Barbara Eichhorst
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Clemens-Martin Wendtner
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Anton W Langerak
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Karl-Anton Kreuzer
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Matthias Ritgen
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Valentin Goede
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Stephan Stilgenbauer
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Mehrdad Mobasher
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
| | - Michael Hallek
- From Department I of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital Cologne and University of Cologne (K.F., O.A.-S., J.B., A.-M.F., S. Robrecht, B.E., K.-A.K., M.H.), the Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital (V.G.), CECAD (Center of Excellence on Cellular Stress Responses in Aging-Associated Diseases) (M.H.), Center for Molecular Medicine Cologne (M.H.), Cologne, Department III of Internal Medicine, University Hospital Rostock, Rostock (S.B.), Department III of Internal Medicine, Ulm University, Ulm (E.T., S.S.), the Departments of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases, and Tropical Medicine, Klinikum Schwabing, Munich (C.-M.W.), Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel (M.R.), and the Department of Hematology, Oncology, and Rheumatology, Saarland University Medical School, Homburg (S.S.) - all in Germany; Roche Products, Welwyn Garden City, United Kingdom (M.T., M.D., S.W., K.H.); Regional Clinical Hospital N.A. Semashko, Nizhny Novgorod, Russia (O.S.); the Division of Onco-Hematology, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy (A.M.L.); the Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (J.P.-I.); the Haematology Department, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (S.O.); First Internal Department, Multiprofile Hospital for Active Treatment Hristo Botev, Vratsa, Bulgaria (L.S.); the Hematology Department, Clinique Victor Hugo, Le Mans, France (K.L.D.); Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (L.M.F.); the Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen (C.U.N.); Wellington Blood and Cancer Centre, Capital and Coast District Health Board, and Malaghan Institute of Medical Research, Wellington, New Zealand (R.W.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S. Robinson); Moores Cancer Center, University of California San Diego, San Diego (T.J.K.), and Genentech, South San Francisco (M.M.) - both in California; AbbVie, North Chicago, IL (R.H.); and the Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, the Netherlands (A.W.L.)
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18
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Tausch E, Bahlo J, Robrecht S, Schneider C, Bloehdorn J, Schrell S, Galler C, Al-Sawaf O, Fink AM, Eichhorst B, Kreuzer KA, Tandon M, Humphrey K, Jiang Y, Schary W, Porro Lurà M, Döhner H, Fischer K, Hallek M, Stilgenbauer S. S105 GENETIC MARKERS AND OUTCOME IN THE CLL14 TRIAL OF THE GCLLSG COMPARING FRONT LINE OBINUTUZUMAB PLUS CHLORAMBUCIL OR VENETOCLAX IN PATIENTS WITH COMORBIDITY. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000558640.93333.00] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Fischer K, Porro Lurà M, Al-Sawaf O, Bahlo J, Fink A, Tandon M, Dixon M, Robrecht S, Warburton S, Humphrey K, Samoylova O, Liberati A, Pinilla-Ibarz J, Opat S, Sivcheva L, Le Dû K, Fogliatto L, Utoft Niemann C, Weinkove R, Robinson S, Kipps T, Boettcher S, Tausch E, Schary W, Eichhorst B, Wendtner C, Langerak A, Kreuzer K, Goede V, Stilgenbauer S, Mobasher M, Ritgen M, Hallek M. FIXED-DURATION VENETOCLAX PLUS OBINUTUZUMAB IMPROVES PFS AND MINIMAL RESIDUAL DISEASE NEGATIVITY IN PATIENTS WITH PREVIOUSLY UNTREATED CLL AND COMORBIDITIES. Hematol Oncol 2019. [DOI: 10.1002/hon.52_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)
- K. Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - M. Porro Lurà
- Pharmaceuticals Division; PDGo, F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - O. Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - J. Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - A. Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - M. Tandon
- Clinical Development Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - M. Dixon
- Biostatistics; Roche Products Limited; Welwyn Garden City United Kingdom
| | - S. Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - S. Warburton
- Product Development - Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - K. Humphrey
- Clinical Development Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - O. Samoylova
- Hematology Department; Regional Clinical Hospital N.A. Semashko; Nizhny Novgorod Russian Federation
| | - A.M. Liberati
- Division of Onco-Hematology; Santa Maria Terni Hospital, University of Perugia; Perugia Italy
| | - J. Pinilla-Ibarz
- Department of Malignant Hematology; H. Lee Moffitt Cancer Center & Research Institute; Tampa FL United States
| | - S. Opat
- Haematology Department; School of Clinical Sciences at Monash Health; Monash University Victoria Australia
| | - L. Sivcheva
- First Internal Department; MHAT Hristo Botev; AD, Vratsa Bulgaria
| | - K. Le Dû
- Hematology Department; Clinique Victor Hugo; Le Mans France
| | - L.M. Fogliatto
- Department of Hematology; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
| | - C. Utoft Niemann
- Department of Hematology; Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - R. Weinkove
- Wellington Blood & Cancer Centre; Capital & Coast District Health Board, Wellington, New Zealand and Cancer Immunotherapy Programme, Malaghan Institute of Medical Research; Wellington New Zealand
| | - S. Robinson
- Department of Medicine; Division of Hematology, QEII Health Sciences Center; Halifax NS Canada
| | - T.J. Kipps
- Moores Cancer Center; UC San Diego Health; San Diego CA United States
| | - S. Boettcher
- Department III of Internal Medicine; University Hospital Rostock; Rostock Germany
| | - E. Tausch
- Department III of Internal Medicine; Ulm University; Ulm Germany
| | - W.L. Schary
- Clinical Development Oncology; AbbVie Inc.; North Chicago IL United States
| | - B. Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - C. Wendtner
- Department of Hematology; Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine; Klinikum Schwabing Munich Germany
| | - A.W. Langerak
- Department of Immunology; Laboratory Medical Immunology, Erasmus MC; Rotterdam Netherlands
| | - K. Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - V. Goede
- Oncogeriatric Unit; Dept. of Geriatric Medicine, St. Marien Hospital; Cologne Germany
| | - S. Stilgenbauer
- Department III of Internal Medicine, Ulm University, Ulm, Germany and Department for Hematology, Oncology and Rheumatology; Saarland University Medical School; Homburg/Saar Germany
| | - M. Mobasher
- Product Development Oncology; Genentech, Inc.; South San Francisco CA United States
| | - M. Ritgen
- Department II of Internal Medicine; Campus Kiel, University of Schleswig-Holstein; Kiel Germany
| | - M. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, CECAD (Cluster of Excellence on Cellular Stress Responses in Aging-Associated Diseases); University of Cologne; Cologne Germany
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Al-Sawaf O, Lilienweiss E, Bahlo J, Robrecht S, Fink A, Patz M, Tandon M, Humphrey K, Jiang Y, Schary W, Porro Lurà M, Ritgen M, Tausch E, Stilgenbauer S, Eichhorst B, Fischer K, Hallek M, Kreuzer K. HIGH EFFICACY OF VENETOCLAX PLUS OBINUTUZUMAB IN PATIENTS WITH COMPLEX KARYOTYPE (CKT) AND CHRONIC LYMPHOCYTIC LEUKEMIA (CLL): A PROSPECTIVE ANALYSIS FROM THE CLL14 TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.68_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- O. Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - E. Lilienweiss
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - J. Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - S. Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - A. Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - M. Patz
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - M. Tandon
- Clinical Development Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - K. Humphrey
- Clinical Development Oncology; Roche Products Limited; Welwyn Garden City United Kingdom
| | - Y. Jiang
- Oncology Biomarker Development; Genentech Inc.; South San Francisco CA United States
| | - W. Schary
- Clinical Development; Oncology, AbbVie Inc.; North Chicago IL United States
| | - M. Porro Lurà
- Pharmaceuticals Division, PDGo; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - M. Ritgen
- Department II of Internal Medicine, Campus Kiel; University of Schleswig-Holstein; Kiel Germany
| | - E. Tausch
- Department III of Internal Medicine; Ulm University; Ulm Germany
| | - S. Stilgenbauer
- Department III of Internal Medicine, Ulm University, Ulm, Germany, and Department for Hematology, Oncology and Rheumatology; Saarland University Medical School; Homburg/Saar Germany
| | - B. Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - K. Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
| | - M. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, CECAD (Cluster of Excellence on Cellular Stress Responses in Aging-Associated Diseases); University of Cologne; Cologne Germany
| | - K. Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn; University Hospital; Cologne Germany
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Fischer K, Al-Sawaf O, Bahlo J, Fink AM, Tandon M, Dixon M, Robrecht S, Humphrey K, Böttcher S, Tausch E, Humerickhouse R, Eichhorst B, Wendtner CM, Langerak AW, Kreuzer KA, Goede V, Stilgenbauer S, Mobasher M, Ritgen M, Hallek MJ. Effect of fixed-duration venetoclax plus obinutuzumab (VenG) on progression-free survival (PFS), and rates and duration of minimal residual disease negativity (MRD–) in previously untreated patients (pts) with chronic lymphocytic leukemia (CLL) and comorbidities. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7502 Background: The multinational, open-label, phase 3 CLL14 trial compared fixed-duration targeted VenG treatment with chlorambucil-obinutuzumab (ClbG) in previously untreated pts with CLL and comorbidities. Here we present endpoint analyses with particular emphasis on MRD− and PFS. Methods: Pts with a CIRS score >6 and/or an estimated creatinine clearance <70 mL/min were randomized 1:1 to receive equal duration treatment with 12 cycles (C) of standard Clb or Ven 400 mg daily in combination with G for first 6 C. Primary endpoint was PFS. MRD− in peripheral blood (PB) or bone marrow (BM) 3 months (mo) after treatment completion was a key secondary endpoint. MRD was analyzed serially from C4 every 3 mo by an allele-specific oligonucleotide polymerase chain reaction assay (ASO-PCR; cut-off, 10-4) and by next generation sequencing (NGS; cut-offs, 10-4, 10-5,10-6). Results: 432 pts were enrolled; 216 in each treatment group (intent-to-treat population). After 29 mo median follow-up, superior PFS was observed with VenG vs ClbG (HR 0.35; 95% CI 0.23–0.53; P<0.0001). MRD− by ASO-PCR was significantly higher with VenG vs ClbG in both PB (76% vs 35% [P<0.0001]) and BM (57% vs 17% [P<0.0001]) 3 mo after treatment completion. Overall, 75% of VenG MRD-negative pts in PB were also MRD-negative in BM vs 49% in the ClbG group. Landmark analysis for this timepoint by PB MRD status showed that MRD− was associated with longer PFS. Higher MRD− rates were achieved early and were more sustainable with VenG: 81% (VenG) vs 27% (ClbG) of pts were MRD-negative 12 mo after treatment completion; HR for MRD conversion 0.19; 95% CI 0.12–0.30 (median time off-treatment: 19 mo). MRD− rates by NGS confirmed these results; 78% (VenG) vs 34% (ClbG) of pts had MRD− at <10-4, 31% vs 4% at <10-6 and 35% vs 15% at ≥10-6–<10-5, respectively. Conclusions: Fixed-duration VenG induced deep (<10-6 in 1/3 of pts), high, and long lasting MRD− rates (with a low rate of conversion to MRD+ status 1 year after treatment) in previously untreated pts with CLL and comorbidities, translating into improved PFS. Clinical trial information: NCT02242942.
