TY - JOUR A1 - Rinaldetti, Sébastien A1 - Pfirrmann, Markus A1 - Manz, Kirsi A1 - Guilhot, Joelle A1 - Dietz, Christian A1 - Panagiotidis, Panayiotidis A1 - Spiess, Birgit A1 - Seifarth, Wolfgang A1 - Fabarius, Alice A1 - Müller, Martin A1 - Pagoni, Maria A1 - Dimou, Maria A1 - Dengler, Jolanta A1 - Waller, Cornelius F. A1 - Brümmendorf, Tim H. A1 - Herbst, Regina A1 - Burchert, Andreas A1 - Janßen, Carsten A1 - Goebeler, Maria Elisabeth A1 - Jost, Philipp J. A1 - Hanzel, Stefan A1 - Schafhausen, Philippe A1 - Prange-Krex, Gabriele A1 - Illmer, Thomas A1 - Janzen, Viktor A1 - Klausmann, Martine A1 - Eckert, Robert A1 - Büschel, Gerd A1 - Kiani, Alexander A1 - Hofmann, Wolf-Karsten A1 - Mahon, François-Xavier A1 - Saussele, Susanne T1 - Effect of ABCG2, OCT1, and ABCB1 (MDR1) Gene Expression on Treatment-Free Remission in a EURO-SKI Subtrial JF - Clinical Lymphoma, Myeloma & Leukemia N2 - Within the EURO-SKI trial, 132 chronic phase CML patients discontinued imatinib treatment. RNA was isolated from peripheral blood in order to analyze the expression of MDR1, ABCG2 and OCT1. ABCG2 was predictive for treatment-free remission in Cox regression analysis. High transcript levels of the ABCG2 efflux transporter (>4.5 parts per thousand) were associated with a twofold higher risk of relapse. Introduction: Tyrosine kinase inhibitors (TKIs) can safely be discontinued in chronic myeloid leukemia (CML) patients with sustained deep molecular response. ABCG2 (breast cancer resistance protein), OCT1 (organic cation transporter 1), and ABCB1 (multidrug resistance protein 1) gene products are known to play a crucial role in acquired pharmacogenetic TKI resistance. Their influence on treatment-free remission (TFR) has not yet been investigated. Materials and Methods: RNA was isolated on the last day of TKI intake from peripheral blood leukocytes of 132 chronic phase CML patients who discontinued TKI treatment within the European Stop Tyrosine Kinase Inhibitor Study trial. Plasmid standards were designed including subgenic inserts of OCT1, ABCG2, and ABCB1 together with GUSB as reference gene. For expression analyses, quantitative real-time polymerase chain reaction was used. Multiple Cox regression analysis was performed. In addition, gene expression cutoffs for patient risk stratification were investigated. Results: The TFR rate of 132 patients, 12 months after TKI discontinuation, was 54% (95% confidence interval [CI], 46%-62%). ABCG2 expression (parts per thousand) was retained as the only significant variable (P=.02; hazard ratio, 1.04; 95% CI, 1.01-1.07) in multiple Cox regression analysis. Only for the ABCG2 efflux transporter, a significant cutoff was found (P=.04). Patients with an ABCG2/GUSB transcript level >4.5 parts per thousand (n=93) showed a 12-month TFR rate of 47% (95% CI, 37%-57%), whereas patients with low ABCG2 expression (<= 4.5 parts per thousand; n=39) had a 12-month TFR rate of 72% (95% CI, 55%-82%). Conclusion: In this study, we investigated the effect of pharmacogenetics in the context of a CML treatment discontinuation trial. The transcript levels of the efflux transporter ABCG2 predicted TFR after TKI discontinuation. (C) 2018 The Authors. Published by Elsevier Inc. KW - ABCG2 KW - Biomarker KW - CML KW - Imatinib KW - Prediction Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-226281 VL - 18 IS - 4 ER - TY - JOUR A1 - Rolvering, Catherine A1 - Zimmer, Andreas D. A1 - Ginolhac, Aurélien A1 - Margue, Christiane A1 - Kirchmeyer, Mélanie A1 - Servais, Florence A1 - Hermanns, Heike M. A1 - Hergovits, Sabine A1 - Nazarov, Petr V. A1 - Nicot, Nathalie A1 - Kreis, Stephanie A1 - Haan, Serge A1 - Behrmann, Iris A1 - Haan, Claude T1 - The PD-L1-and IL6-mediated dampening of the IL27/STAT1 anticancer responses are prevented by alpha-PD-L1 or alpha-IL6 antibodies JF - Journal of Leukocyte Biology N2 - Interleukin-27 (IL27) is a type-I cytokine of the IL6/IL12 family and is predominantly secreted by activated macrophages and dendritic cells. We show that IL27 induces STAT factor phosphorylation in cancerous cell lines of different tissue origin. IL27 leads to STAT1 phosphorylation and recapitulates an IFN--like response in the microarray analyses, with up-regulation of genes involved in antiviral defense, antigen presentation, and immune suppression. Like IFN-, IL27 leads to an up-regulation of TAP2 and MHC-I proteins, which mediate increased tumor immune clearance. However, both cytokines also upregulate proteins such as PD-L1 (CD274) and IDO-1, which are associated with immune escape of cancer. Interestingly, differential expression of these genes was observed within the different cell lines and when comparing IL27 to IFN-. In coculture experiments of hepatocellular carcinoma (HCC) cells with peripheral blood mononuclear cells, pre-treatment of the HCC cells with IL27 resulted in lowered IL2 production by anti-CD3/-CD28 activated T-lymphocytes. Addition of anti-PD-L1 antibody, however, restored IL2 secretion. The levels of other T(H)1 cytokines were also enhanced or restored upon administration of anti-PD-L1. In addition, we show that the suppression of IL27 signaling by IL6-type cytokine pre-stimulationmimicking a situation occurring, for example, in IL6-secreting tumors or in tumor inflammation-induced cachexiacan be antagonized by antibodies against IL6-type cytokines or their receptors. Therapeutically, the antitumor effects of IL27 (mediated, e.g., by increased antigen presentation) might thus be increased by combining IL27 with blocking antibodies against PD-L1 or/and IL6-type cytokines. KW - cytokine KW - interferon KW - IFN-gamma KW - IDO-1 KW - OSM Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-226974 VL - 104 IS - 5 ER - TY - JOUR A1 - Ruiz-Heredia, Yanira A1 - Sánchez-Vega, Beatriz A1 - Onecha, Esther A1 - Barrio, Santiago A1 - Alonso, Rafael A1 - Carlos Martínez-Avila, Jose A1 - Cuenca, Isabel A1 - Agirre, Xabier A1 - Braggio, Esteban A1 - Hernández, Miguel-T. A1 - Martínez, Rafael A1 - Rosiñol, Laura A1 - Gutierrez, Norma A1 - Martin-Ramos, Marisa A1 - Ocio, Enrique M. A1 - Echeveste, María-Asunción A1 - Pérez de Oteyza, Jaime A1 - Oriol, Albert A1 - Bargay, Joan A1 - Gironella, Mercedes A1 - Ayala, Rosa A1 - Bladé, Joan A1 - Mateos, María-Victoria A1 - Kortum, Klaus M. A1 - Stewart, Keith A1 - García-Sanz, Ramón A1 - San Miguel, Jesús A1 - José Lahuerta, Juan A1 - Martinez-Lopez, Joaquín T1 - Mutational screening of newly diagnosed multiple myeloma patients by deep targeted sequencing JF - Haematologica N2 - no abstract available KW - Copy number changes KW - Survival Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-227151 VL - 103 IS - 11 ER - TY - JOUR A1 - Röllig, C. A1 - Kramer, M. A1 - Gabrecht, M. A1 - Hänel, M. A1 - Herbst, R. A1 - Kaiser, U. A1 - Schmitz, N. A1 - Kullmer, J. A1 - Fetscher, S. A1 - Link, H. A1 - Mantovani-Löffler, L. A1 - Krümpelmann, U. A1 - Neuhaus, T. A1 - Heits, F. A1 - Einsele, H. A1 - Ritter, B. A1 - Bornhäuser, M. A1 - Schetelig, J. A1 - Thiede, C. A1 - Mohr, B. A1 - Schaich, M. A1 - Platzbecker, U. A1 - Schäfer-Eckart, K. A1 - Krämer, A. A1 - Berdel, W. E. A1 - Serve, H. A1 - Ehninger, G. A1 - Schuler, U. S. T1 - Intermediate-dose cytarabine plus mitoxantrone versus standard-dose cytarabine plus daunorubicin for acute myeloid leukemia in elderly patients JF - Annals of Oncology N2 - Background: The combination of intermediate-dose cytarabine plus mitoxantrone (IMA) can induce high complete remission rates with acceptable toxicity in elderly patients with acute myeloid leukemia (AML). We present the final results of a randomized-controlled trial comparing IMA with the standard 7+3 induction regimen consisting of continuous infusion cytarabine plus daunorubicin (DA). Patients and methods: Patients with newly diagnosed AML>60 years were randomized to receive either intermediate-dose cytarabine (1000 mg/m(2) twice daily on days 1, 3, 5, 7) plus mitoxantrone (10 mg/m(2) days 1-3) (IMA) or standard induction therapy with cytarabine (100 mg/m(2) continuously days 1-7) plus daunorubicin (45 mg/m(2) days 3-5) (DA). Patients in complete remission after DA received intermediate-dose cytarabine plus amsacrine as consolidation treatment, whereas patients after IMA were consolidated with standard-dose cytarabine plus mitoxantrone. Results: Between February 2005 and October 2009, 485 patients were randomized; 241 for treatment arm DA and 244 for IMA; 76% of patients were >65 years. The complete response rate after DA was 39% [95% confidence interval (95% CI): 33-45] versus 55% (95% CI: 49-61) after IMA (odds ratio 1.89, P = 0.001). The 6-week early-death rate was 14% in both arms. Relapse-free survival curves were superimposable in the first year, but separated afterwards, resulting in 3-year relapse-free survival rates of 29% versus 14% in the DA versus IMA arms, respectively (P = 0.042). The median overall survival was 10 months in both arms (P = 0.513). Conclusion: The dose escalation of cytarabine in induction therapy lead to improved remission rates in the elderly AML patients. This did not translate into a survival advantage, most likely due to differences in consolidation treatment. Thus, effective consolidation strategies need to be further explored. In combination with an effective consolidation strategy, the use of intermediate-dose cytarabine in induction may improve curative treatment for elderly AML patients. KW - acute myeloid leukemia KW - cytarabine dose KW - elderly Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-226473 VL - 29 IS - 4 ER - TY - JOUR A1 - Santoro, Nicole A1 - Labopin, Myriam A1 - Giannotti, Federica A1 - Ehninger, Gerard A1 - Niederwieser, Dietger A1 - Brecht, Arne A1 - Stelljes, Matthias A1 - Kröger, Nicolaus A1 - Einsele, Herman A1 - Eder, Matthias A1 - Hallek, Michael A1 - Glass, Bertram A1 - Finke, Jürgen A1 - Ciceri, Fabio A1 - Mohty, Mohamad A1 - Ruggeri, Annalisa A1 - Nagler, Arnon T1 - Unmanipulated haploidentical in comparison with matched unrelated donor stem cell transplantation in patients 60 years and older with acute myeloid leukemia: a comparative study on behalf of the ALWP of the EBMT JF - Journal of Hematology & Oncology N2 - Background: Acute myeloid leukemia (AML) is both more common and with more biologically aggressive phenotype in the elderly. Allogenic stem cell transplantation (allo-SCT) is the best treatment option in fit patients. Either HLA-matched unrelated donor (MUD) or haploidentical (Haplo) donor are possible alternative for patients in need. Methods: We retrospectively compared non-T-cell-depleted Haplo (n = 250) to 10/10 MUD (n = 2589) in AML patients >= 60 years. Results: Median follow-up was 23 months. Disease status at transplant differs significantly between the two groups (p < 10(-4)). Reduced intensity conditioning (RIC) was administrated to 73 and 77% of Haplo and MUD, respectively (p = 0.23). Stem cell source was the bone marrow (BM) in 52% of the Haplo and 6% of MUD (p < 10(-4)). Anti-thymocyte globulin (ATG) was most frequently used in MUD (p < 10(-4)) while post-Tx cyclophosphamide (PT-Cy) was given in 62% of Haplo. Engraftment was achieved in 90% of the Haplo vs 97% of MUD (p < 10(-4)). In multivariate analysis, no significant difference was found between Haplo and MUD for acute (a) graft versus host disease (GVHD) grade II-IV, relapse incidence (RI), non-relapse mortality (NRM), leukemia free survival (LFS), graft-versus-host-free-relapse free survival (GRFS), and overall survival (OS). Extensive chronic (c) GVHD was significantly higher for MUD as compared to Haplo (HR 2, p = 0.01, 95% CI 1.17-3.47). A propensity score analysis confirmed the higher risk of extensive cGVHD for MUD without differences for other outcomes. Conclusions: Allo-SCT from both Haplo and MUD are valid option for AML patients >= 60 years of age with similar results. Transplantation from MUD was associated with higher extensive cGVHD. Our findings suggest that Haplo is a suitable and attractive graft source for patients >= 60 with AML in need of allo-SCT. KW - MUD KW - Haploidentical KW - Allogeneic stem cell transplantation KW - Acute myeloid leukemia KW - Elderly Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-227315 VL - 11 ER - TY - JOUR A1 - Saussele, Susanne A1 - Hehlmann, Ruediger A1 - Fabarius, Alice A1 - Jeromin, Sabine A1 - Proetel, Ulrike A1 - Rinaldetti, Sebastien A1 - Kohlbrenner, Katharina A1 - Einsele, Hermann A1 - Falge, Christine A1 - Kanz, Lothar A1 - Neubauer, Andreas A1 - Kneba, Michael A1 - Stegelmann, Frank A1 - Pfreundschuh, Michael A1 - Waller, Cornelius F. A1 - Oppliger Leibundgut, Elisabeth A1 - Heim, Dominik A1 - Krause, Stefan W. A1 - Hofmann, Wolf-Karsten A1 - Hasford, Joerg A1 - Pfirrmann, Markus A1 - Müller, Martin C. A1 - Hochhaus, Andreas A1 - Lauseker, Michael T1 - Defining therapy goals for major molecular remission in chronic myeloid leukemia: results of the randomized CML Study IV JF - Leukemia N2 - Major molecular remission (MMR) is an important therapy goal in chronic myeloid leukemia (CML). So far, MMR is not a failure criterion according to ELN management recommendation leading to uncertainties when to change therapy in CML patients not reaching MMR after 12 months. At monthly landmarks, for different molecular remission status Hazard ratios (HR) were estimated for patients registered to CML study IV who were divided in a learning and a validation sample. The minimum HR for MMR was found at 2.5 years with 0.28 (compared to patients without remission). In the validation sample, a significant advantage for progression-free survival (PFS) for patients in MMR could be detected (p-value 0.007). The optimal time to predict PFS in patients with MMR could be validated in an independent sample at 2.5 years. With our model we provide a suggestion when to define lack of MMR as therapy failure and thus treatment change should be considered. The