TY - JOUR A1 - Loda, Sophia A1 - Krebs, Jonathan A1 - Danhof, Sophia A1 - Schreder, Martin A1 - Solimando, Antonio G. A1 - Strifler, Susanne A1 - Rasche, Leo A1 - Kortüm, Martin A1 - Kerscher, Alexander A1 - Knop, Stefan A1 - Puppe, Frank A1 - Einsele, Hermann A1 - Bittrich, Max T1 - Exploration of artificial intelligence use with ARIES in multiple myeloma research JF - Journal of Clinical Medicine N2 - Background: Natural language processing (NLP) is a powerful tool supporting the generation of Real-World Evidence (RWE). There is no NLP system that enables the extensive querying of parameters specific to multiple myeloma (MM) out of unstructured medical reports. We therefore created a MM-specific ontology to accelerate the information extraction (IE) out of unstructured text. Methods: Our MM ontology consists of extensive MM-specific and hierarchically structured attributes and values. We implemented “A Rule-based Information Extraction System” (ARIES) that uses this ontology. We evaluated ARIES on 200 randomly selected medical reports of patients diagnosed with MM. Results: Our system achieved a high F1-Score of 0.92 on the evaluation dataset with a precision of 0.87 and recall of 0.98. Conclusions: Our rule-based IE system enables the comprehensive querying of medical reports. The IE accelerates the extraction of data and enables clinicians to faster generate RWE on hematological issues. RWE helps clinicians to make decisions in an evidence-based manner. Our tool easily accelerates the integration of research evidence into everyday clinical practice. KW - natural language processing KW - ontology KW - artificial intelligence KW - multiple myeloma KW - real world evidence Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-197231 SN - 2077-0383 VL - 8 IS - 7 ER - TY - JOUR A1 - Danhof, Sophia A1 - Schreder, Martin A1 - Strifler, Susanne A1 - Einsele, Hermann A1 - Knop, Stefan T1 - Long-Term Disease Control by Pomalidomide-/Dexamethasone-Based Therapy in a Patient with Advanced Multiple Myeloma: A Case Report and Review of the Literature JF - Case Reports in Oncology N2 - Background: Therapy for multiple myeloma (MM) has substantially improved in the era of immunomodulatory drugs and bortezomib. However, the prognosis of patients with progressive disease despite treatment with these ‘novel agents' remains poor. Recently, pomalidomide was approved in this setting, but a median progression-free survival of <4 months still leaves room for improvement. Pomalidomide-based combination therapies are currently under investigation, but data on long-term treatment are lacking. Case Report: We present the case of a 68-year-old woman with refractory MM who received pomalidomide in combination with various drugs including anthracyclines, alkylators and proteasome inhibitors. Initially, major hematological toxicities and infectious complications including a hepatitis B virus reactivation were encountered. With careful dose adjustments and selection of combination partners, pomalidomide treatment was maintained for over 4 years and led to a sustained partial remission. In particular, the well-tolerated regimen of bortezomib, cyclophosphamide and dexamethasone together with pomalidomide was administered for >30 cycles. Conclusion: This case illustrates the value of an individualized approach to myeloma care given an increasing availability of ‘novel agents'. Tailored treatment using these drugs as a backbone is essential to achieve long-lasting responses and minimize side effects. KW - Hepatitis B virus reactivation KW - pomalidomide KW - combination therapy KW - multiple myeloma Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-126093 VL - 8 IS - 1 ER - TY - JOUR A1 - Zhou, Xiang A1 - Rasche, Leo A1 - Kortüm, K. Martin A1 - Danhof, Sophia A1 - Hudecek, Michael A1 - Einsele, Hermann T1 - Toxicities of Chimeric Antigen Receptor T Cell Therapy in Multiple Myeloma: An Overview of Experience From Clinical Trials, Pathophysiology, and Management Strategies JF - Frontiers in Immunology N2 - In the last few years, monoclonal antibodies (mAbs) such as elotuzumab and daratutumab have brought the treatment of multiple myeloma (MM) into the new era of immunotherapy. More