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Stelljes M, Middeke JM, Bug G, Wagner-Drouet EM, Müller LP, Schmid C, Krause SW, Bethge W, Jost E, Platzbecker U, Klein SA, Schubert J, Niederland J, Kaufmann M, Schäfer-Eckart K, Schaich M, Baldauf H, Stölzel F, Petzold C, Röllig C, Alakel N, Steffen B, Hauptrock B, Schliemann C, Sockel K, Lang F, Kriege O, Schaffrath J, Reicherts C, Berdel WE, Serve H, Ehninger G, Schmidt AH, Bornhäuser M, Mikesch JH, Schetelig J. Remission induction versus immediate allogeneic haematopoietic stem cell transplantation for patients with relapsed or poor responsive acute myeloid leukaemia (ASAP): a randomised, open-label, phase 3, non-inferiority trial. Lancet Haematol 2024; 11:e324-e335. [PMID: 38583455 DOI: 10.1016/s2352-3026(24)00065-6] [Citation(s) in RCA: 1] [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] [Received: 01/08/2024] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Whether high-dose cytarabine-based salvage chemotherapy, administered to induce complete remission in patients with poor responsive or relapsed acute myeloid leukaemia scheduled for allogeneic haematopoietic stem-cell transplantation (HSCT) after intensive conditioning confers a survival advantage, is unclear. METHODS To test salvage chemotherapy before allogeneic HSCT, patients aged between 18 and 75 years with non-favourable-risk acute myeloid leukaemia not in complete remission after first induction or untreated first relapse were randomly assigned 1:1 to remission induction with high-dose cytarabine (3 g/m2 intravenously, 1 g/m2 intravenously for patients >60 years or with a substantial comorbidity) twice daily on days 1-3 plus mitoxantrone (10 mg/m2 intravenously) on days 3-5 or immediate allogeneic HSCT for the disease control group. Block randomisation with variable block lengths was used and patients were stratified by age, acute myeloid leukaemia risk, and disease status. The study was open label. The primary endpoint was treatment success, defined as complete remission on day 56 after allogeneic HSCT, with the aim to show non-inferiority for disease control compared with remission induction with a non-inferiority-margin of 5% and one-sided type 1 error of 2·5%. The primary endpoint was analysed in both the intention-to-treat (ITT) population and in the per-protocol population. The trial is completed and was registered at ClinicalTrials.gov, NCT02461537. FINDINGS 281 patients were enrolled between Sept 17, 2015, and Jan 12, 2022. Of 140 patients randomly assigned to disease control, 135 (96%) proceeded to allogeneic HSCT, 97 (69%) after watchful waiting only. Of 141 patients randomly assigned to remission induction, 134 (95%) received salvage chemotherapy and 128 (91%) patients subsequently proceeded to allogeneic HSCT. In the ITT population, treatment success was observed in 116 (83%) of 140 patients in the disease control group versus 112 (79%) of 141 patients with remission induction (test for non-inferiority, p=0·036). Among per-protocol treated patients, treatment success was observed in 116 (84%) of 138 patients with disease control versus 109 (81%) of 134 patients in the remission induction group (test for non-inferiority, p=0·047). The difference in treatment success between disease control and remission induction was estimated as 3·4% (95% CI -5·8 to 12·6) for the ITT population and 2·7% (-6·3 to 11·8) for the per-protocol population. Fewer patients with disease control compared with remission induction had non-haematological adverse events grade 3 or worse (30 [21%] of 140 patients vs 86 [61%] of 141 patients, χ2 test p<0·0001). Between randomisation and the start of conditioning, with disease control two patients died from progressive acute myeloid leukaemia and zero from treatment-related complications, and with remission induction two patients died from progressive acute myeloid leukaemia and two from treatment-related complications. Between randomisation and allogeneic HSCT, patients with disease control spent a median of 27 days less in hospital than those with remission induction, ie, the median time in hospital was 15 days (range 7-64) versus 42 days (27-121, U test p<0·0001), respectively. INTERPRETATION Non-inferiority of disease control could not be shown at the 2·5% significance level. The rate of treatment success was also not statistically better for patients with remission induction. Watchful waiting and immediate transplantation could be an alternative for fit patients with poor response or relapsed acute myeloid leukaemia who have a stem cell donor available. More randomised controlled intention-to-transplant trials are needed to define the optimal treatment before transplantation for patients with active acute myeloid leukaemia. FUNDING DKMS and the Gert and Susanna Mayer Stiftung Foundation.
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Affiliation(s)
| | | | - Gesine Bug
- Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Lutz P Müller
- University Hospital, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Christoph Schmid
- Faculty of Medicine, Augsburg University Hospital, Augsburg, Germany
| | | | | | - Edgar Jost
- University Hospital Aachen & Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, Aachen, Germany
| | | | | | | | - Judith Niederland
- Helios Klinikum Berlin-Buch, Klinik für Hämatologie und Zelltherapie, Berlin, Germany
| | | | | | | | | | - Friedrich Stölzel
- University Hospital TU Dresden, Dresden, Germany; University Hospital Schleswig-Holstein, Kiel, Germany
| | | | | | - Nael Alakel
- University Hospital TU Dresden, Dresden, Germany
| | - Björn Steffen
- Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | | | - Katja Sockel
- University Hospital TU Dresden, Dresden, Germany
| | - Fabian Lang
- Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Judith Schaffrath
- University Hospital, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | | | | | - Hubert Serve
- Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gerhard Ehninger
- University Hospital TU Dresden, Dresden, Germany; Cellex Cell Professionals, Cologne, Germany
| | | | - Martin Bornhäuser
- University Hospital TU Dresden, Dresden, Germany; National Center for Tumor Diseases, Dresden, Germany
| | | | - Johannes Schetelig
- University Hospital TU Dresden, Dresden, Germany; DKMS gemeinnützige GmbH, Tübingen und Dresden, Germany.
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2
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Baden D, Zukunft S, Hernandez G, Wolgast N, Steinhauser S, Pohlmann A, Schliemann C, Mikesch JH, Steffen B, Sauer T, Hanoun M, Schafer-Eckart K, Krause SW, Hanel M, Einsele H, Jost E, Brummendorf TH, Scholl S, Hochhaus A, Neubauer A, Burchert A, Kaufmann M, Niemann D, Schaich M, Blau W, Kiani A, Gorner M, Kaiser U, Kullmer J, Weber T, Berdel WE, Ehninger G, Muller-Tidow C, Platzbecker U, Serve H, Bornhauser M, Rollig C, Baldus CD, Fransecky L. Time from diagnosis to treatment has no impact on survival in newly diagnosed acute myeloid leukemia treated with venetoclax-based regimens. Haematologica 2024. [PMID: 38654660 DOI: 10.3324/haematol.2024.285225] [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] [Received: 02/06/2024] [Indexed: 04/26/2024] Open
Abstract
In newly diagnosed acute myeloid leukemia, immediate initiation of treatment is standard of care. However, deferral of antileukemic therapy may be indicated to assess comorbidities or pre-therapeutic risk factors. We explored the impact of time from diagnosis to treatment on outcomes in newly diagnosed acute myeloid leukemia undergoing venetoclax-based therapy in two distinct cohorts. By querying the Study Alliance Leukemia database and the global health network TriNetX, we identified 138 and 717 patients respectively with an average age of 76 and 72 years who received venetoclax-based firstline therapy. When comparing patients who started treatment earlier or later than 10 days after initial diagnosis, no significant difference in median overall survival was observed - neither in the SAL cohort (7.7 vs. 9.6 months, p=.42) nor in the TriNetX cohort (7.5 vs. 7.2 months, p=.41). Similarly, severe infections, bleeding, and thromboembolic events were equally observed between early and later treatments, both in the overall patient groups and specific subgroups (age ≥75 years or leukocytes ≥20x109/L). This retrospective analysis indicates that delaying the start of venetoclax-based therapy in newly diagnosed acute myeloid leukemia might be a safe option for selected patients, provided that close clinical monitoring is performed.
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Affiliation(s)
- David Baden
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany; University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Kiel.
| | - Sven Zukunft
- Medical Department I, University Hospital of TU Dresden, Dresden
| | | | - Nadine Wolgast
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany; University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Kiel
| | - Sophie Steinhauser
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany; University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Kiel
| | | | | | | | - Bjorn Steffen
- Medical Department II, J.-W.-Goethe University Hospital Frankfurt
| | - Tim Sauer
- Medical Department V, Heidelberg University Hospital
| | - Maher Hanoun
- Department of Hematology, Essen University Hospital
| | | | | | - Mathias Hanel
- Department for Internal Medicine III, Klinikum Chemnitz
| | | | - Edgar Jost
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany and Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Dusseldorf (ABCD), Aachen
| | - Tim H Brummendorf
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany and Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Dusseldorf (ABCD), Aachen
| | | | | | - Andreas Neubauer
- Department of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg
| | - Andreas Burchert
- Department of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg
| | - Martin Kaufmann
- Department of Hematology, Oncology and Palliative Medicine, Robert-Bosch-Hospital Stuttgart
| | - Dirk Niemann
- Internal Medicine, Hematology/Oncology, Palliative Medicine, Gemeinschaftsklinikum Mittelrhein, Koblenz
| | - Markus Schaich
- Department for Hematology, Oncology and Palliative Medicine, Rems-Murr-Klinikum, Winnenden
| | - Wolfgang Blau
- Department for Internal Medicine III, Helios Dr Schmidt Hospital Wiesbaden
| | - Alexander Kiani
- Department for Oncology and Hematology, Klinikum Bayreuth, and Comprehensive Cancer Center Erlangen-EMN
| | - Martin Gorner
- Department for Hematology, Oncology and Palliative Medicine, Klinikum Bielefeld, Bielefeld
| | - Ulrich Kaiser
- Medical Department II, St. Bernward Hospital, Hildesheim
| | | | - Thomas Weber
- Department for Internal Medicine IV, University Hospital Halle (Saale)
| | | | - Gerhard Ehninger
- Medical Department I, University Hospital of TU Dresden, Dresden
| | | | - Uwe Platzbecker
- Medical Department I, Hematology and Cell Therapy, University Hospital Leipzig
| | - Hubert Serve
- Medical Department II, J.-W.-Goethe University Hospital Frankfurt
| | | | - Christoph Rollig
- Medical Department I, University Hospital of TU Dresden, Dresden
| | - Claudia D Baldus
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany; University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Kiel
| | - Lars Fransecky
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany; University Cancer Center Schleswig-Holstein, University Hospital Schleswig-Holstein, Kiel
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3
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Fuchs M, Jacob AS, Kaul H, Kobe C, Kuhnert G, Pabst T, Greil R, Bröckelmann PJ, Topp MS, Just M, Hertenstein B, Soekler M, Vogelhuber M, Zijlstra JM, Keller UB, Krause SW, Dührsen U, Meissner J, Viardot A, Eich HT, Baues C, Diehl V, Rosenwald A, Buehnen I, von Tresckow B, Dietlein M, Borchmann P, Engert A, Eichenauer DA. Follow-up of the GHSG HD16 trial of PET-guided treatment in early-stage favorable Hodgkin lymphoma. Leukemia 2024; 38:160-167. [PMID: 37845285 PMCID: PMC10776396 DOI: 10.1038/s41375-023-02064-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/25/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023]
Abstract
The primary analysis of the GHSG HD16 trial indicated a significant loss of tumor control with PET-guided omission of radiotherapy (RT) in patients with early-stage favorable Hodgkin lymphoma (HL). This analysis reports long-term outcomes. Overall, 1150 patients aged 18-75 years with newly diagnosed early-stage favorable HL were randomized between standard combined-modality treatment (CMT) (2x ABVD followed by PET/CT [PET-2] and 20 Gy involved-field RT) and PET-2-guided treatment omitting RT in case of PET-2 negativity (Deauville score [DS] < 3). The study aimed at excluding inferiority of PET-2-guided treatment and assessing the prognostic impact of PET-2 in patients receiving CMT. At a median follow-up of 64 months, PET-2-negative patients had a 5-year progression-free survival (PFS) of 94.2% after CMT (n = 328) and 86.7% after ABVD alone (n = 300; HR = 2.05 [1.20-3.51]; p = 0.0072). 5-year OS was 98.3% and 98.8%, respectively (p = 0.14); 4/12 documented deaths were caused by second primary malignancies and only one by HL. Among patients assigned to CMT, 5-year PFS was better in PET-2-negative (n = 353; 94.0%) than in PET-2-positive patients (n = 340; 90.3%; p = 0.012). The difference was more pronounced when using DS4 as cut-off (DS 1-3: n = 571; 94.0% vs. DS ≥ 4: n = 122; 83.6%; p < 0.0001). Taken together, CMT should be considered standard treatment for early-stage favorable HL irrespective of the PET-2-result.
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Grants
- Sanofi-Genzyme, Takeda
- Employment/leadership position (University Hospital of Cologne, Head of the GHSG Trial Coordination Centre), honorarium (Celgene, BMS, Takeda, Affimed, Lukon, Janssen)
- Takeda Medical Research Foundation
- Bristol-Myers Squibb Company | Bristol-Myers Squibb Canada (BMS Canada)
- BeiGene, MSD Stemline
- Gilead Sciences (Gilead)
- Miltenyi Biotec
- Novartis
- Roche (F. Hoffmann-La Roche Ltd)
- Amgen (Amgen Inc.)
- Pfizer (Pfizer Inc.)
- Merck & Co., Inc. | Merck Sharp and Dohme (Merck Sharp & Dohme)
- AbbVie (AbbVie Inc.)
- AstraZeneca
- allogene, Cerus, incyte, IQVIA, Noscendo, Pentixapharm,
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Affiliation(s)
- Michael Fuchs
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Anne Sophie Jacob
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Helen Kaul
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | | | - Thomas Pabst
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Richard Greil
- IIIrd Medical Department, Paracelcus Medical University and Salzburg Cancer Research Institute, Salzburg, Austria
- Salzburg Cancer Research Institute and AGMT (Arbeitsgemeinschaft Medikamentöse Tumortherapie), Salzburg, Austria
| | - Paul J Bröckelmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Marianne Just
- Dres. med. Just/Düwel/Riesenberg/Steinke/Schäfer, Studiengesellschaft, Bielefeld, Germany
| | - Bernd Hertenstein
- Department of Internal Medicine I, Klinikum Bremen Mitte, Bremen, Germany
| | - Martin Soekler
- Onkology, Spital Thun, Switzerland, formerly University of Tübingen, Tübingen, Germany
| | - Martin Vogelhuber
- Medizinische Klinik III, Universitätsklinik Regensburg, Regensburg, Germany
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Ulrich Bernd Keller
- Department of Internal Medicine III, Klinikum "Rechts der Isar", Munich, Germany
| | - Stefan W Krause
- Department of Internal Medicine 5, Haematology/Oncology, Uniklinikum Erlangen, Erlangen, Germany
| | - Ulrich Dührsen
- Department of Haematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Andreas Viardot
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Hans-Theodor Eich
- Department of Radiotherapy, University Hospital of Muenster, Muenster, Germany
| | - Christian Baues
- Department of Radiotherapy, University of Cologne, Cologne, Germany
| | - Volker Diehl
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Andreas Rosenwald
- Institute of Pathology, Julius Maximilian University of Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Ina Buehnen
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
- Department of Haematology and Stem Cell Transplantation, West German Cancer Center and German Cancer Consortium (DKTK partner site Essen), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany.
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4
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Eckardt JN, Stasik S, Röllig C, Petzold A, Sauer T, Scholl S, Hochhaus A, Crysandt M, Brümmendorf TH, Naumann R, Steffen B, Kunzmann V, Einsele H, Schaich M, Burchert A, Neubauer A, Schäfer-Eckart K, Schliemann C, Krause SW, Herbst R, Hänel M, Hanoun M, Kaiser U, Kaufmann M, Rácil Z, Mayer J, Oelschlägel U, Berdel WE, Ehninger G, Serve H, Müller-Tidow C, Platzbecker U, Baldus CD, Dahl A, Schetelig J, Bornhäuser M, Middeke JM, Thiede C. Mutated IKZF1 is an independent marker of adverse risk in acute myeloid leukemia. Leukemia 2023; 37:2395-2403. [PMID: 37833543 PMCID: PMC10681898 DOI: 10.1038/s41375-023-02061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/24/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023]
Abstract
Genetic lesions of IKZF1 are frequent events and well-established markers of adverse risk in acute lymphoblastic leukemia. However, their function in the pathophysiology and impact on patient outcome in acute myeloid leukemia (AML) remains elusive. In a multicenter cohort of 1606 newly diagnosed and intensively treated adult AML patients, we found IKZF1 alterations in 45 cases with a mutational hotspot at N159S. AML with mutated IKZF1 was associated with alterations in RUNX1, GATA2, KRAS, KIT, SF3B1, and ETV6, while alterations of NPM1, TET2, FLT3-ITD, and normal karyotypes were less frequent. The clinical phenotype of IKZF1-mutated AML was dominated by anemia and thrombocytopenia. In both univariable and multivariable analyses adjusting for age, de novo and secondary AML, and ELN2022 risk categories, we found mutated IKZF1 to be an independent marker of adverse risk regarding complete remission rate, event-free, relapse-free, and overall survival. The deleterious effects of mutated IKZF1 also prevailed in patients who underwent allogeneic hematopoietic stem cell transplantation (n = 519) in both univariable and multivariable models. These dismal outcomes are only partially explained by the hotspot mutation N159S. Our findings suggest a role for IKZF1 mutation status in AML risk modeling.
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Affiliation(s)
- Jan-Niklas Eckardt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - Sebastian Stasik
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Andreas Petzold
- Dresden-Concept Genome Center, Center for Molecular and Cellular Bioengineering, Technische Universität Dresden, Dresden, Germany
| | - Tim Sauer
- German Cancer Research Center (DKFZ) and Medical Clinic V, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Scholl
- Klinik für Innere Medizin II, Jena University Hospital, Jena, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Jena University Hospital, Jena, Germany
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology, and Cell Therapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Tim H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology, and Cell Therapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Ralph Naumann
- Medical Clinic III, St. Marien-Hospital Siegen, Siegen, Germany
| | - Björn Steffen
- Medical Clinic II, University Hospital Frankfurt, Frankfurt (Main), Germany
| | - Volker Kunzmann
- Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg, Germany
| | - Hermann Einsele
- Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg, Germany
| | - Markus Schaich
- Department of Hematology, Oncology and Palliative Care, Rems-Murr-Hospital Winnenden, Winnenden, Germany
| | - Andreas Burchert
- Department of Hematology, Oncology and Immunology, Philipps-University-Marburg, Marburg, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, Philipps-University-Marburg, Marburg, Germany
| | - Kerstin Schäfer-Eckart
- Department of Internal Medicine V, Paracelsus Medizinische Privatuniversität and University Hospital Nuremberg, Nuremberg, Germany
| | | | - Stefan W Krause
- Medical Clinic V, University Hospital Erlangen, Erlangen, Germany
| | - Regina Herbst
- Medical Clinic III, Chemnitz Hospital AG, Chemnitz, Germany
| | - Mathias Hänel
- Medical Clinic III, Chemnitz Hospital AG, Chemnitz, Germany
| | - Maher Hanoun
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - Ulrich Kaiser
- Medical Clinic II, St. Bernward Hospital, Hildesheim, Germany
| | - Martin Kaufmann
- Department of Hematology, Oncology and Palliative Care, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Zdenek Rácil
- Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Uta Oelschlägel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Hubert Serve
- Medical Clinic II, University Hospital Frankfurt, Frankfurt (Main), Germany
| | - Carsten Müller-Tidow
- German Cancer Research Center (DKFZ) and Medical Clinic V, University Hospital Heidelberg, Heidelberg, Germany
| | - Uwe Platzbecker
- Medical Clinic I Hematology and Celltherapy, University Hospital Leipzig, Leipzig, Germany
| | - Claudia D Baldus
- Department of Internal Medicine, University Hospital Kiel, Kiel, Germany
| | - Andreas Dahl
- Dresden-Concept Genome Center, Center for Molecular and Cellular Bioengineering, Technische Universität Dresden, Dresden, Germany
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
- DKMS Clinical Trials Unit, Dresden, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
- German Consortium for Translational Cancer Research DKFZ, Heidelberg, Germany
- National Center for Tumor Disease (NCT), Dresden, Germany
| | - Jan Moritz Middeke
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christian Thiede
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
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5
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Eckardt JN, Bill M, Rausch C, Metzeler K, Spiekermann K, Stasik S, Sauer T, Scholl S, Hochhaus A, Crysandt M, Brümmendorf TH, Krug U, Wörmann B, Hiddemann W, Görlich D, Sauerland C, Steffen B, Einsele H, Neubauer A, Burchert A, Schäfer-Eckart K, Berdel WE, Schliemann C, Krause SW, Hänel M, Hanoun M, Kaufmann M, Fransecky L, Braess J, Ruhnke L, Schetelig J, Middeke JM, Serve H, Baldus CD, Platzbecker U, Müller-Tidow C, Bornhäuser M, Herold T, Thiede C, Röllig C. Secondary-type mutations do not impact outcome in NPM1-mutated acute myeloid leukemia - implications for the European LeukemiaNet risk classification. Leukemia 2023; 37:2282-2285. [PMID: 37679502 PMCID: PMC10624615 DOI: 10.1038/s41375-023-02016-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Jan-Niklas Eckardt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Marius Bill
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Mildred Scheel Early Career Center, Medical Clinic and Policlinic I, University Hospital of the Technical University Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Medical Faculty and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Dresden, Germany
| | - Christian Rausch
- Laboratory for Leukemia Diagnostics, Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Klaus Metzeler
- Medical Clinic and Policlinic I Hematology and Cell Therapy, University Hospital, Leipzig, Germany
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Stasik
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Tim Sauer
- German Cancer Research Center (DKFZ) and Medical Clinic V, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Scholl
- Klinik für Innere Medizin II, Jena University Hospital, Jena, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Jena University Hospital, Jena, Germany
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology, and Cell Therapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Tim H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology, and Cell Therapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Utz Krug
- Department of Medicine III, Hospital Leverkusen, Leverkusen, Germany
| | - Bernhard Wörmann
- Department of Hematology, Oncology and Tumor Immunology, Charité, Berlin, Germany
| | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Dennis Görlich
- Institute for Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | - Cristina Sauerland
- Institute for Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | - Björn Steffen
- Medical Clinic II, University Hospital Frankfurt, Frankfurt (Main), Germany
| | - Hermann Einsele
- Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, Philipps-University-Marburg, Marburg, Germany
| | - Andreas Burchert
- Department of Hematology, Oncology and Immunology, Philipps-University-Marburg, Marburg, Germany
| | - Kerstin Schäfer-Eckart
- Department of Internal Medicine V, Paracelsus Medizinische Privatuniversität and University Hospital Nuremberg, Nuremberg, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | | | | | - Mathias Hänel
- Medical Clinic III, Chemnitz Hospital AG, Chemnitz, Germany
| | - Maher Hanoun
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - Martin Kaufmann
- Department of Hematology, Oncology and Palliative Care, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Lars Fransecky
- Department of Internal Medicine, University Hospital Kiel, Kiel, Germany
| | - Jan Braess
- Hospital Barmherzige Brueder Regensburg, Regensburg, Germany
| | - Leo Ruhnke
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jan Moritz Middeke
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Hubert Serve
- Medical Clinic II, University Hospital Frankfurt, Frankfurt (Main), Germany
| | - Claudia D Baldus
- Department of Internal Medicine, University Hospital Kiel, Kiel, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I Hematology and Cell Therapy, University Hospital, Leipzig, Germany
| | - Carsten Müller-Tidow
- German Cancer Research Center (DKFZ) and Medical Clinic V, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Mildred Scheel Early Career Center, Medical Clinic and Policlinic I, University Hospital of the Technical University Dresden, Dresden, Germany
- National Center for Tumor Diseases Dresden (NCT/UCC), Medical Faculty and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Dresden, Germany
| | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christian Thiede
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
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6
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Ruhnke L, Röllig C, Herold S, Sauer T, Brandts CH, Steffen B, Schäfer-Eckart K, Krause SW, Hänel M, Reichle A, Scholl S, Neubauer A, Mikesch JH, Schetelig J, Stölzel F, Kramer M, Haake A, Frimmel J, Krämer A, Schlenk R, Platzbecker U, Serve H, Baldus CD, Müller-Tidow C, Aust D, Bornhäuser M, Ehninger G, Thiede C. Midostaurin in addition to intensive chemotherapy in acute myeloid leukemia with t(8;21) and KIT and/or FLT3- ITD mutations: results of the SAL MIDOKIT trial. Haematologica 2023; 108:2520-2525. [PMID: 36779591 PMCID: PMC10483343 DOI: 10.3324/haematol.2022.281636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Not available.
