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Locher M, Jukic E, Bohn JP, Untergasser G, Steurer M, Cramer CA, Schwendinger S, Vogi V, Verdorfer I, Witsch-Baumgartner M, Nachbaur D, Gunsilius E, Wolf D, Zschocke J, Steiner N. Clonal dynamics in a composite chronic lymphocytic leukemia and hairy cell leukemia-variant. Genes Chromosomes Cancer 2020; 60:287-292. [PMID: 33277788 PMCID: PMC7984250 DOI: 10.1002/gcc.22925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/28/2022] Open
Abstract
Composite lymphoma is the rare simultaneous manifestation of two distinct lymphomas. Chronic lymphocytic leukemia (CLL) has a propensity for occurring in composite lymphomas, a phenomenon that remains to be elucidated. We applied cytogenetics, droplet digital polymerase chain reaction, and massively parallel sequencing to analyze longitudinally a patient with CLL, who 3 years later showed transformation to a hairy cell leukemia-variant (HCL-V). Outgrowth of the IGHV4-34-positive HCL-V clone at the expense of the initially dominant CLL clone with trisomy 12 and MED12 mutation started before CLL-guided treatment and was accompanied by a TP53 mutation, which was already detectable at diagnosis of CLL. Furthermore, deep sequencing of IGH showed a composite lymphoma with presence of both disease components at all analyzed timepoints (down to a minor clone: major clone ratio of ~1:1000). Overall, our analyses showed a disease course that resembled clonal dynamics reported for malignancies with intratumoral heterogeneity and illustrate the utility of deep sequencing of IGH to detect distinct clonal populations at diagnosis, monitor clonal response to therapy, and possibly improve clinical outcomes.
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Affiliation(s)
- Maurus Locher
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Emina Jukic
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Jan-Paul Bohn
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerold Untergasser
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Steurer
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Simon Schwendinger
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Vogi
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Irmgard Verdorfer
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - David Nachbaur
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | - Eberhard Gunsilius
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | - Dominik Wolf
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria.,Medical Clinic III, Oncology, Hematology, Immuno-Oncology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Johannes Zschocke
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Normann Steiner
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
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Locher M, Steurer M, Jukic E, Keller MA, Fresser F, Ruepp C, Wöll E, Verdorfer I, Gastl G, Willenbacher W, Weger R, Nachbaur D, Wolf D, Gunsilius E, Zschocke J, Steiner N. The prognostic value of additional copies of 1q21 in multiple myeloma depends on the primary genetic event. Am J Hematol 2020; 95:1562-1571. [PMID: 32936982 PMCID: PMC7756645 DOI: 10.1002/ajh.25994] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/19/2022]
Abstract
Hyperdiploidy (HRD) and specific immunoglobulin heavy locus (IGH) translocations are primary chromosomal abnormalities (CA) in multiple myeloma (MM). In this retrospective study of 794 MM patients we aimed to investigate clinical features and common CA including gain(1q) in separate subgroups defined by primary CA. In the entire group, we confirmed that gain(1q) was associated with short time to next treatment and adverse overall survival (OS). The impact was worse for four or more copies of 1q21 as compared to three copies. However, in a subgroup of patients with clonal gain(11q) and without known primary IGH translocations (CG11q), already three copies of 1q21 were associated with a poor outcome; in the absence of gain(1q), patients in this subgroup had a remarkably long median OS of more than nine years. These cases were associated with HRD, coexpression of CD56 and CD117, male gender, and IgG subtype. In non‐CG11q patients, four or more copies of 1q21 (but not three copies) had a significant adverse impact on outcome. Several associations with CA and clinical findings were observed for the defined subgroups. As an example, we found a predominance of early tetraploidy, plasma cell leukemia, and female gender in the t(14;16) subgroup. Our results underscore the importance of subgrouping in MM.
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Affiliation(s)
- Maurus Locher
- Institute of Human Genetics Medical University of Innsbruck Innsbruck Austria
| | - Michael Steurer
- Department of Internal Medicine V Medical University of Innsbruck Innsbruck Austria
| | - Emina Jukic
- Institute of Human Genetics Medical University of Innsbruck Innsbruck Austria
| | - Markus A. Keller
- Institute of Human Genetics Medical University of Innsbruck Innsbruck Austria
| | - Friedrich Fresser
- Institute of Human Genetics Medical University of Innsbruck Innsbruck Austria
| | - Carmen Ruepp
- Department of Internal Medicine St. Vinzenz Krankenhaus Betriebs GmbH Zams Austria
| | - Ewald Wöll
- Department of Internal Medicine St. Vinzenz Krankenhaus Betriebs GmbH Zams Austria
| | - Irmgard Verdorfer
- Institute of Human Genetics Medical University of Innsbruck Innsbruck Austria
| | - Günther Gastl
- Department of Internal Medicine V Medical University of Innsbruck Innsbruck Austria
| | - Wolfgang Willenbacher
- Department of Internal Medicine V Medical University of Innsbruck Innsbruck Austria
- ONCOTYROL ‐ Center for Personalized Cancer Medicine Innsbruck Austria
| | - Roman Weger
- ONCOTYROL ‐ Center for Personalized Cancer Medicine Innsbruck Austria
| | - David Nachbaur
- Department of Internal Medicine V Medical University of Innsbruck Innsbruck Austria
| | - Dominik Wolf
- Department of Internal Medicine V Medical University of Innsbruck Innsbruck Austria
- Medical Clinic 3, Oncology, Hematology, Immuno‐Oncology and Rheumatology University Hospital Bonn Bonn Germany
| | - Eberhard Gunsilius
- Department of Internal Medicine V Medical University of Innsbruck Innsbruck Austria
| | - Johannes Zschocke
- Institute of Human Genetics Medical University of Innsbruck Innsbruck Austria
| | - Normann Steiner
- Department of Internal Medicine V Medical University of Innsbruck Innsbruck Austria
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Henninger B, Steurer M, Plaikner M, Weiland E, Jaschke W, Kremser C. Magnetic resonance cholangiopancreatography with compressed sensing at 1.5 T: clinical application for the evaluation of branch duct IPMN of the pancreas. Eur Radiol 2020; 30:6014-6021. [PMID: 32556465 PMCID: PMC7554004 DOI: 10.1007/s00330-020-06996-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/23/2020] [Accepted: 05/29/2020] [Indexed: 12/28/2022]
Abstract
Objectives To evaluate magnetic resonance cholangiopancreatography (MRCP) with compressed sensing (CS) for the assessment of branch duct intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas. For this purpose, conventional navigator-triggered (NT) sampling perfection with application-optimized contrast using different flip angle evolutions (SPACE) MRCP was compared with various CS-SPACE-MRCP sequences in a clinical setting. Methods A total of 41 patients (14 male, 27 female, mean age 68 years) underwent 1.5-T MRCP for the evaluation of BD-IPMN. The MRCP protocol consisted of the following sequences: conventional NT-SPACE-MRCP, CS-SPACE-MRCP with long (BHL, 17 s) and short single breath-hold (BHS, 8 s), and NT-CS-SPACE-MRCP. Two board-certified radiologists evaluated image quality, duct sharpness, duct visualization, lesion conspicuity, confidence, and communication with the main pancreatic duct in consensus using a 5-point scale (1–5), with higher scores indicating better quality/delineation/confidence. Maximum intensity projection reconstructions and originally acquired data were used for evaluation. Wilcoxon signed-rank test was used to compare the intra-individual difference between sequences. Results BHS-CS-SPACE-MRCP had the highest scores for image quality (3.85 ± 0.79), duct sharpness (3.81 ± 1.05), and duct visualization (3.81 ± 1.01). There was a significant difference compared with NT-CS-SPACE-MRCP (p < 0.05) but no significant difference to the standard NT-SPACE-MRCP (p > 0.05). Concerning diagnostic quality, BHS-CS-SPACE-MRCP had the highest scores in lesion conspicuity (3.95 ± 0.92), confidence (4.12 ± 1.08), and communication (3.8 ± 1.06), significantly higher compared with NT-SPACE-MRCP, BHL-SPACE-MRCP, and NT-CS-SPACE-MRCP (p = <0.05). Conclusions MRCP with CS 3D SPACE for the evaluation of BD-IPMN at 1.5 T provides the best results using a short breath-hold sequence. This approach is feasible and an excellent alternative to standard NT 3D MRCP sequences. Key Points • 1.5-T MRCP with compressed sensing for the evaluation of branch duct IPMN is a feasible method. • Short breath-hold sequences provide the best results for this purpose.
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Affiliation(s)
- Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Michael Steurer
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michaela Plaikner
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | | | - Werner Jaschke
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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Bohn JP, Reinstadler V, Pall G, Stockhammer G, Steurer M, Oberacher H, Wolf D. Cerebrospinal Fluid Drug Concentrations and Clinical Outcome of Patients with Neoplastic Meningitis Treated with Liposomal Cytarabine. Eur J Drug Metab Pharmacokinet 2020; 44:845-851. [PMID: 31435852 PMCID: PMC6828631 DOI: 10.1007/s13318-019-00572-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Objective Liposomal cytarabine is a slow-release formulation for intrathecal application in patients with neoplastic meningitis. Although standard dosing intervals range from 2 to 4 weeks, it is unclear whether sustained cytotoxic cerebrospinal fluid (CSF) concentrations can be achieved beyond 14 days from drug injection. The objective of this study was to assess CSF and plasma concentrations of liposomal cytarabine more than 2 weeks after lumbar drug administration and to correlate those findings with clinical outcome. Methods 66 matched CSF and plasma drug concentrations were analyzed by a validated liquid chromatography–tandem mass spectrometry method starting at day 13 from lumbar drug injection in 19 patients with neoplastic meningitis treated with liposomal cytarabine. CSF drug concentrations were correlated with clinical outcome. Results Overall response rate was 63.2% (12/19). 100% (9/9) of patients with positive CSF cytology at diagnosis achieved cytological complete remission, and none of the patients (0/19) experienced on-drug disease progression. In responding patients with controlled systemic disease, CNS-specific progression-free survival was 14 months (n = 4; range 5–25 months). The median CSF concentration of free cytarabine was 156 ng/ml (range 5–4581 ng/ml) and 146 ng/ml (range 5–353 ng/ml) in samples withdrawn at days 13–16 and at days 25–29 after intrathecal drug injection, respectively. Free cytarabine concentrations > 100 ng/ml were detected in 58.8% (20/34) and 53.3% (7/13) of the CSF samples obtained at days 13–16 and days 25–29, respectively. CSF drug concentrations did not differ significantly between responding and nonresponding patients. Conclusion Liposomal cytarabine permits prolonged CSF drug exposure, with cytotoxic cytarabine concentrations that are detectable for 4 weeks in the majority of patients. The preserved clinical activity seen in patients with inferior CSF drug concentrations (< 100 ng/ml) suggests that maintaining lower cytarabine concentrations for a longer period of time may be similarly effective as using short peak concentrations.
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Affiliation(s)
- Jan-Paul Bohn
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Vera Reinstadler
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Pall
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Günther Stockhammer
- Department of Neurology and Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Steurer
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Herbert Oberacher
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dominik Wolf
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Medical Clinic 3, University Hospital Bonn, Bonn, Germany
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Stühlinger MC, Weltermann A, Staber P, Heintel D, Nösslinger T, Steurer M. Recommendations for ibrutinib treatment in patients with atrial fibrillation and/or elevated cardiovascular risk. Wien Klin Wochenschr 2020; 132:97-109. [PMID: 31414181 PMCID: PMC7035304 DOI: 10.1007/s00508-019-1534-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/09/2019] [Indexed: 12/12/2022]
Abstract
Ibrutinib is the first clinically approved inhibitor of Bruton's tyrosine kinase, an enzyme that is essential for survival and proliferation of B‑cells by activating the B‑cell receptor signalling pathway. Ibrutinib has been shown to be highly effective in B‑cell malignancies in clinical trials and is recommended in current international guidelines as a first and/or second line treatment of chronic lymphocytic leukemia. The drug has a favorable tolerability and safety profile but the occurrence of specific side effects (e.g. atrial fibrillation, bleeding and hypertension) may complicate or be of concern for doctors and patients considering the use of this treatment. In many cases, however, it is not necessary to withhold this effective therapy. In contrast, ibrutinib treatment can be initiated or continued, if certain recommendations are followed. The possibilities of prevention, diagnosis and management of specific clinical situations are discussed in detail and recommendations are derived, which should facilitate ibrutinib use.
