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Kiladjian JJ, Marin FF, Al-Ali HK, Alvarez-Larrán A, Beggiato E, Bieniaszewska M, Breccia M, Buxhofer-Ausch V, Cerna O, Crisan AM, Danaila CD, De Stefano V, Döhner K, Empson V, Gora-Tybor J, Griesshammer M, Grosicki S, Guglielmelli P, García-Gutierrez V, Heidel FH, Illés A, Tomuleasa C, James C, Koschmieder S, Krauth MT, Krejcy K, Lazaroiu MC, Mayer J, Nagy ZG, Nicolini FE, Palandri F, Pappa V, Reiter AJ, Sacha T, Schlager S, Schmidt S, Terpos E, Unger M, Wölfler A, Cirici BX, Klade C. ROP-ET: a prospective phase III trial investigating the efficacy and safety of ropeginterferon alfa-2b in essential thrombocythemia patients with limited treatment options. Ann Hematol 2024:10.1007/s00277-024-05665-4. [PMID: 38438627 DOI: 10.1007/s00277-024-05665-4] [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: 01/12/2024] [Accepted: 02/15/2024] [Indexed: 03/06/2024]
Abstract
Interferon-based therapies, such as ropeginterferon alfa-2b have emerged as promising disease-modifying agents for myeloproliferative neoplasms (MPNs), including essential thrombocythemia (ET). Current ET treatments aim to normalize hematological parameters and reduce the thrombotic risk, but they do not modify the natural history of the disease and hence, have no impact on disease progression. Ropeginterferon alfa-2b (trade name BESREMi®), a novel, monopegylated interferon alfa-2b with an extended administration interval, has demonstrated a robust and sustained efficacy in polycythemia vera (PV) patients. Given the similarities in disease pathophysiology and treatment goals, ropeginterferon alfa-2b holds promise as a treatment option for ET. The ROP-ET trial is a prospective, multicenter, single-arm phase III study that includes patients with ET who are intolerant or resistant to, and/or are ineligible for current therapies, such as hydroxyurea (HU), anagrelide (ANA), busulfan (BUS) and pipobroman, leaving these patients with limited treatment options. The primary endpoint is a composite response of hematologic parameters and disease-related symptoms, according to modified European LeukemiaNet (ELN) criteria. Secondary endpoints include improvements in symptoms and quality of life, molecular response and the safety profile of ropeginterferon alfa-2b. Over a 3-year period the trial assesses longer term outcomes, particularly the effects on allele burden and clinical outcomes, such as disease-related symptoms, vascular events and disease progression. No prospective clinical trial data exist for ropeginterferon alfa-2b in the planned ET study population and this study will provide new findings that may contribute to advancing the treatment landscape for ET patients with limited alternatives. TRIAL REGISTRATION: EU Clinical Trials Register; EudraCT, 2023-505160-12-00; Registered on October 30, 2023.
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Affiliation(s)
- Jean-Jacques Kiladjian
- CIC 1427, Inserm, Université Paris Cité, 75010, Paris, France.
- Centre d'Investigations Cliniques, AP-HP, Hôpital Saint-Louis, Paris, 75010, France.
| | - Francisca Ferrer Marin
- Morales Meseguer University General Hospital, Regional Center of Blood Donation. CIBERER. UCAM. IMIB-Murcia, Murcia, Spain
| | - Haifa Kathrin Al-Ali
- University Hospital Halle (Saale), Krukenberg Cancer Center Halle, Halle, Germany
| | | | - Eloise Beggiato
- University Hospital City of Health and Science of Turin - Hospital Molinette, Complex Structure of Hematology, Torino, Italy
| | | | - Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Veronika Buxhofer-Ausch
- Department of Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Johannes Kepler University Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Olga Cerna
- Clinic of Internal Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ana-Manuela Crisan
- Fundeni Clinical Institute, Center for Hematology and Bone Marrow Transplantation, București, Romania
| | - Catalin Doru Danaila
- Department of Clinical Hematology, Regional Institute of Oncology, Iasi, Romania
| | - Valerio De Stefano
- Fondazione Policlinico Gemelli IRCCS, Section of Hematology, Catholic University, Rome, Italy
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | | | - Joanna Gora-Tybor
- Department of Hematooncology, Copernicus Memorial Hospital, Lodz, Poland
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Martin Griesshammer
- Department of Oncology and Hematology, Ruhr University Bochum, Johannes Wesling Hospital Minden, Minden, Germany
| | | | | | - Valentin García-Gutierrez
- Hospital Universitario Ramón y Cajal, Madrid (IRYCIS), Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Florian H Heidel
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School (MHH), Hannover, Germany
| | - Arpád Illés
- Faculty of Medicine, Department of Internal Medicine, Division of Hematology, University of Debrecen, Debrecen, Hungary
| | - Ciprian Tomuleasa
- Ion Chiricuta Institute of Oncology, Hematology Department and Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Chloe James
- University Bordeaux, INSERM, BMC, U1034, F-33600, Pessac, France
- Laboratory of Hematology, Bordeaux University Hospital, Bordeaux, France
| | - Steffen Koschmieder
- Faculty of Medicine, Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation (Medical Clinic IV), RWTH Aachen University, Aachen, Germany
| | - Maria-Theresa Krauth
- Department of Internal Medicine I, Clinical Department of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | | | | | - Jiri Mayer
- University Hospital Brno, Department of Internal Medicine, Hematology and Oncology, Masaryk University, Brno, Czech Republic
| | - Zsolt György Nagy
- Department of Internal Medicine and Hematology, Division of Hematology, Semmelweis University, Budapest, Hungary
| | | | - Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna and Istituto di Ematologia Seràgnoli, Bologna, Italy
| | | | - Andreas Johannes Reiter
- Medical Clinic III, Hematology and Internistic Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Tomasz Sacha
- Department of Hematology, Jagiellonian University Hospital, Kraków, Poland
| | | | - Stefan Schmidt
- Department of Internal Medicine V (Hematology and Oncology), Medical University Innsbruck, Innsbruck, Austria
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Albert Wölfler
- Department of Internal Medicine, Clinical Divison of Hematology, Medical University Graz, Graz, Austria
| | - Blanca Xicoy Cirici
- Institut Català d' Oncologia- Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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2
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Kröger N, Bacigalupo A, Barbui T, Ditschkowski M, Gagelmann N, Griesshammer M, Gupta V, Hamad N, Harrison C, Hernandez-Boluda JC, Koschmieder S, Jain T, Mascarenhas J, Mesa R, Popat UR, Passamonti F, Polverelli N, Rambaldi A, Robin M, Salit RB, Schroeder T, Scott BL, Tamari R, Tefferi A, Vannucchi AM, McLornan DP, Barosi G. Indication and management of allogeneic haematopoietic stem-cell transplantation in myelofibrosis: updated recommendations by the EBMT/ELN International Working Group. Lancet Haematol 2024; 11:e62-e74. [PMID: 38061384 DOI: 10.1016/s2352-3026(23)00305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 12/24/2023]
Abstract
New options for medical therapy and risk scoring systems containing molecular data are leading to increased complexity in the management of patients with myelofibrosis. To inform patients' optimal care, we updated the 2015 guidelines on indications for and management of allogeneic haematopoietic stem-cell transplantation (HSCT) with the support of the European Society for Blood and Marrow Transplantation (EBMT) and European LeukemiaNet (ELN). New recommendations were produced using a consensus-building methodology after a comprehensive review of articles released from January, 2015 to December, 2022. Seven domains and 18 key questions were selected through a series of questionnaires using a Delphi process. Key recommendations in this update include: patients with primary myelofibrosis and an intermediate-2 or high-risk Dynamic International Prognostic Scoring System score, or a high-risk Mutation-Enhanced International Prognostic Score Systems (MIPSS70 or MIPSS70-plus) score, or a low-risk or intermediate-risk Myelofibrosis Transplant Scoring System score should be considered candidates for allogeneic HSCT. All patients who are candidates for allogeneic HSCT with splenomegaly greater than 5 cm below the left costal margin or splenomegaly-related symptoms should receive a spleen-directed treatment, ideally with a JAK-inhibitor; HLA-matched sibling donors remain the preferred donor source to date. Reduced intensity conditioning and myeloablative conditioning are both valid options for patients with myelofibrosis. Regular post-transplantation driver mutation monitoring is recommended to detect and treat early relapse with donor lymphocyte infusion. In a disease where evidence-based guidance is scarce, these recommendations might help clinicians and patients in shared decision making.
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Affiliation(s)
- Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Andrea Bacigalupo
- Department of Hematology, Fondazione Policlinico Universitario Gemelli IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Markus Ditschkowski
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany
| | - Nico Gagelmann
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Bochum, Germany
| | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Nada Hamad
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia; Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia; School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | | | | | - Steffen Koschmieder
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Aachen, Germany; Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Tania Jain
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - John Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruben Mesa
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Uday R Popat
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Francesco Passamonti
- Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Polverelli
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Rambaldi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Marie Robin
- Department of Hematology, University Hospital of Saint Louis, Paris, France
| | | | - Thomas Schroeder
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital of Essen, Essen, Germany
| | | | - Roni Tamari
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alessandro M Vannucchi
- Centro Ricerca e Innovazione delle Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Donal P McLornan
- Department of Haematology and Stem Cell Transplantation, University College London Hospitals NHS Trust, London, UK
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico S Matteo, Pavia, Italy
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Wille K, Deventer E, Sadjadian P, Becker T, Kolatzki V, Hünerbein K, Meixner R, Jiménez-Muñoz M, Fuchs C, Griesshammer M. Arterial and Venous Thromboembolic Complications in 832 Patients with BCR-ABL-Negative Myeloproliferative Neoplasms. Hamostaseologie 2023. [PMID: 37813367 DOI: 10.1055/a-2159-8767] [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: 10/11/2023] Open
Abstract
Arterial (ATE) and venous (VTE) thromboembolic complications are common causes of morbidity and mortality in BCR-ABL-negative myeloproliferative neoplasms (MPNs). However, there are few studies that include all MPN subtypes and focus on both MPN-associated ATE and VTE. In our single-center retrospective study of 832 MPN patients, a total of 180 first thromboembolic events occurred during a median follow-up of 6.6 years (range: 0-37.6 years), of which 105 were VTE and 75 were ATE. The probability of a vascular event at the end of the follow-up period was 36.2%, and the incidence rate for all first ATE/VTE was 2.43% patient/year. The most frequent VTE localizations were deep vein thrombosis with or without pulmonary embolism (incidence rate: 0.59% patient/year), while strokes were the most frequent ATE with an incidence rate of 0.32% patient/year. When comparing the group of patients with ATE/VTE (n = 180) and the group without such an event (n = 652) using multivariate Cox regression analyses, patients with polycythemia vera (hazard ratio [HR]: 1.660; [95% confidence interval [CI] 1.206, 2.286]) had a significantly higher risk of a thromboembolic event than the other MPN subtypes. In contrast, patients with a CALR mutation had a significantly lower risk of thromboembolism compared with JAK2-mutated MPN patients (HR: 0.346; [95% CI: 0.172, 0.699]). In summary, a high incidence of MPN-associated VTE and ATE was observed in our retrospective study. While PV patients or generally JAK2-mutated MPN patients had a significantly increased risk of such vascular events, this risk was reduced in CALR-mutated MPN patients.
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Affiliation(s)
- Kai Wille
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Bochum, Germany
| | - Eva Deventer
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Bochum, Germany
| | - Parvis Sadjadian
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Bochum, Germany
| | - Tatjana Becker
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Bochum, Germany
| | - Vera Kolatzki
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Bochum, Germany
| | - Karlo Hünerbein
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Bochum, Germany
| | - Raphael Meixner
- Core Facility Statistical Consulting, Helmholtz Zentrum München, Munich, Germany
| | - Marina Jiménez-Muñoz
- Core Facility Statistical Consulting, Helmholtz Zentrum München, Munich, Germany
| | - Christiane Fuchs
- Core Facility Statistical Consulting, Helmholtz Zentrum München, Munich, Germany
- Faculty of Business Administration and Economics, Bielefeld University, Bielefeld, Germany
| | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Bochum, Germany
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4
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Manz K, Bahr J, Ittermann T, Döhner K, Koschmieder S, Brümmendorf TH, Griesshammer M, Nauck M, Völzke H, Heidel FH. Validation of myeloproliferative neoplasms associated risk factor RDW as predictor of thromboembolic complications in healthy individuals: analysis on 6849 participants of the SHIP-study. Leukemia 2023; 37:1745-1749. [PMID: 37353711 PMCID: PMC10400416 DOI: 10.1038/s41375-023-01943-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/18/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Kirsi Manz
- Institut für Community Medicine - Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Jeanette Bahr
- Innere Medizin C, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institut für Community Medicine - Abteilung SHIP-KEF, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Konstanze Döhner
- German MPN Study Group, GSG-MPN, Germany
- Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany
| | - Steffen Koschmieder
- German MPN Study Group, GSG-MPN, Germany
- Innere Medizin IV, RWTH Aachen, Aachen, Germany
| | - Tim H Brümmendorf
- German MPN Study Group, GSG-MPN, Germany
- Innere Medizin IV, RWTH Aachen, Aachen, Germany
| | - Martin Griesshammer
- German MPN Study Group, GSG-MPN, Germany
- Mühlenkreisklinikum Minden, Universitätsklinikum Bochum, Minden, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Henry Völzke
- Institut für Community Medicine - Abteilung SHIP-KEF, Universitätsmedizin Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Florian H Heidel
- Innere Medizin C, Universitätsmedizin Greifswald, Greifswald, Germany.
- German MPN Study Group, GSG-MPN, Germany.
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5
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Wille K, Brouka M, Bernhardt J, Rüfer A, Niculescu-Mizil E, Gotic M, Isfort S, Koschmieder S, Barbui T, Sadjadian P, Becker T, Kolatzki V, Meixner R, Marchi H, Fuchs C, Stegelmann F, Döhner K, Kiladjian JJ, Griesshammer M. Outcome of 129 Pregnancies in Polycythemia Vera Patients: A Report of the European LeukemiaNET. Hemasphere 2023; 7:e882. [PMID: 37153877 PMCID: PMC10155895 DOI: 10.1097/hs9.0000000000000882] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Affiliation(s)
- Kai Wille
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Germany
| | - Maja Brouka
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Germany
| | - Johannes Bernhardt
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Germany
| | - Axel Rüfer
- Luzerner Kantonsspital, Division of Hematology, Luzern, Switzerland
| | | | - Mirjana Gotic
- Clinic for Hematology Clinical Center of Serbia, Medical Faculty University of Belgrade, Serbia
| | - Susanne Isfort
- Department of Medicine (Hematology, Oncology, Hemostaseology and SCT), Faculty of Medicine, RWTH Aachen University, Germany
- Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Germany
| | - Steffen Koschmieder
- Department of Medicine (Hematology, Oncology, Hemostaseology and SCT), Faculty of Medicine, RWTH Aachen University, Germany
- Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Germany
| | - Tiziano Barbui
- Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Parvis Sadjadian
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Germany
| | - Tatjana Becker
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Germany
| | - Vera Kolatzki
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Germany
| | - Raphael Meixner
- Core Facility Statistical Consulting, Helmholtz Zentrum München, Munich, Germany
| | - Hannah Marchi
- Core Facility Statistical Consulting, Helmholtz Zentrum München, Munich, Germany
- Faculty of Business Administration and Economics, Bielefeld University, Germany
| | - Christiane Fuchs
- Core Facility Statistical Consulting, Helmholtz Zentrum München, Munich, Germany
- Faculty of Business Administration and Economics, Bielefeld University, Germany
| | - Frank Stegelmann
- Department of Internal Medicine III, University Hospital of Ulm, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Germany
| | - Jean-Jacques Kiladjian
- Université Paris Cité, AP-HP, Hôpital Saint-Louis, Centre d’Investigations Cliniques, Paris, France
| | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Germany
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6
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Barbui T, Carobbio A, Ghirardi A, Iurlo A, Sobas MA, Elli EM, Rumi E, De Stefano V, Lunghi F, Marchetti M, Daffini R, Gasior Kabat M, Cuevas B, Fox ML, Andrade‐Campos MM, Palandri F, Guglielmelli P, Benevolo G, Harrison C, Foncillas M, Bonifacio M, Alvarez‐Larran A, Kiladjian J, Bolaños Calderón E, Patriarca A, Quiroz Cervantes K, Griesshammer M, Garcia‐Gutierrez V, Marin Sanchez A, Magro Mazo E, Carli G, Hernandez‐Boluda JC, Osorio S, Carreno‐Tarragona G, Sagues Serrano M, Kusec R, Navas Elorza B, Angona A, Xicoy Cirici B, Lopez Abadia E, Koschmieder S, Cattaneo D, Bucelli C, Cichocka E, de Nałęcz AK, Cavalca F, Borsani O, Betti S, Bellini M, Curto‐Garcia N, Rambaldi A, Vannucchi AM. Determinants of early triage for hospitalization in myeloproliferative neoplasm (MPN) patients with COVID-19. Am J Hematol 2022; 97:E470-E473. [PMID: 36111658 PMCID: PMC9538387 DOI: 10.1002/ajh.26732] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Tiziano Barbui
- FROM Research FoundationPapa Giovanni XXIII HospitalBergamoItaly
| | | | - Arianna Ghirardi
- FROM Research FoundationPapa Giovanni XXIII HospitalBergamoItaly
| | - Alessandra Iurlo
- Hematology DivisionFoundation IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Marta Anna Sobas
- Department of Hematology, Blood Neoplasms and Bone Marrow TransplantationWroclaw Medical UniversityWrocławPoland
| | - Elena Maria Elli
- Hematology Division and Bone Marrow Transplant Unit, San Gerardo HospitalASST MonzaMonzaItaly
| | - Elisa Rumi
- Department of molecular medicineUniversity of PaviaPaviaItaly
| | - Valerio De Stefano
- Diagnostic Imaging, Oncological Radiotherapy, and Hematology DepartmentFondazione Universitaria Policlinico A. Gemelli ‐ IRCCS ‐ Catholic University of Sacred Heart of RomeRomeItaly
| | - Francesca Lunghi
- Hematology and BMT UnitUniversity Vita‐Salute San Raffaele, San Raffaele Scientific InstituteMilanItaly
| | - Monia Marchetti
- Division of HematologyAOU SS. Antonio e Biagio e C. ArrigoAlessandriaItaly
| | - Rosa Daffini
- Division of HematologyASST‐Spedali CiviliBresciaItaly
| | | | - Beatriz Cuevas
- Division of HematologyHospital Universitario de BurgosBurgosSpain
| | - Maria Laura Fox
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO)Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital CampusBarcelonaSpain
| | | | - Francesca Palandri
- Institute of HematologyIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Paola Guglielmelli
- Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Department of Experimental and Clinical Medicine, Azienda Ospedaliera Universitaria CareggiUniversity of FlorenceFlorenceItaly
| | - Giulia Benevolo
- Hematology UnitAOU Città della Salute e della ScienzaTurinItaly
| | - Claire Harrison
- Department of HaematologyGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | | | | | | | | | | | - Andrea Patriarca
- Division of Hematology, Department of Translational MedicineAOU Maggiore della CaritàNovaraItaly
| | | | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative CareJohannes Wesling Medical CenterMindenGermany
| | | | | | - Elena Magro Mazo
- Division of HematologyHospital Universitario Principe de AsturiasAlcalà de Henares (Madrid)Spain
| | | | | | | | | | - Miguel Sagues Serrano
- Division of HematologyICO L'Hospitalet‐Hospital Moises BroggiSant Joan Despì (Barcelona)Spain
| | - Rajko Kusec
- Department of haematology, Clinic of internal medicineUniversity Hospital Dubrava‐School of Medicine University of ZagrebZagrebCroatia
| | | | - Anna Angona
- Division of HematologyICO Girona Hospital Josep TruetaGironaSpain
| | - Blanca Xicoy Cirici
- Division of HematologyICO Hospital Germans Trias i PujolBadalona (Barcelona)Spain
| | - Emma Lopez Abadia
- Division of HematologyHospital General de ElcheElche (Alicante)Spain
| | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of MedicineRWTH Aachen UniversityAachenGermany
| | - Daniele Cattaneo
- Hematology DivisionFoundation IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly,Department of Oncology and HematologyUniversità degli Studi di MilanoMilanItaly
| | - Cristina Bucelli
- Hematology DivisionFoundation IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Edyta Cichocka
- Department of Hematology and Bone Marrow TransplantationNicolaus Copernicus HospitalTorunPoland
| | | | - Fabrizio Cavalca
- Hematology Division and Bone Marrow Transplant Unit, San Gerardo HospitalASST MonzaMonzaItaly
| | - Oscar Borsani
- Department of molecular medicineUniversity of PaviaPaviaItaly
| | - Silvia Betti
- Diagnostic Imaging, Oncological Radiotherapy, and Hematology DepartmentFondazione Universitaria Policlinico A. Gemelli ‐ IRCCS ‐ Catholic University of Sacred Heart of RomeRomeItaly
| | - Marta Bellini
- Hematology and Bone Marrow Transplant UnitASST Papa Giovanni XXIIIBergamoItaly
| | | | - Alessandro Rambaldi
- Department of Oncology and HematologyUniversità degli Studi di MilanoMilanItaly,Hematology and Bone Marrow Transplant UnitASST Papa Giovanni XXIIIBergamoItaly
| | - Alessandro Maria Vannucchi
- Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Department of Experimental and Clinical Medicine, Azienda Ospedaliera Universitaria CareggiUniversity of FlorenceFlorenceItaly
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Wille K, Sadjadian P, Griesshammer M. Differenzialdiagnose der Erythrozytose – Ursachen und klinische Bedeutung. Transfusionsmedizin 2022. [DOI: 10.1055/a-1761-4441] [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: 10/18/2022]
Abstract
ZusammenfassungAufgrund ihres seltenen Auftretens stellt die Erythrozytose häufig eine Herausforderung für die behandelnden Ärzte dar. Die Erythropoese (= Produktion von Erythrozyten) ist im Knochenmark
angesiedelt, und das Hormon Erythropoetin (EPO) übernimmt die Kontrolle über ihre Regulation. Daher ist die Messung von EPO im Serum einer der wichtigsten diagnostischen Schritte. Bei der
Erythrozytose muss zwischen angeborenen und erworbenen Ursachen unterschieden werden. Darüber hinaus gibt es primäre und sekundäre Formen. Angeborene Ursachen von Erythrozytosen treten sehr
selten auf, werden meist in jungen Jahren diagnostiziert und sollten in spezialisierten Zentren behandelt werden. Die Polycythaemia vera (PV), eine klonale Störung und eine der wichtigsten
myeloproliferativen Neoplasien (neben der essenziellen Thrombozythämie und der primären Myelofibrose), stellt die häufigste primär erworbene Ursache für Erythrozytosen dar. Klinisch treten
eine erhöhte Thrombophilie und mikrovaskuläre Störungen auf. Die Initialtherapie bei Patienten mit PV umfasst die Verabreichung von Aspirin und Aderlass-Therapie. Sekundär erworbene Formen
der Erythrozytose treten vor allem aufgrund einer durch Nikotinabusus oder chronische Herz- und Lungenerkrankungen ausgelösten Hypoxie auf. Als weitere Differenzialdiagnosen müssen eine
tumorbedingte EPO-Produktion, Nierenerkrankungen oder eine exogene Zufuhr von EPO (= EPO-Doping) in Betracht gezogen werden.