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Affiliation(s)
- Leo Ruhnke
- Department of Internal Medicine I, University Hospital Dresden, TU Dresden, Dresden.
| | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Dresden, TU Dresden, Dresden
| | - Sylvia Herold
- Institute of Pathology, University Hospital Dresden, Dresden
| | - Tim Sauer
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; German Cancer Consortium (DKTK) partner site Dresden, Dresden, Germany and German Cancer Research Center (DKFZ), Heidelberg
| | - Christian H Brandts
- Department of Internal Medicine II, University Hospital Frankfurt, Frankfurt
| | - Björn Steffen
- Department of Internal Medicine II, University Hospital Frankfurt, Frankfurt
| | - Kerstin Schäfer-Eckart
- Department of Internal Medicine V, Nuremberg Hospital North, Paracelsus Medical University, Nuremberg
| | - Stefan W Krause
- Department of Internal Medicine V, University Hospital Erlangen, Erlangen
| | - Mathias Hänel
- Department of Internal Medicine III, Chemnitz Hospital, Chemnitz
| | - Albrecht Reichle
- Department of Internal Medicine III, Hematology and Internal Oncology, University Hospital Regensburg, Regensburg
| | - Sebastian Scholl
- Department of Internal Medicine II, Hematology and Internal Oncology, University Hospital Jena, Jena
| | - Andreas Neubauer
- Department of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg, Marburg
| | | | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Dresden, TU Dresden, Dresden, Germany; DKMS Clinical Trials Unit, Dresden
| | - Friedrich Stölzel
- Department of Internal Medicine I, University Hospital Dresden, TU Dresden, Dresden
| | - Michael Kramer
- Department of Internal Medicine I, University Hospital Dresden, TU Dresden, Dresden
| | - Annett Haake
- Department of Internal Medicine I, University Hospital Dresden, TU Dresden, Dresden
| | - Julia Frimmel
- Department of Internal Medicine I, University Hospital Dresden, TU Dresden, Dresden
| | - Alwin Krämer
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; German Cancer Consortium (DKTK) partner site Dresden, Dresden, Germany and German Cancer Research Center (DKFZ), Heidelberg
| | - Richard Schlenk
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; German Cancer Consortium (DKTK) partner site Dresden, Dresden, Germany and German Cancer Research Center (DKFZ), Heidelberg
| | - Uwe Platzbecker
- Department of Internal Medicine I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig
| | - Hubert Serve
- Department of Internal Medicine II, University Hospital Frankfurt, Frankfurt
| | - Claudia D Baldus
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel
| | | | - Daniela Aust
- Institute of Pathology, University Hospital Dresden, Dresden
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Dresden, TU Dresden, Dresden, Germany; German Cancer Consortium (DKTK) partner site Dresden, Dresden, Germany and German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT) Dresden, Dresden
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Dresden, TU Dresden, Dresden
| | - Christian Thiede
- Department of Internal Medicine I, University Hospital Dresden, TU Dresden, Dresden, Germany; Agendix GmbH, Dresden
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7
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Georgi JA, Stasik S, Eckardt JN, Zukunft S, Hartwig M, Röllig C, Middeke JM, Oelschlägel U, Krug U, Sauer T, Scholl S, Hochhaus A, Brümmendorf TH, Naumann R, Steffen B, Einsele H, Schaich M, Burchert A, Neubauer A, Schäfer-Eckart K, Schliemann C, Krause SW, Hänel M, Noppeney R, Kaiser U, Baldus CD, Kaufmann M, Müller-Tidow C, Platzbecker U, Berdel WE, Serve H, Ehninger G, Bornhäuser M, Schetelig J, Kroschinsky F, Thiede C. UBTF tandem duplications are rare but recurrent alterations in adult AML and associated with younger age, myelodysplasia, and inferior outcome. Blood Cancer J 2023; 13:88. [PMID: 37236968 DOI: 10.1038/s41408-023-00858-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Tandem-duplication mutations of the UBTF gene (UBTF-TDs) coding for the upstream binding transcription factor have recently been described in pediatric patients with acute myeloid leukemia (AML) and were found to be associated with particular genetics (trisomy 8 (+8), FLT3-internal tandem duplications (FLT3-ITD), WT1-mutations) and inferior outcome. Due to limited knowledge on UBTF-TDs in adult AML, we screened 4247 newly diagnosed adult AML and higher-risk myelodysplastic syndrome (MDS) patients using high-resolution fragment analysis. UBTF-TDs were overall rare (n = 52/4247; 1.2%), but significantly enriched in younger patients (median age 41 years) and associated with MDS-related morphology as well as significantly lower hemoglobin and platelet levels. Patients with UBTF-TDs had significantly higher rates of +8 (34% vs. 9%), WT1 (52% vs. 7%) and FLT3-ITD (50% vs. 20.8%) co-mutations, whereas UBTF-TDs were mutually exclusive with several class-defining lesions such as mutant NPM1, in-frame CEBPAbZIP mutations as well as t(8;21). Based on the high-variant allele frequency found and the fact that all relapsed patients analyzed (n = 5) retained the UBTF-TD mutation, UBTF-TDs represent early clonal events and are stable over the disease course. In univariate analysis, UBTF-TDs did not represent a significant factor for overall or relapse-free survival in the entire cohort. However, in patients under 50 years of age, who represent the majority of UBTF-mutant patients, UBTF-TDs were an independent prognostic factor for inferior event-free (EFS), relapse-free (RFS) and overall survival (OS), which was confirmed by multivariable analyses including established risk factors such as age and ELN2022 genetic risk groups (EFS [HR: 2.20; 95% CI 1.52-3.17, p < 0.001], RFS [HR: 1.59; 95% CI 1.02-2.46, p = 0.039] and OS [HR: 1.64; 95% CI 1.08-2.49, p = 0.020]). In summary, UBTF-TDs appear to represent a novel class-defining lesion not only in pediatric AML but also younger adults and are associated with myelodysplasia and inferior outcome in these patients.
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Affiliation(s)
- Julia-Annabell Georgi
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Sebastian Stasik
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Jan-Niklas Eckardt
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Sven Zukunft
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Marita Hartwig
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Christoph Röllig
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Jan Moritz Middeke
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Uta Oelschlägel
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Utz Krug
- Medizinische Klinik 3, Klinikum Leverkusen, Leverkusen, Germany
| | - Tim Sauer
- Universität Heidelberg, Medizinische Klinik und Poliklinik, Abteilung Innere Medizin V, Heidelberg, Germany
| | - Sebastian Scholl
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | | | - Ralph Naumann
- Medizinische Klinik III, St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - Björn Steffen
- Medizinische Klinik 2, Hämatologie/Onkologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Markus Schaich
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Rems-Murr-Klinikum Winnenden, Winnenden, Germany
| | - Andreas Burchert
- Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Philipps Universität Marburg, Marburg, Germany
| | - Andreas Neubauer
- Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Philipps Universität Marburg, Marburg, Germany
| | - Kerstin Schäfer-Eckart
- Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Medizinische Klinik 5, Nürnberg, Germany
| | | | - Stefan W Krause
- Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Mathias Hänel
- Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz, Germany
| | - Richard Noppeney
- Klinik für Hämatologie, Universitätsklinikum Essen, Essen, Germany
| | - Ulrich Kaiser
- Medizinische Klinik II, St. Bernward Krankenhaus, Hildesheim, Germany
| | - Claudia D Baldus
- Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Martin Kaufmann
- Abteilung für Hämatologie, Onkologie und Palliativmedizin, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Carsten Müller-Tidow
- Universität Heidelberg, Medizinische Klinik und Poliklinik, Abteilung Innere Medizin V, Heidelberg, Germany
| | - Uwe Platzbecker
- Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Wolfgang E Berdel
- Medizinische Klinik A, Universitätsklinikum Münster, Münster, Germany
| | - Hubert Serve
- Medizinische Klinik 2, Hämatologie/Onkologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | | | - Martin Bornhäuser
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
- National Center for Tumor Diseases NCT, Dresden, Germany
| | - Johannes Schetelig
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
- DKMS Clinical Trials Unit, Dresden, Germany
| | - Frank Kroschinsky
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Christian Thiede
- Medizinische Klinik und Poliklinik 1, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
- AgenDix GmbH, Dresden, Germany.
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8
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Eckardt JN, Röllig C, Metzeler K, Heisig P, Stasik S, Georgi JA, Kroschinsky F, Stölzel F, Platzbecker U, Spiekermann K, Krug U, Braess J, Görlich D, Sauerland C, Woermann B, Herold T, Hiddemann W, Müller-Tidow C, Serve H, Baldus CD, Schäfer-Eckart K, Kaufmann M, Krause SW, Hänel M, Berdel WE, Schliemann C, Mayer J, Hanoun M, Schetelig J, Wendt K, Bornhäuser M, Thiede C, Middeke JM. Unsupervised meta-clustering identifies risk clusters in acute myeloid leukemia based on clinical and genetic profiles. Commun Med (Lond) 2023; 3:68. [PMID: 37198246 DOI: 10.1038/s43856-023-00298-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/03/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Increasingly large and complex biomedical data sets challenge conventional hypothesis-driven analytical approaches, however, data-driven unsupervised learning can detect inherent patterns in such data sets. METHODS While unsupervised analysis in the medical literature commonly only utilizes a single clustering algorithm for a given data set, we developed a large-scale model with 605 different combinations of target dimensionalities as well as transformation and clustering algorithms and subsequent meta-clustering of individual results. With this model, we investigated a large cohort of 1383 patients from 59 centers in Germany with newly diagnosed acute myeloid leukemia for whom 212 clinical, laboratory, cytogenetic and molecular genetic parameters were available. RESULTS Unsupervised learning identifies four distinct patient clusters, and statistical analysis shows significant differences in rate of complete remissions, event-free, relapse-free and overall survival between the four clusters. In comparison to the standard-of-care hypothesis-driven European Leukemia Net (ELN2017) risk stratification model, we find all three ELN2017 risk categories being represented in all four clusters in varying proportions indicating unappreciated complexity of AML biology in current established risk stratification models. Further, by using assigned clusters as labels we subsequently train a supervised model to validate cluster assignments on a large external multicenter cohort of 664 intensively treated AML patients. CONCLUSIONS Dynamic data-driven models are likely more suitable for risk stratification in the context of increasingly complex medical data than rigid hypothesis-driven models to allow for a more personalized treatment allocation and gain novel insights into disease biology.
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Affiliation(s)
- Jan-Niklas Eckardt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany.
- Else Kröner Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany.
| | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Klaus Metzeler
- Medical Clinic and Policlinic I Hematology and Cell Therapy, University Hospital, Leipzig, Germany
| | - Peter Heisig
- Department of Software and Multimedia Technology, Technical University Dresden, Dresden, Germany
| | - Sebastian Stasik
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Julia-Annabell Georgi
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Frank Kroschinsky
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Friedrich Stölzel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I Hematology and Cell Therapy, University Hospital, Leipzig, Germany
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Utz Krug
- Department of Medicine III, Hospital Leverkusen, Leverkusen, Germany
| | - Jan Braess
- Hospital Barmherzige Brueder Regensburg, Regensburg, Germany
| | - Dennis Görlich
- Institute for Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | - Cristina Sauerland
- Institute for Biostatistics and Clinical Research, University Muenster, Muenster, Germany
| | - Bernhard Woermann
- Department of Hematology, Oncology and Tumor Immunology, Charité, Berlin, Germany
| | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Carsten Müller-Tidow
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- German Consortium for Translational Cancer Research DKFZ, Heidelberg, Germany
| | - Hubert Serve
- Department of Medicine 2, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Claudia D Baldus
- Department of Hematology and Oncology, University Hospital Schleswig Holstein, Kiel, Germany
| | | | - Martin Kaufmann
- Department of Hematology, Oncology and Palliative Care, Robert-Bosch Hospital, Stuttgart, Germany
| | - Stefan W Krause
- Department of Internal Medicine 5, University Hospital Erlangen, Erlangen, Germany
| | - Mathias Hänel
- Department of Internal Medicine 3, Klinikum Chemnitz GmbH, Chemnitz, Germany
| | - Wolfgang E Berdel
- Department of Internal Medicine A, University Hospital Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Internal Medicine A, University Hospital Muenster, Muenster, Germany
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Maher Hanoun
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Karsten Wendt
- Else Kröner Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
- Department of Software and Multimedia Technology, Technical University Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
- German Consortium for Translational Cancer Research DKFZ, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Dresden, Germany
| | - Christian Thiede
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jan Moritz Middeke
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
- Else Kröner Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
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9
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Kayser S, Martínez-Cuadrón D, Rodriguez-Veiga R, Hänel M, Tormo M, Schäfer-Eckart K, Botella C, Stölzel F, Del Castillo TB, Keller U, Rodriguez-Medina C, Held G, Amigo ML, Schliemann C, Colorado M, Kaufmann M, Garcia MB, Krause SW, Görner M, Jost E, Steffen B, Zukunft S, Platzbecker U, Ho AD, Baldus CD, Serve H, Müller-Tidow C, Thiede C, Bornhäuser M, Montesinos P, Röllig C, Schlenk RF. Impact of trisomy 19 on outcome according to genetic makeup in patients with acute myeloid leukemia. Haematologica 2023. [PMID: 36815361 PMCID: PMC10388269 DOI: 10.3324/haematol.2022.282127] [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] [Received: 10/28/2022] [Indexed: 02/24/2023] Open
Abstract
We retrospectively studied 97 AML patients with trisomy 19 (tris-19; median age at diagnosis 57 years; range, 17-83 years) treated between 2001 and 2019 within two multicenter study groups. Tris-19 occurred solely in 10 (10.5%), with additional abnormalities in non-complex karyotypes in 8 (8%) and within complex karyotypes in 79 (82%) patients. Altogether, karyotypes characterized by trisomies only were present in 27 (28%) patients. Data on response and outcome of intensively treated patients were available in 92 patients and median follow-up was 6.4 years (95%-CI, 2.9-9.0 years). Complete remission (CR) after induction therapy was achieved in 52% (n=48) and early death rate was 10% (n=9). Notably, patients with tris-19 as sole abnormality had a CR rate of 89%. An allogeneic hematopoietic stem cell transplantation (allo-HCT) was performed in 34 (35%) patients (CR, n=19; active disease, n=15). Five-year relapse-free and overall survival (OS) rates were 26% (95%-CI, 16-43%) and 20% (95%-CI, 13-31%), respectively. OS rates were significantly higher in patients with tris-19 as sole abnormality or within karyotypes characterized by trisomies only (P=0.05). An Andersen-Gill model including allo-HCT as a time dependent covariable on OS revealed tris-19 as sole abnormality or within karyotypes characterized by trisomies only as favorable factors (HR, 0.47; P=0.021); higher age at diagnosis had an adverse impact (10 years difference; HR, 1.29; P=0.002), whereas allo-HCT had no beneficial impact (OR, 1.45; P=0.21). In our cohort, patients with tris-19 as sole abnormality or within karyotypes characterized by trisomies only had a high CR rate and better clinical outcome.
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Affiliation(s)
- Sabine Kayser
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany; NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig.
| | - David Martínez-Cuadrón
- Hematology Department, Hospital Universitari i Politècnic, La Fe, València, Spain; CIBERONC, Instituto Carlos III, Madrid
| | | | | | - Mar Tormo
- Hematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, University of Valencia, Valencia
| | | | | | - Friedrich Stölzel
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden
| | | | - Ulrich Keller
- Department of Hematology, Oncology and Cancer Immunology, Charité-University Medical Center, Campus Benjamin Franklin, Berlin
| | - Carlos Rodriguez-Medina
- Hematology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria
| | | | | | | | | | | | | | - Stefan W Krause
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen, Erlangen
| | - Martin Görner
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum Bielefeld Mitte
| | - Edgar Jost
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Aachen
| | - Björn Steffen
- Department of Internal Medicine II, University Hospital of Frankfurt Main
| | - Sven Zukunft
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig
| | - Anthony D Ho
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg
| | - Claudia D Baldus
- Department of Internal Medicine II, University Hospital of Kiel, Kiel Germany
| | - Hubert Serve
- Department of Internal Medicine II, University Hospital of Frankfurt Main
| | | | - Christian Thiede
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden
| | - Martin Bornhäuser
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic, La Fe, València, Spain; CIBERONC, Instituto Carlos III, Madrid
| | - Christoph Röllig
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden
| | - Richard F Schlenk
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany; Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg
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10
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Hoffmann J, Eminovic S, Wilhelm C, Krause SW, Neubauer A, Thrun MC, Ultsch A, Brendel C. Prediction of Clinical Outcomes with Explainable Artificial Intelligence in Patients with Chronic Lymphocytic Leukemia. Curr Oncol 2023; 30:1903-1915. [PMID: 36826109 PMCID: PMC9955184 DOI: 10.3390/curroncol30020148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The International Prognostic Index (IPI) is applied to predict the outcome of chronic lymphocytic leukemia (CLL) with five prognostic factors, including genetic analysis. We investigated whether multiparameter flow cytometry (MPFC) data of CLL samples could predict the outcome by methods of explainable artificial intelligence (XAI). Further, XAI should explain the results based on distinctive cell populations in MPFC dot plots. METHODS We analyzed MPFC data from the peripheral blood of 157 patients with CLL. The ALPODS XAI algorithm was used to identify cell populations that were predictive of inferior outcomes (death, failure of first-line treatment). The diagnostic ability of each XAI population was evaluated with receiver operating characteristic (ROC) curves. RESULTS ALPODS defined 17 populations with higher ability than the CLL-IPI to classify clinical outcomes (ROC: area under curve (AUC) 0.95 vs. 0.78). The best single classifier was an XAI population consisting of CD4+ T cells (AUC 0.78; 95% CI 0.70-0.86; p < 0.0001). Patients with low CD4+ T cells had an inferior outcome. The addition of the CD4+ T-cell population enhanced the predictive ability of the CLL-IPI (AUC 0.83; 95% CI 0.77-0.90; p < 0.0001). CONCLUSIONS The ALPODS XAI algorithm detected highly predictive cell populations in CLL that may be able to refine conventional prognostic scores such as IPI.
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Affiliation(s)
- Joerg Hoffmann
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
- Correspondence:
| | - Semil Eminovic
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Christian Wilhelm
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Stefan W. Krause
- Department of Medicine 5, Universitätsklinikum Erlangen, Maximiliansplatz 2, 91054 Erlangen, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Michael C. Thrun
- Databionics, Mathematics and Computer Science, Philipps University Marburg, Hans-Meerwein-Strasse 6, 35032 Marburg, Germany
| | - Alfred Ultsch
- Databionics, Mathematics and Computer Science, Philipps University Marburg, Hans-Meerwein-Strasse 6, 35032 Marburg, Germany
| | - Cornelia Brendel
- Department of Hematology, Oncology and Immunology, Philipps University Marburg, University Hospital Giessen and Marburg, Baldingerstrasse, 35043 Marburg, Germany
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11
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Eckardt JN, Stasik S, Röllig C, Sauer T, Scholl S, Hochhaus A, Crysandt M, Brümmendorf TH, Naumann R, Steffen B, Kunzmann V, Einsele H, Schaich M, Burchert A, Neubauer A, Schäfer-Eckart K, Schliemann C, Krause SW, Herbst R, Hänel M, Hanoun M, Kaiser U, Kaufmann M, Rácil Z, Mayer J, Cerqueira T, Kroschinsky F, Berdel WE, Serve H, Müller-Tidow C, Platzbecker U, Baldus CD, Schetelig J, Siepmann T, Bornhäuser M, Middeke JM, Thiede C. Alterations of cohesin complex genes in acute myeloid leukemia: differential co-mutations, clinical presentation and impact on outcome. Blood Cancer J 2023; 13:18. [PMID: 36693840 PMCID: PMC9873811 DOI: 10.1038/s41408-023-00790-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/25/2023] Open
Abstract
Functional perturbations of the cohesin complex with subsequent changes in chromatin structure and replication are reported in a multitude of cancers including acute myeloid leukemia (AML). Mutations of its STAG2 subunit may predict unfavorable risk as recognized by the 2022 European Leukemia Net recommendations, but the underlying evidence is limited by small sample sizes and conflicting observations regarding clinical outcomes, as well as scarce information on other cohesion complex subunits. We retrospectively analyzed data from a multi-center cohort of 1615 intensively treated AML patients and identified distinct co-mutational patters for mutations of STAG2, which were associated with normal karyotypes (NK) and concomitant mutations in IDH2, RUNX1, BCOR, ASXL1, and SRSF2. Mutated RAD21 was associated with NK, mutated EZH2, KRAS, CBL, and NPM1. Patients harboring mutated STAG2 were older and presented with decreased white blood cell, bone marrow and peripheral blood blast counts. Overall, neither mutated STAG2, RAD21, SMC1A nor SMC3 displayed any significant, independent effect on clinical outcomes defined as complete remission, event-free, relapse-free or overall survival. However, we found almost complete mutual exclusivity of genetic alterations of individual cohesin subunits. This mutual exclusivity may be the basis for therapeutic strategies via synthetic lethality in cohesin mutated AML.