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Affiliation(s)
- Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, Germany
| | - Maneesh Tandon
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | - Mark Dixon
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | - Sandra Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, Germany
| | | | - Sebastian Böttcher
- Department III of Internal Medicine, University Hospital Rostock, Rostock, Germany
| | - Eugen Tausch
- Department III of Internal Medicine, Ulm University, Ulm, Germany
| | | | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, Germany
| | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Anton W. Langerak
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, Netherlands
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, Germany
| | - Valentin Goede
- Oncogeriatric Unit, Dept. of Geriatric Medicine, St. Marien Hospital, Cologne, Germany
| | - Stephan Stilgenbauer
- Department III of Internal Medicine, Ulm University, Ulm and Department for Hematology, Oncology and Rheumatology, Saarland University Medical School, Homburg/Saar, Germany
| | | | - Matthias Ritgen
- Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Michael J. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital, Cologne, CECAD (Cluster of Excellence on Cellular Stress Responses in Aging-Associated Diseases), University of Cologne, Cologne, Germany
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Sachanas S, Pangalis GA, Fink AM, Bahlo J, Fischer K, Levidou G, Kyrtsonis MC, Bartzi V, Vassilakopoulos TP, Kalpadakis C, Koulieris E, Moschogiannis M, Yiakoumis X, Tsirkinidis P, Angelopoulou MK, Eichhorst B, Hallek M. Small Lymphocytic Lymphoma: Analysis of Two Cohorts Including Patients in Clinical Trials of the German Chronic Lymphocytic Leukemia Study Group (GCLLSG) or in "Real-Life" Outside of Clinical Trials. Anticancer Res 2019; 39:2591-2598. [PMID: 31092457 DOI: 10.21873/anticanres.13382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/16/2019] [Accepted: 04/19/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Only few studies have focused exclusively on patients with small lymphocytic lymphoma (SLL). PATIENTS AND METHODS In the present report, 103 SLL patients were analyzed from both, clinical trials of the German Chronic Lymphocytic Leukemia Study Group and Greek centers, and emphasis was placed on the therapeutic strategy. The impact of lymph node characteristics, such as the presence of proliferation centers (PCs) on response and survival was also assessed. RESULTS SLL patients included in clinical trials were treated mostly with fludarabine-based regimens while those in "real-life" were staged and treated mostly as patients with low-grade lymphomas. Our analysis showed a trend for better survival for patients with SLL without detectable PCs. CONCLUSION Patients with SLL outside of clinical trials are usually treated as cases of lymphoma. In addition, this analysis supports published data regarding the adverse prognostic value of the presence of PCs in lymphoid nodes in SLL.
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Affiliation(s)
- Sotirios Sachanas
- Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece
| | | | - Anna-Maria Fink
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Georgia Levidou
- Pathology Department, University of Athens, Athens, Greece.,Pathology Department, Humanpathologie GmbH, Erlangen, Germany
| | | | - Vassiliki Bartzi
- Department of Haematology, General Hospital of Karditsa, Karditsa, Greece
| | | | - Christina Kalpadakis
- Department of Haematology, University Hospital, University of Crete, Heraklion, Greece
| | - Efstathios Koulieris
- Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece
| | - Maria Moschogiannis
- Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece
| | - Xanthi Yiakoumis
- Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece
| | - Pantelis Tsirkinidis
- Department of Haematology, Athens Medical Center-Psychikon Branch, Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology, University of Athens, Laikon General Hospital, Athens, Greece
| | - Barbara Eichhorst
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
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von Tresckow J, Eichhorst B, Bahlo J, Hallek M. The Treatment of Chronic Lymphatic Leukemia. Dtsch Arztebl Int 2019; 116:41-46. [PMID: 30855005 PMCID: PMC6415618 DOI: 10.3238/arztebl.2019.0041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 09/28/2017] [Accepted: 11/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) mainly affects older persons and is the commonest form of leukemia, with an incidence of 6 cases per 100 000 per- sons per year. In Germany, approximately 1000 men and 850 women die of CLL each year. METHODS This review is based on pertinent publications retrieved by a selective literature search in PubMed and on the authors' scientific and clinical experience. RESULTS The diagnosis of CLL requires the detection of at least 5000 B-lymphocytes per microliter in the peripheral blood. Courses of CLL may be indolent and require no treatment, but may also be aggressive and progress rapidly. Treatment should be initiated when there is marked evidence of bone-marrow suppression or disease- related symptoms such as B symptoms or fatigue. In the past ten years, a number of targeted drugs have been introduced that can achieve a very good, long-lasting response, particularly when used in combination. The combination of chemotherapy with anti-CD20 antibodies (chemoimmunotherapy) is the standard first-line treat- ment. In younger patients without any relevant accompanying illnesses, the combi- nation of fludarabine, cyclophosphamide, and rituximab prolongs survival. Patients with comorbidities should be treated with a combination of chlorambucil and obinutuzumab. In the last few years, ibrutinib, idelalsib, and venetoclax have been approved for clinical use. These substances inhibit cellular signal transduction pathways and are being increasingly used. CONCLUSION Recent progress in the development of novel treatment options gives hope that CLL may soon be a controllable disease. Even at present, chemoimmuno- therapy can achieve a progression-free survival of more than eight years in certain genetically defined subgroups of CLL patients.
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Affiliation(s)
- Julia von Tresckow
- Department of Internal Medicine I – Oncology, Hematology, Clinical Infectiology, Clinical Immunology, Hemostaseology, Internal Intensive Care; University Hospital Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department of Internal Medicine I – Oncology, Hematology, Clinical Infectiology, Clinical Immunology, Hemostaseology, Internal Intensive Care; University Hospital Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department of Internal Medicine I – Oncology, Hematology, Clinical Infectiology, Clinical Immunology, Hemostaseology, Internal Intensive Care; University Hospital Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine I – Oncology, Hematology, Clinical Infectiology, Clinical Immunology, Hemostaseology, Internal Intensive Care; University Hospital Cologne, Cologne, Germany
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24
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Al-Sawaf O, Bahlo J, Robrecht S, Fischer K, Herling CD, Hoechstetter M, Fink AM, von Tresckow J, Langerbeins P, Cramer P, Stilgenbauer S, Wendtner CM, Eichhorst B, Hallek M, Goede V. Outcome of patients aged 80 years or older treated for chronic lymphocytic leukaemia. Br J Haematol 2018; 183:727-735. [PMID: 30460980 DOI: 10.1111/bjh.15604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022]
Abstract
Clinical management of chronic lymphocytic leukaemia (CLL) in patients aged ≥80 years is based on limited evidence due to the lack of published information. Therefore, we analysed CLL patients aged ≥80 years using data from seven phase III clinical trials of the German CLL Study Group. Among 3552 participants, 152 were ≥80 years old at initiation of first-line study treatment. Median age was 82 years (range 80-90). Concomitant diseases were present in 99% of the patients, with a median cumulative illness rating scale score of 8 (0-18). Chemoimmunotherapy with chlorambucil-obinutuzumab (CLB-OB) or chlorambucil-rituximab (CLB-R) was administered to 61 (40%) and 56 (37%) patients. The remaining patients received CLB (n = 19) or fludarabine (F, n = 10), F/cyclophosphamide (FC, n = 1), FC/rituximab (FCR, n = 2) or bendamustine/rituximab (BR, n = 3). Rates of grade 3 or 4 neutropenia and infections were 35% and 13%. Overall response rate was 77% with 13% complete remissions. Median progression-free survival and treatment-free survival were 17·2 and 32·3 months, respectively. Median overall survival was 48·3 months; adverse events (22%) and progressive CLL (16·4%) were the most frequent causes of death. These findings suggest that anti-leukaemic treatment including chemoimmunotherapy is feasible and efficacious in ≥80-year-old CLL patients. However, this group of patients lives for a shorter time than age-matched controls of the general population.
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Affiliation(s)
- Othman Al-Sawaf
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Carmen D Herling
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Manuela Hoechstetter
- Department of Haematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, German CLL Study Group, Hospital Munich-Schwabing, Munich, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Julia von Tresckow
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | | | - Clemens M Wendtner
- Department of Haematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, German CLL Study Group, Hospital Munich-Schwabing, Munich, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany.,Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Disease (CECAD), University of Cologne, Cologne, Germany
| | - Valentin Goede
- Department I of Internal Medicine and Centre of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital, Cologne, Germany.,Oncogeriatric Unit, Department of Geriatric Medicine, St. Marien Hospital, Cologne, Germany
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25
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Pflug N, Cramer P, Robrecht S, Bahlo J, Westermann A, Fink AM, Schrader A, Mayer P, Oberbeck S, Seiler T, Zenz T, Dürig J, Kreuzer KA, Stilgenbauer S, Eichhorst B, Hallek M, Herling M, Hopfinger G. New lessons learned in T-PLL: results from a prospective phase-II trial with fludarabine-mitoxantrone-cyclophosphamide-alemtuzumab induction followed by alemtuzumab maintenance. Leuk Lymphoma 2018; 60:649-657. [PMID: 30234404 DOI: 10.1080/10428194.2018.1488253] [Citation(s) in RCA: 8] [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] [Indexed: 10/28/2022]
Abstract
Clinical trials in T-cell prolymphocytic leukemia (T-PLL) are scarce. Based on a precursor study testing fludarabine, mitoxantrone, and cyclophosphamide followed by alemtuzumab (FMC-A), we aimed to improve this regimen by upfront combining subcutaneous (s.c.) alemtuzumab with FMC for four cycles followed by an alemtuzumab-maintenance (FMCA + A). This prospective multicenter phase-II trial assessed response, survival, and toxicity of that regimen administered to pretreated (n = 4) and treatment-naïve (n = 12) T-PLL patients. The best overall response rate after FMCA was 68.8% (n = 11) including five CRs (31.3%) and six PRs (37.5%). Six patients entered the alemtuzumab-maintenance. Median overall and progression-free survival was 16.7 and 11.2 months, respectively. Hematologic toxicities were the most frequent grade 3/4 side effects. A reduced incidence of CMV-reactivations was attributed to the prophylactic administration of valganciclovir. Overall, FMCA + A did not improve the efficacy of the FMC-A-regimen or of single i.v. alemtuzumab. It suggests that a chemotherapy backbone prevents efficient alemtuzumab dosing and confirms that intravenous alemtuzumab is to be preferred over its s.c. route in T-PLL. ClinicalTrials.gov identifier: NCT01186640.
