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Niederwieser D, Lang T, Krahl R, Heinicke T, Maschmeyer G, Al-Ali HK, Schwind S, Jentzsch M, Cross M, Kahl C, Wolf HH, Sayer H, Schulze A, Dreger P, Hegenbart U, Krämer A, Junghanss C, Mügge LO, Hähling D, Hirt C, Späth C, Peter N, Opitz B, Florschütz A, Reifenrath K, Zojer N, Scholl S, Pönisch W, Heyn S, Vucinic V, Hochhaus A, Aul C, Giagounidis A, Balleisen L, Oldenkott B, Staib P, Kiehl M, Schütte W, Naumann R, Eimermacher H, Dörken B, Sauerland C, Lengfelder E, Hiddemann W, Wörmann B, Müller-Tidow C, Serve H, Schliemann C, Hehlmann R, Berdel WE, Pfirrmann M, Krug U, Hoffmann VS. Different treatment strategies versus a common standard arm (CSA) in patients with newly diagnosed AML over the age of 60 years: a randomized German inter-group study. Ann Hematol 2023; 102:547-561. [PMID: 36695874 PMCID: PMC9977880 DOI: 10.1007/s00277-023-05087-8] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/01/2023] [Indexed: 01/26/2023]
Abstract
A randomized inter-group trial comparing more intensive treatment strategies to a common standard arm 3 + 7 (CSA) was conducted in patients with non-M3 AML. Untreated patients ≥ 60 years were allocated to the CSA (n = 132) or to the study group arms (n = 1154) of the AMLCG (TAD/HAM versus HAM/HAM ± G-CSF followed by TAD and maintenance) and the OSHO (intermediate-dose ara-C/mitoxantrone followed by ara-C/mitoxantrone). Median age of the 1147 eligible patients was 69 (range 60-87) years. CR/CRi status at 90 days was not significantly different between the CSA (54% (95%CI: 45-64)) and the study group arms (53% (95%CI: 47-60) and 59% (95%CI: 58-63)). The five-year event-free survival (EFS) probability (primary endpoint) was 6.2% (95%CI: 2.7-14.0) in the CSA, 7.6% (95%CI: 4.5-12.8) in study group A and 11.1% (95%CI: 9.0-13.7) in B. The 5-year OS was 17.2% (95%CI: 11.0-26.9), 17.0% (95%CI: 2.0-23.9), and 19.5% (95%CI: 16.7-22.8) in CSA, study group A and B, respectively. Neither study group differed significantly from the CSA regarding EFS, OS, or relapse-free survival. In multivariate analyses, allocation to the treatment strategy was not significantly associated with the time-to-event endpoints. The evaluation of more intensive treatment strategies did not show clinically relevant outcome differences when compared to CSA.
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Affiliation(s)
- Dietger Niederwieser
- University Leipzig, 04106, Leipzig, Germany. .,Lithuanian University of Health Sciences, Kaunas, Lithuania. .,Aichi Medical University, Nagakute, Japan.
| | - Thomas Lang
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig Maximilian Universität München, München, Germany
| | | | - Thomas Heinicke
- Dept. Hematology and Oncology, Otto-Von-Guericke-University, Magdeburg, Germany
| | - Georg Maschmeyer
- Dept. Hematology, Oncology and Palliative Care, Klinikum Ernst Von Bergmann, Potsdam, Germany
| | - Haifa Kathrin Al-Ali
- Department of Internal Medicine IV, Oncology/Hematology, Krukenberg Cancer-Center, University Hospital Halle (Saale), Halle, Germany
| | | | | | | | - Christoph Kahl
- Dept. Internal Medicine, Clinic III - Hematology, Oncology and Palliative Care, Rostock University Medical Center, Rostock, Germany.,Dept. Hematology, Oncology and Palliative Care, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | | | - Herbert Sayer
- Medizinische Klinik (Hämatologie, Stammzelltransplantation, Onkologie), Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Peter Dreger
- Medical Department V, University Hospital, Heidelberg, Germany
| | - Ute Hegenbart
- Medical Department V, University Hospital, Heidelberg, Germany
| | - Alwin Krämer
- Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Dept. of Internal Medicine V, University, Heidelberg, Germany
| | - Christian Junghanss
- Department of Medicine, Clinic III (Hematology, Oncology, Palliative Medicine), Rostock University Medical Center, Rostock, Germany
| | - Lars-Olof Mügge
- Innere Medizin III (Hämatologie, Onkologie Und Palliativmedizin), Hospital Zwickau, Germany
| | - Detlev Hähling
- Dept. Hematology and Oncology, Klinikum Schwerin, Schwerin, Germany
| | - Carsten Hirt
- Innere Medizin C, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Christian Späth
- Innere Medizin C, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Norma Peter
- Medizinische Klinik, Carl-Thieme-Klinikum GmbH, Cottbus, Germany
| | - Bernhard Opitz
- St. Elisabeth Und St, Barbara Hospital Halle (Saale), Halle, Germany
| | | | | | - Niklas Zojer
- 1St Medical Department, Center for Oncology and Hematology & Palliative Care, Klinik Ottakring, Vienna, Austria
| | | | | | | | | | | | - Carlo Aul
- Klinik Für Hämatologie Und Onkologie, St. Johannes Hospital, Duisburg, Germany
| | - Aristoteles Giagounidis
- Klinik Für Hämatologie Und Onkologie, St. Johannes Hospital, Duisburg, Germany.,Dept. Oncology, Hematology and Palliative Care, Marienhospital Düsseldorf, Düsseldorf, Germany
| | | | - Bernd Oldenkott
- Dept. Hematology and Oncology, St. Hedwig Krankenhaus Berlin, Berlin, Germany
| | - Peter Staib
- Dept. Hematology/Oncology, St. Antonius Krankenhaus Eschweiler, Eschweiler, Germany
| | - Michael Kiehl
- Dept. Medicine I, Klinikum Frankfurt/Oder, FrankfurtOder, Germany
| | - Wolfgang Schütte
- Dept. Internal Medicine II, Krankenhaus Martha-Maria, Halle, Germany
| | - Ralph Naumann
- Dept. Hematology, Oncology and Palliative Care, St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - Hartmut Eimermacher
- Dept. Hematology and Oncology, Katholisches Krankenhaus Hagen, Hagen, Germany
| | - Bernd Dörken
- Dept. Hematology and Oncology, Charité Campus Virchow, Berlin, Germany
| | - Cristina Sauerland
- Institute of Biometry and Clinical Research, University Hospital Münster, Münster, Germany
| | - Eva Lengfelder
- IIIrd Medical Dept, University Hospital of Mannheim, Mannheim, Germany
| | | | - Bernhard Wörmann
- Division of Hematology, Oncology and Tumour Immunology, Department of Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie, Berlin, Germany
| | - Carsten Müller-Tidow
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany.,Dept. of Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hubert Serve
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany.,Department of Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | | | - Rüdiger Hehlmann
- Mannheim, University of Heidelberg, Mannheim, Germany.,European LeukemiaNet, Weinheim, Germany
| | - Wolfgang E Berdel
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig Maximilian Universität München, München, Germany
| | - Utz Krug
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany.,Dept. of Medicine 3, Klinikum Leverkusen, Leverkusen, Germany
| | - Verena S Hoffmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig Maximilian Universität München, München, Germany
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Heinicke T, Krahl R, Kahl C, Cross M, Scholl S, Wolf HH, Hähling D, Hegenbart U, Peter N, Schulze A, Florschütz A, Schmidt V, Reifenrath K, Zojer N, Junghanss C, Sayer HG, Maschmeyer G, Späth C, Hochhaus A, Fischer T, Al-Ali HK, Niederwieser D. Correction to: Allogeneic hematopoietic stem cell transplantation improves long‑term outcome for relapsed AML patients across all ages: results from two East German Study Group Hematology and Oncology (OSHO) trials. Ann Hematol 2021; 100:2877-2878. [PMID: 34529106 DOI: 10.1007/s00277-021-04638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Thomas Heinicke
- Department of Hematology and Oncology, University of Magdeburg, Magdeburg, Germany
| | - Rainer Krahl
- University Hospital Leipzig, 04106, Leipzig, Germany
| | - Christoph Kahl
- Department of Hematology and Oncology, Hospital Magdeburg, Magdeburg, Germany
| | - Michael Cross
- University Hospital Leipzig, 04106, Leipzig, Germany
| | - Sebastian Scholl
- Klinik fur Innere Medizin II, Universitatsklinikum Jena, Jena, Germany
| | - Hans-Heinrich Wolf
- Department of Hematology and Oncology, University Hospital, Halle, Germany
| | - Detlev Hähling
- Department of Hematology and Oncology, Klinikum Schwerin, Schwerin, Germany
| | - Ute Hegenbart
- Departement of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Norma Peter
- Medizinische Klinik, Carl-Thieme-Klinikum GmbH, Cottbus, Germany
| | - Antje Schulze
- Department of Hematology and Oncology, Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Volker Schmidt
- Department of Hematology and Oncology, Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Niklas Zojer
- Department of Medicine I, Wilhelminen Cancer Research Institute, WilhelminenhospitalVienna, Austria
| | - Christian Junghanss
- Hematology, Oncology, Palliative Medicine, University of Rostock, Rostock, Germany
| | - Herbert G Sayer
- Department of Hematology and Oncology, Helios Klinikum Erfurt, Erfurt, Germany
| | - Georg Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Ernst Von Bergmann Hospital, Potsdam, Germany
| | - Christian Späth
- Hematology and Oncology, University of Greifswald, Greifswald, Germany
| | - Andreas Hochhaus
- Klinik fur Innere Medizin II, Universitatsklinikum Jena, Jena, Germany
| | - Thomas Fischer
- Department of Hematology and Oncology, University of Magdeburg, Magdeburg, Germany
| | | | - Dietger Niederwieser
- University Hospital Leipzig, 04106, Leipzig, Germany. .,Lithuanian University of Health Sciences, Kaunas, Lithuania. .,Aichi Medical University, Nagakute, Japan.