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Affiliation(s)
- Kai Wille
- Universitätsklinikum für Hämatologie, Onkologie, Gerinnungsstörungen und Palliativmedizin, Johannes-Wesling-Klinikum in Minden
| | - Parvis Sadjadian
- Universitätsklinikum für Hämatologie, Onkologie, Gerinnungsstörungen und Palliativmedizin, Johannes-Wesling-Klinikum in Minden
| | - Martin Griesshammer
- Universitätsklinikum für Hämatologie, Onkologie, Gerinnungsstörungen und Palliativmedizin, Johannes-Wesling-Klinikum in Minden
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Neumann JM, Freitag H, Hartmann JS, Niehaus K, Galanis M, Griesshammer M, Kellner U, Bednarz H. Subtyping non-small cell lung cancer by histology-guided spatial metabolomics. J Cancer Res Clin Oncol 2021; 148:351-360. [PMID: 34839410 PMCID: PMC8800912 DOI: 10.1007/s00432-021-03834-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/11/2021] [Indexed: 01/04/2023]
Abstract
Purpose Most cancer-related deaths worldwide are associated with lung cancer. Subtyping of non-small cell lung cancer (NSCLC) into adenocarcinoma (AC) and squamous cell carcinoma (SqCC) is of importance, as therapy regimes differ. However, conventional staining and immunohistochemistry have their limitations. Therefore, a spatial metabolomics approach was aimed to detect differences between subtypes and to discriminate tumor and stroma regions in tissues. Methods Fresh-frozen NSCLC tissues (n = 35) were analyzed by matrix-assisted laser desorption/ionization-mass spectrometry imaging (MALDI-MSI) of small molecules (< m/z 1000). Measured samples were subsequently stained and histopathologically examined. A differentiation of subtypes and a discrimination of tumor and stroma regions was performed by receiver operating characteristic analysis and machine learning algorithms. Results Histology-guided spatial metabolomics revealed differences between AC and SqCC and between NSCLC tumor and tumor microenvironment. A diagnostic ability of 0.95 was achieved for the discrimination of AC and SqCC. Metabolomic contrast to the tumor microenvironment was revealed with an area under the curve of 0.96 due to differences in phospholipid profile. Furthermore, the detection of NSCLC with rarely arising mutations of the isocitrate dehydrogenase (IDH) gene was demonstrated through 45 times enhanced oncometabolite levels. Conclusion MALDI-MSI of small molecules can contribute to NSCLC subtyping. Measurements can be performed intraoperatively on a single tissue section to support currently available approaches. Moreover, the technique can be beneficial in screening of IDH-mutants for the characterization of these seldom cases promoting the development of treatment strategies. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03834-w.
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Affiliation(s)
- Judith Martha Neumann
- Faculty of Biology, Proteome and Metabolome Research, Center for Biotechnology (CeBiTec), Bielefeld University, Bielefeld, Germany
| | - Hinrich Freitag
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jasmin Saskia Hartmann
- Faculty of Biology, Proteome and Metabolome Research, Center for Biotechnology (CeBiTec), Bielefeld University, Bielefeld, Germany
| | - Karsten Niehaus
- Faculty of Biology, Proteome and Metabolome Research, Center for Biotechnology (CeBiTec), Bielefeld University, Bielefeld, Germany
| | - Michail Galanis
- Universitätsklinik für Allgemeinchirurgie, Viszeral-, Thorax- und Endokrine Chirurgie, Johannes Wesling Klinikum Minden, Minden, Germany.,Clinic for Thoracic Surgery and Thoracic Endoscopy, University Hospital Bielefeld Mitte, Bielefeld, Germany
| | - Martin Griesshammer
- Universitätsklinik für Hämatologie, Onkologie, Hämostaseologie und Palliativmedizin, Universitätszentrum Innere Medizin, Johannes Wesling Klinikum Minden, Minden, Germany
| | - Udo Kellner
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany. .,Institut für Pathologie, Johannes Wesling Klinikum, Minden, Germany.
| | - Hanna Bednarz
- Faculty of Biology, Proteome and Metabolome Research, Center for Biotechnology (CeBiTec), Bielefeld University, Bielefeld, Germany. .,Medical School OWL, AG1: Sustainable Environmental Health Sciences, Bielefeld University, Bielefeld, Germany.
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Stegelmann F, Wille K, Busen H, Fuchs C, Schauer S, Sadjadian P, Becker T, Kolatzki V, Döhner H, Stadler R, Döhner K, Griesshammer M. Publisher Correction: Significant association of cutaneous adverse events with hydroxyurea: results from a prospective non-interventional study in BCR-ABL1-negative myeloproliferative neoplasms (MPN) - on behalf of the German Study Group-MPN. Leukemia 2021; 35:3635. [PMID: 34785798 PMCID: PMC8632683 DOI: 10.1038/s41375-021-01366-3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Frank Stegelmann
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany.
| | - Kai Wille
- University Clinic for Hematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Hannah Busen
- Faculty of Business Administration and Economics, Bielefeld University, Bielefeld, Germany.,Institute of Computational Biology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany
| | - Christiane Fuchs
- Faculty of Business Administration and Economics, Bielefeld University, Bielefeld, Germany.,Institute of Computational Biology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany
| | - Stefanie Schauer
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Parvis Sadjadian
- University Clinic for Hematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Tatjana Becker
- University Clinic for Hematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Vera Kolatzki
- University Clinic for Hematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Rudolf Stadler
- University Clinic for Dermatology, Venereology, Allergology and Phlebology, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | | | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
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Wille K, Huenerbein K, Jagenberg E, Sadjadian P, Becker T, Kolatzki V, Meixner R, Marchi H, Fuchs C, Griesshammer M. Bleeding complications in bcr-abl-negative myeloproliferative neoplasms (MPN): A retrospective single-center study of 829 MPN patients. Eur J Haematol 2021; 108:154-162. [PMID: 34719056 DOI: 10.1111/ejh.13721] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 12/17/2022]
Abstract
In patients with bcr-abl-negative myeloproliferative neoplasms (MPN), concerns are often raised about the use of anticoagulants because of an increased bleeding risk. However, there are few MPN studies focusing on bleeding. To investigate bleeding complications in MPN, we report our retrospective, single-center study of 829 patients with a median follow-up of 5.5 years (range: 0.1-35.6). A first bleeding event occurred in 143 of 829 patients (17.2%), corresponding to an incidence rate of 2.29% per patient/year. During the follow-up period, one out of 829 patients (0.1%) died due to bleeding. Regarding anticoagulation, most bleeding occurred in patients on antiplatelet therapies (60.1%), followed by patients on anticoagulation therapies (20.3%) and patients not on anticoagulation (19.6%). In multivariate analysis, administration of antiplatelet (HR 2.31 [1.43, 3.71]) and anticoagulation therapies (HR 4.06 [2.32, 7.09]), but not age, gender or mutation status, was associated with an increased bleeding risk. Comparing the "probability of bleeding-free survival" between the MPN subtypes, no significant difference was observed (p = 0.91, log-rank test). Our retrospective study shows that antiplatelet and anticoagulation therapies significantly increase the risk of bleeding in MPN patients without affecting mortality. However, there is no reason to refrain from guideline-conform primary or secondary anticoagulation in MPN patients.
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Affiliation(s)
- Kai Wille
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Karlo Huenerbein
- University Institute for Anesthesiology, Intensive Care and Emergency Medicine, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Ellen Jagenberg
- University Institute for Anesthesiology, Intensive Care and Emergency Medicine, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Parvis Sadjadian
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Tatjana Becker
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Vera Kolatzki
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Raphael Meixner
- Institute of Computational Biology, Helmholtz Center Munich, Neuherberg, Germany
| | - Hannah Marchi
- Institute of Computational Biology, Helmholtz Center Munich, Neuherberg, Germany.,Bielefeld University, Bielefeld, Germany
| | - Christiane Fuchs
- Institute of Computational Biology, Helmholtz Center Munich, Neuherberg, Germany.,Bielefeld University, Bielefeld, Germany
| | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
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Alvarez-Larrán A, Sant'Antonio E, Harrison C, Kiladjian JJ, Griesshammer M, Mesa R, Ianotto JC, Palandri F, Hernández-Boluda JC, Birgegård G, Nangalia J, Koschmieder S, Rumi E, Barbui T. Unmet clinical needs in the management of CALR-mutated essential thrombocythaemia: a consensus-based proposal from the European LeukemiaNet. Lancet Haematol 2021; 8:e658-e665. [PMID: 34450103 DOI: 10.1016/s2352-3026(21)00204-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 12/18/2022]
Abstract
Recommendations regarding management of essential thrombocythaemia rely on studies done before the discovery of the CALR mutation. On May 20, 2020, the European LeukemiaNet annual meeting was held with the goal to identify unmet clinical needs in myeloproliferative neoplasms. Because patients with a CALR mutation have specific clinical characteristics, treatment of CALR-mutated essential thrombocythaemia was considered an unmet clinical need by the European LeukemiaNet. The elaboration of a consensus document with recommendations according to current evidence was proposed as a solution for resolving uncertainties in the treatment of CALR-mutated essential thrombocythaemia. A steering committee comprising four European LeukemiaNet members was then formed and a panel of ten experts in the field was recruited. The experts proposed 51 potential unmet clinical needs in the management of CALR-mutated essential thrombocythaemia and were asked to score the relevance of each topic. Those topics that obtained the highest scores as relevant unmet clinical needs were identified, including antiplatelet therapy in patients at low risk, definition of extreme thrombocytosis and its management in patients at low risk, indications of cytoreduction and targets of therapy, first-line treatment of choice in young patients (<60 years), and management of pregnancy. After the steering committee revised the available evidence for each topic, a consensus on management and proposal for improving knowledge was achieved by use of an email-based, two round, Delphi approach. Consensus was achieved when 90% of the panellists agreed with a statement and included 14 recommendations and six solution proposals. Key recommendations included careful observation for asymptomatic patients with classical, low-risk, CALR-mutated essential thrombocythaemia without cardiovascular risk factors; caution in the use of antiplatelet therapy for symptomatic patients at low risk with platelet counts of 1000-1500 × 109 platelets per L, in such cases cytoreduction is an adequate option, especially if adquired Von Willebrand disease is present; cytoreduction is recommended for extreme thrombocytosis (platelet count >1500 × 109 platelets per L) with pegylated interferon alfa being the preferred option for younger patients; both hydroxycarbamide and anagrelide might be given to patients ineligible for pegylated interferon alfa; and treatment algorithms for patients with high-risk pregnancies should not be changed according to genotype. The European LeukemiaNet proposes to use these recommendations in the routine management of patients with CALR-mutated essential thrombocythaemia, and designing new clinical studies in this field might be useful.
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Affiliation(s)
- Alberto Alvarez-Larrán
- Hematology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | | | - Claire Harrison
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jean-Jacques Kiladjian
- Université de Paris, AP-HP, HÔpital Saint-Louis, Centre d'Investigations Cliniques, INSERM, CIC1427, Paris, France
| | - Martin Griesshammer
- Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden UKRUB, University of Bochum, Germany
| | - Ruben Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Jean Christophe Ianotto
- Service d'Hématologie Clinique, Institut de Cancero-Hematologie, CHRU de Brest, Brest, France
| | - Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | | | - Gunnar Birgegård
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Elisa Rumi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
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12
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Gecht J, Tsoukakis I, Kricheldorf K, Stegelmann F, Klausmann M, Griesshammer M, Schulz H, Hollburg W, Göthert JR, Sockel K, Heidel FH, Gattermann N, Maintz C, Al-Ali HK, Platzbecker U, Hansen R, Hänel M, Parmentier S, Bommer M, Pahl HL, Lang F, Kirschner M, Isfort S, Brümmendorf TH, Döhner K, Koschmieder S. Kidney Dysfunction Is Associated with Thrombosis and Disease Severity in Myeloproliferative Neoplasms: Implications from the German Study Group for MPN Bioregistry. Cancers (Basel) 2021; 13:cancers13164086. [PMID: 34439237 PMCID: PMC8393882 DOI: 10.3390/cancers13164086] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary In patients with myeloproliferative neoplasms (MPN) and in patients with kidney dysfunction, a higher rate of thrombosis has been reported compared with the general population. Furthermore, MPN patients are more prone to develop kidney dysfunction. In our study, we assessed the importance of specific risk factors for kidney dysfunction and thrombosis in MPN patients. We found that the rate of thrombosis is correlated with the degree of kidney dysfunction, especially in myelofibrosis. Significant associations for kidney dysfunction included arterial hypertension, MPN treatment, and increased inflammation, and those for thrombosis comprised arterial hypertension, non-excessive platelet counts, and antithrombotic therapy. The identified risk factor associations varied between MPN subtypes. Our data suggest that kidney dysfunction in MPN patients is associated with an increased risk of thrombosis, mandating closer monitoring, and, possibly, early thromboprophylaxis. Abstract Inflammation-induced thrombosis represents a severe complication in patients with myeloproliferative neoplasms (MPN) and in those with kidney dysfunction. Overlapping disease-specific attributes suggest common mechanisms involved in MPN pathogenesis, kidney dysfunction, and thrombosis. Data from 1420 patients with essential thrombocythemia (ET, 33.7%), polycythemia vera (PV, 38.5%), and myelofibrosis (MF, 27.9%) were extracted from the bioregistry of the German Study Group for MPN. The total cohort was subdivided according to the calculated estimated glomerular filtration rate (eGFR, (mL/min/1.73 m2)) into eGFR1 (≥90, 21%), eGFR2 (60–89, 56%), and eGFR3 (<60, 22%). A total of 29% of the patients had a history of thrombosis. A higher rate of thrombosis and longer MPN duration was observed in eGFR3 than in eGFR2 and eGFR1. Kidney dysfunction occurred earlier in ET than in PV or MF. Multiple logistic regression analysis identified arterial hypertension, MPN treatment, increased uric acid, and lactate dehydrogenase levels as risk factors for kidney dysfunction in MPN patients. Risk factors for thrombosis included arterial hypertension, non-excessive platelet counts, and antithrombotic therapy. The risk factors for kidney dysfunction and thrombosis varied between MPN subtypes. Physicians should be aware of the increased risk for kidney disease in MPN patients, which warrants closer monitoring and, possibly, early thromboprophylaxis.