recently, chimeric antigen receptor (CAR) modified T cell, a novel cellular immunotherapy, has been developed for treatment of relapsed/refractory (RR) MM, and early phase clinical trials have shown promising efficacy of CAR T cell therapy. Many patients with end stage RRMM regard CAR T cell therapy as their “last chance” and a “hope of cure”. However, severe adverse events (AEs) and even toxic death related to CAR T cell therapy have been observed. The management of AEs related to CAR T cell therapy represents a new challenge, as the pathophysiology is not fully understood and there is still no well-established standard of management. With regard to CAR T cell associated toxicities in MM, in this review, we will provide an overview of experience from clinical trials, pathophysiology, and management strategies. KW - CAR T cell KW - clinical trial KW - multiple myeloma KW - toxicity KW - pathophysiology KW - management Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219911 SN - 1664-3224 VL - 11 ER - TY - THES A1 - Danhof, Sophia T1 - Molekulare Untersuchung der Interaktion von Neutrophil Extracellular Traps mit dem humanen Pathogen Neisseria meningitidis T1 - Molecular investigation of the interaction of Neutrophil Extracellular Traps with the human pathogen Neisseria meningitidis N2 - Neisseria meningitidis ist ein wichtiger Erreger von Meningitis und Sepsis insbesondere bei jungen Menschen, gleichzeitig sind hohe Raten asymptomatischen Trägertums bekannt. Als die Virulenz begünstigende Faktoren wurden unter anderem die Kapsel, Pili, äußere Membranvesikel (OMV) und Lipopolysaccharid (LPS) identifiziert, die es dem Erreger erleichtern, das menschliche Immunsystem zu überwinden. Dabei war bisher die Rolle von Neutrophil Extracellular Traps (NETs) als neu beschriebene Komponente der angeborenen Immunantwort nicht untersucht worden. NETs stellen spinnennetzartige DNA-Strukturen mit globulären Proteindomänen dar, die aus neutrophilen Granulozyten entstehen und als antimikrobiell gelten. Ziel dieser Arbeit war es, die Wirkung von NETs auf Meningokokken zu charakterisieren und mögliche Resistenzmechanismen der Bakterien zu identifizieren. In den vorliegenden Versuchen konnte gezeigt werden, dass Meningokokken an NETs binden und durch diese in ihrer Proliferation gehemmt werden. Eine Lokalisation der Bakterien an die NETs konnte dargestellt werden, LPS und Pili wurden als wichtige Strukturen für die Vermittlung der NET-Bindung identifiziert. OMVs zeigten sich als protektiv gegenüber dem Einfluss der NETs, indem sie die Bindung der Erreger an die NETs blockierten. Wenig empfindlich zeigten sich die Bakterien gegenüber Histonen als den quantitativ bedeutsamsten NET-Proteinen. Meningokokken schützen sich gegenüber dem Einfluss der NETs durch Ausbildung von Kapsel und LPS mit intakter Phosphoethanolamin-Modifikation. Ebenso vermitteln zwei Cathelicidin-Resistenzgene den Bakterien einen Überlebensvorteil. Keine Rolle bei der NET-Resistenz spielten die untersuchten Effluxmechanismen. Neuere Untersuchungen von Lappann et al. indentifizierten Meningokokken und OMVs als potente NET-Induktoren. Damit könnten durch die relativ NET-resistenten Mikroorganismen andere Abwehrmechanismen der Neutrophilen konterkariert werden und eine Immunevasion begünstigt werden. Genauere Untersuchungen diesbezüglich stehen noch aus. N2 - Neisseria meningitidis is an important pathogenic agent of meningitis and sepsis especially in young adults, at the same time high rates of asymptomatic carriage are well-established. Known factors promoting virulence are, among others, the capsule, pili, outer membrane vesicles (OMV) and the lipopolysaccharide (LPS). In host defense against meningococcal disease, the role of Neutrophil Extracellular Traps (NETs), a recently described component of the innate immune response, had not yet been investigated. NETs are web like structures with globular protein domains that arise from neutrophil granulocytes and are considered being antimicrobial. The aim of the present study was to further investigate interactions between N. meningitidis and NETs and to identify possible resistance mechanisms of meningococci. In this thesis I could demonstrate that