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Affiliation(s)
- Markus C. Stühlinger
- University Clinic of Internal Medicine III/Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | | | - Philipp Staber
- University Clinic of Internal Medicine I, Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Daniel Heintel
- 1st Medical Department, Center for Oncology and Hematology, Wilhelminenspital Vienna, Vienna, Austria
| | - Thomas Nösslinger
- 3rd Medical Department, Hematology and Oncology, Hanusch Hospital Vienna, Vienna, Austria
| | - Michael Steurer
- University Clinic of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
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Miklos U, Strugov V, Lewerin C, Grosicki S, Mazur G, Steurer M, Montillo M, Kryachok I, Middeke JM, Rekhtman G, Stefanelli T, Vincent G, Govindaraju S, Österborg A. Five-year survival follow-up of a phase III randomised trial comparing ofatumumab versus physicians' choice for bulky fludarabine-refractory chronic lymphocytic leukaemia: a short report. Br J Haematol 2020; 189:689-693. [PMID: 31994178 DOI: 10.1111/bjh.16429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/08/2019] [Indexed: 11/28/2022]
Abstract
In 2014, an interim analysis of a phase 3 study was performed to evaluate the effectiveness of ofatumumab in patients with bulky fludarabine-refractory chronic lymphocytic leukaemia (BFR CLL) as compared to physician's choice. The five-year follow-up of this phase 3 trial showed that ofatumumab therapy resulted in a numerically but not significantly longer overall survival. As only few patients had the chance to receive a kinase inhibitor later, the study displays the survival of BFR CLL patients in the period prior to receiving small-molecule inhibitors. Ofatumumab is a well-tolerable treatment option in multiresistant advanced CLL.
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Affiliation(s)
- Udvardy Miklos
- Department of Hematology, Debrecen University, Debrecen, Hungary
| | - Vladimir Strugov
- Almazov National Medical Research Centre, St. Petersburg, Russian Federation
| | - Catharina Lewerin
- Section of Hematology and Coagulation, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Grosicki
- Department of Hematology and Cancer Prevention, Medical University of Silesia, Katowice, Poland
| | | | | | - Marco Montillo
- Department of Onco-Hematology, Division of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan, Italy
| | - Irina Kryachok
- Oncohematology, National Cancer Institute, Kyiv, Ukraine
| | - Jan M Middeke
- Medizinische Klinik I, Universitaetsklinikum C.G.Carus, Dresden, Germany
| | | | | | | | | | - Anders Österborg
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
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7
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Sztankay M, Neppl L, Wintner LM, Loth FL, Willenbacher W, Weger R, Weyrer W, Steurer M, Rumpold G, Holzner B. Complementing clinical cancer registry data with patient reported outcomes: A feasibility study on routine electronic patient-reported outcome assessment for the Austrian Myelome Registry. Eur J Cancer Care (Engl) 2019; 28:e13154. [PMID: 31465136 PMCID: PMC6900154 DOI: 10.1111/ecc.13154] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/22/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Routinely assessed patient-reported outcomes (PROs), such as quality of life (QOL), are important to supplement clinical cancer data but requires rigorous implementation. This study aims at depicting the implementation procedure and evaluating the feasibility of routine electronic PRO monitoring (ePRO) for collecting data supplementing the Austrian Myeloma Registry (AMR). METHODS Integration of ePRO monitoring into clinical routine was planned according to the Replicating Effective Programs framework. QOL data were assessed regularly during treatment and aftercare at the hematooncological outpatient unit at the Medical University of Innsbruck with the EORTC QLQ-C30/ +MY20 and the EQ-5D-5L. Feasibility and usability testing were performed via a multimethod approach. RESULTS Within the first year, 94.4% of the MM patients (N = 142, mean age 65.4, SD 11.8, 60% male) provided 748 PRO assessment time points overall. Patients and clinicians were satisfied with ePRO monitoring and indicated no to little disruption in clinical routine. Patient preference on assessment time points and completion frequency became evident. CONCLUSIONS Complementing the AMR with ePRO data proved to be feasible. Our findings provide useful insights for healthcare providers considering introducing ePRO monitoring to their units for informing clinical registries as well as individualised feedback to patients alike.
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Affiliation(s)
- Monika Sztankay
- Medical University of InnsbruckInnsbruckTirolAustria
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
- University of InnsbruckInnsbruckTirolAustria
| | - Lucia Neppl
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
| | - Lisa M. Wintner
- Medical University of InnsbruckInnsbruckTirolAustria
- University of InnsbruckInnsbruckTirolAustria
| | - Fanny L. Loth
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
| | - Wolfgang Willenbacher
- Internal Medicine V: Haematology & OncologyInnsbruck University HospitalInnsbruckTirolAustria
- Oncotyrol–Center for Personalized Cancer MedicineInnsbruckTirolAustria
| | - Roman Weger
- Oncotyrol–Center for Personalized Cancer MedicineInnsbruckTirolAustria
| | - Walpurga Weyrer
- Internal Medicine V: Haematology & OncologyInnsbruck University HospitalInnsbruckTirolAustria
| | - Michael Steurer
- Internal Medicine V: Haematology & OncologyInnsbruck University HospitalInnsbruckTirolAustria
| | | | - Bernhard Holzner
- Medical University of InnsbruckInnsbruckTirolAustria
- Psychiatry IIInnsbruck University HospitalInnsbruckTirolAustria
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Bohn J, Pircher A, Wanner D, Vill D, Foeger B, Wolf D, Steurer M. Low-dose vemurafenib in hairy cell leukemia patients with active infection. Am J Hematol 2019; 94:E180-E182. [PMID: 30916799 PMCID: PMC6593695 DOI: 10.1002/ajh.25474] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 03/20/2019] [Accepted: 03/25/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Jan‐Paul Bohn
- Internal Medicine V, Hematology and OncologyMedical University of Innsbruck Innsbruck Austria
| | - Andreas Pircher
- Internal Medicine V, Hematology and OncologyMedical University of Innsbruck Innsbruck Austria
| | - David Wanner
- Internal Medicine V, Hematology and OncologyMedical University of Innsbruck Innsbruck Austria
| | - David Vill
- Department of Internal MedicineAcademic Teaching Hospital Hall Hall Austria
| | - Bernhard Foeger
- Department of Internal MedicineHospital Bregenz Bregenz Austria
| | - Dominik Wolf
- Internal Medicine V, Hematology and OncologyMedical University of Innsbruck Innsbruck Austria
- Medical Clinic 3University Hospital Bonn Bonn Germany
| | - Michael Steurer
- Internal Medicine V, Hematology and OncologyMedical University of Innsbruck Innsbruck Austria
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Egle A, Jäger U, Skrabs C, Dürig J, Nösslinger T, Wanner D, Steurer M, Ringshausen I, Melchardt T, Greil R, Ysebaert L. UNMAINTAINED REMISSION AFTER DISCONTINUATION OF KINASE INHIBITOR TREATEMENT IN CHRONIC LYMPHOCYTIC LEUKEMIA: AN OBSERVATIONAL COHORT. Hematol Oncol 2019. [DOI: 10.1002/hon.33_2630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A. Egle
- 3rd Medical Department; Paracelsus Medical University; Salzburg Austria
| | - U. Jäger
- Dept. Internal Medicine I; Medical University Vienna; Vienna Austria
| | - C. Skrabs
- Dept. Internal Medicine I; Medical University Vienna; Vienna Austria
| | - J. Dürig
- Dept. Hematology; University Hospital Essen; Essen Germany
| | - T. Nösslinger
- 3rd Medical Department for Hematology and Oncology; Hanusch Hospital Vienna; Vienna Austria
| | - D. Wanner
- Dept. Internal Medicine V; Medical University Innsbruck; Innsbruck Austria
| | - M. Steurer
- Dept. Internal Medicine V; Medical University Innsbruck; Innsbruck Austria
| | - I. Ringshausen
- Department of Haematology; University of Cambridge; Cambridge United Kingdom
| | - T. Melchardt
- 3rd Medical Department; Paracelsus Medical University; Salzburg Austria
| | - R. Greil
- 3rd Medical Department; Paracelsus Medical University; Salzburg Austria
| | - L. Ysebaert
- Service d'Hématologie; IUCT-Oncopole; Toulouse France
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Steurer M, Montillo M, Scarfò L, Mauro FR, Andel J, Wildner S, Trentin L, Janssens A, Burgstaller S, Frömming A, Dümmler T, Riecke K, Baumann M, Beyer D, Vauléon S, Ghia P, Foà R, Caligaris-Cappio F, Gobbi M. Olaptesed pegol (NOX-A12) with bendamustine and rituximab: a phase IIa study in patients with relapsed/refractory chronic lymphocytic leukemia. Haematologica 2019; 104:2053-2060. [PMID: 31097627 PMCID: PMC6886437 DOI: 10.3324/haematol.2018.205930] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 05/09/2019] [Indexed: 01/04/2023] Open
Abstract
Olaptesed pegol (NOX-A12) is a pegylated structured L-oligoribonucleotide that binds and neutralizes CXCL12, a chemokine tightly regulating the life cycle of chronic lymphocytic leukemia cells. The resulting inhibition of CXCR4 and CXCR7 signaling reduces the protective activity of the bone marrow and lymph node microenvironment. CXCL12 inhibition mobilizes chronic lymphocytic leukemia cells into the circulation and prevents their homing into the protective niches. In this phase I/II study, 28 patients with relapsed/refractory chronic lymphocytic leukemia were treated with olaptesed pegol in combination with bendamustine and rituximab. Combination treatment was preceded by single escalating pilot doses of olaptesed pegol in the first ten patients for evaluation of safety and pharmacokinetics. Peak concentrations and systemic exposure of olaptesed pegol were dose-linear; plasma elimination was monophasic with a 53.2 h half-life. A rapid increase in circulating chronic lymphocytic leukemia cells was observed already 1 h after administration of olaptesed pegol and lasted for at least 72 h. Single-agent treatment was well tolerated and no dose-limiting toxicity was observed. The combination regimen yielded an overall response rate of 86%, with 11% of patients achieving a complete response and 75% a partial response. Notably, all ten high-risk patients, including four with a 17p deletion, responded to treatment. The median progression-free survival was 15.4 (95% confidence interval: 12.2, 26.2) months while the median overall survival was not reached with >80% of patients alive after a median follow-up of 28 months. Olaptesed pegol was well tolerated and did not result in additional toxicity when combined with bendamustine and rituximab (ClinicalTrials.gov identifier: NCT01486797). Further clinical development of this novel CXCL12 inhibitor is thus warranted.
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Affiliation(s)
- Michael Steurer
- Division of Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - Marco Montillo
- Department of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan, Italy
| | - Lydia Scarfò
- Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milan, Italy
| | - Francesca R Mauro
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | - Sophie Wildner
- Division of Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padua, Padua, Italy
| | - Ann Janssens
- Department of Hematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Sonja Burgstaller
- Department of Internal Medicine IV, Wels-Grieskirchen Hospital, Wels, Austria
| | | | - Thomas Dümmler
- NOXXON Pharma, Berlin, Germany.,current affiliation: Mologen AG, Berlin, Germany and
| | | | - Matthias Baumann
- NOXXON Pharma, Berlin, Germany.,current affiliation: Mologen AG, Berlin, Germany and
| | | | | | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milan, Italy
| | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | - Marco Gobbi
- Haematology Clinic, Department of Internal Medicine, University of Genoa, and Ospedale Policlinico S. Martino, Clinica Ematologica, Genoa, Italy
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11
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Egle A, Melchardt T, Obrtlíková P, Smolej L, Kozák T, Steurer M, Andel J, Burgstaller S, Mikušková E, Gercheva L, Nösslinger T, Papajík T, Ladická M, Girschikofsky M, Hrubiško M, Jäger U, Voskova D, Pecherstorfer M, Králiková E, Burcoveanu C, Spasov E, Petzer A, Mihaylov G, Raynov J, Oexle H, Zabernigg A, Flochová E, Palášthy S, Stehlíková O, Doubek M, Altenhofer P, Weiss L, Magnes T, Pleyer L, Klingler A, Mayer J, Greil R. Rituximab maintenance overcomes the negative prognostic factor of obesity in CLL: Subgroup analysis of the international randomized AGMT CLL-8a mabtenance trial. Cancer Med 2019; 8:1401-1405. [PMID: 30888118 PMCID: PMC6488104 DOI: 10.1002/cam4.1980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/18/2018] [Accepted: 12/27/2018] [Indexed: 11/29/2022] Open
Abstract
No data are available regarding obesity and outcome in Chronic Lymphocytic Leukemia (CLL). We analyzed 263 patients from the AGMT CLL‐8a Mabtenance trial for the impact of obesity. The trial included patients after rituximab‐containing induction treatment in first or second line that had achieved at least a PR. A randomization to rituximab maintenance treatment (375 mg/m2 q3 months for 2 years) vs observation was performed. In this cohort 22% of the patients (58/263) were classified as obese. The baseline response to induction treatment was inferior in obese patients with a lower CR rate (43.1% vs 60.5% in obese vs non‐obese, P = 0.018) and with a lower rate of patients achieving MRD negativity after chemoimmunotherapy induction treatment (19.6% vs 35.8%, P = 0.02). The PFS outcome of obese patients was significantly worse in the observation group of the trial (24 vs 39 months median PFS, P = 0.03). However, in the rituximab maintenance group the outcome for obese vs non‐obese was not different (P = 0.4). In summary, obesity was overall associated with a worse outcome of chemoimmunotherapy induction. However, rituximab maintenance treatment seems to be able to overcome this negative effect.