optimal response time for 1% BCR-ABL at about 12-15 months was confirmed and for deep molecular remission no specific time point was detected. Nevertheless, it was demonstrated that the earlier the MMR is achieved the higher is the chance to attain deep molecular response later. KW - Chronic myeloid leukaemia KW - Molecularly targeted therapy KW - Risk factors KW - Risk factors KW - Translational research Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-227528 VL - 32 IS - 5 ER - TY - JOUR A1 - Siegmund, Daniela A1 - Ehrenschwender, Martin A1 - Wajant, Harald T1 - TNFR2 unlocks a RIPK1 kinase activity-dependent mode of proinflammatory TNFR1 signaling JF - Cell Death & Disease N2 - TNF is not only a major effector molecule of PAMP/DAMP-activated macrophages, but also regulates macrophage function and viability. We recently demonstrated that TNFR2 triggers necroptosis in macrophages with compromised caspase activity by two cooperating mechanisms: induction of endogenous TNF with subsequent stimulation of TNFR1 and depletion of cytosolic TRAF2-cIAP complexes. Here we show that TNFR2 activation in caspase-inhibited macrophages results in the production of endogenous TNF and TNFR1 stimulation followed by upregulation of A20, TRAF1, IL-6, and IL-1β. Surprisingly, TNFR1-mediated induction of IL-6 and IL-1β was clearly evident in response to TNFR2 stimulation but occurred not or only weakly in macrophages selectively and directly stimulated via TNFR1. Moreover, TNFR2-induced TNFR1-mediated gene induction was largely inhibited by necrostatin-1, whereas upregulation of A20 and TRAF1 by direct and exclusive stimulation of TNFR1 remained unaffected by this compound. Thus, treatment with TNFR2/ZVAD enables TNFR1 in macrophages to stimulate gene induction via a pathway requiring RIPK1 kinase activity. TNFR2/ZVAD-induced production of IL-6 and IL-1β was largely blocked in necroptosis-resistant MLKL- and RIPK3-deficient macrophages, whereas induction of A20 and TRAF1 remained unaffected. In sum, our results show that in caspase-inhibited macrophages TNFR2 not only triggers TNF/TNFR1-mediated necroptosis but also TNF/TNFR1-mediated RIPK3/MLKL-dependent and -independent gene induction. Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-238034 VL - 9 ER - TY - JOUR A1 - Sirtl, Simon A1 - Knoll, Gertrud A1 - Dieu Thuy, Trinh A1 - Lang, Isabell A1 - Siegmund, Daniela A1 - Gross, Stefanie A1 - Schuler-Thurner, Beatrice A1 - Neubert, Patrick A1 - Jantsch, Jonathan A1 - Wajant, Harald A1 - Ehrenschwender, Martin T1 - Hypertonicity-enforced BCL-2 addiction unleashes the cytotoxic potential of death receptors JF - Oncogene N2 - Attempts to exploit the cytotoxic activity of death receptors (DR) for treating cancer have thus far been disappointing. DR activation in most malignant cells fails to trigger cell death and may even promote tumor growth by activating cell death-independent DR-associated signaling pathways. Overcoming apoptosis resistance is consequently a prerequisite for successful clinical exploitation of DR stimulation. Here we show that hyperosmotic stress in the tumor microenvironment unleashes the deadly potential of DRs by enforcing BCL-2 addiction of cancer cells. Hypertonicity robustly enhanced cytotoxicity of tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) and other DR ligands in various cancer entities. Initial events in TRAIL DR signaling remained unaffected, but hypertonic conditions unlocked activation of the mitochondrial death pathway and thus amplified the apoptotic signal. Mechanistically, we demonstrate that hyperosmotic stress imposed a BCL-2-addiction on cancer cells to safeguard the integrity of the outer mitochondrial membrane (OMM), essentially exhausting the protective capacity of BCL-2-like pro-survival proteins. Deprivation of these mitochondrial safeguards licensed DR-generated truncated BH3-interacting domain death agonist (tBID) to activate BCL-2-associated X protein (BAX) and initiated mitochondrial outer membrane permeabilization (MOMP). Our work highlights that hyperosmotic stress in the tumor environment primes mitochondria for death and lowers the threshold for DR-induced apoptosis. Beyond TRAIL-based therapies, our findings could help to strengthen the efficacy of other apoptosis-inducing cancer treatment regimens. KW - apoptosis KW - cancer microenvironment KW - cytokines Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-238327 VL - 37 ER - TY - JOUR A1 - Solimando, A G A1 - Brandl, A A1 - Mattenheimer, K A1 - Graf, C A1 - Ritz, M A1 - Ruckdeschel, A A1 - Stühmer, T A1 - Mokhtari, Z A1 - Rudelius, M A1 - Dotterweich, J A1 - Bittrich, M A1 - Desantis, V A1 - Ebert, R A1 - Trerotoli, P A1 - Frassanito, M A A1 - Rosenwald, A A1 - Vacca, A A1 - Einsele, H A1 - Jakob, F A1 - Beilhack, A T1 - JAM-A as a prognostic factor and new therapeutic target in multiple myeloma JF - Leukemia N2 - Cell adhesion in the multiple myeloma (MM) microenvironment has been recognized as a major mechanism of MM cell survival and the development of drug resistance. Here we addressed the hypothesis that the protein junctional adhesion molecule-A (JAM-A) may represent a novel target and a clinical biomarker in MM. We evaluated JAM-A expression in MM cell lines and in 147 MM patient bone marrow aspirates and biopsies at different disease stages. Elevated JAM-A levels in patient-derived plasma cells were correlated with poor prognosis. Moreover, circulating soluble JAM-A (sJAM-A) levels were significantly increased in MM patients as compared with controls. Notably, in vitro JAM-A inhibition impaired MM migration, colony formation, chemotaxis, proliferation and viability. In vivo treatment with an anti-JAM-A monoclonal antibody (αJAM-A moAb) impaired tumor progression in a murine xenograft MM model. These results demonstrate that therapeutic targeting of JAM-A has the potential to prevent MM progression, and lead us to propose JAM-A as a biomarker in MM, and sJAM-A as a serum-based marker for clinical stratification. KW - haematological cancer KW - myeloma Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239069 VL - 32 ER - TY - THES A1 - Strifler, Susanne T1 - Eine späte, dritte Hochdosis-Chemotherapie als wirksame Rezidivbehandlung des fortgeschrittenen multiplen Myeloms T1 - A third autologous stem cell transplant as an effective treatment in relapsed multiple myeloma N2 - Das multiple Myelom muss trotz aller Therapierfolge in den letzten drei Jahrzehnten seit Einführung der Melphalan-basierten Hochdosistherapie mit autologer Stammzell-Transplantation als eine unheilbare maligne hämatologische Systemerkrankung angesehen werden. Trotz einer großen Anzahl vielversprechender neuer Therapieoptionen im Bereich von IMiDs, PIs und gänzlich neuer immuntherapeutischer Behandlungsansätze stellt dabei die Behandlung eines Myelom-Patienten im späten Krankheitsrezidiv nach Versagen von Lenalidomid und Bortezomib eine therapeutische Herausforderung