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Schmidmaier R, Mörsdorf K, Baumann P, Emmerich B, Meinhardt G. Evidence for Cell Adhesion-Mediated Drug Resistance of Multiple Myeloma Cells in Vivo. Int J Biol Markers 2018; 21:218-22. [PMID: 17177159 DOI: 10.1177/172460080602100404] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background/Aims Multiple myeloma is an incurable disease and patients eventually die of disease progression due to drug resistance. VLA-4 (very late antigen 4), VCAM (vascular adhesion molecule), LFA-1 (leukocyte function-associated antigen 1), and ICAM-1 (intercellular adhesion molecule 1)-mediated adhesion of myeloma cells to bone marrow stromal cells induces primary multidrug resistance in vitro. Based on these preclinical data we hypothesized that myeloma cells with strong adhesion - due to strong expression of adhesion molecules on the cell surface - are selected by chemotherapy in patients. To prove this hypothesis we determined the expression levels of adhesion molecules in 31 multiple myeloma patients by flow cytometry. Methods A 3-color stain with CD38, CD138 and antibodies against VLA-4, ICAM-1, LFA-1, and VCAM was performed. The patients were either at diagnosis (chemo-naive; n=17) or at relapse (pre-treated; n=15). Furthermore, the response to the next chemotherapy of chemo-naive patients was correlated with the expression levels of adhesion molecules. Results ICAM-1, VLA-4, and VCAM expression was higher in pre-treated patients than in chemo-naive patients and the expression levels increased with the number of chemotherapy regimens. Primarily multidrug-resistant patients had significantly higher expression levels of VLA-4 and ICAM-1 than responders. Conclusion This study suggests that multiple myeloma cells expressing high levels of VLA-4 and ICAM-1 are drug resistant and that such a subpopulation of cells is selected by chemotherapy.
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Affiliation(s)
- R Schmidmaier
- Department of Hematology and Oncology, Medizinische Klinik Innenstadt, Klinikum der Universität München, München, Germany.
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2
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Dimopoulou C, Ormanns S, Eigenbrod S, Müller-Lisse U, Emmerich B, Reincke M. Extramedullary multiple myeloma presenting as a pituitary mass lesion. Exp Clin Endocrinol Diabetes 2012; 120:501-4. [PMID: 22851185 DOI: 10.1055/s-0032-1321810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION A plasmocytoma involving the pituitary gland is an extremely rare entity, with approximately 22 cases of solitary myeloma or multiple myeloma presenting with sellar mass reported in the literature so far. CASE REPORT Here, we report the case of a 71-year-old female patient affected by an extramedullary IgG-lambda multiple myeloma presenting as a pituitary mass lesion. We summarize the diagnostic approaches that confirmed the diagnosis of multiple myeloma and describe treatment outcome after therapy. DISCUSSION Intrasellar plasmocytoma though rare, should be considered in the differential diagnosis of a pituitary mass lesion, since associated with different therapeutic and prognostic implications. Physicians should be alert for intrasellar plasma cell tumors in case of well preserved anterior pituitary function in combination with cranial nerve neuropathies and sellar destruction.
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Affiliation(s)
- C Dimopoulou
- Medizinische Klinik Campus Innenstadt, Klinikum der LMU, Munich, Germany.
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3
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Hrusovsky I, Emmerich B, von Rohr A, Voegeli J, Taverna C, Olie RA, Pliskat H, Frohn C, Hess G. Bortezomib retreatment in relapsed multiple myeloma - results from a retrospective multicentre survey in Germany and Switzerland. Oncology 2011; 79:247-54. [PMID: 21372599 DOI: 10.1159/000322866] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 10/08/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This multicenter, retrospective survey evaluated the efficacy and safety of bortezomib retreatment in patients with relapsed multiple myeloma who had responded to initial bortezomib treatment. METHODS Clinical records of 94 patients receiving bortezomib retreatment in Germany and Switzerland were reviewed. RESULTS Sixty patients were included according to prespecified criteria. Patients had received a mean 3.7 ± 2.3 therapies prior to initial bortezomib. Overall response rate to bortezomib retreatment was 63.3%; 8 (13.3%), 3 (5.0%) and 27 (45.0%) patients achieved complete response (CR), near-CR and partial response, respectively. Response to retreatment was associated with response to initial treatment (75.0% of patients with CR to initial treatment responded to retreatment) and treatment-free interval (TFI) after initial treatment (76.9 vs. 38.1% overall response rate for patients with TFI >6 vs. ≤ 6 months). After retreatment, median time to progression was 9.3 months. Median TFI was 5.7 months; 31.7, 25.0 and 15.0% of patients experienced a TFI longer than 6, 9 and 12 months, respectively. Reported adverse drug reactions were consistent with the known safety profile of bortezomib and most resolved completely. CONCLUSIONS These results demonstrate that relapsed multiple myeloma patients who respond to initial bortezomib treatment have a sustained susceptibility to bortezomib and do not experience uncommon toxicity to retreatment.
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Affiliation(s)
- I Hrusovsky
- Diakonie-Krankenhaus, Schwäbisch Hall, Germany.
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4
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Knauf W, Langenmayer L, Nerl C, Dietzfelbinger H, Maubach P, Ziegler-Heitbrock H, Emmerich B, Thiel E. lnterferon-alpha2b for Early Phase Chronic Lymphocytic Leukemia with High Risk for Progression – First Results of a Randomized Multicenter AlO-Study. Oncol Res Treat 2009. [DOI: 10.1159/000217333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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5
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Schmidmaier R, Oversohl N, Schnabel B, Straka C, Emmerich B. Helper T cells (CD3 + /CD4 + ) within the autologous peripheral blood stem cell graft positively correlate with event free survival of multiple myeloma patients. Exp Oncol 2008; 30:240-243. [PMID: 18806749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The microenvironment in the bone marrow - including lymphocytes - is part of the pathophysiology of multiple myeloma (MM). High dose chemotherapy followed by autologous stem cell transplantation is standard of care for younger patients. AIM To determine the influence of reinfused lymphocyte subsets on event free survival (EFS) and overall survival (OS). METHODS In peripheral blood (PB) and aphaeresis products (AP) of 41 MM patients lymphocyte subsets were determined by flow cytometry and were correlated with clinical outcome. RESULTS PB lymphocyte subsets did not influence EFS or OS. Residual plasma cells in the AP were not correlated with poor outcome, whereas a high percentage of B cells (CD19+) showed a trend towards reduced EFS (P = 0.051). A high amount of CD4 cells and an increased CD4/CD8 ratio were significantly associated with prolonged EFS. In contrast, high percentage of HLA-DR positive lymphocytes showed negative impact on EFS and OS (P = 0.03 and 0.02, respectively). CONCLUSION Obtained data suggest the non-activated (HLA-DR negative) helper CD4+ T cells in the AP to be tumour protective.
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Affiliation(s)
- R Schmidmaier
- Department of Hematology and Oncology, Medizinische Klinik Innenstadt, Klinikum der Universitat Munchen, Munich, Germany.
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6
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Bauer C, Dauer M, Schnurr M, Jauch K, Ruettinger D, Conrad C, Bruns C, Emmerich B, Endres S, Eigler A. Vaccination therapy of pancreatic carcinoma patients with autologous, tumor-lysate pulsed dendritic cells: Results of a phase II study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.3069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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7
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Bauer C, Dauer M, Saraj S, Schnurr M, Jauch K, Rüttinger D, Bruns C, Emmerich B, Endres S, Eigler A. Immunological and clinical response after vaccination therapy of pancreatic carcinoma patients with autologous, tumor-lysate pulsed dendritic cells: Results of a phase II-study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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
4579 Background: Multiple studies in the experimental and in the clinical setting have shown that vaccine therapy using dendritic cells can induce antitumor immunity. Here, we report about the results of a phase II-study using autologous, tumor-lysate pulsed dendritic cells for the treatment of patients with advanced pancreatic carcinoma. Methods: Pancreatic carcinoma patients receiving abdominal surgery were included into to the study protocol. Tumor-lysate was derived by freeze-taw-cycles from surgically derived tissue specimens. Patients were eligible for DC vaccination after recurrence of pancreatic carcinoma or in a primarily palliative situation. DC were derived from PBMC according to a six-day protocol, loaded with tumor lysate and stimulated with TNF-a and PgE2. DC were applicated intracutaneously into the groin region every other week for three cycles, then monthly. All patients received standard chemotherapy with gemcitabine concomitantly. Immune response was controlled by DTH skin testing. Samples of non adherent cells were frozen for MLR and ELISPOT assays to monitor immune response ex vivo. Main study end point was partial or complete remission. Results: Ten patients have received dendritic cell vaccination so far. Of these, one patient developed a partial remission after a four-months course of vaccination therapy. Another patient showed stable disease after having received five vaccinations. Both patients showed immunological response. The patient with stable disease had a mean of 56 IFN-γ positive spots per 50E3 DC-stimulated non adherent cells prior to vaccination. After vaccination, this number increased to 191 spots per 50E3 cells (negative control: 5; positive control: 315). Both patients are alive 13 and 7 months after the start of vaccination therapy, respectively. Conclusions: Vaccination therapy with dendritic cells can be of clinical benefit in the setting of advanced pancreatic carcinoma. Clinical responses were associated with the induction of a stable immunological response. No significant financial relationships to disclose.