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Affiliation(s)
- Judith Gecht
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
| | - Ioannis Tsoukakis
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
- Department of Medicine, Hematology/Oncology, Goethe-University, 60590 Frankfurt am Main, Germany;
| | - Kim Kricheldorf
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
| | - Frank Stegelmann
- Department of Internal Medicine III, University Hospital of Ulm, 89081 Ulm, Germany; (F.S.); (K.D.)
| | | | - Martin Griesshammer
- Johannes Wesling Medical Center, University Clinic for Hematology, Oncology, Hemostaseology, and Palliative Care (UKRUB), University of Bochum, 32429 Minden, Germany;
| | | | - Wiebke Hollburg
- HOPA-Hämatologisch-Onkologische Praxis Altona, 22767 Hamburg, Germany;
| | - Joachim R. Göthert
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, 45147 Essen, Germany;
| | - Katja Sockel
- Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany;
| | - Florian H. Heidel
- Innere Medizin C, Universitätsmedizin Greifswald, 17475 Greifswald, Germany;
- Department of Hematology/Oncology, Clinic of Internal Medicine II, Jena University Hospital, 07747 Jena, Germany
| | - Norbert Gattermann
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
- Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | | | - Haifa K. Al-Ali
- Department of Hematology/Oncology, University Hospital Halle, 06120 Halle, Germany;
| | - Uwe Platzbecker
- Department of Hematology and Cellular Therapy, Medical Clinic and Policlinic I, Leipzig University Hospital, 04103 Leipzig, Germany;
| | - Richard Hansen
- Oncological Practice Dres. Hansen & Reeb, 67655 Kaiserslautern, Germany;
| | - Mathias Hänel
- Department of Internal Medicine III, Klinikum Chemnitz, 09116 Chemnitz, Germany;
| | - Stefani Parmentier
- Department of Hematology and Oncology, Rems-Murr-Klinikum Winnenden, 71364 Winnenden, Germany;
- Onkologie/Hämatologie, Claraspital Tumorzentrum Basel, 4058 Basel, Switzerland
| | - Martin Bommer
- Department of Hematology, Oncology, Infectious Diseases and Palliative Care, Alb-Fils-Kliniken, 73035 Göppingen, Germany;
| | - Heike L. Pahl
- Department of Medicine I, Hematology and Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Fabian Lang
- Department of Medicine, Hematology/Oncology, Goethe-University, 60590 Frankfurt am Main, Germany;
| | - Martin Kirschner
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
| | - Susanne Isfort
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
| | - Tim H. Brümmendorf
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, 89081 Ulm, Germany; (F.S.); (K.D.)
| | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology and SCT, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (J.G.); (I.T.); (K.K.); (M.K.); (S.I.); (T.H.B.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany;
- Correspondence: ; Tel.: +49-241-8036102
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Huenerbein K, Sadjadian P, Becker T, Kolatzki V, Deventer E, Engelhardt C, Griesshammer M, Wille K. Direct oral anticoagulants (DOAC) for prevention of recurrent arterial or venous thromboembolic events (ATE/VTE) in myeloproliferative neoplasms. Ann Hematol 2021; 100:2015-2022. [PMID: 33216197 PMCID: PMC8285319 DOI: 10.1007/s00277-020-04350-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/11/2020] [Indexed: 12/22/2022]
Abstract
In patients with BCR-ABL-negative myeloproliferative neoplasms (MPN), arterial or venous thromboembolic events (ATE/VTE) are a major burden. In order to control these complications, vitamin K antagonists (VKA) are widely used. There is no robust evidence supporting the use of direct oral anticoagulants (DOAC) in MPN patients. We therefore compared the efficacy and safety of both anticoagulants in 71 cases from a cohort of 782 MPN patients. Seventy-one of 782 MPN patients (9.1%) had ATE/VTE with nine ATE (12.7%) and 62 VTE (87.3%). Forty-five of 71 ATE/VTE (63.4%) were treated with VKA and 26 (36.6%) with DOAC. The duration of anticoagulation therapy (p = 0.984), the number of patients receiving additional aspirin (p = 1.0), and the proportion of patients receiving cytoreductive therapy (p = 0.807) did not differ significantly between the VKA and DOAC groups. During anticoagulation therapy, significantly more relapses occurred under VKA (n = 16) compared to DOAC treatment (n = 0, p = 0.0003). However, during the entire observation period of median 3.2 years (0.1-20.4), ATE/VTE relapse-free survival (p = 0.2) did not differ significantly between the two anticoagulants. For all bleeding events (p = 0.516) or major bleeding (p = 1.0), no significant differences were observed between VKA and DOAC. In our experience, the use of DOAC was as effective and safe as VKA, possibly even potentially beneficial with a lower number of recurrences and no increased risk for bleedings. However, further and larger studies are required before DOAC can be routinely used in MPN patients.
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Affiliation(s)
- Karlo Huenerbein
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, University of Bochum, Hans-Nolte-Straße 1, D-32429 Minden, Germany
| | - Parvis Sadjadian
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, University of Bochum, Hans-Nolte-Straße 1, D-32429 Minden, Germany
| | - Tatjana Becker
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, University of Bochum, Hans-Nolte-Straße 1, D-32429 Minden, Germany
| | - Vera Kolatzki
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, University of Bochum, Hans-Nolte-Straße 1, D-32429 Minden, Germany
| | - Eva Deventer
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, University of Bochum, Hans-Nolte-Straße 1, D-32429 Minden, Germany
| | | | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, University of Bochum, Hans-Nolte-Straße 1, D-32429 Minden, Germany
| | - Kai Wille
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, University of Bochum, Hans-Nolte-Straße 1, D-32429 Minden, Germany
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14
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Passamonti F, Gupta V, Martino B, Foltz L, Zaritskey A, Al-Ali HK, Tavares R, Maffioli M, Raanani P, Giraldo P, Griesshammer M, Guglielmelli P, Bouard C, Paley C, Tiwari R, Vannucchi AM. Comparing the safety and efficacy of ruxolitinib in patients with Dynamic International Prognostic Scoring System low-, intermediate-1-, intermediate-2-, and high-risk myelofibrosis in JUMP, a Phase 3b, expanded-access study. Hematol Oncol 2021; 39:558-566. [PMID: 34224180 PMCID: PMC8518822 DOI: 10.1002/hon.2898] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/05/2021] [Accepted: 06/24/2021] [Indexed: 01/05/2023]
Abstract
Ruxolitinib, a potent Janus kinase 1/2 inhibitor, has demonstrated durable improvements in patients with myelofibrosis. In this analysis of the Phase 3b JUMP study, which included patients aged ≥18 years with a diagnosis of primary or secondary myelofibrosis, we assessed the safety and efficacy of ruxolitinib in patients stratified by Dynamic International Prognostic Scoring System (DIPSS) risk categories. Baseline characteristic data were available to assess DIPSS status for 1844 of the 2233 enrolled patients; 60, 835, 755, and 194 in the low‐, intermediate (Int)‐1‐, Int‐2‐, and high‐risk groups, respectively. Ruxolitinib was generally well tolerated across all risk groups, with an adverse‐event (AE) profile consistent with previous reports. The most common hematologic AEs were thrombocytopenia and anemia, with highest rates of Grade ≥3 events in high‐risk patients. Approximately, 73% of patients experienced ≥50% reductions in palpable spleen length at any point in the ≤24‐month treatment period, with highest rates in lower‐risk categories (low, 82.1%; Int‐1, 79.3%; Int‐2, 67.1%; high risk, 61.6%). Median time to spleen length reduction was 5.1 weeks and was shortest in lower‐risk patients. Across measures, 40%–57% of patients showed clinically meaningful symptom improvements, which were observed from 4 weeks after treatment initiation and maintained throughout the study. Overall survival (OS) was 92% at Week 72 and 75% at Week 240 (4.6 years). Median OS was longer for Int‐2‐risk than high‐risk patients (253.6 vs. 147.3 weeks), but not evaluable in low‐/Int‐1‐risk patients. By Week 240, progression‐free survival (PFS) and leukemia‐free survival (LFS) rates were higher in lower‐risk patients (PFS: low, 90%; Int‐1, 82%; Int‐2, 46%; high risk, 15%; LFS: low, 92%; Int‐1, 86%; Int‐2, 58%; high risk, 19%). Clinical benefit was seen across risk groups, with more rapid improvements in lower risk patients. Overall, this analysis indicates that ruxolitinib benefits lower‐risk DIPSS patients in addition to higher risk.
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Affiliation(s)
| | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Bruno Martino
- Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Lynda Foltz
- St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrey Zaritskey
- Federal Almazov Medical Research Center of the Russian Ministry of Health, St Petersburg, Russia
| | | | | | | | - Pia Raanani
- Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pilar Giraldo
- Miguel Servet University Hospital and Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER), Zaragoza, Spain
| | | | - Paola Guglielmelli
- CRIMM, Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
| | | | | | - Ranjan Tiwari
- Novartis Healthcare Pvt., Ltd., Hyderabad, Telangana, India
| | - Alessandro M Vannucchi
- CRIMM, Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
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15
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Abstract
Introduction: Hydroxyurea (HU) is an S-phase specific oral chemotherapeutic agent that inhibits ribonucleotide diphosphate reductase. It is the most common used cytoreductive drug in patients (pts) with BCR-ABL1 negative myeloproliferative neoplasms (MPN) and sickle cell disease (SCD). The World Health Organization lists HU as an "essential drug". Although most patients tolerate HU well, cutaneous adverse events (CAE) are frequent side effects and may limit its long-term use. This has become increasingly evident in recent years, especially in MPN patients, where CAE were previously underestimated and underdiagnosed.Areas covered: In this review, we present the available literature on HU-related CAE in MPN patients. In particular, data from a recently published and so far, only prospective non-interventional study investigating CAE in 172 MPN patients will be discussed in detail and compared with previously available data. Finally, we give an overview of the management of HU-related CAE in MPN patients and provide recommendations on the practical clinical approach.Expert opinion: In clinical practice, HU associated CAE are common and have important diagnostic and therapeutic consequences. Therefore, they should be considered in all MPN patients treated with HU in the future.
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Affiliation(s)
- Martin Griesshammer
- University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Germany
| | - Kai Wille
- University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Germany
| | - Parvis Sadjadian
- University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Germany
| | - Frank Stegelmann
- Department of Internal Medicine III, University Hospital of Ulm, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Germany
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16
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Kirschner M, do Ó Hartmann N, Parmentier S, Hart C, Henze L, Bisping G, Griesshammer M, Langer F, Pabinger-Fasching I, Matzdorff A, Riess H, Koschmieder S. Primary Thromboprophylaxis in Patients with Malignancies: Daily Practice Recommendations by the Hemostasis Working Party of the German Society of Hematology and Medical Oncology (DGHO), the Society of Thrombosis and Hemostasis Research (GTH), and the Austrian Society of Hematology and Oncology (ÖGHO). Cancers (Basel) 2021; 13:2905. [PMID: 34200741 PMCID: PMC8230401 DOI: 10.3390/cancers13122905] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with cancer, both hematologic and solid malignancies, are at increased risk for thrombosis and thromboembolism. In addition to general risk factors such as immobility and major surgery, shared by non-cancer patients, cancer patients are exposed to specific thrombotic risk factors. These include, among other factors, cancer-induced hypercoagulation, and chemotherapy-mediated endothelial dysfunction as well as tumor-cell-derived microparticles. After an episode of thrombosis in a cancer patient, secondary thromboprophylaxis to prevent recurrent thromboembolism has long been established and is typically continued as long as the cancer is active or actively treated. On the other hand, primary prophylaxis, even though firmly established in hospitalized cancer patients, has only recently been studied in ambulatory patients. This recent change is mostly due to the emergence of direct oral anticoagulants (DOACs). DOACs have a shorter half-life than vitamin K antagonists (VKA), and they overcome the need for parenteral application, the latter of which is associated with low-molecular-weight heparins (LMWH) and can be difficult for the patient to endure in the long term. Here, first, we discuss the clinical trials of primary thromboprophylaxis in the population of cancer patients in general, including the use of VKA, LMWH, and DOACs, and the potential drug interactions with pre-existing medications that need to be taken into account. Second, we focus on special situations in cancer patients where primary prophylactic anticoagulation should be considered, including myeloma, major surgery, indwelling catheters, or immobilization, concomitant diseases such as renal insufficiency, liver disease, or thrombophilia, as well as situations with a high bleeding risk, particularly thrombocytopenia, and specific drugs that may require primary thromboprophylaxis. We provide a novel algorithm intended to aid specialists but also family practitioners and nurses who care for cancer patients in the decision process of primary thromboprophylaxis in the individual patient.
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Affiliation(s)
- Martin Kirschner
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (M.K.); (N.d.Ó.H.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany
| | - Nicole do Ó Hartmann
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (M.K.); (N.d.Ó.H.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany
| | - Stefani Parmentier
- Oncology and Hematology, Tumor Center, St. Claraspital, 4058 Basel, Switzerland;
| | - Christina Hart
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Larissa Henze
- Department of Medicine, Clinic III—Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany;
| | - Guido Bisping
- Department of Medicine I, Mathias Spital Rheine, 48431 Rheine, Germany;
| | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, 32429 Minden, Germany;
| | - Florian Langer
- II.Medical Clinic and Polyclinic, Center for Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Ingrid Pabinger-Fasching
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Axel Matzdorff
- Department of Internal Medicine II, Asklepios Clinic Uckermark, 16303 Schwedt, Germany;
| | - Hanno Riess
- Medical Department, Division of Oncology and Hematology, Campus Charité Mitte, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany; (M.K.); (N.d.Ó.H.)
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), 52074 Aachen, Germany
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17
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Wille K, Bernhardt J, Sadjadian P, Becker T, Kolatzki V, Huenerbein K, Griesshammer M. The management, outcome, and postpartum disease course of 41 pregnancies in 20 women with polycythemia vera. Eur J Haematol 2021; 107:122-128. [PMID: 33763907 DOI: 10.1111/ejh.13627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Pregnancies in women with polycythemia vera (PV) are associated with an increased risk of PV-related maternal complications and often result in miscarriage. Recommendations for the management of PV pregnancies are mainly based on studies with a small number of patients. A correlation between pregnancy outcome and postpartum course has been reported for essential thrombocythemia, but corresponding data for PV are lacking so far. METHODS In 41 PV pregnancies, the pregnancy outcome, the use of PV-specific therapies (ie, acetylsalicylic acid, low-molecular weight heparin and/or interferon-alpha), and the postpartum PV course were investigated. RESULTS A live birth rate of 51.2% (21/41 pregnancies) was observed. 43.9% of pregnancies ended in spontaneous abortion and 4.9% in stillbirth. A significantly increased live birth rate occurred in pregnancies with PV-specific therapies compared to standard antenatal care (69.0% vs. 8.3%; P < .0019). The use of PV-specific therapy significantly increased the number of maternal hemorrhages (P = .021) without increasing the risk of fetal complications. During the median postpartum follow-up period of 1.2 years (range 0.1-13.7), complicated postpartum PV occurred significantly more often after miscarriages (P = .035). CONCLUSIONS According to our analysis, PV-specific therapy improved the live birth rate. Significantly more complicated postpartum PV courses were observed after miscarriages.
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Affiliation(s)
- Kai Wille
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Johannes Bernhardt
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Parvis Sadjadian
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Tatjana Becker
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Vera Kolatzki
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Karlo Huenerbein
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
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18
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Barbui T, De Stefano V, Carobbio A, Iurlo A, Alvarez-Larran A, Cuevas B, Ferrer Marín F, Vannucchi AM, Palandri F, Harrison C, Sibai H, Griesshammer M, Bonifacio M, Elli EM, Trotti C, Koschmieder S, Carli G, Benevolo G, Ianotto JC, Goel S, Falanga A, Betti S, Cattaneo D, Arellano-Rodrigo E, Mannelli L, Vianelli N, Doyle A, Gupta V, Wille K, Tremblay D, Mascarenhas J. Direct oral anticoagulants for myeloproliferative neoplasms: results from an international study on 442 patients. Leukemia 2021; 35:2989-2993. [PMID: 34012132 PMCID: PMC8132485 DOI: 10.1038/s41375-021-01279-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/14/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Tiziano Barbui
- grid.460094.f0000 0004 1757 8431FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Valerio De Stefano
- grid.8142.f0000 0001 0941 3192Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy
| | - Alessandra Carobbio
- grid.460094.f0000 0004 1757 8431FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandra Iurlo
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | - Alessandro M. Vannucchi
- grid.8404.80000 0004 1757 2304CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Firenze, Italy
| | - Francesca Palandri
- grid.6292.f0000 0004 1757 1758Institute of Hematology “L. & A. Seragnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Claire Harrison
- grid.420545.2Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Hassan Sibai
- grid.415224.40000 0001 2150 066XPrincess Margaret Cancer Centre, Toronto, ON Canada
| | - Martin Griesshammer
- grid.5570.70000 0004 0490 981XJohannes Wesling Medical Center, University of Bochum, Bochum, Germany
| | - Massimiliano Bonifacio
- grid.5611.30000 0004 1763 1124Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Elena M. Elli
- grid.415025.70000 0004 1756 8604Hematology Division and Bone Marrow Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Chiara Trotti
- grid.8982.b0000 0004 1762 5736Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Pavia, Italy
| | - Steffen Koschmieder
- grid.1957.a0000 0001 0728 696XFaculty of Medicine, Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, RWTH Aachen University, Aachen, Germany
| | - Giuseppe Carli
- grid.416303.30000 0004 1758 2035Ospedale San Bortolo, Vicenza, Italy
| | - Giulia Benevolo
- Hematology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Jean-Christophe Ianotto
- grid.411766.30000 0004 0472 3249Service d’Hématologie Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Brest, France
| | - Swati Goel
- grid.240283.f0000 0001 2152 0791Albert Einstein Montefiore Medical Center, New York, NY USA
| | - Anna Falanga
- grid.460094.f0000 0004 1757 8431ASST Papa Giovanni XXIII, Bergamo, Italy ,grid.7563.70000 0001 2174 1754School of Medicine, University of Milan Bicocca, Monza, Italy
| | - Silvia Betti
- grid.8142.f0000 0001 0941 3192Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Policlinico Universitario “A. Gemelli” IRCCS, Roma, Italy
| | - Daniele Cattaneo
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Lara Mannelli
- grid.8404.80000 0004 1757 2304CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, AOU Careggi, Firenze, Italy
| | - Nicola Vianelli
- grid.6292.f0000 0004 1757 1758Institute of Hematology “L. & A. Seragnoli”, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrew Doyle
- grid.420545.2Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Vikas Gupta
- grid.415224.40000 0001 2150 066XPrincess Margaret Cancer Centre, Toronto, ON Canada
| | - Kai Wille
- grid.5570.70000 0004 0490 981XJohannes Wesling Medical Center, University of Bochum, Bochum, Germany
| | - Douglas Tremblay
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - John Mascarenhas
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY USA
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19
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Gupta V, Griesshammer M, Martino B, Foltz L, Tavares R, Al-Ali HK, Giraldo P, Guglielmelli P, Lomaia E, Bouard C, Paley C, Tiwari R, Zor E, Raanani P. Analysis of predictors of response to ruxolitinib in patients with myelofibrosis in the phase 3b expanded-access JUMP study. Leuk Lymphoma 2020; 62:918-926. [DOI: 10.1080/10428194.2020.1845334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Bruno Martino
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Hematology Unit, Reggio Calabria, Italy
| | | | | | | | - Pilar Giraldo
- Miguel Servet University Hospital and Centro de Investigacion Biomedica en Red de Enfermadades Raras (CIBERER), Zaragoza, Spain
| | - Paola Guglielmelli
- Azienda Ospedaliero-Universitaria Careggi Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elza Lomaia
- Almazov National Medical Research Centre, St Petersburg, Russia
| | | | | | | | | | - Pia Raanani
- Rabin Medical Center, Petah Tikva & Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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20
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Schrickel L, Heidel FH, Sadjadian P, Becker T, Kolatzki V, Hochhaus A, Griesshammer M, Wille K. Interferon alpha for essential thrombocythemia during 34 high-risk pregnancies: outcome and safety. J Cancer Res Clin Oncol 2020; 147:1481-1491. [PMID: 33140210 DOI: 10.1007/s00432-020-03430-4] [Citation(s) in RCA: 6] [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] [Received: 08/10/2020] [Accepted: 10/08/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Pregnancies in women with essential thrombocythemia (ET) are at a higher risk for obstetrical complications. Acetylsalicylic acid (ASA) and low-molecular weight heparin (LMWH) are common options to prevent miscarriages and maternal complications, whereas interferon alpha (IFN) seems to be the cytoreductive therapy of choice. This retrospective study analyzes the largest number of IFN pregnancies to date in terms of outcome and safety. METHODS Data of 34 high-risk pregnancies in 23 women presenting at the University hospitals of Minden and Jena from 01-Jun-2007 to 01-Jun-2020 were collected. Reasons defining high-risk ET pregnancy in all 23 patients were: Thrombosis (n = 9) or severe hemorrhage (n = 2) in history, platelet count ≥ 1500 × 103/µl (n = 8) or severe microcirculatory disturbances not completely responding to ASA (n = 4). RESULTS Without the use of IFN, live birth rate was 60% (6/10), however, after the use of IFN live birth rate increased to 73.5% (25/34 pregnancies). Nine pregnancies ended in miscarriages (9/34; 26.5%); all of them spontaneous abortions. Live birth rate significantly improved with ASA (90% versus 50%, p = 0.0168), however, if ASA and LMWH was added (n = 14), live birth rate was 100%. IFN compound (PEGylated versus standard IFN) and JAK2-driver mutation had no impact on pregnancy outcome. One major maternal complication occurred as a major peripartal bleeding after abortion curettage. CONCLUSION IFN was associated with an encouraging live birth rate of 73.5% with no fatal maternal events and manageable side effects.
