Brioli A.,Universitatsklinikum Jena |
Mugge L.-O.,Klinik fur Innere Medizin III |
Hochhaus A.,Universitatsklinikum Jena |
Von Lilienfeld-Toal M.,Universitatsklinikum Jena
Expert Review of Hematology | Year: 2017
Introduction: In the last decade, the availability of new drugs for the treatment of Multiple Myeloma (MM) significantly improved patients’ outcomes, but also raised attention towards a new spectrum of adverse events. Recently, four novel agents with different mechanisms of action (carfilzomib, elotuzumab, daratumumab and panobinostat) have been approved for the treatment of MM. This review aims at providing physicians with the tools to recognize and handle toxicity issues related with these new treatments. Areas covered: This review focuses on the management of drug related adverse events of the latest approved drug combinations. New drug combinations under development and still in the phase of approval will be briefly discussed. PubMed was searched using the terms ‘toxicity’, ‘carfilzomib’, ‘elotuzumab’ ‘daratumumab’ and ‘panobinostat’. Phase II and III clinical trials and previously published analyses on toxicities were reviewed. For new drug combination abstracts presented at the latest ASH, ASCO and EHA meetings as well as clinicaltrial.gov website was searched and reviewed. Expert commentary: With the development of newer drugs and the availability of different treatment options for MM patients, an accurate evaluation of treatment side effects, their prompt recognition and management is mandatory for all clinical hematologists. © 2017 Informa UK Limited, trading as Taylor & Francis Group.
Ukena C.,Klinik fur Innere Medizin III |
Mahfoud F.,Klinik fur Innere Medizin III |
Kindermann I.,Klinik fur Innere Medizin III |
Barth C.,Klinik fur Innere Medizin III |
And 9 more authors.
Journal of the American College of Cardiology | Year: 2011
Objectives: This study sought to investigate the effects of interventional renal sympathetic denervation (RD) on cardiorespiratory response to exercise. Background: RD reduces blood pressure at rest in patients with resistant hypertension. Methods: We enrolled 46 patients with therapy-resistant hypertension as extended investigation of the Symplicity HTN-2 (Renal Denervation With Uncontrolled Hypertension) trial. Thirty-seven patients underwent bilateral RD and 9 patients were assigned to the control group. Cardiopulmonary exercise tests were performed at baseline and 3-month follow-up. Results: In the RD group, compared with baseline examination, blood pressure at rest and at maximum exercise after 3 months was significantly reduced by 31 ± 13/9 ± 13 mm Hg (p < 0.0001) and by 21 ± 20/5 ± 14 mm Hg (p < 0.0001), respectively. Achieved work rate increased by 5 ± 13 W (p = 0.029) whereas peak oxygen uptake remained unchanged. Blood pressure 2 min after exercise was significantly reduced by 29 ± 17/8 ± 15 mm Hg (p < 0.001 for systolic blood pressure; p = 0.002 for diastolic blood pressure). Heart rate at rest decreased after RD (4 ± 11 beats/min; p = 0.028), whereas maximum heart rate and heart rate increase during exercise were not different. Heart rate recovery improved significantly by 4 ± 7 beats/min after renal denervation (p = 0.009). In the control group, there were no significant changes in blood pressure, heart rate, maximum work rate, or ventilatory parameters after 3 months. Conclusions: RD reduces blood pressure during exercise without compromising chronotropic competence in patients with resistant hypertension. Heart rate at rest decreased and heart rate recovery improved after the procedure. (Renal Denervation With Uncontrolled Hypertension; [Symplicity HTN-2]; NCT00888433) © 2011 American College of Cardiology Foundation.
Rittger H.,Friedrich - Alexander - University, Erlangen - Nuremberg |
Hochadel M.,University of Heidelberg |
Behrens S.,Klinik fur Kardiologie und Kons. Intensivmedizin |
Hauptmann K.-E.,Klinik fur Innere Medizin III |
And 5 more authors.
EuroIntervention | Year: 2012
Aims: The elderly constitute an increasing proportion of all patients with acute coronary syndromes (ACS). However, increased age has been identified as an important risk factor for adverse events and complications of ACS and treatment. The purpose of this study was to investigate age-related differences in presentation and diagnostics, as well as contemporary treatment and outcome in a large series of elderly patients receiving an invasive strategy for ACS. Methods and results: The present study is an analysis of all patients, who were enrolled in the German Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) registry in 2008. To assess age-related differences, subjects were divided into three groups: (<75 yrs, 75 to 85 yrs and >85 yrs). Out of 19,708 consecutive patients who were admitted for the treatment of ACS and enrolled in the ALKK registry, 14,174 (71.9%) were <75 yrs, 4,685 (23.8%) were between 75 and 84 yrs and 849 (4.3%) patients were >85 yrs. Therapy recommendation after diagnostic angiography was conservative in 24.6% of the youngest, in 25.1% of the elderly, and in 25.3% of the very elderly patients. Interventional success rates were 95.2% in the youngest vs. 93.1% in the elderly and very elderly patient group (p<0.001). Overall in-hospital event rate increased significantly with age (3.4% vs. 7.4% vs. 8.3%, respectively; p<0.001). Conclusions: Our analysis shows that there is a high success rate among the large proportion of elderly patients who are treated for ACS by an intervention. Complication rates increased significantly, however, with age. © Europa Edition 2012. All rights reserved.