meningococci bind to NETs and are therewith being restricted in proliferation. A localization of bacteria to NETs was illustrated, and the mediating effect of LPS and pili on binding was identified. OMVs were shown to be protective against the properties of NETs by blocking the binding of pathogens to NETs. Bacteria were minor sensitive to histones which represent the quantitatively most significant group of proteins in NETs. Meningococci are protected against the effect of NETs by the formation of capsule and LPS when correctly modified with phosphoethanolamine. Two genes involved in cathelicidin resistance were shown to be beneficial on the survival of the bacteria. The investigated efflux mechanisms did not affect resistance to NETs though. Recent data by Lappann et al. identified the role of meningococci and OMVs as potent inducers of NET-formation. This might be a strategy of the NET-resilient microorganism to thwart neutrophil phagocytosis or degranulation and to facilitate immune escape, which is yet to be investigated. KW - Neisseria meningitidis KW - Meningokokken KW - Neutrophil Extracellular Traps KW - neutrophile Granulozyten KW - äußere Membranvesikel KW - antimikrobielle Peptide KW - meningococci KW - neutrophil granulocytes KW - outer membrane vesicles KW - antimicrobial peptides Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-85231 ER - TY - JOUR A1 - Maucher, Marius A1 - Srour, Micha A1 - Danhof, Sophia A1 - Einsele, Hermann A1 - Hudecek, Michael A1 - Yakoub-Agha, Ibrahim T1 - Current limitations and perspectives of chimeric antigen receptor-T-cells in acute myeloid leukemia JF - Cancers N2 - Adoptive transfer of gene-engineered chimeric antigen receptor (CAR)-T-cells has emerged as a powerful immunotherapy for combating hematologic cancers. Several target antigens that are prevalently expressed on AML cells have undergone evaluation in preclinical CAR-T-cell testing. Attributes of an ‘ideal’ target antigen for CAR-T-cell therapy in AML include high-level expression on leukemic blasts and leukemic stem cells (LSCs), and absence on healthy tissues, normal hematopoietic stem and progenitor cells (HSPCs). In contrast to other blood cancer types, where CAR-T therapies are being similarly studied, only a rather small number of AML patients has received CAR-T-cell treatment in clinical trials, resulting in limited clinical experience for this therapeutic approach in AML. For curative AML treatment, abrogation of bulk blasts and LSCs is mandatory with the need for hematopoietic recovery after CAR-T administration. Herein, we provide a critical review of the current pipeline of candidate target antigens and corresponding CAR-T-cell products in AML, assess challenges for clinical translation and implementation in routine clinical practice, as well as perspectives for overcoming them. KW - AML KW - CAR-T-cell KW - hematology KW - gene therapy KW - adoptive cell therapy Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-252180 SN - 2072-6694 VL - 13 IS - 24 ER - TY - JOUR A1 - Danhof, Sophia A1 - Rasche, Leo A1 - Mottok, Anja A1 - Steinmüller, Tabea A1 - Zhou, Xiang A1 - Schreder, Martin A1 - Kilian, Teresa A1 - Strifler, Susanne A1 - Rosenwald, Andreas A1 - Hudecek, Michael A1 - Einsele, Hermann A1 - Gerhard-Hartmann, Elena T1 - Elotuzumab for the treatment of extramedullary myeloma: a retrospective analysis of clinical efficacy and SLAMF7 expression patterns JF - Annals of Hematology N2 - Extramedullary disease (EMD) represents a high-risk state of multiple myeloma (MM) associated with poor prognosis. While most anti-myeloma therapeutics demonstrate limited efficacy in this setting, some studies exploring the utility of chimeric antigen receptor (CAR)-modified T cells reported promising results. We have recently designed SLAMF7-directed CAR T cells for the treatment of MM. SLAMF7 is a transmembrane receptor expressed on myeloma cells that plays a role in myeloma cell homing to the bone marrow. Currently, the only approved anti-SLAMF7 therapeutic is the monoclonal antibody elotuzumab, but its efficacy in EMD has not been investigated thoroughly. Thus, we retrospectively analyzed the efficacy of elotuzumab-based combination therapy in a