@phdthesis{Heckl2014, author = {Heckl, Steffen}, title = {Kohlenhydratmalassimilation bei der Hashimotothyreoiditis}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-140362}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2014}, abstract = {Die autoimmune Thyreoiditis nach Hashimoto stellt aktuell eine der h{\"a}ufigsten Autoimmunerkrankungen eines Organs und die h{\"a}ufigste Ursache der Hypothyreose dar. Die Hashimotothyreoiditis (HT) weist eine hohe Pr{\"a}valenz und Inzidenz auf. Es existieren Hinweise, dass die Inzidenz der HT aus noch nicht gekl{\"a}rten Gr{\"u}nden gestiegen sein k{\"o}nnte. Die Kohlenhydrate Fruktose, Laktose und Sorbitol werden in der Lebensmittelproduktion umfassend eingesetzt. Insbesondere die industrielle Verwendung sowie der weltweite Konsum von Fruktose und Laktose unterlagen in den letzten Jahrzehnten einer rasanten Steigerung, obwohl ein hoher Prozentsatz der Bev{\"o}lkerung zur Malassimilation jener Kohlenhydrate pr{\"a}disponiert ist. In einer internistischen Praxis (Praxis Frau Dr. med. I. Heckl, Bad Homburg) zeigte sich, dass HT-Patienten trotz verifizierter Euthyreose vermehrt {\"u}ber gastrointestinale Symptome berichteten. Unter anderem wurden eine bakterielle Fehlbesiedelung des D{\"u}nndarmes und eine Z{\"o}liakie ausgeschlossen. In der weiteren Abkl{\"a}rung durch die Praxis Dr. I. Heckl wurde eine deutliche H{\"a}ufung der Malassimilation der Kohlenhydrate Fruktose, Laktose oder Sorbitol unter euthyreoten HT-Patienten ersichtlich. In Abh{\"a}ngigkeit von einer konsequenten Nahrungsumstellung normalisierten sich regelm{\"a}ßig das Befinden der Patienten sowie die sonographischen, die serologischen und die laborchemischen Marker der HT, sodass man einen urs{\"a}chlichen Zusammenhang empirisch vermuten konnte. Im Rahmen einer prospektiven Studie sollte dieser neu beobachtete Zusammenhang zwischen der HT und der Kohlenhydratmalassimilation in der Klinik und Poliklinik f{\"u}r Nuklearmedizin der Universit{\"a}t W{\"u}rzburg untersucht werden. In einem unizentrischen Fall-Kontroll-Studiendesign wurden 45 euthyreote HT-Patienten und 38 schilddr{\"u}sengesunde Kontrollpersonen auf das Vorliegen einer Kohlenhydratmalassimilation mittels des Wasserstoffatemtests (H2-Atemtest) untersucht. Alle Probanden erhielten einen Fruktose-H2-Atemtest sowie einen Laktose-H2-Atemtest inklusive einer kapill{\"a}ren Blutglukosemessung. Im Falle eines positiven Ergebnisses des Fruktose-H2-Atemtests wurde ein Glukose-H2-Atemtest zum Ausschluss einer bakteriellen Fehlbesiedelung des D{\"u}nndarmes durchgef{\"u}hrt. Lieferte der Fruktose-H2-Atemtest ein negatives Ergebnis, so folgte ein H2-Atemtest mit Sorbitol. Das Auftreten gastrointestinaler Symptome w{\"a}hrend der Testdurchf{\"u}hrung wurde dokumentiert. Symptomfrageb{\"o}gen und semiquantitative Ern{\"a}hrungsfrageb{\"o}gen im retrospektiven Design dienten der Erfassung allt{\"a}glicher Symptome und Ern{\"a}hrungsgewohnheiten. Blutproben dienten der Messung von Schilddr{\"u}senhormonen, Schilddr{\"u}senautoantik{\"o}rpern, Gewebstransglutaminase-Antik{\"o}rpern und Antiparietalzell-Autoantik{\"o}rpern. Unter den euthyreoten HT-Patienten konnte ein signifikant h{\"a}ufigeres Auftreten der Fruktose- sowie der Laktosemalassimilation im Vergleich zu den schilddr{\"u}sengesunden Kontrollpersonen demonstriert werden. Die Fruktosemalassimilation wurde bei den HT-Patienten mit 48,9\% signifikant h{\"a}ufiger als in der Kontrollgruppe nachgewiesen (p=0,035). Im Kontrollgruppenkollektiv hatte eine Fruktosemalassimilation lediglich bei 26,3\% der Probanden bestanden. Eine Laktosemalassimilation wurde bei den HT-Patienten mit 42,2\% signifikant h{\"a}ufiger als im Kontrollkollektiv diagnostiziert, welches in 21,1\% der F{\"a}lle eine Laktosemalassimilation aufwies (p=0,04). Insgesamt lag eine Fruktose- und / oder Laktosemalassimilation bei 73,3\% der HT-Patienten und bei 42,1\% der Kontrollgruppenprobanden vor. Somit vertrugen nur 26,7\% der Fallgruppe, jedoch 57,9\% der Kontrollgruppe beide Kohlenhydrate (p=0,004). Hinsichtlich der Pr{\"a}valenz der Sorbitolmalassimilation oder eines positiven Glukose-H2-Atemtestes kam kein signifikanter Unterschied zur Darstellung. Die Auswertung der Ern{\"a}hrungsfrageb{\"o}gen zeigte f{\"u}r beide Kollektive eine vergleichbare durchschnittliche Konsummenge der jeweiligen Kohlenhydrate auf. Gastrointestinale Symptome waren w{\"a}hrend des Laktose-H2-Atemtests sowie w{\"a}hrend des Fruktose-H2-Atemtests jeweils in der Fallgruppe signifikant h{\"a}ufiger anzutreffen als in der Kontrollgruppe. Auch im Hinblick auf das Alltagsleben beschrieben die euthyreoten HT-Patienten signifikant h{\"a}ufiger unter den folgenden Symptomen zu leiden: Weicher Stuhlgang, Oberbauchschmerzen, Meteorismus, laute Darmger{\"a}usche, „Kugelbauch", Sodbrennen, Schleimauflagerungen des Stuhlgangs, Obstipation, M{\"u}digkeit, postprandiale Kraftlosigkeit, Depressionen, Heißhunger auf S{\"u}ßes, Migr{\"a}ne, Konzentrationsmangel und eine vermehrte Infektanf{\"a}lligkeit. Zur Kausalit{\"a}t des hier erstmals beschriebenen Zusammenhangs existieren mehrere Hypothesen. Die Einteilung der HT-Patienten gem{\"a}ß ihrer Schilddr{\"u}senautoantik{\"o}rper-Titer in Subkollektive ergab keinen Hinweis auf einen Einfluss der Aktivit{\"a}t des Autoimmungeschehens auf die H{\"a}ufigkeit der Kohlenhydratmalassimilation. Es steht zur Diskussion, ob die HT zur Entstehung einer Kohlenhydratmalassimilation f{\"u}hren, oder ob eine vorbestehende Kohlenhydratmalassimilation, im Sinne eines neu identifizierten Risikofaktors, zur Genese einer HT pr{\"a}disponieren k{\"o}nnte. In der vorliegenden Studie konnte erstmalig eine signifikante H{\"a}ufung der Kohlenhydratmalassimilation bei euthyreoten HT-Patienten aufgezeigt werden. Vor dem Hintergrund der weitreichenden lebensmittelindustriellen Verwendung und des hohen Konsums der Kohlenhydrate Fruktose, Laktose und Sorbitol sowie der hohen Pr{\"a}valenz und Inzidenz der HT, ergibt sich eine hohe Relevanz des hier nachgewiesenen Zusammenhangs. In der differenzialdiagnostischen Abkl{\"a}rung gastrointestinaler Beschwerden bei euthyreoten HT-Patienten nimmt die hier beschriebene Assoziation zwischen der HT und der Kohlenhydratmalassimilation einen besonderen Stellenwert ein. Die Kohlenhydratmalassimilation verk{\"o}rpert einen neuen, sowohl klinisch, als auch potentiell pathogenetisch relevanten Aspekt der Hashimotothyreoiditis.