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Affiliation(s)
- Natali Pflug
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Paula Cramer
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Sandra Robrecht
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Jasmin Bahlo
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Anne Westermann
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Anna-Maria Fink
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Alexandra Schrader
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Petra Mayer
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Sebastian Oberbeck
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Till Seiler
- b Medizinische Klinik und Poliklinik III , LMU University of Munich , Munich , Germany
| | - Thorsten Zenz
- c National Center for Tumor Diseases Heidelberg , Heidelberg , Germany
| | - Jan Dürig
- d Klinik für Hämatologie , University of Essen , Essen , Germany
| | - Karl-Anton Kreuzer
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | | | - Barbara Eichhorst
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Michael Hallek
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Marco Herling
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Georg Hopfinger
- f AKH Wien , Universitätsklinik für Innere Medizin I , Vienna , Austria
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26
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Cramer P, von Tresckow J, Bahlo J, Robrecht S, Langerbeins P, Al-Sawaf O, Engelke A, Fink AM, Fischer K, Tausch E, Seiler T, Fischer von Weikersthal L, Hebart H, Kreuzer KA, Böttcher S, Ritgen M, Kneba M, Wendtner CM, Stilgenbauer S, Eichhorst B, Hallek M. Bendamustine followed by obinutuzumab and venetoclax in chronic lymphocytic leukaemia (CLL2-BAG): primary endpoint analysis of a multicentre, open-label, phase 2 trial. Lancet Oncol 2018; 19:1215-1228. [DOI: 10.1016/s1470-2045(18)30414-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022]
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27
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Julia VT, Carsten N, Kater AP, Bahlo J, Fürstenau M, Fink AM, Gregor M, Thornton P, Tadmor T, Fischer K, Ritgen M, Kreuzer KA, Eldering E, Stilgenbauer S, Van Oers M, Geisler C, Hallek MJ, Eichhorst B. The GAIA (CLL13) trial: An international intergroup phase III study for frontline therapy in chronic lymphocytic leukemia (CLL). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps7582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Von Tresckow Julia
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Niemann Carsten
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Nordic CLL Study Group, Copenhagen, Denmark
| | - Arnon P. Kater
- Department of Hematology, Academic Medical Center Amsterdam, University of Amsterdam, on behalf of the HOVON CLL Working Group, Amsterdam, Netherlands
| | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Colgne, Germany
| | - Moritz Fürstenau
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Michael Gregor
- Division of Hematology. Cantonal Hospital of Lucerne, Lucerne, Switzerland, on behalf of the SAKK, Lucerne, Switzerland
| | | | - Tamar Tadmor
- Bnai–Zion Medical Center, on behalf of the Israeli CLL Study Group, Haifa, IL
| | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Matthias Ritgen
- 2nd Department of Internal Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Karl A Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Eric Eldering
- Department of Hematology, Academic Medical Center, on behalf of the HOVON CLL Working Group, Amsterdam, Netherlands
| | | | - Marinus Van Oers
- Department of Hematology, Academic Medical Center, Amsterdam, the Netherlands, on behalf of the HOVON CLL Working Group, Amsterdam, Netherlands
| | - Christian Geisler
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Nordic CLL Study Group, Copenhagen, Denmark
| | - Michael J. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, CECAD Cluster of Excellence at the University of Cologne, Clinical Research Unit (KFO) 286, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
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28
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Julia VT, Cramer P, Bahlo J, Robrecht S, Al-Sawaf O, Langerbeins P, Fürstenau M, Engelke A, Fink AM, Fischer K, Kreuzer KA, Ritgen M, Boettcher S, Wendtner CM, Stilgenbauer S, Eichhorst B, Hallek MJ. Comparison of different phase II studies using sequential combinations of targeted agents for treating chronic lymphocytic leukemia. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7513] [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: 11/20/2022] Open
Affiliation(s)
- Von Tresckow Julia
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Colgne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Colgne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Moritz Fürstenau
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Anja Engelke
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Karl A Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Matthias Ritgen
- 2nd Department of Internal Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sebastian Boettcher
- Clinic III, Hematology, Oncology and Palliative Medicine, University of Rostock, Rostock, Germany
| | - Clemens Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | | | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University of Cologne, Cologne, Germany
| | - Michael J. Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, CECAD Cluster of Excellence at the University of Cologne, Clinical Research Unit (KFO) 286, German CLL Study Group, University of Cologne, Cologne, Germany
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29
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Cramer P, von Tresckow J, Bahlo J, Engelke A, Langerbeins P, Fink AM, Fischer K, Wendtner CM, Kreuzer KA, Stilgenbauer S, Böttcher S, Eichhorst B, Hallek M. CLL2-BXX Phase II trials: sequential, targeted treatment for eradication of minimal residual disease in chronic lymphocytic leukemia. Future Oncol 2018; 14:499-513. [PMID: 29465308 DOI: 10.2217/fon-2017-0442] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Four Phase II trials (clinical trials numbers: NCT02345863, NCT02401503, NCT02445131 and NCT02689141) evaluate a different combination of targeted agents in an all-comer population of approximately 60 patients with chronic lymphocytic leukemia irrespective of prior treatment, physical fitness and genetic risk factors. Patients with a higher tumor load start with a debulking treatment with bendamustine. The subsequent induction and maintenance treatment with an anti-CD20 antibody (obinutuzumab or ofatumumab) and a targeted oral agent (ibrutinib, idelalisib or venetoclax) are continued until achievement of a complete response and minimal residual disease negativity. CONCLUSION This strategy represents a new era of chronic lymphocytic leukemia therapy where chemotherapy is increasingly replaced by targeted agents and treatment duration is tailored to the patient's individual tumor load and response.
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Affiliation(s)
- Paula Cramer
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Julia von Tresckow
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Anja Engelke
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Clemens-Martin Wendtner
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany.,Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases & Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | | | - Sebastian Böttcher
- Department III of Internal Medicine, University Hospital Rostock, Rostock, Germany.,Department II of Internal Medicine, Campus Kiel, University of Schleswig-Holstein, Kiel, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine & Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital Cologne, Cologne, Germany
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30
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Klymenko T, Bloehdorn J, Bahlo J, Robrecht S, Akylzhanova G, Cox K, Estenfelder S, Wang J, Edelmann J, Strefford JC, Wojdacz TK, Fischer K, Hallek M, Stilgenbauer S, Cragg M, Gribben J, Braun A. Lamin B1 regulates somatic mutations and progression of B-cell malignancies. Leukemia 2018; 32:364-375. [PMID: 28804121 PMCID: PMC5808072 DOI: 10.1038/leu.2017.255] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/07/2017] [Accepted: 07/31/2017] [Indexed: 12/24/2022]
Abstract
Somatic hypermutation (SHM) is a pivotal process in adaptive immunity that occurs in the germinal centre and allows B cells to change their primary DNA sequence and diversify their antigen receptors. Here, we report that genome binding of Lamin B1, a component of the nuclear envelope involved in epigenetic chromatin regulation, is reduced during B-cell activation and formation of lymphoid germinal centres. Chromatin immunoprecipitation-Seq analysis showed that kappa and heavy variable immunoglobulin domains were released from the Lamin B1 suppressive environment when SHM was induced in B cells. RNA interference-mediated reduction of Lamin B1 resulted in spontaneous SHM as well as kappa-light chain aberrant surface expression. Finally, Lamin B1 expression level correlated with progression-free and overall survival in chronic lymphocytic leukaemia, and was strongly involved in the transformation of follicular lymphoma. In summary, here we report that Lamin B1 is a negative epigenetic regulator of SHM in normal B-cells and a 'mutational gatekeeper', suppressing the aberrant mutations that drive lymphoid malignancy.
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MESH Headings
- B-Lymphocytes/pathology
- Cell Line, Tumor
- Chromatin Immunoprecipitation/methods
- Disease Progression
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Lamin Type B/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Somatic Hypermutation, Immunoglobulin/genetics
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Affiliation(s)
- T Klymenko
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University, London, UK
| | - J Bloehdorn
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - J Bahlo
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - S Robrecht
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - G Akylzhanova
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University, London, UK
| | - K Cox
- Academic Unit of Cancer Sciences, Faculty of Medicine, Cancer Research UK Centre and Experimental Cancer Medicine Centre, University of Southampton, Southampton, UK
| | - S Estenfelder
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - J Wang
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University, London, UK
| | - J Edelmann
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University, London, UK
| | - J C Strefford
- Academic Unit of Cancer Sciences, Faculty of Medicine, Cancer Research UK Centre and Experimental Cancer Medicine Centre, University of Southampton, Southampton, UK
| | - T K Wojdacz
- Academic Unit of Cancer Sciences, Faculty of Medicine, Cancer Research UK Centre and Experimental Cancer Medicine Centre, University of Southampton, Southampton, UK
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - K Fischer
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - M Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - S Stilgenbauer
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - M Cragg
- Academic Unit of Cancer Sciences, Faculty of Medicine, Cancer Research UK Centre and Experimental Cancer Medicine Centre, University of Southampton, Southampton, UK
| | - J Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University, London, UK
| | - A Braun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University, London, UK
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31
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Kovacs G, Robrecht S, Fink AM, Bahlo J, Cramer P, von Tresckow J, Maurer C, Langerbeins P, Fingerle-Rowson G, Ritgen M, Kneba M, Döhner H, Stilgenbauer S, Klapper W, Wendtner CM, Fischer K, Hallek M, Eichhorst B, Böttcher S. Minimal Residual Disease Assessment Improves Prediction of Outcome in Patients With Chronic Lymphocytic Leukemia (CLL) Who Achieve Partial Response: Comprehensive Analysis of Two Phase III Studies of the German CLL Study Group. J Clin Oncol 2017; 34:3758-3765. [PMID: 27573660 DOI: 10.1200/jco.2016.67.1305] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose To determine the value of minimal residual disease (MRD) assessments, together with the evaluation of clinical response in chronic lymphocytic leukemia according to the 2008 International Workshop on Chronic Lymphocytic Leukemia criteria. Patients and Methods Progression-free survival (PFS) and overall survival of 554 patients from two randomized trials of the German CLL Study Group (CLL8: fludarabine and cyclophosphamide [FC] v FC plus rituximab; CLL10: FC plus rituximab v bendamustine plus rituximab) were analyzed according to MRD assessed in peripheral blood at a threshold of 10-4 and clinical response. The prognostic value of different parameters defining a partial response (PR) was further investigated. Results Patients with MRD-negative complete remission (CR), MRD-negative PR, MRD-positive CR, and MRD-positive PR experienced a median PFS from a landmark at end of treatment of 61 months, 54 months, 35 months, and 21 months, respectively. PFS did not differ significantly between MRD-negative CR and MRD-negative PR; however, PFS was longer for MRD-negative PR than for MRD-positive CR ( P = .048) and for MRD-positive CR compared with MRD-positive PR ( P = .002). Compared with MRD-negative CR, only patients with MRD-positive PR had a significantly shorter overall survival (not reached v 72 months; P = .001), whereas there was no detectable difference for patients with MRD-negative PR or MRD-positive CR ( P = 0.612 and P = 0.853, respectively). Patients with MRD-negative PR who presented with residual splenomegaly had only a similar PFS (63 months) compared with patients with MRD-negative CR (61 months; P = .354), whereas patients with MRD-negative PR with lymphadenopathy showed a shorter PFS (31 months; P < .001). Conclusion MRD quantification allows for improved PFS prediction in both patients who achive PR and CR, which thus supports its application in all responders. In contrast to residual lymphadenopathy, persisting splenomegaly does not impact outcome in patients with MRD-negative PR.