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Affiliation(s)
- Jan-Niklas Eckardt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany. .,Division of Health Care Sciences, Dresden International University, Dresden, Germany.
| | - Sebastian Stasik
- grid.412282.f0000 0001 1091 2917Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christoph Röllig
- grid.412282.f0000 0001 1091 2917Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Tim Sauer
- grid.5253.10000 0001 0328 4908German Cancer Research Center (DKFZ) and Medical Clinic V, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Scholl
- grid.275559.90000 0000 8517 6224Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | - Andreas Hochhaus
- grid.275559.90000 0000 8517 6224Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | - Martina Crysandt
- grid.412301.50000 0000 8653 1507Department of Hematology, Oncology, Hemostaseology, and Cell Therapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Tim H. Brümmendorf
- grid.412301.50000 0000 8653 1507Department of Hematology, Oncology, Hemostaseology, and Cell Therapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Ralph Naumann
- Medical Clinic III, St. Marien-Hospital Siegen, Siegen, Germany
| | - Björn Steffen
- grid.411088.40000 0004 0578 8220Medical Clinic II, University Hospital Frankfurt, Frankfurt (Main), Germany
| | - Volker Kunzmann
- grid.411760.50000 0001 1378 7891Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg, Germany
| | - Hermann Einsele
- grid.411760.50000 0001 1378 7891Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg, Germany
| | - Markus Schaich
- grid.459932.0Department of Hematology, Oncology and Palliative Care, Rems-Murr-Hospital Winnenden, Winnenden, Germany
| | - Andreas Burchert
- grid.10253.350000 0004 1936 9756Department of Hematology, Oncology and Immunology, Philipps-University-Marburg, Marburg, Germany
| | - Andreas Neubauer
- grid.10253.350000 0004 1936 9756Department of Hematology, Oncology and Immunology, Philipps-University-Marburg, Marburg, Germany
| | - Kerstin Schäfer-Eckart
- grid.511981.5Department of Internal Medicine V, Paracelsus Medizinische Privatuniversität and University Hospital Nurnberg, Nurnberg, Germany
| | - Christoph Schliemann
- grid.16149.3b0000 0004 0551 4246Department of Medicine A, University Hospital Münster, Münster, Germany
| | - Stefan W. Krause
- grid.411668.c0000 0000 9935 6525Medical Clinic V, University Hospital Erlangen, Erlangen, Germany
| | - Regina Herbst
- grid.459629.50000 0004 0389 4214Medical Clinic III, Chemnitz Hospital AG, Chemnitz, Germany
| | - Mathias Hänel
- grid.459629.50000 0004 0389 4214Medical Clinic III, Chemnitz Hospital AG, Chemnitz, Germany
| | - Maher Hanoun
- grid.410718.b0000 0001 0262 7331Department of Hematology, University Hospital Essen, Essen, Germany
| | - Ulrich Kaiser
- grid.460019.aMedical Clinic II, St. Bernward Hospital, Hildesheim, Germany
| | - Martin Kaufmann
- grid.416008.b0000 0004 0603 4965Department of Hematology, Oncology and Palliative Care, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Zdenek Rácil
- grid.412554.30000 0004 0609 2751Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Jiri Mayer
- grid.412554.30000 0004 0609 2751Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Tiago Cerqueira
- grid.440925.e0000 0000 9874 1261Division of Health Care Sciences, Dresden International University, Dresden, Germany
| | - Frank Kroschinsky
- grid.412282.f0000 0001 1091 2917Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Wolfgang E. Berdel
- grid.16149.3b0000 0004 0551 4246Department of Medicine A, University Hospital Münster, Münster, Germany
| | - Hubert Serve
- grid.411088.40000 0004 0578 8220Medical Clinic II, University Hospital Frankfurt, Frankfurt (Main), Germany
| | - Carsten Müller-Tidow
- grid.5253.10000 0001 0328 4908German Cancer Research Center (DKFZ) and Medical Clinic V, University Hospital Heidelberg, Heidelberg, Germany
| | - Uwe Platzbecker
- grid.411339.d0000 0000 8517 9062Medical Clinic I Hematology and Celltherapy, University Hospital Leipzig, Leipzig, Germany
| | - Claudia D. Baldus
- grid.412468.d0000 0004 0646 2097Department of Internal Medicine, University Hospital Kiel, Kiel, Germany
| | - Johannes Schetelig
- grid.412282.f0000 0001 1091 2917Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany ,DKMS Clinical Trials Unit, Dresden, Germany
| | - Timo Siepmann
- grid.440925.e0000 0000 9874 1261Division of Health Care Sciences, Dresden International University, Dresden, Germany ,grid.4488.00000 0001 2111 7257Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Bornhäuser
- grid.412282.f0000 0001 1091 2917Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany ,grid.7497.d0000 0004 0492 0584German Consortium for Translational Cancer Research DKTK, Heidelberg, Germany ,National Center for Tumor Disease (NCT), Dresden, Germany
| | - Jan Moritz Middeke
- grid.412282.f0000 0001 1091 2917Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christian Thiede
- grid.412282.f0000 0001 1091 2917Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
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12
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Kunadt D, Stasik S, Metzeler KH, Röllig C, Schliemann C, Greif PA, Spiekermann K, Rothenberg-Thurley M, Krug U, Braess J, Krämer A, Hochhaus A, Scholl S, Hilgendorf I, Brümmendorf TH, Jost E, Steffen B, Bug G, Einsele H, Görlich D, Sauerland C, Schäfer-Eckart K, Krause SW, Hänel M, Hanoun M, Kaufmann M, Wörmann B, Kramer M, Sockel K, Egger-Heidrich K, Herold T, Ehninger G, Burchert A, Platzbecker U, Berdel WE, Müller-Tidow C, Hiddemann W, Serve H, Stelljes M, Baldus CD, Neubauer A, Schetelig J, Thiede C, Bornhäuser M, Middeke JM, Stölzel F. Impact of IDH1 and IDH2 mutational subgroups in AML patients after allogeneic stem cell transplantation. J Hematol Oncol 2022; 15:126. [PMID: 36064577 PMCID: PMC9442956 DOI: 10.1186/s13045-022-01339-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background The role of allogeneic hematopoietic cell transplantation (alloHCT) in acute myeloid leukemia (AML) with mutated IDH1/2 has not been defined. Therefore, we analyzed a large cohort of 3234 AML patients in first complete remission (CR1) undergoing alloHCT or conventional chemo-consolidation and investigated outcome in respect to IDH1/2 mutational subgroups (IDH1 R132C, R132H and IDH2 R140Q, R172K). Methods Genomic DNA was extracted from bone marrow or peripheral blood samples at diagnosis and analyzed for IDH mutations with denaturing high-performance liquid chromatography, Sanger sequencing and targeted myeloid panel next-generation sequencing, respectively. Statistical as-treated analyses were performed using R and standard statistical methods (Kruskal–Wallis test for continuous variables, Chi-square test for categorical variables, Cox regression for univariate and multivariable models), incorporating alloHCT as a time-dependent covariate. Results Among 3234 patients achieving CR1, 7.8% harbored IDH1 mutations (36% R132C and 47% R132H) and 10.9% carried IDH2 mutations (77% R140Q and 19% R172K). 852 patients underwent alloHCT in CR1. Within the alloHCT group, 6.2% had an IDH1 mutation (43.4% R132C and 41.4% R132H) and 10% were characterized by an IDH2 mutation (71.8% R140Q and 24.7% R172K). Variants IDH1 R132C and IDH2 R172K showed a significant benefit from alloHCT for OS (p = .017 and p = .049) and RFS (HR = 0.42, p = .048 and p = .009) compared with chemotherapy only. AlloHCT in IDH2 R140Q mutated AML resulted in longer RFS (HR = 0.4, p = .002). Conclusion In this large as-treated analysis, we showed that alloHCT is able to overcome the negative prognostic impact of certain IDH mutational subclasses in first-line consolidation treatment and could pending prognostic validation, provide prognostic value for AML risk stratification and therapeutic decision making. Supplementary Information The online version contains supplementary material available at 10.1186/s13045-022-01339-8.
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Affiliation(s)
- Desiree Kunadt
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
| | - Sebastian Stasik
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Klaus H Metzeler
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Christoph Röllig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | | | - Philipp A Greif
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Karsten Spiekermann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Maja Rothenberg-Thurley
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Utz Krug
- Medizinische Klinik III, Klinikum Leverkusen, Leverkusen, Germany
| | - Jan Braess
- Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Alwin Krämer
- Medizinische Klinik Und Poliklinik, Abteilung Innere Medizin V, Universität Heidelberg, Heidelberg, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Sebastian Scholl
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | | | - Edgar Jost
- Medizinische Klinik IV, Uniklinik RWTH Aachen, Aachen, Germany
| | - Björn Steffen
- Medizinische Klinik 2, Hämatologie/Onkologie, Goethe-Universität, Frankfurt am Main, Germany
| | - Gesine Bug
- Medizinische Klinik 2, Hämatologie/Onkologie, Goethe-Universität, Frankfurt am Main, Germany
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Dennis Görlich
- Institut für Biometrie und Klinische Forschung, Universität Münster, Münster, Germany
| | - Cristina Sauerland
- Institut für Biometrie und Klinische Forschung, Universität Münster, Münster, Germany
| | - Kerstin Schäfer-Eckart
- Klinik für Innere Medizin 5, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nuremberg, Germany
| | - Stefan W Krause
- Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Mathias Hänel
- Medizinische Klinik III, Klinikum Chemnitz, Chemnitz, Germany
| | - Maher Hanoun
- Klinik für Hämatologie, Universitätsklinikum Essen, Essen, Germany
| | - Martin Kaufmann
- Abteilung für Hämatologie, Onkologie und Palliativmedizin, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Bernhard Wörmann
- Abteilung für Hämatologie, Onkologie und Palliativmedizin, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Michael Kramer
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Katja Sockel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | | | - Tobias Herold
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Gerhard Ehninger
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Andreas Burchert
- Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Philipps Universität Marburg, Marburg, Germany
| | - Uwe Platzbecker
- Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Wolfgang E Berdel
- Medizinische Klinik A, Universitätsklinikum Münster, Münster, Germany
| | - Carsten Müller-Tidow
- Medizinische Klinik Und Poliklinik, Abteilung Innere Medizin V, Universität Heidelberg, Heidelberg, Germany
| | - Wolfgang Hiddemann
- Laboratory for Leukemia Diagnostics, Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Hubert Serve
- Medizinische Klinik 2, Hämatologie/Onkologie, Goethe-Universität, Frankfurt am Main, Germany
| | - Matthias Stelljes
- Medizinische Klinik A, Universitätsklinikum Münster, Münster, Germany
| | - Claudia D Baldus
- Klinik für Innere Medizin II, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Andreas Neubauer
- Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Philipps Universität Marburg, Marburg, Germany
| | - Johannes Schetelig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.,DKMS Clinical Trials Unit, Dresden, Germany
| | - Christian Thiede
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Martin Bornhäuser
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.,National Center for Tumor Diseases, Dresden (NCT/UCC), Dresden, Germany.,German Consortium for Translational Cancer Research (DKTK), DKFZ, Heidelberg, Germany
| | - Jan M Middeke
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Friedrich Stölzel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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13
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Röhnert MA, Kramer M, Schadt J, Ensel P, Thiede C, Krause SW, Bücklein V, Hoffmann J, Jaramillo S, Schlenk RF, Röllig C, Bornhäuser M, McCarthy N, Freeman S, Oelschlägel U, von Bonin M. Reproducible measurable residual disease detection by multiparametric flow cytometry in acute myeloid leukemia. Leukemia 2022; 36:2208-2217. [PMID: 35851154 PMCID: PMC9417981 DOI: 10.1038/s41375-022-01647-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/08/2022]
Abstract
Measurable residual disease (MRD) detected by multiparametric flow cytometry (MFC) is associated with unfavorable outcome in patients with AML. A simple, broadly applicable eight-color panel was implemented and analyzed utilizing a hierarchical gating strategy with fixed gates to develop a clear-cut LAIP-based DfN approach. In total, 32 subpopulations with aberrant phenotypes with/without expression of markers of immaturity were monitored in 246 AML patients after completion of induction chemotherapy. Reference values were established utilizing 90 leukemia-free controls. Overall, 73% of patients achieved a response by cytomorphology. In responders, the overall survival was shorter for MRDpos patients (HR 3.8, p = 0.006). Overall survival of MRDneg non-responders was comparable to MRDneg responders. The inter-rater-reliability for MRD detection was high with a Krippendorffs α of 0.860. The mean time requirement for MRD analyses at follow-up was very short with 04:31 minutes. The proposed one-tube MFC approach for detection of MRD allows a high level of standardization leading to a promising inter-observer-reliability with a fast turnover. MRD defined by this strategy provides relevant prognostic information and establishes aberrancies outside of cell populations with markers of immaturity as an independent risk feature. Our results imply that this strategy may provide the base for multicentric immunophenotypic MRD assessment.
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Affiliation(s)
- Maximilian A Röhnert
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany.
| | - Michael Kramer
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Jonas Schadt
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Philipp Ensel
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Christian Thiede
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
- AgenDix GmbH, Dresden, Germany
| | - Stefan W Krause
- Department of Medicine 5, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Veit Bücklein
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
| | - Jörg Hoffmann
- Department of Internal Medicine and Hematology, Oncology and Immunology, Philipps University Marburg and University Hospital Giessen and Marburg, Marburg, Germany
| | - Sonia Jaramillo
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Richard F Schlenk
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Christoph Röllig
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
- National Center of Tumor Diseases, Dresden, Germany
| | - Nicholas McCarthy
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Uta Oelschlägel
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Malte von Bonin
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
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14
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Ferreri AJM, Cwynarski K, Pulczynski E, Fox CP, Schorb E, Celico C, Falautano M, Nonis A, La Rosée P, Binder M, Fabbri A, Ilariucci F, Krampera M, Roth A, Hemmaway C, Johnson PW, Linton KM, Pukrop T, Gørløv JS, Balzarotti M, Hess G, Keller U, Stilgenbauer S, Panse J, Tucci A, Orsucci L, Pisani F, Zanni M, Krause SW, Schmoll HJ, Hertenstein B, Rummel M, Smith J, Thurner L, Cabras G, Pennese E, Ponzoni M, Deckert M, Politi LS, Finke J, Ferranti A, Cozens K, Burger E, Ielmini N, Cavalli F, Zucca E, Illerhaus G. Long-term efficacy, safety and neurotolerability of MATRix regimen followed by autologous transplant in primary CNS lymphoma: 7-year results of the IELSG32 randomized trial. Leukemia 2022; 36:1870-1878. [PMID: 35562406 DOI: 10.1038/s41375-022-01582-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/16/2022] [Accepted: 04/20/2022] [Indexed: 11/09/2022]
Abstract
219 HIV-negative adults ≤70 years with primary CNS lymphoma (PCNSL) were enrolled in the randomized IELSG32 trial. Enrolled patients were randomly assigned to receive methotrexate-cytarabine (arm A), or methotrexate-cytarabine-rituximab (B), or methotrexate-cytarabine-thiotepa-rituximab (MATRix; arm C). A second randomization allocated patients with responsive/stable disease to whole-brain irradiation (WBRT) or carmustine-thiotepa-conditioned autologous transplantation (ASCT). First results, after a median follow-up of 30 months, showed that MATRix significantly improves outcome, with both WBRT and ASCT being similarly effective. However, sound assessment of overall survival (OS), efficacy of salvage therapy, late complications, secondary tumors, and cognitive impairment requires longer follow-up. Herein, we report the results of this trial at a median follow-up of 88 months. As main findings, MATRix was associated with excellent long-lasting outcome, with a 7-year OS of 21%, 37%, and 56% respectively for arms A, B, and C. Notably, patients treated with MATRix and consolidation had a 7-year OS of 70%. The superiority of arm B on arm A suggests a benefit from the addition of rituximab. Comparable efficacy of WBRT and ASCT was confirmed. Salvage therapy was ineffective; benefit was recorded only in patients with late relapse re-treated with methotrexate. Eight (4%) patients developed a second cancer. Importantly, MATRix and ASCT did not result in higher non-relapse mortality or second tumors incidence. Patients who received WBRT experienced impairment in attentiveness and executive functions, whereas patients undergoing ASCT experienced improvement in these functions as well as in memory and quality of life.
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Affiliation(s)
- Andrés J M Ferreri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milano, Italy.
| | | | | | | | | | | | | | - Alessandro Nonis
- Ateneo Vita-Salute San Raffaele University, Pathology Unit, Milano, Italy
| | - Paul La Rosée
- Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany
| | - Mascia Binder
- Universitätsklinikum Hamburg- Eppendorf, Hamburg, Germany
| | | | - Fiorella Ilariucci
- Azienda Ospedaliera Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Mauro Krampera
- Dipartimento di Medicina, Sezione di Ematologia, Università di Verona, Verona, Italy
| | | | | | - Peter W Johnson
- Medical Oncology Unit, Southampton General Hospital, Southampton, UK
| | - Kim M Linton
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | | | | | | | - Georg Hess
- J. Gutenberg Universität, Mainz, Germany
| | | | | | - Jense Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital Aachen, Aachen, Germany
| | | | - Lorella Orsucci
- AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Francesco Pisani
- Hematology and Stem Cell Transplantation Unit, IRCCS Istituto Nazionale dei Tumori Regina Elena, Roma, Italy
| | - Manuela Zanni
- A.O. Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | | | - Mathias Rummel
- Klinikum Der Justus-Liebig-Universität, Giessen, Germany
| | | | | | | | | | - Maurilio Ponzoni
- Ateneo Vita-Salute San Raffaele University, Pathology Unit, Milano, Italy
| | - Martina Deckert
- Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Letterio S Politi
- Istituto Clinico Humanitas, Milano Rozzano, Italy
- Unit of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Kelly Cozens
- Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Elvira Burger
- Zentrum Klinische Studien, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Nicoletta Ielmini
- International Extranodal Lymphoma Study Group, Foundation for the Institute of Oncology Research, Bellinzona, Switzerland
| | - Franco Cavalli
- International Extranodal Lymphoma Study Group, Foundation for the Institute of Oncology Research, Bellinzona, Switzerland
- Istituto Oncologico della Svizzera Italiana, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Emanuele Zucca
- International Extranodal Lymphoma Study Group, Foundation for the Institute of Oncology Research, Bellinzona, Switzerland
- Istituto Oncologico della Svizzera Italiana, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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15
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Kayser S, Martínez-Cuadrón D, Hanoun M, Stölzel F, Gil C, Reinhardt HC, Aguiar E, Schäfer-Eckart K, Burgues JMB, Steffen B, Bernal T, Krause SW, Riaza R, Schliemann C, Cervera J, Kaufmann M, Torres-Miñana L, Hänel M, Acuña-Cruz E, Jost E, Algarra JL, Crysandt M, Fransecky L, Cornago-Navascues J, Kraus S, Martinez-Lopez J, Einsele H, Niemann D, Neubauer A, Seggewiss-Bernhardt R, Scholl S, Klein SA, Schmid C, Schaich M, Schmidt-Hieber M, Zukunft S, Ho AD, Platzbecker U, Baldus CD, Müller-Tidow C, Thiede C, Bornhäuser M, Serve H, Levis MJ, Montesinos P, Röllig C, Schlenk RF. Characteristics and outcome of patients with acute myeloid leukemia and trisomy 4. Haematologica 2022; 108:34-41. [PMID: 35678031 PMCID: PMC9827151 DOI: 10.3324/haematol.2022.281137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 02/04/2023] Open
Abstract
We retrospectively studied 125 patients with acute myeloid leukemia and trisomy 4 (median age at diagnosis, 58 years; range, 16-77 years) treated between 2000 and 2019 within a multicenter study. Trisomy 4 was the sole abnormality in 28 (22%) patients and additional abnormalities were present in 97 (78%) patients. Twenty-two (22%) and 15 (15%) of 101 tested patients harbored NPM1 and FLT3-ITD mutations. Two (3%) of 72 tested patients had double CEBPA mutations. Data on response to intensive anthracycline-based induction therapy were available for 119 patients. Complete remission was achieved in 67% (n=80) and the early death rate was 5% (n=6). Notably, patients with trisomy 4 as sole abnormality had a complete remission rate of 89%. Allogeneic hematopoietic cell transplantation was performed in 40 (34%) patients, of whom 19 were transplanted in first complete remission. The median follow-up of the intensively treated cohort was 5.76 years (95% confidence interval [95% CI]: 2.99-7.61 years). The 5-year overall survival and relapse-free survival rates were 30% (95% CI: 22-41%) and 27% (95% CI: 18-41%), respectively. An Andersen-Gill regression model on overall survival revealed that favorable-risk according to the European LeukemiaNet classification (hazard ratio [HR]=0.34; P=0.006) and trisomy 4 as sole abnormality (HR=0.41; P=0.01) were favorable factors, whereas age with a difference of 10 years (HR=1.15; P=0.11), female gender (HR=0.74; P=0.20) and allogeneic hematopoietic cell transplantation (HR=0.64; P=0.14) did not have an significant impact. In our cohort, patients with trisomy 4 as their sole abnormality had a high complete remission rate and favorable clinical outcome. Allogeneic hematopoietic cell transplantation did not seem to improve overall survival.