}, subject = {Schilddr{\"u}se}, language = {de} } @phdthesis{Sahraizadeh2014, author = {Sahraizadeh, Heidar}, title = {Das Leben mit PEG-Sonde : Probleme, Zufriedenheit der Betroffenen, Auswirkungen auf die Lebensqualit{\"a}t - Ergebnisse einer prospektiven Studie}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-137286}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2014}, abstract = {In der vorliegenden Studie wurden 220 Patientinnen und Patienten prospektiv 1 Jahr lang nach der Anlage einer PEG-Sonde verfolgt. Die Studie sollte der Frage nachgehen, welche Patienten bzw. welche Indikationsgruppen in welchem Umfang von einer PEG-Anlage kurz- oder langfristig profitieren. Außerdem wurde die Zufriedenheit der Patienten, ihrer Angeh{\"o}rigen, Betreuer und Haus{\"a}rzte sowie auf den Einfluss einer PEG-Anlage und der Sondenern{\"a}hrung auf die Lebensqualit{\"a}t der Betroffenen untersucht. Die Befragung wurde {\"u}ber strukturierte Telefoninterviews nach 7 Tagen, 4 Wochen und dann im Abstand von jeweils 3 Monaten bis abschließend ein Jahr nach Sondenanlage durchgef{\"u}hrt. Die Gesamtheit der Patienten setzte sich zu 41\% aus Frauen und 59\% aus M{\"a}nnern zusammen. Das Durchschnittsalter lag bei 72 Jahren, die Altersspanne bewegte sich zwischen 39 und 97 Jahren. Es zeigte sich eine außergew{\"o}hnlich hohe Zufriedenheit aller Befragten mit der PEG-Sonde und deren Auswirkung auf die Lebensqualit{\"a}t. 95,7\% der befragten Patienten beurteilten ihre Zufriedenheit mit der PEG als sehr gut oder gut. Der Grad der Zufriedenheit war auch bei den Angeh{\"o}rigen, Pflegekr{\"a}ften und {\"A}rzten sehr hoch: 94\%, 95,2\% und 92\% bewerteten die PEG mit sehr gut/ gut. Die wenigen negativen Beurteilungen basierten im Wesentlichen auf Komplikationen, die in Verbindung mit der Sondenern{\"a}hrung auftraten, und auf dem Hinterfragen der Notwendigkeit der PEG-Anlagen. Unterschiede zwischen den einzelnen Indikationsgruppen gaben die Befragten mit einer Ausnahme nicht an. W{\"a}hrend Angeh{\"o}rige und Pflegekr{\"a}fte ihre hohe Zustimmung zur PEG auch bei den Demenzkranken zum Ausdruck brachten (100\%, bzw. 95\% sehr gute/gute Bewertung), lassen die Haus{\"a}rzte in dieser Indikation gewisse Vorbehalte erkennen. 9,1\% vergaben die Noten mangelhaft/ungen{\"u}gend und weitere 13,6\% die Bewertung befriedigend/ausreichend. Sie begr{\"u}nden ihre Kritik mit ethischen und medizinischen {\"U}berlegungen. Zusammenfassend best{\"a}tigt sich die PEG in dieser prospektiven Studie als sichere und effektive Maßnahme zur enteralen Ern{\"a}hrung. Die Indikationsstellung darf nicht nur den Erhalt oder die Steigerung des K{\"o}rpergewichtes ber{\"u}cksichtigen, sondern sollte auch die Aspekte wie Komorbidit{\"a}ten, Prognose und nicht zuletzt Allgemeinzustand und Lebensqualit{\"a}t der Patienten beachten. Nach einer PEG-Anlage ist die allgemeine Zufriedenheit bei Patienten Angeh{\"o}rigen, Pflegekr{\"a}ften und {\"A}rzten fast ausnahmslos sehr hoch.}, subject = {Enterale Ern{\"a}hrung}, language = {de} } @phdthesis{Schmitt2014, author = {Schmitt, Friderike}, title = {Etablierung und Evaluierung eines Nachweisverfahrens klinisch relevanter Zygomyzeten anhand der Polymerasekettenreaktion}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-135334}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2014}, abstract = {Invasive Zygomykosen verzeichnen in den letzten Jahren eine steigende Inzidenz, insbesondere im Risikokollektiv immunsupprimierter Patienten. Aufgrund des h{\"a}ufig letalen Verlaufs dieser Infektionen ist eine rasche, korrekte Diagnosestellung essentiell, um rechtzeitig eine ad{\"a}quate Therapie einzuleiten. Jedoch sieht sich die konventionelle, mikrobiologische Diagnostik mit vielen Problemen konfrontiert, so dass molekularbiologische Nachweisverfahren zunehmend in den Fokus der Aufmerksamkeit r{\"u}cken. Eine zuverl{\"a}ssige, mit relativ geringem Zeit- und Kostenaufwand praktizierbare Methode stellt in diesem Zusammenhang die Real-time-PCR dar, deren Aussagekraft durch anschließende Speziesidentifizierung mittels Sequenzierung noch verst{\"a}rkt werden kann. Aus diesem Grund wurden im Rahmen dieser Arbeit 3 PCR-Assays entwickelt und deren Sensitivit{\"a}t, Spezifit{\"a}t und klinische Anwendbarkeit evaluiert. Alle 3 Systeme nutzten Multi-copy-Gene des ribosomalen Operons der Zygomyzeten als Target und erwiesen sich als zuverl{\"a}ssige Werkzeuge zur Amplifikation fungaler DNA. Sie wurde sowohl an Pilzkulturen, als auch an klinischen Proben und einem Quasi-Tiermodell mit Erfolg ausgetestet und werden m{\"o}glicherweise in Zukunft der klinischen Routinediagnostik zur Verf{\"u}gung stehen. Bedingt durch die Seltenheit invasiver Zygomykosen besteht in diesem Bereich noch ein großer Forschungsbedarf, auch, um die noch nicht optimale Therapie dieser Erkrankungen zu verbessern. Es bleibt daher zu hoffen, dass sich in absehbarer Zeit mehr Forschungsgruppen mit diesen Erregern besch{\"a}ftigen, damit den schwer kranken Patienten eine echte Heilungschance geboten werden kann.}, subject = {Real-time PCR}, language = {de} } @article{ProetelPletschLausekeretal.2014, author = {Proetel, Ulrike and Pletsch, Nadine and Lauseker, Michael and M{\"u}ller, Martin C. and Hanfstein, Benjamin and Krause, Stefan W. and Kalmanti, Lida and Schreiber, Annette and Heim, Dominik and Baerlocher, Gabriela M. and Hofmann, Wolf-Karsten and Lange, Elisabeth and Einsele, Hermann and Wernli, Martin and Kremers, Stephan and Schlag, Rudolf and M{\"u}ller, Lothar and H{\"a}nel, Mathias and Link, Hartmut and Hertenstein, Bernd and Pfirrmann, Markus and Hochhaus, Andreas and Hasford, Joerg and Hehlmann, R{\"u}diger and Saußele, Susanne}, title = {Older patients with chronic myeloid leukemia (≥65 years) profit more from higher imatinib doses than younger patients: a subanalysis of the randomized CML-Study IV}, series = {Annals of Hematology}, volume = {93}, journal = {Annals of Hematology}, number = {7}, issn = {0939-5555}, doi = {10.1007/s00277-014-2041-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-121574}, pages = {1167-76}, year = {2014}, abstract = {The impact of imatinib dose on response rates and survival in older patients with chronic myeloid leukemia in chronic phase has not been studied well. We analyzed data from the German CML-Study IV, a randomized five-arm treatment optimization study in newly diagnosed BCR-ABL-positive chronic myeloid leukemia in chronic phase. Patients randomized to imatinib 400 mg/day (IM400) or imatinib 800 mg/day (IM800) and