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  • 1
    In: Journal of Chromatography B, Elsevier BV, Vol. 864, No. 1-2 ( 2008-03), p. 179-
    Type of Medium: Online Resource
    ISSN: 1570-0232
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2008
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    SSG: 11
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  • 2
    In: Blood, American Society of Hematology, Vol. 102, No. 13 ( 2003-12-15), p. 4541-4546
    Abstract: Resistance of leukemic cells to chemotherapeutic agents is associated with an unfavorable outcome in pediatric acute lymphoblastic leukemia (ALL). To investigate the underlying mechanisms of cellular drug resistance, the activation of various apoptotic parameters in leukemic cells from 50 children with ALL was studied after in vitro exposure with 4 important drugs in ALL therapy (prednisolone, vincristine, l-asparaginase, and daunorubicin). Exposure to each drug resulted in early induction of phosphatidylserine (PS) externalization and mitochondrial transmembrane (Δψm) depolarization followed by caspase-3 activation and poly(ADP-ribose) polymerase (PARP) inactivation in the majority of patients. For all 4 drugs, a significant inverse correlation was found between cellular drug resistance and (1) the percentage of cells with PS externalization ( & lt; .001 & lt; P & lt; .008) and (2) the percentage of cells with Δψm depolarization (.002 & lt; P & lt; .02). However, the percentage of cells with caspase-3 activation and the percentage of cells with PARP inactivation showed a significant inverse correlation with cellular resistance for prednisolone (P = .001; P = .001) and l-asparaginase (P = .01; P = .001) only. This suggests that caspase-3 activation and PARP inactivation are not essential for vincristine- and daunorubicin-induced apoptosis. In conclusion, resistance to 4 unrelated drugs is associated with defect(s) upstream or at the level of PS externalization and Δψm depolarization. This leads to decreased activation of apoptotic parameters in resistant cases of pediatric ALL. (Blood. 2003;102:4541-4546)
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2003
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  • 3
    In: Blood, American Society of Hematology, Vol. 111, No. 5 ( 2008-03-01), p. 2573-2580
    Abstract: High-dose methotrexate (MTX) has been extensively used for treatment of acute lymphoblastic leukemia (ALL). To determine the optimal dose of MTX in childhood relapsed ALL, the ALL Relapse Berlin-Frankfurt-Münster (ALL-REZ BFM) Study Group performed this prospective randomized study. A total of 269 children with a first early/late isolated (n = 156) or combined (n = 68) bone marrow or any isolated extramedullary relapse (n = 45) of precursor B-cell (PBC) ALL (excluding very early marrow relapse within 18 months after initial diagnosis) were registered at the ALL-REZ BFM90 trial and randomized to receive methotrexate infusions at either 1 g/m2 over 36 hours (intermediate dose, ID) or 5 g/m2 over 24 hours (high dose, HD) during 6 (or 4) intensive polychemotherapy courses. Intensive induction/consolidation therapy was followed by cranial irradiation, and by conventional-dose maintenance therapy. Fifty-five children received stem-cell transplants. At a median follow-up of 14.1 years, the 10-year event-free survival probability was .36 (± .04) for the ID group (n = 141), and .38 (± .04) for the HD group (n = 128, P = .919). The 2 groups did not differ in terms of prognostic factors and other therapeutic parameters. In conclusion, methotrexate infusions at 5 g/m2 per 24 hours, compared with 1 g/m2 per 36 hours, are not associated with increased disease control in relapsed childhood PBC acute lymphoblastic leukemia.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2008
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  • 4
    In: New England Journal of Medicine, Massachusetts Medical Society, Vol. 351, No. 6 ( 2004-08-05), p. 533-542
    Type of Medium: Online Resource
    ISSN: 0028-4793 , 1533-4406
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    Language: English
    Publisher: Massachusetts Medical Society
    Publication Date: 2004