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Affiliation(s)
- Gabor Kovacs
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Sandra Robrecht
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Anna Maria Fink
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Jasmin Bahlo
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Paula Cramer
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Julia von Tresckow
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Christian Maurer
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Petra Langerbeins
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Günter Fingerle-Rowson
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Matthias Ritgen
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Michael Kneba
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Hartmut Döhner
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Stephan Stilgenbauer
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Wolfram Klapper
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Clemens-Martin Wendtner
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Kirsten Fischer
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Michael Hallek
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Barbara Eichhorst
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
| | - Sebastian Böttcher
- Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland
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Wolf C, Garding A, Filarsky K, Bahlo J, Robrecht S, Becker N, Zucknick M, Rouhi A, Weigel A, Claus R, Weichenhan D, Eichhorst B, Fischer K, Hallek M, Kuchenbauer F, Plass C, Döhner H, Stilgenbauer S, Lichter P, Mertens D. NFATC1 activation by DNA hypomethylation in chronic lymphocytic leukemia correlates with clinical staging and can be inhibited by ibrutinib. Int J Cancer 2017; 142:322-333. [PMID: 28921505 DOI: 10.1002/ijc.31057] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/31/2017] [Indexed: 12/22/2022]
Abstract
B cell receptor (BCR) signaling is a key for survival of chronic lymphocytic leukemia (CLL) cells, and BCR signaling inhibitors are clinically active. However, relapse and resistance to treatment require novel treatment options. To detect novel candidate therapeutic targets, we performed a genome-wide DNA methylation screen with custom arrays and identified aberrant promoter DNA methylation in 2,192 genes. The transcription factor NFATC1 that is a downstream effector of BCR signaling was among the top hypomethylated genes and was concomitantly transcriptionally upregulated in CLL. Intriguingly, NFATC1 promoter DNA hypomethylation levels were significantly variant in clinical trial cohorts from different disease progression stages and furthermore correlated with Binet disease staging and thymidine kinase levels, strongly suggesting a central role of NFATC1 in CLL development. Functionally, DNA hypomethylation at NFATC1 promoter inversely correlated with RNA levels of NFATC1 and dysregulation correlated with expression of target genes BCL-2, CCND1 and CCR7. The inhibition of the NFAT regulator calcineurin with tacrolimus and cyclosporin A and the BCR signaling inhibitor ibrutinib significantly reduced NFAT activity in leukemic cell lines, and NFAT inhibition resulted in increased apoptosis of primary CLL cells. In summary, our results indicate that the aberrant activation of NFATC1 by DNA hypomethylation and BCR signaling plays a major role in the pathomechanism of CLL.
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Affiliation(s)
- Christine Wolf
- Mechanisms of Leukemogenesis, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Angela Garding
- Signaling to Chromatin Laboratory, Institute of Molecular Biology, Mainz, Germany
| | - Katharina Filarsky
- Mechanisms of Leukemogenesis, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Köln, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Köln, Germany
| | - Natalia Becker
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Manuela Zucknick
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Arefeh Rouhi
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Anja Weigel
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Rainer Claus
- Department Medical Clinic II, Klinikum Augsburg, Augsburg, Germany
| | - Dieter Weichenhan
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Köln, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Köln, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Köln, Germany
| | | | - Christoph Plass
- Division of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | | | - Peter Lichter
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Mertens
- Mechanisms of Leukemogenesis, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Internal Medicine III, University of Ulm, Ulm, Germany
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Fink AM, Bahlo J, Robrecht S, Al-Sawaf O, Aldaoud A, Hebart H, Jentsch-Ullrich K, Dörfel S, Fischer K, Wendtner CM, Nösslinger T, Ghia P, Bosch F, Kater AP, Döhner H, Kneba M, Kreuzer KA, Tausch E, Stilgenbauer S, Ritgen M, Böttcher S, Eichhorst B, Hallek M. Lenalidomide maintenance after first-line therapy for high-risk chronic lymphocytic leukaemia (CLLM1): final results from a randomised, double-blind, phase 3 study. Lancet Haematol 2017; 4:e475-e486. [PMID: 28916311 DOI: 10.1016/s2352-3026(17)30171-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND The combined use of genetic markers and detectable minimal residual disease identifies patients with chronic lymphocytic leukaemia with poor outcome after first-line chemoimmunotherapy. We aimed to assess lenalidomide maintenance therapy in these high-risk patients. METHODS In this randomised, double-blind, phase 3 study (CLLM1; CLL Maintenance 1 of the German CLL Study Group), patients older than 18 years and diagnosed with immunophenotypically confirmed chronic lymphocytic leukaemia with active disease, who responded to chemoimmunotherapy 2-5 months after completion of first-line therapy and who were assessed as having a high risk for an early progression with at least a partial response after four or more cycles of first-line chemoimmunotherapy, were eligible if they had high minimal residual disease levels or intermediate levels combined with an unmutated IGHV gene status or TP53 alterations. Patients were randomly assigned (2:1) to receive either lenalidomide (5 mg) or placebo. Randomisation was done with a fixed block size of three, and was stratified according to the minimal residual disease level achieved after first-line therapy. Maintenance was started with 5 mg daily, and was escalated to the target dose of 15 mg. If tolerated, medication was administered until disease progression. The primary endpoint was progression-free survival according to an independent review. The pre-planned interim analysis done by intention to treat was done after 20% of the calculated progression-free survival events. This study is registered with ClinicalTrials.gov, number NCT01556776; treatment in the lenalidomide group is still ongoing. FINDINGS Between July 5, 2012, and March 15, 2016, 468 previously untreated patients with chronic lymphocytic leukaemia were screened for the study; 379 (81%) were not eligible. Recruitment was closed prematurely due to poor accrual after 89 of 200 planned patients were randomly assigned: 60 (67%) enrolled patients were assigned to the lenalidomide group and 29 (33%) to the placebo group, of whom 56 (63%) received lenalidomide and 29 (33%) placebo, with a median of 11·0 (IQR 4·5-20·5) treatment cycles at data cutoff. After a median observation time of 17·9 months (IQR 9·1-28·1), the hazard ratio for progression-free survival assessed by an independent review was 0·168 (95% CI 0·074-0·379). Median progression-free survival was 13·3 months (95% CI 9·9-19·7) in the placebo group and not reached (95% CI 32·3-not evaluable) in the lenalidomide group. The most frequent adverse events were skin disorders (35 patients [63%] in the lenalidomide group vs eight patients [28%] in the placebo group), gastrointestinal disorders (34 [61%] vs eight [28%]), infections (30 [54%] vs 19 [66%]), haematological toxicity (28 [50%] vs five [17%]), and general disorders (28 [50%] vs nine [31%]). One fatal adverse event was reported in each of the treatment groups (one [2%] patient with fatal acute lymphocytic leukaemia in the lenalidomide group and one patient (3%) with fatal multifocal leukoencephalopathy in the placebo group). INTERPRETATION Lenalidomide is an efficacious maintenance therapy reducing the relative risk of progression in first-line patients with chronic lymphocytic leukaemia who do not achieve minimal residual disease negative disease state following chemoimmunotherapy approaches. The toxicity seems to be acceptable considering the poor prognosis of the eligible patients. The trial independently confirms the clinical significance of a novel, minimal residual disease-based algorithm to predict short progression-free survival, which might be incorporated in future clinical trials to identify candidates for additional maintenance treatment. FUNDING Celgene Corporation.
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Affiliation(s)
- Anna Maria Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany.
| | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | - Ali Aldaoud
- Gemeinschaftspraxis für Hämatologie und Onkologie, Leipzig, Germany
| | - Holger Hebart
- Zentrum für Innere Medizin, Hämatologie/Onkologie, Stauferklinikum Schwäbisch-Gmünd, Germany
| | | | | | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | - Clemens-Martin Wendtner
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany; Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Thomas Nösslinger
- 3rd Department for Hematology and Oncology, Hanusch Hospital, Vienna, Austria
| | - Paolo Ghia
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milan, Italy
| | - Francesc Bosch
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain; on behalf of the Spanish Group of CLL (GELLC)
| | - Arnon P Kater
- Department of Hematology, Academic Medical Center Amsterdam, University of Amsterdam, Netherlands; on behalf of the Dutch-Belgium HOVON CLL study group
| | - Hartmut Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Michael Kneba
- Campus Kiel, 2nd Deptartment of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | - Eugen Tausch
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | | | - Matthias Ritgen
- Campus Kiel, 2nd Deptartment of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany
| | - Sebastian Böttcher
- Campus Kiel, 2nd Deptartment of Internal Medicine, University of Schleswig-Holstein, Kiel, Germany; Department of Medicine III-Hematology/Oncology/Palliative Care, Rostock University Medical Center, Rostock, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study Group, University Hospital of Cologne, Cologne, Germany
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Knittel G, Rehkämper T, Korovkina D, Liedgens P, Fritz C, Torgovnick A, Al-Baldawi Y, Al-Maarri M, Cun Y, Fedorchenko O, Riabinska A, Beleggia F, Nguyen PH, Wunderlich FT, Ortmann M, Montesinos-Rongen M, Tausch E, Stilgenbauer S, P Frenzel L, Herling M, Herling C, Bahlo J, Hallek M, Peifer M, Buettner R, Persigehl T, Reinhardt HC. Two mouse models reveal an actionable PARP1 dependence in aggressive chronic lymphocytic leukemia. Nat Commun 2017; 8:153. [PMID: 28751718 PMCID: PMC5532225 DOI: 10.1038/s41467-017-00210-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 08/22/2016] [Accepted: 06/13/2017] [Indexed: 12/11/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) remains an incurable disease. Two recurrent cytogenetic aberrations, namely del(17p), affecting TP53, and del(11q), affecting ATM, are associated with resistance against genotoxic chemotherapy (del17p) and poor outcome (del11q and del17p). Both del(17p) and del(11q) are also associated with inferior outcome to the novel targeted agents, such as the BTK inhibitor ibrutinib. Thus, even in the era of targeted therapies, CLL with alterations in the ATM/p53 pathway remains a clinical challenge. Here we generated two mouse models of Atm- and Trp53-deficient CLL. These animals display a significantly earlier disease onset and reduced overall survival, compared to controls. We employed these models in conjunction with transcriptome analyses following cyclophosphamide treatment to reveal that Atm deficiency is associated with an exquisite and genotype-specific sensitivity against PARP inhibition. Thus, we generate two aggressive CLL models and provide a preclinical rational for the use of PARP inhibitors in ATM-affected human CLL. ATM and TP53 mutations are associated with poor prognosis in chronic lymphocytic leukaemia (CLL). Here the authors generate mouse models of Tp53- and Atm-defective CLL mimicking the high-risk form of human disease and show that Atm-deficient CLL is sensitive to PARP1 inhibition.
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Affiliation(s)
- Gero Knittel
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany. .,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany. .,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany.
| | - Tim Rehkämper
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Darya Korovkina
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Paul Liedgens
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Christian Fritz
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Alessandro Torgovnick
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Yussor Al-Baldawi
- Department of Radiology, Medical Faculty, University Hospital of Cologne, Cologne, 50931, Germany
| | - Mona Al-Maarri
- Max-Planck-Institute for Metabolism Research, Cologne, 50931, Germany
| | - Yupeng Cun
- Department of Translational Genomics, University of Cologne, Cologne, 50931, Germany
| | - Oleg Fedorchenko
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Arina Riabinska
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Filippo Beleggia
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Phuong-Hien Nguyen
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | | | - Monika Ortmann
- Institute of Pathology, University Hospital of Cologne, Cologne, 50931, Germany
| | | | - Eugen Tausch
- Department of Internal Medicine III, Ulm University, Ulm, 89070, Germany
| | | | - Lukas P Frenzel
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Marco Herling
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany.,Center of Molecular Medicine, University of Cologne, Cologne, 50931, Germany
| | - Carmen Herling
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Jasmin Bahlo
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany
| | - Michael Hallek
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany.,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany
| | - Martin Peifer
- Department of Translational Genomics, University of Cologne, Cologne, 50931, Germany
| | - Reinhard Buettner
- Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany.,Institute of Pathology, University Hospital of Cologne, Cologne, 50931, Germany
| | - Thorsten Persigehl
- Department of Radiology, Medical Faculty, University Hospital of Cologne, Cologne, 50931, Germany
| | - H Christian Reinhardt
- Clinic I of Internal Medicine, University Hospital of Cologne, Cologne, 50931, Germany. .,Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany. .,Center of Integrated Oncology (CIO), University Hospital of Cologne, Cologne, 50931, Germany. .,Center of Molecular Medicine, University of Cologne, Cologne, 50931, Germany.