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Affiliation(s)
- C. Bauer
- Medizinische Klinik Innenstadt, Muenchen, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Muenchen, Germany
| | - M. Dauer
- Medizinische Klinik Innenstadt, Muenchen, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Muenchen, Germany
| | - S. Saraj
- Medizinische Klinik Innenstadt, Muenchen, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Muenchen, Germany
| | - M. Schnurr
- Medizinische Klinik Innenstadt, Muenchen, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Muenchen, Germany
| | - K. Jauch
- Medizinische Klinik Innenstadt, Muenchen, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Muenchen, Germany
| | - D. Rüttinger
- Medizinische Klinik Innenstadt, Muenchen, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Muenchen, Germany
| | - C. Bruns
- Medizinische Klinik Innenstadt, Muenchen, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Muenchen, Germany
| | - B. Emmerich
- Medizinische Klinik Innenstadt, Muenchen, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Muenchen, Germany
| | - S. Endres
- Medizinische Klinik Innenstadt, Muenchen, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Muenchen, Germany
| | - A. Eigler
- Medizinische Klinik Innenstadt, Muenchen, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Muenchen, Germany
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8
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Schwemmlein M, Stieglmaier J, Kellner C, Peipp M, Saul D, Oduncu F, Emmerich B, Stockmeyer B, Lang P, Beck JD, Fey GH. A CD19-specific single-chain immunotoxin mediates potent apoptosis of B-lineage leukemic cells. Leukemia 2007; 21:1405-12. [PMID: 17495978 DOI: 10.1038/sj.leu.2404687] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CD19 is a B-lineage-specific transmembrane signaling protein participating in the control of proliferation and differentiation. It is present at high surface density on chronic B-lymphocytic leukemia (B-CLL) cells and cells of other B-cell malignancies, and is a prime target for therapy with antibody-derived agents. Many attempts have been made to target malignant cells via CD19, but to date none of these agents have received drug approval. Here we report the design of a monovalent immunotoxin consisting of a CD19-specific single-chain Fv antibody fragment fused to a derivative of Pseudomonas Exotoxin A. This fusion protein induced efficient antigen-restricted apoptosis of several human leukemia- and lymphoma-derived cell lines including Nalm-6, which it eliminated at an effective concentration (EC(50)) of 2.5 nM. The agent displayed synergistic toxicity when used in combination with valproic acid and cyclosporin A in cell-culture assays. It induced apoptosis of primary malignant cells in 12/12 samples from B-CLL patients, including patients responding poorly to fludarabine, and of cells from one pediatric acute lymphoblastic leukemia patient. In NOD/SCID mice transplanted with Nalm-6 cells, the toxin prevented engraftment and significantly prolonged survival of treated mice. Owing to its efficient antigen-restricted antileukemic activity, the agent deserves further development towards clinical testing.
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Affiliation(s)
- M Schwemmlein
- Genetics, University of Erlangen-Nuremberg, Erwin-Rommel-Strasse 3, Erlangen, Germany
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9
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Bauer C, Dauer M, Schnurr M, Junkmann J, Bauernfeind F, Conrad C, Bruns C, Jauch K, Emmerich B, Endres S, Eigler A. Preliminary results of a phase II-study: Vaccination therapy of pancreatic carcinoma patients with autologous, tumor lysate pulsed dendritic cells. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14102] [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
14102 Background: Vaccination trials in the experimental and in the clinical setting have shown that it is possible to use dendritic cells (DC) to induce a specific antitumoral immune response. In this study, a protocol for the treatment of patients with metastasised pancreatic carcinoma with autologous, tumor-lysate pulsed dendritic cells was established. Methods: Patients with strong suspicion of pancreatic carcinoma receiving abdominal surgery are recruited to the study. Tumor-lysate is derived by freeze-taw-cycles from surgically derived tissue specimens. After recurrence of histologically verified pancreatic carcinoma or in a primarily palliative situation, patients are eligible for DC vaccination. DC are derived from PBMC according to a six-day protocol, loaded with tumor lysate and stimulated with TNF-alpha and PgE2. DC are applicated intracutaneously into the groin region three times in twice weekly cycles, then in monthly cycles. Immune response is controlled by DTH skin testing. Samples of non adherent cells are frozen for future MLR and ELISPOT assays. Main study end point is partial or complete remission four months after the start of vaccination. Alternative end points are adverse effects, quality of life, one-year survival and immuno-monitoring. Results: Tumor material of 49 patients has been worked up to tumor lysate and stored for future vaccinations. Four patients have received dendritic cell vaccination. Two of these patients have received their four months staging CT. In one case local disease was stable. The other patient showed progressive disease. A more pronounced proliferation of specific T cells compared to the control setting could be demonstrated by MLR assay. Discussion: A protocol for vaccination with tumor lysate pulsed dendritic cells of patients with pancreatic carcinoma has been established. Four patients have been vaccinated with dendritic cells according to a phase II study protocol. Vaccination was tolerated well. Because of a severe adverse reaction after the beginning of gemcitabine therapy, vaccination had to be omitted intercurrently with this patient. Results of most immuno monitoring assays are pending. One patient receiving DC vaccination therapy showed stable local disease. No significant financial relationships to disclose.
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Affiliation(s)
- C. Bauer
- Medizinische Klinik Innenstadt, Munich, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Munich, Germany
| | - M. Dauer
- Medizinische Klinik Innenstadt, Munich, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Munich, Germany
| | - M. Schnurr
- Medizinische Klinik Innenstadt, Munich, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Munich, Germany
| | - J. Junkmann
- Medizinische Klinik Innenstadt, Munich, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Munich, Germany
| | - F. Bauernfeind
- Medizinische Klinik Innenstadt, Munich, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Munich, Germany
| | - C. Conrad
- Medizinische Klinik Innenstadt, Munich, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Munich, Germany
| | - C. Bruns
- Medizinische Klinik Innenstadt, Munich, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Munich, Germany
| | - K. Jauch
- Medizinische Klinik Innenstadt, Munich, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Munich, Germany
| | - B. Emmerich
- Medizinische Klinik Innenstadt, Munich, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Munich, Germany
| | - S. Endres
- Medizinische Klinik Innenstadt, Munich, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Munich, Germany
| | - A. Eigler
- Medizinische Klinik Innenstadt, Munich, Germany; Chirurgische Klinik und Poliklinik Groβhadern, Munich, Germany
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10
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Frick E, Tyroller M, Fischer N, Busch R, Emmerich B, Bumeder I. When is the best time for psychotherapeutic intervention following autologous peripheral blood stem cell transplantation? ACTA ACUST UNITED AC 2006. [DOI: 10.1007/s10332-006-0120-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Schnabel B, Schmidmaier R, Franke D, Emmerich B, Straka C. Correlation of residual leukocyte subsets with neutropenic fever during severe leukopenia after high-dose chemotherapy and autologous stem cell transplantation. Cytotherapy 2006; 8:473-9. [PMID: 17050252 DOI: 10.1080/14653240600941531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND High-dose chemotherapy with autologous stem cell transplantation is the standard treatment of eligible patients with multiple myeloma. However, this treatment is associated with a substantial risk of infectious complications during leukopenia. The aim of our pilot study was to determine the residual leukocyte subsets during severe cytopenia after high-dose melphalan and to correlate this with the occurrence of neutropenic fever. METHODS Residual leukocyte subsets in the peripheral blood on days 4-7 following autologous stem cell transplantation were analyzed by three-color flow cytometry in 20 patients with multiple myeloma. In addition, we determined the number of T cells that were transfused with the autografts. RESULTS Absolute numbers of lymphocytes (mean 25/microL) and monocytes (mean 4/microL) were strongly reduced but rather constant during the period of severe neutropenia. Neutrophil engraftment and duration of neutropenia were very similar in patients with and without neutropenic fever. Low absolute lymphocyte counts and absolute CD4+ T-cell counts on days 4-7 after stem cell transplantation correlated with neutropenic fever. Furthermore, T-cell numbers in the autologous stem cell grafts that the patients received were significantly lower in patients with neutropenic fever. DISCUSSION These observations suggest that the number of T cells, and in particular CD4+ T cells, in the blood during severe cytopenia is playing a role in defense of infection. T-cell numbers in the graft could provide a predictive factor for the risk of infection in the post-transplant period. However, this needs to be confirmed in a larger study.
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Affiliation(s)
- B Schnabel
- Medizinische Klinik Innenstadt, Klinikum der Universität München, München, Germany
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12
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Abstract
Diagnosis and treatment of chronic lymphatic leukaemia (CLL) are currently undergoing great change. New knowledge of prognosis factors and the numerous new therapeutic procedures now available, such as purine analogues, high-dose treatment and monoclonal antibodies are making major contributions to this progress. As a consequence, the options for treatment of CLL are considerably more diverse now than a few years ago, and now include procedures that take into account age and risk. At the same time, it should be emphasized that many important questions regarding the treatment of CLL remain unresolved. It is anticipated that these questions will be answered over the coming few years by including patients in multicentre studies like those being carried out by the German CLL study group.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Disease Progression
- Dose-Response Relationship, Drug
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Multicenter Studies as Topic
- Neoplasm Staging
- Prognosis
- Randomized Controlled Trials as Topic
- Stem Cell Transplantation
- Survival Rate
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Affiliation(s)
- M Hallek
- Klinik I für Innere Medizin, Universität Köln, Germany.
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13
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Wendtner CM, Ritgen M, Schweighofer CD, Fingerle-Rowson G, Campe H, Jäger G, Eichhorst B, Busch R, Diem H, Engert A, Stilgenbauer S, Döhner H, Kneba M, Emmerich B, Hallek M. Consolidation with alemtuzumab in patients with chronic lymphocytic leukemia (CLL) in first remission--experience on safety and efficacy within a randomized multicenter phase III trial of the German CLL Study Group (GCLLSG). Leukemia 2004; 18:1093-101. [PMID: 15071604 DOI: 10.1038/sj.leu.2403354] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patients with CLL responding to initial chemotherapy with fludarabine alone (F) or in combination with cyclophosphamide (FC) were randomized for treatment with alemtuzumab (30 mg i.v. TIW, 12 weeks) or observation. Of 21 evaluable patients, 11 were randomized to alemtuzumab before the study was stopped due to severe infections in seven of 11 patients. These infections (one life-threatening pulmonary aspergillosis IV; four CMV reactivations III requiring i.v. ganciclovir; one pulmonary tuberculosis III; one herpes zoster III) were successfully treated and not associated with cumulative dose of alemtuzumab. In the observation arm, one herpes zoster infection II and one sinusitis I were documented. At 6 months after randomization, two patients in the alemtuzumab arm converted to CR, while three patients in the observation arm progressed. After alemtuzumab treatment, five of six patients achieved a molecular remission in peripheral blood while all patients in the observation arm remained MRD-positive (P=0.048). At 21.4 months median follow-up, patients receiving alemtuzumab showed a significant longer progression-free survival (no progression vs mean 24.7 months; P=0.036). In conclusion, a consolidation therapy with alemtuzumab is able to achieve molecular remissions and longer survival in CLL, but a safe treatment regimen needs to be determined.