    detail.hit.zdb_id: 1468837-2
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  • 5
    In: Blood, American Society of Hematology, Vol. 116, No. 15 ( 2010-10-14), p. 2644-2650
    Abstract: To define a role for hematopoietic stem cell transplantation (HSCT) in infants with acute lymphoblastic leukemia and rearrangements of the mixed-lineage-leukemia gene (MLL+), we compared the outcome of MLL+ patients from trial Interfant-99 who either received chemotherapy only or HSCT. Of 376 patients with a known MLL status in the trial, 297 (79%) were MLL+. Among the 277 of 297 MLL+ patients (93%) in first remission (CR), there appeared to be a significant difference in disease-free survival (adjusted by waiting time to HSCT) between the 37 (13%) who received HSCT and the 240 (87%) who received chemotherapy only (P = .03). However, the advantage was restricted to a subgroup with 2 additional unfavorable prognostic features: age less than 6 months and either poor response to steroids at day 8 or leukocytes more than or equal to 300 g/L. Ninety-seven of 297 MLL+ patients (33%) had such high-risk criteria, with 87 achieving CR. In this group, HSCT was associated with a 64% reduction in the risk of failure resulting from relapse or death in CR (hazard ratio = 0.36, 95% confidence interval, 0.15-0.86). In the remaining patients, there was no advantage for HSCT over chemotherapy only. In summary, HSCT seems to be a valuable option for a subgroup of infant MLL+ acute lymphoblastic leukemia carrying further poor prognostic factors. The trial was registered at www.clinicaltrials.gov as #NCT00015873 and at www.controlled-trials.com as #ISRCTN24251487.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2010
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  • 6
    In: Blood, American Society of Hematology, Vol. 104, No. 11 ( 2004-11-16), p. 3619-3619
    Abstract: ICL670 (deferasirox) is an investigational once-daily oral iron chelator that has demonstrated the ability to induce sustained, clinically relevant reductions in liver iron content (LIC) in heavily transfused patients with β-thalassemia and iron overload. The efficacy and safety of ICL670 is being assessed in a multicenter, randomized, open-label Phase III study in comparison with deferoxamine (DFO) in patients aged ≥2 years with β-thalassemia and transfusional hemosiderosis. Between March and November 2003, 587 patients began treatment (296 on ICL670; 291 on DFO) in the following 12 countries : Italy (200), Turkey (87), Tunisia (68), US (48), Greece (46), Germany (27), Argentina (24), Belgium (24), Brazil (20), UK (18), Canada (13) and France (12). Based on LIC at baseline (2–3, 〉 3–7, 〉 7–14 and 〉 14 mg Fe/g dw), patients were randomized in a 1:1 ratio to receive either oral ICL670 once daily at doses of 5, 10, 20 or 30 mg/kg, respectively, or subcutaneous DFO at doses of 20–60 mg/kg/day for 5 days/week. Treatment was for one year initially, to be followed by an extension phase during which patients randomized to DFO may switch to ICL670. LIC, the primary outcome variable, was assessed at baseline by liver biopsy or, in some children, non-invasively by magnetic susceptometry using a Superconducting QUantum Interference Device (SQUID). LIC will be reassessed after 12 months of therapy in each patient using the same methodology as at baseline. Liver biopsies are analyzed at a single center (Rennes, France) and SQUID assessments are performed in 3 centers (Turin, Italy; Hamburg, Germany; Oakland, US). At baseline, median (25–75th percentiles) LIC was 13.0 mg Fe/g dw (7.2–21.0) by biopsy and 5.6 (4.0–7.7) in those patients assessed by SQUID. Total body iron balance will be assessed to determine the relative chelation efficacies of ICL670 and DFO. A summary of patient demographics and baseline characteristics (median values or no. of pts) is given in the table. ICL670 has been well tolerated with mild, transient gastrointestinal complaints as the main AEs with a suspected relationship to study drug. As of May 2004, 8 patients on ICL670 and 2 on DFO had discontinued therapy due to AEs. The key efficacy and safety data from the initial 12 months of therapy for all randomized patients will be available late November 2004. Treatment group (by initial dose) ICL670 (n=296) Deferoxamine (n=291) 10 mg/kg n = ≤ 94 20 mg/kg n = 83 30 mg/kg n = 119 〈 35 mg/kg n = 51 35- 〈 50 mg/kg n = 119 ≥ 50 mg/kg n = 121 Age (yrs) median 15 15 15 15 14 17 No. of pts 2 - 〈 16 years 49 44 60 26 63 56 No. of ≥ pts 16 yrs 45 39 59 25 56 65 No. of males/females 44/50 41/42 54/65 32/19 50/69 61/60 LIC (mg Fe/g dry weight) 4.7 10.6 21.8 4.5 9.1 19.5 No. of pts with biopsy/SQUID* 60/34 69/14 117/0* 36/15 93/26 119/2 Serum ferritin (ng/ml) 1881 1954 3250 1546 2037 2383