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Affiliation(s)
- Sabine Kayser
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany,NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany,S. Kayser
| | - David Martínez-Cuadrón
- Hematology Department, Hospital Universitari i Politècnic, La Fe, València, Spain,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Maher Hanoun
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - Friedrich Stölzel
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Dresden, Germany
| | | | - H. Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - Eliana Aguiar
- Clinical Haematology Department, Centro Hospitalar São João, Oporto, Portugal
| | - Kerstin Schäfer-Eckart
- Department of Internal Medicine 5, Paracelsus Medical Private University Nürnberg, Nürnberg, Germany
| | | | - Björn Steffen
- Department of Internal Medicine II, University Hospital of Frankfurt Main, Frankfurt Main, Germany
| | | | - Stefan W. Krause
- Department of Internal Medicine 5 – Hematology/Oncology, University Hospital of Erlangen, Erlangen, Germany
| | - Rosalía Riaza
- Hematology Department, Hospital Universitario Severo Ochoa, Madrid, Spain
| | | | - Jose Cervera
- Hematology Department, Hospital Universitari i Politècnic, La Fe, València, Spain,CIBERONC, Instituto Carlos III, Madrid, Spain
| | | | - Laura Torres-Miñana
- Hematology Department, Hospital Universitari i Politècnic, La Fe, València, Spain,CIBERONC, Instituto Carlos III, Madrid, Spain
| | | | - Evelyn Acuña-Cruz
- Hematology Department, Hospital Universitari i Politècnic, La Fe, València, Spain,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Edgar Jost
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Lars Fransecky
- Department of Internal Medicine II, University Hospital of Kiel, Kiel, Germany
| | | | | | | | | | - Dirk Niemann
- Gemeinschaftsklinikum Mittelrhein gGmbH, Koblenz, Germany
| | - Andreas Neubauer
- Philipps University Marburg, and University Hospital Giessen and Marburg, Marburg, Germany
| | | | - Sebastian Scholl
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Stefan A. Klein
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Schmid
- Department of Hematology and Oncology, Augsburg University Hospital, Augsburg, Germany
| | - Markus Schaich
- Department of Hematology, Oncology and Palliative Care, Rems-Murr-Hospital Winnenden, Winnenden, Germany
| | | | - Sven Zukunft
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Dresden, Germany
| | - Anthony D. Ho
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Claudia D. Baldus
- Department of Internal Medicine II, University Hospital of Kiel, Kiel, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Thiede
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Dresden, Germany
| | - Hubert Serve
- Department of Internal Medicine II, University Hospital of Frankfurt Main, Frankfurt Main, Germany
| | - Mark J. Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic, La Fe, València, Spain,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Christoph Röllig
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, Dresden, Germany
| | - Richard F. Schlenk
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany,Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
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16
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Eckardt JN, Stölzel F, Kunadt D, Röllig C, Stasik S, Wagenführ L, Jöhrens K, Kuithan F, Krämer A, Scholl S, Hochhaus A, Crysandt M, Brümmendorf TH, Naumann R, Steffen B, Kunzmann V, Einsele H, Schaich M, Burchert A, Neubauer A, Schäfer-Eckart K, Schliemann C, Krause SW, Herbst R, Hänel M, Hanoun M, Kaiser U, Kaufmann M, Rácil Z, Mayer J, Kroschinsky F, Berdel WE, Ehninger G, Serve H, Müller-Tidow C, Platzbecker U, Baldus CD, Schetelig J, Bornhäuser M, Thiede C, Middeke JM. Molecular profiling and clinical implications of patients with acute myeloid leukemia and extramedullary manifestations. J Hematol Oncol 2022; 15:60. [PMID: 35562747 PMCID: PMC9107142 DOI: 10.1186/s13045-022-01267-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/17/2022] [Indexed: 12/05/2022] Open
Abstract
Background Extramedullary manifestations (EM) are rare in acute myeloid leukemia (AML) and their impact on clinical outcomes is controversially discussed. Methods We retrospectively analyzed a large multi-center cohort of 1583 newly diagnosed AML patients, of whom 225 (14.21%) had EM. Results AML patients with EM presented with significantly higher counts of white blood cells (p < 0.0001), peripheral blood blasts (p < 0.0001), bone marrow blasts (p = 0.019), and LDH (p < 0.0001). Regarding molecular genetics, EM AML was associated with mutations of NPM1 (OR: 1.66, p < 0.001), FLT3-ITD (OR: 1.72, p < 0.001) and PTPN11 (OR: 2.46, p < 0.001). With regard to clinical outcomes, EM AML patients were less likely to achieve complete remissions (OR: 0.62, p = 0.004), and had a higher early death rate (OR: 2.23, p = 0.003). Multivariable analysis revealed EM as an independent risk factor for reduced overall survival (hazard ratio [HR]: 1.43, p < 0.001), however, for patients who received allogeneic hematopoietic cell transplantation (HCT) survival did not differ. For patients bearing EM AML, multivariable analysis unveiled mutated TP53 and IKZF1 as independent risk factors for reduced event-free (HR: 4.45, p < 0.001, and HR: 2.05, p = 0.044, respectively) and overall survival (HR: 2.48, p = 0.026, and HR: 2.63, p = 0.008, respectively). Conclusion Our analysis represents one of the largest cohorts of EM AML and establishes key molecular markers linked to EM, providing new evidence that EM is associated with adverse risk in AML and may warrant allogeneic HCT in eligible patients with EM. Supplementary Information The online version contains supplementary material available at 10.1186/s13045-022-01267-7.
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Affiliation(s)
- Jan-Niklas Eckardt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Saxony, Germany.
| | - Friedrich Stölzel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Saxony, Germany
| | - Desiree Kunadt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Saxony, Germany
| | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Saxony, Germany
| | - Sebastian Stasik
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Saxony, Germany
| | - Lisa Wagenführ
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Saxony, Germany
| | - Korinna Jöhrens
- Department of Pathology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Friederike Kuithan
- Medical Care Center, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Alwin Krämer
- German Cancer Research Center (DKFZ) and Medical Clinic V, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Scholl
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | - Andreas Hochhaus
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology, and Cell Therapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Tim H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology, and Cell Therapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Ralph Naumann
- Medical Clinic III, St. Marien-Hospital Siegen, Siegen, Germany
| | - Björn Steffen
- Medical Clinic II, University Hospital Frankfurt, Frankfurt (Main), Germany
| | - Volker Kunzmann
- Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg, Germany
| | - Hermann Einsele
- Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg, Germany
| | - Markus Schaich
- Department of Hematology, Oncology and Palliative Care, Rems-Murr-Hospital Winnenden, Winnenden, Germany
| | - Andreas Burchert
- Department of Hematology, Oncology and Immunology, Philipps-University-Marburg, Marburg, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, Philipps-University-Marburg, Marburg, Germany
| | - Kerstin Schäfer-Eckart
- Department of Internal Medicine V, Paracelsus Medizinische Privatuniversität and University Hospital Nuremberg, Nuremberg, Germany
| | | | - Stefan W Krause
- Medical Clinic V, University Hospital Erlangen, Erlangen, Germany
| | - Regina Herbst
- Medical Clinic III, Chemnitz Hospital AG, Chemnitz, Germany
| | - Mathias Hänel
- Medical Clinic III, Chemnitz Hospital AG, Chemnitz, Germany
| | - Maher Hanoun
- Department of Hematology, University Hospital Essen, Essen, Germany
| | - Ulrich Kaiser
- Medical Clinic II, St. Bernward Hospital, Hildesheim, Germany
| | - Martin Kaufmann
- Department of Hematology, Oncology and Palliative Care, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Zdenek Rácil
- Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - Frank Kroschinsky
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Saxony, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, University Hospital Münster, Münster, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Saxony, Germany
| | - Hubert Serve
- Medical Clinic II, University Hospital Frankfurt, Frankfurt (Main), Germany
| | - Carsten Müller-Tidow
- German Cancer Research Center (DKFZ) and Medical Clinic V, University Hospital Heidelberg, Heidelberg, Germany
| | - Uwe Platzbecker
- Medical Clinic I Hematology and Celltherapy, University Hospital Leipzig, Leipzig, Germany
| | - Claudia D Baldus
- Department of Internal Medicine, University Hospital Kiel, Kiel, Germany
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Saxony, Germany.,DKMS Clinical Trials Unit, Dresden, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Saxony, Germany.,German Consortium for Translational Cancer Research DKFZ, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany
| | - Christian Thiede
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Saxony, Germany
| | - Jan Moritz Middeke
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Saxony, Germany
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17
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Mallesh N, Zhao M, Meintker L, Höllein A, Elsner F, Lüling H, Haferlach T, Kern W, Westermann J, Brossart P, Krause SW, Krawitz PM. Knowledge transfer to enhance the performance of deep learning models for automated classification of B cell neoplasms. Patterns (N Y) 2021; 2:100351. [PMID: 34693376 PMCID: PMC8515009 DOI: 10.1016/j.patter.2021.100351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/10/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
Multi-parameter flow cytometry (MFC) is a cornerstone in clinical decision making for leukemia and lymphoma. MFC data analysis requires manual gating of cell populations, which is time-consuming, subjective, and often limited to a two-dimensional space. In recent years, deep learning models have been successfully used to analyze data in high-dimensional space and are highly accurate. However, AI models used for disease classification with MFC data are limited to the panel they were trained on. Thus, a key challenge in deploying AI into routine diagnostics is the robustness and adaptability of such models. This study demonstrates how transfer learning can be applied to boost the performance of models with smaller datasets acquired with different MFC panels. We trained models for four additional datasets by transferring the features learned from our base model. Our workflow increased the model's overall performance and, more prominently, improved the learning rate for small training sizes. Device capabilities and diagnostic approaches differ greatly in lymphoma MFC panels Single laboratories generate too little data to train an AI model with high accuracy Transfer learning across panels increases classification performance significantly Merging MFC data from multiple tubes per sample increases the model's transferability
Multi-parameter flow cytometry (MFC) is a critical tool in leukemia and lymphoma diagnostics. Advances in cytometry technology and diagnostic standardization efforts have led to an ever-increasing volume of data, presenting an opportunity to use artificial intelligence (AI) in diagnostics. However, the MFC protocol is prone to changes depending on the diagnostic workflow and the available cytometer. The changes to the MFC protocol limit the deployment of AI in routine diagnostics settings. We present a workflow that allows existing AI to adapt to multiple MFC protocols. We combine transfer learning (TL) with MFC data merging to increase the robustness of AI. Our results show that TL improves the performance of AI and allows models to achieve higher performance with less training data. This gain in performance for smaller training data allows for an already deployed AI to adapt to changes without the need for retraining a new model that requires more training data.
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Affiliation(s)
- Nanditha Mallesh
- Institute for Genomic Statistics and Bioinformatics, University Bonn, Bonn, Germany
| | - Max Zhao
- Institute for Genomic Statistics and Bioinformatics, University Bonn, Bonn, Germany.,Institute of Human Genetics and Medical Genetics, Charité University Hospital, Berlin, Germany
| | - Lisa Meintker
- Department of Medicine 5, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Alexander Höllein
- MLL Munich Leukemia Laboratory, Munich, Germany.,Red Cross Hospital Munich, Munich, Germany
| | | | | | | | | | - Jörg Westermann
- Department of Hematology, Oncology and Tumor Immunology, Charité-Campus Virchow Clinic and Labor Berlin Charité Vivantes, Berlin, Germany
| | - Peter Brossart
- Department of Oncology, Hematology, Immuno-oncology and Rheumatology, University Hospital of Bonn, Bonn, Germany
| | - Stefan W Krause
- Department of Medicine 5, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Peter M Krawitz
- Institute for Genomic Statistics and Bioinformatics, University Bonn, Bonn, Germany
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18
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Classen AY, Henze L, von Lilienfeld-Toal M, Maschmeyer G, Sandherr M, Graeff LD, Alakel N, Christopeit M, Krause SW, Mayer K, Neumann S, Cornely OA, Penack O, Weißinger F, Wolf HH, Vehreschild JJ. Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors: 2020 updated guidelines of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO/DGHO). Ann Hematol 2021; 100:1603-1620. [PMID: 33846857 PMCID: PMC8116237 DOI: 10.1007/s00277-021-04452-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/04/2021] [Indexed: 12/11/2022]
Abstract
Hematologic and oncologic patients with chemo- or immunotherapy-related immunosuppression are at substantial risk for bacterial infections and Pneumocystis jirovecii pneumonia (PcP). As bacterial resistances are increasing worldwide and new research reshapes our understanding of the interactions between the human host and bacterial commensals, administration of antibacterial prophylaxis has become a matter of discussion. This guideline constitutes an update of the 2013 published guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). It gives an overview about current strategies for antibacterial prophylaxis in cancer patients while taking into account the impact of antibacterial prophylaxis on the human microbiome and resistance development. Current literature published from January 2012 to August 2020 was searched and evidence-based recommendations were developed by an expert panel. All recommendations were discussed and approved in a consensus conference of the AGIHO prior to publication. As a result, we present a comprehensive update and extension of our guideline for antibacterial and PcP prophylaxis in cancer patients.
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Affiliation(s)
- Annika Y Classen
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Larissa Henze
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Marie von Lilienfeld-Toal
- Department of Hematology and Oncology, Clinic for Internal Medicine II, University Hospital Jena, Jena, Germany
| | - Georg Maschmeyer
- Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Michael Sandherr
- Specialist Clinic for Haematology and Oncology, Medical Care Center Penzberg, Penzberg, Germany
| | - Luisa Durán Graeff
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Nael Alakel
- Department I of Internal Medicine, Hematology and Oncology, University Hospital Dresden, Dresden, Germany
| | - Maximilian Christopeit
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Stefan W Krause
- Department of Medicine 5 - Hematology and Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Karin Mayer
- Medical Clinic III for Oncology, Hematology, Immunooncology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany
| | - Silke Neumann
- Interdisciplinary Center for Oncology, Wolfsburg, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Olaf Penack
- Medical Department for Hematology, Oncology and Tumor Immunology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Florian Weißinger
- Department for Internal Medicine, Hematology/Oncology, and Palliative Care, Evangelisches Klinikum Bethel v. Bodelschwinghsche Stiftungen Bethel, Bielefeld, Germany
| | - Hans-Heinrich Wolf
- Department IV of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Jörg Janne Vehreschild
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany.
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany.
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Kayser S, Schlenk RF, Lebon D, Carre M, Götze KS, Stölzel F, Berceanu A, Schäfer-Eckart K, Peterlin P, Hicheri Y, Rahme R, Raffoux E, Chermat F, Krause SW, Aulitzky WE, Rigaudeau S, Noppeney R, Berthon C, Görner M, Jost E, Carassou P, Keller U, Orvain C, Braun T, Saillard C, Arar A, Kunzmann V, Wemeau M, De Wit M, Niemann D, Bonmati C, Schwänen C, Abraham J, Aljijakli A, Haiat S, Krämer A, Reichle A, Gnadler M, Willekens C, Spiekermann K, Hiddemann W, Müller-Tidow C, Thiede C, Röllig C, Serve H, Bornhäuser M, Baldus CD, Lengfelder E, Fenaux P, Platzbecker U, Adès L. Characteristics and outcome of patients with low-/intermediate-risk acute promyelocytic leukemia treated with arsenic trioxide - an international collaborative study. Haematologica 2021; 106:3100-3106. [PMID: 34047178 PMCID: PMC8634174 DOI: 10.3324/haematol.2021.278722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to characterize a large series of 154 patients with acute promyelocytic leukemia (median age, 53 years; range, 18-90 years) and evaluate real-life outcome after up-front treatment with arsenic trioxide and all-trans retinoic acid. All patients were included in the prospective NAPOLEON registry (NCT02192619) between 2013 and 2019. The acute promyelocytic leukemia was de novo in 91% (n=140) and therapy-related in 9% (n=14); 13% (n=20) of the patients were older than 70 years. At diagnosis bleeding/hemorrhage was present in 38% and thrombosis in 3%. Complete remission was achieved in 152 patients (99%), whereas two patients (1%) experienced induction death within 18 days after starting therapy. With a median follow-up of 1.99 years (95% confidence interval: 1.61-2.30 years) 1-year and 2-year overall survival rates were 97% (95% confidence interval: 94-100%) and 95% (95% confidence interval: 91-99%), respectively. Age above 70 years was associated with a significantly shorter overall survival (P<0.001) compared to that of younger patients. So far no relapses have been observed. Six patients (4%) died in complete remission at a median of 0.95 years after diagnosis (range, 0.18-2.38 years). Our data confirm the efficiency and durability of arsenic trioxide and all-trans retinoic acid therapy in the primary management of adults with low-/intermediate-risk acute promyelocytic leukemia in the real-life setting, irrespective of age.
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Affiliation(s)
- Sabine Kayser
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany; NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg.
| | - Richard F Schlenk
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg; Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg
| | | | - Martin Carre
- 5HCE Grenoble, Service d'Oncologie et Hématologie Pédiatrique, Grenoble
| | | | - Friedrich Stölzel
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, TU Dresden
| | - Ana Berceanu
- Service d'Hématologie du Pr. Cahn Hopital Jean Minjoz, Besancon
| | | | | | - Yosr Hicheri
- Département d'Hématologie Clinique du Chu Saint Eloi Montpellier
| | - Ramy Rahme
- Hôpital Saint Louis, Université Paris Diderot, Paris
| | | | | | - Stefan W Krause
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen
| | | | - Sophie Rigaudeau
- Service d'Hémato-Oncologie du Pr. Castaigne Hopital Andre Mignot le Chesnay
| | | | - Celine Berthon
- Service des Maladies du Sang Chru, Hopital Claude Huriez, Lille
| | - Martin Görner
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum Bielefeld Mitte
| | | | - Philippe Carassou
- Service de Médecine interne, Hématologie du Pr. Christian Chr Metz Thionville, Hopital de Marcy, Metz
| | - Ulrich Keller
- Department of Hematology, Oncology and Tumor Immunology, Charité-University Medical Center, Campus Benjamin Franklin, Berlin
| | - Corentin Orvain
- Angers University Hospital, Maladies du Sang, Angers; Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL, France; Université d'Angers, Inserm, CRCINA, Angers
| | - Thorsten Braun
- Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris
| | | | - Ali Arar
- Service d' Oncologie Médicale Hopital de la Source, Orleans
| | | | | | | | - Dirk Niemann
- Gemeinschaftsklinikum Mittelrhein gGmbH, Koblenz
| | - Caroline Bonmati
- Division of Hematology, Hôpital de Brabois, Centre Hospitalier Universitaire de Nancy, Nancy
| | | | - Julie Abraham
- Service d' Hématologie, Thérapie Cellulaire du Pr. Bordessoule, Hopital Universitaire Dupuytren, Limoges
| | - Ahmad Aljijakli
- Service d'Hématologie du Dr. Sutton Centre Hospitalier v. Dupouy, Argenteuil
| | - Stephanie Haiat
- Service d'Hematologie Clinique, CH Sud Francilien, Corbeil Essonnes
| | - Alwin Krämer
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg; German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg
| | - Albrecht Reichle
- Department of Medicine III - Hematology and Internal Oncology, University Hospital Regensburg, Regensburg
| | - Martina Gnadler
- St. Vincentius Kliniken, Abteilung für Hämatologie, Onkologie, Immunologie und Palliativmedizin, Karlsruhe
| | - Christophe Willekens
- Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, Villejuif; INSERM Unit 1170, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif
| | - Karsten Spiekermann
- Department of Medicine III, University Hospital, Ludwig-Maximilians University (LMU) Munich, Munich
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital, Ludwig-Maximilians University (LMU) Munich, Munich
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg
| | - Christian Thiede
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, TU Dresden
| | - Christoph Röllig
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, TU Dresden
| | - Hubert Serve
- Department of Internal Medicine II, University Hospital of Frankfurt Main
| | - Martin Bornhäuser
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, TU Dresden
| | | | - Eva Lengfelder
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim
| | - Pierre Fenaux
- Hôpital Saint Louis, Université Paris Diderot, Paris
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig
| | - Lionel Adès
- Hôpital Saint Louis, Université Paris Diderot, Paris
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20
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Plank K, Dorn C, Krause SW. The effect of erythrocyte lysing reagents on enumeration of leukocyte subpopulations compared with a no-lyse-no-wash protocol. Int J Lab Hematol 2021; 43:939-947. [PMID: 33580753 DOI: 10.1111/ijlh.13484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Standard protocols in flow cytometry (FCM) require lysis of erythrocytes, which may induce an unwanted loss of leukocytes as bystander effect. METHODS In the present study, we investigated the influence of 6 laboratory protocols using 4 different lysing reagents, FACS® Lysing Solution (FacsL), QUICKLYSIS® (QuickL), IOTest® 3 Lysing Solution (NH4Cl), VersaLyse® (VersaL), and VersaLyse® with added fixative (VersaFix) on the relative quantity of leukocyte subsets identified by CD3, CD4, CD8, CD19, CD14, CD16, CD56, and CD45, applying a no-lyse-no-wash (NoL) protocol as reference. In addition, we compared the efficiency of red blood cell (RBC) lysis. RESULTS Peripheral blood samples from 52 individuals were analyzed. NoL was suitable as reference method, but led to less clear-cut gating of lymphocyte and monocyte populations due to a wider distribution of light scatter. Best completeness of RBC lysis with remaining erythrocytes below 10% was achieved using NH4Cl and VersaL. We observed a loss of 11% of monocytes after QuickL. Lymphocyte counts were 19% lower after FacsL. Cell subsets within the lymphocyte compartment were rather similar between the different methods with the exception of lower B-cell counts (-8%) and higher NK-cell counts (+11%) after FacsL. NH4Cl and VersaL were in good accordance with the NoL method and also with the mean values of all methods. CONCLUSION Our data show that the lysing reagents tested lead to specific deviations in the quantitation of leukocyte subsets and show different efficiency of erythrocyte lysis.