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Heinicke T, Krahl R, Kahl C, Cross M, Scholl S, Wolf HH, Hähling D, Hegenbart U, Peter N, Schulze A, Florschütz A, Schmidt V, Reifenrath K, Zojer N, Junghanss C, Sayer HG, Maschmeyer G, Späth C, Hochhaus A, Fischer T, Al-Ali HK, Niederwieser D. Allogeneic hematopoietic stem cell transplantation improves long-term outcome for relapsed AML patients across all ages: results from two East German Study Group Hematology and Oncology (OSHO) trials. Ann Hematol 2021; 100:2387-2398. [PMID: 34232360 PMCID: PMC8357692 DOI: 10.1007/s00277-021-04565-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/10/2020] [Accepted: 06/04/2021] [Indexed: 12/14/2022]
Abstract
Relapse of acute leukemia is a frequent complication with uncertain outcome and poorly defined risk factors. From 1621 patients entered into two prospective clinical trials (AML02; n = 740 and AML04; n = 881), 74.2% reached complete remission (CR) 1 after induction(s) and 59 patients after additional induction ± hematopoietic cell transplantation (HCT). Of the non-refractory patients, 48.4% with a median age of 63 (range 17-85) years relapsed. Relapses occurred within 6 months after CR in 46.5%, between 7 and 18 months in 38.7%, and after 18 months in 14.8% of patients. Relapse treatment resulted in CR2 in 39% of patients depending upon age (54.5% of ≤ 60 and 28.6% of > 60 years), duration of CR1, and treatment of relapse. Overall survival (OS) was 10.9 (7.4-16.2) %, but OS after HCT ± intensive chemotherapy (ICT) was 39.3% (31.8-48.6) at 5 years and not different in younger and older patients. Donor lymphocyte infusion ± chemotherapy and ICT alone resulted only in OS of 15.4% and of 5%, respectively. Independent favorable factors for OS were long CR1 duration, and HCT, while non-monosomal disease was beneficial for OS in elderly patients. Leukemia-free survival [LFS; 24.9 (19.5-31.7) % at 10 years] was affected by similar risk factors. In a competing risk model, the relapse incidence at 5 years was 53.5 ± 3.5% and the non-relapse mortality rate 21.7 ± 2.9%. Lower relapse incidence was observed in patents with HCT, long CR1 duration, and female gender. Risk factors for non-relapse mortality were HCT in younger and type of AML in elderly patients. In conclusion, allogeneic HCT ± IC improved the results in relapsed AML in younger and elderly patients. Increasing CR2 rates and HCT frequency will be the challenge for the next years. Relapse of the disease remains the major problem.
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Affiliation(s)
- Thomas Heinicke
- Department of Hematology and Oncology, University of Magdeburg, Magdeburg, Germany
| | - Rainer Krahl
- University Hospital Leipzig, 04106, Leipzig, Germany
| | - Christoph Kahl
- Department of Hematology and Oncology, Hospital Magdeburg, Magdeburg, Germany
| | - Michael Cross
- University Hospital Leipzig, 04106, Leipzig, Germany
| | - Sebastian Scholl
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Hans-Heinrich Wolf
- Department of Hematology and Oncology, University Hospital, Halle, Germany
| | - Detlev Hähling
- Department of Hematology and Oncology, Klinikum Schwerin, Schwerin, Germany
| | - Ute Hegenbart
- Departement of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Norma Peter
- Medizinische Klinik, Carl-Thieme-Klinikum GmbH, Cottbus, Germany
| | - Antje Schulze
- Department of Hematology and Oncology, Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Volker Schmidt
- Department of Hematology and Oncology, Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Niklas Zojer
- Department of Medicine I, Wilhelminen Cancer Research Institute, Wilhelminenhospital, , Vienna, Austria
| | - Christian Junghanss
- Hematology, Oncology, Palliative Medicine, University of Rostock, Rostock, Germany
| | - Herbert G Sayer
- Department of Hematology and Oncology, Helios Klinikum Erfurt, Erfurt, Germany
| | - Georg Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Ernst Von Bergmann Hospital, Potsdam, Germany
| | - Christian Späth
- Hematology and Oncology, University of Greifswald, Greifswald, Germany
| | - Andreas Hochhaus
- Klinik Für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Thomas Fischer
- Department of Hematology and Oncology, University of Magdeburg, Magdeburg, Germany
| | | | - Dietger Niederwieser
- University Hospital Leipzig, 04106, Leipzig, Germany.
- Lithuanian University of Health Sciences, Kaunas, Lithuania.
- Aichi Medical University, Nagakute, Japan.
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Lange T, Niederwieser C, Gil A, Krahl R, von Grünhagen U, Al-Ali HK, Jentsch-Ullrich K, Spohn C, Lakner V, Assmann M, Junghanss C, Cross M, Hehlmann R, Deininger M, Pfirrmann M, Niederwieser D. No advantage of Imatinib in combination with hydroxyurea over Imatinib monotherapy: a study of the East German Study Group (OSHO) and the German CML study group. Leuk Lymphoma 2020; 61:2821-2830. [PMID: 32672489 DOI: 10.1080/10428194.2020.1786556] [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] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The combination of Imatinib (IM) and hydroxyurea (HU) was explored for the treatment of chronic myelogenous leukemia (CML). METHOD After in vitro testing and a phase I study (n = 20), 59 patients were randomized in the IM/HU and 29 in the IM arm. According to protocol, 49 propensity-score matched IM patients were included from the CML-IV study. RESULTS Additive specific inhibition of CML cells by IM/HU was detected in vitro. HU 500 mg qd in combination with IM 400 mg qd proved feasible in the phase I study. Overall, no significant difference with respect to major molecular response (MMR) at 18 months (IM/HU and IM 66%; primary endpoint) was observed. Significant differences were noted for MMR at 6 months (p = 0.04) and for cumulative incidences of adverse events (p = 0.03) in favor of IM monotherapy (secondary endpoints). CONCLUSION IM/HU combination was more potent in selectively inhibiting CML cells in vitro, but not superior to IM in vivo. (NCT02480608).
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Affiliation(s)
- Thoralf Lange
- Abteilung Hämatologie und Onkologie, Universität Leipzig, Leipzig, Germany.,Krankenhaus Weißenfels, Weißenfels, Germany
| | - Christian Niederwieser
- Klinik für Stammzelltransplantation, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - Arthur Gil
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rainer Krahl
- Abteilung Hämatologie und Onkologie, Universität Leipzig, Leipzig, Germany
| | | | - Haifa Kathrin Al-Ali
- Abteilung Hämatologie und Onkologie, Universität Leipzig, Leipzig, Germany.,Krukenberg Cancer Center, University Hospital Halle, Halle, Germany
| | | | - Claudia Spohn
- Gemeinschaftspraxis für Hämatologie und Onkologie, Halle, Germany
| | - Volker Lakner
- Gemeinschaftspraxis für Hämatologie und Onkologie, Rostock, Germany
| | | | | | - Michael Cross
- Abteilung Hämatologie und Onkologie, Universität Leipzig, Leipzig, Germany
| | - Rüdiger Hehlmann
- III. Medizinische Klinik, Universität Heidelberg, Mannheim, Germany
| | - Michael Deininger
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT, USA
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Dietger Niederwieser
- School of Medicine, University Leipzig, Leipzig Germany.,Lithuanian University of Health Sciences, Kaunas, Lithuania.,Aichi Medical University, NagakuteAichi/Nagoya, Japan
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Tessenow H, Holzvogt M, Holzvogt B, Andrea M, Heyn S, Schliwa T, Schwarz M, Zehrfeld T, Becker C, Pfrepper C, Franke GN, Krahl R, Jentzsch M, Leiblein S, Schwind S, Bill M, Vucinic V, Lange T, Niederwieser D, Pönisch W. Successful treatment of patients with newly diagnosed/untreated light chain multiple myeloma with a combination of bendamustine, prednisone and bortezomib (BPV). J Cancer Res Clin Oncol 2017; 143:2049-2058. [DOI: 10.1007/s00432-017-2439-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 05/12/2017] [Indexed: 11/29/2022]
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Niederwieser D, Al-Ali HK, Krahl R, Kahl C, Wolf HH, Kreibich U, Vucinic V, Hegenbart U, Hirt C, Peter N, Opitz B, Florschütz A, Schulze A, Scholl S, Jakob C, Junghanss C, Sayer H, Hochhaus A, Fischer T, Maschmeyer G. Hematopoietic stem cell transplantation (HSCT) compared to consolidation chemotherapy (CT) to increase leukemia free survival (LFS) in acute myelogenous leukemia (AML) patients between 60 and 75 years irrespective of genetic risk: Report from the AML 2004 of the East German Study Group (OSHO). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Dietger Niederwieser
- Universitatsklinikum Leipzig AoR, Abt. Hamatologie und internistische Onkologie, Leipzig, Germany
| | | | | | - Christoph Kahl
- Department for Hematology, Klinikum Magdeburg, Magdeburg, Germany
| | | | | | | | - Ute Hegenbart
- Department of Hematology, Oncology, and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Carsten Hirt
- Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany
| | | | | | | | | | | | | | - Christian Junghanss
- Department of Hematology and Oncology, University Hospital, Rostock, Germany
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Niederwieser C, Starke S, Fischer L, Krahl R, Beck J, Gruhn B, Ebell W, Körholz D, Wößmann W, Bader P, Lang P, Al-Ali HK, Cross M, Eisfeld AK, Heyn S, Vucinic V, Franke GN, Lange T, Pönisch W, Behre G, Christiansen H. Favorable outcome in children and adolescents with a high proportion of advanced phase disease using single/multiple autologous or matched/mismatched allogeneic stem cell transplantations. Ann Hematol 2015; 95:473-81. [DOI: 10.1007/s00277-015-2569-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022]
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Hebenstreit K, Iacobelli S, Leiblein S, Eisfeld AK, Pfrepper C, Heyn S, Vucinic V, Franke GN, Krahl R, Fricke S, Becker C, Pönisch W, Behre G, Niederwieser D, Lange T. Low tumor burden is associated with early B-cell reconstitution and is a predictor of favorable outcome after non-myeloablative stem cell transplant for chronic lymphocytic leukemia. Leuk Lymphoma 2013; 55:1274-80. [PMID: 23964650 DOI: 10.3109/10428194.2013.836598] [Citation(s) in RCA: 3] [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] [Indexed: 11/13/2022]
Abstract
Abstract Reconstitution, engraftment kinetics and tumor cell clearance were analyzed after reduced intensity conditioning hematopoietic cell transplant (RIC-HCT) in patients with chronic lymphocytic leukemia (CLL). Patients were transplanted from unrelated (n = 40) or related (n = 10) donors after fludarabine and 2 Gy total body irradiation followed by cyclosporine and mycophenolate mofetil. The vast majority of patients (96%) engrafted with absolute neutrophil count (ANC) > 0.5 × 10(9)/L at day + 22. CLL cells decreased (median 2%, range 0-69%) within 28 days, but disappeared by day + 180 after HCT. Donor T-cell chimerism increased to > 95% at day 56 and donor B-cell chimerism to 94% at day + 360. Overall survival was 51 ± 8%, incidence of progression 37 ± 7% and non-relapse related mortality (NRM) 30 ± 7% at 4 years. The most common causes of NRM were graft-versus-host disease (GvHD) (14%) and sepsis (6%). Disease status at HCT was significantly associated with early B-cell reconstitution (p = 0.04) and with increased risk of relapse/progression in univariate and multivariate analysis (p = 0.022). Tumor cells were undetectable by day + 180, although B-cell reconstitution did not occur until 1.5 years after RIC-HCT. The best predictors for progression-free survival (PFS) and overall survival (OS) were complete response (CR) or first partial response (PR1) and the absence of bulky disease at transplant, respectively.