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Cramer P, von Tresckow J, Bahlo J, Robrecht S, Al-Sawaf O, Langerbeins P, Engelke A, Fink A, Fischer K, Seiler T, von Weikersthal L, Hebart H, Kreuzer K, Ritgen M, Kneba M, Wendtner C, Stilgenbauer S, Eichhorst B, Hallek M. BENDAMUSTINE (B), FOLLOWED BY OBINUTUZUMAB (G) AND VENETOCLAX (A) IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL): CLL2-BAG TRIAL OF THE GERMAN CLL STUDY GROUP (GCLLSG). Hematol Oncol 2017. [DOI: 10.1002/hon.2437_5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- P. Cramer
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - J. von Tresckow
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - J. Bahlo
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - S. Robrecht
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - O. Al-Sawaf
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - P. Langerbeins
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - A. Engelke
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - A.M. Fink
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - K. Fischer
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - T. Seiler
- Department III of Internal Medicine; University Hospital Munich, Ludwig-Maximilians University, Campus Großhadern; Munich Germany
| | | | - H. Hebart
- Center for Internal Medicine; Stauferklinikum Schwäbisch Gmünd; Mutlangen Germany
| | - K.A. Kreuzer
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - M. Ritgen
- Department II of Internal Medicine; University of Schleswig-Holstein; Campus Kiel, Kiel Germany
| | - M. Kneba
- Department II of Internal Medicine; University of Schleswig-Holstein; Campus Kiel, Kiel Germany
| | - C.M. Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing; Munich Germany
| | - S. Stilgenbauer
- Department III of Internal Medicine; University Hospital Ulm; Ulm Germany
| | - B. Eichhorst
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
| | - M. Hallek
- Department I of Internal Medicine and German CLL Study Group; University of Cologne; Cologne Germany
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36
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Al-Sawaf O, Bahlo J, Fischer K, Herling C, Bergmann M, Fink A, von Tresckow J, Langerbeins P, Cramer P, Stilgenbauer S, Wendtner C, Eichhorst B, Hallek M, Goede V. CHARACTERISTICS, TREATMENT, AND OUTCOMES OF ≥ 80 YEAR OLD PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) ENROLLED TO PROSPECTIVE TRIALS OF THE GERMAN CLL STUDY GROUP. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_88] [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: 11/06/2022]
Affiliation(s)
- O. Al-Sawaf
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - J. Bahlo
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - K. Fischer
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - C. Herling
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - M. Bergmann
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine; Klinikum Schwabing; Munich Germany
| | - A.M. Fink
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - J. von Tresckow
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - P. Langerbeins
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - P. Cramer
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - S. Stilgenbauer
- Department III of Internal Medicine; University Hospital Ulm; Ulm Germany
| | - C.M. Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine; Klinikum Schwabing; Munich Germany
| | - B. Eichhorst
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - M. Hallek
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
| | - V. Goede
- Department I of Internal Medicine, German CLL Study Group; University Hospital of Cologne; Cologne Germany
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37
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Xochelli A, Baliakas P, Kavakiotis I, Agathangelidis A, Sutton LA, Minga E, Ntoufa S, Tausch E, Yan XJ, Shanafelt T, Plevova K, Boudjogra M, Rossi D, Davis Z, Navarro A, Sandberg Y, Vojdeman FJ, Scarfo L, Stavroyianni N, Sudarikov A, Veronese S, Tzenou T, Karan-Djurasevic T, Catherwood M, Kienle D, Chatzouli M, Facco M, Bahlo J, Pott C, Pedersen LB, Mansouri L, Smedby KE, Chu CC, Giudicelli V, Lefranc MP, Panagiotidis P, Juliusson G, Anagnostopoulos A, Vlahavas I, Antic D, Trentin L, Montillo M, Niemann C, Döhner H, Langerak AW, Pospisilova S, Hallek M, Campo E, Chiorazzi N, Maglaveras N, Oscier D, Gaidano G, Jelinek DF, Stilgenbauer S, Chouvarda I, Darzentas N, Belessi C, Davi F, Hadzidimitriou A, Rosenquist R, Ghia P, Stamatopoulos K. Chronic Lymphocytic Leukemia with Mutated IGHV4-34 Receptors: Shared and Distinct Immunogenetic Features and Clinical Outcomes. Clin Cancer Res 2017; 23:5292-5301. [PMID: 28536306 DOI: 10.1158/1078-0432.ccr-16-3100] [Citation(s) in RCA: 25] [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: 12/09/2016] [Revised: 04/11/2017] [Accepted: 05/18/2017] [Indexed: 11/16/2022]
Abstract
Purpose: We sought to investigate whether B cell receptor immunoglobulin (BcR IG) stereotypy is associated with particular clinicobiological features among chronic lymphocytic leukemia (CLL) patients expressing mutated BcR IG (M-CLL) encoded by the IGHV4-34 gene, and also ascertain whether these associations could refine prognostication.Experimental Design: In a series of 19,907 CLL cases with available immunogenetic information, we identified 339 IGHV4-34-expressing cases assigned to one of the four largest stereotyped M-CLL subsets, namely subsets #4, #16, #29 and #201, and investigated in detail their clinicobiological characteristics and disease outcomes.Results: We identified shared and subset-specific patterns of somatic hypermutation (SHM) among patients assigned to these subsets. The greatest similarity was observed between subsets #4 and #16, both including IgG-switched cases (IgG-CLL). In contrast, the least similarity was detected between subsets #16 and #201, the latter concerning IgM/D-expressing CLL. Significant differences between subsets also involved disease stage at diagnosis and the presence of specific genomic aberrations. IgG subsets #4 and #16 emerged as particularly indolent with a significantly (P < 0.05) longer time-to-first-treatment (TTFT; median TTFT: not yet reached) compared with the IgM/D subsets #29 and #201 (median TTFT: 11 and 12 years, respectively).Conclusions: Our findings support the notion that BcR IG stereotypy further refines prognostication in CLL, superseding the immunogenetic distinction based solely on SHM load. In addition, the observed distinct genetic aberration landscapes and clinical heterogeneity suggest that not all M-CLL cases are equal, prompting further research into the underlying biological background with the ultimate aim of tailored patient management. Clin Cancer Res; 23(17); 5292-301. ©2017 AACR.
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Affiliation(s)
- Aliki Xochelli
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece.,Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Panagiotis Baliakas
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Ioannis Kavakiotis
- Department of informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Agathangelidis
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece.,Division of Experimental Oncology and Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lesley-Ann Sutton
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Eva Minga
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece
| | | | - Eugen Tausch
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Xiao-Jie Yan
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Tait Shanafelt
- Department of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Karla Plevova
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Myriam Boudjogra
- Department of Hematology, Hopital Pitie-Salpetriere and University Pierre et Marie Curie, Paris, France
| | - Davide Rossi
- Division of Haematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Zadie Davis
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Alba Navarro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Yorick Sandberg
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Lydia Scarfo
- Division of Experimental Oncology and Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Niki Stavroyianni
- Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Silvio Veronese
- Molecular Pathology Unit and Haematology Department, Niguarda Cancer Center, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Tatiana Tzenou
- First Department of Propaedeutic Medicine, University of Athens, Athens, Greece
| | - Teodora Karan-Djurasevic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Mark Catherwood
- Department of Haemato-Oncology, Belfast City Hospital, Belfast, United Kingdom
| | - Dirk Kienle
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Maria Chatzouli
- Hematology Department, Nikea General Hospital, Piraeus, Greece
| | - Monica Facco
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padova, Italy
| | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Christiane Pott
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Larry Mansouri
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Charles C Chu
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Véronique Giudicelli
- IMGT®, the international ImMunoGeneTics information system®, Université de Montpellier, LIGM, Institut de Génétique Humaine IGH, UPR CNRS 1142, Montpellier, France
| | - Marie-Paule Lefranc
- IMGT®, the international ImMunoGeneTics information system®, Université de Montpellier, LIGM, Institut de Génétique Humaine IGH, UPR CNRS 1142, Montpellier, France
| | | | - Gunnar Juliusson
- Lund University and Hospital Department of Hematology, Lund Stem Cell Center, Lund, Sweden
| | | | - Ioannis Vlahavas
- Department of informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Darko Antic
- Clinic for Hematology, Clinical Center, Belgrade, Serbia.,Medical faculty, University of Belgrade, Belgrade, Serbia
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padova, Italy
| | - Marco Montillo
- Molecular Pathology Unit and Haematology Department, Niguarda Cancer Center, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Carsten Niemann
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Hartmut Döhner
- Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Anton W Langerak
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sarka Pospisilova
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology, University Hospital Cologne, Cologne, Germany
| | - Elias Campo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Nicholas Chiorazzi
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Nikos Maglaveras
- Laboratory of Medical Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - David Oscier
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Diane F Jelinek
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Ioanna Chouvarda
- Laboratory of Medical Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikos Darzentas
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | | | - Frederic Davi
- Department of Hematology, Hopital Pitie-Salpetriere and University Pierre et Marie Curie, Paris, France
| | - Anastasia Hadzidimitriou
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece. .,Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Richard Rosenquist
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Ghia
- Division of Experimental Oncology and Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milan, Italy
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece.,Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.,Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
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Al-Sawaf O, Fischer K, Herling CD, Ritgen M, Böttcher S, Bahlo J, Elter T, Stilgenbauer S, Eichhorst BF, Busch R, Elberskirch U, Abenhardt W, Kneba M, Hallek M, Wendtner CM. Alemtuzumab consolidation in chronic lymphocytic leukaemia: a phase I/II multicentre trial. Eur J Haematol 2016; 98:254-262. [PMID: 27862308 DOI: 10.1111/ejh.12825] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Despite high rates of long-lasting remissions in patients with chronic lymphocytic leukaemia (CLL) treated with chemoimmunotherapy, none of the current therapeutic approaches is curative with the exception of allogeneic transplantation. One strategy to extend progression-free survival and long-term survival might be the establishment of consolidation therapies. METHODS In this trial, patients with complete or partial second remission after fludarabine-based treatment received consolidation therapy with alemtuzumab. The aim of this phase I/II trial was to determine the maximal tolerable dose (MTD) of alemtuzumab consolidation and to evaluate safety and efficacy in patients who responded to second-line fludarabine-based treatment. Thirteen patients in complete (CR) or partial remission (PR) received alemtuzumab dose escalation starting with 10 mg intravenously (iv) once weekly for 8 wk and increasing in 10-mg intervals per dose level. RESULTS The main dose-limiting toxicities (DLTs) were infectious complications, and the MTD was determined at 10 mg. After alemtuzumab consolidation, seven of 13 patients (53%) were in CR, and four of these patients (30.7%) achieved minimal residual disease (MRD) negativity (<1 × 10E-4). At a median follow-up of 71.5 months, four patients were progression-free, with a median progression-free survival (PFS) of 28.5 months after the end of second-line treatment. CONCLUSION The results provide a safe and efficient schedule with weekly intravenous application of 10 mg of alemtuzumab as a consolidation regime in patients with CLL.