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MESH Headings
- Adult
- Aged
- Alemtuzumab
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/administration & dosage
- Antibodies, Neoplasm/adverse effects
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Disease-Free Survival
- Female
- Germany
- Humans
- Infections/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Male
- Middle Aged
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/mortality
- Neutropenia/chemically induced
- Remission Induction
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Affiliation(s)
- C-M Wendtner
- Klinikum Grosshadern, Medical Clinic III, Ludwig-Maximilians-University, Munich, Germany
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14
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Straka C, Hebart H, Adler-Reichel S, Werding N, Emmerich B, Einsele H. Blood Stem Cell Collections after Mobilization with Combination Chemotherapy Containing Ifosfamide Followed by G-CSF in Multiple Myeloma. Oncology 2003; 65 Suppl 2:94-8. [PMID: 14586157 DOI: 10.1159/000073368] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
High-dose chemotherapy with autologous peripheral blood stem cell transplantation is the standard treatment of patients with multiple myeloma today. In this study we used a combination mobilizing chemotherapy containing ifosfamide with G-CSF before stem cell collection. The chemotherapy regimen consisted of ifosfamide (2,500 mg/m(2) days 1-3), epirubicin (100 mg/m(2) day 1) and etoposide (150 mg/m(2) days 1-3) followed by G-CSF (5 mug/kg from day 5). In 30 younger patients (median age 51 years; range 41-60 years) who received the IEV regimen in 100% dosage, a median of 11.15 x 10(6) CD34(+) cells/kg (range 0-44.60 x 10(6) CD34(+) cells/kg) was collected. In 22 elder patients (median age 64 years; range 59-72 years) similar collection results were obtained with a median of 10.82 x 10(6) CD34(+) cells/kg (range 0.99-42.22 x 10(6) CD34(+) cells/kg) after the IEV regimen in 75% dosage. The pretreatment chemotherapy cycles before mobilization were fewer in elder patients with a median of 0 cycles (range 0-7 cycles) compared with younger patients with a median of 4 cycles (range 0-7 cycles). These collection results were favorable and allowed to support a tandem transplantation procedure in younger and elder patients in 97 and 95%, respectively. In the majority of patients, the hematological toxicity of IEV was of WHO grade 3/4. The extramedullary toxicity was mild to moderate and there were only few cases (5-10%) of relevant nephrotoxicity or neurotoxicity associated with the application of ifosfamide.
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Affiliation(s)
- C Straka
- Medizinische Klinik-Innenstadt, Klinikum der Universität München, München, Germany.
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15
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Hallek M, Bergmann M, Goede V, Fingerle-Rowson G, Schweighofer C, Schmitt B, Wendtner CM, Emmerich B. [Current concepts in chronic lymphocytic leukemia. Better chances for young patients]. MMW Fortschr Med 2003; 145:46-9. [PMID: 14587189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
MESH Headings
- Age Factors
- Aged
- Alemtuzumab
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Monoclonal, Murine-Derived
- Antibodies, Neoplasm/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols
- Bendamustine Hydrochloride
- Chlorambucil/administration & dosage
- Chlorambucil/therapeutic use
- Combined Modality Therapy
- Enzyme Inhibitors/administration & dosage
- Enzyme Inhibitors/therapeutic use
- Humans
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/radiotherapy
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Middle Aged
- Nitrogen Mustard Compounds/administration & dosage
- Nitrogen Mustard Compounds/therapeutic use
- Radiotherapy Dosage
- Randomized Controlled Trials as Topic
- Risk Factors
- Rituximab
- Time Factors
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- M Hallek
- Medizinische Klinik III, Klinikum, Universität München-Grosshadern.
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16
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Tschöp K, Rommel F, Schmidkonz P, Emmerich B, Schulze J. [Neuropathy after cyclophosphamide high dose chemotherapy in a Morbus Werlhof patient]. Dtsch Med Wochenschr 2003; 126:T17-T20. [PMID: 12751019 DOI: 10.1055/s-2001-12093] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Neuropathy after cyclophosphamide high dose chemotherapy in a Morbus Werlhof patient. PERSONAL HISTORY: A 24 year old patient with longstanding autoimmune idiopathic thrombocytopenic purpura (M. Werlhof) was treated with glucocorticoids, immunoglobulins, splenectomy, immunosuppression and vincristin without lasting success. After a second treatment cycle with cyclosphosphamide and autologous peripheral stem cell transplantation she acutely develpod symptoms of a peripheral sensoric and motoric polyneuro-pathy. MEDICAL EXAMINATION: At admission she was in good general health, but had steroid-induced Cushing's symptoms, generalized petechial bleeding and thrombocytopenia (1000/ micro l). THERAPY AND COURSE: After 2.5 g/m 2 cyclophosphamide and stem cell transplantation distally pronounced polyneuropathy developed within a week with bladder insufficiency. Major bleeding or brain damage were excluded, and symptoms only partially reversed when treated with steroids, carbamazepine and amitriptyline. Thrombocytopenia persisted, and the patient died 4 month later from acute brain hemorrhage. CONCLUSIONS: Direct neurotoxicity has to be assumed as the likely causative agent in this case, illustrating the possibility of peripheral neuropathic lesions by high dose cyclophosphamide treatment.
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Affiliation(s)
- K Tschöp
- Abteilung für Klinische Pharmakologie der
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17
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Oduncu FS, Kimmig R, Hepp H, Emmerich B. Cancer in pregnancy: maternal-fetal conflict. J Cancer Res Clin Oncol 2003; 129:133-46. [PMID: 12684890 DOI: 10.1007/s00432-002-0406-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2002] [Accepted: 11/19/2002] [Indexed: 11/24/2022]
Abstract
The occurrence of malignancies during pregnancy has increased over the last decades. They complicate approximately 1 per 1000 pregnancies. The most common malignancies associated with pregnancy include malignant melanoma, malignant lymphomas and leukemia, and cancer of the cervix, breast, ovary, colon and thyroid. Since it is impossible for prospective randomized clinical trials to be conducted in this field, relevant data have been generated from case reports and matched historical cohort studies in order to evaluate the treatment outcomes and the issues complicating the management of malignancy in the pregnant patient. There is almost always a conflict between optimal maternal therapy and fetal well-being. The maternal interest is for an immediate treatment of the recently diagnosed tumor. However, the optimal therapy, be it chemotherapy, radiotherapy or surgery, may impose great risks on the fetus. Consequently, either maternal or fetal health, or both, will be compromised. Therefore, both the pregnant patient and her physician are often in a dilemma as to the optimal course. On the basis of the medical facts, we discuss the issues raising potential ethical conflicts and present a practical ethical approach which may help to increase clarity in maternal-fetal conflicts. We review the available data informing the incidence and impact of the most common malignancies during pregnancy and their treatment on both the pregnant woman and her fetus. The optimal therapy for the tragic diagnosis of cancer in pregnancy requires a collaborative and interdisciplinary approach between gynecologists, oncologists, obstetricians, surgeons, neonatologists, psychologists, nursing staff and other disciplines. The purpose of this article is not to answer specific questions or to construct management schemes for specific tumors but to provide a framework for approaching some of these complex issues.
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19
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Abstract
A 30-year-old man with underlying Wiskott-Aldrich syndrome, which is a rare X-linked congenital immunodeficiency syndrome characterized by recurrent infections, thrombopenia, eczema and hematopoietic malignancies, presented with bloody diarrhea. Endoscopic and histological evaluation was compatible with ulcerative colitis. Congenital immune defects are paralleled by enterocolitis mimicking inflammatory bowel disease in a substantial number of patients. Despite therapy with prednisolone and 5-ASA compounds, the patient described here experienced a relapse of the colitis twice. Subsequently a JC virus infection of the central nervous system was diagnosed, and he died due to progressive multifocal leukencephalopathy.
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Affiliation(s)
- C Folwaczny
- Medizinische Klinik, Ludwig-Maximilians-Universität, Munich, Germany.
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20
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Hallek M, Bergmann M, Brittinger G, Döhner H, Dreger P, Herold M, Hopfinger G, Jäger U, Knauf W, Nerl C, Rummel M, Schmitt B, Wendtner CM, Emmerich B. [Chronic lymphatic leukemia. Current therapy concepts]. Internist (Berl) 2002; 43:1245-54. [PMID: 12524905 DOI: 10.1007/s00108-002-0707-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
MESH Headings
- Antibodies, Monoclonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Clinical Trials as Topic
- Dose-Response Relationship, Drug
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/classification
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Stem Cell Transplantation
- Treatment Outcome
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Affiliation(s)
- M Hallek
- Medizinische Klinik III, Klinikum der Universität Grosshadern, Marchioninistrasse 15, 81377 München.
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21
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Schmid-Wendtner MH, Lebeau A, Sander CA, Volkenandt M, Emmerich B, Wendtner CM. Lymphadenopathy detected by ultrasound examination as first diagnostic hint of chronic lymphocytic leukaemia in a patient with melanoma. J Eur Acad Dermatol Venereol 2002; 16:491-3. [PMID: 12428845 DOI: 10.1046/j.1468-3083.2002.00554.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recent reports indicate that patients with malignant melanoma might be at higher risk for developing a non-cutaneous unrelated second malignancy. We describe the case of a 46-year-old woman who had a malignant melanoma on her right shoulder that was treated in 1998 by surgical excision combined with axillary lymph node dissection. In 1999, ultrasound examination of peripheral lymph nodes revealed one suspicious echopoor structure in the woman's right axilla that was not palpable. Diagnostic excision and histopathological examination revealed a small B-cell lymphocytic lymphoma, and further investigations led to a diagnosis of chronic lymphocytic B-cell leukaemia (B-CLL). We would like to point out the value of high-resolution ultrasound examination in the follow-up of patients with malignant melanoma; this examination can detect early metastasis as well as other unrelated malignancies.