stratified according to age (≥65 years vs. <65 years) were compared regarding dose, response, adverse events, rates of progression, and survival. The full 800 mg dose was given after a 6-week run-in period with imatinib 400 mg/day. The dose could then be reduced according to tolerability. A total of 828 patients were randomized to IM400 or IM800. Seven hundred eighty-four patients were evaluable (IM400, 382; IM800, 402). One hundred ten patients (29 \%) on IM400 and 83 (21 \%) on IM800 were ≥65 years. The median dose per day was lower for patients ≥65 years on IM800, with the highest median dose in the first year (466 mg/day for patients ≥65 years vs. 630 mg/day for patients <65 years). Older patients on IM800 achieved major molecular remission and deep molecular remission as fast as younger patients, in contrast to standard dose imatinib with which older patients achieved remissions much later than younger patients. Grades 3 and 4 adverse events were similar in both age groups. Five-year relative survival for older patients was comparable to that of younger patients. We suggest that the optimal dose for older patients is higher than 400 mg/day. ClinicalTrials.gov identifier: NCT00055874}, language = {en} } @article{BedkeIannittiDeLucaetal.2014, author = {Bedke, Tanja and Iannitti, Rossana G. and De Luca, Antonella and Giovannini, Gloria and Fallarino, Francesca and Berges, Carsten and Latg{\´e}, Jean-Paul and Einsele, Hermann and Romani, Luigina and Topp, Max S.}, title = {Distinct and complementary roles for Aspergillus fumigatus-specific Tr1 and \(Foxp3^+\) regulatory T cells in humans and mice}, series = {Immunology and Cell Biology}, volume = {92}, journal = {Immunology and Cell Biology}, number = {8}, doi = {10.1038/icb.2014.34}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-121449}, pages = {659-70}, year = {2014}, abstract = {Unlike induced \(Foxp3^+\) regulatory T cells (\(Foxp3^+\) \(iT_{reg}\)) that have been shown to play an essential role in the development of protective immunity to the ubiquitous mold Aspergillus fumigatus, type-(1)-regulatory T cells (Tr1) cells have, thus far, not been implicated in this process. Here, we evaluated the role of Tr1 cells specific for an epitope derived from the cell wall glucanase Crf-1 of A. fumigatus (Crf-1/p41) in antifungal immunity. We identified Crf-1/p41-specific latent-associated \(peptide^+\) Tr1 cells in healthy humans and mice after vaccination with Crf-1/p41+zymosan. These cells produced high amounts of interleukin (IL)-10 and suppressed the expansion of antigen-specific T cells in vitro and in vivo. In mice, in vivo differentiation of Tr1 cells was dependent on the presence of the aryl hydrocarbon receptor, c-Maf and IL-27. Moreover, in comparison to Tr1 cells, \(Foxp3^+\) \(iT_{reg}\) that recognize the same epitope were induced in an interferon gamma-type inflammatory environment and more potently suppressed innate immune cell activities. Overall, our data show that Tr1 cells are involved in the maintenance of antifungal immune homeostasis, and most likely play a distinct, yet complementary, role compared with \(Foxp3^+\) \(iT_{reg}\).}, language = {en} } @article{MoussetBuchheidtHeinzetal.2014, author = {Mousset, Sabine and Buchheidt, Dieter and Heinz, Werner and Ruhnke, Markus and Cornely, Oliver A. and Egerer, Gerlinde and Kr{\"u}ger, William and Link, Hartmut and Neumann, Silke and Ostermann, Helmut and Panse, Jens and Penack, Olaf and Rieger, Christina and Schmidt-Hieber, Martin and Silling, Gerda and S{\"u}dhoff, Thomas and Ullmann, Andrew J. and Wolf, Hans-Heinrich and Maschmeyer, Georg and B{\"o}hme, Angelika}, title = {Treatment of invasive fungal infections in cancer patients—updated recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)}, series = {Annals of Hematology}, volume = {96}, journal = {Annals of Hematology}, doi = {10.1007/s00277-013-1867-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-121340}, pages = {13-32}, year = {2014}, abstract = {Invasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. Early antifungal treatment is mandatory to improve survival. Today, a number of effective and better-tolerated but more expensive antifungal agents compared to the former gold standard amphotericin B deoxycholate are available. Clinical decision-making must consider results from numerous studies and published guidelines, as well as licensing status and cost pressure. New developments in antifungal prophylaxis improving survival rates result in a continuous need for actualization. The treatment options for invasive Candida infections include fluconazole, voriconazole, and amphotericin B and its lipid formulations, as well as echinocandins. Voriconazole, amphotericin B, amphotericin B lipid formulations, caspofungin, itraconazole, and posaconazole are available for the treatment of invasive aspergillosis. Additional procedures, such as surgical interventions, immunoregulatory therapy, and granulocyte transfusions, have to be considered. The Infectious Diseases Working Party of the German Society of Hematology and Oncology here presents its 2008 recommendations discussing the dos and do-nots, as well as the problems and possible solutions, of evidence criteria selection.}, language = {en} } @article{WendlerBurmesterSoerensenetal.2014, author = {Wendler, J{\"o}rg and Burmester, Gerd R. and S{\"o}rensen, Helmut and Krause, Andreas and Richter, Constanze and Tony, Hans-Peter and Rubbert-Roth, Andrea and Bartz-Bazzanella, Peter and Wassenberg, Siegfried and Haug-Rost, Iris and D{\"o}rner, Thomas}, title = {Rituximab in patients with rheumatoid arthritis in routine practice (GERINIS): six-year results from a prospective, multicentre, non-interventional study in 2,484 patients}, series = {Arthritis Research \& Therapy}, volume = {16}, journal = {Arthritis Research \& Therapy}, number = {2}, doi = {10.1186/ar4521}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-121184}, pages = {R80}, year = {2014}, abstract = {INTRODUCTION: The aim of this study was to evaluate the safety and efficacy of rituximab (RTX) in a large cohort of patients with rheumatoid arthritis in routine care, and to monitor changes in daily practice since the introduction of RTX therapy. METHODS: This was a multicentre, prospective, non-interventional study conducted under routine practice conditions in Germany. Efficacy was evaluated using Disease Activity Score in 28 joints (DAS28) and Health Assessment Questionnaire-Disability