cohort of 15 patients with EMD. Moreover, since the presence of the target antigen is an indispensable prerequisite for effective targeted therapy, we investigated the SLAMF7 expression on extramedullary located tumor cells before and after treatment. We observed limited efficacy of elotuzumab-based combination therapies, with an overall response rate of 40% and a progression-free and overall survival of 3.8 and 12.9 months, respectively. Before treatment initiation, all available EMD tissue specimens (n = 3) demonstrated a strong and consistent SLAMF7 surface expression by immunohistochemistry. Furthermore, to investigate a potential antigen reduction under therapeutic selection pressure, we analyzed samples of de novo EMD (n = 3) outgrown during elotuzumab treatment. Again, immunohistochemistry documented strong and consistent SLAMF7 expression in all samples. In aggregate, our data point towards a retained expression of SLAMF7 in EMD and encourage the development of more potent SLAMF7-directed immunotherapies, such as CAR T cells. KW - plasma cells KW - extramedullary disease KW - monoclonal antibody KW - CD319 KW - CS1 KW - antigen loss Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266468 SN - 1432-0584 VL - 100 IS - 6 ER - TY - JOUR A1 - Zhou, Xiang A1 - Flüchter, Patricia A1 - Nickel, Katharina A1 - Meckel, Katharina A1 - Messerschmidt, Janin A1 - Böckle, David A1 - Knorz, Sebastian A1 - Steinhardt, Maximilian Johannes A1 - Krummenast, Franziska A1 - Danhof, Sophia A1 - Einsele, Hermann A1 - Kortüm, K. Martin A1 - Rasche, Leo T1 - Carfilzomib based treatment strategies in the management of relapsed/refractory multiple myeloma with extramedullary disease JF - Cancers N2 - Published experience with carfilzomib in patients with relapsed/refractory multiple myeloma (RRMM) and extramedullary disease (EMD) is still limited. The current study aimed to assess the efficacy and safety of carfilzomib containing therapy regimens in EMD. We retrospectively analyzed 45 patients with extramedullary RRMM treated with carfilzomib from June 2013 to September 2019. The median age at the start of carfilzomib was 64 (range 40–80) years. Twenty (44%) and 25 (56%) patients had paraosseous manifestation and EMD without adjacency to bone, respectively. The serological overall response rate (ORR) was 59%. Extramedullary response was evaluable in 33 patients, nine (27%) of them achieved partial remission (PR) (ORR = 27%). In 15 (33%) patients, we observed no extramedullary response despite serological response. The median progression-free survival (PFS) and overall survival (OS) were five (95% CI, 3.5–6.5) and ten (95% CI, 7.5–12.5) months, respectively. EMD without adjacency to bone was associated with a significantly inferior PFS (p = 0.004) and OS (p = 0.04) compared to paraosseous lesions. Carfilzomib based treatment strategies showed some efficacy in heavily pretreated patients with extramedullary RRMM but could not overcome the negative prognostic value of EMD. Due to the discrepancy between serological and extramedullary response, evaluation of extramedullary response using imaging is mandatory in these patients. KW - carfilzomib KW - extramedullary disease KW - multiple myeloma KW - relapse KW - refractory Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-203704 SN - 2072-6694 VL - 12 IS - 4 ER - TY - JOUR A1 - Zhou, Xiang A1 - Ruckdeschel, Anna A1 - Peter, Jessica A1 - Böckle, David A1 - Hornburger, Hannah A1 - Danhof, Sophia A1 - Steinhardt, Maximilian Johannes A1 - Heimeshoff, Larissa A1 - Einsele, Hermann A1 - Kortüm, Klaus Martin A1 - Rasche, Leo T1 - Salvage therapy with "Dara-KDT-P(A)CE" in heavily pretreated, high-risk, proliferative, relapsed/refractory multiple myeloma JF - Hematological Oncology N2 - The multi-agent therapy “VDT-PACE” represents an established regimen in relapsed/refractory multiple myeloma (RRMM). Here, we report on our experience with a “modified VDT-PACE” incorporating new generation anti-MM agents daratumumab and carfilzomib (“Dara-KDT-P(A)CE”). We retrospectively analyzed 38 patients with RRMM treated with “Dara-KDT-P(A)CE”. The median age was 62 (range 45–82) years, and the patients were heavily pretreated with a median