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Affiliation(s)
- Lukas Schrickel
- University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, Ruhr-University Bochum, Minden, Germany.
| | - Florian H Heidel
- Department of Internal Medicine 2, Haematology and Oncology, University Hospital Jena, Jena, Germany.,Internal Medicine C, University Medicine Greifswald, Greifswald, Germany
| | - Parvis Sadjadian
- University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, Ruhr-University Bochum, Minden, Germany
| | - Tatjana Becker
- University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, Ruhr-University Bochum, Minden, Germany
| | - Vera Kolatzki
- University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, Ruhr-University Bochum, Minden, Germany
| | - Andreas Hochhaus
- Department of Internal Medicine 2, Haematology and Oncology, University Hospital Jena, Jena, Germany
| | - Martin Griesshammer
- University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, Ruhr-University Bochum, Minden, Germany
| | - Kai Wille
- University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, Ruhr-University Bochum, Minden, Germany
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Sadjadian P, Wille K, Griesshammer M. Ruxolitinib-Associated Infections in Polycythemia Vera: Review of the Literature, Clinical Significance, and Recommendations. Cancers (Basel) 2020; 12:cancers12113132. [PMID: 33114733 PMCID: PMC7693745 DOI: 10.3390/cancers12113132] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Polycythemia vera (PV) is a chronic blood disease characterized by elevated red blood cells and splenomegaly. About 98% of all PV patients harbor the JAK2 mutation. Ruxolitinib (RUX), a JAK1/JAK2 inhibitor, received approval as a second-line indication in PV patients who are resistant or intolerant to standard therapy hydroxyurea in both the United States (2014) and Europe (2015). In the studies relevant to approval, RUX achieved excellent PV control. Due to its mechanism of action, RUX also has immunosuppressive effects. As expected, an increased rate of infection was observed in clinical studies and in practical application. In this overview, we have compiled all previous literature references on RUX and infections in PV. However, apart from a few individual cases with special infections and an increased rate of zoster infections, there are no exceptional high infection problems. Recommendations are given on how infections in RUX treated PV patients can be avoided. Abstract Ruxolitinib (RUX), a JAK1/JAK2 inhibitor, is approved for second-line therapy in patients with polycythemia vera (PV) who are resistant or intolerant to hydroxyurea. Due to the immunomodulatory and immunosuppressive effect of RUX, there is an increased susceptibility to infections. However, an increased risk of infection is inherent to even untreated myeloproliferative neoplasms (MPN). To obtain more information on the clinical significance of RUX-associated infections in PV, we reviewed the available literature. There is no evidence-based approach to managing infection risks. Most data on RUX-associated infections are available for MF. In all studies, the infection rates in the RUX and control groups were fairly similar, with the exception of infections with the varicella zoster virus (VZV). However, individual cases of bilateral toxoplasmosis retinitis, disseminated molluscum contagiosum, or a mycobacterium tuberculosis infection or a hepatitis B reactivation are reported. A careful assessment of the risk of infection for PV patients is required at the initial presentation and before the start of RUX. Screening for hepatitis B is recommended in all patients. The risk of RUX-associated infections is lower with PV than with MF, but compared to a normal population there is an increased risk of VZV infection. However, primary VZV prophylaxis for PV patients is not recommended, while secondary prophylaxis can be considered individually. As early treatment is most effective for VZV, patients should be properly informed and trained to seek medical advice immediately if cutaneous signs of VZV develop. Vaccination against influenza, herpes zoster, and pneumococci should be considered in all PV patients at risk of infection, especially if RUX treatment is planned. Current recommendations do not support adjusting or discontinuing JAK inhibition in MPN patients to reduce the risk of COVID-19.
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Marchetti M, Ghirardi A, Masciulli A, Carobbio A, Palandri F, Vianelli N, Rossi E, Betti S, Di Veroli A, Iurlo A, Cattaneo D, Finazzi G, Bonifacio M, Scaffidi L, Patriarca A, Rumi E, Casetti IC, Stephenson C, Guglielmelli P, Elli EM, Palova M, Rapezzi D, Erez D, Gomez M, Wille K, Perez‐Encinas M, Lunghi F, Angona A, Fox ML, Beggiato E, Benevolo G, Carli G, Cacciola R, McMullin MF, Tieghi A, Recasens V, Isfort S, Pane F, De Stefano V, Griesshammer M, Alvarez‐Larran A, Vannucchi AM, Rambaldi A, Barbui T. Second cancers in MPN: Survival analysis from an international study. Am J Hematol 2020; 95:295-301. [PMID: 31816122 DOI: 10.1002/ajh.25700] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/28/2022]
Abstract
One out of ten patients with Philadelphia-negative myeloproliferative neoplasms (MPN) develop a second cancer (SC): in such patients we aimed at assessing the survival impact of SC itself and of MPN-specific therapies. Data were therefore extracted from an international nested case-control study, recruiting 798 patients with SC diagnosed concurrently or after the MPN. Overall, 2995 person-years (PYs) were accumulated and mortality rate (MR) since SC diagnosis was 5.9 (5.1-6.9) deaths for every 100 PYs. A "poor prognosis" SC (stomach, esophagus, liver, pancreas, lung, ovary, head-and-neck or nervous system, osteosarcomas, multiple myeloma, aggressive lymphoma, acute leukemia) was reported in 26.3% of the patients and was the cause of death in 65% of them (MR 11.0/100 PYs). In contrast, patients with a "non-poor prognosis" SC (NPPSC) incurred a MR of 4.6/100 PYs: 31% of the deaths were attributed to SC and 15% to MPN evolution. At multivariable analysis, death after SC diagnosis was independently predicted (HR and 95% CI) by patient age greater than 70 years (2.68; 1.88-3.81), the SC prognostic group (2.57; 1.86-3.55), SC relapse (1.53; 10.6-2.21), MPN evolution (2.72; 1.84-4.02), anemia at SC diagnosis (2.32; 1.49-3.59), exposure to hydroxyurea (1.89; 1.26-2.85) and to ruxolitinib (3.63; 1.97-6.71). Aspirin was protective for patients with a NPPSC (0.60; 0.38-0.95). In conclusion, SC is a relevant cause of death competing with MPN evolution. Prospective data are awaited to confirm the role of cytoreductive and anti-platelet drugs in modulating patient survival after the occurrence of a SC.
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Affiliation(s)
| | - Arianna Ghirardi
- FROM Research Foundation, Papa Giovanni XXIII Hospital Bergamo Italy
| | - Arianna Masciulli
- FROM Research Foundation, Papa Giovanni XXIII Hospital Bergamo Italy
| | | | - Francesca Palandri
- Institute of Hematology “L. and A. Seràgnoli”, S. Orsola‐Malpighi Hospital Bologna Italy
| | - Nicola Vianelli
- Institute of Hematology “L. and A. Seràgnoli”, S. Orsola‐Malpighi Hospital Bologna Italy
| | - Elena Rossi
- Institute of HematologyCatholic University Rome Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Silvia Betti
- Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | | | - Alessandra Iurlo
- Division of HematologyFoundation IRCCS Caʼ Granda Ospedale Maggiore Policlinico, and University of Milan Milan Italy
| | - Daniele Cattaneo
- Division of HematologyFoundation IRCCS Caʼ Granda Ospedale Maggiore Policlinico, and University of Milan Milan Italy
| | - Guido Finazzi
- Division of HematologyPapa Giovanni XXIII Hospital Bergamo Italy
| | | | - Luigi Scaffidi
- Department of Medicine, Section of HematologyUniversity of Verona Verona Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational MedicineUniversity of Eastern Piedmont Novara Italy
| | - Elisa Rumi
- Department of Hematology OncologyFondazione IRCCS Policlinico San Matteo Pavia Pavia Italy
- Department of Molecular MedicineUniversity of Pavia Pavia Italy
| | | | | | - Paola Guglielmelli
- CRIMM‐Center of Research and Innovation of Myeloproliferative NeoplasmsAzienda Ospedaliera Universitaria Careggi Firenze Italy
- Department Experimental and Clinical MedicineUniversity of Florence Firenze Italy
| | | | - Miroslava Palova
- Department of Hemato‐oncologyUniversity Hospital Olomouc Olomouc Czech Republic
| | - Davide Rapezzi
- S.C. EmatologiaAzienda Ospedaliera S. Croce e Carle Cuneo Italy
| | - Daniel Erez
- Hematology Institute and Blood BankMeir Medical Center Kfar Saba Israel
- Sackler School of MedicineTel Aviv University Tel Aviv Israel
| | - Montse Gomez
- Department of HematologyHospital Clínico Universitario Valencia Spain
| | - Kai Wille
- University Clinic for Hematology and Oncology Minden, University of Bochum Minden Germany
| | - Manuel Perez‐Encinas
- Deparment of HematologyHospital Clínico Universitario de Santiago de Compostela Santiago de Compostela Spain
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplantation UnitIRCCS San Raffaele Scientific Institute Milan Italy
| | - Anna Angona
- Department of HematologyHospital del Mar Barcelona Spain
| | - Maria Laura Fox
- Department of HematologyHospital Universitario Vall dʼHebron Barcelona Spain
| | - Eloise Beggiato
- Unit of Hematology, Department of OncologyUniversity of Torino Torino Italy
| | - Giulia Benevolo
- Division of HematologyCittà della Salute e della Scienza Hospital Torino Italy
| | - Giuseppe Carli
- Division of HematologySan Bortolo Hospital Vicenza Italy
| | - Rossella Cacciola
- Haemostasis Unit, Department of Clinical and Experimental MedicineUniversity of Catania, “Policlinico‐Vittorio Emanuele” Hospital Catania Italy
| | | | - Alessia Tieghi
- Hematology UnitAzienda Unità Sanitaria Locale‐IRCCS di Reggio Emilia Reggio Emilia Italy
| | - Valle Recasens
- Department of HematologyHospital Universitario Miguel Servet Zaragoza Spain
| | - Susanne Isfort
- Center for Translational & Clinical Research Aachen (CTC‐A)University Hospital RWTH Aachen Aachen Germany
| | - Fabrizio Pane
- Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant CenterUniversity of Naples Federico II Naples Italy
| | - Valerio De Stefano
- Institute of HematologyCatholic University Rome Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Martin Griesshammer
- University Clinic for Hematology and Oncology Minden, University of Bochum Minden Germany
| | | | - Alessandro Maria Vannucchi
- CRIMM‐Center of Research and Innovation of Myeloproliferative NeoplasmsAzienda Ospedaliera Universitaria Careggi Firenze Italy
- Department Experimental and Clinical MedicineUniversity of Florence Firenze Italy
| | | | - Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital Bergamo Italy
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23
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Al-Ali HK, Griesshammer M, Foltz L, Palumbo GA, Martino B, Palandri F, Liberati AM, le Coutre P, García-Hernández C, Zaritskey A, Tavares R, Gupta V, Raanani P, Giraldo P, Hänel M, Damiani D, Sacha T, Bouard C, Paley C, Tiwari R, Mannelli F, Vannucchi AM. Primary analysis of JUMP, a phase 3b, expanded-access study evaluating the safety and efficacy of ruxolitinib in patients with myelofibrosis, including those with low platelet counts. Br J Haematol 2020; 189:888-903. [PMID: 32017044 DOI: 10.1111/bjh.16462] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/04/2019] [Indexed: 12/17/2022]
Abstract
Ruxolitinib is a potent Janus kinase (JAK) 1/JAK2 inhibitor approved for the treatment of myelofibrosis (MF). Ruxolitinib was assessed in JUMP, a large (N = 2233), phase 3b, expanded-access study in MF in countries without access to ruxolitinib outside a clinical trial, which included patients with low platelet counts (<100 × 109 /l) and patients without splenomegaly - populations that have not been extensively studied. The most common adverse events (AEs) were anaemia and thrombocytopenia, but they rarely led to discontinuation (overall, 5·4%; low-platelet cohort, 12·3%). As expected, rates of worsening thrombocytopenia were higher in the low-platelet cohort (all grades, 73·2% vs. 53·5% overall); rates of anaemia were similar (all grades, 52·9% vs. 59·5%). Non-haematologic AEs, including infections, were mainly grade 1/2. Overall, ruxolitinib led to meaningful reductions in spleen length and symptoms, including in patients with low platelet counts, and symptom improvements in patients without splenomegaly. In this trial, the largest study of ruxolitinib in patients with MF to date, the safety profile was consistent with previous reports, with no new safety concerns identified. This study confirms findings from the COMFORT studies and supports the use of ruxolitinib in patients with platelet counts of 50-100 × 109 /l. (ClinicalTrials.gov identifier NCT01493414).
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Affiliation(s)
| | - Martin Griesshammer
- Johannes Wesling Medical Center Minden, University Clinic for Hematology, Oncology, Hemostaseology, and Palliative Care, UKRUB, University of Bochum, Minden, Germany
| | - Lynda Foltz
- St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Giuseppe A Palumbo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Bruno Martino
- Azienda Ospedaliera "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - Francesca Palandri
- Department of Hematology/Oncology, "Seràgnoli" Institute of Hematology, University of Bologna School of Medicine, Bologna, Italy
| | | | | | | | | | | | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pilar Giraldo
- Miguel Servet University Hospital and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Zaragoza, Spain
| | | | | | | | | | - Carole Paley
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Francesco Mannelli
- Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Alessandro M Vannucchi
- Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
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24
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Kiladjian JJ, Zachee P, Hino M, Pane F, Masszi T, Harrison CN, Mesa R, Miller CB, Passamonti F, Durrant S, Griesshammer M, Kirito K, Besses C, Moiraghi B, Rumi E, Rosti V, Blau IW, Francillard N, Dong T, Wroclawska M, Vannucchi AM, Verstovsek S. Long-term efficacy and safety of ruxolitinib versus best available therapy in polycythaemia vera (RESPONSE): 5-year follow up of a phase 3 study. Lancet Haematol 2020; 7:e226-e237. [PMID: 31982039 DOI: 10.1016/s2352-3026(19)30207-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/22/2019] [Accepted: 08/08/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Polycythaemia vera is a myeloproliferative neoplasm characterised by excessive proliferation of erythroid, myeloid, and megakaryocytic components in the bone marrow due to mutations in the Janus kinase 2 (JAK2) gene. Ruxolitinib, a JAK 1 and JAK 2 inhibitor, showed superiority over best available therapy in a phase 2 study in patients with polycythaemia vera who were resistant to or intolerant of hydroxyurea. We aimed to compare the long-term safety and efficacy of ruxolitinib with best available therapy in patients with polycythaemia vera who were resistant to or intolerant of hydroxyurea. METHODS We report the 5-year results for a randomised, open-label, phase 3 study (RESPONSE) that enrolled patients at 109 sites across North America, South America, Europe, and the Asia-Pacific region. Patients (18 years or older) with polycythaemia vera who were resistant to or intolerant of hydroxyurea were randomly assigned 1:1 to receive either ruxolitinib or best available therapy. Patients randomly assigned to the ruxolitinib group received the drug orally at a starting dose of 10 mg twice a day. Single-agent best available therapy comprised hydroxyurea, interferon or pegylated interferon, pipobroman, anagrelide, approved immunomodulators, or observation without pharmacological treatment. The primary endpoint, composite response (patients who achieved both haematocrit control without phlebotomy and 35% or more reduction from baseline in spleen volume) at 32 weeeks was previously reported. Patients receiving best available therapy could cross over to ruxolitinib after week 32. We assessed the durability of primary composite response, complete haematological remission, overall clinicohaematological response, overall survival, patient-reported outcomes, and safety after 5-years of follow-up. This study is registered with ClinicalTrials.gov, NCT01243944. FINDINGS We enrolled patients between Oct 27, 2010, and Feb 13, 2013, and the study concluded on Feb 9, 2018. Of 342 individuals screened for eligibility, 222 patients were randomly assigned to receive ruxolitinib (n=110, 50%) or best available therapy (n=112, 50%). The median time since polycythaemia vera diagnosis was 8·2 years (IQR 3·9-12·3) in the ruxolitinib group and 9·3 years (4·9-13·8) in the best available therapy group. 98 (88%) of 112 patients initially randomly assigned to best available therapy crossed over to receive ruxolitinib and no patient remained on best available therapy after 80 weeks of study. Among 25 primary responders in the ruxolitinib group, six had progressed at the time of final analysis. At 5 years, the probability of maintaining primary composite response was 74% (95% CI 51-88). The probability of maintaining complete haematological remission was 55% (95% CI 32-73) and the probability of maintaining overall clinicohaematological responses was 67% (54-77). In the intention-to-treat analysis not accounting for crossover, the probability of survival at 5 years was 91·9% (84·4-95·9) with ruxolitinib therapy and 91·0% (82·8-95·4) with best available therapy. Anaemia was the most common adverse event in patients receiving ruxolitinib (rates per 100 patient-years of exposure were 8·9 for ruxolitinib and 8·8 for the crossover population), though most anaemia events were mild to moderate in severity (grade 1 or 2 anaemia rates per 100 patient-years of exposure were 8·0 for ruxolitinib and 8·2 for the crossover population). Non-haematological adverse events were generally lower with long-term ruxolitinib treatment than with best available therapy. Thromboembolic events were lower in the ruxolitinib group than the best available therapy group. There were two on-treatment deaths in the ruxolitinib group. One of these deaths was due to gastric adenocarcinoma, which was assessed by the investigator as related to ruxolitinib treatment. INTERPRETATION We showed that ruxolitinib is a safe and effective long-term treatment option for patients with polycythaemia vera who are resistant to or intolerant of hydroxyurea. Taken together, ruxolitinib treatment offers the first widely approved therapeutic alternative for this post-hydroxyurea patient population. FUNDING Novartis Pharmaceuticals Corporation.