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Affiliation(s)
- Karin Hebenstreit
- Department of Hematology/Oncology, University of Leipzig , Leipzig , Germany
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Cross M, Bach E, Tran T, Krahl R, Jaekel N, Niederwieser D, Junghanss C, Maschmeyer G, Al-Ali HK. Pretreatment long interspersed element (LINE)-1 methylation levels, not early hypomethylation under treatment, predict hematological response to azacitidine in elderly patients with acute myeloid leukemia. Onco Targets Ther 2013; 6:741-8. [PMID: 23836986 PMCID: PMC3699298 DOI: 10.2147/ott.s45459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Epigenetic modulations, including changes in DNA cytosine methylation, are implicated in the pathogenesis and progression of acute myeloid leukemia (AML). Azacitidine is a hypomethylating agent that is incorporated into RNA as well as DNA. Thus, there is a rationale to its use in patients with AML. We determined whether baseline and/or early changes in the methylation of long interspersed element (LINE)-1 or CDH13 correlate with bone marrow blast clearance, hematological response, or survival in patients with AML treated with azacitidine. Methods An open label, phase I/II trial was performed in 40 AML patients (median bone marrow blast count was 42%) unfit for intensive chemotherapy treated with azacitidine 75 mg/m2/day subcutaneously for 5 days every 4 weeks. Bone marrow mononuclear cell samples were taken on day 0 (pretreatment) and day 15 during the first treatment cycle; LINE-1 and CDH13 methylation levels were quantified by methylation-specific, semiquantitative, real-time polymerase chain reaction. Results Treatment with azacitidine significantly reduced LINE-1 but not CDH13 methylation levels over the first cycle (P < 0.0001). Absolute LINE-1 methylation levels tended to be lower on day 0 (P = 0.06) and day 15 of cycle 1 (P = 0.03) in patients who went on to achieve subsequent complete remission, partial remission or hematological improvement versus patients with stable disease. However, the decrease in LINE-1 methylation over the first treatment cycle did not correlate with subsequent response (P = 0.31). Baseline methylation levels of LINE-1 or CDH13 did not correlate with disease-related prognostic factors, including cytogenetic risk, relapsed/refractory AML, or presence of NPM1 or FLT3 mutations. No correlation was observed between LINE-1 or CDH13 methylation levels and overall survival. Conclusion Analysis of baseline LINE-1 methylation levels may help identify elderly AML patients who are most likely to respond to azacitidine therapy.
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Affiliation(s)
- Michael Cross
- Division of Hematology and Oncology, University of Leipzig, Leipzig, Germany
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Lange T, Edelmann A, Siebolts U, Krahl R, Nehring C, Jäkel N, Cross M, Maier J, Niederwieser D, Wickenhauser C. JAK2 p.V617F allele burden in myeloproliferative neoplasms one month after allogeneic stem cell transplantation significantly predicts outcome and risk of relapse. Haematologica 2013; 98:722-8. [PMID: 23300178 DOI: 10.3324/haematol.2012.076901] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The risk profile and prognosis of patients with myelofibrosis is well described by the Dynamic International Prognostic Scoring System risk categorization. Allogeneic stem cell transplantation is considered for intermediate-2/high risk disease. However, indicators of prognosis after transplantation are still lacking. Seventy simultaneously collected pairs of trephine and blood samples were quantified for JAK2 p.V617F allele burden to compare test sensitivity. The course of 30 patients with JAK2 p.V617F-positive myeloproliferative neoplasia was correlated with allele burden after transplantation. Monitoring can be performed on full blood samples as well as trephine biopsies, provided that techniques with ample sensitivity (0.01% to 0.001%) are available. Measurement of allele burden on day 28 after transplantation discriminates two prognostic groups: patients with a JAK2 p.V617F allele burden >1% have a significantly higher risk of relapse of JAK2 p.V617F positive neoplasia (P=0.04) and a poorer overall survival (P<0.01). In conclusion, measurement of JAK2 p.V617F allele burden early after transplantation is an important predictive parameter in monitoring patients following this treatment. As this might provide an important tool in early management of imminent early relapse it will be important to define consensus guidelines for optimal monitoring.
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Affiliation(s)
- Thoralf Lange
- Department of Hematology/ Oncology and Hemostaseology, University Hospital of Leipzig, and 2Institute of Pathology, University Hospital of Leipzig, Leipzig, Germany
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11
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Eisfeld AK, Krahl R, Jaekel N, Niederwieser D, Al-Ali HK. Kinetics of iron removal by phlebotomy in patients with iron overload after allogeneic hematopoietic cell transplantation. Am J Blood Res 2012; 2:243-253. [PMID: 23226624 PMCID: PMC3512175] [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] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 11/13/2012] [Indexed: 06/01/2023]
Abstract
UNLABELLED Excess body iron could persist for years after allogeneic hematopoietic cell transplantation (HCT) with possible deleterious sequels. An iron depletive therapy with phlebotomy seems rational. Kinetics of iron removal by phlebotomy without erythropoietin support in non-thalassemic adult patients with iron overload after HCT and the impact of pre- and post-HCT hemochromatosis (HFE) genotype on iron mobilization were investigated. PATIENTS AND METHODS Phlebotomy was initiated in 61 recipients of allografts due to hematologic malignancies (median age 48 years) after a median of 18 months. The prephlebotomy median serum ferritin (SF) was 1697ng/ml and the median number of blood transfusions 28 units. Alanine aminotransferase (ALT)/aspartate aminotransferase (AST), alkaline phosphates (AP), and bilirubin were elevated in 55.7%, 64% and 11.5% patients respectively. HFE-genotype was elucidated by polymerase chain reaction using hybridization probes and melting curve analysis. RESULTS Phlebotomy was well-tolerated irrespective of age or conditioning. A negative iron balance in 80% of patients (median SF 1086 ng/ml) and a rise in hemoglobin were observed (p<0.0001). Higher transfusional burden and SF were associated with a greater iron mobilization per session (p=0.02). In 58% of patients, a plateau after an initial steady decline in SF was followed by a second decline under further phlebotomy. The improvement in ALT (p=0.002), AST (p=0.03), AP (p=0.01), and bilirubin (p<0.0001) did not correlate with the decline in SF. Mutant HFE-gene variants were detected in 14/55 (25%) pre-HCT and 22/55 (40%) patients post-HCT. Overall, dissimilar pre- and posttransplantational HFE-genotypes were detected in 20/55 (40%) patients. Posttransplantational mutant HFE variants correlated with a slower decline in SF (p=0.007). CONCLUSIONS Phlebotomy is a convenient therapy of iron overload in survivors of HCT. A negative iron balance and a rise in hemoglobin were observed in the majority of patients. Liver dysfunction improved irrespective of SF reduction suggesting a probable rapid decline of the deleterious labile plasma iron. In recipients of grafts with mutant HFE variants a "mixed chimerism" of HFE in body tissues might be created with a change in the set point for iron regulation. The transient plateau in SF after an initial decline might reflect iron mobilization from various tissues.
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Büchner T, Schlenk RF, Schaich M, Döhner K, Krahl R, Krauter J, Heil G, Krug U, Sauerland MC, Heinecke A, Späth D, Kramer M, Scholl S, Berdel WE, Hiddemann W, Hoelzer D, Hehlmann R, Hasford J, Hoffmann VS, Döhner H, Ehninger G, Ganser A, Niederwieser DW, Pfirrmann M. Acute Myeloid Leukemia (AML): different treatment strategies versus a common standard arm--combined prospective analysis by the German AML Intergroup. J Clin Oncol 2012; 30:3604-10. [PMID: 22965967 DOI: 10.1200/jco.2012.42.2907] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Identifying true therapeutic progress in patients with acute myeloid leukemia (AML) requires a comparison of treatment strategies and results on the basis of uniform patient selection. To foster comparability across five clinical studies, we introduced a common standard arm combined with a general upfront randomization and performed prospective analyses with adjustment for differences in prognostic baseline characteristics. PATIENTS AND METHODS Whereas the studies' own regimens differed in chemotherapies, risk adaption, and guidelines for allogeneic stem-cell transplantation, the standard arm contained uniform cytarabine- and anthracycline-based standard-dose remission induction and high-dose consolidation courses. RESULTS Of 2,995 evaluable patients aged 16 to 60 years, 290 patients were randomly assigned to the common standard arm. Seventy percent of the 290 achieved complete remissions (62% with complete recovery, 8% with incomplete recovery; 95% CI, 65% to 76%). Five-year survival probabilities were 44.3% (95% CI, 37.7% to 50.7%) for overall survival, 44.8% (95% CI, 37.0% to 52.2%) for relapse-free survival, and 31.5% (95% CI, 25.7% to 37.4%) for event-free survival. Neither the unadjusted survival probabilities of the Kaplan-Meier method nor their adjustment for prognostic variables in multiple Cox regression models led to statistically significant different results in the three survival end points when the outcomes of each study were compared with the standard arm. CONCLUSION A strictly prospective comparison of different treatment strategies in patients with AML did not show clinically relevant outcome differences when compared through a common standard treatment arm. The results provide a representative basis for further therapeutic approaches.
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Affiliation(s)
- Thomas Büchner
- Department of Internal Medicine A-Hematology, Oncology and Pneumology, University of Münster, Albert-Schweitzer Campus 1, Geb. A 1, 48129 Münster, Germany.