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Affiliation(s)
- Othman Al-Sawaf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study group, University of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study group, University of Cologne, Cologne, Germany
| | - Carmen D Herling
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study group, University of Cologne, Cologne, Germany
| | - Matthias Ritgen
- Department II of Internal Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sebastian Böttcher
- Department II of Internal Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study group, University of Cologne, Cologne, Germany
| | - Thomas Elter
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study group, University of Cologne, Cologne, Germany
| | | | - Barbara F Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study group, University of Cologne, Cologne, Germany
| | - Raymonde Busch
- Institute for Medical Statistic and Epidemiology, Technical University, Munich, Germany
| | - Ute Elberskirch
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study group, University of Cologne, Cologne, Germany
| | | | - Michael Kneba
- Department II of Internal Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study group, University of Cologne, Cologne, Germany
| | - Clemens-Martin Wendtner
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, German CLL Study group, University of Cologne, Cologne, Germany.,Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
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Shanafelt TD, Parikh SA, Noseworthy PA, Goede V, Chaffee KG, Bahlo J, Call TG, Schwager SM, Ding W, Eichhorst B, Fischer K, Leis JF, Chanan-Khan AA, Hallek M, Slager SL, Kay NE. Atrial fibrillation in patients with chronic lymphocytic leukemia (CLL). Leuk Lymphoma 2016; 58:1630-1639. [PMID: 27885886 DOI: 10.1080/10428194.2016.1257795] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Although preliminary data suggests that ibrutinib may increase risk of atrial fibrillation (AF), the incidence of AF in a general cohort of chronic lymphocytic leukemia (CLL) patients is unknown. We evaluated the prevalence of AF at CLL diagnosis and incidence of AF during follow-up in 2444 patients with newly diagnosed CLL. A prior history of AF was present at CLL diagnosis in 148 (6.1%). Among the 2292 patients without history of AF, 139 (6.1%) developed incident AF during follow-up (incidence approximately 1%/year). Older age (p < .0001), male sex (p = .01), valvular heart disease (p = .001), and hypertension (p = .04) were associated with risk of incident AF on multivariate analysis. A predictive model for developing incident AF constructed from these factors stratified patients into 4 groups with 10-year rates of incident AF ranging from 4% to 33% (p < .0001). This information provides context for interpreting rates of AF in CLL patients treated with novel therapies.
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Affiliation(s)
| | - Sameer A Parikh
- a Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Peter A Noseworthy
- b Division of Cardiovascular Diseases , Mayo Clinic , Rochester , MN , USA
| | - Valentin Goede
- c Department I of Internal Medicine , Center of Integrated Oncology, University of Cologne , Cologne , Germany
| | - Kari G Chaffee
- d Research Comp Genomics , Mayo Clinic , Rochester , MN , USA
| | - Jasmin Bahlo
- e Department I of Internal Medicine , Centre for Integrated Oncology, University Hospital Cologne , Cologne , Germany
| | - Timothy G Call
- f Department of Hematology and Internal Oncology , University of Cologne , Cologne , Germany
| | - Susan M Schwager
- f Department of Hematology and Internal Oncology , University of Cologne , Cologne , Germany
| | - Wei Ding
- f Department of Hematology and Internal Oncology , University of Cologne , Cologne , Germany
| | - Barbara Eichhorst
- g Department of Internal Medicine and Oncology , University of Cologne , Cologne , Germany
| | - Kirsten Fischer
- g Department of Internal Medicine and Oncology , University of Cologne , Cologne , Germany
| | - Jose F Leis
- h Division of Hematology/Oncology , Mayo Clinic Arizona , , Scottsdale , AZ , USA
| | | | - Michael Hallek
- j Department of Internal Medicine , Center of Integrated Oncology, University of Cologne , Cologne , Germany
| | - Susan L Slager
- k Division of Health Sciences Research , Mayo Clinic , Rochester , MN , USA
| | - Neil E Kay
- l Division of Hematology , Mayo Clinic , Rochester , MN , USA
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40
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Kron F, Kutsch N, Kostenko A, Dohle I, Glossmann JP, Müller D, Heimann SM, Bahlo J, von Bergwelt-Baildon M, Eichhorst B, Wolf J, Hallek M, Zander T. Economic evaluation of chronic lymphocytic leukemia from a hospital management perspective. Eur J Haematol 2016; 98:169-176. [PMID: 27727474 DOI: 10.1111/ejh.12817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Treatment of chronic lymphocytic leukemia (CLL) is currently undergoing dramatic changes. We analyzed economic risks in hospitalized patients with CLL from a management perspective. METHODS One hundred and twelve patients with CLL hospitalized in 2013 and 2014 at the University Hospital of Cologne were analyzed. To assess profit margins (PMs) per case, diagnosis-related group (DRG) reimbursement data were merged with an internal cost accounting scheme depending on age, prognostic factors, and DRG key performance indicators. RESULTS In 112 patients, 284 cases coded by 19 different DRG with strongly fluctuating cost revenue ratios were found with an overall negative PM of €137 147. The DRG R61H was identified as the one most commonly coded (174 cases, 61.3%) with a deficit per case of €814. Subanalysis demonstrated that the payments were not cost covering due to excessive length of stay and staff costs. Significant differences in PM per case concerning age, length of stay and number of operation and procedure key (OPS) codes (P < 0.05) were found. CONCLUSION In our research-driven tertiary care hospital, inpatient treatment of patients with CLL is not cost covering. This analysis demonstrates the need for novel care/reimbursement structures in CLL. From a hospital management perspective, cost revenue controlling is crucial to avoid major economic risks.
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Affiliation(s)
- Florian Kron
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Nadine Kutsch
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Anna Kostenko
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Ines Dohle
- Department of Controlling, University Hospital of Cologne, Cologne, Germany
| | - Jan-Peter Glossmann
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.,Department of Controlling, University Hospital of Cologne, Cologne, Germany
| | - Dirk Müller
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Sebastian M Heimann
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Michael von Bergwelt-Baildon
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Thomas Zander
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
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Asikanius E, Rufibach K, Bahlo J, Bieska G, Burger HU. Comparison of design strategies for a three-arm clinical trial with time-to-event endpoint: Power, time-to-analysis, and operational aspects. Biom J 2016; 58:1295-1310. [PMID: 27346746 DOI: 10.1002/bimj.201500077] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 02/17/2016] [Accepted: 03/31/2016] [Indexed: 12/17/2022]
Abstract
To optimize resources, randomized clinical trials with multiple arms can be an attractive option to simultaneously test various treatment regimens in pharmaceutical drug development. The motivation for this work was the successful conduct and positive final outcome of a three-arm randomized clinical trial primarily assessing whether obinutuzumab plus chlorambucil in patients with chronic lympocytic lymphoma and coexisting conditions is superior to chlorambucil alone based on a time-to-event endpoint. The inference strategy of this trial was based on a closed testing procedure. We compare this strategy to three potential alternatives to run a three-arm clinical trial with a time-to-event endpoint. The primary goal is to quantify the differences between these strategies in terms of the time it takes until the first analysis and thus potential approval of a new drug, number of required events, and power. Operational aspects of implementing the various strategies are discussed. In conclusion, using a closed testing procedure results in the shortest time to the first analysis with a minimal loss in power. Therefore, closed testing procedures should be part of the statistician's standard clinical trials toolbox when planning multiarm clinical trials.
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Affiliation(s)
| | | | - Jasmin Bahlo
- German CLL Study Group, Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
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42
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Kutsch N, Busch R, Bahlo J, Mayer J, Hensel M, Hopfinger G, Hess G, von Grünhagen U, Wendtner CM, Maria Fink A, Fischer K, Hallek M, Eichhorst B. FCR front-line therapy and quality of life in patients with chronic lymphocytic leukemia. Leuk Lymphoma 2016; 58:399-407. [PMID: 27357445 DOI: 10.1080/10428194.2016.1190966] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The chemoimmunotherapy FCR (fludarabine and cyclophosphamide with rituximab) is the standard first-line treatment for physically fit chronic lymphocytic leukemia (CLL) patients. To assess the risks and benefits, we investigated health-related quality of life (HRQOL). 817 untreated CLL patients received either FC or FCR within the GCLLSG CLL8 trial. The European Organization for Research and Treatment of Cancer Quality of life Questionnaire C30 was sent to all patients at baseline, after 3, 6, and 12 months and then yearly as follow-up. A total of 769 (94%) of 817 patients completed at least one questionnaire. Comparing HRQOL of CLL patients with the general German population, CLL patients' health declined in most scales except for global health and pain. No major differences in HRQOL were found during treatment or follow-up between both treatment arms. Females were more likely to have treatment-related symptoms than males. Although FCR was associated with more side effects, this did not influence HRQOL. During follow-up after FCR only minor improvement of HRQOL compared with FC was assessed.
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Affiliation(s)
- Nadine Kutsch
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany
| | - Raymonde Busch
- b Institute of Medical Statistics and Epidemiology , Technical University , Munich , Germany
| | - Jasmin Bahlo
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany
| | - Jiri Mayer
- c Department of Internal Medicine, Hematology and Oncology , University Hospital Brno , Brno , Czech Republic
| | - Manfred Hensel
- d Internal Medicine V , University of Heidelberg , Heidelberg , Germany
| | - Georg Hopfinger
- e Department of Internal Medicine I, Vienna General Hospital, Medical University of Vienna , Vienna , Austria
| | - Georg Hess
- f Department of Hematology and Oncology , Johannes Gutenberg-Universitat , Mainz , Germany
| | | | - Clemens-Martin Wendtner
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany.,h Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine , Klinikum Schwabing , Munich , Germany
| | - Anna Maria Fink
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany
| | - Kirsten Fischer
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany
| | - Michael Hallek
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany
| | - Barbara Eichhorst
- a Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University Hospital of Cologne , Cologne , Germany
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43
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Maurer C, Langerbeins P, Bahlo J, Cramer P, Fink AM, Pflug N, Engelke A, von Tresckow J, Kovacs G, Stilgenbauer S, Wendtner CM, Müller L, Ritgen M, Seiler T, Fischer K, Hallek M, Eichhorst B. Effect of first-line treatment on second primary malignancies and Richter's transformation in patients with CLL. Leukemia 2016; 30:2019-2025. [PMID: 27133817 DOI: 10.1038/leu.2016.113] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/23/2016] [Accepted: 04/05/2016] [Indexed: 12/15/2022]
Abstract
This study aimed to assess the frequency of and the contributing factors for second primary malignancies (SPMs) and Richter's transformations (RTs) following first-line treatment of chronic lymphocytic leukemia within four phase II/III trials of the GCLLSG evaluating fludarabine (F) vs F+cyclophosphamide (FC), chlorambucil vs F, FC without or with rituximab, and bendamustine+R (BR). Among 1458 patients, 239 (16.4%) experienced either an SPM (N=191) or a RT (N=75). Solid tumors (N=115; 43.2% of all second neoplasias) appeared most frequently, followed by RTs (N=75; 28.2%). Patients showed a 1.23-fold increased risk of solid tumors in comparison to the age-matched general population from the German cancer registry. Age>65 (hazard ratio (HR) 2.1; P<0.001), male sex (HR 1.7; P=0.01), co-morbidities (HR 1.6; P=0.01) and number of subsequent treatments⩾1 (HR 12.1; P<0.001) showed an independent adverse prognostic impact on SPM-free survival. Serum thymidine kinase>10 U/l at trial enrollment (HR 3.9; P=0.02), non-response to first-line treatment (HR 3.6; P<0.001) and number of subsequent treatments⩾1 (HR 30.2; P<0.001) were independently associated with increased risk for RT.