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Affiliation(s)
- Jean-Jacques Kiladjian
- Hôpital Saint-Louis, Assitance Publique - Hôpitaux de Paris, Université de Paris, Inserm, Paris, France.
| | - Pierre Zachee
- Ziekenhuis Netwerk Antwerpen, Stuivenberg, Antwerp, Belgium
| | - Masayuki Hino
- Department of Clinical Hematology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Tamas Masszi
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | | | - Ruben Mesa
- UT Health San Antonio Cancer Center, San Antonio, TX, USA
| | | | | | - Simon Durrant
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Keita Kirito
- Department of Hematology and Oncology, University of Yamanashi, Japan
| | - Carlos Besses
- Haematology Department, Hospital del Mar-IMIM, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Elisa Rumi
- Department of Haematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vittorio Rosti
- Center for the Study of Myelofibrosis, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Igor Wolfgang Blau
- Medical Department, Division of Hematology, Oncology, and Tumor Immunology, Charité Universitätsmedizin Berlin, Germany
| | | | - Tuochuan Dong
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Srdan Verstovsek
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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25
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Barbui T, Ghirardi A, Masciulli A, Carobbio A, Palandri F, Vianelli N, De Stefano V, Betti S, Di Veroli A, Iurlo A, Cattaneo D, Delaini F, Bonifacio M, Scaffidi L, Patriarca A, Rumi E, Casetti IC, Stephenson C, Guglielmelli P, Elli EM, Palova M, Bertolotti L, Erez D, Gomez M, Wille K, Perez-Encinas M, Lunghi F, Angona A, Fox ML, Beggiato E, Benevolo G, Carli G, Cacciola R, McMullin MF, Tieghi A, Recasens V, Marchetti M, Griesshammer M, Alvarez-Larran A, Vannucchi AM, Finazzi G. Second cancer in Philadelphia negative myeloproliferative neoplasms (MPN-K). A nested case-control study. Leukemia 2019; 33:1996-2005. [PMID: 31142846 DOI: 10.1038/s41375-019-0487-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 01/07/2023]
Abstract
We conducted a large international nested case-control study including 1881 patients with Philadelphia-negative myeloproliferative neoplasms (MPN). Cases (n = 647) were patients with second cancer (SC: carcinoma, non-melanoma skin cancer, hematological second cancer, and melanoma) and controls (n = 1234) were patients without SC, matched with cases for sex, age at MPN diagnosis, date of MPN diagnosis, and MPN disease duration. The aim was to evaluate the risk of SC after exposure to cytoreductive drugs. Patients exposed to hydroxyurea (HU) (median: 3 years) had a risk of SC similar to unexposed patients (OR = 1.06, 95% CI 0.82-1.38). In contrast, in cancer-specific stratified multivariable analysis, HU had two-fold higher risk of non-melanoma (NM) skin cancer (OR = 2.28, 95% CI 1.15-4.51). A significantly higher risk of NM-skin cancer was also documented for pipobroman (OR = 3.74, 95% CI 1.00-14.01), ruxolitinib (OR = 3.87, 95% CI 1.18-12.75), and for drug combination (OR = 3.47, 95% CI 1.55-7.75). These three drugs did not show excess risk of carcinoma and hematological second cancer compared with unexposed patients. Exposure to interferon, busulfan, and anagrelide did not increase the risk. In summary, while it is reassuring that no excess of carcinoma was documented, a careful dermatologic active surveillance before and during the course of treatments is recommended.
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Affiliation(s)
- Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Arianna Ghirardi
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Arianna Masciulli
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Francesca Palandri
- Institute of Hematology "L. and A. Seràgnoli", S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Nicola Vianelli
- Institute of Hematology "L. and A. Seràgnoli", S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Valerio De Stefano
- Institute of Hematology, Catholic University, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Silvia Betti
- Institute of Hematology, Catholic University, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Federica Delaini
- Hematology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Elisa Rumi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | | | | | - Paola Guglielmelli
- CRIMM-Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, Department of Experimental and Clinical Medicine, and Denothe Center, University of Florence, Florence, Italy
| | - Elena Maria Elli
- Hematology Division, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Miroslava Palova
- Department of Hemato-oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Laura Bertolotti
- S.C. Ematologia, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Daniel Erez
- Hematology Institute and Blood Bank, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Montse Gomez
- Hematology Department, Hospital Clínico Universitario, Valencia, Spain
| | - Kai Wille
- University Clinic for Hematology and Oncology Minden, University of Bochum, Bochum, Germany
| | - Manuel Perez-Encinas
- Hematology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Anna Angona
- Hematology Department, Hospital del Mar, Barcelona, Spain
| | - Maria Laura Fox
- Hematology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Eloise Beggiato
- Unit of Hematology, Department of Oncology, University of Torino, Torino, Italy
| | - Giulia Benevolo
- Hematology Division, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Giuseppe Carli
- Hematology Division, San Bortolo Hospital, Vicenza, Italy
| | - Rossella Cacciola
- HAEMOSTASIS UNIT, Department of Clinical and Experimental Medicine, University of Catania, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | | | - Alessia Tieghi
- Hematology Unit, Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valle Recasens
- Hematology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Martin Griesshammer
- University Clinic for Hematology and Oncology Minden, University of Bochum, Bochum, Germany
| | | | - Alessandro Maria Vannucchi
- CRIMM-Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, Department of Experimental and Clinical Medicine, and Denothe Center, University of Florence, Florence, Italy
| | - Guido Finazzi
- Hematology Division, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Abstract
Thromboembolic events and cardiovascular disease are the most prevalent complications in patients with polycythemia vera (PV) compared with other myeloproliferative disorders and are the major cause of morbidity and mortality in this population. Moreover, a vascular complication such as arterial or venous thrombosis often leads to the diagnosis of PV. The highest rates of thrombosis typically occur shortly before or at diagnosis and decrease over time, probably due to the effects of treatment. Important risk factors include age (≥ 60 years old) and a history of thrombosis; elevated hematocrit and leukocytosis are also associated with an increased risk of thrombosis. The goal of therapy is to reduce the risk of thrombosis by controlling hematocrit to < 45%, a target associated with reduced rates of cardiovascular death and major thrombosis. Low-risk patients (< 60 years old with no history of thrombosis) are managed with phlebotomy and low-dose aspirin, whereas high-risk patients (≥ 60 years old and/or with a history of thrombosis) should be treated with cytoreductive agents. Interferon and ruxolitinib are considered second-line therapies for patients who are intolerant of or have an inadequate response to hydroxyurea, which is typically used as first-line therapy. In this review, we discuss factors associated with thrombosis and recent data on current treatments, including anticoagulation, highlighting the need for more controlled studies to determine the most effective cytoreductive therapies for reducing the risk of thrombosis in patients with PV.
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Affiliation(s)
- Martin Griesshammer
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, University of Bochum, Hans-Nolte-Straße 1, 32429, Minden, Germany.
| | - Jean-Jacques Kiladjian
- Hôpital Saint-Louis, AP-HP, Centre d'Investigations Cliniques (CIC 1427), Université Paris Diderot, INSERM UMRS 1131, 1 Avenue Claude Vellefaux, Paris, France
| | - Carlos Besses
- Hospital del Mar-IMIM, Passeig Marítim 25-29, 08003, Barcelona, Spain
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Wille K, Sadjadian P, Griesshammer M. Differenzialdiagnose der Erythrozytose – Ursachen und klinische Bedeutung. Dtsch Med Wochenschr 2019; 144:128-135. [DOI: 10.1055/a-0739-8340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AbstractDue to its rare incidence, erythrocytosis frequently represents a challenge for the treating doctors. The erythropoiesis (= production of erythrocytes) is located in the bone marrow, and the hormone erythropoietin (EPO) takes control in its regulation. Therefore, measurement of EPO in serum is one of the main diagnostic steps. In erythrocytosis, congenital causes have to be distinguished from acquired ones. Furthermore, there are primary and secondary forms. Congenital causes of erythrocytoses occur very infrequently, are mainly diagnosed in young age and should be treated in specialized centers. Polycythemia vera (PV), a clonal disorder and one of the main myeloproliferative neoplasms (beside essential thrombocythemia and primary myelofibrosis), represents the most frequent primary acquired cause of erythrocytosis. Clinically, increased thrombophilia and microvascular disturbance occur. The first-line treatment in patients with PV includes administration of aspirin and phlebotomies. Secondary acquired forms of erythrocytosis mainly occur due to hypoxia triggered by nicotine abuse or chronic heart and lung diseases. Regarding other differential diagnoses, a cancer-associated EPO production, kidney diseases or exogenous supply with EPO (= EPO doping) have to be considered.
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Birgegård G, Folkvaljon F, Garmo H, Holmberg L, Besses C, Griesshammer M, Gugliotta L, Wu J, Achenbach H, Kiladjian JJ, Harrison CN. Leukemic transformation and second cancers in 3649 patients with high-risk essential thrombocythemia in the EXELS study. Leuk Res 2018; 74:105-109. [PMID: 30368038 DOI: 10.1016/j.leukres.2018.10.006] [Citation(s) in RCA: 9] [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] [Received: 08/22/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
EXELS, a post-marketing observational study, is the largest prospective study of high-risk essential thrombocythemia (ET) patients, with an observation time of 5 years. EXELS found higher event rates of acute leukemia transformation in patients treated with hydroxycarbamide (HC). In the current analysis, we report age-adjusted rates of malignant transformation from 3460 EXELS patients exposed to HC, anagrelide (ANA), or both. At registration, 481 patients had ANA treatment without HC exposure, 2305 had HC without ANA exposure, and 674 had been exposed to both. Standard incidence ratios (SIRs) were calculated using data from the Cancer Incidence in Five Continents database to account for differences in age-, gender-, and country-specific background rates. SIRs for acute myelogenous leukemia (AML) were high in ET patients. SIRs for AML were high in HC-treated patients, but AML was rare in ANA-treated patients; no cases of AML were found in patients only treated with ANA. No statistically significant difference was seen between SIRs for ANA and HC treatment for AML or skin cancer. SIRs for other cancers were similar in the HC and ANA groups and close to 1, indicating little difference in risk. Although statistically inconclusive, this study strengthens concerns regarding possible leukemogenic risk with HC treatment. (NCT00202644).
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Affiliation(s)
- Gunnar Birgegård
- Department of Haematology, Institute for Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Folke Folkvaljon
- Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Hans Garmo
- Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Lars Holmberg
- King's College London, Faculty of Life Sciences and Medicine, London, UK; Department of Surgical Sciences, Medical Faculty, Uppsala University, Uppsala, Sweden
| | - Carlos Besses
- Department of Haematology, Hospital del Mar-IMIM, Barcelona, Spain
| | | | - Luigi Gugliotta
- Department of Haematology, 'L e A Seragnoli', St Orsola-Malpighi Hospital, Bologna, Italy
| | - Jingyang Wu
- Global Biometrics, Shire Pharmaceuticals, Lexington, MA, USA
| | | | | | - Claire N Harrison
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Wille K, Sadjadian P, Becker T, Kolatzki V, Horstmann A, Fuchs C, Griesshammer M. High risk of recurrent venous thromboembolism in BCR-ABL-negative myeloproliferative neoplasms after termination of anticoagulation. Ann Hematol 2018; 98:93-100. [PMID: 30155552 DOI: 10.1007/s00277-018-3483-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 04/22/2018] [Accepted: 08/20/2018] [Indexed: 12/30/2022]
Abstract
Venous thromboembolism (VTE) is a major burden in patients with BCR-ABL-negative myeloproliferative neoplasms (MPN). In addition to cytoreductive treatment anticoagulation is mandatory, but optimal duration of anticoagulation is a matter of debate. In our single center study, we retrospectively included 526 MPN patients. In total, 78 of 526 MPN patients (14.8%) had 99 MPN-associated VTE. Median age at first VTE was 52.5 years (range 23-81). During a study period of 3497 years, a VTE event rate of 1.7% per patient/year was detected. 38.4% (38/99) of all VTEs appeared before or at MPN diagnosis and 55.6% (55/99) occurred at "uncommon" sites like splanchnic or cerebral veins. MPN patients with VTEs were significantly more female (p = 0.028), JAK2 positive (p = 0.018), or had a polycythemia vera (p = 0.009). MPN patients without VTEs were more often CALR positive (p = 0.023). Total study period after first VTE was 336 years with 20 VTE recurrences accounting for a recurrence rate of 6% per patient/year. In 36 of 71 MPN patients with anticoagulation therapy after first VTE event (50.7%), prophylactic anticoagulation was terminated after a median time of 6 months (range 1-61); 13 of those 36 patients (36.1%) had a VTE recurrence after a median of 13 months (range 4-168). In contrast, only three of 35 (8.6%) patients with ongoing anticoagulation had a VTE recurrence (p = 0.0127). Thus, termination of prophylactic anticoagulation was associated with a significantly higher risk of VTE recurrence. Our data suggest that in MPN patients with VTE, a prolonged duration of anticoagulation may be beneficial.
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Affiliation(s)
- Kai Wille
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Hans-Nolte-Straße 1, 32429, Minden, Germany.
| | - Parvis Sadjadian
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Tatjana Becker
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Vera Kolatzki
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Anette Horstmann
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Christiane Fuchs
- Faculty of Business Administration and Economics, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.,Institute of Computational Biology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Hans-Nolte-Straße 1, 32429, Minden, Germany
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Griesshammer M, Sadjadian P, Wille K. Contemporary management of patients with BCR-ABL1-negative myeloproliferative neoplasms during pregnancy. Expert Rev Hematol 2018; 11:697-706. [PMID: 30084669 DOI: 10.1080/17474086.2018.1506325] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 10/28/2022]
Abstract
INTRODUCTION The management of pregnancy during the course of BCR-ABL1-negative myeloproliferative neoplasms (MPN) is an increasingly relevant problem. This is mostly due to earlier and better diagnosis of MPN together with the trend in modern society toward delaying pregnancy until later life. Areas Covered: The present review aims to provide an overview of the available literature data concerning outcome of pregnancy in MPN. Possible therapeutic modalities are discussed and a management algorithm is suggested. Expert Commentary: Most data are available for women with essential thrombocythemia and we present 793 published pregnancies. Live birth rate is 68.5% with 31.5% miscarriages. Spontaneous abortion is the most frequent complication with 26.5%, followed by stillbirth with 4.8%. Maternal complications are relatively low with 1.8% major thrombotic and 2.4% major bleeding events. In polycythemia vera the situation is clinically more complex and roughly 150 pregnancy reports are available. There is very limited information in primary myelofibrosis with less than 20 reported pregnancies. With active management including control of blood counts, aspirin, low molecular weight heparin and in higher risk cases interferon alpha pregnancy in MPN is manageable with a success rate not far below the normal situation with 80%.
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Affiliation(s)
- Martin Griesshammer
- a University Clinic for Haematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, University of Bochum , Minden , Germany
| | - Parvis Sadjadian
- a University Clinic for Haematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, University of Bochum , Minden , Germany
| | - Kai Wille
- a University Clinic for Haematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, University of Bochum , Minden , Germany
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Hatalova A, Schwarz J, Gotic M, Penka M, Hrubisko M, Kusec R, Egyed M, Griesshammer M, Podolak-Dawidziak M, Hellmann A, Klymenko S, Niculescu-Mizil E, Petrides PE, Grosicki S, Sever M, Cantoni N, Thiele J, Wolf D, Gisslinger H. Recommendations for the diagnosis and treatment of patients with polycythaemia vera. Eur J Haematol 2018; 101:654-664. [PMID: 30058088 DOI: 10.1111/ejh.13156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To present the Central European Myeloproliferative Neoplasm Organisation (CEMPO) treatment recommendations for polycythaemia vera (PV). METHODS During meetings held from 2015 through 2017, CEMPO discussed PV and its treatment and recent data. RESULTS PV is associated with increased risks of thrombosis/thrombo-haemorrhagic complications, fibrotic progression and leukaemic transformation. Presence of Janus kinase (JAK)-2 gene mutations is a diagnostic marker and standard diagnostic criterion. World Health Organization 2016 diagnostic criteria for PV, focusing on haemoglobin levels and bone marrow morphology, are mandatory. PV therapy aims at managing long-term risks of vascular complications and progression towards transformation to acute myeloid leukaemia and myelodysplastic syndrome. Risk stratification for thrombotic complications guides therapeutic decisions. Low-risk patients are treated first line with low-dose aspirin and phlebotomy. Cytoreduction is considered for low-risk (phlebotomy intolerance, severe/progressive symptoms, cardiovascular risk factors) and high-risk patients. Hydroxyurea is suspected of leukaemogenic potential. IFN-α has demonstrated efficacy in many clinical trials; its pegylated form is best tolerated, enabling less frequent administration than standard interferon. Ropeginterferon alfa-2b has been shown to be more efficacious than hydroxyurea. JAK1/JAK2 inhibitor ruxolitinib is approved for hydroxyurea resistant/intolerant patients. CONCLUSIONS Greater understanding of PV is serving as a platform for new therapy development and treatment response predictors.