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
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  • 7
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 1462-1462
    Abstract: Despite the very good overall prognosis of childhood acute lymphoblastic leukemia (ALL), longtime survival may only be maintained if immunological control mechanisms prevent immune escape of leukemic blasts. Under physiological conditions members of the NGF/TNF receptor family are of outstanding importance for B cell/T cell interaction. There is growing evidence that nerve growth factor (NGF) itself also contributes to maintenance of immune system homeostasis. The NGF receptor (NGFR) promotes mitotic cell cycle arrest and induces pro-apoptotic programs depending on the developmental stage of cells. It has moreover become clear, that high NGFR expression level has a favorable impact on the clinical outcome in diverse non-neuronal neoplasma. Due to its potential role in tumorigenesis and immunomodulatory functions, we prospectively studied NGFR expression on primary precursor B (BCP) ALL blasts of pediatric patients (pts) (n=75). All pts ( & lt;17y) were treated according to the Co-ALL 1997 study protocol. Blasts exclusively exhibited an immunophenotype of c-ALL (n=52) or pre-B-ALL (n=23). The criteria for prognostic classification into high risk (HR; n=30) and low risk (LR; n=45) pts at initial diagnosis include leukocyte count (WBC), age, genetic translocations and the in vitro resistance to chemotherapeutic agents (PVA score). In flow cytometry analysis half of the pts expressed no or low level NGFR ( & lt;10%) (median: 9%; range 0–91%). Mean level assessed in those pts overexpressing NGFR beyond 10% was 50%±25% (±SD). In terms of the above mentioned prognostic discrimination criteria we found significantly lower NGFR expression in BCP-ALL blasts of HR pts (6%; 0–83%) compared to the LR group (22%; 0–91%) (p=0.027). When looking at the risk factors individually, pts with high initial WBC exhibited significantly lower NGFR levels in contrast to those with low WBC at diagnosis (7%; 0–83% vs 16%; 0–91%; p= 0.037). Also blasts carrying the prognostically positive tel-aml rearrangement showed significantly higher NGFR expression compared to those without cytogenetic aberrations (7%; 0–85% vs 36%; 1–91%; p=0.028). However, we detected no association between NGFR expression level and pt age, the examined immunophenotypes or PVA score. Of note, NGFR expression was significantly lower in the 15 pts who subsequently developed relapse (3%; 0–50%) compared to those remaining in remission (12%; 0–91%) (p=0.042). Whereas NGFR expression displayed no impact on overall survival, relapse free (RFS) and event-free survival (EFS) was significantly better in pts expressing high surface NGFR level (RFS 100% vs 72% p=0.006; EFS 90% vs 70%, p=0.04) in Kaplan Meier analysis. Multivariate Cox regression analysis for determination of the relative prognostic importance of the different risk parameters revealed that in addition to WBC (p= 0.007) high NGFR expression (p=0.042) is independently associated with superior EFS in our pediatric ALL pt cohort. Thus, high NGFR expression is a novel, independent prognostic marker that identifies a group of pediatric ALL patients with favorable outcome. Conversely, pts with no or low NGFR level are at high risk to suffer from relapse.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
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  • 8
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 3279-3279