Index (HAQ-DI). Safety was assessed by recording adverse drug reactions (ADRs). Physician and patient global efficacy and tolerability assessments were also evaluated. RESULTS: Overall, 2,484 patients (76.7\% female, mean age 56.4 years, mean disease duration 11.7 years) received RTX treatment (22.7\% monotherapy). The total observation period was approximately six-years (median follow-up 14.7 months). RTX treatment led to improvements in DAS28 and HAQ-DI that were sustained over multiple courses. DAS28 improvements positively correlated with higher rheumatoid factor levels up to 50 IU/ml. Response and tolerability were rated good/very good by the majority of physicians and patients. Mean treatment intervals were 10.5 and 6.8 months for the first and last 400 enrolled patients, respectively. Infections were the most frequently reported ADRs (9.1\%; 11.39/100 patient-years); approximately 1\% of patients per course discontinued therapy due to ADRs. CONCLUSIONS: Prolonged RTX treatment in routine care is associated with good efficacy and tolerability, as measured by conventional parameters and by physicians' and patients' global assessments. Rheumatoid factor status served as a distinct and quantitative biomarker of RTX responsiveness. With growing experience, physicians repeated treatments earlier in patients with less severe disease activity.}, language = {en} } @article{FujKappEinsele2014, author = {Fuj, Shigeo and Kapp, Markus and Einsele, Hermann}, title = {Possible Implication of Bacterial Infection in Acute Graft-Versus-Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation}, series = {Frontiers in Oncology}, volume = {4}, journal = {Frontiers in Oncology}, number = {89}, issn = {2234-943X}, doi = {10.3389/fonc.2014.00089}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-120674}, year = {2014}, abstract = {Graft-versus-host disease (GVHD) is still one of the major causes of morbidity and mortality in allogeneic hematopoietic stem cell transplantation (HSCT). In the pathogenesis of acute GVHD, it has been established that donor-derived T-cells activated in the recipient play a major role in GVHD in initiation and maintenance within an inflammatory cascade. To reduce the risk of GVHD, intensification of GVHD prophylaxis like T-cell depletion is effective, but it inevitably increases the risk of infectious diseases and abrogates beneficial graft-versus-leukemia effects. Although various cytokines are considered to play an important role in the pathogenesis of GVHD, GVHD initiation is such a complex process that cannot be prevented by means of single inflammatory cytokine inhibition. Thus, efficient methods to control the whole inflammatory milieu both on cellular and humoral view are needed. In this context, infectious diseases can theoretically contribute to an elevation of inflammatory cytokines after allogeneic HSCT and activation of various subtypes of immune effector cells, which might in summary lead to an aggravation of acute GVHD. The appropriate treatments or prophylaxis of bacterial infection during the early phase after allogeneic HSCT might be beneficial to reduce not only infectious-related but also GVHD-related mortality. Here, we aim to review the literature addressing the interactions of bacterial infections and GVHD after allogeneic HSCT.}, language = {en} } @article{KunzmannHerrmannBluemeletal.2014, author = {Kunzmann, Volker and Herrmann, Ken and Bluemel, Christina and Kapp, Markus and Hartlapp, Ingo and Steger, Ulrich}, title = {Intensified neoadjuvant chemotherapy with nab-paclitaxel plus gemcitabine followed by FOLFIRINOX in a patient with locally advanced unresectable pancreatic cancer}, series = {Case Reports in Oncology}, volume = {7}, journal = {Case Reports in Oncology}, number = {3}, issn = {1662-6575}, doi = {10.1159/000367966}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-120189}, pages = {648-55}, year = {2014}, abstract = {The prognosis of patients with locally advanced pancreatic cancer can be improved if secondary complete (R0) resection is possible. In patients initially staged as unresectable this may be achieved with neoadjuvant treatment which is usually chemoradiotherapy based. We report the case of a 46-year-old patient with an unresectable, locally advanced pancreatic cancer (pT4 Nx cM0 G2) who was treated with a sequential neoadjuvant chemotherapy regimen consisting of 2 cycles of nab-paclitaxel plus gemcitabine followed by 4 cycles of FOLFIRINOX. Neoadjuvant chemotherapy resulted in secondary resectability (R0 resection). After 2 cycles of nab-paclitaxel plus gemcitabine, the patient already had a complete metabolic remission as measured by integrated fludeoxyglucose ((18)F) positron emission tomography and computerized tomography. After a follow-up of 18 months the patient is alive without progression of disease. We propose to assess the clinical benefit of sequencing the combinations nab-paclitaxel plus gemcitabine and FOLFIRINOX as neoadjuvant therapy for patients with locally advanced and initially unresectable pancreatic cancer in a controlled clinical trial.}, language = {en} } @article{SchwarzerNickelGodauetal.2014, author = {Schwarzer, R. and Nickel, N. and Godau, J. and Willie, B. M. and Duda, G. N. and Schwarzer, R. and Cirovic, B. and Leutz, A. and Manz, R. and Bogen, B. and D{\"o}rken, B. and Jundt, F.}, title = {Notch pathway inhibition controls myeloma bone disease in the murine MOPC315.BM model}, series = {Blood Cancer Journal}, volume = {4}, journal = {Blood Cancer Journal}, number = {e217}, issn = {2044-5385}, doi = {10.1038/bcj.2014.37}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-119683}, year = {2014}, abstract = {Despite evidence that deregulated Notch signalling is a master regulator of multiple myeloma (MM) pathogenesis, its contribution to myeloma bone disease remains to be resolved. Notch promotes survival of human MM cells and triggers human osteoclast activity in vitro. Here, we show that inhibition of Notch through the γ-secretase inhibitor XII (GSI XII) induces apoptosis of murine MOPC315.BM myeloma cells with high Notch activity. GSI XII impairs murine osteoclast differentiation of receptor activator of NF-κB ligand (RANKL)-stimulated RAW264.7 cells in vitro. In the murine MOPC315.BM myeloma model GSI XII has potent anti-MM activity and reduces osteolytic lesions as evidenced by diminished myeloma-specific monoclonal immunoglobulin (Ig)-A serum levels and quantitative assessment of bone structure changes via high-resolution microcomputed tomography scans. Thus, we suggest that Notch inhibition through GSI XII controls myeloma bone disease mainly by targeting Notch in MM cells and possibly in osteoclasts in their microenvironment. We conclude that Notch inhibition is a valid therapeutic strategy in MM.