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Affiliation(s)
- Antónia Hatalova
- Clinic of Hematology and Blood Transfusion, University Hospital, Faculty of Medicine, Medical School Comenius University, Slovak Medical University, Bratislava, Slovakia
| | - Jiri Schwarz
- Clinical Section, Institute of Hematology and Blood Transfusion, Institute of Clinical and Experimental Hematology, Charles University, Prague, Czechia
| | - Mirjana Gotic
- Clinic for Hematology Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Miroslav Penka
- Department of Clinical Hematology, Masaryk University Hospital, Brno, Czechia
| | - Mikulas Hrubisko
- Clinic of Hematology and Blood Transfusion, University Hospital, Faculty of Medicine, Medical School Comenius University, Slovak Medical University, Bratislava, Slovakia
| | - Rajko Kusec
- Department of Hematology, Dubrava University Hospital, University of Zagreb, Medical School, Zagreb, Croatia
| | - Miklós Egyed
- Department of Hematology, Somogy County Mór Kaposi General Hospital, Kaposvár, Hungary
| | - Martin Griesshammer
- Department of Hematology, Oncology and Palliative Medicine, Johannes Wesling Academic Medical Center, Minden, Germany
- University Clinic for Hematology, Oncology and Palliative Medicine, Johannes Wesling Medical Center Minden, University of Bochum, Bochum, Germany
| | - Maria Podolak-Dawidziak
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wróclaw Medical University, Wróclaw, Poland
| | - Andrzej Hellmann
- Department of Hematology and Transplantology, Medical University Hospital, Gdaňsk, Poland
| | - Sergiy Klymenko
- Department of Medical Genetics, State Institution National Research Center for Radiation Medicine of National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | | | - Petro E Petrides
- Hematology Oncology Center Munich, Ludwig-Maximilian's University, Munich, Germany
| | - Sebastian Grosicki
- Department of Cancer Prevention, Public School of Health, Silesian Medical University, Katowice, Poland
| | - Matjaz Sever
- Department of Hematology, University Clinical Center, Ljubljana, Slovenia
| | - Nathan Cantoni
- Division of Hematology, University Clinic of Medicine, Kantonsspital Aarau, Switzerland
| | - Jürgen Thiele
- Institute of Pathology, University of Cologne, Cologne, Germany
| | - Dominik Wolf
- Department of Internal Medicine V, Hematology & Oncology, Innsbruck Medical University, Innsbruck, Austria
- Medical Clinic 3, Oncology, Hematology and Rheumatology, University Hospital of Bonn, Bonn, Germany
| | - Heinz Gisslinger
- Division of Hematology and Blood Coagulation, Department of Internal Medicine I, Medical University of Vienna Hospital, Vienna, Austria
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Dührsen U, Müller S, Hertenstein B, Thomssen H, Kotzerke J, Mesters R, Berdel WE, Franzius C, Kroschinsky F, Weckesser M, Kofahl-Krause D, Bengel FM, Dürig J, Matschke J, Schmitz C, Pöppel T, Ose C, Brinkmann M, La Rosée P, Freesmeyer M, Hertel A, Höffkes HG, Behringer D, Prange-Krex G, Wilop S, Krohn T, Holzinger J, Griesshammer M, Giagounidis A, Raghavachar A, Maschmeyer G, Brink I, Bernhard H, Haberkorn U, Gaska T, Kurch L, van Assema DME, Klapper W, Hoelzer D, Geworski L, Jöckel KH, Scherag A, Bockisch A, Rekowski J, Hüttmann A. Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin Lymphomas (PETAL): A Multicenter, Randomized Phase III Trial. J Clin Oncol 2018; 36:2024-2034. [PMID: 29750632 DOI: 10.1200/jco.2017.76.8093] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [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
Purpose Interim positron emission tomography (PET) using the tracer, [18F]fluorodeoxyglucose, may predict outcomes in patients with aggressive non-Hodgkin lymphomas. We assessed whether PET can guide therapy in patients who are treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Patients and Methods Newly diagnosed patients received two cycles of CHOP-plus rituximab (R-CHOP) in CD20-positive lymphomas-followed by a PET scan that was evaluated using the ΔSUVmax method. PET-positive patients were randomly assigned to receive six additional cycles of R-CHOP or six blocks of an intensive Burkitt's lymphoma protocol. PET-negative patients with CD20-positive lymphomas were randomly assigned or allocated to receive four additional cycles of R-CHOP or the same treatment with two additional doses rituximab. The primary end point was event-free survival time as assessed by log-rank test. Results Interim PET was positive in 108 (12.5%) and negative in 754 (87.5%) of 862 patients treated, with statistically significant differences in event-free survival and overall survival. Among PET-positive patients, 52 were randomly assigned to R-CHOP and 56 to the Burkitt protocol, with 2-year event-free survival rates of 42.0% (95% CI, 28.2% to 55.2%) and 31.6% (95% CI, 19.3% to 44.6%), respectively (hazard ratio, 1.501 [95% CI, 0.896 to 2.514]; P = .1229). The Burkitt protocol produced significantly more toxicity. Of 754 PET-negative patients, 255 underwent random assignment (129 to R-CHOP and 126 to R-CHOP with additional rituximab). Event-free survival rates were 76.4% (95% CI, 68.0% to 82.8%) and 73.5% (95% CI, 64.8% to 80.4%), respectively (hazard ratio, 1.048 [95% CI, 0.684 to 1.606]; P = .8305). Outcome prediction by PET was independent of the International Prognostic Index. Results in diffuse large B-cell lymphoma were similar to those in the total group. Conclusion Interim PET predicted survival in patients with aggressive lymphomas treated with R-CHOP. PET-based treatment intensification did not improve outcome.
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Affiliation(s)
- Ulrich Dührsen
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Stefan Müller
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Bernd Hertenstein
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Henrike Thomssen
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Jörg Kotzerke
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Rolf Mesters
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Wolfgang E Berdel
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Christiane Franzius
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Frank Kroschinsky
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Matthias Weckesser
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Dorothea Kofahl-Krause
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Frank M Bengel
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Jan Dürig
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Johannes Matschke
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Christine Schmitz
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Thorsten Pöppel
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Claudia Ose
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Marcus Brinkmann
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Paul La Rosée
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Martin Freesmeyer
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Andreas Hertel
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Heinz-Gert Höffkes
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Dirk Behringer
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Gabriele Prange-Krex
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Stefan Wilop
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Thomas Krohn
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Jens Holzinger
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Martin Griesshammer
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Aristoteles Giagounidis
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Aruna Raghavachar
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Georg Maschmeyer
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Ingo Brink
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Helga Bernhard
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Uwe Haberkorn
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Tobias Gaska
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Lars Kurch
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Daniëlle M E van Assema
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Wolfram Klapper
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Dieter Hoelzer
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Lilli Geworski
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Karl-Heinz Jöckel
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - André Scherag
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Andreas Bockisch
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Jan Rekowski
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Andreas Hüttmann
- Ulrich Dührsen, Stefan Müller, Jan Dürig, Johannes Matschke, Christine Schmitz, Thorsten Pöppel, Andreas Bockisch, and Andreas Hüttmann, Universitätsklinikum Essen; Claudia Ose, Marcus Brinkmann, Karl-Heinz Jöckel, André Scherag, and Jan Rekowski, Universität Duisburg-Essen, Essen; Bernd Hertenstein and Henrike Thomssen, Klinikum Bremen Mitte; Christiane Franzius, Zentrum für moderne Diagnostik, Bremen; Jörg Kotzerke and Frank Kroschinsky, Universitätsklinikum Carl Gustav Carus; Gabriele Prange-Krex, Onkologische Gemeinschaftspraxis, Dresden; Rolf Mesters, Wolfgang E. Berdel, and Matthias Weckesser, Universitätsklinikum Münster, Münster; Dorothea Kofahl-Krause, Frank M. Bengel, and Lilli Geworski, Medizinische Hochschule Hannover, Hannover; Paul La Rosée, Martin Freesmeyer, and André Scherag, Universitätsklinikum Jena, Jena; Andreas Hertel and Heinz-Gert Höffkes, Klinikum Fulda, Fulda; Dirk Behringer, Augusta-Kranken-Anstalt, Bochum; Stefan Wilop and Thomas Krohn, Universitätsklinikum Aachen, Aachen; Jens Holzinger and Martin Griesshammer, Johannes Wesling Klinikum, Minden; Aristoteles Giagounidis, Helios St Johannes Klinik, Duisburg; Aruna Raghavachar, Helios Universitätsklinikum, Wuppertal; Georg Maschmeyer and Ingo Brink, Klinikum Ernst von Bergmann, Potsdam; Helga Bernhard, Klinikum Darmstadt, Darmstadt; Uwe Haberkorn, Universitätsklinikum Heidelberg, Heidelberg; Tobias Gaska, Brüderkrankenhaus St Josef, Paderborn; Lars Kurch, Universitätsklinikum Leipzig, Leipzig; Wolfram Klapper, Universitätsklinikum Schleswig-Holstein, Kiel; Dieter Hoelzer, Onkologikum, Frankfurt/Main, Germany; and Daniëlle M.E. van Assema, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
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De Stefano V, Carobbio A, Di Lazzaro V, Guglielmelli P, Iurlo A, Finazzi MC, Rumi E, Cervantes F, Elli EM, Randi ML, Griesshammer M, Palandri F, Bonifacio M, Hernandez-Boluda JC, Cacciola R, Miroslava P, Carli G, Beggiato E, Ellis MH, Musolino C, Gaidano G, Rapezzi D, Tieghi A, Lunghi F, Loscocco GG, Cattaneo D, Cortelezzi A, Betti S, Rossi E, Finazzi G, Censori B, Cazzola M, Bellini M, Arellano-Rodrigo E, Bertozzi I, Sadjadian P, Vianelli N, Scaffidi L, Gomez M, Cacciola E, Vannucchi AM, Barbui T. Benefit-risk profile of cytoreductive drugs along with antiplatelet and antithrombotic therapy after transient ischemic attack or ischemic stroke in myeloproliferative neoplasms. Blood Cancer J 2018. [PMID: 29535299 PMCID: PMC5849668 DOI: 10.1038/s41408-018-0048-9] [Citation(s) in RCA: 22] [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] [Indexed: 01/30/2023] Open
Abstract
We analyzed 597 patients with myeloproliferative neoplasms (MPN) who presented transient ischemic attacks (TIA, n = 270) or ischemic stroke (IS, n = 327). Treatment included aspirin, oral anticoagulants, and cytoreductive drugs. The composite incidence of recurrent TIA and IS, acute myocardial infarction (AMI), and cardiovascular (CV) death was 4.21 and 19.2%, respectively at one and five years after the index event, an estimate unexpectedly lower than reported in the general population. Patients tended to replicate the first clinical manifestation (hazard ratio, HR: 2.41 and 4.41 for recurrent TIA and IS, respectively); additional factors for recurrent TIA were previous TIA (HR: 3.40) and microvascular disturbances (HR: 2.30); for recurrent IS arterial hypertension (HR: 4.24) and IS occurrence after MPN diagnosis (HR: 4.47). CV mortality was predicted by age over 60 years (HR: 3.98), an index IS (HR: 3.61), and the occurrence of index events after MPN diagnosis (HR: 2.62). Cytoreductive therapy was a strong protective factor (HR: 0.24). The rate of major bleeding was similar to the general population (0.90 per 100 patient-years). In conclusion, the long-term clinical outcome after TIA and IS in MPN appears even more favorable than in the general population, suggesting an advantageous benefit-risk profile of antithrombotic and cytoreductive treatment.
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Affiliation(s)
- Valerio De Stefano
- Institute of Hematology, Catholic University, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
| | | | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Biomedico di Roma, Rome, Italy
| | - Paola Guglielmelli
- CRIMM-Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, and Departmentt Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Alessandra Iurlo
- Hematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, and University of Milan, Milan, Italy
| | | | - Elisa Rumi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Elena Maria Elli
- Hematology Division, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | | | - Martin Griesshammer
- University Clinic for Hematology and Oncology Minden, University of Bochum, Bochum, Germany
| | - Francesca Palandri
- Institute of Hematology "L. and A. Seràgnoli", S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | | | - Rossella Cacciola
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Palova Miroslava
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Giuseppe Carli
- Hematology Department, Ospedale San Bortolo, Vicenza, Italy
| | - Eloise Beggiato
- Unit of Hematology, Department of Oncology, University of Torino, Torino, Italy
| | - Martin H Ellis
- Hematology Institute and Blood Bank, Meir Medical Center, Kfar Saba, and Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Caterina Musolino
- Division of Hematology, Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva, Policlinico G Martino, University of Messina, Messina, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Davide Rapezzi
- S.C. Ematologia, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Alessia Tieghi
- Divisione di Ematologia, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Giuseppe Gaetano Loscocco
- CRIMM-Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, and Departmentt Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Daniele Cattaneo
- Hematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, and University of Milan, Milan, Italy
| | - Agostino Cortelezzi
- Hematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, and University of Milan, Milan, Italy
| | - Silvia Betti
- Institute of Hematology, Catholic University, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
| | - Elena Rossi
- Institute of Hematology, Catholic University, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
| | - Guido Finazzi
- Hematology Division, Papa Giovanni XXIII hospital, Bergamo, Italy
| | - Bruno Censori
- Neurology Division, Papa Giovanni XXIII hospital, Bergamo, Italy
| | - Mario Cazzola
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Bellini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Irene Bertozzi
- Department of Medicine - DIMED, University of Padua, Padova, Italy
| | - Parvis Sadjadian
- University Clinic for Hematology and Oncology Minden, University of Bochum, Bochum, Germany
| | - Nicola Vianelli
- Institute of Hematology "L. and A. Seràgnoli", S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Montse Gomez
- Hematology Department, Hospital Clínico Universitario, Valencia, Spain
| | - Emma Cacciola
- Department of Medical, Surgical and Advanced Technologies Sciences "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Alessandro M Vannucchi
- CRIMM-Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera Universitaria Careggi, and Departmentt Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII hospital, Bergamo, Italy.
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Kiladjian JJ, Guglielmelli P, Griesshammer M, Saydam G, Masszi T, Durrant S, Passamonti F, Jones M, Zhen H, Li J, Gadbaw B, Perez Ronco J, Khan M, Verstovsek S. Efficacy and safety of ruxolitinib after and versus interferon use in the RESPONSE studies. Ann Hematol 2018; 97:617-627. [DOI: 10.1007/s00277-017-3225-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022]
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Germowitz A, Beneke H, Guethner C, Griesshammer M, Gruenewald M. Coagulation Factor II Activity Determination Is Not Useful as a Screening Tool for the G20210A Prothrombin Gene Allele. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Griesshammer M, Sadjadian P. The BCR-ABL1-negative myeloproliferative neoplasms: a review of JAK inhibitors in the therapeutic armamentarium. Expert Opin Pharmacother 2017; 18:1929-1938. [PMID: 29134817 DOI: 10.1080/14656566.2017.1404574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/31/2022]
Abstract
INTRODUCTION The classical BCR-ABL1-negative myeloproliferative neoplasms (MPN) include primary myelofibrosis (PMF), polycythemia vera (PV) and essential thrombocythemia (ET). They are characterized by stem cell-derived clonal proliferation, harbor Janus kinase 2 (JAK2), or calreticulin (CALR), or myeloproliferative leukemia virus oncogene (MPL) driver mutations and exert an over activated JAK-signal transducer and activator of transcription (STAT) pathway. Therefore JAK inhibiting strategies have been successfully investigated in MPN clinical trials. Areas covered: The present review aims to provide a concise overview of the current and future role of JAK inhibitors in the therapeutic armamentarium of MPN. Expert opinion: The JAK1/JAK2 inhibitor ruxolitinib has clearly enriched the therapeutic armamentarium of MPN and is now licenced for more than five years in MF and over three years as second line in PV. Momelotinib, although of limited activity in MPN trials, demonstrated unique property of improving MF associated anemia. Less myelosuppressive or more selective JAK inhibitors like pacritinib, NS-01872 or Itacitinib are new promising agents tested in MF. JAK inhibition has become a cornerstone of MPN therapy and future efforts focus on ruxolitinib-based combinations and new JAK inhibitors.
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Affiliation(s)
- Martin Griesshammer
- a University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care , Johannes Wesling Medical Center Minden, UKRUB, University of Bochum , Minden , Germany
| | - Parvis Sadjadian
- a University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care , Johannes Wesling Medical Center Minden, UKRUB, University of Bochum , Minden , Germany
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Wille K, Sadjadian P, Griesshammer M. [Thrombocytosis and thrombocytopenia - background and clinical relevance]. Dtsch Med Wochenschr 2017; 142:1732-1743. [PMID: 29145678 DOI: 10.1055/s-0042-111096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Due to the central role of platelets in hemostasis, the clinical relevance of quantitative changes in platelet counts (< 150 G/l or > 450 G/l) may be significant. Thrombopoesis (= production of platelets) occurs in the bone marrow, and the hormone thrombopoetin takes control on its regulation.In thrombocytosis, primary causes have to be distinguished from the far more common reactive (= secondary) reasons. The most important form of primary thrombocytosis occurs in myeloproliferative neoplasms especially in essential thrombocythemia (ET). Clinically, increased thrombophilia, microcirculatory disturbances as well as an increased hemorrhagic diathesis occur in patients with myeloproliferative neoplasms. According to the WHO diagnosis criteria 2016 standard diagnostic procedure in myeloproliferative neoplasms includes bone marrow biopsy and the detection of one of the acquired and typical MPN mutations in the JAK2, MPL or CALR gene.In contrast, patients with thrombocytopenia more often suffer from bleeding complications, however, in antiphospholipid syndrome or thrombotic microangiopathy (TMA) thrombotic events occur in spite of a low platelet count. Generally it makes sense to differentiate between pathological changes in thrombopoesis and the various causes of increased peripheral platelet turnover. Concerning differential diagnosis a careful anamnesis is very important in order to get hints like drugs associated with thrombocytopenia, signs of infection or autoimmune disorders. As an initial diagnostic approach we recommend examination of the blood smear in order to exclude pseudothrombocytopenia or disorderes like thrombotic microangiopathy, myelodysplasia or other hematological diseases.
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Birgegård G, Besses C, Griesshammer M, Gugliotta L, Harrison CN, Hamdani M, Wu J, Achenbach H, Kiladjian JJ. Treatment of essential thrombocythemia in Europe: a prospective long-term observational study of 3649 high-risk patients in the Evaluation of Anagrelide Efficacy and Long-term Safety study. Haematologica 2017; 103:51-60. [PMID: 29079600 PMCID: PMC5777190 DOI: 10.3324/haematol.2017.174672] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 06/20/2017] [Accepted: 10/25/2017] [Indexed: 01/01/2023] Open
Abstract
Evaluation of Anagrelide (Xagrid®) Efficacy and Long-term Safety, a phase IV, prospective, non-interventional study performed in 13 European countries enrolled high-risk essential thrombocythemia patients treated with cytoreductive therapy. The primary objectives were safety and pregnancy outcomes. Of 3721 registered patients, 3649 received cytoreductive therapy. At registration, 3611 were receiving: anagrelide (Xagrid®) (n=804), other cytoreductive therapy (n=2666), or anagrelide + other cytoreductive therapy (n=141). The median age was 56 vs. 70 years for anagrelide vs. other cytoreductive therapy. Event rates (patients with events/100 patient-years) were 1.62 vs. 2.06 for total thrombosis and 0.15 vs. 0.53 for venous thrombosis. Anagrelide was more commonly associated with hemorrhage (0.89 vs. 0.43), especially with anti-aggregatory therapy (1.35 vs. 0.33) and myelofibrosis (1.04 vs. 0.30). Other cytoreductive therapies were more associated with acute leukemia (0.28 vs. 0.07) and other malignancies (1.29 vs. 0.44). Post hoc multivariate analyses identified increased risk for thrombosis with prior thrombohemorrhagic events, age ≥65, cardiovascular risk factors, or hypertension. Risk factors for transformation were prior thrombohemorrhagic events, age ≥65, time since diagnosis, and platelet count increase. Safety analysis reflected published data, and no new safety concerns for anagrelide were found. Live births occurred in 41/54 pregnancies (76%). clinicaltrials.gov Identifier: 00567502.