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Affiliation(s)
- C Maurer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - P Langerbeins
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - J Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - P Cramer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - A M Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - N Pflug
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - A Engelke
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - J von Tresckow
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - G Kovacs
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - S Stilgenbauer
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - C-M Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - L Müller
- Oncology Leer, Practice for Hematology and Oncology, Leer, Germany
| | - M Ritgen
- Second Department of Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T Seiler
- Department of Medicine III, University Hospital Großhadern/LMU München, Munich, Germany
| | - K Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - M Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany.,Cluster of Excellence in Cellular Stress Responses in Aging-associated Diseases, Univeristy of Cologne, Cologne, Germany
| | - B Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
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44
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Pflug N, Kluth S, Vehreschild JJ, Bahlo J, Tacke D, Biehl L, Eichhorst B, Fischer K, Cramer P, Fink AM, von Bergwelt-Baildon M, Stilgenbauer S, Hallek M, Cornely OA, Vehreschild MJGT. Efficacy of antineoplastic treatment is associated with the use of antibiotics that modulate intestinal microbiota. Oncoimmunology 2016; 5:e1150399. [PMID: 27471619 DOI: 10.1080/2162402x.2016.1150399] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [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: 11/19/2015] [Revised: 01/27/2016] [Accepted: 01/31/2016] [Indexed: 01/14/2023] Open
Abstract
Reduced anticancer efficacy of cyclophosphamide and platinum salts has been reported in animals treated with anti-Gram-positive antibiotics. These effects were related to translocation of Gram-positive bacteria during mucositis with subsequent induction of cytotoxic oxygen reactive species and tumor invasion by pathogenic Th17 cells. To assess these hypotheses in a clinical setting, we identified patients receiving cyclophosphamide for chronic lymphocytic leukemia (CLL) and cisplatin for relapsed lymphoma. Data originated from the CLL8 trial (NCT00281918) and the Cologne Cohort of Neutropenic Patients (NCT01821456). Relevant antibiotics were defined as compounds with primary activity against Gram-positive bacteria. We evaluated their impact on response, progression-free survival (PFS) and overall survival (OS) by Kaplan-Meier methodology and Cox proportional hazards regression analysis. Among 800 available CLL patients, those receiving anti-Gram-positive antibiotics (n = 45/800) achieved a significantly lower overall response rate (OR 74.3% vs. 90.2%, p = 0.007). Patients with anti-Gram-positive antibiotics progressed significantly earlier, had a reduced OS (median PFS 14.1 vs. 44.1 mo, p < 0.001; median OS 56.1 vs. 91.7 mo, p < 0.001) and multivariate analysis showed that administration of anti-Gram-positive antibiotic treatment was independently associated with reduced PFS (Hazard ratio (HR) 2.090, p = 0.001) and OS (HR 2.966, p < 0.001). Of 122 patients with relapsed lymphoma, those treated with anti-Gram-positive antibiotics (n = 21/122) achieved a significantly lower OR rate (70.3% vs. 42.9%, p = 0.016). Patients with anti-Gram-positive antibiotics progressed significantly earlier than others (median PFS 2.3 vs. 11.5 mo, p = 0.001). As for multivariate analysis, the use of anti-Gram-positive antibiotics was independently associated with reduced PFS (HR 2.237, p = 0.012) and OS (HR 7.831, p < 0.001). Our data supports a potential negative impact of anti-Gram-positive antibiotics on the anticancer activity of cyclophosphamide and cisplatin in a clinical setting.
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Affiliation(s)
- Natali Pflug
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German CLL Study Group (GCLLSG), Cologne, Germany
| | - Sandra Kluth
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German CLL Study Group (GCLLSG), Cologne, Germany
| | - Jörg J Vehreschild
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), Partner site Bonn-Cologne, Cologne, Germany
| | - Jasmin Bahlo
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German CLL Study Group (GCLLSG), Cologne, Germany
| | - Daniela Tacke
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), Partner site Bonn-Cologne, Cologne, Germany
| | - Lena Biehl
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), Partner site Bonn-Cologne, Cologne, Germany
| | - Barbara Eichhorst
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German CLL Study Group (GCLLSG), Cologne, Germany
| | - Kirsten Fischer
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German CLL Study Group (GCLLSG), Cologne, Germany
| | - Paula Cramer
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German CLL Study Group (GCLLSG), Cologne, Germany
| | - Anna-Maria Fink
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German CLL Study Group (GCLLSG), Cologne, Germany
| | - Michael von Bergwelt-Baildon
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne , Cologne, Germany
| | | | - Michael Hallek
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German CLL Study Group (GCLLSG), Cologne, Germany
| | - Oliver A Cornely
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), Partner site Bonn-Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), and Clinical Trials Center Cologne, ZKS Köln, University of Cologne, Cologne, Germany
| | - Maria J G T Vehreschild
- 1st Department of Internal Medicine and Center for Integrated Oncology CIO Köln/Bonn, University Hospital of Cologne, Cologne, Germany; German Center for Infection Research (DZIF), Partner site Bonn-Cologne, Cologne, Germany
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45
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Langerbeins P, Bahlo J, Rhein C, Cramer P, Pflug N, Fischer K, Stilgenbauer S, Kreuzer KA, Wendtner CM, Eichhorst B, Hallek M. The CLL12 trial protocol: a placebo-controlled double-blind Phase III study of ibrutinib in the treatment of early-stage chronic lymphocytic leukemia patients with risk of early disease progression. Future Oncol 2016; 11:1895-903. [PMID: 26161926 DOI: 10.2217/fon.15.95] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Observation (watch and wait) is the standard of care for patients with asymptomatic Binet stage A chronic lymphocytic leukemia (CLL). However, the clinical course of these patients is very heterogeneous with some patients requiring treatment rather soon and others not progressing for ages. The clinical staging does not reflect this high variability of the clinical course of CLL. Published data demonstrate that the comprehensive use of several risk factors dramatically improves the accuracy of prognostication independent of clinical stage. The treatment of CLL underwent considerable changes with the introduction of kinase-inhibitors, including ibrutinib, an orally administered, well-tolerated and potent inhibitor of Bruton's tyrosine kinase. This is the first prospective, multicenter, placebo-controlled, double-blind, Phase III study to compare efficacy and safety of ibrutinib to a watch-and-wait approach in Binet stage A CLL with risk of disease progression defined by the comprehensive CLL score.
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Affiliation(s)
- Petra Langerbeins
- Department I of Internal Medicine, Center of Integrated Oncology (CIO), & CECAD - Cluster of Excellence 'Cellular Stress Responses in Aging-Associated Diseases,' University of Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine, Center of Integrated Oncology (CIO), & CECAD - Cluster of Excellence 'Cellular Stress Responses in Aging-Associated Diseases,' University of Cologne, Cologne, Germany
| | - Christina Rhein
- Department I of Internal Medicine, Center of Integrated Oncology (CIO), & CECAD - Cluster of Excellence 'Cellular Stress Responses in Aging-Associated Diseases,' University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine, Center of Integrated Oncology (CIO), & CECAD - Cluster of Excellence 'Cellular Stress Responses in Aging-Associated Diseases,' University of Cologne, Cologne, Germany
| | - Natali Pflug
- Department I of Internal Medicine, Center of Integrated Oncology (CIO), & CECAD - Cluster of Excellence 'Cellular Stress Responses in Aging-Associated Diseases,' University of Cologne, Cologne, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine, Center of Integrated Oncology (CIO), & CECAD - Cluster of Excellence 'Cellular Stress Responses in Aging-Associated Diseases,' University of Cologne, Cologne, Germany
| | | | - Karl Anton Kreuzer
- Department I of Internal Medicine, Center of Integrated Oncology (CIO), & CECAD - Cluster of Excellence 'Cellular Stress Responses in Aging-Associated Diseases,' University of Cologne, Cologne, Germany
| | | | - Barbara Eichhorst
- Department I of Internal Medicine, Center of Integrated Oncology (CIO), & CECAD - Cluster of Excellence 'Cellular Stress Responses in Aging-Associated Diseases,' University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center of Integrated Oncology (CIO), & CECAD - Cluster of Excellence 'Cellular Stress Responses in Aging-Associated Diseases,' University of Cologne, Cologne, Germany
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46
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Maurer C, Pflug N, Bahlo J, Kluth S, Rhein C, Cramer P, Gross-Ophoff C, Langerbeins P, Fink AM, Eichhorst B, Kreuzer KA, Fischer N, Tausch E, Stilgenbauer S, Böttcher S, Döhner H, Kneba M, Dreyling M, Binder M, Hallek M, Wendtner CM, Bergmann M, Fischer K. Bendamustine and rituximab in combination with lenalidomide in patients with chronic lymphocytic leukemia. Eur J Haematol 2016; 97:253-60. [PMID: 26643449 DOI: 10.1111/ejh.12714] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE A phase I/II trial to assess safety and efficacy of the combination bendamustine, rituximab, and lenalidomide (BRL) in patients with chronic lymphocytic leukemia (CLL). PATIENTS AND METHODS Seventeen relapsed or refractory (R/R) and five previously untreated (FL) CLL patients were enrolled in the trial. In the R/R cohort, four different dose levels of lenalidomide (maximum 15 mg/d) were used. In the FL cohort, lenalidomide was dose escalated from 5 mg/d to 15 mg/d. Bendamustine was used at doses of 50 or 90 mg/m(2) for R/R or FL treatment, respectively. 375 mg/m(2) Rituximab were used for the first and 500 mg/m(2) for subsequent treatment courses. Treatment consisted of up to six courses of 28 d. RESULTS The maximal tolerable dose of lenalidomide was 5 mg/d. The response rate was 47.1% in R/R and 60% in FL patients. Median progression-free survival was 8.0 months. Median overall survival was 22.9 and 12.3 months, respectively, in R/R and FL patients. Grade 3/4 hematological toxicity was observed in 71.4%, and severe infections in 47.6% of patients. Due to high toxicity and low response rate of BRL, the trial was closed prematurely. CONCLUSION BRL was associated with a high toxicity rate, a high number of treatment interruptions, and a low remission rate. Therefore, BRL cannot be considered an appropriate treatment option for patients with CLL.