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Affiliation(s)
- Alexander Egle
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Thomas Melchardt
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Petra Obrtlíková
- First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Lukáš Smolej
- Fourth Department of Internal Medicine - Hematology, Faculty of Medicine in Hradec Králové, University Hospital and Charles University in Prague, Hradec Králové, Czech Republic
| | - Tomáš Kozák
- Department of Internal Medicine - Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michael Steurer
- Department of Internal Medicine V, Medical University Innsbruck, Innsbruck, Austria
| | | | - Sonja Burgstaller
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen GmbH, Wels, Austria
| | - Eva Mikušková
- Department of Hemato-oncology 2, National Cancer Institute Bratislava, Bratislava, Slovakia
| | - Liana Gercheva
- Clinic of Hematology, University Hospital St Marina Varna, Varna, Bulgaria
| | - Thomas Nösslinger
- Third Medical Department for Hematology and Oncology, Hanusch Krankenhaus der Wiener Gebietskrankenkasse, Vienna, Austria
| | - Tomáš Papajík
- Department of Hemato-oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Miriam Ladická
- Department of Clinical Oncology 1, National Cancer Institute Bratislava, Bratislava, Slovakia
| | | | - Mikuláš Hrubiško
- Clinic of Hematology and Transfusiology, Slovak Medical University, University Hospital Bratislava, Bratislava, Slovakia
| | - Ulrich Jäger
- Department of Medicine I, Division of Hematology and Hemostaeology, Medical University Vienna, Vienna, Austria
| | - Daniela Voskova
- Department of Internal Medicine 3, Kepler Universitätsklinikum GmbH, Med Campus III., Linz, Austria
| | - Martin Pecherstorfer
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University of Health Sciences, Krems, Austria
| | - Eva Králiková
- Department of Hematology, FNsP F D Roosevelta Banská Bystrica, Banska Bystrica, Slovakia
| | | | - Emil Spasov
- Clinic of Hematology, UMHAT St George and Medical University Plovdiv, Plovdiv, Bulgaria
| | - Andreas Petzer
- Innere Medizin I, Ordensklinikum Linz GmbH, Linz, Austria
| | - Georgi Mihaylov
- Hematological Clinic NSHATHD Sofia, Queen Joanna University Hospital, Sofia, Bulgaria
| | - Julian Raynov
- Clinic of Medical Hematology, Military Medical Academy Sofia, Sofia, Bulgaria
| | - Horst Oexle
- Innere Medizin, Landeskrankenhaus Hall, Hall in Tirol, Austria
| | - August Zabernigg
- Innere Medizin II, Bezirkskrankenhaus Kufstein, Kufstein, Austria
| | - Emília Flochová
- Department of Hematology and Transfusion, University Hospital Martin, Martin, Slovakia
| | - Stanislav Palášthy
- Department of Clinical Hematology, FNsP, J A Reimana Prešov, Prešov, Slovakia
| | - Olga Stehlíková
- Faculty of Medicine and CEITEC, University Hospital Brno, Brno, Czech Republic
| | - Michael Doubek
- Faculty of Medicine and CEITEC, University Hospital Brno, Brno, Czech Republic
| | - Petra Altenhofer
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lukas Weiss
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Teresa Magnes
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lisa Pleyer
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Anton Klingler
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - Jiří Mayer
- Faculty of Medicine and CEITEC, University Hospital Brno, Brno, Czech Republic
| | - Richard Greil
- Third Medical Department, Paracelsus Medical University Salzburg, Salzburg, Austria.,Salzburg Cancer Research Institute (SCRI), Salzburg, Austria.,Cancer Cluster Salzburg (CCS), Salzburg, Austria
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12
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Plaikner M, Kremser C, Zoller H, Steurer M, Glodny B, Jaschke W, Henninger B. Does gadoxetate disodium affect MRE measurements in the delayed hepatobiliary phase? Eur Radiol 2019; 29:829-837. [PMID: 30027410 PMCID: PMC6302879 DOI: 10.1007/s00330-018-5616-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/24/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess if the administration of gadoxetate disodium (Gd-EOB-DTPA) significantly affects hepatic magnetic resonance elastography (MRE) measurements in the delayed hepatobiliary phase (DHBP). METHODS A total of 47 patients (15 females, 32 males; age range 23-78 years, mean 54.28 years) were assigned to standard hepatic magnetic resonance imaging (MRI) with application of Gd-EOB-DTPA and hepatic MRE. MRE was performed before injection of Gd-EOB-DTPA and after 40-50 min in the DHBP. Liver stiffness values were obtained before and after contrast media application and differences between pre- and post-Gd-EOB-DTPA values were evaluated using a Bland-Altman plot and the Mann-Whitney-Wilcoxon test. In addition, the data were compared with regard to the resulting fibrosis classification. RESULTS Mean hepatic stiffness for pre-Gd-EOB-DTPA measurements was 4.01 kPa and post-Gd-EOB-DTPA measurements yielded 3.95 kPa. We found a highly significant individual correlation between pre- and post-Gd-EOB-DTPA stiffness values (Pearson correlation coefficient of r = 0.95 (p < 0.001) with no significant difference between the two measurements (p =0.49)). Bland-Altman plot did not show a systematic effect for the difference between pre- and post-stiffness measurements (mean difference: 0.06 kPa, SD 0.81). Regarding the classification of fibrosis stages, the overall agreement was 87.23% and the intraclass correlation coefficient was 96.4%, indicating excellent agreement. CONCLUSIONS Administration of Gd-EOB-DTPA does not significantly influence MRE stiffness measurements of the liver in the DHBP. Therefore, MRE can be performed in the DHBP. KEY POINTS • MRE of the liver can reliably be performed in the delayed hepatobiliary phase. • Gd-EOB-DTPA does not significantly influence MRE stiffness measurements of the liver. • MRE performed in the delayed hepatobiliary-phase is reasonable in patients with reduced liver function.
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Affiliation(s)
- M Plaikner
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - C Kremser
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - H Zoller
- Department of Internal Medicine, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - M Steurer
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - B Glodny
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - W Jaschke
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - B Henninger
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria.
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13
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Bohn JP, Willenbacher W, Haas G, Peschel I, Oberacher H, Steurer M. Pomalidomide in primary intraocular lymphoma. Leuk Lymphoma 2019; 60:1584-1586. [PMID: 30632826 DOI: 10.1080/10428194.2018.1538508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jan-Paul Bohn
- a Department of Internal Medicine V , Medical University of Innsbruck , Innsbruck , Austria
| | - Wolfgang Willenbacher
- a Department of Internal Medicine V , Medical University of Innsbruck , Innsbruck , Austria.,b Oncotyrol, Center for Personalized Cancer Medicine , Innsbruck , Austria
| | - Gertrud Haas
- c Department of Ophthalmology and Optometry , Medical University of Innsbruck , Innsbruck , Austria
| | - Ines Peschel
- d Central Institute for Medical and Chemical Laboratory Diagnostics , Medical University of Innsbruck , Innsbruck , Austria
| | - Herbert Oberacher
- e Institute of Legal Medicine and Core Facility Metabolomics , Medical University of Innsbruck , Innsbruck , Austria
| | - Michael Steurer
- a Department of Internal Medicine V , Medical University of Innsbruck , Innsbruck , Austria
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14
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Egle A, Steurer M, Melchardt T, Weiss L, Gassner FJ, Zaborsky N, Geisberger R, Catakovic K, Hartmann TN, Pleyer L, Voskova D, Thaler J, Lang A, Girschikofsky M, Petzer A, Greil R. Correction to: Fludarabine and rituximab with escalating doses of lenalidomide followed by lenalidomide/rituximab maintenance in previously untreated chronic lymphocytic leukaemia (CLL): the REVLIRIT CLL-5 AGMT phase I/II study. Ann Hematol 2018; 97:1745. [PMID: 29934835 PMCID: PMC6828337 DOI: 10.1007/s00277-018-3403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The original version of this article contained a mistake. The name of Tanja Nicole Hartman should have been Tanja Nicole Hartmann. The original article has been corrected.
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Affiliation(s)
- Alexander Egle
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Michael Steurer
- Division of Hematology and Oncology, Laboratory for Molecular Genetics and Diagnostics, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas Melchardt
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Franz Josef Gassner
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Nadja Zaborsky
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Roland Geisberger
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Kemal Catakovic
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Tanja Nicole Hartmann
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lisa Pleyer
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Daniela Voskova
- Centre for Hematology and Medical Oncology, Kepler University Hospital, Linz, Austria
| | - Josef Thaler
- Department for Internal Medicine IV, Hospital Wels-Grieskirchen, Wels, Austria
| | - Alois Lang
- Internal Medicine, Hospital, Feldkirch, Austria
| | - Michael Girschikofsky
- Internal Medicine I (Hemostasis, Hematology and Stem Cell Transplantation and Medical Oncology), Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Andreas Petzer
- Department for Internal Medicine IV, Hospital Barmherzige Schwestern Linz, Linz, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner-Hauptstr. 48, 5020, Salzburg, Austria.
- Salzburg Cancer Research Institute - Laboratory of Immunological and Molecular Cancer Research (SCRI-LIMCR) and Cancer Cluster Salzburg (CCS), Salzburg, Austria.
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15
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Abstract
Immune thrombocytopenia (ITP) is an acquired autoimmune phenomenon resulting in low platelet count and increased bleeding risk. Goals of upfront management include prompt control of severe bleeding-which is rare-as well as induction and maintenance of a hemostatic platelet count. Thus, optimal management of ITP patients is often challenging and requires a highly individualized approach. Many patients may not suffer significant bleeding despite severe thrombocytopenia and the risk of toxicity associated with treatment may outweigh its benefit. Most patients treated with standard first-line regimen of glucocorticoids achieve an initial response. However, the rate of long-term remission remains low and multiple lines of therapy are often required. Current investigations aim at defining the subgroup of patients at risk of relapse and providing intensified risk-balanced induction regimens to improve long-term disease control. This short review summarizes current and emerging treatment strategies in adult ITP.
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Affiliation(s)
- Jan-Paul Bohn
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Michael Steurer
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
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16
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Affiliation(s)
- Jan-Paul Bohn
- a Department of Internal Medicine V , Medical University of Innsbruck , Innsbruck , Austria
| | - Wolfgang Willenbacher
- a Department of Internal Medicine V , Medical University of Innsbruck , Innsbruck , Austria.,b Oncotyrol , Center for Personalized Cancer Medicine , Innsbruck , Austria
| | - Ines Peschel
- c Central Institute for Medical and Chemical Laboratory Diagnostics , Medical University Innsbruck , Innsbruck , Austria
| | - Herbert Oberacher
- d Institute of Legal Medicine and Core Facility Metabolomics , Medical University of Innsbruck , Innsbruck , Austria
| | - Michael Steurer
- a Department of Internal Medicine V , Medical University of Innsbruck , Innsbruck , Austria
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17
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Wanner D, Steurer M. Chronic lymphocytic leukemia at ASH 2017. Memo 2018; 11:105-108. [PMID: 29983825 PMCID: PMC6006235 DOI: 10.1007/s12254-018-0414-0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
At ASH (American Society of Hematology) 2017 three out of a plethora of trials showed remarkable and promising results. The combinations of venetoclax with rituximab and ibrutinib with venetoclax convinced with striking efficacy together with a manageable safety profile in relapsed/refractory setting as well as in first line therapy of high-risk disease. These two combinations are potential new standard treatment options in chronic lymphocytic leukemia.