dar. Daneben erweisen sich dabei im klinischen Alltag mit zunehmender Zahl an Vortherapien insbesondere auch Behandlungs-assoziierte Toxizitäten als den Behandlungserfolg limitierende Faktoren. Diese retrospektive Analyse zeigt, dass eine dritte Melphalan-Hochdosistherapie mit anschließender autologer Stammzelltransplantation in dieser Situation eine wirkungsvolle Therapieoption darstellt, die zum einen ein überzeugendes Ansprechen (ORR 59 %) bewirkt, und über diese unmittelbare Wirksamkeit hinaus zu einem Zugewinn Progressions-freier Überlebenszeit von im Mittel 9 Monaten führt. Zudem kann insbesondere auch die neuerliche autologe Transplantation durch eine Verbesserung der häufig Therapie-assoziiert erschöpften hämatopoetischen Funktion dazu beitragen, dass Patienten im nahezu unweigerlich auftretenden neuerlichen Rezidiv durch bessere Therapieadhärenz und höhere Therapieintensität maximal von Folgetherapien profitieren. Dieser Effekt spiegelt sich in einem gemessen an einem trotz intensiv vortherapierter Patienten langen mittleren Überlebens von 26 Monaten wider. Trotz hoher Therapieeffektivität zeigt sich dabei ein günstiges Sicherheitsprofil mit einer Therapie-assoziierten Mortalität von 4,9 %. Daneben konnte diese Arbeit in einer großen Kohorte bestätigen, dass eine lange Kryokonservierung autologer Stammzellen nicht nur in vitro sondern auch in vivo nicht zu einem Qualitätsverlust und somit beeinträchtigtem Stammzell-Engraftment führt. Insgesamt kann sich die ASCT3 im späten Krankheitsrezidiv in ihrer Wirksamkeit und Sicherheit in refraktären/relabierten Fällen mit Proteasomen-Inhibitoren sowie immunmodulatorischen Substanzen der zweiten bzw. dritten Generation messen lassen, ist jedoch ebenso wenig wie diese im alleinigen Einsatz in der Lage, den negativ-prognostischen Einfluss einer Doppel-Refraktärität bzw. einer Hochrisiko-Zytogenetik vollständig zu überwinden. Hieraus ergeben sich neue Ansätze für Therapiekonzepte, die beispielsweise immunmodulatorische Substanzen sowie Proteasomen-Inhibitoren der neueren und neuesten Generation ebenso wie Antikörper-basierte Therapien im Rahmen einer prospektiven Studie mit einer dritten Hochdosistherapie und anschließender autologer Stammzelltransplantation kombinieren könnten, um das Gesamtüberleben von Myelom-Patienten weiter zu verlängern. N2 - This analysis demonstrates that a third autologous stem cell transplant after high-dose Melphalan-based chemotherapy contributes to an improved PFS of 9 months. Furthermore, a median OS of 26 months in heavily pre-treated patients could indicate that a third transplant’s improvement of haematopoietic function contributes to better tolerability and thus viability of additional lines of therapy. Moreover, this paper provides scarce in vivo data about the unimpaired durability of long-term cryopreserved stem cells. In summary, a third autologous stem cell transplant is able to compete with next generation novel agent based treatment in multiple myeloma regarding safety and efficacy, but as a monotherapy neither overcomes adverse prognosis of high risk cytogenetics and IMiD and PI-refractory patients. Given these facts, the inclusion of ASCT3 into new, next generation IMiD-, PI- or even antibody-based therapeutic concepts could be a promising new approach in the treatment of relapsed and refractory multiple myeloma. A third autologous stem cell transplant as an effective treatment in relapsed multiple myeloma KW - Plasmozytom KW - multiples Myelom KW - Rezidiv KW - Hochdosischemotherapie KW - Periphere Stammzellentransplantation KW - autologe Stammzelltransplantation KW - Rezidivtherapie KW - refraktär Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-149373 ER - TY - JOUR A1 - Ticha, Olga A1 - Moos, Lukas A1 - Wajant, Harald A1 - Bekeredjian-Ding, Isabelle T1 - Expression of Tumor Necrosis Factor Receptor 2 Characterizes TLR9-Driven Formation of Interleukin-10-Producing B Cells JF - Frontiers in Immunology N2 - B cell-derived interleukin-10 (IL-10) production has been described as a hallmark for regulatory function in B lymphocytes. However, there is an ongoing debate on the origin of IL-10-secreting B cells and lack of specific surface markers has turned into an important obstacle for studying human B regulatory cells. In this study, we propose that tumor necrosis factor receptor 2 (TNFR2) expression can be used for enrichment of IL-10-secreting B cells. Our data confirm that IL-10 production can be induced by TLR9 stimulation with CpG ODN and that IL-10 secretion accompanies differentiation of peripheral blood B cells into plasma blasts. We further show that CpG ODN stimulation induces TNFR2 expression, which correlates with IL-10 secretion and terminal differentiation. Indeed, flow cytometric sorting of TNFR2+ B cells revealed that TNFR2+ and TNFR2− fractions correspond to IL-10+ and IL-10− fractions, respectively. Furthermore, CpG-induced TNFR2+ B cells were predominantly found in the IgM+ CD27+ B cell subset and spontaneously released immunoglobulin. Finally, our data corroborate the functional impact of TNFR2 by demonstrating that stimulation with a TNFR2 agonist significantly augments IL-10 and IL-6 production in B cells. Altogether, our data highlight a new role for TNFR2 in IL-10-secreting human B lymphocytes along with the potential to exploit this finding for sorting and isolation of this currently ill-defined B cell subset. KW - human KW - B cells KW - interleukin-10 KW - tumor necrosis factor receptor 2 KW - TLR 9 KW - Breg Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-241323 VL - 8 ER - TY - THES A1 - Weber [geb. Spalek], Evelyn T1 - Poststationäres Management Helicobacter pylori positiver Patienten im Raum Aschaffenburg T1 - Post-hospital management of helicobacter pylori positive patients in the area of Aschaffenburg N2 - 2009 wurde die deutsche S3-Leitlinie „Helicobacter pylori und gastroduodenale Ulkuskrankheit“ publiziert, in der klare Empfehlungen für die Diagnostik, die Indikationen für eine Eradikation, die Therapie und das Follow-Up beschrieben sind. Das Management der H. pylori Infektion im praktischen Alltag zeigt nach dieser Arbeit indessen ein anderes Bild. Ein Optimierungsbedarf für die Zukunft kann daraus abgeleitet werden. Diese Arbeit beschäftigt sich mit dem poststationären Management von Patienten mit einer H. pylori Infektion im Raum Aschaffenburg. Hierzu wurden 199 Patienten identifiziert, bei denen im Rahmen eines stationären Aufenthaltes im Klinikum Aschaffenburg im Jahr 2011 eine H. pylori Infektion diagnostiziert worden war. Aus den Patientenakten wurden alle relevanten Daten entnommen, wie zum Beispiel Diagnose, Indikation zur H. pylori Eradikation und deren stationäre Initiierung beziehungsweise Empfehlung an den Hausarzt. Nachfolgend wurden die 97 Hausärzte der 199 Patienten angeschrieben und um das ausfüllen eines Fragebogens gebeten. Dieser enthielt sechs Fragen zum poststationären Management der Patienten mit H. pylori Infektion. Während des stationären Aufenthaltes war bei 88/199 Patienten (44,2%) die Eradikationstherapie begonnen und bei 24 von ihnen (12,1%) bereits abgeschlossen worden. Bei den anderen 64 Patienten sollte die Medikation ambulant fortgeführt werden. Bei 77 Patienten (38,7%) wurde dem Hausarzt die Einleitung einer ambulanten Eradikationsbehandlung empfohlen. 