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Bach E, Krahl R, Lange T, Schüler F, Al-Ali H, Büchner T, Haferlach T, Dölken G, Niederwieser D, Cross M. Delayed processing of bone marrow samples reveals a prognostic pattern of NME mRNA expression in cytogenetically normal acute myeloid leukemia. Leuk Lymphoma 2012; 53:1561-8. [PMID: 22421058 DOI: 10.3109/10428194.2012.676176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Improvements in the therapy of cytogenetically normal acute myeloid leukemia (CN-AML) will depend largely on the characterization of functional subtypes identified by prognostic markers. Exposing leukemic cells to stress ex vivo may reveal relevant phenotypic markers not apparent in freshly explanted cells. Here, we assess the prognostic relevance of expression of the nucleoside diphosphate kinase genes NME1 and NME2 in a cohort of 78 patients with CN-AML aged < 60 years using archived mononuclear cell samples originally prepared from bone marrow either directly (n = 25) or following 2-3 days of transport (n = 53). The stress conditions arising during transport resulted in the development of a prognostic pattern of NME mRNA with maintenance of high NME2 mRNA being a strong indicator of increased event-free survival independent of FLT3-internal tandem duplication. Prospective analysis of CN-AML bone marrow (n = 7) confirmed that NME1 mRNA is always decreased during storage, while NME2 mRNA is either decreased or maintained. We conclude that ex vivo stress can reveal novel prognostic markers.
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Affiliation(s)
- Enrica Bach
- Department of Hematology, Oncology and Hemostasiology, University of Leipzig, Leipzig, Germany
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Al-Ali HK, Jaekel N, Junghanss C, Maschmeyer G, Krahl R, Cross M, Hoppe G, Niederwieser D. Azacitidine in patients with acute myeloid leukemia medically unfit for or resistant to chemotherapy: a multicenter phase I/II study. Leuk Lymphoma 2011; 53:110-7. [PMID: 21767242 DOI: 10.3109/10428194.2011.606382] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The safety and efficacy of azacitidine (5-day schedule) were assessed in a multicenter study in 40 patients (median age 72 years) with acute myeloid leukemia (AML) medically unfit for (n = 20) or resistant to chemotherapy (n = 20) from April to October 2008. Median marrow blasts were 42%. After a median follow-up of 13 months, response (complete remission [CR]/partial remission [PR]/hematologic improvement [HI]) was 50% and 10% in newly diagnosed and relapsed/refractory patients, respectively (p = 0.008). Median time-to-response was 2.5 months with a median duration of 5.9 months. Median survival was not reached for responders versus 3.8 months for 15 (38%) patients with stable disease (p < 0.045). High-risk cytogenetics was associated with inferior survival (p = 0.05). Lower marrow blasts on day 15 of cycle 1, irrespective of pretreatment count, predicted subsequent response (p = 0.01). Azacitidine is active and well tolerated in elderly patients with newly diagnosed AML.
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Affiliation(s)
- Haifa K Al-Ali
- Department of Hematology/Oncology, University of Leipzig, Leipzig, Germany.
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Niederwieser D, Maschmeyer G, Fischer T, Uharek L, Kortmann R, Hegenbart U, Dreger P, Herold M, Sayer HG, Wolf H, Kreibich U, Hähling D, Junghanss C, Grobe N, Krahl R, Lange T, Al-Ali HK, Pönisch W, Nehring C, Doelken G. Relapse incidence and leukemia-free survival (LFS) in patients (pts) older than age 60 with AM undergoing stem cell transplantation: A report of the East German Study Group Hematology and Oncology (OSHO). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lange T, Niederwieser D, Hoffmann V, Pfirrmann M, Maschmeyer G, Fischer T, Herold M, Sayer HG, Junghanss C, Krahl R, Al-Ali HK, Pönisch W, Vucinic V, Doelken G, Sauerland MC, Heinecke A, Hoelzer D, Hehlmann R, Berdel WE, Buchner T. Intergroup study in elderly patients with AML to compare complete remission rate and overall survival after intermediate-dose or low-dose AraC. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Al-Ali H, Krahl R, Jaekel N, Hoppe G, Cross M, Lange T, Niederwieser D. 285 Low pre-treatment global methylation and day-15 marrow-blasts <45% but not WT1-expression correlate with response to azacitidine in AML. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70287-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Krauter J, Wagner K, Schäfer I, Marschalek R, Meyer C, Heil G, Schaich M, Ehninger G, Niederwieser D, Krahl R, Büchner T, Sauerland C, Schlegelberger B, Döhner K, Döhner H, Schlenk RF, Ganser A. Prognostic Factors in Adult Patients up to 60 Years Old With Acute Myeloid Leukemia and Translocations of Chromosome Band 11q23: Individual Patient Data–Based Meta-Analysis of the German Acute Myeloid Leukemia Intergroup. J Clin Oncol 2009; 27:3000-6. [DOI: 10.1200/jco.2008.16.7981] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [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 To identify risk factors for induction success and overall survival (OS) and relapse-free survival (RFS) and to evaluate the impact of allogeneic stem-cell transplantation (alloSCT) in adult patients up to 60 years old with acute myeloid leukemia (AML) and reciprocal translocations involving chromosome band 11q23 [t(11q23)]. Patients and Methods An individual patient data-based meta-analysis was performed on 180 adult patients with AML and t(11q23). These patients were identified by cytogenetics and/or molecular techniques and treated within eight prospective multicenter trials of the German AML Intergroup. The median follow-up time was 53 months. Results Complete remission rate was 71%. Favorable factors for induction success were the presence of a t(9;11), t(11q23) as a sole aberration, and de novo leukemia. OS rate at 4 years was 29%. Translocations other than t(9;11), platelets less than the median, secondary leukemia, and peripheral blasts greater than the median were adverse risk factors for OS. RFS rate at 4 years was 29%. The presence of a t(6;11) and peripheral blasts greater than the median had a negative impact on RFS. Three risk groups for OS and RFS could be defined by the combination of these factors with 4-year OS rates of 50%, 28%, and 5% and 4-year RFS rates of 37%, 26%, and 5%. An alloSCT from matched related or unrelated donors in first complete remission was beneficial, especially in t(6;11)-negative patients. Conclusion Risk stratification of AML patients with reciprocal translocations of chromosome band 11q23 is feasible based on the translocation partner and clinical parameters.
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Affiliation(s)
- Jürgen Krauter
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Katharina Wagner
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Irina Schäfer
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Rolf Marschalek
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Claus Meyer
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Gerhard Heil
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Markus Schaich
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Gerhard Ehninger
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Dietger Niederwieser
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Rainer Krahl
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Thomas Büchner
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Cristina Sauerland
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Brigitte Schlegelberger
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Konstanze Döhner
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Hartmut Döhner
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Richard F. Schlenk
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
| | - Arnold Ganser
- From the Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation and Cellular and Molecular Pathology, Hannover Medical School, Hannover; Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia/Zentrum für Arzneimittelforschung, Entwicklung, und Sicherheit, Johann Wolfgang Goethe University, Biocenter, Frankfurt am Main; Medizinische Klinik und Poliklinik I, Universitätsklinikum C.G. Carus, Dresden; Department of Hematology and Oncology, University of Leipzig,
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Schulze E, Leiblein S, Körner I, Federbusch J, Hofmann U, Burdach S, Krahl R, Helbig W. The Influence of lnterleukin-2 and Lymphokine-Activated Killer Cells on Normal Hemopoietic Stem Cells. Oncol Res Treat 2009. [DOI: 10.1159/000217365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Messerer D, Engel J, Hasford J, Schaich M, Ehninger G, Sauerland C, Büchner T, Schumacher A, Krahl R, Niederwieser D, Krauter J, Ganser A, Creutzig U, Döhner H, Schlenk RF. Impact of different post-remission strategies on quality of life in patients with acute myeloid leukemia. Haematologica 2008; 93:826-33. [PMID: 18469349 DOI: 10.3324/haematol.11987] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The impact on quality of life of allogeneic stem cell transplantation or conventional chemotherapy in patients with acute myeloid leukemia remains unclear, mainly because of a lack of studies with long-term follow-up. The German AML-Intergroup, therefore, initiated a survey on quality of life of patients with a relapse-free survival of at least 5 years after first-line treatment. DESIGN AND METHODS The EORTC Quality of Life Core Questionnaire (QLQ-C30), supplemented by information on self-assessed concomitant diseases, late treatment effects, and demographics was used. The questionnaire was returned by 419 of 818 patients (51.2%) identified by six study groups. The patients' median age at diagnosis was 42 years, and the median follow-up period was 8 years. One hundred and seventy patients were treated with stem cell transplantation (121 allogenic, 49 autologous) in first complete remission; the other 249 patients were treated with conventional chemotherapy. RESULTS The ECOG activity index revealed normal activity in 45% vs. 60% of the patients in the allogeneic stem cell transplantation vs. conventional chemotherapy groups, respectively and disabled person status in 60% vs. 35%. All QLQ-C30 functions, except physical functioning and pain, were poorer in allogeneic stem cell transplantation patients. Problems in leisure-time activities, social life, and financial management, sexual limitations and adverse effects were significantly more frequent in patients after allogeneic stem cell transplantation than after conventional chemotherapy. Multivariate logistic regression models on global health status revealed concomitant disease, age > 45 years, and allogeneic stem cell transplantation as significant risk factors. CONCLUSIONS These results indicate that, compared to conventional chemotherapy, allogeneic stem cell transplantation has a significantly worse long-term impact on quality of life. This needs to be considered when treatment options are discussed.
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Affiliation(s)
- Dorle Messerer
- Institut für Med. Informationsverarbeitung, Biometrie und Epidemiologie der Universität München (IBE), Marchioninistr. 15, D-81377 München, Germany.