PubMed | Robert Bosch GmbH, Charité - Medical University of Berlin, Masaryk University, Friedrich - Alexander - University, Erlangen - Nuremberg and 9 more.
Type: Journal Article | Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation | Year: 2016
Allogeneic hematopoietic cell transplantation (alloHCT) as a postremission therapy in patients with FLT3-ITD-positive intermediate-risk acute myeloid leukemia (AML) remains controversial. FLT3-ITD mutations are heterogeneous with respect to allelic ratio, location, and length of the insertion, with a high mutant-to-wild-type ratio consistently associated with inferior prognosis. We retrospectively analyzed the role of alloHCT in first remission in relationship to the allelic ratio and presence or absence of nucleophosmin 1 mutations (NPM1) in the Study Alliance Leukemia AML2003 trial. FLT3-ITD mutations were detected in 209 patients and concomitant NPM1 mutations in 148 patients. Applying a predefined cutoff ratio of .8, AML was grouped into high- and low-ratio FLT3-ITD AML (HR(FLT3-ITD) and LR(FLT3-ITD)). Sixty-one patients (29%) were transplanted in first remission. Overall survival (OS) (HR, .3; 95% CI, .16 to .7; P=.004) and event-free survival (EFS) (HR, .4; 95% CI, .16 to .9; P= .02) were significantly increased in patients with HR(FLT3-ITD) AML who received alloHCT as consolidation treatment compared with patients who received consolidation chemotherapy. Patients with LR(FLT3-ITD) AML and wild-type NPM1 who received alloHCT in first remission had increased OS (HR, .3; 95% CI, .1 to .8; P= .02) and EFS (HR, .2; 95% CI, .1 to .8; P= .02), whereas alloHCT in first remission did not have a significant impact on OS and EFS in patients with LR(FLT3-ITD) AML and concomitant NPM1 mutation. In conclusion, our results provide additional evidence that alloHCT in first remission improves EFS and OS in patients with HR(FLT3-ITD) AML and in patients with LR(FLT3-ITD) AML and wild-type NPM1.
Braun J.,Rheumazentrum Ruhrgebiet |
Pfeilschifter J.,Klinik Fur Innere Medizin III
Zeitschrift fur Rheumatologie | Year: 2010
Osteoporotic fractures are a frequent cause of disability and loss of quality of life in old age. Maintaining muscle function and balance, a daily calcium intake of 1000 mg, sufficient vitamin D and prudent use of drugs associated with falls and osteoporosis are key components to fracture prevention. The German guideline recommends that a specific long-term osteoporosis medication be initiated in individuals with a 30% 10-year risk for hip fractures and vertebral fractures. © Springer-Verlag 2010.
Weingartner O.,Klinik fur Innere Medizin III |
Lutjohann D.,Universitatsklinikum Bonn |
Bohm M.,Klinik fur Innere Medizin III |
Laufs U.,Klinik fur Innere Medizin III
Deutsche Medizinische Wochenschrift | Year: 2011
Hypercholesterolemia is a major risk factor for cardiovascular diseases. Serumcholesterol concentrations are regulated by enteral absorption and hepatic synthesis. Statins inhibit the rate-limiting enzyme of endogenous cholesterol synthesis, HMG-CoA-reductase and reduce serum cholesterol concentrations as well as cardiovascular morbidity. Indirect evidence from smaller studies shows, that patients with high baseline cholesterol absorption may show only a small response to statin treatment in terms of cholesterol lowering. Moreover, evidence from recent clinical studies suggests that increased cholesterol absorption and decreased hepatic cholesterol synthesis is associated with an increased cardiovascular risk. This article reviews the current literature on this issue and suggests prospective clinical studies to analyze whether determination of the baseline relation of cholesterol synthesis and absorption may facilitate an individualized lipid lowering therapy to further reduce cardiovascular risk. © Georg Thieme Verlag KG Stuttgart · New York.
Ewen S.,Klinik Fur Innere Medizin III |
Ukena C.,Klinik Fur Innere Medizin III |
Linz D.,Klinik Fur Innere Medizin III |
Kindermann I.,Klinik Fur Innere Medizin III |
And 6 more authors.