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Affiliation(s)
- David Wanner
- Medical University Innsbruck, Innsbruck, Austria
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18
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Wanner D, Bohn JP, Rudzki J, Stockhammer G, Steurer M. Autoimmune myelitis in a CLL patient undergoing treatment with ibrutinib. Ann Hematol 2018; 98:205-207. [PMID: 29804266 DOI: 10.1007/s00277-018-3381-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/21/2018] [Indexed: 01/16/2023]
Affiliation(s)
- David Wanner
- Department of Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria.
| | - Jan-Paul Bohn
- Department of Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
| | - Jakob Rudzki
- Department of Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Michael Steurer
- Department of Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
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19
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Henninger B, Raithel E, Kranewitter C, Steurer M, Jaschke W, Kremser C. Evaluation of an accelerated 3D SPACE sequence with compressed sensing and free-stop scan mode for imaging of the knee. Eur J Radiol 2018; 102:74-82. [DOI: 10.1016/j.ejrad.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/30/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
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20
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Buxhofer-Ausch V, Steurer M, Sormann S, Schloegl E, Schimetta W, Gisslinger B, Schalling M, Krauth MT, Thiele J, Ruckser R, Gastl G, Gisslinger H. Impact of white blood cells on thrombotic risk in patients with optimized platelet count in essential thrombocythemia. Eur J Haematol 2018; 101:131-135. [PMID: 29603799 DOI: 10.1111/ejh.13070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Risk of thrombosis is significantly enhanced by both elevated platelet (PLT) and white blood cell (WBC) counts according to a retrospective analysis of a large anagrelide registry in thrombocythemic MPN patients. We were interested in the impact of elevated WBC counts on thrombosis risk in patients where PLT counts were reduced below the calculated cutoff of 574.5 G/L by treatment with anagrelide. METHODS Cox regression analysis and Kaplan-Meier plot were applied on all patients in the registry with optimized PLT counts. RESULTS Using the calculated cutoff of 9.66 G/L for WBC, Cox regression analysis revealed a clear influence of elevated WBC counts on the occurrence of a major thrombotic event (P = .012). A Kaplan-Meier plot revealed a markedly shorter time to a major thrombotic event for patients with WBC counts above the cutoff (P = .001). CONCLUSIONS These data suggest that additional correction of elevated WBC counts is mandatory in patients with optimally managed PLT counts to reduce thrombotic risk. This study is the first investigation in a prospectively observed large patient cohort which was treated homogenously allowing for evaluation of single parameters for an effect on thrombophilia.
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Affiliation(s)
- Veronika Buxhofer-Ausch
- Division of Hematology and Blood Coagulation, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine I, Ordensklinikum Linz, Elisabethinen Hospital, Linz, Austria
| | - Michael Steurer
- Division of Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Ernst Schloegl
- Department of Internal Medicine 3, Hanusch Hospital, Vienna, Austria
| | - Wolfgang Schimetta
- Department of Applied Systems Research and Statistics, Johannes Kepler University, Linz, Austria
| | - Bettina Gisslinger
- Division of Hematology and Blood Coagulation, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Martin Schalling
- Division of Hematology and Blood Coagulation, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Maria Theresa Krauth
- Division of Hematology and Blood Coagulation, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Jürgen Thiele
- Department of Pathology, University of Cologne, Cologne, Germany
| | | | - Günther Gastl
- Division of Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - Heinz Gisslinger
- Division of Hematology and Blood Coagulation, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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21
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Fontana MC, Marconi G, Milosevic Feenstra JD, Fonzi E, Papayannidis C, Ghelli Luserna di Rorá A, Padella A, Solli V, Franchini E, Ottaviani E, Ferrari A, Baldazzi C, Testoni N, Iacobucci I, Soverini S, Haferlach T, Guadagnuolo V, Semerad L, Doubek M, Steurer M, Racil Z, Paolini S, Manfrini M, Cavo M, Simonetti G, Kralovics R, Martinelli G. Chromothripsis in Acute Myeloid Leukemia: biological features and
impact on survival. Leukemia 2017:10.1038/leu.2017.351. [PMCID: PMC5892717 DOI: 10.1038/leu.2017.351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2022]
Abstract
Chromothripsis is a one-step genome-shattering catastrophe resulting from
disruption of one or few chromosomes in multiple fragments and consequent random
rejoining and repair. This study define incidence of chromothripsis in 395
newly-diagnosed adult acute myeloid leukemia (AML) patients from three
institutions, its impact on survival and its genomic background. SNP 6.0 or
CytoscanHD Array (Affymetrix®) were performed on all samples. We detected
chromothripsis with a custom algorithm in 26/395 patients. Patients harboring
chromothripsis had higher age (p=.002), ELN high risk (HR) (p<.001),
lower white blood cell (WBC) count (p=.040), TP53 loss and/or
mutations (p<.001) while FLT3 (p=.025) and
NPM1 (p=.032) mutations were mutually exclusive with
chromothripsis. Chromothripsis-positive patients showed a worse overall survival
(OS) (p<.001) compared with HR patients (p=.011) and a poor prognosis in
a COX-HR optimal regression model. Chromothripsis presented the hallmarks of
chromosome instability [i.e. TP53 alteration, 5q deletion,
higher mean of copy number alteration (CNA), complex karyotype, alterations in
DNA repair and cell cycle] and focal deletions on chromosomes 4, 7, 12, 16, 17.
CBA. FISH showed that chromothripsis is associated with marker, derivative and
ring chromosomes. In conclusion, chromothripsis frequently occurs in AML (6.6%)
and influences patient prognosis and disease biology.
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Affiliation(s)
| | - Giovanni Marconi
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | | | - Eugenio Fonzi
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | | | | | - Antonella Padella
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | - Vincenza Solli
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | - Eugenia Franchini
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | - Emanuela Ottaviani
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | - Anna Ferrari
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | - Carmen Baldazzi
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | - Nicoletta Testoni
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | - Ilaria Iacobucci
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | - Simona Soverini
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | | | | | - Lukas Semerad
- Department of Internal Medicine - Hematology and Oncology, Masaryk
University and Hospital, Brno, CR
| | - Michael Doubek
- Department of Internal Medicine - Hematology and Oncology, Masaryk
University and Hospital, Brno, CR
| | - Michael Steurer
- Division of Hematology and Oncology, Medical University of
Innsbruck, Innsbruck, Austria
| | - Zdenek Racil
- Department of Internal Medicine - Hematology and Oncology, Masaryk
University and Hospital, Brno, CR
| | - Stefania Paolini
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | - Marco Manfrini
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | - Michele Cavo
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | - Giorgia Simonetti
- Institute of Hematology “L. and A. Seràgnoli”,
University of Bologna, Italy
| | - Robert Kralovics
- CeMM Research Center for Molecular Medicine of the Austrian Academy
of Sciences, Wien, Austria
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22
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Abstract
Brain metastases are a major cause of morbidity and mortality in cancer patients. While the mainstay treatment comprises surgery and radiation therapy, the role of systemic agents remains controversial. In general, it has been presumed that poor blood-brain barrier (BBB) penetration and inherently more resistant metastatic brain disease preclude a favorable systemic treatment approach. However, a better understanding of tumor biology and the subsequent development of targeted drugs have reawakened interest in systemic therapy. Despite still limited brain distribution, a variety of targeted drugs have demonstrated activity in brain metastases in early clinical trials. Nevertheless, disease progression commonly occurs, and it remains to be elucidated whether limited CNS drug distribution or the acquisition of resistant metastatic clones must be held responsible for this prognosis. Moreover, micrometastatic brain disease beyond an intact BBB-and ultimately prevention of brain metastasis formation-may generally remain inaccessible for first-generation targeted agents with poor CNS penetration. To overcome limited brain distribution and possibly emerging acquired resistance, highly potent next-generation targeted drugs with enhanced CNS distribution have been developed. In view of this emerging but yet undefined role of targeted therapies in the treatment of brain metastases from solid tumors, this review aims to summarize the current knowledge from clinical trials and discusses clinically relevant obstacles to overcome.
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Affiliation(s)
- Jan-Paul Bohn
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
| | - Georg Pall
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Guenther Stockhammer
- Department of Neurology and Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Steurer
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
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23
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Crazzolara R, Kropshofer G, Steurer M, Sopper S, Schwinger W. Detection of Residual Donor Erythroid Progenitor Cells after Hematopoietic Stem Cell Transplantation for Patients with Hemoglobinopathies. J Vis Exp 2017. [PMID: 28930976 DOI: 10.3791/56002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The presence of incomplete chimerism is noted in a large proportion of patients following bone marrow transplant for thalassemia major or sickle cell disease. This observation has tremendous implications, as subsequent therapeutic immunomodulation strategies can improve clinical outcome. Conventionally, polymerase chain reaction-based analysis of short tandem repeats is used to identify chimerism in donor-derived blood cells. However, this method is restricted to nucleated cells and cannot distinguish between dissociated single-cell lineages. We applied the analysis of short tandem repeats to flow cytometric-sorted hematopoietic progenitor cells and compared this with the analysis of short tandem repeats obtained from selected burst-forming unit - erythroid colonies, both collected from the bone marrow. With this method we are able to demonstrate the different proliferation and differentiation of donor cells in the erythroid compartment. This technique is eligible to complete current monitoring of chimerism in the stem cell transplant setting and thus may be applied in future clinical studies, stem cell research and design of gene therapy trials.
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Affiliation(s)
| | | | - Michael Steurer
- Department of Internal Medicine V (Hematology & Oncology), Medical University Innsbruck
| | - Sieghart Sopper
- Department of Internal Medicine V (Hematology & Oncology), Medical University Innsbruck; Tyrolean Cancer Research Institute
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24
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Widmann G, Juranek D, Waldenberger F, Schullian P, Dennhardt A, Hoermann R, Steurer M, Gassner EM, Puelacher W. Influence of Ultra-Low-Dose and Iterative Reconstructions on the Visualization of Orbital Soft Tissues on Maxillofacial CT. AJNR Am J Neuroradiol 2017; 38:1630-1635. [PMID: 28596194 PMCID: PMC7960431 DOI: 10.3174/ajnr.a5239] [Citation(s) in RCA: 9] [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] [Received: 02/10/2017] [Accepted: 03/19/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Dose reduction on CT scans for surgical planning and postoperative evaluation of midface and orbital fractures is an important concern. The purpose of this study was to evaluate the variability of various low-dose and iterative reconstruction techniques on the visualization of orbital soft tissues. MATERIALS AND METHODS Contrast-to-noise ratios of the optic nerve and inferior rectus muscle and subjective scores of a human cadaver were calculated from CT with a reference dose protocol (CT dose index volume = 36.69 mGy) and a subsequent series of low-dose protocols (LDPs I-4: CT dose index volume = 4.18, 2.64, 0.99, and 0.53 mGy) with filtered back-projection (FBP) and adaptive statistical iterative reconstruction (ASIR)-50, ASIR-100, and model-based iterative reconstruction. The Dunn Multiple Comparison Test was used to compare each combination of protocols (α = .05). RESULTS Compared with the reference dose protocol with FBP, the following statistically significant differences in contrast-to-noise ratios were shown (all, P ≤ .012) for the following: 1) optic nerve: LDP-I with FBP; LDP-II with FBP and ASIR-50; LDP-III with FBP, ASIR-50, and ASIR-100; and LDP-IV with FBP, ASIR-50, and ASIR-100; and 2) inferior rectus muscle: LDP-II with FBP, LDP-III with FBP and ASIR-50, and LDP-IV with FBP, ASIR-50, and ASIR-100. Model-based iterative reconstruction showed the best contrast-to-noise ratio in all images and provided similar subjective scores for LDP-II. ASIR-50 had no remarkable effect, and ASIR-100, a small effect on subjective scores. CONCLUSIONS Compared with a reference dose protocol with FBP, model-based iterative reconstruction may show similar diagnostic visibility of orbital soft tissues at a CT dose index volume of 2.64 mGy. Low-dose technology and iterative reconstruction technology may redefine current reference dose levels in maxillofacial CT.
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Affiliation(s)
- G Widmann
- From the Departments of Radiology (G.W., P.S., M.S., E.-M.G.)
| | - D Juranek
- Craniomaxillofacial Surgery (D.J., F.W., A.D., W.P.)
| | | | - P Schullian
- From the Departments of Radiology (G.W., P.S., M.S., E.-M.G.)
| | - A Dennhardt
- Craniomaxillofacial Surgery (D.J., F.W., A.D., W.P.)
| | - R Hoermann
- Division of Functional and Clinical Anatomy (R.H.), Innsbruck Medical University, Innsbruck, Austria
| | - M Steurer
- From the Departments of Radiology (G.W., P.S., M.S., E.-M.G.)
| | - E-M Gassner
- From the Departments of Radiology (G.W., P.S., M.S., E.-M.G.)
| | - W Puelacher
- Craniomaxillofacial Surgery (D.J., F.W., A.D., W.P.)