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21
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Niederwieser D, Verdonck L, Cornelissen J, Al-Ali H, Gratwohl A, Nehring C, Krahl R, Becker C, Leiblein S, Poenisch W, Lange T, Lowenberg B. OP38 Reduced intensity conditioning hematopoietic cell transplants in elderly patients with AML. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Schaich M, Schlenk RF, Al-Ali HK, Döhner H, Ganser A, Heil G, Illmer T, Krahl R, Krauter J, Sauerland C, Büchner T, Ehninger G. Prognosis of acute myeloid leukemia patients up to 60 years of age exhibiting trisomy 8 within a non-complex karyotype: individual patient data-based meta-analysis of the German Acute Myeloid Leukemia Intergroup. Haematologica 2007; 92:763-70. [PMID: 17550848 DOI: 10.3324/haematol.11100] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Trisomy 8 (+8) is among the commonest genetic aberrations seen in acute myeloid leukemia (AML). However, the prognostic significance of this aberration and the best consolidation strategy for patients with it are still not resolved. Additional prognostic indicators are needed to further classify these patients and determine their appropriate management. DESIGN AND METHODS Individual patient data-based meta-analysis was performed on 131 patients (median age 50 (18-60) years) with +8 as a sole aberration or +8 with one additional aberration treated between 1993 and 2002 in eight prospective German AML treatment trials. All patients received state-of-the-art treatment including high-dose cytarabine with the option for autologous or allogeneic hematopoietic stem cell transplantation (HSCT). RESULTS In total, the 131 patients had a 3-year overall survival (OS) of 29% and a 3-year relapse-free survival (RFS) of 32%. Independent prognostic factors contributing to shorter OS were age > or = 45 years, extramedullary disease, and a percentage of +8 positive metaphases >/=80%. Combining these three prognostic variables established a hierarchical model for OS. The 3-year OS was 13% for the high-risk group, 36% for the intermediate-risk group, and 55% for the low-risk group (p<0.0001). Age <45 years and allogeneic HSCT (as treated) were independent prognostic factors for longer RFS. Additional cytogenetic aberrations other than t(8;21), inv(16), t(16;16), t(15;17) or 11q23 had no influence on treatment outcome. INTERPRETATION AND CONCLUSIONS We provide a new prognostic model for risk stratification of AML patients with +8. The data indicate that allogeneic HSCT may prolong RFS compared to that achieved with other strategies of post-remission therapy.
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Affiliation(s)
- Markus Schaich
- Department of Internal Medicine I, University of Dresden, Germany.
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23
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Niederwieser D, Becker C, Krahl R, Al-Ali H, Lange T, Gerhardt A, Schulze A, Hähling D, Schulze M, Freund M. Hematopoietic cell transplantation (HCT) after low-dose, total body irradiation-based regimen increased leukemia-free survival (LFS) in elderly patients with cytogenetic high-risk AML compared to chemotherapy (OSHO 97 study). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7003 Background: Even after reaching initial CR, most AML patients > 60 years relapse within 2 years of diagnosis. Cytogenetic high risk AML (abn 3q26, abn 11q23, -5/5q-, -7/7q- and complex) has an even worse prognosis. Attempts to improve survival by intensifying consolidation chemotherapy have so far failed. We investigated the role of allogeneic HCT in comparison to chemotherapy among patients with high risk cytogenetics entered into the OSHO AML 97 protocol. Methods: Initial treatment consisted of a course of induction therapy (AraC 2 g/m2 iv on day 1,3,5,7 + mitoxantrone 10 mg/m2 iv day 1 –3, repeated once in case of PR) followed by one consolidation course (AraC 240 mg/m2 iv day 1 –5 + mitoxantrone 10 mg/m2 iv day 1 –2). Patients in CR1 after the consolidation I were either treated with an additional consolidation therapy or with an allogeneic HCT from related (n=2) or unrelated (n=10) donors. Transplant patients were conditioned with fludarabine and TBI 200 cGy and immunosuppressed with cyclosporine and mycofenolate mofetil. Results: A total of 347 patients are evaluable. Of 105 (33%) patients with high-risk cytogenetics, 53 (50%) went into remission after one or two cycles of induction chemotherapy. Of these 53 patients, 42 received consolidation I and 35 patients were available for either consolidation II (n=23) or HCT (n=12). Median age of the patients receiving chemotherapy was 64 (range 61–77) years and that of the transplant patients was 64 (range 61–68) years. LFS at 4 years was 42 ± 14% after HCT and 15 ± 8% after chemotherapy. Major differences in relapse incidences were seen between the two groups, with the lowest RI at 4 years after HCT (36 ± 15%) followed by chemotherapy (85±8%, p<0.04). Treatment related mortality at 4 years was 35±17% and 0±0% for patients receiving HCT and chemotherapy, respectively (p<0.05). Conclusions: From these results, we conclude that consolidation with allogeneic HCT after minimal conditioning is superior to chemotherapy even in older patients with high risk cytogenetics. While differences in TRM were seen between the treatment arms, a lower relapse incidence after related and unrelated HCT contributed to the improved LFS. No significant financial relationships to disclose.
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Affiliation(s)
- D. Niederwieser
- Division of Hematology/Oncology, Leipzig, Germany; Hospital, Potsdam, Germany; Hospital, Erfurt, Germany; Hospital, Schwerin, Germany; Hospital, Zittau, Germany; Univeristy, Rostock, Germany
| | - C. Becker
- Division of Hematology/Oncology, Leipzig, Germany; Hospital, Potsdam, Germany; Hospital, Erfurt, Germany; Hospital, Schwerin, Germany; Hospital, Zittau, Germany; Univeristy, Rostock, Germany
| | - R. Krahl
- Division of Hematology/Oncology, Leipzig, Germany; Hospital, Potsdam, Germany; Hospital, Erfurt, Germany; Hospital, Schwerin, Germany; Hospital, Zittau, Germany; Univeristy, Rostock, Germany
| | - H. Al-Ali
- Division of Hematology/Oncology, Leipzig, Germany; Hospital, Potsdam, Germany; Hospital, Erfurt, Germany; Hospital, Schwerin, Germany; Hospital, Zittau, Germany; Univeristy, Rostock, Germany
| | - T. Lange
- Division of Hematology/Oncology, Leipzig, Germany; Hospital, Potsdam, Germany; Hospital, Erfurt, Germany; Hospital, Schwerin, Germany; Hospital, Zittau, Germany; Univeristy, Rostock, Germany
| | - A. Gerhardt
- Division of Hematology/Oncology, Leipzig, Germany; Hospital, Potsdam, Germany; Hospital, Erfurt, Germany; Hospital, Schwerin, Germany; Hospital, Zittau, Germany; Univeristy, Rostock, Germany
| | - A. Schulze
- Division of Hematology/Oncology, Leipzig, Germany; Hospital, Potsdam, Germany; Hospital, Erfurt, Germany; Hospital, Schwerin, Germany; Hospital, Zittau, Germany; Univeristy, Rostock, Germany
| | - D. Hähling
- Division of Hematology/Oncology, Leipzig, Germany; Hospital, Potsdam, Germany; Hospital, Erfurt, Germany; Hospital, Schwerin, Germany; Hospital, Zittau, Germany; Univeristy, Rostock, Germany
| | - M. Schulze
- Division of Hematology/Oncology, Leipzig, Germany; Hospital, Potsdam, Germany; Hospital, Erfurt, Germany; Hospital, Schwerin, Germany; Hospital, Zittau, Germany; Univeristy, Rostock, Germany
| | - M. Freund
- Division of Hematology/Oncology, Leipzig, Germany; Hospital, Potsdam, Germany; Hospital, Erfurt, Germany; Hospital, Schwerin, Germany; Hospital, Zittau, Germany; Univeristy, Rostock, Germany
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Deininger M, Schleuning M, Greinix H, Sayer HG, Fischer T, Martinez J, Maziarz R, Olavarria E, Verdonck L, Schaefer K, Boqué C, Faber E, Nagler A, Pogliani E, Russell N, Volin L, Schanz U, Doelken G, Kiehl M, Fauser A, Druker B, Sureda A, Iacobelli S, Brand R, Krahl R, Lange T, Hochhaus A, Gratwohl A, Kolb H, Niederwieser D. The effect of prior exposure to imatinib on transplant-related mortality. Haematologica 2006; 91:452-9. [PMID: 16585011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Imatinib is an effective treatment for chronic myeloid leukemia (CML) and Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL). However, relapse is common in patients with advanced or high risk disease. Such patients may be eligible for allogeneic stem cell transplantation (SCT), raising the question whether imatinib therapy may compromise the outcome of subsequent SCT. DESIGN AND METHODS We retrospectively analyzed 70 patients with CML and 21 with Ph+ ALL who had received imatinib prior to SCT. Data were retrieved by directly contacting centers. Multivariate analysis was used to define factors associated with major outcomes (engraftment, graft-versus-host disease, relapse, non-relapse mortality) in addition to descriptive statistics. For the CML patients major outcomes were compared with those of historical controls drawn from the EBMT registry. RESULTS At SCT, 44% of CML patients were in accelerated phase or blast crisis and 40% of ALL patients had active disease compared to 84% and 95% prior to imatinib. At 24 months, estimated transplant-related mortality was 44% and estimated relapse mortality 24%. Factors associated with shorter overall and progression-free survival were advanced disease at SCT and a female donor/male recipient pairing. No unusual organ toxicities were observed. Compared to historical controls, prior imatinib treatment did not influence overall survival, progression-free survival or non-relapse mortality, while there was a trend towards higher relapse mortality and significantly less chronic graft-versus-host disease. INTERPRETATION AND CONCLUSIONS Within the limits of a heterogeneous and relatively small cohort of patients, we found no evidence that imatinib negatively affects major outcomes after SCT, suggesting that imatinib prior to SCT is safe.
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Affiliation(s)
- Michael Deininger
- Center for Hematologic Malignancies, Oregon Health & Science University, Portland, OR 97239, USA.
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25
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Lange T, Bumm T, Mueller M, Otto S, Al-Ali HK, Grommisch L, Musiol S, Franke C, Krahl R, Niederwieser D, Deininger MWN. Durability of molecular remission in chronic myeloid leukemia patients treated with imatinib vs allogeneic stem cell transplantation. Leukemia 2005; 19:1262-5. [PMID: 15858618 DOI: 10.1038/sj.leu.2403752] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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26
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Banning U, Lange T, Krahl R, Mauz-Körholz C, Krutmann J, Niederwieser D, Körholz D. Prognostic value of T-1 cell numbers prior to allogeneic stem cell transplantation in patients with severe graft-versus-host disease. Bone Marrow Transplant 2005; 35:691-7. [PMID: 15696178 DOI: 10.1038/sj.bmt.1704874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Assessment of risk factors for acute graft-versus-host disease (aGvHD) might help in tailoring the intensity of prophylactic immunosuppression after allogeneic stem cell transplantation (SCT), thereby decreasing the relapse rate in leukaemia patients. In this study, we analysed whether the number of recipient blood T cells and plasma levels of different cytokines were correlated with the risk of aGvHD after allogeneic SCT. Analyses were performed in 23 patients receiving pSCT immediately before or during the first 2 days of the conditioning regimen. In all, 40 or more Tc-1 cells/microl pretransplant were associated with a significantly increased risk of aGvHD (10/10 patients with GvHD>/=II; 4/13 patients without aGvHD with a Tc-1 number >40/microl, P<0.002, Fisher's exact test). In addition, 40 or more Th-1 cells/microl pretransplant were also associated with a significantly increased risk of aGvHD (P<0.04, Fisher's exact test). Furthermore, the number of Th-2 cells was significantly higher in patients with severe aGvHD even though the median absolute cell counts were very low. However, all other investigated parameters did not reveal predictive value. In conclusion, determination of T-1 cells prior to SCT might determine patients with high/low risk of aGvHD and could thus be used to control immunosuppression after SCT.