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Affiliation(s)
- M H Schmid-Wendtner
- Department of Dermatology, Klinikum Innenstadt, Ludwig-Maximilians-University, Munich, Germany.
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22
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Jahrsdörfer B, Jox R, Mühlenhoff L, Tschoep K, Krug A, Rothenfusser S, Meinhardt G, Emmerich B, Endres S, Hartmann G. Modulation of malignant B cell activation and apoptosis by bcl‐2 antisense ODN and immunostimulatory CpG ODN. J Leukoc Biol 2002. [DOI: 10.1189/jlb.72.1.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- B. Jahrsdörfer
- Division of Clinical Pharmacology and Oncology, Department of Internal Medicine, University of Munich, Germany
| | - R. Jox
- Division of Clinical Pharmacology and Oncology, Department of Internal Medicine, University of Munich, Germany
| | - L. Mühlenhoff
- Division of Clinical Pharmacology and Oncology, Department of Internal Medicine, University of Munich, Germany
| | - K. Tschoep
- Division of Clinical Pharmacology and Oncology, Department of Internal Medicine, University of Munich, Germany
| | - A. Krug
- Division of Clinical Pharmacology and Oncology, Department of Internal Medicine, University of Munich, Germany
| | - S. Rothenfusser
- Division of Clinical Pharmacology and Oncology, Department of Internal Medicine, University of Munich, Germany
| | - G. Meinhardt
- Division of Hematology and Oncology, Department of Internal Medicine, University of Munich, Germany
| | - B. Emmerich
- Division of Hematology and Oncology, Department of Internal Medicine, University of Munich, Germany
| | - S. Endres
- Division of Clinical Pharmacology and Oncology, Department of Internal Medicine, University of Munich, Germany
| | - G. Hartmann
- Division of Clinical Pharmacology and Oncology, Department of Internal Medicine, University of Munich, Germany
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23
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Jahrsdörfer B, Jox R, Mühlenhoff L, Tschoep K, Krug A, Rothenfusser S, Meinhardt G, Emmerich B, Endres S, Hartmann G. Modulation of malignant B cell activation and apoptosis by bcl-2 antisense ODN and immunostimulatory CpG ODN. J Leukoc Biol 2002; 72:83-92. [PMID: 12101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Inhibition of bcl-2 expression by antisense oligodeoxynucleotides (ODN) might render bcl-2 overexpressing malignant B cells more susceptible to chemotherapy. ODN containing unmethylated CG dinucleotides (CpG) are known to activate B cells. We studied the effects of two bcl-2 antisense ODN, with (G3139) or without CG dinucleotides (NOV 2009) within the sequence, and the effects of a nonantisense, CpG-containing ODN (ODN 2006) on activation and apoptosis of malignant B cell lines and primary B-CLL cells. Without cationic lipids, no antisense-mediated inhibition of bcl-2 synthesis was achieved with G3139 and NOV 2009. Instead, G3139, but not NOV 2009, induced similar changes as ODN 2006 in proliferation, expression of costimulatory and antigen-presenting molecules, as well as in bcl-2 and bcl-xL levels of primary B-CLL cells. G3139 and ODN 2006 inhibited in vitro, spontaneous apoptosis in B-CLL cells of patients with high serum thymidine kinase activity (s-TK, marker for proliferative activity of malignant B cells), whereas in patients with low s-TK activity, apoptosis was induced. In conclusion, our results suggest that modulation of malignant B cell apoptosis by G3139 depends on its immunostimulatory properties rather than on antisense-mediated reduction of bcl-2 expression. Immunostimulatory CpG ODN may have a therapeutic potential in patients with B-CLL, especially those with low s-TK activity.
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MESH Headings
- Adjuvants, Immunologic/chemistry
- Adjuvants, Immunologic/pharmacology
- Apoptosis
- Gene Expression Regulation
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphocyte Activation
- Oligodeoxyribonucleotides/chemistry
- Oligodeoxyribonucleotides/pharmacology
- Oligodeoxyribonucleotides, Antisense/pharmacology
- Phosphatidylethanolamines
- Proto-Oncogene Proteins c-bcl-2/biosynthesis
- Proto-Oncogene Proteins c-bcl-2/genetics
- Thymidine Kinase/metabolism
- Tumor Cells, Cultured
- bcl-X Protein
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Affiliation(s)
- B Jahrsdörfer
- Division of Clinical Pharmacology, Department of Internal Medicine, University of Munich, Ziemssenstrasse 1, 80336 Munich, Germany
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24
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Schaarschmidt K, Emmerich B, Fritzsch G. Physical principles of ultrasonic dissection and clinical application of BERCHTOLD SONO-CUT reusable ultrasonic scissors. MINIM INVASIV THER 2002; 11:231-236. [PMID: 28561601 DOI: 10.1080/13645706.2003.11873719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Technical principles and physical action mechanisms of ultrasonic dissection are introduced. We list various indications for using the BERCHTOLD SONO-CUT scissors and describe early clinical experiences, e.g. in pediatric laparoscopic surgery.
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Affiliation(s)
| | - B Emmerich
- b Berchtold Medizin-Elektronik Ltd. , Tuttlingen , Germany
| | - G Fritzsch
- b Berchtold Medizin-Elektronik Ltd. , Tuttlingen , Germany
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25
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Siegmund B, Welsch J, Loher F, Meinhardt G, Emmerich B, Endres S, Eigler A. Phosphodiesterase type 4 inhibitor suppresses expression of anti-apoptotic members of the Bcl-2 family in B-CLL cells and induces caspase-dependent apoptosis. Leukemia 2001; 15:1564-71. [PMID: 11587214 DOI: 10.1038/sj.leu.2402232] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
B cell chronic lymphocytic leukemia (B-CLL) is an incurable clonal disease which shows initial responsiveness to a number of chemotherapeutic drugs. However, in most patients the disease becomes resistant to treatment. Rolipram, a specific inhibitor of phosphodiesterase (PDE) type 4, the PDE predominantly expressed in B-CLL cells, has been shown to induce cAMP-dependent apoptosis in these cells. In the present study, we demonstrate that the extent of rolipram-induced apoptosis is similar to fludarabine-induced apoptosis in vitro. The combination of rolipram and fludarabine results in an enhancement in the number of apoptotic cells compared to apoptosis induced by either agent alone. Second, rolipram suppresses the expression of anti-apoptotic members of the Bcl-2 family and induces the pro-apoptotic protein Bax, thereby shifting the balance between pro- and anti-apoptotic members of the Bcl-2 family towards a pro-apoptotic direction. Finally rolipram-induced apoptosis is caspase-dependent. PDE 4 inhibitors are currently under investigation for chronic obstructive pulmonary disease and asthma in phase III clinical trials showing promising results with tolerable side-effects. In conclusion, by inducing apoptosis, by enhancing apoptosis induced by fludarabine, by suppressing Bcl-2, Bcl-X and by inducing Bax expression, PDE 4 inhibitors may add a new therapeutic option for patients with B-CLL.
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MESH Headings
- 3',5'-Cyclic-AMP Phosphodiesterases/antagonists & inhibitors
- Aged
- Antineoplastic Agents/pharmacology
- Apoptosis/drug effects
- Caspases/metabolism
- Caspases/pharmacology
- Cyclic Nucleotide Phosphodiesterases, Type 4
- Down-Regulation
- Drug Interactions
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/enzymology
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Mitoxantrone/pharmacology
- Phosphodiesterase Inhibitors/pharmacology
- Proto-Oncogene Proteins c-bcl-2/drug effects
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Rolipram/pharmacology
- Tumor Cells, Cultured/drug effects
- Vidarabine/analogs & derivatives
- Vidarabine/pharmacology
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Affiliation(s)
- B Siegmund
- Division of Clinical Pharmacology, Medizinische Klinik Innenstadt, Klinikum of the Ludwig-Maximilians-University Munich, Germany
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26
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Huhn D, von Schilling C, Wilhelm M, Ho AD, Hallek M, Kuse R, Knauf W, Riedel U, Hinke A, Srock S, Serke S, Peschel C, Emmerich B. Rituximab therapy of patients with B-cell chronic lymphocytic leukemia. Blood 2001; 98:1326-31. [PMID: 11520778 DOI: 10.1182/blood.v98.5.1326] [Citation(s) in RCA: 258] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rituximab (IDEC-C2B8) is a chimeric antibody that binds to the B-cell surface antigen CD20. Rituximab has significant activity in follicular non-Hodgkin lymphomas. Much less is known about the effects in chronic lymphocytic leukemia (CLL). We have initiated a phase II trial to evaluate the efficacy and safety of rituximab in patients with CD20+ pretreated CLL. To avoid the rituximab-associated toxicity, we restricted the tumor cell load, as measured by the number of circulating lymphocytes and the spleen size, in the first 2 cohorts of patients included in the study. Patients received 4 intravenous infusions of 375 mg/m2 once a week over a period of 1 month. Of the 28 patients evaluable for response, 7 patients showed a partial remission (National Cancer Institute criteria) lasting for a median of 20 weeks, with 1 patient still in remission after 71 weeks. Based on lymphocyte counts only, we found at least a 50% reduction of lymphocyte counts lasting for at least 4 weeks in 13 (45%) of 29 patients. Fifteen patients from 3 institutions were monitored for the immunophenotype profile of lymphocyte subsets. The number of CD5+CD20+ cells decreased significantly and remained low until day 28 after therapy. T-cell counts were not affected. With the exception of one rituximab-related death, adverse events in the remaining patients were mild. The results suggest that rituximab has clinical activity in pretreated patients with B-CLL. Toxicity is tolerable. Response duration after withdrawal of rituximab is rather short. Therefore, other modes of application and the combination with other agents need to be tested.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antigens, CD20/immunology
- Antigens, Neoplasm/immunology
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/immunology
- Antineoplastic Agents/therapeutic use
- Cardiovascular Diseases/chemically induced
- Disease Progression
- Female
- Fever/chemically induced
- Humans
- Immunophenotyping
- Immunotherapy
- Infusions, Intravenous
- Life Tables
- Lymphocyte Count
- Lymphoma, Follicular/immunology
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/therapy
- Male
- Middle Aged
- Multiple Organ Failure/chemically induced
- Remission Induction
- Rituximab
- Survival Analysis
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Affiliation(s)
- D Huhn
- Department of Medicine/Hematology and Oncology, Charité Campus Virchow-Klinikum, Humboldt Universität Berlin, Germany.