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25
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Bruderer U, Fisler A, Steurer MP, Steurer M, Dullenkopf A. Post-discharge nausea and vomiting after total intravenous anaesthesia and standardised PONV prophylaxis for ambulatory surgery. Acta Anaesthesiol Scand 2017. [PMID: 28626981 DOI: 10.1111/aas.12921] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The incidence of post-discharge nausea and vomiting (PDNV) after ambulatory anaesthesia using total intravenous anaesthesia with a risk-stratified anti-emetic approach is not well documented in the literature. In this study, we outline such an approach. The goal was to achieve an acceptably low rate of PDNV both immediately and the day after surgery. METHODS With ethics committee approval, adult patients undergoing outpatient surgery received a Propofol-based general anaesthetic plus standardised PONV-prophylaxis corresponding to their Apfel risk-score (0-4); ondansetron (risk-score 2), additional dexamethasone (risk-score 3), and additional droperidol (risk-score 4). On post-operative days one and two, patients scored PDNV and pain (numeric rating scale (NRS); 0 = none at all; 10 = worst imaginable). On post-operative day two, patients indicated the level of interference of PDNV and/or pain with their quality of life. Data are descriptive (%) or mean. RESULTS There were 222 patients included (age 43 years, 44% female, anaesthesia time 95 min). On the day of surgery, 69.4% of patients did not experience any nausea, 10.4% complained about severe (NRS > 6) nausea, 6.3% experienced vomiting or retching. On the first and second postoperative day, nausea was absent in 88.7% of patients and 97.3%, respectively. Quality of life was impacted (NRS ≥ 4) more by pain (32.8% of cases), than by PDNV (13.6%). CONCLUSION Acceptably low rates of PDNV were achieved with the proposed standardised approach to PDNV prophylaxis. For almost 90% of patients, PDNV was not an issue the first day after surgery. Pain after discharge was a more common problem.
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Affiliation(s)
- U. Bruderer
- Department of Anaesthesiology and Intensive Care Medicine; Kantonsspital Frauenfeld; Frauenfeld Switzerland
| | - A. Fisler
- Department of Anaesthesiology and Intensive Care Medicine; Kantonsspital Frauenfeld; Frauenfeld Switzerland
| | - M. P. Steurer
- Department of Anesthesia and Perioperative Care; University of California; San Francisco CA USA
| | - M. Steurer
- Department of Pediatrics; University of California; San Francisco CA USA
| | - A. Dullenkopf
- Department of Anaesthesiology and Intensive Care Medicine; Kantonsspital Frauenfeld; Frauenfeld Switzerland
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26
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Piccin A, Steurer M, Feistritzer C, Murphy C, Eakins E, Van Schilfgaarde M, Corvetta D, Di Pierro AM, Pusceddu I, Marcheselli L, Gambato R, Langes M, Veneri D, Perbellini O, Pacquola E, Gottardi M, Gherlinzoni F, Mega A, Tauber M, Mazzoleni G, Piva E, Plebani M, Krampera M, Gastl G. Observational retrospective study of vascular modulator changes during treatment in essential thrombocythemia. Transl Res 2017; 184:21-34. [PMID: 28259616 DOI: 10.1016/j.trsl.2017.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Received: 07/30/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 02/07/2023]
Abstract
Essential thrombocythemia (ET) patients are at risk of developing thrombotic events. Qualitative platelet (PLT) abnormalities and activation of endothelial cells (ECs) and PLTs are thought to be involved. Microparticles (MPs) can originate from PLTs (PMPs), ECs (EMPs), or red cells (RMPs). Previous studies have indicated that MPs contribute to ET pathophysiology. Endothelial modulators (eg, nitric oxide [NO], adrenomedullin [ADM], and endothelin-1 [ET-1]) are also involved in the pathophysiology of this condition. We hypothesized that treatments for reducing PLT count might also indirectly affect MP generation and endothelial activity by altering endothelial modulator production. The rationale of this study was that hydroxyurea (HU), a cytostatic drug largely used in ET, induces the production of a potent vasoactive agent NO in ECs. An observational retrospective study was designed to investigate the relationship between MPs, NO, ADM, and ET-1 in ET patients on treatment with HU, anagrelide (ANA), aspirin (ASA), and a group of patients before treatment. A total of 63 patients with ET diagnosis: 18 on HU + ASA, 15 on ANA + ASA, 19 on ASA only, and 11 untreated patients, and 18 healthy controls were included in this study. Blood samples were analyzed for MP (absolute total values) and functional markers (percentage values) by flow cytometry. PLT-derived MPs were studied using CD61, CD62P, CD36, and CD63, whereas endothelial-derived MPs were studied using CD105, CD62E, and CD144. Endothelial modulator markers (NO, ADM, and ET-1) were measured by ELISA. Total MP count was higher in the group treated with ANA + ASA (P < 0.01). MP markers modified in ET patients returned to levels of healthy controls following treatment, in particular, in patients on ANA treatment. NO and ADM values were higher in the HU group (P < 0.001). HU and ANA treatment also affected MP production in a cell origin-specific manner. HU and ANA, although acting via different pathways, have similar final effects. For instance, HU causes vasodilatation by increasing NO and ADM levels, whereas ANA impairs vasoconstriction by reducing ET-1. In conclusion, therapy with HU cytostatic drugs and ANA can reduce PLT count in ET, and also affect endothelial modulatory agents, with HU sustaining vasodilation and prothrombotic MP concentration, whereas ANA decreases vasoconstriction.
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Affiliation(s)
- Andrea Piccin
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria; Department of Haematology, San Maurizio Regional Hospital, Bolzano/Bozen, South Tyrol, Italy; Irish Blood Transfusion Service, Dublin, Ireland; IMREST Interdisciplinary Medical Research Center South Tyrol, Italy.
| | - Michael Steurer
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | - Clemens Feistritzer
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elva Eakins
- Irish Blood Transfusion Service, Dublin, Ireland
| | | | - Daisy Corvetta
- Department of Haematology, San Maurizio Regional Hospital, Bolzano/Bozen, South Tyrol, Italy; IMREST Interdisciplinary Medical Research Center South Tyrol, Italy
| | - Angela Maria Di Pierro
- IMREST Interdisciplinary Medical Research Center South Tyrol, Italy; Central Laboratory, San Maurizio Regional Hospital, Bolzano/Bozen, South Tyrol, Italy
| | - Irene Pusceddu
- IMREST Interdisciplinary Medical Research Center South Tyrol, Italy; Central Laboratory, San Maurizio Regional Hospital, Bolzano/Bozen, South Tyrol, Italy
| | - Luigi Marcheselli
- Department of Diagnostic, Medicine University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Gambato
- Department of Haematology, San Maurizio Regional Hospital, Bolzano/Bozen, South Tyrol, Italy
| | - Martin Langes
- Department of Haematology, San Maurizio Regional Hospital, Bolzano/Bozen, South Tyrol, Italy
| | - Dino Veneri
- Department of Haematology, University of Medicine, Verona, Italy
| | - Omar Perbellini
- Department of Haematology, University of Medicine, Verona, Italy
| | - Enrica Pacquola
- Department of Haematology, Cà Foncello Hospital, Treviso, Italy
| | | | | | - Andrea Mega
- IMREST Interdisciplinary Medical Research Center South Tyrol, Italy; Department of Gastroenterology, San Maurizio Regional Hospital, Bolzano/Bozen, South Tyrol, Italy
| | - Martina Tauber
- Department of Pathology, San Maurizio Regional Hospital, Bolzano/Bozen, South Tyrol, Italy
| | - Guido Mazzoleni
- Department of Pathology, San Maurizio Regional Hospital, Bolzano/Bozen, South Tyrol, Italy
| | - Elisa Piva
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Mauro Krampera
- Department of Haematology, University of Medicine, Verona, Italy
| | - Günther Gastl
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
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Cines DB, Wasser J, Rodeghiero F, Chong BH, Steurer M, Provan D, Lyons R, Garcia-Chavez J, Carpenter N, Wang X, Eisen M. Safety and efficacy of romiplostim in splenectomized and nonsplenectomized patients with primary immune thrombocytopenia. Haematologica 2017; 102:1342-1351. [PMID: 28411254 PMCID: PMC5541869 DOI: 10.3324/haematol.2016.161968] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/12/2017] [Indexed: 02/02/2023] Open
Abstract
Primary immune thrombocytopenia is an autoimmune disorder characterized by increased platelet destruction and insufficient platelet production without another identified underlying disorder. Splenectomy may alter responsiveness to treatment and/or increase the risk of thrombosis, infection, and pulmonary hypertension. The analysis herein evaluated the safety and efficacy of the thrombopoietin receptor agonist romiplostim in splenectomized and nonsplenectomized adults with primary immune thrombocytopenia. Data were pooled across 13 completed clinical studies in adults with immune thrombocytopenia from 2002-2014. Adverse event rates were adjusted for time of exposure. Results were considered different when 95% confidence intervals were non-overlapping. Safety was analyzed for 1111 patients (395 splenectomized; 716 nonsplenectomized) who received romiplostim or control (placebo or standard of care). At baseline, splenectomized patients had a longer median duration of immune thrombocytopenia and a lower median platelet count, as well as a higher proportion with >3 prior immune thrombocytopenia treatments versus nonsplenectomized patients. In each treatment group, splenectomized patients used rescue medications more often than nonsplenectomized patients. Platelet response rates (≥50×109/L) for romiplostim were 82% (310/376) for splenectomized and 91% (592/648) for nonsplenectomized patients (P<0.001 by Cochran-Mantel-Haenszel test). Platelet responses were stable over time in both subgroups. Exposure-adjusted adverse event rates were higher for control versus romiplostim for both splenectomized (1857 versus 1226 per 100 patient-years) and nonsplenectomized patients (1052 versus 852 per 100 patient-years). In conclusion, responses to romiplostim were seen in both splenectomized and nonsplenectomized patients, and romiplostim was not associated with an increase in the risk of adverse events in splenectomized patients. clinicaltrials.gov Identifier: 00111475(A)(B), 00117143, 00305435, 01143038, 00102323, 00102336, 00415532, 00603642, 00508820, 00907478, 00116688, and 00440037.
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Affiliation(s)
- Douglas B Cines
- Perelman University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Jeffrey Wasser
- University of Connecticut Health Center, Farmington, CT, USA
| | - Francesco Rodeghiero
- Hematology Project Foundation, Vicenza, Italy.,San Bortolo Hospital, Vicenza, Italy
| | - Beng H Chong
- St George Hospital/University of New South Wales, Sydney, Australia
| | | | - Drew Provan
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Roger Lyons
- Texas Oncology and US ONCOLOGY Research, San Antonio, TX
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28
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Wieser T, Steurer MP, Steurer M, Dullenkopf A. Factors influencing the level of patients using the internet to gather information before anaesthesia: a single-centre survey of 815 patients in Switzerland : The internet for patient information before anaesthesia. BMC Anesthesiol 2017; 17:39. [PMID: 28270097 PMCID: PMC5341440 DOI: 10.1186/s12871-017-0319-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 02/13/2017] [Indexed: 11/23/2022] Open
Abstract
Background Aim of this study was to identify factors associated with patients using the internet to find information about their upcoming surgery in general, and more specifically about anaesthesia. Methods With Ethics committee approval, 1000 consecutive patients seen before elective surgery in the anaesthesia preoperative clinic of a Swiss Level 2 hospital were asked to complete a questionnaire. Primary outcome were patients using the internet to gather any medical information related to their upcoming hospital stay, secondary outcome patients using the internet to gather information regarding the upcoming anaesthesia. Multiple regression was performed to identify independent factors associated with internet use. Results Eighty-two percent of the patients (n = 815) participated. 97% of those were ASA physical status 1 or 2; 83% (n = 676) had experience with previous anaesthetics, 86% (n = 700) reported to use the internet in general. Overall, about one-third of the participants used the internet to learn more about their medical condition, 26% regarding their upcoming surgical procedure. Only 7% (n = 55) obtained information about the anaesthetic. In multivariate analyses, factors associated with internet use were generally doing so, and planned moderate compared to minor surgery; not using the internet was associated with previous anaesthetic experience. Of those who did not use the Internet to learn about their anaesthetic, 34% indicated that they would have visited a trusted website. Conclusion Only few patients used the internet to obtain information about their upcoming procedure and the anaesthetic part played an even smaller role. However, many patients would have appreciated guidance to find trustworthy internet sites. Trial registration German Clinical Trials Register (DRKS00005434; date of registration: 27th December 2013); date of enrolment of first patient: 1st August 2013; study retrospectively registered.
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Affiliation(s)
- T Wieser
- Department of Anaesthesiology and Intensive Care Medicine, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - M P Steurer
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, USA
| | - M Steurer
- Department of Pediatrics, UCSF, San Francisco, USA
| | - A Dullenkopf
- Department of Anaesthesiology and Intensive Care Medicine, Kantonsspital Frauenfeld, Frauenfeld, Switzerland.