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Affiliation(s)
- Karin Plank
- Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carla Dorn
- Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan W Krause
- Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen, Germany
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21
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Krause SW. On Its Way to Primetime: Artificial Intelligence in Flow Cytometry Diagnostics. Cytometry A 2020; 97:990-993. [PMID: 32686266 DOI: 10.1002/cyto.a.24191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Stefan W Krause
- Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen, Germany
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22
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Boch T, Spiess B, Heinz W, Cornely OA, Schwerdtfeger R, Hahn J, Krause SW, Duerken M, Bertz H, Reuter S, Kiehl M, Claus B, Deckert PM, Hofmann WK, Buchheidt D, Reinwald M. Aspergillus specific nested PCR from the site of infection is superior to testing concurrent blood samples in immunocompromised patients with suspected invasive aspergillosis. Mycoses 2020; 62:1035-1042. [PMID: 31402465 DOI: 10.1111/myc.12983] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 12/16/2022]
Abstract
Invasive aspergillosis (IA) is a severe complication in immunocompromised patients. Early diagnosis is crucial to decrease its high mortality, yet the diagnostic gold standard (histopathology and culture) is time-consuming and cannot offer early confirmation of IA. Detection of IA by polymerase chain reaction (PCR) shows promising potential. Various studies have analysed its diagnostic performance in different clinical settings, especially addressing optimal specimen selection. However, direct comparison of different types of specimens in individual patients though essential, is rarely reported. We systematically assessed the diagnostic performance of an Aspergillus-specific nested PCR by investigating specimens from the site of infection and comparing it with concurrent blood samples in individual patients (pts) with IA. In a retrospective multicenter analysis PCR was performed on clinical specimens (n = 138) of immunocompromised high-risk pts (n = 133) from the site of infection together with concurrent blood samples. 38 pts were classified as proven/probable, 67 as possible and 28 as no IA according to 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group consensus definitions. A considerably superior performance of PCR from the site of infection was observed particularly in pts during antifungal prophylaxis (AFP)/antifungal therapy (AFT). Besides a specificity of 85%, sensitivity varied markedly in BAL (64%), CSF (100%), tissue samples (67%) as opposed to concurrent blood samples (8%). Our results further emphasise the need for investigating clinical samples from the site of infection in case of suspected IA to further establish or rule out the diagnosis.
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Affiliation(s)
- Tobias Boch
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Birgit Spiess
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Oliver A Cornely
- First Department of Internal Medicine and ZKS Köln, BMBF 01KN1106, University Hospital Cologne, Deutsches Zentrum für Infektionsforschung, Cologne, Germany
| | | | - Joachim Hahn
- Regensburg University Hospital, Regensburg, Germany
| | | | - Matthias Duerken
- Department of Pediatric Hematology, Mannheim University Hospital, Mannheim, Germany
| | | | | | | | - Bernd Claus
- Ludwigshafen General Hospital, Ludwigshafen, Germany
| | | | | | - Dieter Buchheidt
- University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Mark Reinwald
- Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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23
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Zierk J, Krebs A, Rauh M, Metzler M, Löscher A, Strasser E, Krause SW. Blood counts in adult and elderly individuals: defining the norms over eight decades of life. Br J Haematol 2020; 189:777-789. [DOI: 10.1111/bjh.16430] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/03/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Jakob Zierk
- Department of Pediatrics and Adolescent Medicine University Hospital Erlangen Erlangen Germany
- Center of Medical Information and Communication Technology University Hospital Erlangen Erlangen Germany
| | | | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine University Hospital Erlangen Erlangen Germany
| | - Markus Metzler
- Department of Pediatrics and Adolescent Medicine University Hospital Erlangen Erlangen Germany
| | - Astrid Löscher
- Central Laboratory University Hospital Erlangen Erlangen Germany
| | - Erwin Strasser
- Department of Transfusion Medicine and Haemostaseology University Hospital Erlangen Erlangen Germany
| | - Stefan W. Krause
- Department of Medicine 5 ‐ Haematology and Oncology University Hospital Erlangen Erlangen Germany
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24
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Abstract
Abstract
Reticulated platelets are immature platelets freshly released from the bone marrow into the circulation and contain vestigial amounts of ribonucleic acid. Thus, they can serve as an indicator for the activity of thrombopoiesis. Despite the current lack of a standardized reference method, two types of hematology analyzers have incorporated a fully automated measurement of reticulated platelets. The “immature platelet fraction” (IPF; Sysmex XE-/XN-series) has some clinical utility in the differential diagnosis of thrombocytopenia. This is less clear for “reticulated platelets” (retPLT; Abbott CELL-DYN Sapphire/Alinity HQ). The usefulness of these parameters in the prediction of platelet recovery after chemotherapy or stem cell transplantation and as a decision aid for platelet transfusions has not been unequivocally confirmed. Recent findings have shown an association of reticulated platelets with an adverse risk in patients with coronary artery disease and stroke as well as resistance to anti-platelet therapy. Furthermore, a role of reticulated platelets for the prediction of sepsis was indicated. However, validation in larger prospective trials is necessary to establish the clinical benefit of reticulated platelets in these conditions. This review gives an overview of the available analytical methods and summarizes the current knowledge regarding the clinical application of reticulated platelets.
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Affiliation(s)
- Lisa Meintker
- Department of Medicine 5 for Hematology and Oncology , University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany
| | - Stefan W. Krause
- Department of Medicine 5 for Hematology and Oncology , University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany
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25
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Fuchs M, Goergen H, Kobe C, Kuhnert G, Lohri A, Greil R, Sasse S, Topp MS, Schäfer E, Hertenstein B, Soekler M, Vogelhuber M, Zijlstra JM, Keller UB, Krause SW, Wilhelm M, Maschmeyer G, Thiemer J, Dührsen U, Meissner J, Viardot A, Eich H, Baues C, Diehl V, Rosenwald A, von Tresckow B, Dietlein M, Borchmann P, Engert A. Positron Emission Tomography-Guided Treatment in Early-Stage Favorable Hodgkin Lymphoma: Final Results of the International, Randomized Phase III HD16 Trial by the German Hodgkin Study Group. J Clin Oncol 2019; 37:2835-2845. [PMID: 31498753 DOI: 10.1200/jco.19.00964] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Combined-modality treatment (CMT) with 2× ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) and small-field radiotherapy is standard of care for patients with early-stage favorable Hodgkin lymphoma (HL). However, the role of radiotherapy has been challenged. Positron emission tomography (PET) after 2× ABVD (PET-2) might help to predict individual outcomes and guide treatment. METHODS Between November 2009 and December 2015, we recruited patients age 18 to 75 years with newly diagnosed, early-stage favorable HL for this international randomized phase III trial. Patients were assigned to standard CMT of 2× ABVD and 20-Gy involved-field radiotherapy or PET-guided treatment, omitting involved-field radiotherapy after negative PET-2 (Deauville score < 3). Primary objectives were to exclude inferiority of 10% or more in 5-year progression-free survival (PFS) of ABVD alone compared with CMT in a per-protocol analysis among PET-2-negative patients (noninferiority margin for hazard ratio, 3.01) and to confirm PET-2 positivity (Deauville score ≥ 3) as a risk factor for PFS among CMT-treated patients. RESULTS We enrolled 1,150 patients. Median follow-up was 45 months. Among 628 PET-2-negative, per-protocol-treated patients, 5-year PFS was 93.4% (95% CI, 90.4% to 96.5%) with CMT and 86.1% (95% CI, 81.4% to 90.9%) with ABVD (difference 7.3% [95% CI, 1.6% to 13.0%]; hazard ratio, 1.78 [95% CI, 1.02 to 3.12]). Five-year overall survival was 98.1% (95% CI, 96.5% to 99.8%) with CMT and 98.4% (95% CI, 96.5% to 100.0%) with ABVD. Among 693 patients who were assigned to CMT, 5-year PFS was 93.2% (95% CI, 90.2% to 96.2%) among PET-2-negative patients and 88.4% (95% CI, 84.2% to 92.6%) in PET-2-positive patients (P = .047). When using the more common liver cutoff (Deauville score, 4) for PET-2 positivity, the difference was more pronounced (5-year PFS, 93.1% [95% CI, 90.7% to 95.5%] v 80.9% [95% CI, 72.2% to 89.7%]; P = .0011). CONCLUSION In early-stage favorable HL, a positive PET after two cycles ABVD indicates a high risk for treatment failure, particularly when a Deauville score of 4 is used as a cutoff for positivity. In PET-2-negative patients, radiotherapy cannot be omitted from CMT without clinically relevant loss of tumor control.
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Affiliation(s)
- Michael Fuchs
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Helen Goergen
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Georg Kuhnert
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Andreas Lohri
- Cantonal Hospital Baselland, Liestal, Switzerland.,Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Richard Greil
- IIIrd Medical Department, Paracelcus Medical University and Salzburg Cancer Research Institute, Salzburg, Austria.,Salzburg Cancer Research Institute and AGMT (Arbeitsgemeinschaft Medikamentöse Tumortherapie), Salzburg, Austria
| | - Stephanie Sasse
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Erhardt Schäfer
- Dres. med. Just/Düwel/Riesenberg/Steinke/Schäfer, Studiengesellschaft, Bielefeld, Germany
| | - Bernd Hertenstein
- Department of Internal Medicine I, Klinikum Bremen Mitte, Bremen, Germany
| | | | - Martin Vogelhuber
- Medizinische Klinik III, Universitätsklinik Regensburg, Regensburg, Germany
| | - Josée M Zijlstra
- Amsterdam University Medical Center, Vrije Universiteit, Department of Hematology, Amsterdam, Netherlands
| | - Ulrich Bernd Keller
- Department of Internal Medicine III, Klinikum "Rechts der Isar", Munich, Germany
| | - Stefan W Krause
- Department of Internal Medicine 5, Haematology/Oncology, University of Erlangen, Erlangen, Germany
| | - Martin Wilhelm
- Department of Medical Oncology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | - Georg Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Julia Thiemer
- Clinic for Hematology, Oncology and Immunology, Philipps University, Marburg, Germany
| | - Ulrich Dührsen
- Department of Haematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Andreas Viardot
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Hans Eich
- Department of Radiotherapy, University Hospital of Muenster, Muenster, Germany
| | - Christian Baues
- Department of Radiotherapy, University of Cologne, Cologne, Germany
| | - Volker Diehl
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Andreas Rosenwald
- Institute of Pathology, Julius Maximilian University of Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
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26
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Ostgathe C, Wendt KN, Heckel M, Kurkowski S, Klein C, Krause SW, Fuchs FS, Bayer CM, Stiel S. Identifying the need for specialized palliative care in adult cancer patients - development and validation of a screening procedure based on proxy assessment by physicians and filter questions. BMC Cancer 2019; 19:646. [PMID: 31262285 PMCID: PMC6604384 DOI: 10.1186/s12885-019-5809-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/07/2019] [Indexed: 11/08/2022] Open
Abstract
Background One challenge in caring for cancer patients with incurable disease is the adequate identification of those in need for specialized palliative care (SPC). The study’s aim was to validate an easy to use phenomenological screening tool. Methods The German tool is based on the National Comprehensive Cancer Network (NCCN) Palliative Care guidelines and contains ten items in five domains that focus e.g. on diagnosis, functional status, complications, comorbidities, and palliative care relevant problems such as symptom management, distress, and support of family and team members. Sum score ranges from 0 to 14 (no need to great need). Assessment to identify SPC needs was done in university hospital wards between 1 and 08/2017 by health care professionals on admission of the patient if the disease was incurable and expected prognosis < 12 months. The Integrated Palliative Outcome Scale (IPOS, staff version), an outcome assessment instrument for palliative care that consists of ten items, served as external criterion; in sub samples inter-rater/test-retest were performed. Results Data from 208 patients with incurable disease and life expectancy < 12 months (54.8% female; average age 63.5 years, range 21–96) were assessed using the tool. The tool has good convergent validity; the correlation between the sum scores of IPOS and our tool showed a significant and substantial effect. The sum score was independent of the patient’s age, gender and primary diagnosis. Patients who already were in contact with SPC had significantly higher screening scores than patients without. With a cut point of ≥ 5, 80.8% of the screened patients were in need for SPC. Cronbach’s alpha was α = .600. Rater agreement (inter-rater, test-retest) varied between single items. Correlation coefficients showed significant substantial effects. Conclusions This is the first validation of a screening procedure in German language identifying SPC needs of adult patients with advanced cancer and the first using filter questions as a pre-screening. Proxy assessment of SPC needs by physicians in cancer care settings is feasible and the suggested tool presents a valid instrument to trigger a PC consultation. Trial registration The study was not registered.
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Affiliation(s)
- Christoph Ostgathe
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Kim N Wendt
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Maria Heckel
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany. .,Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.
| | - Sandra Kurkowski
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Carsten Klein
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Stefan W Krause
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Internal Medicine 5, Haematology and Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Florian S Fuchs
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Division of Respiratory Medicine, Department of Internal Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen , Erlangen, Germany
| | - Christian M Bayer
- Comprehensive Cancer Center CCC Erlangen - EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany.,Department of Gynecology and Obstetrics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, University Breast Center Franconia, Erlangen, Germany
| | - Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Hannover, Germany
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Zierk J, Arzideh F, Haeckel R, Rauh M, Metzler M, Ganslandt T, Krause SW. Indirect determination of hematology reference intervals in adult patients on Beckman Coulter UniCell DxH 800 and Abbott CELL-DYN Sapphire devices. ACTA ACUST UNITED AC 2019; 57:730-739. [DOI: 10.1515/cclm-2018-0771] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/28/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Conventional establishment of reference intervals for hematological analytes is challenging due to the need to recruit healthy persons. Indirect methods address this by deriving reference intervals from clinical laboratory databases which contain large datasets of both physiological and pathological test results.
Methods
We used the “Reference Limit Estimator” (RLE) to establish reference intervals for common hematology analytes in adults aged 18–60 years. One hundred and ninety-five samples from 44,519 patients, measured on two different devices in a tertiary care center were analyzed. We examined the influence of patient cohorts with an increasing proportion of abnormal test results, compared sample selection strategies, explored inter-device differences, and analyzed the stability of reference intervals in simulated datasets with varying overlap of pathological and physiological test results.
Results
Reference intervals for hemoglobin, hematocrit, red cell count and platelet count remained stable, even if large numbers of pathological samples were included. Reference intervals for red cell indices, red cell distribution width and leukocyte count were sufficiently stable, if patient cohorts with the highest fraction of pathological samples were excluded. In simulated datasets, estimated reference limits shifted, if the pathological dataset contributed more than 15%–20% of total samples and approximated the physiological distribution. Advanced sample selection techniques did not improve the algorithm’s performance. Inter-device differences were small except for red cell distribution width.
Conclusions
The RLE is well-suited to create reference intervals from clinical laboratory databases even in the challenging setting of a adult tertiary care center. The procedure can be used as a complement for reference interval determination where conventional approaches are limited.
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Michel C, Burchert A, Hochhaus A, Saussele S, Neubauer A, Lauseker M, Krause SW, Kolb HJ, Hossfeld DK, Nerl C, Baerlocher GM, Heim D, Brümmendorf TH, Fabarius A, Haferlach C, Schlegelberger B, Balleisen L, Goebeler ME, Hänel M, Ho A, Dengler J, Falge C, Möhle R, Kremers S, Kneba M, Stegelmann F, Köhne CH, Lindemann HW, Waller CF, Spiekermann K, Berdel WE, Müller L, Edinger M, Mayer J, Beelen DW, Bentz M, Link H, Hertenstein B, Fuchs R, Wernli M, Schlegel F, Schlag R, de Wit M, Trümper L, Hebart H, Hahn M, Thomalla J, Scheid C, Schafhausen P, Verbeek W, Eckart MJ, Gassmann W, Schenk M, Brossart P, Wündisch T, Geer T, Bildat S, Schäfer E, Hasford J, Hehlmann R, Pfirrmann M. Imatinib dose reduction in major molecular response of chronic myeloid leukemia: results from the German Chronic Myeloid Leukemia-Study IV. Haematologica 2018; 104:955-962. [PMID: 30514803 PMCID: PMC6518910 DOI: 10.3324/haematol.2018.206797] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 11/22/2018] [Indexed: 12/20/2022] Open
Abstract
Standard first-line therapy of chronic myeloid leukemia is treatment with imatinib. In the randomized German Chronic Myeloid Leukemia-Study IV, more potent BCR-ABL inhibition with 800 mg (‘high-dose’) imatinib accelerated achievement of a deep molecular remission. However, whether and when a de-escalation of the dose intensity under high-dose imatinib can be safely performed without increasing the risk of losing deep molecular response is unknown. To gain insights into this clinically relevant question, we analyzed the outcome of imatinib dose reductions from 800 mg to 400 mg daily in the Chronic Myeloid Leukemia-Study IV. Of the 422 patients that were randomized to the 800 mg arm, 68 reduced imatinib to 400 mg after they had achieved at least a stable major molecular response. Of these 68 patients, 61 (90%) maintained major molecular remission on imatinib at 400 mg. Five of the seven patients who lost major molecular remission on the imatinib standard dose regained major molecular remission while still on 400 mg imatinib. Only two of 68 patients had to switch to more potent kinase inhibition to regain major molecular remission. Importantly, the lengths of the intervals between imatinib high-dose treatment before and after achieving major molecular remission were associated with the probabilities of maintaining major molecular remission with the standard dose of imatinib. Taken together, the data support the view that a deep molecular remission achieved with high-dose imatinib can be safely maintained with standard dose in most patients. Study protocol registered at clinicaltrials.gov 00055874.
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Affiliation(s)
- Christian Michel
- Universitätsklinikum Gießen und Marburg, Campus Marburg, Klinik für Hämatologie, Onkologie und Immunologie, Philipps Universität Marburg, Germany
| | - Andreas Burchert
- Universitätsklinikum Gießen und Marburg, Campus Marburg, Klinik für Hämatologie, Onkologie und Immunologie, Philipps Universität Marburg, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Jena, Germany
| | - Susanne Saussele
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, University Heidelberg, Mannheim, Germany
| | - Andreas Neubauer
- Universitätsklinikum Gießen und Marburg, Campus Marburg, Klinik für Hämatologie, Onkologie und Immunologie, Philipps Universität Marburg, Germany
| | - Michael Lauseker
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stefan W Krause
- Medizinische Klinik 5, Universitätsklinikum, Erlangen, Germany
| | | | | | | | | | | | | | - Alice Fabarius
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, University Heidelberg, Mannheim, Germany
| | | | | | | | - Maria-Elisabeth Goebeler
- Comprehensive Cancer Center Mainfranken und Medizinische Klinik II, Zentrum für Innere Medizin, Würzburg, Germany
| | | | - Anthony Ho
- Medizinische Klinik V, Universität Heidelberg, Germany
| | | | | | - Robert Möhle
- Medizinische Abteilung 2, Universitätsklinikum, Tübingen, Germany
| | | | - Michael Kneba
- 2. Medizinische Klinik und Poliklinik, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | | | | | | | | | | | | | - Matthias Edinger
- Klinik und Poliklinik für Innere Medizin 3, Universitätsklinikum, Regensburg, Germany
| | - Jiri Mayer
- Masaryk University Hospital, Brno, Czech Republic
| | | | - Martin Bentz
- Medizinische Klinik 3, Städtisches Klinikum, Karlsruhe, Germany
| | - Hartmut Link
- Hematology, Medical Oncology, Kaiserslautern, Germany
| | | | | | | | | | - Rudolf Schlag
- Hämatologische-Onkologische Schwerpunktpraxis, Würzburg, Germany
| | - Maike de Wit
- Klinik für Innere Medizin II, Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Lorenz Trümper
- Klinik für Hämatologie und medizinische Onkologie, Universitätsmedizin, Göttingen, Germany
| | - Holger Hebart
- Stauferklinikum Schwäbisch Gmünd, Mutlangen, Germany
| | | | - Jörg Thomalla
- Praxisklinik für Hämatologie und Onkologie, Koblenz, Germany
| | - Christof Scheid
- Klinik 1 für Innere Medizin, Universitätsklinikum, Köln, Germany
| | | | | | | | | | | | | | - Thomas Wündisch
- Universitätsklinikum Gießen und Marburg, Campus Marburg, Klinik für Hämatologie, Onkologie und Immunologie, Philipps Universität Marburg, Germany
| | | | | | | | - Joerg Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rüdiger Hehlmann
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, University Heidelberg, Mannheim, Germany
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, Munich, Germany
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Ugele M, Weniger M, Stanzel M, Bassler M, Krause SW, Friedrich O, Hayden O, Richter L. Label-Free High-Throughput Leukemia Detection by Holographic Microscopy. Adv Sci (Weinh) 2018; 5:1800761. [PMID: 30581697 PMCID: PMC6299719 DOI: 10.1002/advs.201800761] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/18/2018] [Indexed: 05/12/2023]
Abstract
Complete blood count and differentiation of leukocytes (DIFF) belong to the most frequently performed laboratory diagnostic tests. Here, a flow cytometry-based method for label-free DIFF of untouched leukocytes by digital holographic microscopy on the rich phase contrast of peripheral leukocyte images, using highly controlled 2D hydrodynamic focusing conditions is reported. Principal component analysis of morphological characteristics of the reconstructed images allows classification of nine leukocyte types, in addition to different types of leukemia and demonstrates disappearance of acute myeloid leukemia cells in remission. To exclude confounding effects, the classification strategy is tested by the analysis of 20 blinded clinical samples. Here, 70% of the specimens are correctly classified with further 20% classifications close to a correct diagnosis. Taken together, the findings indicate a broad clinical applicability of the cytometry method for automated and reagent-free diagnosis of hematological disorders.