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Affiliation(s)
- U Banning
- Division of Paediatric Hematology, Oncology and Hemostaseology, Clinic for Children and Adolescents, University of Leipzig Medical Center, Leipzig, Germany.
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27
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Al-Ali HK, Heinrich MC, Lange T, Krahl R, Mueller M, Müller C, Niederwieser D, Druker BJ, Deininger MWN. High incidence of BCR-ABL kinase domain mutations and absence of mutations of the PDGFR and KIT activation loops in CML patients with secondary resistance to imatinib. ACTA ACUST UNITED AC 2004; 5:55-60. [PMID: 14745431 DOI: 10.1038/sj.thj.6200319] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Imatinib, a specific inhibitor of the Abl, Kit and platelet-derived growth factor receptor (PDGFR) tyrosine kinases, is effective in all phases of chronic myelogenous leukemia. While responses in chronic phase are usually durable, resistance frequently develops in patients with advanced disease after an initial response. Several mechanisms of resistance have been demonstrated in vivo, including mutations in the BCR-ABL kinase domain and amplification of the BCR-ABL gene. We analyzed cytogenetics and screened for mutations of the BCR-ABL kinase domain as well as the activation loops of KIT and PDGFRA and B in 49 patients with CML or Ph-positive acute lymphoblastic leukemia with resistance to imatinib. Mutations in the kinase domain of BCR-ABL were detected in 51.6% of patients with secondary resistance but not in patients with primary resistance. Three of these mutations have not been described before (T315D, F359D and D276G). By contrast, KIT and PDGFRA and B were consistently wildtype. Clonal evolution prior to imatinib was present in 68.8% of patients with primary resistance and in 45.5% with secondary resistance. Additional cytogenetic aberrations developed in 18.2% of patients at the time of relapse. Our results confirm the high frequency of BCR-ABL kinase domain mutations in patients with secondary resistance to imatinib and exclude mutations of the activation loops of KIT, PDGFRA and PDGFRB as possible causes of resistance in patients without ABL mutations.
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28
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Schlenk RF, Benner A, Krauter J, Büchner T, Sauerland C, Ehninger G, Schaich M, Mohr B, Niederwieser D, Krahl R, Pasold R, Döhner K, Ganser A, Döhner H, Heil G. Individual Patient Data–Based Meta-Analysis of Patients Aged 16 to 60 Years With Core Binding Factor Acute Myeloid Leukemia: A Survey of the German Acute Myeloid Leukemia Intergroup. J Clin Oncol 2004; 22:3741-50. [PMID: 15289486 DOI: 10.1200/jco.2004.03.012] [Citation(s) in RCA: 250] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo evaluate prognostic factors for relapse-free survival (RFS) and overall survival (OS) and to assess the impact of different postremission therapies in adult patients with core binding factor (CBF) acute myeloid leukemias (AML).Patients and MethodsIndividual patient data–based meta-analysis was performed on 392 adults (median age, 42 years; range, 16 to 60 years) with CBF AML (t(8;21), n = 191; inv(16), n = 201) treated between 1993 and 2002 in prospective German AML treatment trials.ResultsRFS was 60% and 58% and OS was 65% and 74% in the t(8;21) and inv(16) groups after 3 years, respectively. For postremission therapy, intention-to-treat analysis revealed no difference between intensive chemotherapy and autologous transplantation in the t(8;21) group and between chemotherapy, autologous, and allogeneic transplantation in the inv(16) group. In the t(8;21) group, significant prognostic variables for longer RFS and OS were lower WBC and higher platelet counts; loss of the Y chromosome in male patients was prognostic for shorter OS. In the inv(16) group, trisomy 22 was a significant prognostic variable for longer RFS. For patients who experienced relapse, second complete remission rate was significantly lower in patients with t(8;21), resulting in a significantly inferior survival duration after relapse compared with patients with inv(16).ConclusionWe provide novel prognostic factors for CBF AML and show that patients with t(8;21) who experience relapse have an inferior survival duration.
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Affiliation(s)
- R F Schlenk
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
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29
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Lange T, Deininger M, Brand R, Hegenbart U, Al-Ali H, Krahl R, Poenisch W, Uharek L, Leiblein S, Gentilini C, Petersdorf E, Storb RF, Niederwieser D. BCR-ABL transcripts are early predictors for hematological relapse in chronic myeloid leukemia after hematopoietic cell transplantation with reduced intensity conditioning. Leukemia 2004; 18:1468-75. [PMID: 15241437 DOI: 10.1038/sj.leu.2403425] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Kinetics of BCR-ABL transcript elimination and its prognostic implications on relapse were analyzed in patients with chronic myeloid leukemia (CML) after reduced intensity hematopoietic cell transplantation (HCT). In all, 19 CML patients were conditioned with 2 Gy total-body irradiation in combination with (n=14) or without (n=3) fludarabine 3 x 30 mg/m(2) (Flu) or 4.5 Gy total lymphoid irradiation (TLI) with Flu and OKT3 3 x 5 mg (n=2) and were treated with cyclosporine (CSP) and mycophenolate mofetil after allogeneic HCT. BCR-ABL transcripts were analyzed by nested RT-PCR and Taqman((R)) RT-PCR on days +28, +56 and +84 after HCT and were evaluated for their association with relapse. Of the 19 patients, 14 achieved sustained remissions of which six had a negative RT-PCR 28 days after HCT. Five patients relapsed +41, +54, +57, +136 and +234 days after HCT. Predictors for relapse were advanced disease stage (P=0.02) and slow reduction of BCR-ABL transcripts at day 28 (P=0.006) and day 56 (P=0.047) post-transplant. We conclude that a complete clearance of BCR-ABL transcripts is achievable within 4 weeks from HCT even after minimal conditioning and that early kinetics of BCR-ABL transcripts significantly correlate with the probability of hematological relapse.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy
- Cyclosporine/administration & dosage
- Female
- Fusion Proteins, bcr-abl/genetics
- Hematopoietic Stem Cell Transplantation
- Hematopoietic System/drug effects
- Hematopoietic System/radiation effects
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Middle Aged
- Mycophenolic Acid/administration & dosage
- Mycophenolic Acid/analogs & derivatives
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/therapy
- Prognosis
- RNA, Messenger/analysis
- RNA, Neoplasm/genetics
- RNA, Neoplasm/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Sensitivity and Specificity
- Transplantation Conditioning
- Transplantation, Homologous
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
- Whole-Body Irradiation
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Affiliation(s)
- T Lange
- Division of Hematology and Oncology, University of Leipzig, Germany.
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30
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Lange T, Bumm T, Otto S, Al-Ali HK, Kovacs I, Krug D, Köhler T, Krahl R, Niederwieser D, Deininger MWN. Quantitative reverse transcription polymerase chain reaction should not replace conventional cytogenetics for monitoring patients with chronic myeloid leukemia during early phase of imatinib therapy. Haematologica 2004; 89:49-57. [PMID: 14754606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Imatinib is the new standard drug treatment for patients with chronic myelogenous leukemia (CML). Quantitative reverse transcription-polymerase chain reaction (qPCR) for detection of BCR-ABL transcripts is frequently used for monitoring patients in addition to or instead of conventional cytogenetics, although its place in the overall diagnostic framework is not yet clear. In this study, we compared qPCR and conventional cytogenetics for monitoring of patients during the early phases of imatinib therapy. DESIGN AND METHODS One hundred and seventeen patients treated with imatinib for CML in chronic or accelerated phase were prospectively followed with qPCR and karyotyping. Comparisons were made between both methods and between qPCR results from bone marrow and peripheral blood. To determine the prognostic impact of qPCR and cytogenetics during the early phase of imatinib treatment on subsequent cytogenetic response and progression-free survival (PFS), a multivariate model was generated that included established prognostic baseline variables. RESULTS We found a significant correlation between the proportion of Philadelphia (Ph) chromosome-positive metaphases and qPCR in the bone marrow and peripheral blood. Low qPCR values after 3 months of therapy were correlated with major cytogenetic response (MCyR) at 6 months and PFS at 2 years. However, in multivariate analysis, the cytogenetic response at 3 months emerged as the only independent parameter predictive of MCyR at 6 months and PFS at 2 years. INTERPRETATION AND CONCLUSIONS Our data suggest that conventional karyotyping should remain the standard method for following patients on imatinib during the early phases of therapy.
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MESH Headings
- Adult
- Aged
- Benzamides
- Bone Marrow/chemistry
- Bone Marrow/metabolism
- Bone Marrow/pathology
- Cytogenetic Analysis/methods
- Cytogenetic Analysis/statistics & numerical data
- Disease-Free Survival
- Female
- Fusion Proteins, bcr-abl/blood
- Fusion Proteins, bcr-abl/genetics
- Glyceraldehyde-3-Phosphate Dehydrogenases/blood
- Glyceraldehyde-3-Phosphate Dehydrogenases/genetics
- Humans
- Imatinib Mesylate
- In Situ Hybridization, Fluorescence/methods
- In Situ Hybridization, Fluorescence/statistics & numerical data
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Multivariate Analysis
- Philadelphia Chromosome
- Piperazines/therapeutic use
- Prognosis
- Pyrimidines/therapeutic use
- Remission Induction/methods
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Reverse Transcriptase Polymerase Chain Reaction/statistics & numerical data
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Affiliation(s)
- Thoralf Lange
- Department of Hematology, University of Leipzig, Germany
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31
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Lange T, Günther C, Köhler T, Krahl R, Musiol S, Leiblein S, Al-Ali HK, van Hoomissen I, Niederwieser D, Deininger MWN. High levels of BAX, low levels of MRP-1, and high platelets are independent predictors of response to imatinib in myeloid blast crisis of CML. Blood 2003; 101:2152-5. [PMID: 12406906 DOI: 10.1182/blood-2002-05-1366] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Imatinib induces remissions in approximately 30% of patients with chronic myeloid leukemia (CML) in myeloid blast crisis (M-BC). Because most patients eventually relapse, allogeneic stem cell transplantation (SCT) in remission offers the best chance for cure. Remission induction with imatinib alone would seem ideal because it is less toxic than conventional chemotherapy. Conversely, patients unlikely to respond may benefit from combination therapy up front. To identify prognostic factors, we studied the mRNA expression of genes related to drug resistance and apoptosis in leukemic cells from patients with M-BC and their in vitro sensitivity to imatinib, and analyzed the results with other baseline factors for their impact on response. We show that high levels of BAX, low levels of MRP-1, and a high platelet count are independently predictive of response to imatinib. Combined into a score, these parameters may be clinically useful for risk-adapted patient stratification.