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29
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Affiliation(s)
- Jan-Paul Bohn
- a Department of Internal Medicine V , Medical University of Innsbruck , Innsbruck , Austria
| | - David Wanner
- a Department of Internal Medicine V , Medical University of Innsbruck , Innsbruck , Austria
| | - Michael Steurer
- a Department of Internal Medicine V , Medical University of Innsbruck , Innsbruck , Austria
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30
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Steurer M, Quittet P, Papadaki HA, Selleslag D, Viallard JF, Kaiafa G, Janssens A, Kozak T, Wadenvik H, Schoonen M, Belton L, Kreuzbauer G. A large observational study of patients with primary immune thrombocytopenia receiving romiplostim in European clinical practice. Eur J Haematol 2016; 98:112-120. [DOI: 10.1111/ejh.12807] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Steurer
- Division of Haematology and Oncology; Innsbruck Medical University; Innsbruck Austria
| | | | - Helen A. Papadaki
- Department of Haematology; University of Crete School of Medicine; University Hospital of Heraklion; Crete Greece
| | | | | | - Georgia Kaiafa
- AHEPA University General Hospital; Medical Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Ann Janssens
- Department of Haematology; University Hospitals Leuven; Leuven Belgium
| | - Tomas Kozak
- 3rd Medical Faculty; Charles University; Prague Czech Republic
| | - Hans Wadenvik
- Section of Haematology; Sahlgrenska University Hospital; Gothenburg Sweden
| | | | | | - Georg Kreuzbauer
- International Medical Development and Research; Amgen (Europe) GmbH; Zug Switzerland
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31
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Kropshofer G, Sopper S, Steurer M, Schwinger W, Crazzolara R. Successful management of mixed chimerism after bone marrow transplant in beta-thalassemia major. Am J Hematol 2016; 91:E357-8. [PMID: 27239048 DOI: 10.1002/ajh.24436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 05/22/2016] [Accepted: 05/24/2016] [Indexed: 11/08/2022]
Affiliation(s)
| | - Sieghart Sopper
- Tyrolean Cancer Research Institute; Innsbruck Austria
- Department of Internal Medicine V (Hematology & Oncology); Medical University Innsbruck; Innsbruck Austria
| | - Michael Steurer
- Department of Internal Medicine V (Hematology & Oncology); Medical University Innsbruck; Innsbruck Austria
| | | | - Roman Crazzolara
- Department of Pediatrics; Medical University Innsbruck; Innsbruck Austria
- Tyrolean Cancer Research Institute; Innsbruck Austria
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32
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Jaeger T, Muendlein A, Hodaie J, Untergasser G, Steurer M, Saely CH, Drexel H, Lang AH. Prevalence of calreticulin exon 9 indel mutations in vascular risk patients. Thromb Res 2016; 144:215-7. [DOI: 10.1016/j.thromres.2016.06.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/29/2016] [Indexed: 01/31/2023]
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Bohn JP, Gastl G, Steurer M. Long-term treatment of hairy cell leukemia with interferon-α: still a viable therapeutic option. Memo 2016; 9:63-65. [PMID: 27429657 PMCID: PMC4923076 DOI: 10.1007/s12254-016-0269-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/24/2016] [Indexed: 11/21/2022]
Abstract
Classic hairy cell leukemia (HCL) is a rare indolent B‑cell-lymphoproliferative disorder, first described as a distinct disease entity in 1958. After more than two decades without effective chemotherapeutic options and a dismal prognosis of less than 5 years, only the introduction of interferon‑α (IFN‑α) allowed for response rates between 80–90 % and survival improvement. Nowadays, however, patients are rarely treated with IFN-α as purine analogues were found to be highly effective in HCL facilitating a near normal life span in most cases. Moreover, novel therapeutic tools for patients with relapsed or refractory disease after purine analogues have emerged such as rituximab and, more recently, vemurafenib. In the absence of long-term safety data for these novel agents, however, IFN-α may still represent a viable therapeutic option when the profound immunosuppressive side effects of purine analogues are to be avoided. We herein report a HCL patient, who has received multiple lines of therapy, including pentostatin, cladribine, and a total of 164 months of treatment with IFN‑α yielding long-term disease control. Our case illustrates that long-term administration of IFN-α with adequate dose-adjustments according to toxicity and disease activity is feasible in HCL and may still be a viable therapeutic option when purine analogues are considered unsuitable.
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Affiliation(s)
- Jan-Paul Bohn
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Guenther Gastl
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Michael Steurer
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Greil R, Obrtlíková P, Smolej L, Kozák T, Steurer M, Andel J, Burgstaller S, Mikušková E, Gercheva L, Nösslinger T, Papajík T, Ladická M, Girschikofsky M, Hrubiško M, Jäger U, Fridrik M, Pecherstorfer M, Králiková E, Burcoveanu C, Spasov E, Petzer A, Mihaylov G, Raynov J, Oexle H, Zabernigg A, Flochová E, Palášthy S, Stehlíková O, Doubek M, Altenhofer P, Pleyer L, Melchardt T, Klingler A, Mayer J, Egle A. Rituximab maintenance versus observation alone in patients with chronic lymphocytic leukaemia who respond to first-line or second-line rituximab-containing chemoimmunotherapy: final results of the AGMT CLL-8a Mabtenance randomised trial. Lancet Haematol 2016; 3:e317-29. [PMID: 27374465 DOI: 10.1016/s2352-3026(16)30045-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/29/2016] [Accepted: 05/04/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND In many patients with chronic lymphocytic leukaemia requiring treatment, induction therapy with rituximab plus chemotherapy improves outcomes compared with chemotherapy alone. In this study we aimed to investigate the potential of rituximab maintenance therapy to prolong disease control in patients who respond to rituximab-containing induction regimens. METHODS In this randomised, international, multicentre, open-label, phase 3 clinical trial, we enrolled patients who had achieved a complete response (CR), CR with incomplete bone marrow recovery (CRi), or partial response (PR) to first-line or second-line rituximab-containing chemoimmunotherapy and randomly assigned them in a 1:1 ratio (central block randomisation in the electronic case report form system) to either intravenous rituximab 375 mg/m(2) every 3 months, or observation alone, for 2 years. Stratification was by country, line of treatment, type of chemotherapy added to the rituximab backbone, and degree of remission following induction. The primary endpoint was progression-free survival. Efficacy analysis was done in the intention-to-treat population. This is the final, event-triggered analysis. Final analysis was triggered by the occurrence of 92 events. This trial is registered with ClinicalTrials.gov, number NCT01118234. FINDINGS Between April 1, 2010, and Dec 23, 2013, 134 patients were randomised to rituximab and 129 to observation alone. Median observation times were 33·4 months (IQR 25·7-42·8) for the rituximab group and 34·0 months (25·4-41·9) for the observation group. Progression-free survival was significantly longer in the rituximab maintenance group (47·0 months, IQR 28·5-incalculable) than with observation alone (35·5 months, 95% CI 25·7-46·3; hazard ratio [HR] 0·50, 95% CI 0·33-0·75, p=0·00077). The incidence of grade 3-4 haematological toxicities other than neutropenia was similar in the two treatment groups. Grade 3-4 neutropenia occurred in 28 (21%) patients in the rituximab group and 14 (11%) patients in the observation group. Apart from neutropenia, the most common grade 3-4 adverse events were upper (five vs one [1%] patient in the observation group) and lower (three [2%] vs one [1%]) respiratory tract infection, pneumonia (nine [7%] vs two [2%]), thrombopenia (four [3%] vs four [3%]), neoplasms (five [4%] vs four [3%]), and eye disorders (four [3%] vs two [2%]). The overall incidence of infections of all grades was higher among rituximab recipients (88 [66%] vs 65 [50%]). INTERPRETATION Rituximab maintenance therapy prolongs progression-free survival in patients achieving at least a PR to induction with rituximab plus chemotherapy, and the treatment is well tolerated overall. Although it is associated with an increase in infections, there is no excess in infection mortality, suggesting that remission maintenance with rituximab is an effective and safe option in the management of chronic lymphocytic leukaemia in early treatment phases. FUNDING Arbeitsgemeinschaft Medikamentöse Tumortherapie gemeinnützige GmbH (AGMT), Roche.
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Affiliation(s)
- Richard Greil
- Third Medical Department at the Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Cancer Cluster Salzburg (CCS), Salzburg, Austria.
| | - Petra Obrtlíková
- First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Lukáš Smolej
- Fourth Department of Internal Medicine-Hematology, University Hospital and Charles University in Prague, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
| | - Tomáš Kozák
- Department of Internal Medicine-Hematology, Univ Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michael Steurer
- Department of Internal Medicine V, Medical University Innsbruck, Austria
| | - Johannes Andel
- Abteilung für Innere Medizin III, Landeskrankenhaus Steyr, Austria
| | - Sonja Burgstaller
- Abteilung für Innere Medizin IV, Klinikum Wels-Grieskirchen GmbH, Austria
| | - Eva Mikušková
- Department of Hematooncology 2, National Cancer Institute, Bratislava, Slovakia
| | - Liana Gercheva
- Clinic of Hematology, University Hospital St Marina, Varna, Bulgaria
| | - Thomas Nösslinger
- Third Medical Department for Hematology and Oncology, Hanusch Krankenhaus der Wiener Gebietskrankenkasse, Vienna, Austria
| | - Tomáš Papajík
- Department of Hemato-oncology, University Hospital, Olomouc, Czech Republic
| | - Miriam Ladická
- Department of Clinical Oncology 1, National Cancer Institute, Bratislava, Slovakia
| | | | - Mikuláš Hrubiško
- Clinic of Hematology and Transfusiology, Slovak Medical University, University Hospital Bratislava, Slovakia
| | - Ulrich Jäger
- Department of Medicine I, Division of Hematology and Hemostaeology, Medical University Vienna, Austria
| | - Michael Fridrik
- Department of Internal Medicine 3, Kepler Universitätsklinikum GmbH, Med Campus III, Linz, Austria
| | - Martin Pecherstorfer
- University Hospital Krems, Karl Landsteiner Private University of Health Sciences, Department of Internal Medicine 2, Krems, Austria
| | - Eva Králiková
- Department of Hematology, FNsP F D Roosevelta, Banská Bystrica, Slovakia
| | | | - Emil Spasov
- Clinic of Hematology, UMHAT St George and Medical University, Plovdiv, Bulgaria
| | - Andreas Petzer
- Innere Medizin I, Krankenhaus der Barmherzigen Schwestern Linz, Linz, Austria
| | | | - Julian Raynov
- Clinic of Medical Hematology, Military Medical Academy, Sofia, Bulgaria
| | - Horst Oexle
- Innere Medizin, Landeskrankenhaus Hall, Austria
| | | | - Emília Flochová
- Department of Hematology and Transfusion, University Hospital Martin, Martin, Slovakia
| | | | - Olga Stehlíková
- University Hospital, Faculty of Medicine and CEITEC, Brno, Czech Republic
| | - Michael Doubek
- University Hospital, Faculty of Medicine and CEITEC, Brno, Czech Republic
| | - Petra Altenhofer
- Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Lisa Pleyer
- Third Medical Department at the Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Thomas Melchardt
- Third Medical Department at the Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Cancer Cluster Salzburg (CCS), Salzburg, Austria
| | - Anton Klingler
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - Jiří Mayer
- University Hospital, Faculty of Medicine and CEITEC, Brno, Czech Republic
| | - Alexander Egle
- Third Medical Department at the Paracelsus Medical University Salzburg, Salzburg, Austria; Salzburg Cancer Research Institute (SCRI), Salzburg, Austria; Cancer Cluster Salzburg (CCS), Salzburg, Austria
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Buxhofer‐Ausch V, Steurer M, Sormann S, Schloegl E, Schimetta W, Gisslinger B, Ruckser R, Gastl G, Gisslinger H. Influence of platelet and white blood cell counts on major thrombosis – analysis from a patient registry in essential thrombocythemia. Eur J Haematol 2016; 97:511-516. [DOI: 10.1111/ejh.12759] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Veronika Buxhofer‐Ausch
- Division of Hematology and Blood Coagulation Department of Internal Medicine I Medical University of Vienna Vienna Austria
- Department of Internal Medicine I Elisabethinen Hospital Linz Linz Austria
| | - Michael Steurer
- Division of Hematology and Oncology Innsbruck Medical University Innsbruck Austria
| | | | - Ernst Schloegl
- Department of Internal Medicine 3 Hanusch Hospital Vienna Austria
| | - Wolfgang Schimetta
- Department of Applied Systems Research and Statistics Johannes Kepler University Linz Austria
| | - Bettina Gisslinger
- Division of Hematology and Blood Coagulation Department of Internal Medicine I Medical University of Vienna Vienna Austria
| | | | - Günther Gastl
- Division of Hematology and Oncology Innsbruck Medical University Innsbruck Austria
| | - Heinz Gisslinger
- Division of Hematology and Blood Coagulation Department of Internal Medicine I Medical University of Vienna Vienna Austria
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Österborg A, Udvardy M, Zaritskey A, Andersson PO, Grosicki S, Mazur G, Kaplan P, Steurer M, Schuh A, Montillo M, Kryachok I, Middeke JM, Kulyaba Y, Rekhtman G, Gorczyca M, Daly S, Chang CN, Lisby S, Gupta I. Phase III, randomized study of ofatumumab versus physicians’ choice of therapy and standard versus extended-length ofatumumab in patients with bulky fludarabine-refractory chronic lymphocytic leukemia. Leuk Lymphoma 2016; 57:2037-46. [DOI: 10.3109/10428194.2015.1122783] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ludwig H, Evstatiev R, Kornek G, Aapro M, Bauernhofer T, Buxhofer-Ausch V, Fridrik M, Geissler D, Geissler K, Gisslinger H, Koller E, Kopetzky G, Lang A, Rumpold H, Steurer M, Kamali H, Link H. Iron metabolism and iron supplementation in cancer patients. Wien Klin Wochenschr 2015; 127:907-19. [PMID: 26373748 PMCID: PMC4679104 DOI: 10.1007/s00508-015-0842-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/29/2015] [Indexed: 12/21/2022]
Abstract
Iron deficiency and iron deficiency-associated anemia are common complications in cancer patients. Most iron deficient cancer patients present with functional iron deficiency (FID), a status with adequate storage iron, but insufficient iron supply for erythroblasts and other iron dependent tissues. FID is the consequence of the cancer-associated cytokine release, while in absolute iron deficiency iron stores are depleted resulting in similar but often more severe symptoms of insufficient iron supply. Here we present a short review on the epidemiology, pathophysiology, diagnosis, clinical symptoms, and treatment of iron deficiency in cancer patients. Special emphasis is given to intravenous iron supplementation and on the benefits and limitations of different formulations. Based on these considerations and recommendations from current international guidelines we developed recommendations for clinical practice and classified the level of evidence and grade of recommendation according to the principles of evidence-based medicine.