of 5 (range 2–12) prior lines of therapy. Twenty-one (55%) patients suffered from penta-refractory MM. High-risk cytogenetics was present in 31 (81%) patients. The patients received a median of 2 (range 1–10) cycles of this therapy, and the overall response rate (ORR) was 70%. Patients with penta-refractory MM and high-risk cytogenetics showed similar ORR of 65% and 79%, respectively. The median progression-free survival (PFS) and overall survival were 4.1 (95% CI 2.7–5.4) and 8.4 (95% CI 6.7–10.0) months, respectively. Patients with lactate dehydrogenase >250 IU/L showed significantly shorter PFS in comparison with others patients (p = 0.006). We used this regimen as bridging therapy prior to chimeric antigen receptor T-cell infusion in four patients. In conclusion, “Dara-KDT-P(A)CE” is an effective salvage therapy for patients with heavily pretreated, multi-refractory, high-risk RRMM lacking alternative options. KW - Dara-KDT-P(A)CE KW - multiple myeloma KW - refractory KW - salvage Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-257495 VL - 40 IS - 2 ER - TY - JOUR A1 - Zhou, Xiang A1 - Steinhardt, Maximilian Johannes A1 - Düll, Johannes A1 - Krummenast, Franziska A1 - Danhof, Sophia A1 - Meckel, Katharina A1 - Nickel, Katharina A1 - Grathwohl, Denise A1 - Leicht, Hans‐Benno A1 - Rosenwald, Andreas A1 - Einsele, Hermann A1 - Rasche, Leo A1 - Kortüm, Martin T1 - Obinutuzumab and venetoclax induced complete remission in a patient with ibrutinib‐resistant non‐nodal leukemic mantle cell lymphoma JF - European Journal of Haematology N2 - We herein report the case of a 73‐year‐old male patient who was diagnosed with leukemic non‐nodal MCL. This patient had received six cycles of bendamustine, which resulted in a transient remission, and a second‐line therapy with ibrutinib, which unfortunately failed to induce remission. We started a treatment with single‐agent obinutuzumab at a dose of 20 mg on day 1, 50 mg on day 2‐4, 330 mg on day 5, and 1000 mg on day 6. The laboratory analysis showed a rapid decrease of leukocyte count. Four weeks later, we repeated the treatment with obinutuzumab at a dose of 1000 mg q4w and started a therapy with venetoclax at a dose of 400 mg qd, which could be increased to 800 mg qd from the third cycle. This combination therapy was well tolerated. The patient achieved a complete remission (CR) after three cycles of obinutuzumab and venetoclax. To date, the patient has a progression‐free survival of 17 months under ongoing obinutuzumab maintenance q4w. This is the first report about obinutuzumab and venetoclax induced CR in rituximab‐intolerant patient with an ibrutinib‐resistant MCL. This case suggests that obinutuzumab‐ and venetoclax‐based combination therapy might be salvage therapy in patients with ibrutinib‐resistant MCL. KW - mantle cell lymphoma KW - obinutuzumab KW - venetoclax Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-215513 VL - 104 IS - 4 SP - 352 EP - 355 ER - TY - JOUR A1 - Hose, Dorothea A1 - Schreder, Martin A1 - Hefner, Jochen A1 - Bittrich, Max A1 - Danhof, Sophia A1 - Strifler, Susanne A1 - Krauth, Maria-Theresa A1 - Schoder, Renate A1 - Gisslinger, Bettina A1 - Einsele, Hermann A1 - Gisslinger, Heinz A1 - Knop, Stefan T1 - Elotuzumab, pomalidomide, and dexamethasone is a very well tolerated regimen associated with durable remission even in very advanced myeloma: a retrospective study from two academic centers JF - Journal of Cancer Research and Clinical Oncology N2 - Background The anti-SLAMF7 monoclonal antibody, elotuzumab (elo), plus lenalidomide (len) and dexamethasone (dex) is approved for relapsed/refractory MM in the U.S. and Europe. Recently, a small phase 2 study demonstrated an advantage in progression-free survival (PFS) for elo plus pomalidomide (pom)/dex compared to pom/dex alone and resulted in licensing of this novel triplet combination, but clinical experience is still limited. Purpose To analyze the efficacy and safety of elo/pom/dex in a “real world” cohort of patients with advanced MM, we queried the databases of the university hospitals of Würzburg and Vienna. Findings We identified 22 patients with a median number of five prior lines of therapy who received elo/pom/dex