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Affiliation(s)
- Matthias Ugele
- In‐Vitro DX and BioscienceDepartment of Strategy and InnovationSiemens Healthcare GmbHGünther‐Scharowsky‐Str. 191058ErlangenGermany
- Department of Chemical and Biological EngineeringInstitute of Medical BiotechnologyFriedrich‐Alexander‐University Erlangen‐NurembergPaul‐Gordan‐Str. 391052ErlangenGermany
| | - Markus Weniger
- In‐Vitro DX and BioscienceDepartment of Strategy and InnovationSiemens Healthcare GmbHGünther‐Scharowsky‐Str. 191058ErlangenGermany
| | - Manfred Stanzel
- In‐Vitro DX and BioscienceDepartment of Strategy and InnovationSiemens Healthcare GmbHGünther‐Scharowsky‐Str. 191058ErlangenGermany
| | - Michael Bassler
- Analysesysteme und SensorikFraunhofer IMMCarl‐Zeiss‐Str. 18‐2055129MainzGermany
| | - Stefan W. Krause
- Medizinische Klinik 5Hämatologie and Internistische OnkologieUlmenweg 1891054ErlangenGermany
| | - Oliver Friedrich
- Department of Chemical and Biological EngineeringInstitute of Medical BiotechnologyFriedrich‐Alexander‐University Erlangen‐NurembergPaul‐Gordan‐Str. 391052ErlangenGermany
| | - Oliver Hayden
- In‐Vitro DX and BioscienceDepartment of Strategy and InnovationSiemens Healthcare GmbHGünther‐Scharowsky‐Str. 191058ErlangenGermany
- Heinz‐Nixdorf‐Chair of Biomedical ElectronicsDepartment of Electrical and Computer EngineeringTranslaTUMCampus Klinikum rechts der IsarTechnical University of MunichIsmaningerstr. 2281675MunichGermany
| | - Lukas Richter
- In‐Vitro DX and BioscienceDepartment of Strategy and InnovationSiemens Healthcare GmbHGünther‐Scharowsky‐Str. 191058ErlangenGermany
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30
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Schröder SD, Krause SW, Erfurt-Berge C. Genital ulcers as diagnostic clue for acute myeloid leukaemia. Int Wound J 2018; 15:845-848. [DOI: 10.1111/iwj.12923] [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] [Received: 02/18/2018] [Accepted: 02/27/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sina D Schröder
- Department of Dermatology; University Hospital Erlangen; Erlangen Germany
| | - Stefan W Krause
- Department of Hematology and Oncology; University Hospital Erlangen; Erlangen Germany
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31
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Mellinghoff SC, Panse J, Alakel N, Behre G, Buchheidt D, Christopeit M, Hasenkamp J, Kiehl M, Koldehoff M, Krause SW, Lehners N, von Lilienfeld-Toal M, Löhnert AY, Maschmeyer G, Teschner D, Ullmann AJ, Penack O, Ruhnke M, Mayer K, Ostermann H, Wolf HH, Cornely OA. Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO). Ann Hematol 2017; 97:197-207. [PMID: 29218389 PMCID: PMC5754425 DOI: 10.1007/s00277-017-3196-2] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022]
Abstract
Immunocompromised patients are at high risk of invasive fungal infections (IFI), in particular those with haematological malignancies undergoing remission-induction chemotherapy for acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS) and recipients of allogeneic haematopoietic stem cell transplants (HSCT). Despite the development of new treatment options in the past decades, IFI remains a concern due to substantial morbidity and mortality in these patient populations. In addition, the increasing use of new immune modulating drugs in cancer therapy has opened an entirely new spectrum of at risk periods. Since the last edition of antifungal prophylaxis recommendations of the German Society for Haematology and Medical Oncology in 2014, seven clinical trials regarding antifungal prophylaxis in patients with haematological malignancies have been published, comprising 1227 patients. This update assesses the impact of this additional evidence and effective revisions. Our key recommendations are the following: prophylaxis should be performed with posaconazole delayed release tablets during remission induction chemotherapy for AML and MDS (AI). Posaconazole iv can be used when the oral route is contraindicated or not feasible. Intravenous liposomal amphotericin B did not significantly decrease IFI rates in acute lymphoblastic leukaemia (ALL) patients during induction chemotherapy, and there is poor evidence to recommend it for prophylaxis in these patients (CI). Despite substantial risk of IFI, we cannot provide a stronger recommendation for these patients. There is poor evidence regarding voriconazole prophylaxis in patients with neutropenia (CII). Therapeutic drug monitoring TDM should be performed within 2 to 5 days of initiating voriconazole prophylaxis and should be repeated in case of suspicious adverse events or of dose changes of interacting drugs (BIItu). General TDM during posaconazole prophylaxis is not recommended (CIItu), but may be helpful in cases of clinical failure such as breakthrough IFI for verification of compliance or absorption.
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Affiliation(s)
- Sibylle C Mellinghoff
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany. .,Department I of Internal Medicine, German Centre for Infection Research (DZIF), University Hospital of Cologne, University of Cologne, Cologne, Germany.
| | - Jens Panse
- Department of Oncology, Haematology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Nael Alakel
- Department I of Internal Medicine, Haematology and Oncology, University Hospital Dresden, Dresden, Germany
| | - Gerhard Behre
- Division of Haematology and Oncology, Leipzig University Hospital, Leipzig, Germany
| | - Dieter Buchheidt
- Department of Internal Medicine-Haematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Justin Hasenkamp
- Clinic for Haematology and Medical Oncology with Department for Stem Cell Transplantation, University Medicine Göttingen, Göttingen, Germany
| | - Michael Kiehl
- Department I for Internal Medicine, Klinikum Frankfurt (Oder), Frankfurt (Oder), Germany
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Centre, University Hospital of Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Stefan W Krause
- Department V for Internal Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Nicola Lehners
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Annika Y Löhnert
- Department I of Internal Medicine, German Centre for Infection Research (DZIF), University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Georg Maschmeyer
- Department of Haematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Daniel Teschner
- Department of Haematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andrew J Ullmann
- Department II of Internal Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Olaf Penack
- Department for Haematology, Oncology and Tumour immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Ruhnke
- Department of Haematology and Oncology, Paracelsus-Kliniken Osnabrück, Osnabrück, Germany
| | - Karin Mayer
- Department III of Internal Medicine, University Hospital Bonn, Bonn, Germany
| | - Helmut Ostermann
- Department of Haematology and Oncology, University of Munich, Munich, Germany
| | - Hans-H Wolf
- Department IV of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Department I of Internal Medicine, German Centre for Infection Research (DZIF), University Hospital of Cologne, University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
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32
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Ferreri AJM, Cwynarski K, Pulczynski E, Fox CP, Schorb E, La Rosée P, Binder M, Fabbri A, Torri V, Minacapelli E, Falautano M, Ilariucci F, Ambrosetti A, Roth A, Hemmaway C, Johnson P, Linton KM, Pukrop T, Sønderskov Gørløv J, Balzarotti M, Hess G, Keller U, Stilgenbauer S, Panse J, Tucci A, Orsucci L, Pisani F, Levis A, Krause SW, Schmoll HJ, Hertenstein B, Rummel M, Smith J, Pfreundschuh M, Cabras G, Angrilli F, Ponzoni M, Deckert M, Politi LS, Finke J, Reni M, Cavalli F, Zucca E, Illerhaus G. Whole-brain radiotherapy or autologous stem-cell transplantation as consolidation strategies after high-dose methotrexate-based chemoimmunotherapy in patients with primary CNS lymphoma: results of the second randomisation of the International Extranodal Lymphoma Study Group-32 phase 2 trial. Lancet Haematol 2017; 4:e510-e523. [PMID: 29054815 DOI: 10.1016/s2352-3026(17)30174-6] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND The International Extranodal Lymphoma Study Group-32 (IELSG32) trial is an international randomised phase 2 study that addresses two key clinical questions in the treatment of patients with newly diagnosed primary CNS lymphoma. Results of the first randomisation have demonstrated that methotrexate, cytarabine, thiotepa, and rituximab (called the MATRix regimen) is the induction combination associated with significantly better outcome compared with the other induction combinations tested. Here, we report the results of the second randomisation that addresses the efficacy of myeloablative chemotherapy supported by autologous stem-cell transplantation (ASCT), as an alternative to whole-brain radiotherapy (WBRT), as consolidation after high-dose-methotrexate-based chemoimmunotherapy. METHODS HIV-negative patients (aged 18-70 years) with newly diagnosed primary CNS lymphoma and an Eastern Cooperative Oncology Group performance status of 0-3 were randomly assigned to receive four courses of methotrexate 3·5 g/m2 on day 1 plus cytarabine 2 g/m2 twice daily on days 2 and 3 (group A); or the same combination plus two doses of rituximab 375 mg/m2 on days -5 and 0 (group B); or the same methotrexate-cytarabine-rituximab combination plus thiotepa 30 mg/m2 on day 4 (group C), with the three groups repeating treatment every 3 weeks. Patients with responsive or stable disease after induction treatment, with adequate autologous peripheral blood stem-cell collection, and without persistent iatrogenic side-effects, were eligible for the second randomisation between WBRT (photons of 4-10 MeV; five fractions per week; fraction size 180 cGy; started within 4 weeks from the last induction course; group D) and carmustine-thiotepa conditioned ASCT (carmustine 400 mg/m2 on day -6, and thiotepa 5 mg/kg every 12 h on days -5 and -4, followed by reinfusion of autologous peripheral blood stem cells; group E). A permuted block randomised design was adopted for both randomisations, and a computer-generated randomisation list was used within each stratum. No masking after assignment to intervention was adopted. The primary endpoint was 2-year progression-free survival, with induction group and response to induction chemotherapy as stratification parameters. Analyses were done on a modified intention-to-treat basis. This study is registered with ClinicalTrials.gov, number NCT01011920. FINDINGS Between Feb 19, 2010, and Aug 27, 2014, 227 patients were recruited from 53 centres in five countries. 219 of 227 enrolled patients were assessable. Of the 122 patients eligible for the second randomisation, 118 patients were randomly assigned to WBRT or ASCT (59 patients per group) and constitute the study population. WBRT and ASCT were both effective, and achieved the predetermined efficacy threshold of at least 40 progression-free survivors at 2 years among the first 52 patients in both groups D and E. There were no significant differences in 2-year progression-free survival between WBRT and ASCT: 80% (95% CI 70-90) in group D and 69% (59-79) in group E (hazard ratio 1·50, 95% CI 0·83-2·71; p=0·17). Both consolidation therapies were well tolerated. Grade 4 non-haematological toxicity was uncommon; as expected, haematological toxicity was more common in patients treated with ASCT than in those who received WBRT. Two toxic deaths (infections) were recorded, both in patients who received ASCT. INTERPRETATION WBRT and ASCT are both feasible and effective as consolidation therapies after high-dose methotrexate-based chemoimmunotherapy in patients aged 70 years or younger with primary CNS lymphoma. The risks and implications of cognitive impairment after WBRT should be considered at the time of therapeutic decision. FUNDING Agenzia Italiana del Farmaco, Cancer Research UK, Oncosuisse, and Swiss National Science Foundation.
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Affiliation(s)
- Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Kate Cwynarski
- Royal Free Hospital/University College London Hospital, London, UK
| | | | - Christopher P Fox
- University Hospitals National Health Service (NHS) Trust, Nottingham, UK
| | | | | | - Mascha Binder
- Uke Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Valter Torri
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | - Monica Falautano
- Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fiorella Ilariucci
- Azienda Ospedaliera Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Achille Ambrosetti
- Dipartimento di Medicina, Sezione di Ematologia, Università di Verona, Verona, Italy
| | | | | | - Peter Johnson
- Medical Oncology Unit, Southampton General Hospital, Southampton, UK
| | - Kim M Linton
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | | | | | | | | | | | | | - Jens Panse
- University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | | | - Lorella Orsucci
- AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Francesco Pisani
- Hematology and Stem Cell Transplantation Unit, Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | | | | | | | | | - Mathias Rummel
- Klinikum Der Justus-Liebig-Universität, Giessen, Germany
| | | | | | | | | | - Maurilio Ponzoni
- Ateneo Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Deckert
- Institute of Neuropathology, University Hospital of Cologne, Cologne, Germany
| | - Letterio S Politi
- Unit of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Michele Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Franco Cavalli
- Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
| | - Emanuele Zucca
- Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
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Hehlmann R, Lauseker M, Saussele S, Pfirrmann M, Neubauer A, Krause SW, Hossfeld DK, Nerl C, Baerlocher GM, Heim D, Kolb HJ, Proetel U, Kohlbrenner K, Gratwohl A, Burchert A, Voskanyan A, Rinaldetti SL, Hochhaus A, Hasford J. Ten-year survival after randomized comparison of imatinib (IM) 400 mg vs. IM 800 mg vs. IM + IFN vs. IM + Ara C vs. IM after IFN in chronic myeloid leukemia (CML). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7049] [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
7049 Background: It is unclear whether IM 400 mg is the optimum choice for the successful treatment of CML. Treatment optimization was therefore attempted. Methods: From July 2002 to March 2012, 1551 newly diagnosed patients in chronic phase (CP) were randomized into a 5-arm study to analyze 2 IM doses and 3 combinations. 1536 patients were evaluable, 400 for IM 400 mg, 420 for IM 800 mg, 430 for IM + Interferon (IFN), 158 for IM + Ara C and 128 for IM after IFN. Recruitment to the latter two arms was stopped after a pilot phase. Results: 10-year overall survival (OS) of all patients was 82%, 10-year progression free survival (PFS) 80%. 10-year OS was 80% with IM 400 mg, 79% with IM 800 mg, 84% with IM + IFN, 84% with IM + Ara C and 79% with IM after IFN. The differences were not significant. 10-year PFS was 80% with IM 400mg, 77% with IM 800mg, 83% with IM + IFN, 82% with IM + Ara C and 75% with IM after IFN. The differences were not significant either. Survival with any treatment was not significantly different from IM 400mg at any risk level by any risk score (Euro Sokal, EUTOS, ELTS). 87 patients progressed to blast crisis (BC). The 10-year cumulative incidence of BC was 5.8% (95% CI: 4.7%; 7.1%) equally distributed across treatment arms. Most BC occurred in the first 2 years. Median survival after BC was 7.9 months across treatment arms. 275 patients have died, 23 after stem cell transplantation in first CP. Two thirds of deaths were unrelated to CML. Incidence of death due to CML by competing risk analysis with death unrelated to CML as competing risk was not different between the 5-treatment arms. 10-year relative survival probability was 92% when compared to matched general population data. Patients reaching the cytogenetic or molecular response landmarks according to European LeukemiaNet criteria ( < 10% BCR-ABL IS at 3 months, < 1% BCR-ABL IS or complete cytogenetic remission at 6 months, < 0.1% BCR-ABL IS (MMR) at 12 months) had a significantly better survival than those not reaching the landmarks regardless of therapy. Conclusions: In conclusion, outcome of CML is currently more determined by prognostic markers than by choice of therapy. IM400 mg remains an excellent choice for initial therapy of CP-CML. Clinical trial information: NCT00055874.
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Affiliation(s)
- Ruediger Hehlmann
- Medizinische Fakultaet Mannheim Universitaet Heidelberg, Mannheim, Germany
| | | | - Susanne Saussele
- Medizinische Fakultaet Mannheim der Universitaet Heidelberg, Mannheim, Germany
| | - Markus Pfirrmann
- Institute for Medical Informatics and Biometry, LMU Muenchen, Munich, Germany
| | | | - Stefan W. Krause
- Medizinische Klinik 5, Universitaetsklinikum Erlangen, Erlangen, Germany
| | | | | | | | | | | | - Ulrike Proetel
- Med. Fakultaet Mannheim,. Universitaet Heidelberg, Mannheim, Germany
| | | | | | | | - Astghik Voskanyan
- Medizinische Fakultaet Mannheim der Universitaet Heidelberg, Mannheim, Germany
| | | | | | - Joerg Hasford
- Institute for Medical Informatics and Biometry, Munich, Germany
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Cybulska A, Meintker L, Ringwald J, Krause SW. Measurements of immature platelets with haematology analysers are of limited value to separate immune thrombocytopenia from bone marrow failure. Br J Haematol 2017; 177:612-619. [DOI: 10.1111/bjh.14628] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/31/2016] [Indexed: 01/19/2023]
Affiliation(s)
| | - Lisa Meintker
- Department of Medicine 5 - Haematology and Oncology; Universitätsklinikum Erlangen; Erlangen Germany
| | - Jürgen Ringwald
- Department of Transfusion Medicine and Haemostaseology; Universitätsklinikum Erlangen; Erlangen Germany
| | - Stefan W. Krause
- Department of Medicine 5 - Haematology and Oncology; Universitätsklinikum Erlangen; Erlangen Germany
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35
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Koehler P, Hamprecht A, Bader O, Bekeredjian-Ding I, Buchheidt D, Doelken G, Elias J, Haase G, Hahn-Ast C, Karthaus M, Kekulé A, Keller P, Kiehl M, Krause SW, Krämer C, Neumann S, Rohde H, La Rosée P, Ruhnke M, Schafhausen P, Schalk E, Schulz K, Schwartz S, Silling G, Staib P, Ullmann A, Vergoulidou M, Weber T, Cornely OA, Vehreschild MJGT. Epidemiology of invasive aspergillosis and azole resistance in patients with acute leukaemia: the SEPIA Study. Int J Antimicrob Agents 2016; 49:218-223. [PMID: 27989379 DOI: 10.1016/j.ijantimicag.2016.10.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/25/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
Invasive aspergillosis (IA) is a serious hazard to high-risk haematological patients. There are increasing reports of azole-resistant Aspergillus spp. This study assessed the epidemiology of IA and azole-resistant Aspergillus spp. in patients with acute leukaemia in Germany. A prospective multicentre cohort study was performed in German haematology/oncology centres. The incidence of probable and proven aspergillosis according to the revised EORTC/MSG criteria was assessed for all patients with acute leukaemia [acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL)]. Cases were documented into a web-based case report form, and centres provided data on standards regarding prophylactic and diagnostic measures. Clinical isolates were screened centrally for azole resistance and, if applicable, underlying resistance mechanisms were analysed. Between September 2011 and December 2013, 179 cases of IA [6 proven (3.4%) and 173 probable (96.6%)] were diagnosed in 3067 patients with acute leukaemia. The incidence of IA was 6.4% among 2440 AML patients and 3.8% among 627 ALL patients. Mortality at Day 84 was 33.8% (49/145) and attributable mortality was 26.9% (39/145). At Day 84, 53 patients (29.6%) showed a complete response, 25 (14.0%) a partial response and 17 (9.5%) a deterioration or failure. A total of 77 clinical Aspergillus fumigatus isolates were collected during the study period. Two episodes of azole-resistant IA (1.1%) were caused by a TR/L98H mutation in the cyp51A gene. With only two cases of IA due to azole-resistant A. fumigatus, a change of antifungal treatment practices in Germany does not appear warranted currently.
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Affiliation(s)
- Philipp Koehler
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Axel Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Oliver Bader
- Institut für Medizinische Mikrobiologie-Universitätsmedizin Göttingen, Göttingen, Germany
| | - Isabelle Bekeredjian-Ding
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Dieter Buchheidt
- Department of Haematology and Oncology, Mannheim University Hospital, University of Heidelberg, Mannheim, Germany
| | - Gottfried Doelken
- Friedrich Loeffler Institute for Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Johannes Elias
- Institute of Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Gerhard Haase
- Department of Haematology, Oncology, Haemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Corinna Hahn-Ast
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Meinolf Karthaus
- Medical Clinic IV, Haematology and Oncology, Neuperlach Hospital, Munich, Germany
| | - Alexander Kekulé
- Martin Luther University Halle-Wittenberg, Institute for Medical Microbiology, Halle (Saale), Germany
| | - Peter Keller
- University Hospital of Jena, Institute of Medical Microbiology, Jena, Germany
| | - Michael Kiehl
- Department of Haematology and Oncology, Klinikum Frankfurt Oder, Frankfurt, Germany
| | - Stefan W Krause
- Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Carolin Krämer
- Department of Haematology, Oncology, Haemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Silke Neumann
- Institut für Medizinische Mikrobiologie-Universitätsmedizin Göttingen, Göttingen, Germany
| | - Holger Rohde
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Paul La Rosée
- University Hospital of Jena, Institute of Medical Microbiology, Jena, Germany
| | | | - Philippe Schafhausen
- Department of Internal Medicine II, Hubertus Wald Tumor Center-University Cancer Center Hamburg, Hamburg, Germany
| | - Enrico Schalk
- Department of Haematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Katrin Schulz
- Friedrich Loeffler Institute for Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | | | - Gerda Silling
- Department A of Internal Medicine, University Hospital of Münster, Münster, Germany
| | - Peter Staib
- Klinik für Hämatologie und Onkologie, St Antonius Hospital Eschweiler, Eschweiler, Germany
| | - Andrew Ullmann
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Thomas Weber
- Martin Luther University Halle-Wittenberg, Institute for Medical Microbiology, Halle (Saale), Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany; Clinical Trials Centre Cologne, ZKS Köln, Köln, Germany
| | - Maria J G T Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.
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Ferreri AJM, Cwynarski K, Pulczynski E, Ponzoni M, Deckert M, Politi LS, Torri V, Fox CP, Rosée PL, Schorb E, Ambrosetti A, Roth A, Hemmaway C, Ferrari A, Linton KM, Rudà R, Binder M, Pukrop T, Balzarotti M, Fabbri A, Johnson P, Gørløv JS, Hess G, Panse J, Pisani F, Tucci A, Stilgenbauer S, Hertenstein B, Keller U, Krause SW, Levis A, Schmoll HJ, Cavalli F, Finke J, Reni M, Zucca E, Illerhaus G. Chemoimmunotherapy with methotrexate, cytarabine, thiotepa, and rituximab (MATRix regimen) in patients with primary CNS lymphoma: results of the first randomisation of the International Extranodal Lymphoma Study Group-32 (IELSG32) phase 2 trial. Lancet Haematol 2016; 3:e217-27. [PMID: 27132696 DOI: 10.1016/s2352-3026(16)00036-3] [Citation(s) in RCA: 364] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Standard treatment for patients with primary CNS lymphoma remains to be defined. Active therapies are often associated with increased risk of haematological or neurological toxicity. In this trial, we addressed the tolerability and efficacy of adding rituximab with or without thiotepa to methotrexate-cytarabine combination therapy (the MATRix regimen), followed by a second randomisation comparing consolidation with whole-brain radiotherapy or autologous stem cell transplantation in patients with primary CNS lymphoma. We report the results of the first randomisation in this Article. METHODS For the international randomised phase 2 International Extranodal Lymphoma Study Group-32 (IELSG32) trial, HIV-negative patients (aged 18-70 years) with newly diagnosed primary CNS lymphoma and measurable disease were enrolled from 53 cancer centres in five European countries (Denmark, Germany, Italy, Switzerland, and the UK) and randomly assigned (1:1:1) to receive four courses of methotrexate 3·5 g/m(2) on day 1 plus cytarabine 2 g/m(2) twice daily on days 2 and 3 (group A); or the same combination plus two doses of rituximab 375 mg/m(2) on days -5 and 0 (group B); or the same methotrexate-cytarabine-rituximab combination plus thiotepa 30 mg/m(2) on day 4 (group C), with the three groups repeating treatment every 3 weeks. Patients with responsive or stable disease after the first stage were then randomly allocated between whole-brain radiotherapy and autologous stem cell transplantation. A permuted blocks randomised design (block size four) was used for both randomisations, and a computer-generated randomisation list was used within each stratum to preserve allocation concealment. Randomisation was stratified by IELSG risk score (low vs intermediate vs high). No masking after assignment to intervention was used. The primary endpoint of the first randomisation was the complete remission rate, analysed by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT01011920. FINDINGS Between Feb 19, 2010, and Aug 27, 2014, 227 eligible patients were recruited. 219 of these 227 enrolled patients were assessable. At median follow-up of 30 months (IQR 22-38), patients treated with rituximab and thiotepa had a complete remission rate of 49% (95% CI 38-60), compared with 23% (14-31) of those treated with methotrexate-cytarabine alone (hazard ratio 0·46, 95% CI 0·28-0·74) and 30% (21-42) of those treated with methotrexate-cytarabine plus rituximab (0·61, 0·40-0·94). Grade 4 haematological toxicity was more frequent in patients treated with methotrexate-cytarabine plus rituximab and thiotepa, but infective complications were similar in the three groups. The most common grade 3-4 adverse events in all three groups were neutropenia, thrombocytopenia, anaemia, and febrile neutropenia or infections. 13 (6%) patients died of toxicity. INTERPRETATION With the limitations of a randomised phase 2 study design, the IELSG32 trial provides a high level of evidence supporting the use of MATRix combination as the new standard chemoimmunotherapy for patients aged up to 70 years with newly diagnosed primary CNS lymphoma and as the control group for future randomised trials. FUNDING Associazione Italiana del Farmaco, Cancer Research UK, Oncosuisse, and Swiss National Foundation.