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Affiliation(s)
- Heinz Ludwig
- c/o 1. Medizinische Abteilung, Zentrum für Onkologie, Wilhelminen-Krebsforschungsinstitut, Wilhelminenspital, Montleartstraße 37, 1160, Wien, Austria.
| | - Rayko Evstatiev
- Universitätsklinik für Innere Medizin III, MedUni, Wien, Austria
| | - Gabriela Kornek
- Universitätsklinik für Innere Medizin I, MedUni, Wien, Austria
| | - Matti Aapro
- Institut Multidisciplinaire d'Oncologie IMO, Clinique de Genolier, Genolier, Switzerland
| | | | | | | | - Dietmar Geissler
- 1. Medizinische Abteilung, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Klaus Geissler
- 5. Medizinische Abteilung, Krankenhaus Hietzing, Wien, Austria
| | | | | | - Gerhard Kopetzky
- 1. Medizinische Abteilung, Landesklinikum St. Pölten, Pölten, Austria
| | - Alois Lang
- Abteilung für Innere Medizin, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Holger Rumpold
- Abteilung für Interne 1, Krankenhaus der Barmherzigen Schwestern, Linz, Austria
| | - Michael Steurer
- Universitätsklinik für Innere Medizin V, MedUni Innsbruck, Innsbruck, Austria
| | | | - Hartmut Link
- Medizinische Klinik I, Westpfalz-Klinikum, Kaiserslautern, Germany
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Ninkovic M, Fiegl M, Mian M, Mondello P, Kocher F, Waldthaler C, Verdorfer I, Steurer M, Gastl G, Pircher A. Routine Use of Bendamustine in Patients with Chronic Lymphocytic Leukemia: An Observational Study. Anticancer Res 2015; 35:5129-5139. [PMID: 26254418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Bendamustine is an established treatment option in chronic lymphocytic leukemia (CLL) and frequently used in Austria and Italy. Therefore, we analyzed 100 unselected, consecutive patients with CLL (treatment-naïve and relapsed/refractory) receiving bendamustine in a real-life setting. Most patients were treated with bendamustine in combination with rituximab (BR). However, bendamustine monotherapy was additionally evaluated. Patients treated with BR had a significantly higher overall response rate of 76% (complete response=22%) when compared to those treated solely with bendamustine (overall response rate=50%; complete response=13%). Overall survival (OS) and progression -ree survival (PFS) were significantly lower in the bendamustine-treated group (OS=14.3 months; PFS=8.3 months) compared to the BR group (OS=42.7; PFS=22.5 months; both p<0.001). In multivariate analysis, patients with a good cytogenetic risk and those receiving BR had a significantly better OS. Grade 3/4 hematological complications were seen in 32% of the patients. Hence, bendamustine, especially in combination with rituximab, is an effective therapy with manageable toxicity for non-selected patients with CLL including those pre-treated with fludarabine and the elderly.
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Affiliation(s)
- Marijana Ninkovic
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Fiegl
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Mian
- Department of Hematology and CBMT, Hospital of Bolzano, Bolzano, Italy
| | - Patrizia Mondello
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Florian Kocher
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Waldthaler
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Irmgard Verdorfer
- Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Steurer
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Günther Gastl
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Pircher
- Department of Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
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Janssens A, Tarantino M, Bird RJ, Mazzucconi MG, Boccia RV, Fernández MFL, Kozak T, Steurer M, Boekhorst PT, Dillingham K, Kreuzbauer G, Woodard P. Romiplostim Treatment in Adults with Immune Thrombocytopenia of Varying Duration and Severity. Acta Haematol 2015; 134:215-28. [PMID: 26066765 DOI: 10.1159/000381657] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/14/2015] [Indexed: 11/19/2022]
Abstract
Romiplostim is recommended for the second- and third-line treatment of primary immune thrombocytopenia (ITP). We conducted a large, single-arm study (clinicaltrials.gov; NCT00508820) with broad entry criteria to evaluate the safety of romiplostim in adult ITP. Patients (n = 407) with ITP lasting 0.03-57.14 years and low platelet counts (median 14.0 × 10 9 /l) or uncontrolled bleeding received romiplostim for up to 4 years. The rates of treatment-related, serious adverse events, serious hemorrhage events, thromboembolic events and fatal events were similar to those reported in previous romiplostim trials (0.2, 0.4, 0.2 and 0.1/100 patient-weeks, respectively). Bone marrow reticulin was observed in 4 patients, but biopsies were not routinely performed so the true incidence of this event cannot be determined. Type I collagen (nonserious, unrelated) was reported in 1 patient who likely had myelodysplastic syndrome. No new class of adverse events was reported. Platelet responses were achieved by >90% of the patients, typically within 1-2 weeks of the initiation of romiplostim treatment. From week 8, median platelet counts were >100 × 10 9 /l; 47% of the patients received rescue medications (the use decreased over time). This study confirms and extends the tolerability/efficacy findings of previous romiplostim clinical studies. It was performed on a large ITP population, which is likely more representative of clinical practice.
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Piccin A, Steurer M, Mitterer M, Blöchl EM, Marcheselli L, Pusceddu I, Marabese A, Bertozzi I, Corvetta D, Randi ML, Elli E, Pogliani EM, Veneri D, Perbellini O, Krampera M, Pacquola E, Gottardi M, Tiribelli M, Guella A, Innella B, Vivaldi P, De Biasi E, Sancetta R, Rocconi R, Bassan R, Gherlinzoni F, Pizzolo G, Gastl G, Cortelazzo S. Role of blood cells dynamism on hemostatic complications in low-risk patients with essential thrombocythemia. Intern Emerg Med 2015; 10:451-60. [PMID: 25585678 DOI: 10.1007/s11739-015-1186-8] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
Abstract
Patients with essential thrombocythemia (ET) aged less than 60 years, who have not suffered a previous vascular event (low-risk patients), may develop thrombotic or hemorrhagic events. So far, it has not been possible to identify useful markers capable of predicting which of these patients are more likely to develop an event and therefore who needs to be treated. In the present study, we analysed the relationship between vascular complications and longitudinal blood counts of 136 low-risk ET patients taken over a sustained period of time (blood cells dynamism). After a median follow-up of 60 months, 45 out of 136 patients (33%) suffered 40 major thrombotic and 5 severe hemorrhagic complications. A total number of 5,781 blood counts were collected longitudinally. Thrombotic and hemorrhagic events were studied together (primary endpoint) but also separately (thrombotic alone = secondary endpoint; hemorrhagic alone = tertiary endpoint). The primary endpoint showed no significant association between platelet and WBC count at diagnosis and risk of any event (platelet, p = 0.797; WBC, p = 0.178), while Hb at baseline did show an association (p = 0.024). In the dynamic analysis with Cox regression model, where the blood count values were studied by time of follow-up, we observed that the risk for Hb was 1.49 (95% CI 1.13-1.97) for every increase of 1 g/dL, and that this risk then marginally decreased during follow-up. WBC was associated with an increased risk at baseline for every increase of 1 × 10(9)/L (hazard ratio (HR) 1.07, 95% CI 1.01-1.13, p = 0.034), the risk was stable during follow-up (HR 0.95, p = 0.187 at 60 months). Also, for each increment at baseline of 100 × 10(9) platelets/L, HR was increased by 1.08 (95% CI 0.97-1.22, p = 0.159) and decreases during follow-up. In conclusion, this study is the first to evaluate in ET low-risk patients, the risk of developing a thrombotic/hemorrhagic event considering blood counts over time. Overall our study shows that the risk changes over time. For example, the risk associated with WCC is not linear as previously reported. An interesting new finding is that PLT and even Hb contribute to the risk of developing vascular events. Future treatments should take into consideration these findings and aim to control all parameters over time. We believe this early study may help develop a dynamic analysis model to predict thrombosis in the single patient. Further studies are now warranted to further validate our findings.
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Affiliation(s)
- Andrea Piccin
- Department of Haematology, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy,
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Tortorella G, Piccin A, Tieghi A, Marcheselli L, Steurer M, Gastl G, Codeluppi K, Fama A, Santoro U, Birtolo C, Gugliotta G, Cortelazzo S, Gugliotta L. Anagrelide treatment and cardiovascular monitoring in essential thrombocythemia. A prospective observational study. Leuk Res 2015; 39:592-8. [PMID: 25850727 DOI: 10.1016/j.leukres.2015.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
In this prospective observational single-center study, 55 patients with essential thrombocythemia who were candidates for second line treatment with anagrelide (ANA) received a preliminary cardiovascular (CV) clinical, instrumental and biochemical evaluation (CV history and symptoms, CV risk factors, blood pressure, heart rate, ECG and ECHO-cardio parameters, Troponin I, NT-proBNP). After this in-depth CV screening, 54 out of 55 patients were deemed to be fit for ANA treatment. Thirty-eight of the 55 patients received ANA treatment for a median of 36 months (range 3-48), and were monitored using the same CV evaluation. Fourteen of these 38 patients manifested CV adverse events (10 palpitation, 4 edema, 2 arterial hypertension, 2 acute myocardial infarction) that were not predicted by the in-depth CV evaluation, and that led to ANA withdrawal in only one case (non-cardiac refractory edema). In conclusion, the planned in-depth CV evaluation did not appear to be necessary in ET patients to evaluate their suitability for ANA treatment, and, moreover, was not able to predict the occurrence of CV adverse events during ANA treatment. Nevertheless, the CV adverse events (mostly palpitations and edema) were easily managed by the hematologists, and required the cardiologist involvement in very few selected cases.
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Affiliation(s)
- Giovanni Tortorella
- Cardiology Unit, Azienda Ospedaliera Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Andrea Piccin
- Hematology Department, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy
| | - Alessia Tieghi
- Hematology Department, Azienda Ospedaliera Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Luigi Marcheselli
- Clinical and Public Health Medicine Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Michael Steurer
- Hematology and Oncology Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Günther Gastl
- Hematology and Oncology Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Katia Codeluppi
- Hematology Department, Azienda Ospedaliera Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Angelo Fama
- Hematology Department, Azienda Ospedaliera Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Umberto Santoro
- Statistics Department, University of Bologna, Bologna, Italy
| | - Chiara Birtolo
- Internal Medicine Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Gabriele Gugliotta
- Hematology Institute "L. e A. Seragnoli", S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Sergio Cortelazzo
- Hemato-Oncology Department, Institute Humanitas Gavazzeni, Bergamo, Italy
| | - Luigi Gugliotta
- Hematology Institute "L. e A. Seragnoli", S. Orsola-Malpighi University Hospital, Bologna, Italy.
