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Waldbröl, Germany

Vysniauskaite M.,University of Bonn | Hertfelder H.-J.,University of Bonn | Oldenburg J.,University of Bonn | Dressen P.,St. Franziskus Hospital | And 3 more authors.
PLoS ONE | Year: 2015

Diagnosis of mast cell activation disease (MCAD), i.e. systemic mastocytosis (SM) and idiopathic systemic mast cell activation syndrome (MCAS), usually requires demonstration of increased mast cell (MC) mediator release. Since only a few MC mediators are currently established as biomarkers of MCAD, the sensitivity of plasma heparin level (pHL) as an indicator of increased MC activation was compared with that of serum tryptase, chromogranin A and urinary N-methylhistamine levels in 257 MCAD patients. Basal pHL had a sensitivity of 41% in MCAS patients and 27% in SM patients. Non-pharmacologic stimulation of MC degranulation by obstruction of venous flow for 10 minutes increased the sensitivity of pHL in MCAS patients to 59% and in SM patients to 47%. In MCAS patients tryptase, chromogranin A, and N-methylhistamine levels exhibited low sensitivities (10%, 12%, and 22%, respectively), whereas sensitivities for SM were higher (73%, 63%, and 43%, respectively). Taken together, these data suggest pHL appears more sensitive than the other mediators for detecting systemic MC activity in patients with MCAS. The simple, brief venous occlusion test appears to be a useful indicator of the presence of pathologically irritable MCs, at least in the obstructed compartment of the body. © 2015 Vysniauskaite et al. Source


Puppa G.,Hopitaux Universitaires Of Geneva | Poston G.,University of Liverpool | Jess P.,Copenhagen University | Nash G.F.,Poole General Hospital | And 2 more authors.
World Journal of Gastroenterology | Year: 2013

One of the main changes of the current TNM-7 is the elimination of the category MX, since it has been a source of ambiguity and misinterpretation, especially by pathologists. Therefore the ultimate staging would be better performed by the patient's clinician who can classify the disease M0 (no distant metastasis) or M1 (presence of distant metastasis), having access to the completeness of data resulting from clinical examination, imaging workup and pathology report. However this important change doesn't take into account the diagnostic value and the challenge of small indeterminate visceral lesions encountered, in particular, during radiological staging of patients with colorectal cancer. In this article the diagnosis of these lesions with multiple imaging modalities, their frequency, significance and relevance to staging and disease management are described in a multidisciplinary way. In particular the interplay between clinical, radiological and pathological staging, which are usually conducted independently, is discussed. The integrated approach shows that there are both advantages and disadvantages to abandoning the MX category. To avoid ambiguity arising both by applying and interpreting MX category for stage assigning, its abandoning seems reasonable. The recognition of the importance of small lesion characterization raises the need for applying a separate category; therefore a proposal for their categorization is put forward. By using the proposed categorization the lack of consideration for indeterminate visceral lesions with the current staging system will be overcome, also optimizing tailored follow-up. © 2013 Baishideng. All rights reserved. Source


Muldur E.,Hematology and Palliative Care
Memo - Magazine of European Medical Oncology | Year: 2016

The incidence of prostate cancer is strongly correlated with age, with 35 % of patients aged 65–74 years and 25 % aged 75 years or older being affected [1]. Prostate cancer is third leading cause of cancer death among men aged 80 years and older. Of patients dying of prostate cancer, 41 % are aged 75–84 years, and 30 % above 85 years [2]. Fortunately treatment for metastatic castration-resistant prostate cancer (mCRPC) has evolved dramatically in the last few years. © 2016, Springer-Verlag Wien. Source


Neukirchen J.,Heinrich Heine University Dusseldorf | Nachtkamp K.,Heinrich Heine University Dusseldorf | Schemenau J.,Heinrich Heine University Dusseldorf | Aul C.,Oncology and Clinical Immunology | And 6 more authors.
Leukemia Research | Year: 2015

During the last years, more and more treatment modalities are available for MDS patients. Therefore, we were interested if this is reflected in an improvement of the outcome of the patients. We analyzed the survival and rate of leukemic progression of 4147 patients from the Duesseldorf MDS registry diagnosed during the last 30 years and found an improvement of survival in those patients diagnosed after 2002 (30 vs. 23 months, p < 0.0001). In detail, the improvement of the prognosis was restricted to high-risk MDS patients diagnosed between 2002 and 2014 in comparison to the patient group diagnosed between 1982 and 2001 (19 vs. 13 months, p < 0.001), whereas the prognosis of low-risk MDS patients did not change significantly. The improvement of survival was still measurable after exclusion of RAEB-t patients and of those, that received an allogeneic stem cell transplantation. In line with this finding, we found a lower AML progression rate in the later diagnosed group. Unfortunately, we could not identify a clear reason for this finding but rather a multifactorial cause should be assumed. As death due to bleeding complications and infections was significantly lower, an improvement of BSC may be one of the underlying causes. © 2015 Elsevier Ltd. Source


Zweegman S.,VU University Amsterdam | Van Der Holt B.,Erasmus Medical Center | Mellqvist U.-H.,Sahlgrenska University Hospital | Salomo M.,Rigshospitalet | And 22 more authors.
Blood | Year: 2016

The combination of melphalan, prednisone, and thalidomide (MPT) is considered standard therapy for newlydiagnosed patientswithmultiplemyelomawho are ineligible for stem cell transplantation. Long-term treatment with thalidomide is hampered by neurotoxicity. Melphalan, prednisone, and lenalidomide, followed by lenalidomide maintenance therapy, showed promising results without severe neuropathy emerging. We randomly assigned 668 patients between nine 4-week cycles of MPT followed by thalidomide maintenance until disease progression or unacceptable toxicity (MPT-T) and thesameMP regimen with thalidomide being replaced by lenalidomide (MPR-R). This multicenter, open-label, randomized phase 3 trial was undertaken by Dutch-BelgiumCooperative Trial Group for Hematology Oncology and the Nordic Myeloma Study Group (the HOVON87/NMSG18 trial). The primary end point was progression-free survival (PFS). A total of 318 patients were randomly assigned to receive MPT-T, and 319 received MPR-R. After a median follow-up of 36 months, PFS with MPT-T was 20 months (95% confidence interval [CI], 18-23 months) vs 23 months (95%CI, 19-27months)withMPR-R (hazard ratio, 0.87; 95% CI, 0.72-1.04; P 5.12). Response rates were similar, with at least a very good partial response of 47% and 45%, respectively. Hematologic toxicity was more pronounced with MPR-R, especially grades 3 and 4 neutropenia: 64% vs 27%. Neuropathy of at least grade 3 was significantly higher in the MPT-T arm: 16% vs 2% in MPR-R, resulting in a significant shorter duration of maintenance therapy (5 vs 17 months in MPR-R), irrespective of age. MPR-R has no advantage over MPT-T concerning efficacy. The toxicity profile differed with clinically significant neuropathy during thalidomide maintenance vs myelosuppression with MPR. © 2016 by The American Society of Hematology. Source

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