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MESH Headings
- Adult
- Aged
- Antigens, CD34/analysis
- Antineoplastic Agents/therapeutic use
- Apoptosis/genetics
- Benzamides
- Blast Crisis/drug therapy
- Chemokines, CC/genetics
- Drug Resistance, Neoplasm/genetics
- Drug Screening Assays, Antitumor
- Female
- Gene Expression
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Male
- Middle Aged
- Piperazines/therapeutic use
- Platelet Count
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins c-bcl-2
- Pyrimidines/therapeutic use
- RNA, Messenger/analysis
- Remission Induction
- Stem Cell Transplantation
- Transplantation, Homologous
- Tumor Cells, Cultured
- bcl-2-Associated X Protein
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Affiliation(s)
- Thoralf Lange
- Department of Hematology, University of Leipzig, Germany
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Seyfarth HJ, Nenoff P, Winkler J, Krahl R, Klöppel R, Wirtz H, Borte G. [Invasive pulmonary aspergillosis--CT findings in context with the clinical course]. ROFO-FORTSCHR RONTG 2002; 174:1115-20. [PMID: 12221569 DOI: 10.1055/s-2002-33939] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the impact of chest radiographs and CT in patients suffering from invasive pulmonary aspergillosis (IPA) compared to the clinical course. PATIENTS AND METHODS Twenty-three patients with confirmed diagnosis of IPA between January 1996 and September 1999 were included in this study. Signs of inflammatory infiltrates on chest radiographs and CT were retrospectively evaluated in relation to the onset of the clinical symptoms. Infiltrates on CT were analyzed in detail with respect to number, morphology, and localization. RESULTS Seventy-six infiltrates were found on the CT of 22 patients; one patient had diffuse areas of lung infiltrates. Both lungs were affected by infiltrates in 14 patients. Pleural effusions were confirmed in 12 patients. Twelve patients had typically round foci with halo and nine patients crescent air signs. The preferred localization of lung infiltrates was segment 6. The median interval between the onset of clinical symptoms and the first radiographic changes was 5.5 days, with an additional interval of 4.5 days until confirmation by CT. Localization, number of infiltrates, and clinical course were not related. CONCLUSION In immune-compromised patients with fever, a CT of the chest should be carried out as soon as possible to detect signs indicative of IPA. Morphological changes on CT like a round focus with halo and crescent air sign support the diagnosis of IPA. In this context, special attention should be directed to pulmonary segment 6.
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Müller C, Hennig E, Franke C, Krahl R, Leiblein S, Niederwieser D, Deininger MWN. The BCR/ABL-extra signal fluorescence in situ hybridization system reliably detects deletions upstream of the ABL locus: implications for reporting of results and followup of chronic myelogenous leukemia patients. Cancer Genet Cytogenet 2002; 136:149-50. [PMID: 12237241 DOI: 10.1016/s0165-4608(01)00661-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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34
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Mantovani L, Hasenclever D, Krahl R, Pönisch W, Herold M, Pasold R, Fiedler F, Dölken G, Kämpfe D, Schmoll HJ, Súbert R, Kubel M, Niederwieser D, Helbig W. Intermediate-dose cytarabine treatment delivered at moderate infusion rates for de novo acute myeloid leukemia-results of a phase I-II study. Leuk Lymphoma 2002; 43:265-74. [PMID: 11999557 DOI: 10.1080/10428190290006035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Published randomized trials on different cytarabine doses for the treatment of acute myeloid leukemia (AML) provide evidence of a dose-response effect. However, high-dose cytarabine (HIDAC) regimens correlate with increased morbidity and toxicity related mortality. Typical HIDAC regimens deliver 6 g/m2/d in infusion rates of 500-3000 mg/m2/h. However, pharmacokinetic measurements indicate that intracellular Ara-CTP formation is saturated at lower infusion rates than used in HIDAC schedules, probably causing cytarabine accumulation in the plasma and increased toxicity. It was our objective to investigate in a prospective non-randomized phase I-II study feasibility and efficacy of intermediate doses of cytarabine delivered at the presumptive saturating moderate infusion rate (mir-IDAC), as induction therapy in order to optimize intensified treatment for acute myeloid leukemia. Forty previously untreated patients younger than 60 years of age with de novo AML received intermediate doses of cytarabine (2-4 g/m2/d) at moderate infusion rates (250-667 mg/m2/h) over 6 or 8 h. Cytarabine was applied on alternate days (day 1, 3, 5, 7) in combination with an anthracycline as induction and consolidation therapy. Thirty-two of the 40 patients (80%, 95%CI:64-91%) achieved CR after induction treatment. Treatment-related mortality during induction chemotherapy was 2.5%. No cerebellar toxicity was observed. After two to four mir-IDAC courses stem cell harvesting was successful in 71% of the patients eligible for high-dose chemotherapy. After three years 56% (95%CI:40-72%) of all patients are alive and 59% (95%CI:42-76%) of the patients who entered CR are free of leukemia. In conclusion, favorable long-term outcomes and moderate acute toxicities were observed in patients with de novo AML treated with IDAC schedules delivered at moderate infusion rates (mir-IDAC) starting as induction treatment. The data suggest that a randomized trial should now be undertaken to examine whether mir-IDAC has clinical advantages over HIDAC.
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Affiliation(s)
- Luisa Mantovani
- Department of Internal Medicine I, St. Georg 's Hospital, Leipzig, Germany.
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35
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Köhler T, Schill C, Deininger MW, Krahl R, Borchert S, Hasenclever D, Leiblein S, Wagner O, Niederwieser D. High Bad and Bax mRNA expression correlate with negative outcome in acute myeloid leukemia (AML). Leukemia 2002; 16:22-9. [PMID: 11840259 DOI: 10.1038/sj.leu.2402340] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2001] [Accepted: 09/28/2001] [Indexed: 11/09/2022]
Abstract
The search for molecular markers in AML that allow prediction of outcome has recently focused on genes involved in the regulation of programmed cell death (PCD). The aim of our study was to determine whether mRNA levels of Mdm-2, Bcl-2, Bcl-x(L), Bad, and Bax are independent prognostic parameters for outcome. Transcript levels were analyzed by real-time quantitative RT-PCR in 232 samples collected either at diagnosis or following induction chemotherapy (ICT). Multivariate COX regression analysis adjusted for chemotherapy protocol, de novo vs secondary AML, and de novo vs relapsed AML indicated: (1) At diagnosis, high expression of Bad (P = 0.015) and even more so high Bax and Bad levels (P = 0.018) predicted adverse outcome, regardless of the response to ICT. In patients who subsequently failed to enter complete remission (CR), high levels of Bad, Bax and Bax high/Bad high were associated with an increased relative risk (RR) to die from tumor (RR = 5.0 for Bad, 3.4 for Bax and 6.14 for Bax high/Bad high). (2) Following ICT, high expression of Bax (P= 0.005) and high Bcl-2/Bax ratios (P = 0.004) were independent predictors of unfavorable outcome, regardless of response to ICT. We conclude that high levels of Bax and Bad correlate with poor outcome, particularly in patients who do not enter CR and may serve as prognostic markers in AML.
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Affiliation(s)
- T Köhler
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Division of Molecular Diagnostics, University of Leipzig Medical School, Leipzig, Germany
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36
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Seyfarth HJ, Nenoff P, Winkler J, Krahl R, Haustein UF, Schauer J. Aspergillus detection in bronchoscopically acquired material. Significance and interpretation. Mycoses 2001; 44:356-60. [PMID: 11766098 DOI: 10.1046/j.0933-7407.2001.93.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pulmonary invasive aspergillosis is frequently difficult to diagnose. In particular, the value of the cultivation of Aspergillus and the Aspergillus galactomannan antigen detection (Pastorex) in bronchoscopically acquired material (bronchoalveolar lavage = BAL, bronchial lavage = BL) in the course of diagnosing this mycosis is viewed controversially. Between January 1996 and September 1999, we obtained 114 positive results in 100 bronchoscopically aquired specimens from a total of 69 patients. 59 of the 69 patients were immunosuppressed, 42 suffered from pulmonary aspergillosis and 38 suffered from invasive pulmonary aspergillosis. The positive prediction rate for a positive result with regard to pulmonary aspergillosis in bronchoscopically acquired material was approximately 61%. Cultivation of Aspergillus was more successful in BAL, and the Aspergillus antigen detection was more successful in BL.
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Affiliation(s)
- H J Seyfarth
- Medizinische Klinik I, Abteilung Pneumologie, Universität Leipzig, Germany
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37
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Deininger M, Pönisch W, Krahl R, Leiblein S, Edel E, Lange T, Fiedler F, Freund M, Franke A, Pasold R, von Grünhagen U, Herold M, Dölken G, Hoffmann FA, Uhle R, Schultze W, Steglich J, Schwarzer A, Richter P, Winkelmann C, Kettner E, Dachselt K, Subert R, Schwalbe E, Doepper J, Helbig W, Niederwieser D. Chemotherapy for mobilisation of Ph-negative progenitor cells from patients with CML: impact of different mobilisation regimens. Bone Marrow Transplant 2001; 27:1125-32. [PMID: 11551022 DOI: 10.1038/sj.bmt.1703057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mobilised peripheral blood stem cells are widely used for autografting in patients with chronic myeloid leukaemia (CML) and it is generally thought that a high proportion of Ph-negative progenitor cells in the graft is desirable. We report here the results of 91 stem cell mobilisations performed with various chemotherapy regimens followed by G-CSF. We show that mobilisation of Ph-negative cells is possible after diagnosis as well as in advanced stages of the disease. The yield of Ph-negative cells is highly dependent on the chemotherapy regimen: while the combination of idarubicin and cytarabin for 3-5 days (IC3-5) mobilised Ph-negative cells in most patients, high-dose cyclophosphamide was ineffective. Mobilisation of Ph-negative progenitor cells after IC3 was at least as effective as after IC5; however, less apheresis sessions were required, and toxicity was much reduced after IC3. Compared to historical controls, IC was equally effective as the widely used ICE/miniICE (idarubicin, cytarabin, etoposide) protocol. No correlation was found between graft quality and the cytogenetic response to subsequent treatment with interferon-alpha. We conclude that IC3 is an effective and well-tolerated regimen for mobilising Ph-negative cells that compares well with more aggressive approaches such as IC5 and ICE/miniICE.