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Affiliation(s)
- Gunnar Birgegård
- Department of Haematology, Institute for Medical Sciences, Uppsala University, Sweden
| | - Carlos Besses
- Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain
| | | | - Luigi Gugliotta
- Department of Haematology, 'L e A Seragnoli', Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Claire N Harrison
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mohamed Hamdani
- Global Biometrics, Shire Pharmaceuticals, Lexington, MA, USA
| | - Jingyang Wu
- Global Biometrics, Shire Pharmaceuticals, Lexington, MA, USA
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Scotch AH, Kosiorek H, Scherber R, Dueck AC, Slot S, Zweegman S, Boekhorst PAWT, Commandeur S, Schouten H, Sackmann F, Fuentes AK, Hernández-Maraver D, Pahl HL, Griesshammer M, Stegelmann F, Döhner K, Lehmann T, Bonatz K, Reiter A, Boyer F, Etienne G, Ianotto JC, Ranta D, Roy L, Cahn JY, Harrison CN, Radia D, Muxi P, Maldonado N, Besses C, Cervantes F, Johansson PL, Barbui T, Barosi G, Vannucchi AM, Paoli C, Passamonti F, Andreasson B, Ferrari ML, Rambaldi A, Samuelsson J, Birgegard G, Xiao Z, Xu Z, Zhang Y, Sun X, Xu J, Kiladjian JJ, Zhang P, Gale RP, Mesa RA, Geyer HL. Symptom burden profile in myelofibrosis patients with thrombocytopenia: Lessons and unmet needs. Leuk Res 2017; 63:34-40. [PMID: 29096334 DOI: 10.1016/j.leukres.2017.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/07/2017] [Accepted: 10/11/2017] [Indexed: 12/19/2022]
Abstract
Myelofibrosis is a myeloproliferative neoplasm associated with progressive cytopenias and high symptom burden. MF patients with thrombocytopenia have poor prognosis but the presence of thrombocytopenia frequently precludes the use of JAK2 inhibitors. In this study, we assessed quality of life and symptom burden in 418 MF patients with (n=89) and without (n=329) thrombocytopenia using prospective data from the MPN-QOL study group database, including the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) and Total Symptom Score (MPN10). Thrombocytopenia, defined as platelet count <100×109/L (moderate 51-100×109/L; severe ≤50×109/L), was associated with anemia (76% vs. 45%, p<0.001), leukopenia (29% vs. 11%, p<0.001), and need for red blood cell transfusion (35% vs. 19%, p=0.002). Thrombocytopenic patients had more fatigue, early satiety, inactivity, dizziness, sad mood, cough, night sweats, itching, fever, and weight loss; total symptom scores were also higher (33 vs. 24, p<0.001). Patients with severe thrombocytopenia were more likely to have anemia (86% vs. 67%, p=0.04), leukopenia (40% vs. 20%, p=0.04), and transfusion requirements (51% vs. 20%, p=0.002) but few differences in symptoms when compared to patients with moderate thrombocytopenia. These results suggest that MF patients with thrombocytopenia experience greater symptomatic burden than MF patients without thrombocytopenia and may benefit from additional therapies.
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Affiliation(s)
- Allison H Scotch
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ USA.
| | - Heidi Kosiorek
- Section of Biostatistics, Mayo Clinic, Scottsdale, AZ USA
| | | | - Amylou C Dueck
- Section of Biostatistics, Mayo Clinic, Scottsdale, AZ USA
| | - Stefanie Slot
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | | | | | | | | | | | | | - Heike L Pahl
- Department of Molecular Hematology, University Hospital Freiburg, Freiburg, Germany
| | | | - Frank Stegelmann
- Department of Internal Medicine III, University Hospital of Ulm, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Germany
| | - Thomas Lehmann
- Hematology Department, University Hospital Basel, Switzerland
| | - Karin Bonatz
- Medizinische Klinik, Universitätsmedizin Mannheim, Germany
| | - Andreas Reiter
- Medizinische Klinik, Universitätsmedizin Mannheim, Germany
| | | | | | | | - Dana Ranta
- Hospitalier Universitaire, Nancy, France
| | - Lydia Roy
- Centre Hospitalier Universitaire, Poitiers, France
| | | | - Claire N Harrison
- Dept of Haematology, Guy's and St. Thomas NHS Foundation Trust, London, United Kingdom
| | - Deepti Radia
- Dept of Haematology, Guy's and St. Thomas NHS Foundation Trust, London, United Kingdom
| | - Pablo Muxi
- Unidadde Hematología, Hospital Británico, Montevideo, Uruguay
| | - Norman Maldonado
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Carlos Besses
- Hematology Department, Hospital del Mar, Barcelona, Spain
| | - Francisco Cervantes
- Hematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | | | - Tiziano Barbui
- Unit of Hematology, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - Giovanni Barosi
- Lab of Clinical Epidemiology, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | | | - Chiara Paoli
- Hematology, Dept of Medical and Surgical Care, University of Florence, Florence, Italy
| | - Francesco Passamonti
- Department of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | | | | | - Jan Samuelsson
- Department of Internal Medicine, Stockholm South Hospital, Stockholm, Sweden
| | | | - Zhijian Xiao
- MDS and MPN Centre, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Zefeng Xu
- MDS and MPN Centre, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yue Zhang
- MDS and MPN Centre, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiujuan Sun
- MDS and MPN Centre, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Junqing Xu
- MDS and MPN Centre, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | | | - Peihong Zhang
- Department of Pathology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | | | - Ruben A Mesa
- Department of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ USA
| | - Holly L Geyer
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ USA.
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Gligorov J, Ataseven B, Verrill M, De Laurentiis M, Jung K, Azim H, Al-Sakaff N, Lauer S, Shing M, Pivot X, Koroveshi D, Bouzid K, Casalnuovo M, Cascallar D, Korbenfeld EP, Bastick P, Beith J, Colosimo M, Friedlander M, Ganju V, Green M, Patterson K, Redfern A, Richardson G, Ceric T, Gordana K, Beato CA, Ferrari M, Hegg R, Helena V, Ismael GF, Lessa AE, Mano M, Morelle A, Nogueira JA, Timcheva K, Tomova A, Tsakova M, Zlatareva-Petrova A, Asselah J, Assi H, Brezden-Masley C, Chia S, Freedman O, Harb M, Joy AA, Kulkarni S, Prady C, Gaete AAA, Matamala L, Torres R, Yanez E, Franco S, Urrego M, Gugić D, Vrbanec D, Melichar B, Prausová J, Vyzula R, Pilarte RG, León MI, Muñoz R, Ramos G, Azeem HA, Aziz AA, El Zawahry H, Osegueda FR, Alexandre J, Artignan X, Barletta H, Beguier E, Berdah JF, Marty CB, Bollet M, Bourgeois H, Bressac C, Burki F, Campone M, Coeffic D, Cojocarasu OZ, Dagada C, Dalenc F, Del Piano F, Desauw C, Desmoulins I, Dohollou N, Egreteau J, Ferrero JM, Foa C, Garidi R, Gasnault L, Gligorov J, Guardiola E, Hamizi S, Jarcau R, Jacquin JP, Jaubert D, Jolimoy G, Mineur HL, Largillier R, Leduc B, Martin P, Melis A, Monge J, Moullet I, Mousseau M, Nguyen S, Orfeuvre H, Petit T, Pivot X, Priou F, Bach IS, Simon H, Stefani L, Uwer L, Youssef A, Aktas B, von der Assen A, Augustin D, Balser C, Bauer LE, Bechtner C, Beyer G, Brucker C, Bückner U, Busch S, Christensen B, Deryal M, Farrokh A, Faust E, Friedrichs K, Graf H, Griesshammer M, Grischke EM, Hänle C, Heider A, Henschen S, Hesse T, Jackisch C, Kisro J, Köhler A, Kuemmel S, Lampe D, Lantzsch T, Latos K, Lex B, Liedtke C, Luedders D, Maintz C, Müller V, Overkamp F, Park-Simon TW, Paul M, Prechtl A, Ringsdorf U, Runnebaum I, Ruth S, Salat C, Scheffen I, Schilling J, Schmatloch S, Schmidt M, Schneeweiss A, Schrader I, Seipelt G, Simon E, Stefek A, Stickeler E, Thill M, Tio J, Tuczek A, Warm M, Weigel M, Wischnik A, Wojcinski S, Ziegler-Löhr K, Aravantinos G, Ardavanis A, Fountzilas G, Gogas H, Kakolyris S, Mavroudis D, Papadimitriou C, Papandreou C, Papazisis K, Castro H, Hernandez-Monroy CE, Ngan R, Yeo W, Bittner N, Boer K, Csejtei A, Horvath Z, Kocsis J, Mangel LC, Mezei K, Nagy Z, Szanto J, Atmakusuma D, Fadjari H, Kurnianda D, Prayogo N, Tanggo EH, Coate L, Hennessy B, Kelly C, Martin M, Nasim S, O'Connor M, Aieta M, Allegrini G, Amadori D, Bidoli P, Biti G, Bordonaro R, Bottini A, Carterni G, Cavanna L, Cazzaniga M, Cognetti F, Contu A, Cruciani G, Donadio M, Falcone A, Farci D, Forcignanò RC, Frassoldati A, Gaion F, Gamucci T, Giotta F, de Laurentiis M, Livi L, Lorusso V, Maiello E, Marchetti P, Mariani G, Mion M, Moscetti L, Musolino A, Pazzola A, Pedrazzoli P, Pigi A, de Placido S, Caremoli ER, Santoro A, Tienghi A, Ahn JS, Jung KH, Lee KS, Lee SH, Seo JH, Sohn JH, Cesas A, Juozaityte E, Cheah NLC, Chong FLT, Devi BC, Phua V, Teoh D, Ching LW, Yusof M, Corona J, Dominguez A, Mendoza RLG, Hernandez CA, Ramiro AJ, Santos JM, Espinosa PM, Villarreal Garza CM, Errihani H, Bakker S, van den Berkmortel F, Blaisse R, Huinink DTB, van den Bosch J, Braun J, Dercksen M, Droogendijk H, Erdkamp F, Haringhuizen A, de Jongh F, Kok T, Los M, Madretsma S, Terwogt JMM, van der Padt A, van Rossum-Schornagel QC, Smilde T, de Valk B, van der Velden A, van Warmerdam L, van de Wouw A, North R, Kersten C, Mjaaland I, Wist E, Aziz Z, Masood N, Rashid K, Shah M, Alcedo JC, Aleman D, Neciosup S, Reategui R, Valdiviezo N, Vera L, Fernando G, Roque F, Strebel HM, Krzemieniecki K, Litwiniuk M, Mruk A, Pienkowski T, Sawrycki P, Slomian G, Tomczak P, Afonso N, Cardoso F, Damasceno M, Nave M, Badulescu F, Ciule L, Curescu S, Eniu A, Filip D, Grecea D, Jinga DC, Lungulescu D, Oprean CM, Stanculeanu DL, Turdean M, Dvornichenko V, Emelyanov S, Lichinitser M, Manikhas A, Sakaeva D, Shirinkin V, Stroyakovskiy D, Abulkhair O, Zekri J, Filipovic S, Kovcin V, Nedovic J, Pesic J, Vasovic S, Ng R, Bystricky B, Leskova J, Mardiak J, Mišurová E, Wagnerova M, Takač I, Demetriou GS, Dreosti L, Govender P, Jordaan JP, Veersamy P, Romero JLA, Lopez NB, Arias CC, Chacon J, Aramburo AF, Morales LAF, Garcia M, Estevez LG, Garcia-Palomo Perez A, Garcia Saenz JA, Garcia Sanchis L, Cubells LG, Cortijo LG, Santiago SG, De Aranguiz BHF, Mañas JJI, Gallego PJ, Cussac AL, Ferrandiz CL, Garrido ML, Alvarez PL, Vega JML, Del Prado PM, Jañez NM, Murillo SM, Rosales AM, Jaso LM, Fernandez IP, Martorell AP, Carrion RP, Simon SP, Alcibar AP, Lorenzo JP, Garcia VQ, Asensio TRYC, Maicas MDT, Villanueva Silva MJ, Killander F, Svensson JH, Fehr M, Hauser N, Müller A, Pagani O, Passmann-Kegel H, Popescu R, Rabaglio M, Rauch D, Schlatter C, Zaman K, Chang TW, Huang CS, Wang HC, Yu JC, Bandidwattanawong C, Maneechavakajorn J, Seetalarom K, Dejthevaporn T(S, Somwangprasert A, Vongsaisuwon M, Akbulut H, Altundag K, Arican A, Bozcuk H, Eralp Y, Idris M, Isikdogan A, Senol CH, Sevinc A, Uygun K, Yucel E, Yucel I, Yumuk F, Shparyk Y, Voitko N, Jaloudi M, Adams J, Agrawal R, Ahmed S, Alhasso A, Allerton R, Anwar S, Archer C, Ashford R, Barraclough L, Bertelli G, Bishop J, Branson T, Butt M, Chakrabarti A, Chakraborti P, Churn M, Crowley C, Davis R, Dhadda A, Eldeeb H, Fraser J, Hall J, Hickish T, Hogg M, Howe T, Joffe J, Kelleher M, Kelly S, Kendall A, Kristeleit H, Lumsden G, Macmillan C, MacPherson I, Malik Z, Mithal N, Neal A, Panwar U, Proctor A, Proctor SJ, Raj S, Rehman S, Sandri I, Scatchard K, Sherwin E, Sims E, Singer J, Smith S, Tahir S, Taylor W, Tsalic M, Verrill M, Wardley A, Waters S, Wheatley D, Wright K, Yuille F, Alonso I, Artagaveytia N, Rodriguez R, Arbona E, Garcia Y, Lion L, Marcano D, Van Thuan T. Safety and tolerability of subcutaneous trastuzumab for the adjuvant treatment of human epidermal growth factor receptor 2-positive early breast cancer: SafeHer phase III study's primary analysis of 2573 patients. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Verstovsek S, Courby S, Griesshammer M, Mesa RA, Brachmann CB, Kawashima J, Maltzman JD, Shao L, Xin Y, Huang D, Bajel A. A phase 2 study of momelotinib, a potent JAK1 and JAK2 inhibitor, in patients with polycythemia vera or essential thrombocythemia. Leuk Res 2017. [PMID: 28622623 PMCID: PMC8170698 DOI: 10.1016/j.leukres.2017.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Momelotinib is a potent inhibitor of JAK1 and JAK2 that demonstrated efficacy in patients with primary and secondary myelofibrosis. This phase 2, open-label, randomized study evaluated the efficacy and safety of oral once-daily momelotinib (100mg and 200mg) for the treatment of polycythemia vera (PV) and essential thrombocythemia (ET). The primary endpoint for PV was overall response rate (ORR), defined as the proportion of patients with hematocrit <45%, white blood cell count <10×109/L, platelet count ≤400×109/L, and resolution of palpable splenomegaly, each lasting ≥4 weeks. The definition of ORR for ET excluded the hematocrit component. A total of 39 patients (28 PV, 11 ET) were enrolled, with 28 patients receiving ≥12 weeks of treatment. The study was terminated due to limited efficacy. Two patients (ORR 5.1%) met the primary efficacy endpoint (both PV 200mg). Predose plasma levels of momelotinib were stable over time. A total of 31 (79.5%) patients experienced momelotinib-related adverse events (AEs), the most frequent being headache (23.1%), dizziness (18.0%), somnolence (15.4%), nausea (15.4%), and fatigue (15.4%). Three patients experienced serious AEs (7.7%), with 1 considered related to momelotinib (dyspnea). Peripheral neuropathy occurred in 7 (17.9%) patients (4 PV, 3 ET).
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Affiliation(s)
- Srdan Verstovsek
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
| | - Stephane Courby
- Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | | | | | | | | | | | - Lixin Shao
- Gilead Sciences, Inc., Foster City, CA, USA
| | - Yan Xin
- Gilead Sciences, Inc., Foster City, CA, USA
| | - Daniel Huang
- The Oncology Institute of Hope and Innovation, Santa Ana, CA, USA
| | - Ashish Bajel
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Victoria, Australia
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Harrison CN, Griesshammer M, Miller C, Masszi T, Passamonti F, Zachee P, Durrant S, Pane F, Guglielmelli P, Verstovsek S, Jones MM, Hunter DS, Sun W, Li J, Khan M, Habr D, Kiladjian JJ. Comprehensive haematological control with ruxolitinib in patients with polycythaemia vera resistant to or intolerant of hydroxycarbamide. Br J Haematol 2017; 182:279-284. [PMID: 29984424 DOI: 10.1111/bjh.14764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Tamas Masszi
- St. István and St. László Hospital, Semmelweis University, Budapest, Hungary
| | | | | | - Simon Durrant
- Royal Brisbane & Women's Hospital, Brisbane, Australia
| | | | - Paola Guglielmelli
- CRIMM, Centre for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Srdan Verstovsek
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Jingjin Li
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Mahmudul Khan
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Dany Habr
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Vannucchi AM, Verstovsek S, Guglielmelli P, Griesshammer M, Burn TC, Naim A, Paranagama D, Marker M, Gadbaw B, Kiladjian JJ. Ruxolitinib reduces JAK2 p.V617F allele burden in patients with polycythemia vera enrolled in the RESPONSE study. Ann Hematol 2017; 96:1113-1120. [PMID: 28456851 PMCID: PMC5486779 DOI: 10.1007/s00277-017-2994-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/11/2017] [Indexed: 11/28/2022]
Abstract
In patients with polycythemia vera (PV), an elevated JAK2 p.V617F allele burden is associated with indicators of more severe disease (e.g., leukocytosis, splenomegaly, and increased thrombosis risk); however, correlations between allele burden reductions and clinical benefit in patients with PV have not been extensively evaluated in a randomized trial. This exploratory analysis from the multicenter, open-label, phase 3 Randomized Study of Efficacy and Safety in Polycythemia Vera With JAK Inhibitor INCB018424 Versus Best Supportive Care trial evaluated the long-term effect of ruxolitinib treatment on JAK2 p.V617F allele burden in patients with PV. Evaluable JAK2 p.V617F-positive patients randomized to ruxolitinib (n = 107) or best available therapy (BAT) who crossed over to ruxolitinib at week 32 (n = 97) had consistent JAK2 p.V617F allele burden reductions throughout the study. At all time points measured (up to weeks 208 [ruxolitinib-randomized] and 176 [ruxolitinib crossover]), mean changes from baseline over time in JAK2 p.V617F allele burden ranged from −12.2 to −40.0% (ruxolitinib-randomized) and −6.3 to −17.8% (ruxolitinib crossover). Complete or partial molecular response was observed in 3 patients (ruxolitinib-randomized, n = 2; ruxolitinib crossover, n = 1) and 54 patients (ruxolitinib-randomized, n = 33; ruxolitinib crossover, n = 20; BAT, n = 1), respectively. Among patients treated with interferon as BAT (n = 13), the mean maximal reduction in allele burden from baseline was 25.6% after crossover to ruxolitinib versus 6.6% before crossover. Collectively, the data from this exploratory analysis suggest that ruxolitinib treatment for up to 4 years provides progressive reductions in JAK2 p.V617F allele burden in patients with PV who are resistant to or intolerant of hydroxyurea. The relationship between allele burden changes and clinical outcomes in patients with PV remains unclear.