Hypertension | Year: 2015
Renal denervation can reduce blood pressure in certain patients with resistant hypertension. The effect in patients with isolated systolic hypertension (ISH, ≥140/<90 mm Hg) is unknown. This study investigated the effects of renal denervation in 126 patients divided into 63 patients with ISH and 63 patients with combined hypertension (CH, ≥140/≥90 mm Hg) defined as baseline office systolic blood pressure (SBP) ≥140 mm Hg despite treatment with ≥3 antihypertensive agents. Renal denervation significantly reduced office SBP and diastolic blood pressure (DBP) at 3, 6, and 12 months by 17/18/17 and 5/4/4 mm Hg in ISH and by 28/27/30 and 13/16/18 mm Hg in CH, respectively. The reduction in SBP and DBP in ISH was lower compared with patients with CH at all observed time points (P<0.05 for SBP/DBP intergroup comparison). The nonresponder rate (change in office SBP <10 mm Hg) after 6 months was 37% in ISH and 21% in CH (P<0.001). Mean 24-hour ambulatory SBP and DBP after 3, 6, and 12 months were significantly reduced by 10/13/15 and 6/6/9 mm Hg in CH, respectively. In patients with ISH the reduction in systolic ambulatory blood pressure was 4/8/7 mm Hg (P=0.032/P<0.001/P=0.009) and 3/4/2 mm Hg (P=0.08/P<0.001/P=0.130) in diastolic ambulatory blood pressure after 3, 6, and 12 months, respectively. The ambulatory blood pressure reduction was significantly lower after 3 and 12 months in SBP and after 12 months in ambulatory DBP, respectively. In conclusion, renal denervation reduces office and ambulatory blood pressure in patients with ISH. However, this reduction is less pronounced compared with patients with CH. © 2014 American Heart Association, Inc.
Specific aspects of chemotherapy in non-small-cell lung carcinoma (NSCLC) in elderly patients [Spezielle Aspekte der Chemotherapie des nicht kleinzelligen Bronchialkarzinoms (NSCLC) bei Patienten in fortgeschrittenem Lebensalter]
Von Bierbrauer A.,Klinik fur Innere Medizin III
Atemwegs- und Lungenkrankheiten | Year: 2015
The median age at first diagnosis of NSCLC is approximately 70 years. The data on chemotherapy in the increasing group of elderly NSCLC patients is rather scarce; however, it suggests that age alone is not an adequate prognostic factor for an individual patient with advanced NSCLC. The outcome in elderly patients in PS 0 - 1 can be identical to that in younger patients. Therefore, the application of an effective chemotherapy should always be considered as a therapeutic option in elderly patients with NSCLC in PS < 2. In patients who are in good general condition, a platinum-containing Doublet therapy is effective and feasible and should be considered as the results are clearly superior to monotherapy. In general, the full spectrum of therapy should also be applied in elderly NSCLC patients, but individual characteristics should be taken into account. This holds also true for molecular tests and targeted therapies. In the future, the individual therapy risk should be assessed wherever possible using a multidimensional geriatric oncology assessment (CGA) in order to be able to adequately adapt the therapy decision to each patient's situation, in particular if they are partially impaired elderly patients, and in order to avoid toxicity. However, an ideal and generally accepted CGA tool for this purpose has yet to be established. Due to the demographic development, geriatric oncology research in general has to be intensified in a sustainable way soon. The limiting factor in this context is the high financial and logistic effort necessary to carry out a clinical study in a collective of elderly or very old patients so that it seems questionable whether, apart from publically funded projects, sustainable results can be achieved. © 2015 Dustri-Verlag Dr. Karl Feistle.
Druml W.,Klinik fur Innere Medizin III
Medizinische Klinik - Intensivmedizin und Notfallmedizin | Year: 2013
Renal failure patients in the intensive care unit comprise a heterogeneous group of subjects with widely differing metabolic patterns and nutritional requirements. This group includes patients with acute kidney injury (AKI), acute-on-chronic renal failure, chronic kidney disease, and those on regular hemodialysis therapy. Renal failure is associated with a broad spectrum of specific metabolic alterations. In addition to these alterations and the often underrated impact of renal replacement therapy, the metabolism is also affected by the underlying disease process as well as associated organ failures and complications, especially infections. Nutritional support for renal failure is not fundamentally different from other disease processes, but in designing a nutrition regimen the variations in metabolism and nutrient requirements should be considered. Nutritional needs can differ widely between patients but also in the same patient during the course of disease. Thus, patients with renal failure require an individualized approach to nutritional support. Moreover, because of the altered metabolism of many nutrients and the intolerance of fluids and electrolytes, close monitoring of the nutritional therapy is mandatory in patients with renal failure. © 2013 Springer-Verlag Berlin Heidelberg.
Lange U.,Justus Liebig University |
Muller-Ladner U.,Justus Liebig University |
Pfeilschifter J.,Klinik fur Innere Medizin III
Internist | Year: 2011
Osteoporotic fractures are a frequent cause of functional disabilities and loss of quality of life. Preventive measurements need to focus on training of muscle function and coordination, and adequate daily calcium and vitamin D supplementation; furthermore a regular check up for drugs associated with falls and osteoporosis. The German guideline recommends that a specific osteoporosis medication should be initiated in individuals with a 10-year risk for hip and vertebral fractures of 30%. This article presents the current guideline for osteoporosis including the actual updates. © 2011 Springer-Verlag.