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Affiliation(s)
- M Deininger
- Department of Hematology, University of Leipzig, Germany
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Deininger M, Lehmann T, Krahl R, Hennig E, Müller C, Niederwieser D. No evidence for persistence of BCR-ABL-positive cells in patients in molecular remission after conventional allogenic transplantation for chronic myeloid leukemia. Blood 2000; 96:779-80. [PMID: 10950517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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39
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Köhler T, Leiblein S, Borchert S, Eller J, Rost AK, Lassner D, Krahl R, Helbig W, Wagner O, Remke H. Absolute levels of MDR-1, MRP, and BCL-2 MRNA and tumor remission in acute leukemia. Adv Exp Med Biol 1999; 457:177-85. [PMID: 10500792 DOI: 10.1007/978-1-4615-4811-9_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Mononuclear cells prepared from peripheral blood or bone marrow of 119 AML and 28 ALL patients prior and following therapy were analyzed for absolute transcript levels of the chemoresistance genes mdr-1 and MRP, and the proto-oncogene bcl-2, by validated contamination-protected quantitative RT-PCR. In newly diagnosed AML mainly tumors of the granulocytic lineage (FAB M1-M2) expressed increased mdr-1 mRNA amounts. The MRP gene was expressed in all investigated samples without relation to a particular FAB class. High initial expression of both genes did not confer a poor prognosis even at high number of CD34+ cells. Data compared prior to and after therapy start (paired samples) revealed that AML patients who did not respond to therapy (NR) expressed increased levels of mdr-1 mRNA, as well as MRP and bcl-2 cDNA normalized to GAPDH reference transcripts, when compared to patients achieving complete remission (CR; p = 0.003, 0.008 and 0.0005, respectively). In ALL-NR the mdr-1 and bcl-2 genes were entirely more active after induction chemotherapy. Arbitrary cut-off values were established in order to delimit pathological from non-pathological gene expression. 59% of studied AML and 33% of ALL-NR exceeded the arbitrary values (mdr-1: > 2 amol/microgram RNA, MRP: > 10 zmol/amol GAPDH, bcl-2: > 5 zmol/amol GAPDH) for one and 11% of AML-NR for two parameters. Only 17% of the AML-CR and none of the ALL-CR group were above these limits. The results indicate that high individual activity of usually one, rarely two of the investigated genes might be associated with poor clinical outcome in treated acute leukemia.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- ATP-Binding Cassette Transporters/genetics
- Blast Crisis
- Bone Marrow Cells/pathology
- Drug Resistance, Multiple/genetics
- Genes, MDR
- Genes, bcl-2
- Humans
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Multidrug Resistance-Associated Proteins
- Polymerase Chain Reaction
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Proto-Oncogene Mas
- Proto-Oncogene Proteins c-bcl-2/genetics
- RNA, Messenger/genetics
- Remission Induction
- Reproducibility of Results
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Transcription, Genetic
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Affiliation(s)
- T Köhler
- University of Leipzig Medical School, Department of Clinical Chemistry, Germany
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40
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Schulze E, Krahl R, Thalmeier K, Helbig W. Detection of bcr-abl mRNA in single progenitor colonies from patients with chronic myeloid leukemia by PCR: comparison with cytogenetics and PCR from uncultured cells. Exp Hematol 1995; 23:1649-54. [PMID: 8542960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bone marrow and/or peripheral blood of patients with chronic myeloid leukemia (CML) was investigated by the following three parameters: Ph' chromosome, bcr-abl expression in fresh blood and/or bone marrow, and bcr-abl expression in single hematopoietic progenitor colonies generated from blood and/or bone marrow. Expression of bcr-abl was proven by a reverse "nested primer" polymerase chain reaction (PCR) that is able to detect 1 pg of hybrid mRNA. We performed 108 investigations on 68 patients containing all three parameters: 12 on untreated patients, seven after interferon-alpha (IFN-alpha), seven after low-dose cytosine arabinoside (Ara-C), 22 after cyclic high-dose hydroxyurea (HU), 49 after allogeneic BMT, five before and three after stem cell mobilization, and three after autologous stem cell transplantation (ASCT). In 53 cases (49%), cytogenetics and PCR gave identical results. In 40 cases (37%), PCR from single colonies gave additional information compared to cytogenetics (e.g., mosaic in colonies when all metaphases were positive or negative). Most interesting were the results of one patient after IFN, one patient after ASCT, and 10 patients after BMT (14 investigations = 13%), showing only Ph'-negative mitoses accompanied by a negative nested primer PCR from fresh blood/bone marrow but single bcr-abl-positive progenitor colonies. False-positive results could be widely excluded by repeated insertion of negative controls into the experiments. One explanation for these results could be that CML, progenitors survive in the patient's body by being inactive and not proliferating. These cells express no or very little RNA and bcr-abl is not detectable by reverse PCR. When stimulated ex vivo in a colony assay by external growth factors, cells proliferate and produce detectable amounts of hybrid mRNA. The value of these observations is not clear. A follow-up of the patients will show if such sleeping progenitors can be activated in vivo. Concluding our observations, we can say that in special cases (therapy follow-up, detection of minimal residual disease) it could be useful to perform a PCR analysis of single progenitors in parallel with the routine investigations.
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Affiliation(s)
- E Schulze
- University of Leipzig, Department of Hematology/Oncology, Germany
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41
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Schwarzer A, Schulze E, Leiblein S, Krahl R, Kubel M, Bartram C, Edelmann J, Sack U, Helbig W. Guillain Barré syndrome, a possible side effect of buffy coat transfusion and IFN alpha therapy in relapsed CML after bone marrow transplantation. Ann Oncol 1995; 6:617. [PMID: 8573544 DOI: 10.1093/oxfordjournals.annonc.a059254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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42
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Kubel M, Helbig W, Schwenke H, Hoffmann FA, Leiblein S, Schulze E, Pönisch W, Krahl R, Zuleger B. [Results of therapy of 100 patients with acute leukemia--a retrospective unicenter 5-year analysis]. Z Gesamte Inn Med 1989; 44:58-64. [PMID: 2650473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The results of therapy in 100 patients who newly fell ill (68 AML, 32 ALL) with acute leukaemia were evaluated (1981 to 1985). The 5-year-survival chance of all patients is 15% for AML, 18% for ALL, first of all it is depending on the degree of remission obtained. The CR rate is nearly 43% (AML) and 66% (ALL), respectively, shows a dependence upon age and is impaired above all by a high early death rate (supportive therapy). With increasing aggressiveness the results of the remission induction therapy improve, as it becomes clear in a comparison with an evaluation of patients 1965-1980 (CR: 15-32%). Also in the postremission therapy the results of intensive forms of therapy are more favourable: 4 years recurrence-free survival after CR in autologous bone marrow transplantation 50%, in allogenic bone marrow transplantation 40%, in cyclic chemotherapy 17%, in oral permanent therapy 0%. Starting from these findings the present conception of the therapy of acute leukaemias is discussed in connection with the literature.
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Affiliation(s)
- M Kubel
- Abteilung für Hämatologie und Onkologie, Karl-Marx-Universität Leipzig
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Krahl D, Preuss EG, Krahl R, Müller G. [Differential diagnosis of endangiitis and arteriosclerosis obliterans]. Z Gesamte Inn Med 1982; 37:25-9. [PMID: 7072303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
41 males at the age from 20 to 40 years with chronic obstruction of the arteries of the extremities were on the basis of anamnestic and clinical findings subdivided into the groups obliterating endangiitis (group I = 20 patients) and obliterating arteriosclerosis (group II = 11 patients). In 10 patients in this way no decision for one of the two diagnoses could be made (group III). By multidimensional variance and discriminance analysis of various clinico-chemical parameters the separation of the groups I and II could be proved. The efficiency was 93.6% in the discrimination with 10 characteristics. With the help of the calculated non-elementary, linear characteristics of discriminance the patients could be classified into the group III. 7 patients could be classified into the group II and 3 patients into the group I. Thus we succeeded in differing 23 patients with obliterating endangiitis from 18 patients who as arteriosclerotics belong to the metabolic syndrome.
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Frischleder H, Krahl R, Lehmann E. Intra- and intermolecular interactions of phospholipid headgroups within a two-dimensional hexagonal lattice. Chem Phys Lipids 1981. [DOI: 10.1016/0009-3084(81)90015-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Frischleder H, Gleichmann S, Krahl R. Quantum-chemical and empirical calculations on phospholipids, III. Hydration of the dimethylphosphate anion. Chem Phys Lipids 1977; 19:144-9. [PMID: 880728 DOI: 10.1016/0009-3084(77)90094-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The binding of water to the dimethylphosphate anion (DMP-) was calculated using the PCILO method. We found binding energies of 25.95 kcal-mol-1 in the O1-P-O3 plane bridgeing the anionic oxygen atoms and 19.3 kacl-mol-1 for the one-site association of a water molecule to an anionic oxygen atom of DMP-. In this range on water molecule added to DMP- in the O1...O3 bridged configuration has a significantly higher binding energy to DMP- than water molecules added to other binding sites. The total binding energy of 5 water molecules to DMP- is 92 kcal-mol-1, a quantity which is about 10% less than the sum of the binding energies of the corresponding monohydrates.
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46
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Walter LW, Krosch H, Schmidt GA, Starke K, Krahl R. [Synoptical X-ray diagnostics of pulmonary emphysema (author's transl)]. Z Erkr Atmungsorgane 1976; 145:241-8. [PMID: 983182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In marked chronic obstructive pulmonary emphysema, especially in the classical emphysematous type of abnormal thorax, a good correlation can be found between the anteroposterior expansion of the thorax, the reduced inspiratory capacity, the clinical state, disturbed mechanics of breathing and the x-ray-state. On the contrary, in clinical emphysema of a lower degree, especially in subclinical, i. e. in predominantly asymptomatic pulmonary emphysema of the elderly, the effectiveness of the roentgenological examination is very small.
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