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27
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Hallek M, Schmitt B, Wilhelm M, Busch R, Kröber A, Fostitsch HP, Sezer O, Herold M, Knauf W, Wendtner CM, Kuse R, Freund M, Franke A, Schriever F, Nerl C, Döhner H, Thiel E, Hiddemann W, Brittinger G, Emmerich B. Fludarabine plus cyclophosphamide is an efficient treatment for advanced chronic lymphocytic leukaemia (CLL): results of a phase II study of the German CLL Study Group. Br J Haematol 2001; 114:342-8. [PMID: 11529853 DOI: 10.1046/j.1365-2141.2001.02959.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The efficacy and toxicity of a combination of fludarabine and cyclophosphamide (FC) was evaluated in patients with B-cell chronic lymphocytic leukaemia (CLL). Between April 1997 and July 1998, 36 patients with CLL (median age 59 years) received a regimen that consisted of fludarabine 30 mg/m(2) in a 30-min IV infusion, d 1-3, and cyclophosphamide 250 mg/m(2) in a 30-min IV infusion on d 1-3. Cycles were repeated every 28 d. Twenty-one patients had received between one and three different treatment regimens prior to the study, while 15 patients had received no prior therapy. The median Eastern Cooperative Oncology Group performance score was 1. One patient was at Binet stage A, 18 were stage B and 17 patients were stage C. Objective responses, assessed according to the revised guidelines of the National Cancer Institute-sponsored Working Group, were recorded in 29 out of 32 assessable patients (90.6%). Twenty-four partial remissions and five complete remissions were observed. Two patients showed no change and one patient showed disease progression. At February 2000, three of the responders had relapsed. Severe neutropenia, anaemia and thrombocytopenia (Common Toxicity Criteria grade 3 and 4) were observed in 25, six and six patients (69.4%, 16.7% and 16.7%) respectively. Other side-effects were uncommon. No treatment-related deaths and no grade 3 or 4 infections occurred. We conclude that the combination of fludarabine and cyclophosphamide showed significant activity in patients with CLL. Myelosuppression was the major side-effect. These results warrant further study on the FC combination in randomized trials.
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Affiliation(s)
- M Hallek
- Klinikum der Universität München, Grosshadern, München, Germany.
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28
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MESH Headings
- Abdomen/diagnostic imaging
- Age Factors
- Diagnosis, Differential
- Disease Progression
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/physiopathology
- Lymph Nodes/pathology
- Lymphocytes/pathology
- Neoplasms/etiology
- Prognosis
- Radiography, Thoracic
- Ultrasonography
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Affiliation(s)
- M Hallek
- Medizinische Klinik III, Ludwig-Maximilians-Universität München, Grosshadern.
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29
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MESH Headings
- Antibodies, Monoclonal/therapeutic use
- Antineoplastic Agents/therapeutic use
- Bone Marrow Transplantation
- Chlorambucil/adverse effects
- Chlorambucil/therapeutic use
- Dose-Response Relationship, Radiation
- Drug Therapy, Combination
- Hematopoietic Stem Cell Transplantation
- Humans
- Immunization, Passive
- Immunosuppressive Agents/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Risk Factors
- Splenectomy
- Steroids/adverse effects
- Steroids/therapeutic use
- Transplantation, Autologous
- Vidarabine/adverse effects
- Vidarabine/analogs & derivatives
- Vidarabine/therapeutic use
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Affiliation(s)
- M Hallek
- Medizinische Klinik III, Ludwig-Maximilians-Universität München, Grosshadern
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Abstract
HISTORY AND CLINICAL FINDINGS A 45-year-old man was admitted with generalized itchy papules. He was originally from the Carribean island of Grenada. The disease had started two years before and was diagnosed as lupus erythematosus, polymorphic light eruption and atopic eczema. Physical examination showed skin-colored papules all over the integument, sebostasis and enlarged supraclavicular and inguinal lymph nodes. INVESTIGATIONS Lymphocyte count was elevated with 58% as well as LDH (322 U/l) and gamma GT (133 U/l). In a blood smear characteristic pleomorphic lymphoid cells (flower cells) could be obtained. Histopathologic evaluation demonstrated a subepidermally located infiltrate of pleomorphic lymphocytes with epidermal involvement. HTLV-I/II serology (ELISA-screening test) was positive. Polymerase chain reaction analysis revealed HTLV-specific sequences. DIAGNOSIS, TREATMENT AND COURSE Diagnosis of adult T-cell lymphoma/leukemia was obtained. Treatment consisted of interferon alpha 2b and zidovudine which resulted in a rapid response. However, as a result of an increased loss of weight (12 kg) this therapy was stopped. Two weeks later generalized lymphadenopathy and disseminated skin lesions were observed. Chemotherapy (CHOP-scheme) was initiated. The patient deceased with signs of an acute leukemia after a short period. CONCLUSIONS Adult T-cell lymphoma/leukemia is a rare disease in Europe. However, in patients with skin rashes, and lymphadenopathy, which are originally from HTLV-I endemic areas, adult T-cell lymphoma/leukemia should be considered.
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MESH Headings
- Antibodies, Viral/analysis
- Biopsy
- Bone Marrow Examination
- Deltaretrovirus/genetics
- Deltaretrovirus/immunology
- Diagnosis, Differential
- Enzyme-Linked Immunosorbent Assay
- Genes, Viral
- Humans
- Leukemia, T-Cell/complications
- Leukemia, T-Cell/diagnosis
- Lymphoma, T-Cell, Cutaneous/complications
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Middle Aged
- Polymerase Chain Reaction
- Prognosis
- Skin/pathology
- Skin Neoplasms/complications
- Skin Neoplasms/diagnosis
- Skin Neoplasms/pathology
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Affiliation(s)
- M J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München.
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31
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Mitterer M, Lanthaler AJ, Schnabel B, Svaldi M, Oduncu F, Coser P, Emmerich B, Huemer H, Straka C. Peripheral blood monoclonal B-cells predict the event free survival in multiple myeloma. Leuk Lymphoma 2001; 41:387-95. [PMID: 11378552 DOI: 10.3109/10428190109057994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Reinfusion of myeloma progenitor cells may contribute to relapse of multiple myeloma after autologous stem cell transplantation. The aim of our study was to investigate whether monoclonal B-cells are present in the apheresis product and to evaluate the clinical relevance of these cells. Leukapheresis products of 55 patients were purged with anti-B-cell-Monoclonal antibodies (MoAbs) and immunobeads. Monoclonal B-cells were found in 85% of patients within the B-cell population. In one third of all myeloma patients, the majority of B-cells was represented by monoclonal myeloma progenitor B-cells, whereas in two thirds of patients monoclonal cells only represented a small part of the entire B-cell population. As shown by sequence analysis, monoclonal precursor B-cells and malignant plasma cells had the identical genetic CDR III sequence. The purging efficacy, using a negative selection system, was a median of 3 logs (range 1,5-3,5). No statistical difference in the purging efficacy was found when 3, 4 or 5 MoAbs against B-cells antigens were used. However, a tumor specific signal could be detected in the purged harvest of all patients, when the highly sensitive ASO-PCR approach was used. Furthermore, we found a direct correlation between the amount of remaining monoclonal cells after negative selection and the event free survival of myeloma patients. 10/15 patients with a median of 20 x 10(3) monoclonal cells in the purged product relapsed at a median of 1,4 years, whereas only 6/24 patients with an oligoclonal pattern including a low number of remaining monoclonal cells relapsed at a median of 2,2 years. The event free survival (EFS) was statistically different between the two groups (p = 0,014).
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Affiliation(s)
- M Mitterer
- Department of Haematology and Bone Marrow Transplantation Centre; L. Böhlerstrasse 5, I-39100 Bozen/Bolzano, Italy.
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Lang SM, Kotsianos D, Schmitz I, Hautmann H, Emmerich B, Huber RM. Long-term stent implantation in a case of relapsing intrathoracic Ewing-sarcoma. Wien Klin Wochenschr 2001; 113:69-72. [PMID: 11233473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The overall prognosis of relapsing Ewing sarcoma is poor and therapeutic options can be limited by extensive chemotherapeutic pretreatment. We report on a case of a 27-year-old male, presenting with a large mediastinal mass and malignant pleural effusions. 5 years prior peripheral Ewing sarcoma had been treated according to the CESS 86 protocol. Relapse chemotherapy was initiated (CESS protocol) but tumor progression led to stenoses of both main bronchi. At this critical point, 2 Strecker tantal stents were placed endoscopically to prevent suffocation and provide the time for further chemotherapy, regardless of the poor overall prognosis. Complete remission was achieved by high-dose ifosfamide, surgery, radiotherapy and adjuvant ifosfamide. In spite of possible complications of long-term stent implantation, the stents were not removed until 4 years later when stent dislocation occurred. After removal, the stents were epithelialized and electron microscopy demonstrated structural integrity of the stent. The patient has remained in complete remission since (6 years).
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Affiliation(s)
- S M Lang
- Department of Pneumology, Klinikum Innenstadt der Universität München, Germany.