34 Patienten verließen das Krankenhaus ohne Therapie und auch ohne entsprechende Therapieempfehlung. Die Rücklaufquote der Fragebögen betrug 46,2% (92 von 199 Patienten). Die nachfolgenden Ergebnisse beziehen sich auf diese 92 Patienten (entspricht 100%). Zwei Drittel der Patienten (n=61) stellten sich direkt im Anschluss an die Entlassung aus stationärer Behandlung ihrem Hausarzt vor. Bei 30 Patienten führte der Hausarzt die stationäre begonnene Eradikationstherapie fort (32,6%) oder initiierte sie bei 28 Patienten selbst (30,4%). 17 Patienten erhielten keine Eradikation (18,5%). Die Gründe hierfür waren unterschiedlich, am häufigsten lag ein Informationsdefizit zwischen Klinik und Hausarzt vor. Die französische Triple-Therapie wurde mit 39 mal am häufigsten verordnet, die italienische Triple-Therapie wurde 20 Patienten verschrieben. Andere Behandlungsprotokolle fanden nur vereinzelt Anwendung. Eine Kontrolle des Eradikationserfolges wurde bei 35 Patienten (38%) vorgenommen. Bezieht man die Eradikationskontrolle ausschließlich auf die therapierten Patienten erfolgte diese in der Hälfte der Fälle (49,3%). Von den Patienten mit H. pylori Eradikation und Kontrolle des Eradikationserfolges (n=35) konnten 31 (88,6%) erfolgreich behandelt werden. Die Vorgehensweise nach erfolgloser H. pylori Eradikation umfasste den Versuch einer Zweitlinientherapie, die Überweisung zum Gastroenterologen und den Verzicht auf weitere Maßnahmen. Zusammenfassend zeigt diese Erhebung, dass es einen klaren Optimierungsbedarf in der Anwendung der Empfehlungen aus der Leitlinie bedarf. Dieser Aspekt sollte zukünftig vermehrt Berücksichtigung finden, nicht zuletzt in der Aktualisierung der Leitlinie 2016. N2 - In 2009, the German S3-guideline "Helicobacter pylori and gastroduodenal ulcer disease" was published, in which clear recommendations for diagnosis, the indications for eradication, therapy and follow-up are described. However, the management of H. pylori infection in everyday practice shows a different picture. An optimization requirement for the future can be derived from this. This thesis deals with post-hospital management of patients with H. pylori infection in the area of Aschaffenburg. 199 patients were identified who had been diagnosed with H. pylori infection during their inpatient stay at Aschaffenburg Hospital in 2011. All relevant data were taken from the patient records, such as diagnosis, indication for H. pylori eradication and their inpatient therapy initiation or recommendation to the family doctor. Subsequently, the 97 general practitioners of the 199 patients were contacted and asked to complete a questionnaire. This included six questions about post-hospital management of patients with H. pylori infection. During inpatient treatment, eradication therapy had started in 88/199 patients (44.2%) and had already been completed in 24 of them (12.1%). For the other 64 patients, the medication should be continued on an outpatient basis. In 77 patients (38.7%) the family doctor received a recommended to initiate an eradication therapy. Thirty-four patients left the hospital without therapy and without appropriate therapy recommendation. The response rate of the questionnaires was 46.2% (92 out of 199 patients). The following results refer to these 92 patients (equivalent to 100%). Two-thirds of the patients (n = 61) presented themselves to their family doctor immediately after discharge from hospitalization. In 30 patients, the family doctor continued inpatient eradication therapy (32.6%) or initiated it in 28 patients (30.4%). 17 patients received no eradication (18.5%). The reasons for this varied, with the most common being an information deficit between the clinic and the family doctor. The French triple therapy was prescribed most often in 39 times, the Italian triple therapy was prescribed to 20 patients. Other treatment protocols were used only sporadically. A control of eradication success was made in 35 patients (38%). If the eradication control was exclusively applied to the treated patients, this was done in half of the cases (49.3%). Of the patients with H. pylori eradication and control of eradication success (n = 35), 31 (88.6%) were successfully treated. The procedure after unsuccessful H. pylori eradication included the attempt of a second-line therapy, the referral to the gastroenterologist and the renunciation of further steps. In summary, this scientific work shows that there is a clear need for optimization in the application of the Guideline recommendations. This aspect should be taken more into account in the future, not least in the update of the upcoming guideline update 2016. KW - Ambulante Behandlung KW - Helicobacter KW - Helicobacter pylori KW - Therapie KW - Ärztliche Behandlung KW - Poststationär KW - post-hospital KW - Follow-up KW - leitliniengerecht KW - ambulant KW - Resistenz KW - Adhärenz KW - Compliance KW - Antibiotikatherapie KW - Therapietreue KW - Therapieversagen KW - Patientenversorgung KW - according to guidelines KW - outpatient KW - ambulatory KW - treatment failure KW - resistance KW - adherence KW - compliance KW - antibiotic therapy KW - patient care Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-156634 ER - TY - THES A1 - Weil, Frederik T1 - Einfluss von Spendermerkmalen und Kulturmedien auf die histomorphologische Qualität von humanen artifiziellen Vollhautmodellen T1 - Influence of donor sources and culture media on the histo-morphological quality of human artificial skin models N2 - Humane artifizielle Vollhautmodelle gewinnen im Bereich des Tissue Engineerings zunehmend an Bedeutung und werden mittlerweile in vielen verschiedenen Fachbereichen erforscht, optimiert und sogar als die Grundlagenforschung unterstützende Tierersatzmodelle angewendet. Dieses geht mit hohen Ansprüchen an Qualität und Reproduzierbarkeit dergleichen einher. In der vorliegenden Arbeit wurde erstmals der Einfluss von Kulturbedingen und Spendermaterial auf die Qualität humaner in vitro hergestellter Vollhautmodelle systematisch untersucht. Dazu wurde zunächst ein Katalog an histomorphologischen Qualitätskriterien erarbeitet, der sich an echten humanen Hautbiopsien orientierte und eine Gewichtung dieser Kriterien im Hinblick auf die Verwendung als echte Hautersatzmodelle erlaubte. Für die Herstellung der Hautmodelle wurden die etablierten Medien KGM 2 , KGM 2 variant und EpiLife ® und deren Kultivierungsprotokolle verwendet. Die zelluläre Grundlage der vorliegenden Untersuchungen bildeten die Präputien von sechzehn Kindern nach Zirkumzision. Keratinozyten