}, language = {en} } @article{WeissRauGeier2014, author = {Weiss, Johannes and Rau, Monika and Geier, Andreas}, title = {Non-Alcoholic Fatty Liver Disease Epidemiology, Clinical Course, Investigation, and Treatment}, series = {Deautsches {\"A}rzteblatt International}, volume = {111}, journal = {Deautsches {\"A}rzteblatt International}, number = {26}, doi = {10.3238/arztebl.2014.0447}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-119557}, pages = {447-52}, year = {2014}, abstract = {Background: The global obesity epidemic has increased the prevalence of fatty liver disease. At present, 14\% to 27\% of the general population in the industrialized world has non-alcoholic fatty liver disease (NAFLD). Methods: We review pertinent publications retrieved by a selective search of the PubMed database for the years 1995 to 2013. Results: The term "non-alcoholic fatty liver disease" covers cases of a wide spectrum of severity, ranging from bland fatty liver without any inflammation and with little or no tendency to progress all the way to non-alcoholic steatohepatitis (NASH) with inflammatory reactions and hepatocyte damage, with or without fibrosis. Some 5\% to 20\% of patients with NAFLD develop NASH, which undergoes a further transition to higher-grade fibrosis in 10\% to 20\% of cases. In fewer than 5\% of cases, fibrosis progresses to cirrhosis. These approximate figures lead to an estimate of 0.05\% to 0.3\% for the prevalence of cirrhosis in the general population. About 2\% of all cirrhosis patients per year develop hepatocellular carcinoma. The diagnosis of fatty liver disease can be suspected initially on the basis of abnormally high aspartate aminotransferase (ASAT) and/or alanine aminotransferase (ALAT) levels and abnormal ultrasonographic findings. The positive predictive value of an ultrasonographic study for mild steatosis is 67\% at most. The NAFLD fibrosis score, which is computed on the basis of multiple parameters (age, body-mass index, diabetes status, ASAT, ALAT, platelet count, and albumin level), has a positive predictive value of 82\% to 90\% and a negative predictive value of 88\% to 93\%. Liver biopsy is the gold standard for diagnosis but should be performed sparingly in view of its rare but sometimes life-threatening complications, such as hemorrhage. The treatment of NAFLD and NASH consists mainly of changes in lifestyle and nutrition. Conclusion: NAFLD can, in principle, be reversed. This is only possible with weight reduction by at least 3\% to 5\%.}, language = {en} } @article{LiuHuStoerketal.2014, author = {Liu, Dan and Hu, Kai and St{\"o}rk, Stefan and Herrmann, Sebastian and Kramer, Bastian and Cikes, Maja and Gaudron, Philipp Daniel and Knop, Stefan and Ertl, Georg and Bijnens, Bart and Weidemann, Frank}, title = {Predictive Value of Assessing Diastolic Strain Rate on Survival in Cardiac Amyloidosis Patients with Preserved Ejection Fraction}, series = {PLOS ONE}, volume = {9}, journal = {PLOS ONE}, number = {12}, issn = {1932-6203}, doi = {10.1371/journal.pone.0115910}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-118024}, year = {2014}, abstract = {Objectives: Since diastolic abnormalities are typical findings of cardiac amyloidosis (CA), we hypothesized that speckle-tracking-imaging (STI) derived longitudinal early diastolic strain rate (LSRdias) could predict outcome in CA patients with preserved left ventricular ejection fraction (LVEF >50\%). Background: Diastolic abnormalities including altered early filling are typical findings and are related to outcome in CA patients. Reduced longitudinal systolic strain (LSsys) assessed by STI predicts increased mortality in CA patients. It remains unknown if LSRdias also related to outcome in these patients. Methods: Conventional echocardiography and STI were performed in 41 CA patients with preserved LVEF (25 male; mean age 65±9 years). Global and segmental LSsys and LSRdias were obtained in six LV segments from apical 4-chamber views. Results: Nineteen (46\%) out of 41 CA patients died during a median of 16 months (quartiles 5-35 months) follow-up. Baseline mitral annular plane systolic excursion (MAPSE, 6±2 vs. 8±3 mm), global LSRdias and basal-septal LSRdias were significantly lower in non-survivors than in survivors (all p<0.05). NYHA class, number of non-cardiac organs involved, MAPSE, mid-septal LSsys, global LSRdias, basal-septal LSRdias and E/LSRdias were the univariable predictors of all-cause death. Multivariable analysis showed that number of non-cardiac organs involved (hazard ratio [HR] = 1.96, 95\% confidence interval [CI] 1.17-3.26, P = 0.010), global LSRdias (HR = 7.30, 95\% CI 2.08-25.65, P = 0.002), and E/LSRdias (HR = 2.98, 95\% CI 1.54-5.79, P = 0.001) remained independently predictive of increased mortality risk. The prognostic performance of global LSRdias was optimal at a cutoff value of 0.85 S-1 (sensitivity 68\%, specificity 67\%). Global LSRdias <0.85 S-1 predicted a 4-fold increased mortality in CA patients with preserved LVEF. Conclusions: STI-derived early diastolic strain rate is a powerful independent predictor of survival in CA patients with preserved LVEF.}, language = {en} } @article{EngelhardtTerposKleberetal.2014, author = {Engelhardt, Monika and Terpos, Evangelos and Kleber, Martina and Gay, Francesca and W{\"a}sch, Ralph and Morgan, Gareth and Cavo, Michele and van de Donk, Niels and Beilhack, Andreas and Bruno, Benedetto and Johnsen, Hans Erik and Hajek, Roman and Driessen, Christoph and Ludwig, Heinz and Beksac, Meral and Boccadoro, Mario and Straka, Christian and Brighen, Sara and Gramatzki, Martin and Larocca, Alessandra and Lokhorst, Henk and Magarotto, Valeria and Morabito, Fortunato and Dimopoulos, Meletios A. and Einsele, Hermann and Sonneveld, Pieter and Palumbo, Antonio}, title = {European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma}, series = {Haematologica}, volume = {99}, journal = {Haematologica}, number = {2}, doi = {10.3324/haematol.2013.099358}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-117477}, pages = {232-242}, year = {2014}, abstract = {Multiple myeloma management has undergone