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33
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Gahn B, Brittinger G, Dölken G, Döhner H, Emmerich B, Franke A, Freund M, Huber C, Kuse R, Scholten T, Hiddemann W. Multicenter phase II study of oral idarubicin in treated and untreated patients with B-chronic lymphocytic leukemia. Leuk Lymphoma 2000; 37:169-73. [PMID: 10721782 DOI: 10.3109/10428190009057641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Idarubicin is the first anthracycline that can be administered orally facilitating antineoplastic chemotherapy at an improved quality of life. In different studies idarubicin has proved clinical effectiveness in patients with advanced low grade non Hodgkin's lymphoma. We performed a phase II study in 19 patients with untreated and pretreated B-CLL of Binet stage A-C. Idarubucin was administered orally at a dose of 15 mg/m2 over 3 days every 4 weeks. Of 19 evaluable patients (m:f, 16:3, median age 64 years, range 41-80 years) 7 were previously untreated while 12 patients had received prior therapy with fludarabine, chlorambucil or similar non-anthracycline containing regimens. 12 pts had Binet stage C, 5 Binet stage B and 2 Binet stage A. Five patients achieved a partial remission (26%), 5 patients had stable disease (26%) and 9 patients showed progressive disease (47%), resulting in an overall response of 26% (5/19). There was no correlation of response rate with Binet stages or previous treatment regimens. Treatment associated side effects consisted predominantly of mild nausea and vomiting (26%) as well as minor infections (21%) and diarrhoea (16%). These data demonstrate that oral idarubicin as a single agent is well tolerated but of limited effectiveness in B-CLL. Further studies are needed to assess different doses and schedules of oral idarubucin and to test it in combination with other chemotherapeutic agents.
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Affiliation(s)
- B Gahn
- Department of Hematology and Oncology, Georg-August-University, Göttingen, Germany.
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von Bubnoff N, Adler S, Danhauser-Riedl S, Kamp T, Nerl C, Emmerich B, Hallek M. The activation of intracellular tyrosine kinases by interferon-alpha (IFNalpha) correlates with its antiproliferative activity in B-lymphoid cell lines, but not in B-cell chronic lymphocytic leukemia patients. Ann Hematol 2000; 79:119-26. [PMID: 10803933 DOI: 10.1007/s002770050566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The response to interferon-alpha (IFNalpha) treatment in leukemias of the B-cell lineage shows a marked heterogeneity. A distinct subset of patients with B-CLL responds to treatment with IFNalpha, while the drug has no therapeutic effect in the majority of patients. The mechanism of this phenomenon is poorly understood. The cellular events induced by this cytokine mediated by a number of specific signaling events. Therefore, we studied the effect of recombinant IFNalpha on tyrosine phosphorylation and proliferation of cytosolic proteins in human cell lines and in freshly isolated B-CLL cells in order to test the potential value of these events as a pretreatment test for IFNalpha in CLL. In human lymphoid cell lines, IFNalpha induced tyrosine phosphorylation of multiple cytosolic proteins in a time- and concentration-dependent manner. This effect correlated with its growth-inhibitory effect in almost all cell lines. In marked contrast, in freshly isolated B-CLL cells IFNalpha seemed to have both stimulatory and inhibitory effects on proliferation, but it consistently stimulated tyrosine phosphorylation. Moreover, the clinical response of B-CLL to IFNalpha did not correlate with the activation of tyrosine kinases nor with the inhibition of cell growth in vitro. Therefore, the assessment of IFNalpha-induced tyrosine phosphorylation of cytosolic phospho-proteins does not allow to predict the treatment response to IFNalpha in CLL patients.
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Affiliation(s)
- N von Bubnoff
- Medizinische Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Unversität, Munich, Germany
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35
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Titzer S, Christensen O, Manzke O, Tesch H, Wolf J, Emmerich B, Carsten C, Diehl V, Bohlen H. Vaccination of multiple myeloma patients with idiotype-pulsed dendritic cells: immunological and clinical aspects. Br J Haematol 2000; 108:805-16. [PMID: 10792287 DOI: 10.1046/j.1365-2141.2000.01958.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multiple myeloma (MM) is characterized by a clonal proliferation of malignant plasma cells in the bone marrow secreting a monoclonal immunoglobulin (paraprotein) with specific antigenic determinants, the idiotype (Id), which can be regarded as a tumour-associated antigen (TAA). In order to analyse the impact of a dendritic cell (DC)-based vaccine, 11 patients with advanced MM were treated with CD34 stem cell-derived dendritic cells that were pulsed with Id peptides. Subsequently, the patients received three boost immunizations every other week with a combination of Id and granulocyte-macrophage colony-stimulating factor (GM-CSF) (nine patients) or with Id peptide-pulsed dendritic cells again (two patients). The treatment was well tolerated with no side-effects. The present clinical study was a proof of concept analysis of dendritic cell-based vaccines in MM. The capacity of the dendritic cells to activate idiotype-specific T cells was verified by in vitro stimulation experiments before the vaccination therapy. Immunological effects of the Id vaccination were analysed by monitoring changes in anti-idiotype antibody titres and idiotype-specific T-cell activity. After vaccination, three out of 10 analysed patients showed increased anti-idiotype antibody serum titres, indicating the induction of an idiotype-specific humoral immune response. The idiotype-specific T-cell response analysed by ELISpot was increased in four out of 10 analysed patients after vaccination, and one patient had a decreased plasma cell infiltration in the bone marrow. In conclusion, five out of 11 patients showed a biological response after vaccination. Thus, our data indicate that immunotherapy with Id-pulsed DCs in MM patients is feasible and safe. DC generated from CD34+ progenitor cells can serve as a natural adjuvant for the induction of clinically relevant humoral and cellular idiotype-specific immune responses in patients suffering from advanced MM.
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Affiliation(s)
- S Titzer
- Department of Internal Medicine I, University of Cologne, Joseph-Stelzmannstr. 9, 50924 Cologne, Germany
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36
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Nolte A, Buhmann R, Emmerich B, Schendel D, Hallek M. Reconstitution of the cellular immune response after autologous peripheral blood stem cell transplantation in patients with non-Hodgkin's lymphoma. Br J Haematol 2000; 108:415-23. [PMID: 10691875 DOI: 10.1046/j.1365-2141.2000.01841.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Peripheral blood stem cell (PBSC) transplants may be depleted of lymphoid progenitors, thereby disabling the cellular immune response against viral pathogens after autologous PBSC transplantation (PBSCT). To monitor the cellular immune reconstitution after autologous PBSCT, we investigated the cytolytic activity (CLA) of peripheral blood T lymphocytes against Epstein-Barr virus (EBV) in 13 patients with non-Hodgkin's lymphoma or multiple myeloma. The individual EBV-directed CLA (EBV-CLA) was determined by calculating the number of cytolytic effector cells in 106 T cells needed to lyse 25% of autologous EBV-transformed B-lymphoblastoid cells, expressed as lytic units (LU25). During the first 6 months after PBSCT, the EBV-CLA was only 14.6% of the response of healthy controls (median 4. 8 vs. 32.9 LU25). Thereafter, the EBV-CLA increased to 28.15 LU25 (median) or 86% of healthy controls. Monthly follow-up analyses in five selected patients showed that the EBV-CLA was barely detectable at 4 weeks and recovered at 8-12 weeks after PBSCT in four out of five patients. Effector cells consisted mostly of CD8-positive T lymphocytes, with small CD4- and CD3/CD56-positive lymphocyte fractions. These results suggest that the reconstitution of the cellular immune response against EBV takes 8-12 weeks after autologous PBSCT.
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Affiliation(s)
- A Nolte
- GSF, Forschungszentrum für Umwelt und Gesundheit, Munich, Germany
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37
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Einsele H, Straka C, Emmerich B, Bamberg M, Budach W, Kanz L. High-Dose Chemotherapy with Hematopoietic Stem Cell Transplantation for Patients with Advanced Multiple Myeloma. Oncol Res Treat 2000. [DOI: 10.1159/000027143] [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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38
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Munker R, Grützner S, Hiller E, Aydemir U, Enne W, Dietzfelbinger H, Busch M, Haas R, Emmerich B, Schmidt M, Dühmke E, Hölzel D, Wilmanns W. Second malignancies after Hodgkin's disease: the Munich experience. Ann Hematol 1999; 78:544-54. [PMID: 10647878 DOI: 10.1007/s002770050556] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The occurrence of second malignancies (SM) is an important late event following the treatment of Hodgkin's disease (HD). We sought to determine the incidence, the risk factors, and the prognosis of SM in our population of patients with HD. A total of 1120 patients diagnosed with HD were registered at six participating institutions in Munich (calendar period 1974-1994). The mean follow-up for the development of SM was 9.1 years. A cumulative treatment score was calculated for both radio- and chemotherapy. The relative and absolute risks of SM were established. All SM were investigated for response to treatment and outcome. We observed 85 SM [eight leukemias, 22 non-Hodgkin's lymphomas (NHL), two plasma cell neoplasias, and 53 solid tumors]. Five patients developed third malignancies. The relative risk of developing a second neoplasm was compared with that within the normal population and was 3.1-fold. The risk varied according to the category of SM. Higher relative risks (20.5 and 25.9-fold), but lower absolute risks were observed for leukemias and non-Hodgkin's lymphomas. Solid tumors had lower relative risks (1.8-fold). Splenectomy increased the risk of SM (relative risk 4.4-fold versus 2.7-fold). The risk of SM did not correlate with the initial treatment (radio- or chemotherapy) and did not decrease with prolonged follow-up. The cumulative intensity of radiotherapy, chemotherapy, or the two modalities combined correlated with the risk of SM. Since some cases occurred early after diagnosis, not all second neoplasms can be considered treatment-associated. After 15 years, an actuarial risk of 11.7% was calculated for all SM, of 1.0% for leukemias, of 3.0% for NHL, and of 7.7% for solid tumors. The prognosis of SM varied between good (thyroid cancer, melanoma: median survival 5+ years), average (breast cancer, NHL), and poor (acute myeloid leukemias, lung cancers: median survival 9 months). With the exception of NHL, second cancers often occurred in topographic relation to the field of previous radiotherapy. Taken together, in our patient population, we observed all three categories of SM (solid tumors, leukemias, NHL). The risk for second leukemias is lower than in previous studies, whereas the risk of second NHL is somewhat higher. We confirm that splenectomy is a possible risk factor for SM. Even after correction for the age-specific cancer incidence, treatment intensity is associated with the development of second malignant tumors. Continued follow-up is mandatory after treatment for HD. Since the prognosis of most SM is unfavorable, early recognition and prevention are of the utmost importance.
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Affiliation(s)
- R Munker
- Medizinische Klinik III der Ludwig-Maximilian-Universität, Klinikum Grosshadern, Munich, Germany.