und Fibroblasten wurden isoliert und mit den drei oben genannten Medien und zugrundeliegenden Kultivierungsprotokollen wurden in jeweils dreifacher Ausführung insgesamt 144 humane Vollhautmodelle erstellt, welche dann entsprechend des Bewertungskataloges beurteilt wurden. Die zugrunde gelegten Bewertungs- und Gütekriterien entsprachen histomorphologischen Parametern. Dazu gehörten die Dicke von Epidermis und Dermis, die Adhärenz zwischen Epidermis und Dermis sowie die Abwesenheit von Zellkernen im Stratum corneum der Epidermis. Für die Analyse der Einflussfaktoren Spenderalter und Kultivierungsmedium wurden Regressionsmodelle mittels Generalized Estimating Equations angewandt. Das Spenderalter und das Kultivierungsmedium wurden dabei unabhängig voneinander in einer univariaten Analyse untersucht. Bei der Untersuchung des Einflusses des Kulturmediums auf die terminale Differenzierung innerhalb der Epidermis zeigte sich, dass durch Kultivierung mit EpiLife ® signifikant weniger Vollhautmodelle mit Zellkernen im Stratum corneum hergestellt wurden, im Vergleich zur Kultur mit KGM 2 oder KGM 2 variant. Der Einfluss des Kulturmediums auf die Epidermis- und Dermis-Dicke war jeweils nicht signifikant. Trotzdem zeigte sich ein Trend mit einer dünneren Epidermis und Dermis nach EpiLife ® -Kultivierung. Bei der Analyse des Spenderalters konnte ein positiver Einfluss eines jüngeren Spenders auf die Dicke der Epidermis im Vollhautmodell gezeigt werden. Die Epidermis-Dicke war signifikant größer, je jünger ein Vorhautspender war. Ein höheres Spenderalter dagegen führte zu signifikant weniger Ablösung der Epidermis von der Dermis. Keinen Einfluss hatte das Spenderalter auf die Dermis-Dicke und auf die Abwesenheit von Zellkernen in der Hornschicht. Die drei signifikanten Assoziationen in der univariaten Analyse wurden in einer multivariablen Analyse untersucht. Hierbei zeigte sich der Einfluss des Spenderalters auf die Epidermis-Dicke und die dermo-epidermale Adhäsion unter Einfluss der Kulturmedien, der Abwesenheit von Zellkernen in der Hornschicht und der Dermis-Dicke als Kovariablen ebenfalls signifikant. Auch blieb der Einfluss von EpiLife ® auf die Abwesenheit von Zellkernen in der Hornschicht in der multivariablen Analyse signifikant. Es konnte hierbei außerdem ein signifikanter Einfluss der Dermis auf die Epidermis mit Schrumpfung der Epidermis bei Größerwerden der Dermis gezeigt werden. In einer durchgeführten komplexen statistischen Analyse mittels General Linear Model wurde der Einfluss einer Spender-Medium-Interaktion analysiert, ohne das Spenderalter als Variable mit einzubeziehen. Es zeigte sich ein signifikanter Einfluss der Interaktion des Spenders mit dem Kulturmedium auf die Epidermisund Dermis-Dicke und damit auf die Qualität der in vitro hergestellten Vollhautmodelle. Einerseits bestand also ein unabhängiger Einfluss des Spenderalters und des Mediums, andererseits gab es einen Einfluss von der Abhängigkeit einer optimalen Spender-Medium-Kombination auf die Vollhautmodellqualität. Zusammenfassend konnte in der vorliegenden Arbeit erstmals das komplexe Zusammenspiel von Spenderfaktoren und Kultivierungsbedingungen und deren Auswirkungen auf die Qualität von humanen Vollhautmodellen aufgezeigt werden. Diese Ergebnisse haben Relevanz für den Einsatz dieser Modelle als Tierersatzmodelle in der Forschung. Unter Berücksichtigung dieser Ergebnisse können optimierte organotypische Vollhautmodelle in vitro hergestellt werden, sodass zukünftig komplexere Hautmodelle generiert werden können. In einer Folgearbeit sollen die hier erarbeiteten Grundlagen helfen, Hautmodelle in der Erforschung der akuten GvHD der Haut zu bearbeiten. N2 - Human artificial skin models are increasingly employed as non-animal test platforms for research and medical purposes. However, the overall histopathological quality of such models may vary significantly. Therefore, we studied the effects of manufacturing protocols and donor sources on the quality of skin models built-up from fibroblasts and keratinocytes derived from juvenile foreskins. Histo-morphological parameters such as epidermal thickness, number of epidermal cell layers, dermal thickness, dermo-epidermal adhesion and absence of cellular nuclei in the corneal layer were obtained and scored accordingly. In total, 144 full-thickness skin models derived from 16 different donors, built-up in triplicates using three different culture conditions were successfully generated. In univariate analysis both media and donor age affected the quality of skin models significantly. Both parameters remained statistically significant in multivariate analyses. Performing general linear model analyses we could show that individual medium-donor-interactions influence the quality. These observations suggest that the optimal choice of media may differ from donor to donor and coincides with findings where significant inter-individual variations of growth rates in keratinocytes and fibroblasts have been described. Thus, the consideration of individual medium-donor-interactions may improve the overall quality of human organ models thereby forming a reproducible test platform for sophisticated clinical Research die englische Zusammenfassung ist eine genehmigte Kopie aus der Publikation: Lange, J., F. Weil, C. Riegler, F. Groeber, S. Rebhan, S. Kurdyn, M. Alb, H. Kneitz, G. Gelbrich, H. Walles and S. Mielke (2016). "Interactions of donor sources and media influence the histo-morphological quality of full-thickness skin models." Biotechnol J. KW - Optimierung KW - Einfluss KW - Merkmal KW - Qualität KW - Haut KW - Hautmodell KW - human KW - Kulturmedium KW - Spendermerkmal Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-161882 ER - TY - JOUR A1 - Weiss, Esther A1 - Ziegler, Sabrina A1 - Fliesser, Mirjam A1 - Schmitt, Anna-Lena A1 - Hünniger, Kerstin A1 - Kurzai, Oliver A1 - Morton, Charles-Oliver A1 - Einsele, Hermann A1 - Loeffler, Juergen T1 - First Insights in NK—DC Cross-Talk and the Importance of Soluble Factors During Infection With Aspergillus fumigatus JF - Frontiers in Cellular and Infection Microbiology N2 - Invasive aspergillosis (IA) is an infectious disease caused by the fungal pathogen Aspergillus fumigatus that mainly affects immunocompromised hosts. To investigate immune cell cross-talk during infection with A. fumigatus, we co-cultured natural killer (NK) cells and dendritic cells (DC) after stimulation with whole fungal structures, components of the fungal cell wall, fungal lysate or ligands for distinct fungal receptors. Both cell types showed activation after stimulation with fungal components and were able to transfer activation signals to the counterpart not stimulated cell type. Interestingly, DCs recognized a broader spectrum of fungal components and thereby initiated NK cell activation when those did not recognize fungal structures. These experiments highlighted the supportive function of DCs in NK cell