profound changes in the past thanks to advances in our understanding of the disease biology and improvements in treatment and supportive care approaches. This article presents recommendations of the European Myeloma Network for newly diagnosed patients based on the GRADE system for level of evidence. All patients with symptomatic disease should undergo risk stratification to classify patients for International Staging System stage (level of evidence: 1A) and for cytogenetically defined high-versus standard-risk groups (2B). Novel-agent-based induction and up-front autologous stem cell transplantation in medically fit patients remains the standard of care (1A). Induction therapy should include a triple combination of bortezomib, with either adriamycin or thalidomide and dexamethasone (1A), or with cyclophosphamide and dexamethasone (2B). Currently, allogeneic stem cell transplantation may be considered for young patients with high-risk disease and preferably in the context of a clinical trial (2B). Thalidomide (1B) or lenalidomide (1A) maintenance increases progression-free survival and possibly overall survival (2B). Bortezomib-based regimens are a valuable consolidation option, especially for patients who failed excellent response after autologous stem cell transplantation (2A). Bortezomib-melphalan-prednisone or melphalan-prednisone-thalidomide are the standards of care for transplant-ineligible patients (1A). Melphalan-prednisone-lenalidomide with lenalidomide maintenance increases progression-free survival, but overall survival data are needed. New data from the phase III study (MM-020/IFM 07-01) of lenalidomide-low-dose dexamethasone reached its primary end point of a statistically significant improvement in progression-free survival as compared to melphalan-prednisone-thalidomide and provides further evidence for the efficacy of lenalidomide-low-dose dexamethasone in transplant-ineligible patients (2B).}, language = {en} } @article{GrammatikosLangeSusseretal.2014, author = {Grammatikos, Georgios and Lange, Christian and Susser, Simon and Schwendy, Susanne and Dikopoulos, Nektarios and Buggisch, Peter and Encke, Jens and Teuber, Gerlinde and Goeser, Tobias and Thimme, Robert and Klinker, Hartwig and Boecher, Wulf O. and Schulte-Frohlinde, Ewert and Penna-Martinez, Marissa and Badenhoop, Klaus and Zeuzem, Stefan and Berg, Thomas and Sarrazin, Christoph}, title = {Vitamin D Levels Vary during Antiviral Treatment but Are Unable to Predict Treatment Outcome in HCV Genotype 1 Infected Patients}, series = {PLOS ONE}, volume = {9}, journal = {PLOS ONE}, number = {2}, issn = {1932-6203}, doi = {10.1371/journal.pone.0087974}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-117310}, pages = {e87974}, year = {2014}, abstract = {Background: Different parameters have been determined for prediction of treatment outcome in hepatitis c virus genotype 1 infected patients undergoing pegylated interferon, ribavirin combination therapy. Results on the importance of vitamin D levels are conflicting. In the present study, a comprehensive analysis of vitamin D levels before and during therapy together with single nucleotide polymorphisms involved in vitamin D metabolism in the context of other known treatment predictors has been performed. Methods: In a well characterized prospective cohort of 398 genotype 1 infected patients treated with pegylated interferon-alpha and ribavirin for 24-72 weeks (INDIV-2 study) 25-OH-vitamin D levels and different single nucleotide polymorphisms were analyzed together with known biochemical parameters for a correlation with virologic treatment outcome. Results: Fluctuations of more than 5 (10) ng/ml in 25-OH-vitamin D-levels have been observed in 66 (39) \% of patients during the course of antiviral therapy and neither pretreatment nor under treatment 25-OH-vitamin D-levels were associated with treatment outcome. The DHCR7-TT-polymorphism within the 7-dehydrocholesterol-reductase showed a significant association (P = 0.031) to sustained viral response in univariate analysis. Among numerous further parameters analyzed we found that age (OR = 1.028, CI = 1.002-1.056, P = 0.035), cholesterol (OR = 0.983, CI = 0.975-0.991, P<0.001), ferritin (OR = 1.002, CI = 1.000-1.004, P = 0.033), gGT (OR = 1.467, CI = 1.073-2.006, P = 0.016) and IL28B-genotype (OR = 2.442, CI = 1.271-4.695, P = 0.007) constituted the strongest predictors of treatment response. Conclusions: While 25-OH-vitamin D-levels levels show considerable variations during the long-lasting course of antiviral therapy they do not show any significant association to treatment outcome in genotype 1 infected patients.}, language = {en} } @article{WilhelmSmetakSchaeferEckartetal.2014, author = {Wilhelm, Martin and Smetak, Manfred and Schaefer-Eckart, Kerstin and Kimmel, Brigitte and Birkmann, Josef and Einsele, Hermann and Kunzmann, Volker}, title = {Successful adoptive transfer and in vivo expansion of haploidentical γδ T cells}, series = {Journal of Translational Medicine}, volume = {12}, journal = {Journal of Translational Medicine}, number = {45}, doi = {10.1186/1479-5876-12-45}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-117290}, year = {2014}, abstract = {Background: The primary aim of this pilot study was to determine the feasibility and safety of an adoptive transfer and in vivo expansion of human haploidentical gamma delta T lymphocytes. Methods: Patients with advanced haematological malignancies who are not eligible for allogeneic transplantation received peripheral blood mononuclear cells from half-matched family donors. For that, a single unstimulated leukapheresis product was incubated with both the anti-CD4 and anti-CD8 antibodies conjugated to paramagnetic particles. The depletion procedure was performed on a fully automated CliniMACS (R) device according to the manufacturer's instructions. On average, patients received 2.17 x 10(6)/kg (range 0.9-3.48) γδ T cells with <1\% CD4-or CD8-positive cells remaining in the product. All patients received prior lymphopenia-inducing chemotherapy (fludarabine 20-25 mg/m(2) day -6 until day -2 and cyclophosphamide 30-60 mg/kg day -6 and -5) and were treated with 4 mg zoledronate on day 0 and 1.0x10(6) IU/m(2) IL-2 on day +1 until day +6 for the induction of gamma delta T cell proliferation in vivo. Results: This resulted in a marked in vivo expansion of donor γδ T cells and, to a lower extent, natural killer cells and double-negative αβ T cells (mean 68-fold, eight-fold, and eight-fold, respectively). Proliferation peaked by around day +8 and donor cells persisted up to 28 days. Although refractory to all prior therapies, three out of four patients achieved a complete remission, which lasted for 8 months in a patient with plasma cell leukaemia. One patient died from an infection 6 weeks after treatment. Conclusion: This pilot study shows that adoptive transfer and in vivo expansion of haploidentical γδ T lymphocytes is feasible and suggests a potential role of these cells in the treatment of haematological diseases.