    Abstract: Recognition of specific T-ALL subgroups based upon cytogenetic aberrations may have prognostic relevance. The prognostic relevance of recurrent molecular-cytogenetic abnormalities using RQ-PCR and FISH was established for T-ALL patients enrolled on the DCOG protocols, and assigned to SIL-TAL, HOX11, HOX11L2, or CALM-AF10 subgroups or a rest group lacking any of these abnormalities. RQ-PCR data almost completely matched with FISH data. CALM-AF10 was associated with a poor outcome (p=0.005), whereas HOX11L2 and TAL1 subgroups demonstrated a strong trend towards poor and good outcome, respectively. A significant association between HOX11L2 and poor outcome was validated in a second T-ALL cohort comprising 53 pediatric patients that were enrolled on the COALL97 protocol (p=0.01). The TAL1 subgroup was committed to αβ-lineage T-cell developmental stage. HOX11 T-ALLs were all CD1 positive without expression of Cytβ and/or TCR expression reflecting an early cortical developmental stage. The immunophenotype of the HOX11L2 subgroup was rather heterogeneous consisting of samples with TCRγδ expression as well as phenotypic immature cases. Only 41% of HOX11L2 positive cases expressed CD1, indicating that HOX11L2 and HOX11 represent different T-cell developmental stages. CALM-AF10 was associated with a very immature immunophenotype, frequently expressing CD34 and myeloid markers. The TAL1 subgroup was characterized by high expression levels of TAL1, but about half of the samples with no or other aberrations also highly expressed TAL1. LYL1 was highly expressed in the other subgroups, with the highest expression levels in the most immature subgroups. LMO2 gene expression levels closely matched with LYL1 levels. In conclusion, the presence of CALM-AF10 and HOX11L2 abnormalities define poor prognostic subgroups in pediatric T-ALL.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 9
    In: Blood, American Society of Hematology, Vol. 100, No. 8 ( 2002-10-15), p. 2891-2898
    Abstract: In 65 patients with hemophagocytic lymphohistiocytosis (HLH), we found an as yet undescribed heterogeneity of defects in cellular cytotoxicity when assay conditions were modified by the incubation time, the presence of mitogen, or interleukin-2 (IL-2). The standard 4-hour natural killer (NK) test against K562 targets was negative in all patients. In patients deficient in type 1 (n = 21), type 2 (n = 5), and type 4 (n = 8) HLH, negative NK function could be reconstituted by mitogen, by IL-2, or by prolongation of the incubation time (16 hours), respectively. Most patients (n = 31) displayed the type 3 defect, defined by a lack of any cellular cytotoxicity independent of assay variations. The characteristic hypercytokinemia also concerned counterregulatory cytokines, such as proinflammatory interferon-γ (IFN-γ), simultaneously elevated with suppressive IL-10 in 38% of types 1–, 2–, and 4–deficient patients and in 71% of type 3–deficient patients. Elevated IFN-γ alone correlated with high liver enzymes, but sCD95-ligand and sCD25 did not—though these markers were expected to indicate the extent of histiocytic organ infiltration. Outcome analysis revealed more deaths in patients with type 3 deficiency (P = .017). Molecular defects were associated with homozygously mutated perforin only in 4 patients, but other type 3 patients expressed normal transcripts of effector molecules for target-cell apoptosis, including perforin and granzyme family members, as demonstrated by RNase protection analysis. Thus, target-cell recognition or differentiation defects are likely to explain this severe phenotype in HLH. Hyperactive phagocytes combined with NK defects may imply defects on the level of the antigen-presenting cell.
    Type of Medium: Online Resource
    ISSN: 1528-0020 , 0006-4971
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2002
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  • 10
    In: British Journal of Haematology, Wiley, Vol. 109, No. 3 ( 2000-06), p. 629-634
    Type of Medium: Online Resource
    ISSN: 0007-1048
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    Language: English
    Publisher: Wiley
    Publication Date: 2000
    detail.hit.zdb_id: 1475751-5
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