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Affiliation(s)
- Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Kate Cwynarski
- Royal Free Hospital/University College London Hospital, London, UK
| | | | - Maurilio Ponzoni
- Ateneo Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Deckert
- Institute of Neuropathology, University Hospital of Cologne, Cologne, Germany
| | - Letterio S Politi
- Unit of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valter Torri
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | | | | | - Achille Ambrosetti
- Dipartimento di Medicina, Sezione di Ematologia, Università di Verona, Verona, Italy
| | | | | | - Angela Ferrari
- Azienda Ospedaliera Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Kim M Linton
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Roberta Rudà
- AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Mascha Binder
- Uke Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Peter Johnson
- Medical Oncology Unit, Southampton General Hospital, Southampton, UK
| | | | | | - Jens Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Francesco Pisani
- Hematology and Stem Cell Transplantation Unit, Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | | | | | | | | | | | | | | | - Franco Cavalli
- Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
| | | | - Michele Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Zucca
- Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
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Miranda MB, Lauseker M, Kraus MP, Proetel U, Hanfstein B, Fabarius A, Baerlocher GM, Heim D, Hossfeld DK, Kolb HJ, Krause SW, Nerl C, Brümmendorf TH, Verbeek W, Fauser AA, Prümmer O, Neben K, Hess U, Mahlberg R, Plöger C, Flasshove M, Rendenbach B, Hofmann WK, Müller MC, Pfirrmann M, Hochhaus A, Hasford J, Hehlmann R, Saußele S. Secondary malignancies in chronic myeloid leukemia patients after imatinib-based treatment: long-term observation in CML Study IV. Leukemia 2016; 30:1255-62. [PMID: 26859076 PMCID: PMC4895174 DOI: 10.1038/leu.2016.20] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/14/2015] [Accepted: 12/23/2015] [Indexed: 01/20/2023]
Abstract
Treatment of chronic myeloid leukemia (CML) has been profoundly improved by the introduction of tyrosine kinase inhibitors (TKIs). Long-term survival with imatinib is excellent with a 8-year survival rate of ∼88%. Long-term toxicity of TKI treatment, especially carcinogenicity, has become a concern. We analyzed data of the CML study IV for the development of secondary malignancies. In total, 67 secondary malignancies were found in 64 of 1525 CML patients in chronic phase treated with TKI (n=61) and interferon-α only (n=3). The most common malignancies (n⩾4) were prostate, colorectal and lung cancer, non-Hodgkin's lymphoma (NHL), malignant melanoma, non-melanoma skin tumors and breast cancer. The standardized incidence ratio (SIR) for all malignancies excluding non-melanoma skin tumors was 0.88 (95% confidence interval (0.63-1.20)) for men and 1.06 (95% CI 0.69-1.55) for women. SIRs were between 0.49 (95% CI 0.13-1.34) for colorectal cancer in men and 4.29 (95% CI 1.09-11.66) for NHL in women. The SIR for NHL was significantly increased for men and women. An increase in the incidence of secondary malignancies could not be ascertained. The increased SIR for NHL has to be considered and long-term follow-up of CML patients is warranted, as the rate of secondary malignancies may increase over time.
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Affiliation(s)
- M B Miranda
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - M Lauseker
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität, München, Germany
| | - M-P Kraus
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - U Proetel
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - B Hanfstein
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - A Fabarius
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - G M Baerlocher
- Universitätsklinik für Hämatologie und Hämatologisches Zentrallabor, Inselspital, Bern, Switzerland
| | - D Heim
- Klinik für Hämatologie, Universitätsspital, Basel, Switzerland
| | - D K Hossfeld
- II. Medizinische Klinik, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - H-J Kolb
- Medizinische Klinik und Poliklinik III, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - S W Krause
- Medizinische Klinik 5, Universitätsklinikum, Erlangen, Germany
| | - C Nerl
- Klinik für Hämatologie, Onkologie, Immunologie, Palliativmedizin, Infektiologie und Tropenmedizin, Klinikum Schwabing, München, Germany
| | | | - W Verbeek
- Zentrum für ambulante Hämatologie und Onkologie, Bonn, Germany
| | - A A Fauser
- Klinik für Knochenmarktransplantation und Hämatologie/Onkologie, Klinikum, Idar-Oberstein, Germany
| | - O Prümmer
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum, Kempten, Germany
| | - K Neben
- Medizinische Klinik 2, Klinikum Mittelbaden, Standort Balg, Baden-Baden, Germany
| | - U Hess
- Klinik für Onkologie/Hämatologie, Kantonsspital, St Gallen, Switzerland
| | - R Mahlberg
- Innere Medizin 1, Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - C Plöger
- Mannheimer Onkologie Praxis, Mannheim, Germany
| | - M Flasshove
- Medizinische Klinik III, Krankenhaus, Düren, Germany
| | - B Rendenbach
- Praxis für Innere Medizin, Nephrologie, Hämatologie und Onkologie, Trier, Germany
| | - W-K Hofmann
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - M C Müller
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - M Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität, München, Germany
| | - A Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum, Jena, Germany
| | - J Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität, München, Germany
| | - R Hehlmann
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - S Saußele
- III. Medizinische Klinik, Universitätsmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
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Müller-Tidow C, Tschanter P, Röllig C, Thiede C, Koschmieder A, Stelljes M, Koschmieder S, Dugas M, Gerss J, Butterfaß-Bahloul T, Wagner R, Eveslage M, Thiem U, Krause SW, Kaiser U, Kunzmann V, Steffen B, Noppeney R, Herr W, Baldus CD, Schmitz N, Götze K, Reichle A, Kaufmann M, Neubauer A, Schäfer-Eckart K, Hänel M, Peceny R, Frickhofen N, Kiehl M, Giagounidis A, Görner M, Repp R, Link H, Kiani A, Naumann R, Brümmendorf TH, Serve H, Ehninger G, Berdel WE, Krug U. Azacitidine in combination with intensive induction chemotherapy in older patients with acute myeloid leukemia: The AML-AZA trial of the Study Alliance Leukemia. Leukemia 2015; 30:555-61. [PMID: 26522083 DOI: 10.1038/leu.2015.306] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 11/09/2022]
Abstract
DNA methylation changes are a constant feature of acute myeloid leukemia. Hypomethylating drugs such as azacitidine are active in acute myeloid leukemia (AML) as monotherapy. Azacitidine monotherapy is not curative. The AML-AZA trial tested the hypothesis that DNA methyltransferase inhibitors such as azacitidine can improve chemotherapy outcome in AML. This randomized, controlled trial compared the efficacy of azacitidine applied before each cycle of intensive chemotherapy with chemotherapy alone in older patients with untreated AML. Event-free survival (EFS) was the primary end point. In total, 214 patients with a median age of 70 years were randomized to azacitidine/chemotherapy (arm-A) or chemotherapy (arm-B). More arm-A patients (39/105; 37%) than arm-B (25/109; 23%) showed adverse cytogenetics (P=0.057). Adverse events were more frequent in arm-A (15.44) versus 13.52 in arm-B, (P=0.26), but early death rates did not differ significantly (30-day mortality: 6% versus 5%, P=0.76). Median EFS was 6 months in both arms (P=0.96). Median overall survival was 15 months for patients in arm-A compared with 21 months in arm-B (P=0.35). Azacitidine added to standard chemotherapy increases toxicity in older patients with AML, but provides no additional benefit for unselected patients.
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Affiliation(s)
- C Müller-Tidow
- Department of Medicine, Hematology and Oncology, University of Halle, Halle, Germany.,Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany
| | - P Tschanter
- Department of Medicine, Hematology and Oncology, University of Halle, Halle, Germany.,Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany
| | - C Röllig
- Department of Internal Medicine I, Dresden University Medical Center, Dresden, Germany
| | - C Thiede
- Department of Internal Medicine I, Dresden University Medical Center, Dresden, Germany
| | - A Koschmieder
- Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany.,Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, RWTH Aachen University Hospital, Aachen, Germany
| | - M Stelljes
- Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany
| | - S Koschmieder
- Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany.,Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, RWTH Aachen University Hospital, Aachen, Germany
| | - M Dugas
- Institute of Medical Informatics, University Hospital of Muenster, Muenster, Germany
| | - J Gerss
- Institute of Biometry, University Hospital of Muenster, Muenster, Germany
| | | | - R Wagner
- Center for Clinical Trials, University Hospital Muenster, Muenster, Germany
| | - M Eveslage
- Institute of Biometry, University Hospital of Muenster, Muenster, Germany
| | - U Thiem
- Department of Medical Informatics, Biometry and Epidemiology, University Bochum, Bochum, Germany
| | - S W Krause
- Department of Internal Medicine 5, University of Erlangen-Nürnberg Medical Center, Erlangen, Germany
| | - U Kaiser
- Hematology and Oncology, St Bernward Hospital, Hildesheim, Germany
| | - V Kunzmann
- Department of Internal Medicine II, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - B Steffen
- Department of Medicine, Hematology/Oncology, Goethe University of Frankfurt, Frankfurt, Germany
| | - R Noppeney
- Department of Hematology, University of Essen Medical Center, Essen, Germany
| | - W Herr
- Department for Hematology/Oncology, University of Regensburg, Regensburg, Germany
| | - C D Baldus
- Department of Hematology and Oncology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - N Schmitz
- Department of Hematology and Stem Cell Transplantation, ASKLEPIOS Klinik St. Georg, Hamburg, Germany
| | - K Götze
- Department of Internal Medicine III, University Hospital of Munich, Munich, Germany
| | - A Reichle
- Department for Hematology/Oncology, University of Regensburg, Regensburg, Germany
| | - M Kaufmann
- Hematology and Oncology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - A Neubauer
- Department Hematology, Oncology and Immunology, Philipps University Marburg, Marburg, Germany
| | - K Schäfer-Eckart
- Department of Internal Medicine V, Klinikum Nuernberg Nord, Nuernberg, Germany
| | - M Hänel
- Department of Internal Medicine III, Klinikum Chemnitz GmbH, Chemnitz, Germany
| | - R Peceny
- Department of Hematology and Oncology, Klinikum Osnabrück, Osnabrück, Germany
| | - N Frickhofen
- Department of Hematology and Oncology, HSK, Dr -Horst-Schmidt-Klinik, Wiesbaden, Germany
| | - M Kiehl
- Department of Internal Medicine, Frankfurt (Oder) General hospital, Frankfurt/Oder, Germany
| | - A Giagounidis
- Department of Oncology and Hematology, Marien Hospital Düsseldorf, Duesseldorf, Germany
| | - M Görner
- Department of Hematology and Oncology, Städtische Kliniken, Bielefeld, Germany
| | - R Repp
- Department of Medicine V, Klinikum am Bruderwald, Bamberg, Germany
| | - H Link
- Department of Internal Medicine I, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - A Kiani
- Department IV Hematology and Onkology, Klinikum Bayreuth, Bayreuth, Germany
| | - R Naumann
- Department of Internal Medicine, Stiftungsklinikum Mittelrhein, Koblenz, Germany
| | - T H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, RWTH Aachen University Hospital, Aachen, Germany
| | - H Serve
- Department of Medicine, Hematology/Oncology, Goethe University of Frankfurt, Frankfurt, Germany
| | - G Ehninger
- Department of Internal Medicine I, Dresden University Medical Center, Dresden, Germany
| | - W E Berdel
- Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany
| | - U Krug
- Department of Medicine A - Hematology, Oncology and Pneumology, University of Muenster, Muenster, Germany.,Department of Medicine, Hematology and Oncology, Klinikum Leverkusen, Leverkusen, Germany
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Hehlmann R, Kalmanti L, Dietz C, Lauseker M, Haferlach C, Schlegelberger B, Jotterand M, Müller MC, Haenel M, Köhne CH, Goebeler ME, Pfreundschuh M, Balleisen L, Burchert A, Krause SW, Pfirrmann M, Hasford J, Hochhaus A, Saussele S, Fabarius A. Impact of unbalanced karyotypes at diagnosis on prognosis of CML. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.7041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ruediger Hehlmann
- Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Lida Kalmanti
- Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Christian Dietz
- Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Michael Lauseker
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie der Ludwig Maximilians Universität, München, Germany
| | | | - Brigitte Schlegelberger
- Institut für Zell- und Molekularpathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Martin C. Müller
- Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Mathias Haenel
- Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz, Germany
| | - Claus-Henning Köhne
- Klinik für Onkologie und Hämatologie, Klinikum Oldenburg, Oldenburg, Germany
| | | | | | - Leopold Balleisen
- Abteilung für Hämatologie-Onkologie Evangelisches Krankenhaus Hamm, Hamm, Germany
| | - Andreas Burchert
- Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Germany
| | - Stefan W. Krause
- Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie der Ludwig Maximilians Universität, München, Germany
| | - Joerg Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie der Ludwig Maximilians Universität, München, Germany
| | | | - Susanne Saussele
- Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Alice Fabarius
- Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
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40
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Behringer K, Goergen H, Hitz F, Zijlstra JM, Greil R, Markova J, Sasse S, Fuchs M, Topp MS, Soekler M, Mathas S, Meissner J, Wilhelm M, Koch P, Lindemann HW, Schalk E, Semrau R, Kriz J, Vieler T, Bentz M, Lange E, Mahlberg R, Hassler A, Vogelhuber M, Hahn D, Mezger J, Krause SW, Skoetz N, Böll B, von Tresckow B, Diehl V, Hallek M, Borchmann P, Stein H, Eich H, Engert A. Omission of dacarbazine or bleomycin, or both, from the ABVD regimen in treatment of early-stage favourable Hodgkin's lymphoma (GHSG HD13): an open-label, randomised, non-inferiority trial. Lancet 2015; 385:1418-27. [PMID: 25539730 DOI: 10.1016/s0140-6736(14)61469-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The role of bleomycin and dacarbazine in the ABVD regimen (ie, doxorubicin, bleomycin, vinblastine, and dacarbazine) has been questioned, especially for treatment of early-stage favourable Hodgkin's lymphoma, because of the drugs' toxicity. We aimed to investigate whether omission of either bleomycin or dacarbazine, or both, from ABVD reduced the efficacy of this regimen in treatment of Hodgkin's lymphoma. METHODS In this open-label, randomised, multicentre trial (HD13) we compared two cycles of ABVD with two cycles of the reduced-intensity regimen variants ABV (doxorubicin, bleomycin, and vinblastine), AVD (doxorubicin, vinblastine, and dacarbazine), and AV (doxorubicin and vinblastine), in patients with newly diagnosed, histologically proven, classic or nodular, lymphocyte predominant Hodgkin's lymphoma. In each treatment group, 30 Gy involved-field radiotherapy (IFRT) was given after both cycles of chemotherapy were completed. From Jan 28, 2003, patients were centrally randomly assigned (1:1:1:1) with a minimisation method to the four groups. Because of high event rates, assignment to the AV and ABV groups stopped early, on Sept 30, 2005, and Feb 10, 2006; assignment to ABVD and AVD continued (1:1) until Sept 30, 2009. Our primary objective was to show non-inferiority of the experimental variants compared with ABVD in terms of freedom from treatment failure (FFTF), by excluding a difference of 6% after 5 years corresponding to a hazard ratio (HR) of 1.72, via a 95% CI. Analyses reported here include qualified patients only, and between-group comparisons include only patients recruited during the same period. The trial was registered, number ISRCTN63474366. FINDINGS Of 1502 qualified patients, 566, 198, 571, and 167 were randomly assigned to receive ABVD, ABV, AVD, or AV, respectively. 5 year FFTF was 93.1%, 81.4%, 89.2%, and 77.1% with ABVD, ABV, AVD, and AV, respectively. Compared with ABVD, inferiority of the dacarbazine-deleted variants was detected with 5 year differences of -11.5% (95% CI -18.3 to -4.7; HR 2.06 [1.21 to 3.52]) for ABV and -15.2% (-23.0 to -7.4; HR 2.57 [1.51 to 4.40]) for AV. Non-inferiority of AVD compared with ABVD could also not be detected (5 year difference -3.9%, -7.7 to -0·1; HR 1.50, 1.00 to 2.26). 178 (33%) of 544 patients given ABVD had WHO grade III or IV toxicity, compared with 53 (28%) of 187 given ABV, 142 (26%) of 539 given AVD, and 40 (26%) of 151 given AV. Leucopenia was the most common event, and highest in the groups given bleomycin. INTERPRETATION Dacarbazine cannot be omitted from ABVD without a substantial loss of efficacy. With respect to our predefined non-inferiority margin, bleomycin cannot be safely omitted either, and the standard of care for patients with early-stage favourable Hodgkin's lymphoma should remain ABVD followed by IFRT. FUNDING Deutsche Krebshilfe and Swiss State Secretariat for Education and Research.
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Affiliation(s)
- Karolin Behringer
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Helen Goergen
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Felicitas Hitz
- Cantonal Hospital of St Gallen, St Gallen, Switzerland and SAKK Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | | | - Richard Greil
- Third Medical Department, Paracelcus Medical University, Salzburg, Austria
| | - Jana Markova
- University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stephanie Sasse
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Michael Fuchs
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Max S Topp
- University Hospital Würzburg, Würzburg, Germany
| | | | - Stephan Mathas
- Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | | | | | - Peter Koch
- University Hospital Münster, Münster, Germany
| | | | - Enrico Schalk
- Department of Haematology and Oncology, Medical Centre, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Robert Semrau
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - Jan Kriz
- University Hospital Münster, Münster, Germany
| | - Tom Vieler
- Medizinische Klinik, Universitätsklinik Schleswig-Holstein, Kiel, Germany
| | - Martin Bentz
- Medizinische Klinik, Städtisches Klinikum Karlsruhe, Germany
| | - Elisabeth Lange
- Medizinische Klinik, Hämatologie/Onkologie, Evangelisches Krankenhaus, Hamm, Germany
| | - Rolf Mahlberg
- Medizinische Klinik, Krankenanstalt Mutterhaus d. Borromäerinnen, Trier, Germany
| | - Andre Hassler
- Zentrum für Innere Medizin, Hämatologie/Onkologie, Charité Campus Mitte, Berlin, Germany
| | - Martin Vogelhuber
- Medizinische Klinik, Universitätsklinik Regensburg, Regensburg, Germany
| | - Dennis Hahn
- Klinik für Onkologie, Katharinenhospital, Stuttgart, Germany
| | - Jörg Mezger
- Medizinische Klinik-Hämatologie, Onkologie, Immunologie, Palliativmedizin, St. Vincentius-Kliniken gAG, Karlsruhe, Germany
| | - Stefan W Krause
- Department of Internal Medicine 5, Haematology/Oncology, University of Erlangen, Germany
| | - Nicole Skoetz
- Cochrane Haematological Malignancies Group, Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Boris Böll
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Volker Diehl
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Harald Stein
- Berlin Reference Center for Lymphoma and Haematopathology, Berlin, Germany
| | - Hans Eich
- University Hospital Münster, Münster, Germany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany.
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Strech D, Deh U, Schmitz S, Gürkan I, Ostermann H, Krause SW. Workshop - Ökonomische Steuerungsmechanismen: Beispiel Hämatologie und Onkologie. Oncol Res Treat 2015; 38 Suppl 1:3-22. [DOI: 10.1159/000368873] [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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Röllig C, Bornhäuser M, Kramer M, Thiede C, Ho AD, Krämer A, Schäfer-Eckart K, Wandt H, Hänel M, Einsele H, Aulitzky WE, Schmitz N, Berdel WE, Stelljes M, Müller-Tidow C, Krug U, Platzbecker U, Wermke M, Baldus CD, Krause SW, Stölzel F, von Bonin M, Schaich M, Serve H, Schetelig J, Ehninger G. Allogeneic stem-cell transplantation in patients with NPM1-mutated acute myeloid leukemia: results from a prospective donor versus no-donor analysis of patients after upfront HLA typing within the SAL-AML 2003 trial. J Clin Oncol 2014; 33:403-10. [PMID: 25547501 DOI: 10.1200/jco.2013.54.4973] [Citation(s) in RCA: 64] [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: 11/20/2022] Open
Abstract
PURPOSE The presence of a mutated nucleophosmin-1 gene (NPM1(mut)) in acute myeloid leukemia (AML) is associated with a favorable prognosis. To assess the predictive value with regard to allogeneic stem-cell transplantation (SCT), we compared the clinical course of patients with NPM1(mut) AML eligible for allogeneic SCT in a donor versus no-donor analysis. PATIENTS AND METHODS Of 1,179 patients with AML (age 18 to 60 years) treated in the Study Alliance Leukemia AML 2003 trial, we identified all NPM1(mut) patients with an intermediate-risk karyotype. According to the trial protocol, patients were intended to receive an allogeneic SCT if an HLA-identical sibling donor was available. Patients with no available donor received consolidation or autologous SCT. We compared relapse-free survival (RFS) and overall survival (OS) depending on the availability of a suitable donor. RESULTS Of 304 eligible patients, 77 patients had a sibling donor and 227 had no available matched family donor. The 3-year RFS rates in the donor and no-donor groups were 71% and 47%, respectively (P = .005); OS rates were 70% and 60%, respectively (P = .114). In patients with normal karyotype and no FLT3 internal tandem duplication (n = 148), the 3-year RFS rates in the donor and no-donor groups were 83% and 53%, respectively (P = .004); and the 3-year OS rates were 81% and 75%, respectively (P = .300). CONCLUSION Allogeneic SCT led to a significantly prolonged RFS in patients with NPM1(mut) AML. The absence of a statistically significant difference in OS is most likely a result of the fact that NPM1(mut) patients who experienced relapse responded well to salvage treatment. Allogeneic SCT in first remission has potent antileukemic efficacy and is a valuable treatment option in patients with NPM1(mut) AML with a sibling donor.