activation. Furthermore, we focused on soluble DC mediated NK cell activation and showed that DCs stimulated with the TLR2/Dectin-1 ligand zymosan could maximally stimulate the expression of CD69 on NK cells. Thus, we investigated the influence of both receptors for zymosan, Dectin-1 and TLR2, which are highly expressed on DCs but show only minimal expression on NK cells. Specific focus was laid on the question whether Dectin-1 or TLR2 signaling in DCs is important for the secretion of soluble factors leading to NK cell activation. Our results show that Dectin-1 and TLR2 are negligible for NK cell activation. We conclude that besides Dectin-1 and TLR2 other receptors on DCs are able to compensate for the missing signal. KW - natural killer cells KW - dendritic cells KW - NK-DC cross-talk KW - Aspergillus fumigatus KW - soluble factors KW - innate immunity Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-233565 VL - 8 ER - TY - JOUR A1 - Went, Molly A1 - Sud, Amit A1 - Speedy, Helen A1 - Sunter, Nicola J. A1 - Försti, Asta A1 - Law, Philip J. A1 - Johnson, David C. A1 - Mirabella, Fabio A1 - Holroyd, Amy A1 - Li, Ni A1 - Orlando, Giulia A1 - Weinhold, Niels A1 - van Duin, Mark A1 - Chen, Bowang A1 - Mitchell, Jonathan S. A1 - Mansouri, Larry A1 - Juliusson, Gunnar A1 - Smedby, Karin E A1 - Jayne, Sandrine A1 - Majid, Aneela A1 - Dearden, Claire A1 - Allsup, David J. A1 - Bailey, James R. A1 - Pratt, Guy A1 - Pepper, Chris A1 - Fegan, Chris A1 - Rosenquist, Richard A1 - Kuiper, Rowan A1 - Stephens, Owen W. A1 - Bertsch, Uta A1 - Broderick, Peter A1 - Einsele, Hermann A1 - Gregory, Walter M. A1 - Hillengass, Jens A1 - Hoffmann, Per A1 - Jackson, Graham H. A1 - Jöckel, Karl-Heinz A1 - Nickel, Jolanta A1 - Nöthen, Markus M. A1 - da Silva Filho, Miguel Inacio A1 - Thomsen, Hauke A1 - Walker, Brian A. A1 - Broyl, Annemiek A1 - Davies, Faith E. A1 - Hansson, Markus A1 - Goldschmidt, Hartmut A1 - Dyer, Martin J. S. A1 - Kaiser, Martin A1 - Sonneveld, Pieter A1 - Morgan, Gareth J. A1 - Hemminki, Kari A1 - Nilsson, Björn A1 - Catovsky, Daniel A1 - Allan, James M. A1 - Houlston, Richard S. T1 - Genetic correlation between multiple myeloma and chronic lymphocytic leukaemia provides evidence for shared aetiology JF - Blood Cancer Journal N2 - The clustering of different types of B-cell malignancies in families raises the possibility of shared aetiology. To examine this, we performed cross-trait linkage disequilibrium (LD)-score regression of multiple myeloma (MM) and chronic lymphocytic leukaemia (CLL) genome-wide association study (GWAS) data sets, totalling 11,734 cases and 29,468 controls. A significant genetic correlation between these two B-cell malignancies was shown (Rg = 0.4, P = 0.0046). Furthermore, four of the 45 known CLL risk loci were shown to associate with MM risk and five of the 23 known MM risk loci associate with CLL risk. By integrating eQTL, Hi-C and ChIP-seq data, we show that these pleiotropic risk loci are enriched for B-cell regulatory elements and implicate B-cell developmental genes. These data identify shared biological pathways influencing the development of CLL and, MM and further our understanding of the aetiological basis of these B-cell malignancies. KW - cancer genetics KW - myeloma Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-233627 VL - 9 ER - TY - JOUR A1 - Werner, Rudolf A. A1 - Bundschuh, Ralph A. A1 - Bundschuh, Lena A1 - Javadi, Mehrbod S. A1 - Higuchi, Takahiro A1 - Weich, Alexander A1 - Sheikhbahaei, Sara A1 - Pienta, Kenneth J. A1 - Buck, Andreas K. A1 - Pomper, Martin G. A1 - Gorin, Michael A. A1 - Lapa, Constantin A1 - Rowe, Steven P. T1 - MI-RADS: Molecular Imaging Reporting and Data Systems – A Generalizable Framework for Targeted Radiotracers with Theranostic Implications JF - Annals of Nuclear Medicine N2 - Both prostate-specific membrane antigen (PSMA)- and somatostatin receptor (SSTR)-targeted positron emission tomography (PET) imaging agents for staging and restaging of prostate carcinoma or neuroendocrine tumors, respectively, are seeing rapidly expanding use. In addition to diagnostic applications, both classes of radiotracers can be used to triage patients for theranostic endoradiotherapy. While interpreting PSMA- or SSTR-targeted PET/computed tomography (CT) scans, the reader has to be aware of certain pitfalls. Adding to the complexity of the interpretation of those imaging agents, both normal biodistribution, and also false-positive and -negative findings differ between PSMA- and SSTR-targeted PET radiotracers. Herein summarized under the umbrella term molecular imaging reporting and data systems (MI-RADS), two novel RADS classifications for PSMA- and SSTR-targeted PET imaging are described (PSMA- and SSTR-RADS). Both framework systems may contribute to increase the level of a reader’s confidence and to navigate the imaging interpreter through indeterminate lesions, so that appropriate workup for equivocal findings can be pursued. Notably, PSMA- and SSTR-RADS are structured in a reciprocal fashion, i.e. if the reader is familiar with one system, the other system can readily be applied as well. In the present review we will discuss the most common pitfalls on PSMA- and SSTR-targeted PET/CT, briefly introduce PSMA- and SSTR-RADS, and define a future role of the umbrella framework MI-RADS compared to other harmonization systems. KW - PET KW - Positronen-Emissions-Tomografie KW - prostate cancer KW - neuroendocrine tumor KW - prostate-specific membrane antigen (PSMA) KW - somatostatin receptor (SSTR) KW - positron emission tomography KW - theranostics KW - standardization KW - RADS KW - reporting and data systems KW - personalized medicine Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-166995 SN - 0914-7187 ER - TY - JOUR A1 - Werner, Rudolf A. A1 - Weich, Alexander A1 - Kircher, Malte A1 - Solnes, Lilja B. A1 - Javadi, Mehrbod S. A1 - Higuchi, Takahiro A1 - Buck, Andreas K. A1 - Pomper, Martin G. A1 - Rowe, Steven A1 - Lapa, Constantin T1 - The theranostic promise for neuroendocrine tumors in the late 2010s – Where do we stand, where do we go? JF - Theranostics N2 - More than 25 years after the first peptide receptor radionuclide therapy (PRRT), the concept of somatostatin receptor (SSTR)-directed imaging and therapy for neuroendocrine tumors (NET) is seeing rapidly increasing use. To maximize the full potential of its theranostic promise, efforts in recent years have expanded recommendations in current guidelines and included the evaluation of novel theranostic radiotracers for imaging and treatment of NET. Moreover, the introduction of standardized reporting framework systems may harmonize PET reading, address pitfalls in interpreting SSTR-PET/CT scans and guide the treating physician in selecting PRRT candidates. Notably, the concept of PRRT has also been applied beyond oncology, e.g. for treatment of inflammatory conditions like sarcoidosis. Future perspectives may include the efficacy evaluation