prior to licensing within an early access program. Patients received a median number of 5 four-week treatment cycles. Median PFS was 6.4 months with 12-month and 18-month PFS rates of 35% and 28%, respectively. The overall response rate was 50% and 64% of responding patients who achieved a longer PFS with elo/pom/dex compared to their most recent line of therapy. Objective responses were also seen in five patients who had been pretreated with pomalidomide. Low tumor burden was associated with improved PFS (13.5 months for patients with ISS stage I/II at study entry v 6.4 months for ISS III), although this difference did not reach statistical significance. No infusion-related reactions were reported. The most frequent grade 3/4 adverse events were neutropenia and pneumonia. Conclusion Elo/pom/dex is an active and well-tolerated regimen in highly advanced MM even after pretreatment with pomalidomide. KW - multiple myeloma KW - elotuzumab KW - SLAMF7 KW - pomalidomide KW - lenalidomide Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-235762 SN - 0171-5216 VL - 147 ER - TY - JOUR A1 - Fischer, Julia A1 - Knop, Stefan A1 - Danhof, Sophia A1 - Einsele, Hermann A1 - Keller, Daniela A1 - Löffler, Claudia T1 - The influence of baseline characteristics, treatment and depression on health-related quality of life in patients with multiple myeloma: a prospective observational study JF - BMC Cancer N2 - Background Multiple myeloma (MM) is the third most common hematologic malignancy with increasing importance due to improving treatment strategies and long-term outcomes in an aging population. This study aims to analyse influencing factors on health-related quality of life (HRQoL), such as treatment strategies, participation in a clinical trial and patient characteristics like anxiety, depression, gender, and age. A better understanding of the individual factors in context with HRQoL could provide a helpful instrument for clinical decisions. Methods In this prospective observational study, the HRQoL of MM patients with different therapies (first-line and relapse) was quantified by standardized questionnaires (EORTC QLQ-C30 and -MY20) in the context of sociodemographic data, individual anxiety and depressiveness (PHQ-4), and a selected number of clinical parameters and symptoms at defined time-points before, during, and after therapy. Results In total, 70 patients were included in the study. The median age of the study cohort was 62 years. 44% were female and 56% were male patients. More than half of the patients were fully active with an ECOG 0. Global health status was significantly higher in patients with first-line treatment and even increased after start of therapy, while the pain level decreased. In contrast, patients with relapsed MM reported a decreasing global health status and increasing pain. Additionally, there was a higher global health status in less anxious/depressive patients. HRQoL decreased significantly after start of chemotherapy in the parameters body image, side effects of treatment, and cognitive functioning. Tandem stem-cell transplantation was not found to be a risk factor for higher impairment of HRQoL. Participation in a clinical study led to an improvement of most aspects of HRQoL. Among others, increased anxiety and depression, female gender, older age, impaired performance status, and recurrent disease can be early indicators for a reduced HRQoL. Conclusion This study showed the importance of regular longitudinal assessments of patient reported outcomes (PROs) in routine clinical care. For the first time, to our knowledge, we were able to demonstrate a potential impact between participation in clinical trials and HRQoL. However, due to frequently restrictive inclusion criteria for clinical trials, these MM patients might not be directly comparable with patients treated within standard therapy concepts. Further studies are needed to clarify the relevance of this preliminary data in order to develop an individualized, patient-centred, therapy concept. KW - multiple myeloma KW - quality of life KW - participation in clinical trials KW - depression KW - observational Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300435 VL - 22 ER -