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Affiliation(s)
- Christoph Röllig
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany.
| | - Martin Bornhäuser
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Michael Kramer
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Christian Thiede
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Anthony D Ho
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Alwin Krämer
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Kerstin Schäfer-Eckart
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Hannes Wandt
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Mathias Hänel
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Hermann Einsele
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Walter E Aulitzky
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Norbert Schmitz
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Wolfgang E Berdel
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Matthias Stelljes
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Carsten Müller-Tidow
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Utz Krug
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Uwe Platzbecker
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Martin Wermke
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Claudia D Baldus
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Stefan W Krause
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Friedrich Stölzel
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Malte von Bonin
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Markus Schaich
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Hubert Serve
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Johannes Schetelig
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Gerhard Ehninger
- Christoph Röllig, Martin Bornhäuser, Michael Kramer, Christian Thiede, Uwe Platzbecker, Martin Wermke, Friedrich Stölzel, Malte von Bonin, Markus Schaich, Johannes Schetelig, and Gerhard Ehninger, Medizinische Klinik und Poliklinik I, Universitätsklinikum der Technischen Universität Dresden; Johannes Schetelig, DKMS, German Bone Marrow Donor Center, Dresden; Anthony D. Ho and Alwin Krämer, Medizinische Universitätsklinik, Abteilung Innere Medizin V, Heidelberg; Kerstin Schäfer-Eckart and Hannes Wandt, 5. Medizinische Klinik, Klinikum Nürnberg, Nürnberg; Mathias Hänel, Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz; Hermann Einsele, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg; Walter E. Aulitzky, Robert-Bosch-Krankenhaus, Stuttgart; Norbert Schmitz, Abteilung für Hämatologie, Onkologie und Stammzelltransplantation, ASKLEPIOS Klinik St Georg, Hamburg; Wolfgang E. Berdel, Matthias Stelljes, and Utz Krug, Medizinische Klinik A, Universitätsklinikum Münster, Münster; Carsten Müller-Tidow, Universitätsklinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle, Halle (Saale); Claudia D. Baldus, Medizinische Klinik III, Charité-Universitätsmedizin Berlin, Charité Centrum 14, Campus Benjamin Franklin, Berlin; Stefan W. Krause, Medizinische Klinik 5, Universitätsklinikum Erlangen, Erlangen; and Hubert Serve, Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt, Germany
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Röllig C, Schäfer-Eckardt K, Hänel M, Kramer M, Schaich M, Thiede C, Oelschlägel U, Mohr B, Wagner T, Einsele H, Krause SW, Bodenstein H, Martin S, Stuhlmann R, Ho AD, Bornhäuser M, Ehninger G, Schuler U, Platzbecker U. Two cycles of risk-adapted consolidation therapy in patients with acute promyelocytic leukemia. Results from the SAL-AIDA2000 trial. Ann Hematol 2014; 94:557-63. [DOI: 10.1007/s00277-014-2242-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 10/16/2014] [Indexed: 12/14/2022]
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Proetel U, Pletsch N, Lauseker M, Müller MC, Hanfstein B, Krause SW, Kalmanti L, Schreiber A, Heim D, Baerlocher GM, Hofmann WK, Lange E, Einsele H, Wernli M, Kremers S, Schlag R, Müller L, Hänel M, Link H, Hertenstein B, Pfirrmann M, Hochhaus A, Hasford J, Hehlmann R, Saußele S. Older patients with chronic myeloid leukemia (≥65 years) profit more from higher imatinib doses than younger patients: a subanalysis of the randomized CML-Study IV. Ann Hematol 2014; 93:1167-76. [PMID: 24658964 PMCID: PMC4050299 DOI: 10.1007/s00277-014-2041-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 11/28/2022]
Abstract
The impact of imatinib dose on response rates and survival in older patients with chronic myeloid leukemia in chronic phase has not been studied well. We analyzed data from the German CML-Study IV, a randomized five-arm treatment optimization study in newly diagnosed BCR-ABL-positive chronic myeloid leukemia in chronic phase. Patients randomized to imatinib 400 mg/day (IM400) or imatinib 800 mg/day (IM800) and stratified according to age (≥65 years vs. <65 years) were compared regarding dose, response, adverse events, rates of progression, and survival. The full 800 mg dose was given after a 6-week run-in period with imatinib 400 mg/day. The dose could then be reduced according to tolerability. A total of 828 patients were randomized to IM400 or IM800. Seven hundred eighty-four patients were evaluable (IM400, 382; IM800, 402). One hundred ten patients (29 %) on IM400 and 83 (21 %) on IM800 were ≥65 years. The median dose per day was lower for patients ≥65 years on IM800, with the highest median dose in the first year (466 mg/day for patients ≥65 years vs. 630 mg/day for patients <65 years). Older patients on IM800 achieved major molecular remission and deep molecular remission as fast as younger patients, in contrast to standard dose imatinib with which older patients achieved remissions much later than younger patients. Grades 3 and 4 adverse events were similar in both age groups. Five-year relative survival for older patients was comparable to that of younger patients. We suggest that the optimal dose for older patients is higher than 400 mg/day. ClinicalTrials.gov identifier: NCT00055874
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Affiliation(s)
- Ulrike Proetel
- III. Medizinische Klinik, Universitätsmedizin Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169 Mannheim, Germany
| | - Nadine Pletsch
- III. Medizinische Klinik, Universitätsmedizin Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169 Mannheim, Germany
| | - Michael Lauseker
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität, München, Germany
| | - Martin C. Müller
- III. Medizinische Klinik, Universitätsmedizin Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169 Mannheim, Germany
| | - Benjamin Hanfstein
- III. Medizinische Klinik, Universitätsmedizin Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169 Mannheim, Germany
| | | | - Lida Kalmanti
- III. Medizinische Klinik, Universitätsmedizin Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169 Mannheim, Germany
| | - Annette Schreiber
- III. Medizinische Klinik, Universitätsmedizin Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169 Mannheim, Germany
| | - Dominik Heim
- Klinik für Hämatologie, Universitätsspital, Basel, Switzerland
| | - Gabriela M. Baerlocher
- Universitätsklinik für Hämatologie und hämatologisches Zentrallabor, Inselspital, Bern, Switzerland
| | - Wolf-Karsten Hofmann
- III. Medizinische Klinik, Universitätsmedizin Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169 Mannheim, Germany
| | - Elisabeth Lange
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Evangelisches Krankenhaus, Hamm, Germany
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Universitätsklinikum, Würzburg, Germany
| | - Martin Wernli
- Onkologie/Hämatologie, Kantonsspital, Aarau, Switzerland
| | | | - Rudolf Schlag
- Hämatologisch-Onkologische Praxis, Würzburg, Germany
| | | | - Mathias Hänel
- Klinik für Innere Medizin III, Klinikum, Chemnitz, Germany
| | - Hartmut Link
- Medizinische Klinik I, Westpfalz-Klinikum, Kaiserslautern, Germany
| | | | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität, München, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum, Jena, Germany
| | - Joerg Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität, München, Germany
| | - Rüdiger Hehlmann
- III. Medizinische Klinik, Universitätsmedizin Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169 Mannheim, Germany
| | - Susanne Saußele
- III. Medizinische Klinik, Universitätsmedizin Mannheim der Universität Heidelberg, Pettenkoferstrasse 22, 68169 Mannheim, Germany
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Tacke D, Buchheidt D, Karthaus M, Krause SW, Maschmeyer G, Neumann S, Ostermann H, Penack O, Rieger C, Ruhnke M, Sandherr M, Schweer KE, Ullmann AJ, Cornely OA. Primary prophylaxis of invasive fungal infections in patients with haematologic malignancies. 2014 update of the recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology. Ann Hematol 2014; 93:1449-56. [PMID: 24951122 DOI: 10.1007/s00277-014-2108-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
Invasive fungal infections cause substantial morbidity and mortality in immunocompromised patients, particularly in those with haematological malignancies and recipients of allogeneic haematopoietic stem cell transplantation. Difficulties in diagnosing invasive fungal infections and subsequent delays in treatment initiation lead to unfavourable outcomes and emphasise the importance of prophylaxis. Since the recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology in 2009, results of 14 additional clinical studies have been published comprising 2,899 patients and initiating this update. Key recommendations for adult patients are as follows: Posaconazole remains the drug of choice during remission-induction chemotherapy in acute myeloid leukaemia, myelodysplastic syndrome and allogeneic haematopoietic stem cell transplantation with graft versus host disease (AI). In the pre-engraftment period of allogeneic transplantation, several antifungals are appropriate and can be recommended with equal strength: voriconazole (BI), micafungin (BI), fluconazole (BI) and posaconazole (BII). There is poor evidence regarding antifungal prophylaxis in the post-engraftment period of allogeneic haematopoietic stem cell transplantation if no steroids for treatment of graft versus host disease are required. Aerosolised liposomal amphotericin B inhalation in conjunction with fluconazole can be used in patients with prolonged neutropenia (BII).
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Affiliation(s)
- Daniela Tacke
- Klinik I für Innere Medizin, Uniklinik Köln, Köln, Germany
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Hehlmann R, Kalmanti L, Dietz C, Lauseker M, Heinrich L, Proetel U, Hochhaus A, Müller MC, Fabarius A, Krause SW, Dengler J, Falge C, Baerlocher GM, Kanz L, Stegelmann F, Pfreundschuh M, Spiekermann K, Pfirrmann M, Saussele S, Hasford J. Efficacy and safety of imatinib in CML over 10 years. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rüdiger Hehlmann
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Lida Kalmanti
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Christian Dietz
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Michael Lauseker
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie der Ludwig Maximilians Universität, München, Germany
| | - Lisa Heinrich
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Ulrike Proetel
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum, Jena, Germany
| | - Martin C. Müller
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Alice Fabarius
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | | | - Jolanta Dengler
- Abteilung Innere Medizin V, Universitätsklinikum, Heidelberg, Germany
| | - Christiane Falge
- Hämatologisch-onkologische Ambulanz, Klinikum Nord, Nürnberg, Germany
| | | | - Lothar Kanz
- Klinik für Innere Medizin II, Universitätsklinikum, Tübingen, Germany
| | - Frank Stegelmann
- Klinik für Innere Medizin III, Universitätsklinikum, Ulm, Germany
| | | | - Karsten Spiekermann
- Medizinischen Klinik III und Poliklinik, Klinikum der Universität, München, Germany
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie der Ludwig Maximilians Universität, München, Germany
| | - Susanne Saussele
- III. Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Joerg Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie der Ludwig Maximilians Universität, München, Germany
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Hanfstein B, Lauseker M, Hehlmann R, Saussele S, Erben P, Dietz C, Fabarius A, Proetel U, Schnittger S, Haferlach C, Krause SW, Schubert J, Einsele H, Hänel M, Dengler J, Falge C, Kanz L, Neubauer A, Kneba M, Stegelmann F, Pfreundschuh M, Waller CF, Spiekermann K, Baerlocher GM, Pfirrmann M, Hasford J, Hofmann WK, Hochhaus A, Müller MC. Distinct characteristics of e13a2 versus e14a2 BCR-ABL1 driven chronic myeloid leukemia under first-line therapy with imatinib. Haematologica 2014; 99:1441-7. [PMID: 24837466 DOI: 10.3324/haematol.2013.096537] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The vast majority of chronic myeloid leukemia patients express a BCR-ABL1 fusion gene mRNA encoding a 210 kDa tyrosine kinase which promotes leukemic transformation. A possible differential impact of the corresponding BCR-ABL1 transcript variants e13a2 ("b2a2") and e14a2 ("b3a2") on disease phenotype and outcome is still a subject of debate. A total of 1105 newly diagnosed imatinib-treated patients were analyzed according to transcript type at diagnosis (e13a2, n=451; e14a2, n=496; e13a2+e14a2, n=158). No differences regarding age, sex, or Euro risk score were observed. A significant difference was found between e13a2 and e14a2 when comparing white blood cells (88 vs. 65 × 10(9)/L, respectively; P<0.001) and platelets (296 vs. 430 × 10(9)/L, respectively; P<0.001) at diagnosis, indicating a distinct disease phenotype. No significant difference was observed regarding other hematologic features, including spleen size and hematologic adverse events, during imatinib-based therapies. Cumulative molecular response was inferior in e13a2 patients (P=0.002 for major molecular response; P<0.001 for MR4). No difference was observed with regard to cytogenetic response and overall survival. In conclusion, e13a2 and e14a2 chronic myeloid leukemia seem to represent distinct biological entities. However, clinical outcome under imatinib treatment was comparable and no risk prediction can be made according to e13a2 versus e14a2 BCR-ABL1 transcript type at diagnosis. (clinicaltrials.gov identifier:00055874).
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Affiliation(s)
- Benjamin Hanfstein
- III. Medizinische Klinik - Hämatologie und Onkologie, Universitätsmedizin Mannheim, Germany
| | - Michael Lauseker
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie der Ludwig-Maximilians-Universität München, Germany
| | - Rüdiger Hehlmann
- III. Medizinische Klinik - Hämatologie und Onkologie, Universitätsmedizin Mannheim, Germany
| | - Susanne Saussele
- III. Medizinische Klinik - Hämatologie und Onkologie, Universitätsmedizin Mannheim, Germany
| | - Philipp Erben
- III. Medizinische Klinik - Hämatologie und Onkologie, Universitätsmedizin Mannheim, Germany
| | - Christian Dietz
- III. Medizinische Klinik - Hämatologie und Onkologie, Universitätsmedizin Mannheim, Germany
| | - Alice Fabarius
- III. Medizinische Klinik - Hämatologie und Onkologie, Universitätsmedizin Mannheim, Germany
| | - Ulrike Proetel
- III. Medizinische Klinik - Hämatologie und Onkologie, Universitätsmedizin Mannheim, Germany
| | | | | | - Stefan W Krause
- Medizinische Klinik 5, Universitätsklinikum Erlangen, Germany
| | - Jörg Schubert
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Evangelisches Krankenhaus Hamm, Germany
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Germany
| | - Mathias Hänel
- Klinik für Innere Medizin III, Klinikum Chemnitz, Germany
| | - Jolanta Dengler
- Medizinische Universitätsklinik, Abteilung Innere Medizin V, Ruprecht-Karls-Universität Heidelberg, Germany
| | | | - Lothar Kanz
- Medizinische Klinik II, Universitätsklinikum Tübingen, Germany
| | - Andreas Neubauer
- Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Marburg, Germany
| | - Michael Kneba
- II. Medizinische Klinik und Poliklinik im Städtischen Krankenhaus, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Frank Stegelmann
- Klinik für Innere Medizin III, Universitätsklinikum Ulm, Germany
| | | | | | - Karsten Spiekermann
- Medizinische Klinik und Poliklinik III, Ludwig-Maximilians-Universität München, Germany
| | | | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie der Ludwig-Maximilians-Universität München, Germany
| | - Joerg Hasford
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie der Ludwig-Maximilians-Universität München, Germany
| | - Wolf-Karsten Hofmann
- III. Medizinische Klinik - Hämatologie und Onkologie, Universitätsmedizin Mannheim, Germany
| | - Andreas Hochhaus
- Abteilung für Hämatologie und Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Germany
| | - Martin C Müller
- III. Medizinische Klinik - Hämatologie und Onkologie, Universitätsmedizin Mannheim, Germany
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Hanfstein B, Shlyakhto V, Lauseker M, Hehlmann R, Saussele S, Dietz C, Erben P, Fabarius A, Proetel U, Schnittger S, Krause SW, Schubert J, Einsele H, Hänel M, Dengler J, Falge C, Kanz L, Neubauer A, Kneba M, Stegelmann F, Pfreundschuh M, Waller CF, Spiekermann K, Baerlocher GM, Pfirrmann M, Hasford J, Hofmann WK, Hochhaus A, Müller MC. Velocity of early BCR-ABL transcript elimination as an optimized predictor of outcome in chronic myeloid leukemia (CML) patients in chronic phase on treatment with imatinib. Leukemia 2014; 28:1988-92. [DOI: 10.1038/leu.2014.153] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 03/30/2014] [Accepted: 04/21/2014] [Indexed: 11/09/2022]
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49
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Hehlmann R, Müller MC, Lauseker M, Hanfstein B, Fabarius A, Schreiber A, Proetel U, Pletsch N, Pfirrmann M, Haferlach C, Schnittger S, Einsele H, Dengler J, Falge C, Kanz L, Neubauer A, Kneba M, Stegelmann F, Pfreundschuh M, Waller CF, Spiekermann K, Baerlocher GM, Ehninger G, Heim D, Heimpel H, Nerl C, Krause SW, Hossfeld DK, Kolb HJ, Hasford J, Saußele S, Hochhaus A. Deep Molecular Response Is Reached by the Majority of Patients Treated With Imatinib, Predicts Survival, and Is Achieved More Quickly by Optimized High-Dose Imatinib: Results From the Randomized CML-Study IV. J Clin Oncol 2014; 32:415-23. [DOI: 10.1200/jco.2013.49.9020] [Citation(s) in RCA: 246] [Impact Index Per Article: 24.6] [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 Deep molecular response (MR4.5) defines a subgroup of patients with chronic myeloid leukemia (CML) who may stay in unmaintained remission after treatment discontinuation. It is unclear how many patients achieve MR4.5 under different treatment modalities and whether MR4.5 predicts survival. Patients and Methods Patients from the randomized CML-Study IV were analyzed for confirmed MR4.5 which was defined as ≥ 4.5 log reduction of BCR-ABL on the international scale (IS) and determined by reverse transcriptase polymerase chain reaction in two consecutive analyses. Landmark analyses were performed to assess the impact of MR4.5 on survival. Results Of 1,551 randomly assigned patients, 1,524 were assessable. After a median observation time of 67.5 months, 5-year overall survival (OS) was 90%, 5-year progression-free-survival was 87.5%, and 8-year OS was 86%. The cumulative incidence of MR4.5 after 9 years was 70% (median, 4.9 years); confirmed MR4.5 was 54%. MR4.5 was reached more quickly with optimized high-dose imatinib than with imatinib 400 mg/day (P = .016). Independent of treatment approach, confirmed MR4.5 at 4 years predicted significantly higher survival probabilities than 0.1% to 1% IS, which corresponds to complete cytogenetic remission (8-year OS, 92% v 83%; P = .047). High-dose imatinib and early major molecular remission predicted MR4.5. No patient with confirmed MR4.5 has experienced progression. Conclusion MR4.5 is a new molecular predictor of long-term outcome, is reached by a majority of patients treated with imatinib, and is achieved more quickly with optimized high-dose imatinib, which may provide an improved therapeutic basis for treatment discontinuation in CML.
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Affiliation(s)
- Rüdiger Hehlmann
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Martin C. Müller
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Michael Lauseker
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Benjamin Hanfstein
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Alice Fabarius
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Annette Schreiber
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Ulrike Proetel
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Nadine Pletsch
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Markus Pfirrmann
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Claudia Haferlach
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Susanne Schnittger
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Hermann Einsele
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Jolanta Dengler
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Christiane Falge
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Lothar Kanz
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Andreas Neubauer
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Michael Kneba
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Frank Stegelmann
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Michael Pfreundschuh
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Cornelius F. Waller
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Karsten Spiekermann
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Gabriela M. Baerlocher
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Gerhard Ehninger
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Dominik Heim
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Hermann Heimpel
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Christoph Nerl
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Stefan W. Krause
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Dieter K. Hossfeld
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Hans-Jochem Kolb
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Joerg Hasford
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Susanne Saußele
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
| | - Andreas Hochhaus
- Rüdiger Hehlmann, Martin C. Müller, Benjamin Hanfstein, Alice Fabarius, Annette Schreiber, Ulrike Proetel, Nadine Pletsch, Susanne Saußele, Universitätsmedizin Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim; Jolanta Dengler Universitätsklinikum Heidelberg, Heidelberg; Michael Lauseker, Markus Pfirrmann, Joerg Hasford, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität; Christoph Nerl, Städtisches Klinikum
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Böll B, Goergen H, Arndt N, Meissner J, Krause SW, Schnell R, von Tresckow B, Eichenauer DA, Sasse S, Fuchs M, Behringer K, Klimm BC, Naumann R, Diehl V, Engert A, Borchmann P. Relapsed hodgkin lymphoma in older patients: a comprehensive analysis from the German hodgkin study group. J Clin Oncol 2013; 31:4431-7. [PMID: 24190119 DOI: 10.1200/jco.2013.49.8246] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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 Progression or relapse of Hodgkin lymphoma (HL) is common among older patients. However, prognosis and effects of second-line treatment are thus far unknown. PATIENTS AND METHODS We investigated second-line treatment and survival in older patients with progressive or relapsed HL. Patients treated within German Hodgkin Study Group first-line studies between 1993 and 2007 were screened for refractory disease or relapse (RR-HL). Patients with RR-HL age ≥ 60 years at first-line treatment were included in this analysis. RESULTS We identified 105 patients (median age, 66 years); 28%, 31%, and 41% had progressive disease, early relapse, or late relapse, respectively. Second-line treatment strategies included intensified salvage regimens (22%), conventional polychemotherapy and/or salvage-radiotherapy with curative intent (42%), and palliative approaches (31%). Median overall survival (OS) for the entire cohort was 12 months; OS at 3 years was 31% (95% CI, 22% to 40%). A prognostic score with risk factors (RFs) of early relapse, clinical stage III/IV, and anemia identified patients with favorable and unfavorable prognosis (≤ one RF: 3-year OS, 59%; 95% CI, 44% to 74%; ≥ two RFs: 3-year OS, 9%; 95% CI, 1% to 18%). In low-risk patients, the impact of therapy on survival was significant in favor of the conventional polychemotherapy/salvage radiotherapy approach. In high-risk patients, OS was low overall and did not differ significantly among treatment strategies. CONCLUSION OS in older patients with RR-HL can be predicted using a simple prognostic score. Poor outcome in high-risk patients cannot be overcome by any of the applied treatment strategies. Our results might help to guide treatment decisions and evaluate new compounds in these patients.
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Affiliation(s)
- Boris Böll
- Boris Böll, Bastian von Tresckow, Dennis A. Eichenauer, Stephanie Sasse, Michael Fuchs, Karolin Behringer, Beate C. Klimm, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Bastian von Tresckow, Dennis A. Eichenauer, Stephanie Sasse, Michael Fuchs, Karolin Behringer, Beate C. Klimm, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Nils Arndt and Ralph Naumann, Stiftungsklinikum Mittelrhein, Koblenz; Julia Meissner, Heidelberg University Hospital, Heidelberg; Stefan W. Krause, Erlangen University Hospital, Erlangen; and Roland Schnell, Pioh Medical Oncology and Hematology, Frechen, Germany
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