of PRRT compared to other common treatment options for NET, novel strategies for closer monitoring of potential side effects, the introduction of novel radiotracers with beneficial pharmacodynamic and kinetic properties or the use of supervised machine learning approaches for outcome prediction. This article reviews how the SSTR-directed theranostic concept is currently applied and also reflects on recent developments that hold promise for the future of theranostics in this context. KW - theranostics KW - Positronen-Emissions-Tomografie KW - PRRT KW - somatostatin receptor KW - peptide receptor radionuclide therapy KW - neuroendocrine tumor Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-170264 VL - 8 IS - 22 ER - TY - JOUR A1 - Werner, Rudolf A1 - Solnes, Lilja A1 - Javadi, Mehrbod A1 - Weich, Alexander A1 - Gorin, Michael A1 - Pienta, Kenneth A1 - Higuchi, Takahiro A1 - Buck, Andreas A1 - Pomper, Martin A1 - Rowe, Steven A1 - Lapa, Constantin T1 - SSTR-RADS Version 1.0 as a Reporting System for SSTR-PET Imaging and Selection of Potential PRRT Candidates: A Proposed Standardization Framework JF - Journal of Nuclear Medicine N2 - Reliable standards and criteria for somatostatin receptor (SSTR) positron emission tomography (PET) are still lacking. We herein propose a structured reporting system on a 5-point scale for SSTR-PET imaging, titled SSTR-RADS version 1.0, which might serve as a standardized assessment for both diagnosis and treatment planning in neuroendocrine tumors (NET). SSTR-RADS could guide the imaging specialist in interpreting SSTR-PET scans, facilitate communication with the referring clinician so that appropriate work-up for equivocal findings is pursued, and serve as a reliable tool for patient selection for planned Peptide Receptor Radionuclide Therapy. KW - Radionuclide Therapy KW - Standardisierung KW - Positronen-Emissions-Tomografie KW - 68Ga-DOTATATE/-TOC KW - Gastrointestinal KW - Neuroendocrine KW - Neuroendocrine Tumor KW - Oncology KW - GI KW - PET KW - PET/CT KW - PRRT KW - RADS KW - SSTR Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-161298 SN - 0161-5505 N1 - This research was originally published in JNM. Rudolf A. Werner, Lilja B. Solnes, Mehrbod Som Javadi, Alexander Weich, Michael A. Gorin, Kenneth J. Pienta, Takahiro Higuchi, Andreas K. Buck, Martin G. Pomper, Steven P. Rowe, Constantin Lapa. SSTR-RADS Version 1.0 as a Reporting System for SSTR-PET Imaging and Selection of Potential PRRT Candidates: A Proposed Standardization Framework. J. Nucl. Med. July 1, 2018, vol. 59, no. 7, 1085-1091. © SNMMI ER - TY - THES A1 - Wilke, Philipp T1 - Expression von MTUS1 in Kolorektalen Karzinomen T1 - Expression of MTUS1 in colorectal carcinoma N2 - Im Rahmen dieser Arbeit wurden zunächst bei den gesammelten 14 Tumoren mit einem putativen allelischen Verlust im Bereich 8p21.3-22 nochmals eine LOH-Analyse durchgeführt und die Voruntersuchungen bestätigt. Als zweiter Schritt konnte die Etablierung des MTUS1-Antikörpers erfolgreich durchgeführt werden. Die Paraffinblöcke wurde aus dem Institut für Pathologie herausgesucht und selbstständig Schnitte davon angefertigt. Die immunhistochemische Analyse der MTUS1-Expression ergab einen Expressionsverlust bei 7 von 14 Tumoren und eine Reduktion der Expression bei weiteren 3 der 14 Tumoren. Bei insgesamt 7 von 14 Tumoren scheint somit die Expression von dem allelischen Verlust assoziiert zu sein. Allerdings konnte bei den übrigen 7 Tumoren eine Expression des MTUS1-Gens nachgewiesen werden. Ein allelischer Verlust führt somit nicht immer zu einer Inaktivierung von MTUS1. MTUS1 wird somit nicht immer nach dem klassischen Mechanismen der Knudson-Hypothese (Mutation des ersten Allels gefolgt von der Deletion des zweiten Alles) inaktiviert. Möglicherweise kann in weiteren Studien ein anderes Gen in dem entsprechenden Bereich identifiziert werden, das im Rahmen eines allelischen Verlustes immer komplett inaktiviert wird. Außerdem sollten, da andere Studien eine Relevanz von MTUS1 als Tumorsupressorgen beim kolorektalen Karzinom und auch bei anderen Tumoren zeigen konnten, weitere Studien durchgeführt werden, in denen alternativen Inaktivierungsmechanismen von MTUS1 untersucht werden. N2 - In this thesis 14 tumor samples with putative allelic loss in the region 8p21.3-22 in earlier studies, the allelic loss was confirmed by performing a LOH-analysis. In the second step a MTUS1-antibody was established succsessfully.The tumor samples were collected from the institute of pathology and then cut with a microtome for further analysis.The analysis showed a loss of in 4/14 samples and a reduction of expression of MTUS1 in 3/14 tumor samples. Therefore LOH in 8p21.3-22 might play a role in the inactivation of MTUS1. Therefore in 7/15 samples LOH in 8p21.3-22 might play a role in the inactivation of MTUS1. However MTUS1 expression was detected in 7 tumor samples with a LOH. This shows, an allelic loss does not always leads to the inactivation of MTUS1. Therefore the inactivation of MTUS1 is not always following the classic model of the Knudson theory (Two-Hit model). Perhaps in further studies an other gene in this area can be identified, which can in case of an allelic loss completely inactivate MTUS1. Other studies showed the relevance of MTUS1 as a tumorsupressorgene in colon cancer and other tumor entities. Therefore further studies are necessary to examine the mechanism of inactivation of MTUS1. KW - 27.9c KW - MTUS1 KW - Kolorektales Karzinom KW - Tumorsuppressorgen KW - ATIP KW - Expression Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-168020 ER - TY - JOUR T1 - Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials JF - Lancet Oncology N2 - Background Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. Methods We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality). Findings Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5-14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81%] of 4756 women). More than two thirds (1349 [69%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65%] of 2320 treated with NACT vs 1135 [49%] of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21.4% for NACT versus 15.9% for adjuvant chemotherapy (5.5% increase [95% CI 2.4-8.6]; rate ratio 1.37 [95% CI 1.17-1.61]; p = 0.0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38.2% for NACT vs 38.0% for adjuvant chemotherapy; rate ratio 1.02 [95% CI 0.92-1.14]; p = 0.66), breast cancer mortality (34.4% vs 33.7%; 1.06 [0.95-1.18]; p = 0.31), or death from any cause (40.9% vs 41.2%; 1.04 [0.94-1.15]; p = 0.45). Interpretation Tumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered-eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy. Copyright (c) The Author(s). Published by Elsevier Ltd. KW - Stimulating factor KW - Therapy KW - Methotrexate KW - Radiotherapy KW - Survival KW - Surgery Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-227782 VL - 19 IS - 1 ER -