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Neuwirt H, Wabnig E, Feistritzer C, Eder IE, Salvador C, Puhr M, Culig Z, Massoner P, Tiefenthaler M, Steurer M, Konwalinka G. Akacid medical formulation induces apoptosis in myeloid and lymphatic leukemic cell lines in vitro and in vivo. PLoS One 2015; 10:e0117806. [PMID: 25680181 PMCID: PMC4334520 DOI: 10.1371/journal.pone.0117806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/01/2015] [Indexed: 12/21/2022] Open
Abstract
Akacid medical formulation (AMF) is an oligoguanidine that exerts biocidal activity against airborne and surface microorganisms including bacteria, viruses, fungi, and molds, while showing relatively low toxicity to humans. We have previously shown that AMF exerts antiproliferative effects on a variety of solid tumor cell lines. In this study we raised the question whether AMF could also substantially inhibit cell growth or induce apoptosis in cell lines derived from hematologic malignancies such as leukemia or lymphoma. We found that AMF has antiproliferative effects on various hematologic cell lines derived from human leukemia and lymphoma. Additionally, we show that AMF induces apoptosis in leukemia cell lines not only via the extrinsic and intrinsic pathway, but also in a caspase-independent manner. This effect was found also in G0-arrested cells. Finally, in our animal experiments utilizing male nu/nu Balb/c mice we found a significant growth retardation, which was immunohistochemically associated with a significantly lower number of KI67-positive cells and caspase-3 induction in AMF-treated mice.
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MESH Headings
- Animals
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/pharmacology
- Apoptosis/drug effects
- Caspase Inhibitors/pharmacology
- Caspases/metabolism
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Disease Models, Animal
- Enzyme Activation/drug effects
- G1 Phase Cell Cycle Checkpoints/drug effects
- Guanidines/administration & dosage
- Guanidines/pharmacology
- Humans
- Leukemia, Lymphoid/drug therapy
- Leukemia, Lymphoid/genetics
- Leukemia, Lymphoid/metabolism
- Leukemia, Lymphoid/pathology
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/metabolism
- Leukemia, Myeloid/pathology
- Male
- Mice
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Signal Transduction
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Hannes Neuwirt
- Department of Internal Medicine IV, Medical University of Innsbruck, Innsbruck, Austria
- * E-mail:
| | - Elisabeth Wabnig
- Department of Internal Medicine IV, Medical University of Innsbruck, Innsbruck, Austria
| | - Clemens Feistritzer
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | - Iris E. Eder
- Department of Experimental Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Salvador
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Puhr
- Department of Experimental Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Zoran Culig
- Department of Experimental Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Petra Massoner
- Department of Experimental Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Tiefenthaler
- Department of Internal Medicine IV, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Steurer
- Department of Internal Medicine V, Medical University of Innsbruck, Innsbruck, Austria
| | - Guenther Konwalinka
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
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Valent P, Berger J, Cerny-Reiterer S, Peter B, Eisenwort G, Hoermann G, Müllauer L, Mannhalter C, Steurer M, Bettelheim P, Horny HP, Arock M. Chronic mast cell leukemia (MCL) with KIT S476I: a rare entity defined by leukemic expansion of mature mast cells and absence of organ damage. Ann Hematol 2014; 94:223-31. [PMID: 25209843 DOI: 10.1007/s00277-014-2207-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/27/2014] [Indexed: 01/08/2023]
Abstract
Mast cell leukemia (MCL) is a rare, life-threatening malignancy defined by a substantial increase in neoplastic mast cells (MCs) in bone marrow (BM) smears, drug-resistance, and a poor prognosis. In most patients, the survival time is less than 1 year. However, exceptional cases may present with a less malignant course. We report on a 49-year-old female patient with MCL diagnosed in 2013. In February 2013, first symptoms, including flushing, headache, and diarrhea, were recorded. In addition, mild anemia was detected. The disease was characterized by a massive increase in well-granulated, mature, and often spindle-shaped MCs (80 %) in BM smears. The serum tryptase level amounted to 332 ng/mL. Like in most other MCL patients, no skin lesions were detected. However, unlike in other patients, tryptase levels remained stable, and no other signs or symptoms of MCL-induced organ damage were found. Sequencing studies revealed an isolated S476I point mutation in KIT but no mutation in codon 816. The patient received histamine receptor blockers but refused cytoreductive therapy. After 9 months, still no progression or organ damage was detected. However, progression with transformation to acute MCL occurred after 12 months. We propose that the chronic type of MCL with stable conditions, absence of organ damage, and a mature MC morphology is recognized as a distinct entity that should be distinguished from the acute variant of MCL.
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Affiliation(s)
- Peter Valent
- Department of Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria,
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45
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Schaefer B, Steurer M, Glodny B, Neureiter D, Moser P, Dorn L, Vogel W, Zoller H. First experience with brentuximab vedotin in posttransplant lymphoproliferative disorder after liver transplantation: complete remission followed by lethal sepsis. Liver Transpl 2014; 20:1145-8. [PMID: 24844674 DOI: 10.1002/lt.23918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 05/16/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Benedikt Schaefer
- Gastroenterology and Hepatology, Department of Medicine II, Medical University of Innsbruck, Innsbruck, Austria
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46
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Di Pauli F, Berger T, Walder A, Maier H, Rhomberg P, Uprimny C, Steurer M, Stockhammer G. Progressive multifocal leukoencephalopathy complicating untreated chronic lymphatic leukemia: case report and review of the literature. J Clin Virol 2014; 60:424-7. [PMID: 24929753 DOI: 10.1016/j.jcv.2014.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/28/2014] [Accepted: 05/10/2014] [Indexed: 11/27/2022]
Abstract
A 58-year old female with a four-year history of previously untreated CLL at Binet stage A complained about word finding problems, impaired vision, and gait unsteadiness. Concerning her CLL she was asymptomatic and had never required any specific treatment. Her neurological examination disclosed cognitive alterations, homonyme hemianopia to the right, aphasia, and mild right-sided hemiparesis. Cerebral MRI showed a hyperintense lesion on T2 weighted images without contrast enhancement. CSF examination revealed normal findings, including CSF protein, cell count, cytology and PCR-analysis was negative for the presence of JC virus DNA. On follow-up MRI, performed 2 weeks later, the T2 lesion was further enlarging. Subsequent stereotactic brain biopsy was diagnostic for PML revealing abnormal oligodendrocytes staining positive against antibodies specific for simian vacuolating virus 40. In addition, repeated CSF analyses for JC-Virus DNA in the course of the disease became positive. After confirmation of diagnosis treatment with mirtazapine (30 mg/d) and mefloquine (250 mg/d) was initiated. Rapid clinical progression correlated to further worsening on MRI. Therefore this treatment was terminated after 16 days and the regime was changed to a five-day courses of cytarabine (2 mg/kg/d) combined with intrathecal administration of liposomal cytarabine (50 mg). Due to further clinical progression with global aphasia, blindness and severe right-sided hemiparesia, medication was stopped. The Patient died three and a half months after onset of symptoms.
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Affiliation(s)
- Franziska Di Pauli
- Clinical Department of Neurology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Thomas Berger
- Clinical Department of Neurology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
| | - Alois Walder
- Division of Haematology & Oncology, Regional Hospital Lienz, Emanuel-von-Hibler-Str 5, 9900 Lienz, Austria
| | - Hans Maier
- Institute of Pathology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
| | - Paul Rhomberg
- Department of Radiology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
| | - Christian Uprimny
- Department of Nuclear Medicine, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
| | - Michael Steurer
- Division of Haematology & Oncology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
| | - Guenther Stockhammer
- Clinical Department of Neurology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
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Pircher A, Verdorfer I, Brunner A, Hopfinger G, Steurer M. Paraneoplastic phenomena and diagnostic challenges in angioimmunoblastic T-cell lymphoma (AITL): report of two cases and review of the literature. In Vivo 2014; 28:327-332. [PMID: 24815834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive subtype of peripheral T-cell lymphoma with unique clinical, pathological and genetic features. Clinical diagnosis is often hampered as typical lymphoma-associated symptoms may not be found at the time of first presentation and only occur later during disease progression. However, as AITL leads to a de-regulated immune system, various paraneoplastic syndromes or autoimmune reactions may represent the first clinical signs, resulting in delayed diagnosis and treatment. CASE REPORT We herein describe two AITL cases characterized by a fatal clinical course and the occurrence of unusual paraneoplastic phenomena, including fluid retention and disseminated intravascular coagulation, respectively. Despite multiple diagnostic procedures, both patients died of rapid disease progression and definitive diagnoses could only be established post-mortem. CONCLUSION These cases underscore the complex diagnostic challenges of AITL and illustrate the requirement for careful clinical evaluation and prompt integration of different diagnostic parameters, including immunohistochemistry, flow cytometry, conventional cytogenetics and molecular genetics, to enable adequate and prompt therapeutic interventions.
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Affiliation(s)
- Andreas Pircher
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Aksel S, Steurer M, Steinauer J, Lederle L, Sokoloff A, Drey E. Safety of deep sedation without intubation in late second-trimester dilation and evacuation. Contraception 2014. [DOI: 10.1016/j.contraception.2014.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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Gambacorti Passerini C, Farina F, Stasia A, Redaelli S, Ceccon M, Mologni L, Messa C, Guerra L, Giudici G, Sala E, Mussolin L, Deeren D, King MH, Steurer M, Ordemann R, Cohen AM, Grube M, Bernard L, Chiriano G, Antolini L, Piazza R. Crizotinib in advanced, chemoresistant anaplastic lymphoma kinase-positive lymphoma patients. J Natl Cancer Inst 2014; 106:djt378. [PMID: 24491302 DOI: 10.1093/jnci/djt378] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Anaplastic lymphoma kinase (ALK)-positive lymphomas respond to chemotherapy, but relapses, which bear a poor prognosis, occur. Crizotinib inhibits ALK in vitro and in vivo and was administered as monotherapy to 11 ALK+ lymphoma patients who were resistant/refractory to cytotoxic therapy. The overall response rate was 10 of 11 (90.9%; 95% confidence interval [CI] = 58.7% to 99.8%). Disease status at the latest follow-up is as follows: four patients are in complete response (CR) (months >21, >30, >35, >40) under continuous crizotinib administration; 4 patients had progression of disease (months 1, 2, 2, 2); 1 patient obtained CR on crizotinib, received an allogeneic bone marrow transplant, and is in CR; 2 patients (treated before and/or after allogeneic bone marrow transplant) obtained and are still in CR but they have stopped crizotinib. Overall and progression-free survival rates at 2 years are 72.7% (95% CI = 39.1% to 94.0%) and 63.7% (95% CI = 30.8% to 89.1%), respectively. ALK mutations conferring resistance to crizotinib in vitro could be identified in relapsed patients. Crizotinib exerted a potent antitumor activity with durable responses in advanced, heavily pretreated ALK+ lymphoma patients, with a benign safety profile.
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Affiliation(s)
- Carlo Gambacorti Passerini
- Affiliations of authors: Department of Health Sciences, University Milano Bicocca, Monza, Italy (CGP, FF, AS, SR, MC, LMo, CM, LA, RP); Hematology Unit (CGP) and Nuclear Medicine and PET Unit (CM, LG), San Gerardo Hospital, Monza, Italy; M Tettamanti Research Center, Pediatric Clinic University of Milano Bicocca, Monza, Italy (GG); Medical Genetics Laboratory, San Gerardo Hospital, Monza, Italy (ES); Istituto di Ricerca Pediatrico Fondazione Città della Speranza, Pediatric Clinic University of Padova, Padova, Italy (LMu); H.-Hartziekenhuis Roeselare-Menen vzw, Roeselare, Belgium (DD); Trillium Health Centre, Mississauga Site, Mississauga ON, Canada (MHK); Division of Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria (MS); Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (RO); Hematology Institute, Beilinson Hospital, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (AMC); Department of Haematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany (MG); Hematology/Stem Cell Transplantation, Maisonneuve Rosemont/University of Montreal, Montreal, QC, Canada (LB); School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland (GC)
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Abstract
We report on the case of a young woman with a diagnosis of amyloidosis who developed severe portal and splenic venous thrombosis shortly after hormonal follicle stimulation therapy for oocyte preservation. The clinical implications are discussed.
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Affiliation(s)
- Andrea Piccin
- Haematology Department, San Maurizio Regional Hospital , Bolzano, South Tyrol , Italy
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