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Affiliation(s)
- Christian Maurer
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Natali Pflug
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Sandra Kluth
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Christina Rhein
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Carolin Gross-Ophoff
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Karl-Anton Kreuzer
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
| | - Norbert Fischer
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Eugen Tausch
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | | | - Sebastian Böttcher
- Second Department of Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Michael Kneba
- Second Department of Medicine, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Martin Dreyling
- Department of Medicine III, Hospital of the University LMU München, München, Germany
| | - Mascha Binder
- Department of Oncology and Hematology, BMT with Section Pneumology, Hubertus Wald Tumorzentrum/UVVH, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center of Integrated Oncology Köln Bonn, Cluster of Excellence on "Cellular Stress Responses in Aging" (CECAD), University of Cologne, Cologne, Germany
| | - Clemens-Martin Wendtner
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany.,Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Manuela Bergmann
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Klinikum Schwabing, Munich, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University of Cologne, Cologne, Germany
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Müller D, Fischer K, Kaiser P, Eichhorst B, Walshe R, Reiser M, Kellermann L, Borsi L, Civello D, Mensch A, Bahlo J, Hallek M, Stock S, Fingerle-Rowson G. Cost-effectiveness of rituximab in addition to fludarabine and cyclophosphamide (R-FC) for the first-line treatment of chronic lymphocytic leukemia. Leuk Lymphoma 2015; 57:1130-9. [PMID: 26584689 DOI: 10.3109/10428194.2015.1070151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The cost-effectiveness of rituximab in combination with fludarabine/cyclophosphamide (R-FC) for the first line treatment of chronic lymphocytic leukemia (CLL) was evaluated. Based on long-term clinical data (follow-up of 5.9 years) from the CLL8-trial, a Markov-model with three health states (Free from disease progression, Progressive disease, Death) was used to evaluate the cost per quality-adjusted life-year (QALY) and cost per life years gained (LYG) of R-FC from the perspective of the German statutory health insurance (SHI). The addition of rituximab to FC chemotherapy results in a gain of 1.1 quality-adjusted life-years. The incremental cost-effectiveness ratio (ICER) of R-FC compared with FC was €17,979 per QALY (€15,773 per LYG). Results were robust in deterministic and probabilistic sensitivity analyses. From the German SHI perspective, rituximab in combination with FC chemotherapy represents good value for first-line treatment of patients with CLL and compares favorably with chemotherapy alone.
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Affiliation(s)
- Dirk Müller
- a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany
| | - Kirsten Fischer
- b Department of Internal Medicine and Centre for Integrated Oncology , University of Cologne , Cologne , Germany
| | - Peter Kaiser
- a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany
| | - Barbara Eichhorst
- b Department of Internal Medicine and Centre for Integrated Oncology , University of Cologne , Cologne , Germany
| | | | - Marcel Reiser
- d PIOH, Praxis of Oncology and Hematology , Cologne , Germany
| | | | - Lisa Borsi
- a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany
| | - Daniele Civello
- a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany
| | - Alexander Mensch
- a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany
| | - Jasmin Bahlo
- b Department of Internal Medicine and Centre for Integrated Oncology , University of Cologne , Cologne , Germany
| | - Michael Hallek
- b Department of Internal Medicine and Centre for Integrated Oncology , University of Cologne , Cologne , Germany
| | - Stephanie Stock
- a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany
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Goede V, Bahlo J, Chataline V, Eichhorst B, Dürig J, Stilgenbauer S, Kolb G, Honecker F, Wedding U, Hallek M. Evaluation of geriatric assessment in patients with chronic lymphocytic leukemia: Results of the CLL9 trial of the German CLL study group. Leuk Lymphoma 2015; 57:789-96. [PMID: 26377031 DOI: 10.3109/10428194.2015.1091933] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Multidimensional geriatric assessment (GA) has been demonstrated to predict outcomes in older patients with cancer. This study evaluated GA in a cohort of older patients with chronic lymphocytic leukemia (CLL). Seventy-five of 97 subjects with CLL who were enrolled in a clinical trial of the German CLL Study Group underwent GA prior to the start of study treatment (low-dose chemotherapy with fludarabine). GA included cumulative illness rating scale (CIRS), timed-up-and-go (TUG) test, dementia detection (DEMTECT) test and instrumental activities of daily living (IADL) index. There was little correlation between CIRS, TUG, DEMTECT or IADL results and treatment toxicity, feasibility or efficacy in this study. CIRS and IADL had no statistically significant impact on overall prognosis. However, under-performance in TUG or DEMTECT test was strongly associated with poor survival. The latter findings provide a rationale to further investigate geriatric assessment in CLL and in the context with other CLL treatments.
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Affiliation(s)
- Valentin Goede
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany .,b Department of Geriatric Medicine , St Marien Hospital , Cologne , Germany
| | - Jasmin Bahlo
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany
| | - Viktoria Chataline
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany
| | - Barbara Eichhorst
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany
| | - Jan Dürig
- c Department of Hematology , University Hospital Essen , Essen , Germany
| | | | - Gerald Kolb
- e Department of Geriatric Medicine , Bonifatius Hospital , Lingen , Germany
| | - Friedemann Honecker
- f Department of Oncology , Hematology, Bone Marrow Transplantation with section Pneumology, University Hospital Hamburg-Eppendorf , Hamburg , Germany .,g Tumor and Breast Center ZeTuP , St. Gallen , Switzerland
| | - Ulrich Wedding
- h Department II of Internal Medicine , University Hospital Jena , Jena , Germany , and
| | - Michael Hallek
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany .,i Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD), University of Cologne , Cologne , Germany
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49
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Goede V, Busch R, Bahlo J, Chataline V, Kremers S, Müller L, Reschke D, Schlag R, Schmidt B, Vehling-Kaiser U, Wedding U, Stilgenbauer S, Hallek M. Low-dose fludarabine with or without darbepoetin alfa in patients with chronic lymphocytic leukemia and comorbidity: primary results of the CLL9 trial of the German CLL Study Group. Leuk Lymphoma 2015; 57:596-603. [PMID: 26293380 DOI: 10.3109/10428194.2015.1079314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study was planned as a phase 3 trial to investigate low-dose fludarabine with or without darbepoetin alfa in older patients with previously untreated or treated chronic lymphocytic leukemia (CLL) and comorbidity. Due to slow recruitment, the study was terminated prematurely after accrual of 97 patients who, on average, were 74 years old and had a cumulative illness rating scale (CIRS) total score of 5. We report toxicity and efficacy of the study treatment. Grade 3-5 neutropenia and infection were observed in 25% and 10% of patients, respectively. Response was seen in 73% (5% complete remissions). Median event-free and overall survival was 12.2 and 44.8 months, respectively. No differences in outcome were found for patients treated with versus without darbepoetin alfa. In subjects with progressive/recurrent CLL during or after study treatment, overall survival was similar for patients receiving chemotherapy versus chemoimmunotherapy as salvage treatment.
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Affiliation(s)
- Valentin Goede
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany .,b Department of Geriatric Medicine , St. Marien Hospital , Cologne , Germany
| | - Raymonde Busch
- c Institute of Medical Statistics and Epidemiology, Technical University of Munich , Munich , Germany
| | - Jasmin Bahlo
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany
| | - Viktoria Chataline
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany
| | - Stephan Kremers
- d Department of Hematology and Oncology , Caritas Hospital , Lebach , Germany
| | | | | | | | | | | | - Ulrich Wedding
- j Department of Palliative Care Medicine , University Hospital Jena , Jena , Germany
| | | | - Michael Hallek
- a German CLL Study Group, Department I of Internal Medicine , Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne , Cologne , Germany .,l Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (CECAD), University of Cologne , Cologne , Germany
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50
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Cramer P, Isfort S, Bahlo J, Stilgenbauer S, Döhner H, Bergmann M, Stauch M, Kneba M, Lange E, Langerbeins P, Pflug N, Kovacs G, Goede V, Fink AM, Elter T, Fischer K, Wendtner CM, Hallek M, Eichhorst B. Outcome of advanced chronic lymphocytic leukemia following different first-line and relapse therapies: a meta-analysis of five prospective trials by the German CLL Study Group (GCLLSG). Haematologica 2015; 100:1451-9. [PMID: 26315931 DOI: 10.3324/haematol.2015.124693] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 08/19/2015] [Indexed: 01/22/2023] Open
Abstract
To evaluate the effect of first-line and subsequent therapies, the outcome of 1,558 patients with chronic lymphocytic leukemia from five prospective phase II/III trials conducted between 1999 and 2010 was analyzed. The 3-year overall survival rate was higher after first-line treatment with chemoimmunotherapies such as fludarabine/cyclophosphamide/rituximab (87.9%) or bendamustine/rituximab (90.7%) compared to chemotherapies without an antibody (fludarabine/cyclophosphamide: 84.6%; fludarabine: 77.5%; chlorambucil: 77.4%). Furthermore, the median overall survival was longer in patients receiving at least one antibody-containing regimen in any treatment line (94.4 months) compared to the survival in patients who never received an antibody (84.3 months, P<0.0001). Univariate Cox regression analysis demonstrated that patients who did receive antibody treatment had a 1.42-fold higher risk of death (hazard ratio, 1.42; 95% confidence interval: 1.185-1.694). Therapies administered at relapse were very heterogeneous. Only 55 of 368 patients (14.9%) who started second-line treatment >24 months after first-line therapy repeated the first-line regimen. Among 315 patients requiring treatment ≤24 months after first-line therapy, cyclophosphamide/doxorubicin/vincristine/prednisone with or without rituximab as well as alemtuzumab were the most commonly used therapies. In these early relapsing patients, the median overall survival was shorter following therapies containing an anthracycline and/or three or more cytotoxic agents (e.g. cyclophosphamide/doxorubicin/vincristine/prednisone or fludarabine/cyclophosphamide/mitoxantrone, 30.0 months) compared to single agent chemotherapy (e.g. fludarabine; 39.6 months) and standard chemoimmunotherapy (e.g. fludarabine/cyclophosphamide/rituximab: 61.6 months). In conclusion, the analysis confirms the superior efficacy of chemoimmunotherapies in patients with chronic lymphocytic leukemia. Moreover, the use of aggressive chemo(immuno)therapy combinations in patients with an early relapse does not offer any benefit when compared to less intensive therapies. Trial identifier: NCT00281918, ISRCTN75653261, ISRCTN36294212, NCT00274989 and NCT00147901.
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Affiliation(s)
- Paula Cramer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany
| | - Susanne Isfort
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany Department for Oncology, Hematology and Stem Cell Transplantation, University Hospital Aachen, Munich, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany
| | | | - Hartmut Döhner
- Department III of Internal Medicine, University Hospital Ulm, Munich, Germany
| | - Manuela Bergmann
- Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Hospital Munich-Schwabing, Munich, Germany
| | - Martina Stauch
- Specialized Practice for Hematology and Oncology and Day Hospital, Kronach, Germany
| | - Michael Kneba
- Department II of Internal Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Elisabeth Lange
- Protestant Hospital Hamm, Clinic for Hematology, Oncology and Palliative Care, Hamm, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany
| | - Natali Pflug
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany
| | - Gabor Kovacs
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany
| | - Valentin Goede
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany
| | - Anna-Maria Fink
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany
| | - Thomas Elter
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany
| | - Clemens-Martin Wendtner
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, Hospital Munich-Schwabing, Munich, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and Center of Integrated Oncology Cologne-Bonn, University of Cologne, Munich, Germany
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