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39
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Mitterer M, Oduncu F, Lanthaler AJ, Drexler E, Amaddii G, Fabris P, Emmerich B, Coser P, Straka C. The relationship between monoclonal myeloma precursor B cells in the peripheral blood stem cell harvests and the clinical response of multiple myeloma patients. Br J Haematol 1999; 106:737-43. [PMID: 10468867 DOI: 10.1046/j.1365-2141.1999.01603.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to determine the presence of monoclonal myeloma precursor B cells in peripheral blood stem cell harvests and to investigate their role in the clinical outcome of multiple myeloma patients. A total of 39 multiple myeloma patients were treated with a sequential therapy including double high-dose melphalan therapy followed by a double transplant procedure. The apheresis products for the second transplant were purged using a panel of four or five different mouse monoclonal antibodies against B-cell antigens (CD10, CD19, CD20, CD22 and CD37). In 19/39 patients a tumour-specific CDR III signal was identified in the diagnostic bone marrow. Gene scan analysis after CDR III PCR of the magnetic bead isolated B-cell fraction from the apheresis products in these 19 patients revealed three different patterns: 32% of patients had a predominantly monoclonal B-cell population; 63% of patients had an identifiable monoclonal signal within an oligoclonal B-cell population. In only 1/19 patients were no monoclonal B cells identified in the B-cell population of the apheresis product. A correlation between the clonal pattern and the clinical response after sequential chemotherapy was found. Patients with a predominance of monoclonal myeloma or myeloma precursor B cells had an early relapse or achieved a minimal response or a partial remission. Patients with an oligo- and/or polyclonal pattern achieved a high percentage of partial as well as complete remissions.
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Affiliation(s)
- M Mitterer
- Department of Haematology and Bone Marrow Transplantation Centre, Bozen/Bolzano, Italy.
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40
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Wendtner CM, Schmitt B, Wilhelm M, Dreger P, Montserrat E, Emmerich B, Hallek M. Redefining the therapeutic goals in chronic lymphocytic leukemia: towards an evidence-based, risk-adapted therapy. Ann Oncol 1999; 10:505-9. [PMID: 10415998 DOI: 10.1023/a:1026481430446] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C M Wendtner
- Medizinische Klinik III, Klinikum Grosshadern, Germany
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41
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Meinhardt G, Roth J, Totok G, Auner H, Emmerich B, Hass R. Signaling defect in the activation of caspase-3 and PKCdelta in human TUR leukemia cells is associated with resistance to apoptosis. Exp Cell Res 1999; 247:534-42. [PMID: 10066381 DOI: 10.1006/excr.1998.4383] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Exposure of the two related human leukemic cell lines U937 and TUR to chemotherapeutic compounds resulted in opposite effects on induction and resistance to apoptosis. Incubation of U937 cells with 1-beta-d-arabinofuranosylcytosine or the etoposide VP-16 was accompanied by growth arrest in G0/G1 of the cell cycle and an accumulation of a population in the sub-G1 phase which exhibited characteristics typical for the apoptotic pathway. In contrast, human TUR leukemia cells demonstrated no significant effects after a similar treatment with Ara-C and VP-16. Thus, TUR cells continued to proliferate in the presence of these anti-cancer drugs and the number of apoptotic cells as evaluated by propidium iodide staining and the detection of internucleosomal DNA fragmentation was significantly reduced when compared to the parental U937 cells. Similar effects were observed upon serum-starvation demonstrating resistance to apoptosis in TUR cells. Whereas induction of apoptosis is regulated by a network of distinct factors including the activation of proteolytically active caspases, we investigated these pathways in both cell lines. U937 cells demonstrated activation of the 32-kDa caspase-3 upon drug treatment by cleavage into the 20-kDa activated form. However, there was no 20-kDa caspase-3 fragment detectable in TUR cells. Simultaneously, the enzymatic activity of caspase-3 was significantly increased in drug-treated U937 cells as measured in vitro by enhanced metabolization of a fluorescence substrate and in vivo by cleavage of an appropriate substrate for caspase-3, namely, protein kinase Cdelta. In contrast, there was little if any caspase-3 activation detectable in drug-treated TUR cells. Taken together, these data suggest a signaling defect in the activation of the caspase-3 proteolytic system in TUR cells upon treatment with chemotherapeutic compounds which is associated with resistance to apoptosis in these human leukemia cells.
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Affiliation(s)
- G Meinhardt
- Department of Hematology/Oncology, Ludwig-Maximilians-University, Munich, Germany.
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42
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Buhmann R, Nolte A, Westhaus D, Emmerich B, Hallek M. CD40-activated B-cell chronic lymphocytic leukemia cells for tumor immunotherapy: stimulation of allogeneic versus autologous T cells generates different types of effector cells. Blood 1999; 93:1992-2002. [PMID: 10068672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Although spontaneous remissions may rarely occur in B-cell chronic lymphocytic leukemia (B-CLL), T cells do generally not develop a clinically significant response against B-CLL cells. Because this T-cell anergy against B-CLL cells may be caused by the inability of B-CLL cells to present tumor-antigens efficiently, we examined the possibility of upregulating critical costimulatory (B7-1 and B7-2) and adhesion molecules (ICAM-1 and LFA-3) on B-CLL cells to improve antigen presentation. The stimulation of B-CLL cells via CD40 by culture on CD40L expressing feeder cells induced a strong upregulation of costimulatory and adhesion molecules and turned the B-CLL cells into efficient antigen-presenting cells (APCs). CD40-activated B-CLL (CD40-CLL) cells stimulated the proliferation of both CD4(+) and CD8(+) T cells. Interestingly, stimulation of allogeneic versus autologous T cells resulted in the expansion of different effector populations. Allogeneic CD40-CLL cells allowed for the expansion of specific CD8(+) cytolytic T cells (CTL). In marked contrast, autologous CD40-CLL cells did not induce a relevant CTL response, but rather stimulated a CD4(+), Th1-like T-cell population that expressed high levels of CD40L and released interferon-gamma in response to stimulation by CD40-CLL cells. Together, these results support the view that CD40 activation of B-CLL cells might reverse T-cell anergy against the neoplastic cell clone, although the character of the immune response depends on the major histocompatibility complex (MHC) background on which the CLL or tumor antigens are presented. These findings may have important implications for the design of cellular immunotherapies for B-CLL.
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Affiliation(s)
- R Buhmann
- Laboratorium für Molekulare Biologie, Genzentrum, Medizinische Klinik, Grobetahadern, Ludwig-Maximilians-Universität, München, Germany
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43
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44
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Hallek M, Langenmayer I, Nerl C, Knauf W, Dietzfelbinger H, Adorf D, Ostwald M, Busch R, Kuhn-Hallek I, Thiel E, Emmerich B. Elevated serum thymidine kinase levels identify a subgroup at high risk of disease progression in early, nonsmoldering chronic lymphocytic leukemia. Blood 1999; 93:1732-7. [PMID: 10029603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) shows a remarkably heterogeneous clinical outcome; survival ranges from several months in advanced stages to more than 10 years in early stages. The Binet and Rai staging systems distinguish three major prognostic subgroups, but do not accurately predict the individual risk of disease progression in early CLL (Binet stage A or Rai stage 0 to II). Because most newly diagnosed CLL patients present with early disease, it seems desirable to search for additional prognostic factors to identify early CLL patients at high risk of rapid progression. It has been shown that elevated serum thymidine kinase (s-TK) levels predict disease progression in CLL. Therefore, this study aimed to assess the prognostic value of s-TK in 122 previously untreated patients with Binet stage A CLL (mean age +/- SD, 58.7 +/- 8.5 years). In univariate analyses, 18 of the 22 parameters investigated predicted progression-free survival (PFS). In a stepwise multiple regression analysis, only three parameters provided independent prognostic information on PFS: s-TK greater than 7.1 U/L; presence of lymphadenopathy; and white blood cell (WBC) count greater than 75, 000/microL. When added to the classification of smoldering versus nonsmoldering CLL, s-TK levels separated two groups within the group of nonsmoldering stage A patients: patients with s-TK values greater than 7.1 U/L had a median PFS of 8 months, whereas patients with s-TK values </= 7.1 U/L expected a much longer PFS (49 months; P <. 001), similar to smoldering CLL (42 months). The results demonstrate that s-TK is a prognostic parameter that adds independent prognostic information to the definitions of smoldering and nonsmoldering CLL in Binet stage A.
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Affiliation(s)
- M Hallek
- Medizinische Klinik, Abteilung für Hämatologie und Onkologie, Klinikum Innenstadt, Ludwig-Maximilians-Universität München, Germany
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45
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Nolte A, Buhmann R, Straka C, Emmerich B, Hallek M. Assessment and characterization of the cytolytic T lymphocyte response against Epstein-Barr virus in patients with non-Hodgkin's lymphoma after autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 1998; 21:909-16. [PMID: 9613783 DOI: 10.1038/sj.bmt.1701197] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The cytolytic T lymphocyte (CTL) response has often been used to assess the reconstitution of T cell function after allogeneic or autologous bone marrow transplantation (BMT). Less is known, however, about the reconstitution of the CTL response after peripheral blood stem cell transplantation (PBSCT). Therefore, we investigated the CTL response against Epstein-Barr virus (EBV) of patients undergoing autologous PBSCT. CTLs of six patients with relapsed non-Hodgkin's lymphoma and multiple myeloma were established before and at different times after PBSCT by in vitro stimulation of peripheral blood lymphocytes with autologous EBV-transformed lymphoblastoid cell lines (LCLs). The efficiency of T cell priming by LCLs was assessed at the time of initiation of CTL lines; the proliferative response was strongly reduced during the first 4 months and increased 5 months or more following PBSCT. Cytolytic activity was measured after three or four restimulations of CTLs. All patients investigated had a detectable EBV-specific CTL response which was poor during the first weeks after transplantation, accompanied by a strong non-MHC-restricted cytotoxic activity and a high proportion of CD56-positive T cells. Five or more months after PBSCT, a specific CTL response against EBV was seen which was similar to the situation prior to PBSCT, while the unspecific cytotoxic response decreased. Blocking experiments with monoclonal anti-CD3, anti-CD8 or anti-MHC I antibodies resulted in substantial inhibition of autologous LCL lysis, whereas anti-CD4 or anti-MHC II antibodies had no effect. Finally, autologous PHA blasts of a patient with the HLA haplotype A1/9+, B5/8+, Cw4/7+, were loaded with various EBNA-derived nonapeptides known to be presented by HLA B8 or A11, and exposed to autologous, EBV-directed CTLs. Specific lysis by CTLs only occurred with HLA B8-, but not with HLA A11-restricted nonapeptides. This demonstrated the existence of an MHC I-restricted anti-EBV CTL response after PBSCT. Taken together, the results show that the anlaysis of the EBV-directed CTL activity may serve as a surrogate marker to assess the reconstitution of the cellular immune response in patients undergoing autologous PBSCT.