}, language = {en} } @article{BorgesO'ConnorPhillipsetal.2014, author = {Borges, Alvaro H. and O'Connor, Jemma L. and Phillips, Andrew N. and Baker, Jason V. and Vjecha, Michael J. and Losso, Marcelo H. and Klinker, Hartwig and Lopardo, Gustavo and Williams, Ian and Lundgren, Jens D.}, title = {Factors Associated with D-Dimer Levels in HIV-Infected Individuals}, series = {PLOS ONE}, volume = {9}, journal = {PLOS ONE}, number = {3}, doi = {10.1371/journal.pone.0090978}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-117094}, pages = {e90978}, year = {2014}, abstract = {Background: Higher plasma D-dimer levels are strong predictors of mortality in HIV+ individuals. The factors associated with D-dimer levels during HIV infection, however, remain poorly understood. Methods: In this cross-sectional study, participants in three randomized controlled trials with measured D-dimer levels were included (N = 9,848). Factors associated with D-dimer were identified by linear regression. Covariates investigated were: age, gender, race, body mass index, nadir and baseline CD4(+) count, plasma HIV RNA levels, markers of inflammation (C-reactive protein [CRP], interleukin-6 [IL-6]), antiretroviral therapy (ART) use, ART regimens, co-morbidities (hepatitis B/C, diabetes mellitus, prior cardiovascular disease), smoking, renal function (estimated glomerular filtration rate [eGFR] and cystatin C) and cholesterol. Results: Women from all age groups had higher D-dimer levels than men, though a steeper increase of D-dimer with age occurred in men. Hepatitis B/C co-infection was the only co-morbidity associated with higher D-dimer levels. In this subgroup, the degree of hepatic fibrosis, as demonstrated by higher hyaluronic acid levels, but not viral load of hepatitis viruses, was positively correlated with D-dimer. Other factors independently associated with higher D-dimer levels were black race, higher plasma HIV RNA levels, being off ART at baseline, and increased levels of CRP, IL-6 and cystatin C. In contrast, higher baseline CD4+ counts and higher high-density lipoprotein cholesterol were negatively correlated with D-dimer levels. Conclusions: D-dimer levels increase with age in HIV+ men, but are already elevated in women at an early age due to reasons other than a higher burden of concomitant diseases. In hepatitis B/C co-infected individuals, hepatic fibrosis, but not hepatitis viral load, was associated with higher D-dimer levels.}, language = {en} } @article{BrunekreeftStrohmGoodenetal.2014, author = {Brunekreeft, Kim L. and Strohm, Corinna and Gooden, Marloes J. and Rybczynska, Anna A. and Nijman, Hans W. and Grigoleit, G{\"o}tz U. and Helfrich, Wijnand and Bremer, Edwin and Siegmund, Daniela and Wajant, Harald and de Bruyn, Marco}, title = {Targeted delivery of CD40L promotes restricted activation of antigen-presenting cells and induction of cancer cell death}, series = {Molecular Cancer}, volume = {13}, journal = {Molecular Cancer}, number = {85}, issn = {1476-4598}, doi = {10.1186/1476-4598-13-85}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-116682}, year = {2014}, abstract = {Background: Stimulation of CD40 can augment anti-cancer T cell immune responses by triggering effective activation and maturation of antigen-presenting cells (APCs). Although CD40 agonists have clinical activity in humans, the associated systemic activation of the immune system triggers dose-limiting side-effects. Methods: To increase the tumor selectivity of CD40 agonist-based therapies, we developed an approach in which soluble trimeric CD40L (sCD40L) is genetically fused to tumor targeting antibody fragments, yielding scFv: CD40L fusion proteins. We hypothesized that scFv: CD40L fusion proteins would have reduced CD40 agonist activity similar to sCD40L but will be converted to a highly agonistic membrane CD40L-like form of CD40L upon anchoring to cell surface exposed antigen via the scFv domain. Results: Targeted delivery of CD40L to the carcinoma marker EpCAM on carcinoma cells induced dose-dependent paracrine maturation of DCs similar to 20-fold more effective than a non-targeted control scFv: CD40L fusion protein. Similarly, targeted delivery of CD40L to the B cell leukemia marker CD20 induced effective paracrine maturation of DCs. Of note, the CD20-selective delivery of CD40L also triggered loss of cell viability in certain B cell leukemic cell lines as a result of CD20-induced apoptosis. Conclusions: Targeted delivery of CD40L to cancer cells is a promising strategy that may help to trigger cancer-localized activation of CD40 and can be modified to exert additional anti-cancer activity via the targeting domain.}, language = {en} } @article{StringarisSekineKhoderetal.2014, author = {Stringaris, Kate and Sekine, Takuya and Khoder, Ahmad and Alsuliman, Abdullah and Razzaghi, Bonni and Sargeant, Ruhena and Pavlu, Jiri and Brisley, Gill and de Lavallade, Hugues and Sarvaria, Anushruthi and Sarvaria, Anushruthi and Mielke, Stephan and Apperley, Jane F. and Shpall, Elisabeth J. and Barrett, A. John and Rezvani, Katayoun}, title = {Leukemia-induced phenotypic and functional defects in natural killer cells predict failure to achieve remission in acute myeloid leukemia}, series = {Haematologica}, volume = {99}, journal = {Haematologica}, number = {5}, issn = {1592-8721}, doi = {10.3324/haematol.2013.087536}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-116550}, pages = {836-847}, year = {2014}, abstract = {The majority of patients with acute myeloid leukemia will relapse, and older patients often fail to achieve remission with induction chemotherapy. We explored the possibility that leukemic suppression of innate immunity might contribute to treatment failure. Natural killer cell phenotype and function was measured in 32 consecutive acute myeloid leukemia patients at presentation, including 12 achieving complete remission. Compared