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Affiliation(s)
- Alessandro Maria Vannucchi
- Center for Research and Innovation of Myeloproliferative Neoplasms (CRIMM), AOU Careggi, Largo Brambilla 3 - Padiglione 27B, 50134 Florence, Italy
- Laboratorio Congiunto and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Srdan Verstovsek
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 418, Houston, TX 77030 USA
| | - Paola Guglielmelli
- Center for Research and Innovation of Myeloproliferative Neoplasms (CRIMM), AOU Careggi, Largo Brambilla 3 - Padiglione 27B, 50134 Florence, Italy
- Laboratorio Congiunto and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Martin Griesshammer
- University Clinic for Hematology, Oncology, Hemostaseology and Palliative Care, Johannes Wesling Medical Center, Hans-Nolte-Straße 1, 32429 Minden, Germany
- UKRUB, University of Bochum, Bochum, Germany
| | - Timothy C. Burn
- Incyte Corporation, 1801 Augustine Cut-Off, Wilmington, DE 19803 USA
| | - Ahmad Naim
- Incyte Corporation, 1801 Augustine Cut-Off, Wilmington, DE 19803 USA
| | - Dilan Paranagama
- Incyte Corporation, 1801 Augustine Cut-Off, Wilmington, DE 19803 USA
| | - Mahtab Marker
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936 USA
| | - Brian Gadbaw
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ 07936 USA
| | - Jean-Jacques Kiladjian
- Centre d’Investigations Cliniques (INSERM CIC 1427), Hôpital Saint-Louis, Université Paris Diderot, Paris, France
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Passamonti F, Griesshammer M, Palandri F, Egyed M, Benevolo G, Devos T, Callum J, Vannucchi AM, Sivgin S, Bensasson C, Khan M, Mounedji N, Saydam G. Ruxolitinib for the treatment of inadequately controlled polycythaemia vera without splenomegaly (RESPONSE-2): a randomised, open-label, phase 3b study. Lancet Oncol 2017; 18:88-99. [DOI: 10.1016/s1470-2045(16)30558-7] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 11/28/2022]
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De Stefano V, Vannucchi AM, Ruggeri M, Cervantes F, Alvarez-Larrán A, Iurlo A, Randi ML, Pieri L, Rossi E, Guglielmelli P, Betti S, Elli E, Finazzi MC, Finazzi G, Zetterberg E, Vianelli N, Gaidano G, Nichele I, Cattaneo D, Palova M, Ellis MH, Cacciola E, Tieghi A, Hernandez-Boluda JC, Pungolino E, Specchia G, Rapezzi D, Forcina A, Musolino C, Carobbio A, Griesshammer M, Barbui T. Splanchnic vein thrombosis in myeloproliferative neoplasms: risk factors for recurrences in a cohort of 181 patients. Blood Cancer J 2016; 6:e493. [PMID: 27813534 PMCID: PMC5148051 DOI: 10.1038/bcj.2016.103] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/16/2016] [Indexed: 12/13/2022] Open
Abstract
We retrospectively studied 181 patients with polycythaemia vera (n=67), essential thrombocythaemia (n=67) or primary myelofibrosis (n=47), who presented a first episode of splanchnic vein thrombosis (SVT). Budd–Chiari syndrome (BCS) and portal vein thrombosis were diagnosed in 31 (17.1%) and 109 (60.3%) patients, respectively; isolated thrombosis of the mesenteric or splenic veins was detected in 18 and 23 cases, respectively. After this index event, the patients were followed for 735 patient years (pt-years) and experienced 31 recurrences corresponding to an incidence rate of 4.2 per 100 pt-years. Factors associated with a significantly higher risk of recurrence were BCS (hazard ratio (HR): 3.03), history of previous thrombosis (HR: 3.62), splenomegaly (HR: 2.66) and leukocytosis (HR: 2.8). Vitamin K-antagonists (VKA) were prescribed in 85% of patients and the recurrence rate was 3.9 per 100 pt-years, whereas in the small fraction (15%) not receiving VKA more recurrences (7.2 per 100 pt-years) were reported. Intracranial and extracranial major bleeding was recorded mainly in patients on VKA and the corresponding rate was 2.0 per 100 pt-years. In conclusion, despite anticoagulation treatment, the recurrence rate after SVT in myeloproliferative neoplasms is high and suggests the exploration of new avenues of secondary prophylaxis with new antithrombotic drugs and JAK-2 inhibitors.
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Affiliation(s)
- V De Stefano
- Institute of Hematology, Catholic University, Roma, Italy
| | - A M Vannucchi
- Center for Research and Innovation of Myeloproliferative Neoplasms, A.O.U. Careggi, University of Florence, Florence, Italy
| | - M Ruggeri
- Ospedale San Bortolo, Vicenza, Italy
| | | | - A Alvarez-Larrán
- Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain
| | - A Iurlo
- Oncohematology Division, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - M L Randi
- Clinica Medica 1, Università di Padova, Padova, Italy
| | - L Pieri
- Center for Research and Innovation of Myeloproliferative Neoplasms, A.O.U. Careggi, University of Florence, Florence, Italy
| | - E Rossi
- Institute of Hematology, Catholic University, Roma, Italy
| | - P Guglielmelli
- Center for Research and Innovation of Myeloproliferative Neoplasms, A.O.U. Careggi, University of Florence, Florence, Italy
| | - S Betti
- Institute of Hematology, Catholic University, Roma, Italy
| | - E Elli
- Divisione di Ematologia, Ospedale San Gerardo, ASST Monza, Italy
| | - M C Finazzi
- Hematology Division, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - G Finazzi
- Hematology Division, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - N Vianelli
- Institute of Hematology and Medical Oncology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Gaidano
- Department of Translational Medicine, Università del Piemonte Orientale, Vercelli, Italy
| | - I Nichele
- Ospedale San Bortolo, Vicenza, Italy
| | - D Cattaneo
- Oncohematology Division, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - M Palova
- University Hospital of Olomouc, Olomouc, Czech Republic
| | - M H Ellis
- Department of Hematology, Institute Meir Medical Center, Kfar Saba, Israel
| | - E Cacciola
- Haemostasis Unit, Department of Medical, Surgical and Advanced Technologies Sciences 'G.F. Ingrassia', University of Catania, Catania, Italy
| | - A Tieghi
- Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - E Pungolino
- A.O. Ospedale Niguarda Ca' Granda, Milano, Italy
| | - G Specchia
- A.O. Universitaria, Policlinico di Bari, Italy
| | - D Rapezzi
- A.O. Santa Croce e Carle, Cuneo, Italy
| | - A Forcina
- IRCCS Ospedale San Raffaele, Milano, Italy
| | | | - A Carobbio
- FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - M Griesshammer
- Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - T Barbui
- FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
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46
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Marchetti M, Barosi G, Cervantes F, Birgegård G, Griesshammer M, Harrison C, Hehlmann R, Kiladjian JJ, Kröger N, McMullin MF, Passamonti F, Vannucchi A, Barbui T. Which patients with myelofibrosis should receive ruxolitinib therapy? ELN-SIE evidence-based recommendations. Leukemia 2016; 31:882-888. [DOI: 10.1038/leu.2016.283] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 08/27/2016] [Accepted: 09/14/2016] [Indexed: 12/11/2022]
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Geyer HL, Kosiorek H, Dueck AC, Scherber R, Slot S, Zweegman S, Te Boekhorst PA, Senyak Z, Schouten HC, Sackmann F, Fuentes AK, Hernández-Maraver D, Pahl HL, Griesshammer M, Stegelmann F, Döhner K, Lehmann T, Bonatz K, Reiter A, Boyer F, Etienne G, Ianotto JC, Ranta D, Roy L, Cahn JY, Harrison CN, Radia D, Muxi P, Maldonado N, Besses C, Cervantes F, Johansson PL, Barbui T, Barosi G, Vannucchi AM, Paoli C, Passamonti F, Andreasson B, Ferrari ML, Rambaldi A, Samuelsson J, Cannon K, Birgegard G, Xiao Z, Xu Z, Zhang Y, Sun X, Xu J, Kiladjian JJ, Zhang P, Gale RP, Mesa RA. Associations between gender, disease features and symptom burden in patients with myeloproliferative neoplasms: an analysis by the MPN QOL International Working Group. Haematologica 2016; 102:85-93. [PMID: 27540137 DOI: 10.3324/haematol.2016.149559] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/12/2016] [Indexed: 12/15/2022] Open
Abstract
The myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia and myelofibrosis, are distinguished by their debilitating symptom profiles, life-threatening complications and profound impact on quality of life. The role gender plays in the symptomatology of myeloproliferative neoplasms remains under-investigated. In this study we evaluated how gender relates to patients' characteristics, disease complications and overall symptom expression. A total of 2,006 patients (polycythemia vera=711, essential thrombocythemia=830, myelofibrosis=460, unknown=5) were prospectively evaluated, with patients completing the Myeloproliferative Neoplasm-Symptom Assessment Form and Brief Fatigue Inventory Patient Reported Outcome tools. Information on the individual patients' characteristics, disease complications and laboratory data was collected. Consistent with known literature, most female patients were more likely to have essential thrombocythemia (48.6% versus 33.0%; P<0.001) and most male patients were more likely to have polycythemia vera (41.8% versus 30.3%; P<0.001). The rate of thrombocytopenia was higher among males than females (13.9% versus 8.2%; P<0.001) and males also had greater red-blood cell transfusion requirements (7.3% versus 4.9%; P=0.02) with shorter mean disease duration (6.4 versus 7.2 years, P=0.03). Despite there being no statistical differences in risk scores, receipt of most therapies or prior complications (hemorrhage, thrombosis), females had more severe and more frequent symptoms for most individual symptoms, along with overall total symptom score (22.8 versus 20.3; P<0.001). Females had particularly high scores for abdominal-related symptoms (abdominal pain/discomfort) and microvascular symptoms (headache, fatigue, insomnia, concentration difficulties, dizziness; all P<0.01). Despite complaining of more severe symptom burden, females had similar quality of life scores to those of males. The results of this study suggest that gender contributes to the heterogeneity of myeloproliferative neoplasms by influencing phenotypic profiles and symptom expression.
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Affiliation(s)
- Holly L Geyer
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Heidi Kosiorek
- Section of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Amylou C Dueck
- Section of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Stefanie Slot
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | | | | | | | | | | | | | - Heike L Pahl
- Department of Molecular Hematology, University Hospital Freiburg, Germany
| | | | - Frank Stegelmann
- Department of Internal Medicine III, University Hospital of Ulm, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Germany
| | - Thomas Lehmann
- Hematology Department, University Hospital, Basel, Switzerland
| | - Karin Bonatz
- Medizinische Klinik, Universitätsmedizin, Mannheim, Germany
| | - Andreas Reiter
- Medizinische Klinik, Universitätsmedizin, Mannheim, Germany
| | | | | | | | - Dana Ranta
- Hospitalier Universitaire, Nancy, France
| | - Lydia Roy
- Centre Hospitalier Universitaire, Poitiers, France
| | | | - Claire N Harrison
- Department of Haematology, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Deepti Radia
- Department of Haematology, Guy's and St. Thomas NHS Foundation Trust, London, UK
| | - Pablo Muxi
- Unidadde Hematología, Hospital Británico, Montevideo, Uruguay
| | - Norman Maldonado
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Carlos Besses
- Hematology Department, Hospital del Mar, Barcelona, Spain
| | - Francisco Cervantes
- Hematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | | | - Tiziano Barbui
- Research Foundation (FROM), Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Giovanni Barosi
- Laboratory of Clinical Epidemiology, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Alessandro M Vannucchi
- Center for Research and Innovation of Myeloproliferative Neoplasms, University of Florence, Italy
| | - Chiara Paoli
- Center for Research and Innovation of Myeloproliferative Neoplasms, University of Florence, Italy
| | - Francesco Passamonti
- Ematologia, Dipartimento di Medicina Clinica e Sperimentale, University of Insubria, Varese, Italy
| | | | | | | | - Jan Samuelsson
- Department of Internal Medicine, Stockholm South Hospital, Sweden
| | - Keith Cannon
- Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Zhijian Xiao
- MDS and MPN Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Zefeng Xu
- MDS and MPN Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yue Zhang
- MDS and MPN Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiujuan Sun
- MDS and MPN Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Junqing Xu
- MDS and MPN Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | | | - Peihong Zhang
- Department of Pathology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | | | - Ruben A Mesa
- Department of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
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Al-Ali HK, Griesshammer M, le Coutre P, Waller CF, Liberati AM, Schafhausen P, Tavares R, Giraldo P, Foltz L, Raanani P, Gupta V, Tannir B, Ronco JP, Ghosh J, Martino B, Vannucchi AM. Safety and efficacy of ruxolitinib in an open-label, multicenter, single-arm phase 3b expanded-access study in patients with myelofibrosis: a snapshot of 1144 patients in the JUMP trial. Haematologica 2016; 101:1065-73. [PMID: 27247324 DOI: 10.3324/haematol.2016.143677] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/25/2016] [Indexed: 11/09/2022] Open
Abstract
JUMP is a phase 3b expanded-access trial for patients without access to ruxolitinib outside of a clinical study; it is the largest clinical trial to date in patients with myelofibrosis who have been treated with ruxolitinib. Here, we present safety and efficacy findings from an analysis of 1144 patients with intermediate- or high-risk myelofibrosis, as well as a separate analysis of 163 patients with intermediate-1-risk myelofibrosis - a population of patients not included in the phase 3 COMFORT studies. Consistent with ruxolitinib's mechanism of action, the most common hematologic adverse events were anemia and thrombocytopenia, but these led to treatment discontinuation in only a few cases. The most common non-hematologic adverse events were primarily grade 1/2 and included diarrhea, pyrexia, fatigue, and asthenia. The rates of infections were low and primarily grade 1/2, and no new or unexpected infections were observed. The majority of patients achieved a ≥50% reduction from baseline in palpable spleen length. Improvements in symptoms were rapid, with approximately half of all patients experiencing clinically significant improvements, as assessed by various quality-of-life questionnaires. The safety and efficacy profile in intermediate-1-risk patients was consistent with that in the overall JUMP population and with that previously reported in intermediate-2- and high-risk patients. Overall, ruxolitinib provided clinically meaningful reductions in spleen length and symptoms in patients with myelofibrosis, including those with intermediate-1-risk disease, with a safety and efficacy profile consistent with that observed in the phase 3 COMFORT studies. This trial was registered as NCT01493414 at ClinicalTrials.gov.
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Affiliation(s)
| | - Martin Griesshammer
- Johannes-Wesling Academic Medical Center, University of Hannover Teaching Hospital, Minden, Germany
| | | | - Cornelius F Waller
- Department of Medicine I: Hematology and Oncology, University Hospital Freiburg, Germany
| | | | - Philippe Schafhausen
- Department of Internal Medicine II, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Pilar Giraldo
- Miguel Servet University Hospital. IIS Aragon and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Zaragoza, Spain
| | - Lynda Foltz
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | - Bruno Martino
- Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy
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49
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Alvarez-Larrán A, Pereira A, Guglielmelli P, Hernández-Boluda JC, Arellano-Rodrigo E, Ferrer-Marín F, Samah A, Griesshammer M, Kerguelen A, Andreasson B, Burgaleta C, Schwarz J, García-Gutiérrez V, Ayala R, Barba P, Gómez-Casares MT, Paoli C, Drexler B, Zweegman S, McMullin MF, Samuelsson J, Harrison C, Cervantes F, Vannucchi AM, Besses C. Antiplatelet therapy versus observation in low-risk essential thrombocythemia with a CALR mutation. Haematologica 2016; 101:926-31. [PMID: 27175028 DOI: 10.3324/haematol.2016.146654] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/03/2016] [Indexed: 12/30/2022] Open
Abstract
The role of antiplatelet therapy as primary prophylaxis of thrombosis in low-risk essential thrombocythemia has not been studied in randomized clinical trials. We assessed the benefit/risk of low-dose aspirin in 433 patients with low-risk essential thrombocythemia (271 with a CALR mutation, 162 with a JAK2(V617F) mutation) who were on antiplatelet therapy or observation only. After a follow up of 2215 person-years free from cytoreduction, 25 thrombotic and 17 bleeding episodes were recorded. In CALR-mutated patients, antiplatelet therapy did not affect the risk of thrombosis but was associated with a higher incidence of bleeding (12.9 versus 1.8 episodes per 1000 patient-years, P=0.03). In JAK2(V617F)-mutated patients, low-dose aspirin was associated with a reduced incidence of venous thrombosis with no effect on the risk of bleeding. Coexistence of JAK2(V617F)-mutation and cardiovascular risk factors increased the risk of thrombosis, even after adjusting for treatment with low-dose aspirin (incidence rate ratio: 9.8; 95% confidence interval: 2.3-42.3; P=0.02). Time free from cytoreduction was significantly shorter in CALR-mutated patients with essential thrombocythemia than in JAK2(V617F)-mutated ones (median time 5 years and 9.8 years, respectively; P=0.0002) and cytoreduction was usually necessary to control extreme thrombocytosis. In conclusion, in patients with low-risk, CALR-mutated essential thrombocythemia, low-dose aspirin does not reduce the risk of thrombosis and may increase the risk of bleeding.
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Affiliation(s)
| | - Arturo Pereira
- Hematotherapy and Hemostasis Department, Hospital Clínic, Barcelona, Spain
| | - Paola Guglielmelli
- Center for Research and Innovation of MPN (CRIMM); AOU Careggi, and Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | | | - Francisca Ferrer-Marín
- Hematology and Medical Oncology Department, Hospital Morales Messeguer, IMIB-Arrixaca, UCAM, Murcia, Spain
| | - Alimam Samah
- Haematology Department, Guys' and St Thomas' NHS Foundation Trust, London, UK
| | - Martin Griesshammer
- Hematology, Oncology & Palliative Care, Johannes Wesling Academic Medical Center, University of Hannover Teaching Hospital, Germany
| | - Ana Kerguelen
- Hematology Department, Hospital La Paz, Madrid, Spain
| | - Bjorn Andreasson
- Hematology Section, Uddevalla Hospital, NU Hospital Group, Sweden
| | - Carmen Burgaleta
- Hematology Department, Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - Jiri Schwarz
- Institute of Hematology & Blood Transfusion, Prague, Czech Republic
| | | | - Rosa Ayala
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pere Barba
- Hematology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Chiara Paoli
- Center for Research and Innovation of MPN (CRIMM); AOU Careggi, and Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mary F McMullin
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK
| | - Jan Samuelsson
- Department of Clinical Science and Education, Karolinska Institute, South Hospital, Stockholm, Sweden
| | - Claire Harrison
- Haematology Department, Guys' and St Thomas' NHS Foundation Trust, London, UK
| | | | - Alessandro M Vannucchi
- Center for Research and Innovation of MPN (CRIMM); AOU Careggi, and Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Carlos Besses
- Hematology Department, Hospital del Mar, IMIM, UAB, Barcelona, Spain
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50
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Griesshammer M. Hydroxyurea significantly increases skin toxicity in patients with MPN. Leuk Res 2016. [DOI: 10.1016/s0145-2126(16)30083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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