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Affiliation(s)
- A Nolte
- Genzentrum, Klinikum Innenstadt, Ludwig-Maximilians-Universität München, Germany
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46
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Warmuth M, Bergmann M, Priess A, Häuslmann K, Emmerich B, Hallek M. The Src family kinase Hck interacts with Bcr-Abl by a kinase-independent mechanism and phosphorylates the Grb2-binding site of Bcr. J Biol Chem 1997; 272:33260-70. [PMID: 9407116 DOI: 10.1074/jbc.272.52.33260] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
bcr-abl, the oncogene causing chronic myeloid leukemia, encodes a fusion protein with constitutively active tyrosine kinase and transforming capacity in hematopoietic cells. Various intracellular signaling intermediates become activated and/or associate by/with Bcr-Abl, including the Src family kinase Hck. To elucidate some of the structural requirements and functional consequences of the association of Bcr-Abl with Hck, their interaction was investigated in transiently transfected COS7 cells. Neither the complex formation of Hck kinase with Bcr-Abl nor the activation of Hck by Bcr-Abl was dependent on the Abl kinase activity. Both inactivating point mutations of Hck and dephosphorylation of Hck enhanced its complex formation with Bcr-Abl, indicating that their physical interaction was negatively regulated by Hck (auto)phosphorylation. Finally, experiments with a series of kinase negative Bcr-Abl mutants showed that Hck phosphorylated Bcr-Abl and induced the binding of Grb2 to Tyr177 of Bcr-Abl. Taken together, our results suggest that Bcr-Abl preferentially binds inactive forms of Hck by an Abl kinase-independent mechanism. This physical interaction stimulates the Hck tyrosine kinase, which may then phosphorylate the Grb2-binding site in Bcr-Abl.
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Affiliation(s)
- M Warmuth
- Medizinische Klinik, Klinikum Innenstadt, Universität München, D-80336 München, Germany
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Hallek M, Neumann C, Schäffer M, Danhauser-Riedl S, von Bubnoff N, de Vos G, Druker BJ, Yasukawa K, Griffin JD, Emmerich B. Signal transduction of interleukin-6 involves tyrosine phosphorylation of multiple cytosolic proteins and activation of Src-family kinases Fyn, Hck, and Lyn in multiple myeloma cell lines. Exp Hematol 1997; 25:1367-77. [PMID: 9406996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Binding of interleukin-6 to its receptor (IL-6R) induces the association of the IL-6R alpha chain (IL-6Ralpha) with a 130-kDa transmembrane glycoprotein, gp130. This event activates tyrosine kinases of the Janus kinase (JAK) family and transduces signals to the cytosol or nucleus. To further characterize the biochemical mechanisms by which IL-6 promotes cell proliferation, we investigated the effects of IL-6 on the growth and transmembrane signaling of several lymphoid cell lines. In the IL-6-dependent cell line B-9, IL-6 induced a rapid, transient, and concentration-dependent tyrosine phosphorylation of several cytosolic proteins as detected by antiphosphotyrosine immunoblots. The molecular weight of major bands on sodium dodecyl sulfate-polyacrylamide gel electrophoresis was 44, 65, 70, 80, 137, 148, 184, and 190 kDa, respectively. Similar effects of IL-6 on tyrosine phosphorylation were observed in the human multiple myeloma cell line LP-1. Because JAKs were unlikely to mediate all the biological effects of IL-6, we investigated whether members of the Src family of tyrosine kinases were also activated in B-9 or LP-1 cells. IL-6 induced the activation and tyrosine phosphorylation of p59Fyn, p56/59Hck, and p56Lyn. Coprecipitation experiments with anti-Hck, anti-Lyn, anti-Fyn, and anti-gp130 antibodies revealed a physical association with gp130 of p56/59Hck and p56Lyn, but not p59Fyn, in LP-1 cells. Together, these results show for the first time that several Src kinases may become activated by IL-6 (p59Fyn, p56/59Hck, and p56Lyn) and associate with gp130 (p56/59Hck and p56Lyn).
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Affiliation(s)
- M Hallek
- Medizinische Klinik, Klinikum Innenstadt, Universität München, Germany
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Hallek M, Touitou Y, Lévi F, Mechkouri M, Bogdan A, Bailleul F, Senekowitsch R, Emmerich B. Serum thymidine kinase levels are elevated and exhibit diurnal variations in patients with advanced ovarian cancer. Clin Chim Acta 1997; 267:155-66. [PMID: 9469250 DOI: 10.1016/s0009-8981(97)00132-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Deoxythymidine kinase (TK) is an enzyme involved in DNA synthesis whose serum activity reflects the proliferative activity of tumors and correlates with prognosis in various malignancies. In ovarian cancer, the value of s-TK has not been studied so far. Therefore the serum levels of TK were investigated in patients with advanced ovarian cancer. Because considerable diurnal fluctuations of s-TK levels were reported previously, repeated determinations were performed over a 48-h time span. Fourteen patients (mean age +/- S.D., 56.1 +/- 8.0 years) with advanced ovarian cancer and five healthy volunteers (30.2 +/- 3.5 years) were studied. Serial determinations of s-TK and serum CA 125 (s-CA 125) levels were performed over a 48-h time period. S-TK and s-CA 125 were elevated (> 4.7 U/l and > 35 U/ml) in 10 patients at least once over the 48-h period, respectively. Linear regression analysis showed a strong correlation between s-TK and s-CA 125. However, three patients with consistently normal s-CA 125 values (< or = 35 U/ml) had elevated s-TK levels, indicating that these two parameters may be independent in some patients. Both s-TK and s-CA 125 levels showed considerable diurnal changes over the 24-h period in individual patients, in marked contrast to normal subjects. Individual peak-trough differences ranged from 0.1-8.5 U/l or 5-268% for s-TK, and from 4-75 U/ml or 15-100% for s-CA 125. Peak-trough differences of s-TK > or = 100% were found in five patients. The circadian fluctuations of s-TK and CA 125 did not show a regular circadian pattern nor any temporal covariation. This study demonstrates for the first time that s-TK levels may be elevated in ovarian cancer. In some patients, s-TK levels may exhibit considerable, irregular diurnal fluctuations. Repeated determinations should therefore be performed in situations where this marker is relevant for patient monitoring.
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Affiliation(s)
- M Hallek
- Medizinische Klinik, Klinikum Innenstadt, Universität München, Munich, Germany.
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Knauf WU, Langenmayer I, Ehlers B, Mohr B, Adorf D, Nerl CH, Hallek M, Zwingers TH, Emmerich B, Thiel E. Serum levels of soluble CD23, but not soluble CD25, predict disease progression in early stage B-cell chronic lymphocytic leukemia. Leuk Lymphoma 1997; 27:523-32. [PMID: 9477135 DOI: 10.3109/10428199709058320] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Serum levels of the soluble forms of CD23 (sCD23) and CD25 (sCD25) were prospectively analyzed with respect to their prognostic relevance in early stage B-cell chronic lymphocytic leukemia (B-CLL). SCD23 and sCD25 levels were determined in 105 patients with newly diagnosed B-CLL (Binet stage A). In 93 of the patients, these levels were correlated with other already established indicators for risk of disease progression, including the histologic pattern of bone marrow infiltration, lymphocyte doubling time (LDT), and the serum level of thymidine kinase (TK). High serum levels of both sCD23 and of sCD25 were associated with a diffuse bone marrow infiltration, a LDT < or = 12 months, and elevated (>5 U/L) serum TK, respectively. Moreover, examination of the clinical course of 76 untreated patients showed that high levels of sCD23, but not of sCD25, at initial diagnosis were linked with disease progression. Furthermore, in a stepwise Cox regression model, high levels of sCD23 and a short LDT were shown to be strong predictors of progressive disease within the first year of disease presentation. Therefore, it appears to be justified to incorporate sCD23 levels into the risk profile of early stage B-CLL and to take them into account for stratification in risk-adapted treatment strategies.
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MESH Headings
- Biomarkers, Tumor/blood
- Bone Marrow/physiology
- Disease Progression
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Neoplasm Staging
- Receptors, IgE/blood
- Receptors, Interleukin-2/blood
- Risk Factors
- Statistics as Topic
- Thymidine Kinase/blood
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Affiliation(s)
- W U Knauf
- Department of Hematology, Klinikum Benjamin Franklin, Freie Universität Berlin, Germany
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Oduncu F, Krause G, Röhnisch T, Emmerich B, Pachmann K. Complementary anchor PCR of rearranged variable T-cell receptor beta-chain cDNA regions. Biol Chem 1997; 378:1211-4. [PMID: 9372194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Sequencible amplificates comprising the variable cDNA sequences of the rearranged T-cell receptor (TCR) beta-chain were obtained from the T-leukemia cell line Jurkat using a single-sided PCR approach based on five synthetic oligonucleotides derived from the flanking constant sequence. Double-stranded cDNA was cleaved by a restriction enzyme creating cohesive ends, to which an anchor oligonucleotide was ligated. Since this anchor was complementary to the antisense strand of the known constant region, exclusively the desired ligation product folded into a stem-loop-structure that was enzymatically extended to yield a PCR template, now flanked at both ends by primer binding sites appropriate for nested PCR.
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Affiliation(s)
- F Oduncu
- Klinikum Innenstadt, Ludwig-Maximilians-Universität München, Abt. Hämatologie/Onkologie, Germany
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