to 15 healthy age-matched controls, natural killer cells from acute myeloid leukemia patients were abnormal at presentation, with downregulation of the activating receptor NKp46 (P=0.007) and upregulation of the inhibitory receptor NKG2A (P=0.04). Natural killer cells from acute myeloid leukemia patients had impaired effector function against autologous blasts and K562 targets, with significantly reduced CD107a degranulation, TNF-alpha and IFN-gamma production. Failure to achieve remission was associated with NKG2A overexpression and reduced TNF-alpha production. These phenotypic and functional abnormalities were partially restored in the 12 patients achieving remission. In vitro co-incubation of acute myeloid leukemia blasts with natural killer cells from healthy donors induced significant impairment in natural killer cell TNF-alpha and IFN-gamma production (P=0.02 and P=0.01, respectively) against K562 targets and a trend to reduced CD107a degranulation (P=0.07). Under transwell conditions, the inhibitory effect of AML blasts on NK cytotoxicity and effector function was still present, and this inhibitory effect was primarily mediated by IL-10. These results suggest that acute myeloid leukemia blasts induce long-lasting changes in natural killer cells, impairing their effector function and reducing the competence of the innate immune system, favoring leukemia survival.}, language = {en} } @article{vandeDonkPalumboJohnsenetal.2014, author = {van de Donk, Niels W. C. J. and Palumbo, Antonio and Johnsen, Hans Erik and Engelhardt, Monika and Gay, Francesca and Gregersen, Henrik and Hajek, Roman and Kleber, Martina and Ludwig, Heinz and Morgan, Gareth and Musto, Pellegrino and Plesner, Torben and Sezer, Orhan and Terpos, Evangelos and Waage, Anders and Zweegman, Sonja and Einsele, Hermann and Sonneveld, Pieter and Lokhorst, Henk M.}, title = {The clinical relevance and management of monoclonal gammopathy of undetermined significance and related disorders: recommendations from the European Myeloma Network}, series = {Haematologica}, volume = {99}, journal = {Haematologica}, number = {6}, issn = {0390-6078}, doi = {10.3324/haematol.2013.100552}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-116050}, pages = {984 - 996}, year = {2014}, abstract = {Monoclonal gammopathy of undetermined significance is one of the most common pre-malignant disorders. IgG and IgA monoclonal gammopathy of undetermined significance are precursor conditions of multiple myeloma; light-chain monoclonal gammopathy of undetermined significance of light-chain multiple myeloma; and IgM monoclonal gammopathy of undetermined significance of Waldenstrom's macroglobulinemia and other lymphoproliferative disorders. Clonal burden, as determined by bone marrow plasma cell percentage or M-protein level, as well as biological characteristics, including heavy chain isotype and light chain production, are helpful in predicting risk of progression of monoclonal gammopathy of undetermined significance to symptomatic disease. Furthermore, alterations in the bone marrow microenvironment of monoclonal gammopathy of undetermined significance patients result in an increased risk of venous and arterial thrombosis, infections, osteoporosis, and bone fractures. In addition, the small clone may occasionally be responsible for severe organ damage through the production of a monoclonal protein that has autoantibody activity or deposits in tissues. These disorders are rare and often require therapy directed at eradication of the underlying plasma cell or lymphoplasmacytic clone. In this review, we provide an overview of the clinical relevance of monoclonal gammopathy of undetermined significance. We also give general recommendations of how to diagnose and manage patients with monoclonal gammopathy of undetermined significance.}, language = {en} } @article{HanfsteinLausekerHehlmannetal.2014, author = {Hanfstein, Benjamin and Lauseker, Michael and Hehlmann, R{\"u}diger and Saussele, Susanne and Erben, Philipp and Dietz, Christian and Fabarius, Alice and Proetel, Ulrike and Schnittger, Susanne and Haferlach, Claudia and Krause, Stefan W. and Schubert, J{\"o}rg and Einsele, Hermann and H{\"a}nel, Mathias and Dengler, Jolanta and Falge, Christiane and Kanz, Lothar and Neubauer, Andreas and Kneba, Michael and Stengelmann, Frank and Pfreundschuh, Michael and Waller, Cornelius F. and Spiekerman, Karsten and Baerlocher, Gabriela M. and Pfirrmann, Markus and Hasford, Joerg and Hofmann, Wolf-Karsten and Hochhaus, Andreas and M{\"u}ller, Martin C.}, title = {Distinct characteristics of e13a2 versus e14a2 BCR-ABL1 driven chronic myeloid leukemia under first-line therapy with imatinib}, series = {Haematologica}, volume = {99}, journal = {Haematologica}, number = {9}, issn = {1592-8721}, doi = {10.3324/haematol.2013.096537}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-115476}, pages = {1441-1447}, year = {2014}, abstract = {The vast majority of chronic myeloid leukemia patients express a BCR-ABL1 fusion gene mRNA encoding a 210 kDa tyrosine kinase which promotes leukemic transformation. A possible differential impact of the corresponding BCR-ABL1 transcript variants e13a2 ("b2a2") and e14a2 ("b3a2") on disease phenotype and outcome is still a subject of debate. A total of 1105 newly diagnosed imatinib-treated patients were analyzed according to transcript type at diagnosis (e13a2, n=451; e14a2, n=496; e13a2+e14a2, n=158). No differences regarding age, sex, or Euro risk score were observed. A significant difference was found between e13a2 and e14a2 when comparing white blood cells (88 vs. 65 x 10(9)/L, respectively; P<0.001) and platelets (296 vs. 430 x 109/L, respectively; P<0.001) at diagnosis, indicating a distinct disease phenotype. No significant difference was observed regarding other hematologic features, including spleen size and hematologic adverse events, during imatinib-based therapies. Cumulative molecular response was inferior in e13a2 patients (P=0.002 for major molecular response; P<0.001 for MR4). No difference was observed with regard to cytogenetic response and overall survival. In conclusion, e13a2 and e14a2 chronic myeloid leukemia seem to represent distinct biological entities. However, clinical outcome under imatinib treatment was comparable and no risk prediction can be made according to e13a2 versus e14a2 BCR-ABL1 transcript type at diagnosis. (clinicaltrials.gov identifier: 00055874)}, language = {en} }