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  • 1
    In: American Journal of Hematology, Wiley, Vol. 92, No. 7 ( 2017-07), p. 689-694
    Abstract: Global hypomethylation has been linked to disease progression in several cancers, but has not been reported for Diffuse Large B Cell Lymphoma (DLBCL). This study aimed to assess global methylation in DLBCL and describe its prognostic value. Mean LINE1 methylation, a validated surrogate measure for global methylation, was measured in DNA from 67 tumor biopsies. Additionally, cell‐free circulating DNA (cfDNA) in plasma samples from 74 patients was tested to assess the feasibility of global hypomethylation as a biomarker in liquid biopsies. LINE1 methylation was assessed using a commercially available kit, based on pyrosequencing of PCR amplified bisulfite‐treated DNA. Global hypomethylation was detected in a subset of cases and was associated with poor overall survival in both tumor biopsies ( P  = .001) and cfDNA ( P  = .009). It was the strongest risk factor in multivariate analysis in both biopsies (HR: 10.65, CI: 2.03‐55.81, P  = .005) and cfDNA (HR: 11.87, CI: 2.80‐50.20, P  = .001), outperforming conventional clinical risk factors. Finally, hierarchical cluster analyses were performed for the cfDNA samples using previously published gene‐specific methylation data. This analysis shows that global hypomethylation co‐occurs with other epigenetic abnormalities, including DAPK1 promoter hypermethylation. In conclusion, we have shown that global hypomethylation is strongly associated with poor survival in DLBCL both when present in tumor biopsy DNA and when detected in plasma cfDNA, and has potential for clinical application as a prognostic biomarker.
    Type of Medium: Online Resource
    ISSN: 0361-8609 , 1096-8652
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2017
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  • 2
    Online Resource
    Online Resource
    Wiley ; 2007
    In:  European Journal of Haematology Vol. 79, No. 2 ( 2007-08), p. 100-106
    In: European Journal of Haematology, Wiley, Vol. 79, No. 2 ( 2007-08), p. 100-106
    Type of Medium: Online Resource
    ISSN: 0902-4441 , 1600-0609
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2007
    detail.hit.zdb_id: 2027114-1
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  • 3
    In: Leukemia & Lymphoma, Informa UK Limited, Vol. 52, No. 3 ( 2011-03), p. 400-408
    Type of Medium: Online Resource
    ISSN: 1042-8194 , 1029-2403
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2011
    detail.hit.zdb_id: 2030637-4
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  • 4
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 10, No. 1 ( 2020-06-15)
    Abstract: MicroRNAs are small regulatory RNAs that are deregulated in a wide variety of human cancers, including different types of B-cell lymphoma. Nevertheless, the feasibility of circulating microRNA for early diagnosis of B-cell lymphoma has not been established. To address the possibility of detecting specific circulating microRNAs years before a B-cell lymphoma is diagnosed, we studied the plasma expression of microRNA first in pre-treatment samples from patients with diffuse large B-cell lymphoma and subsequently in repository samples from blood donors who later developed B-cell lymphomas. In addition, we studied the microRNA expression in the diagnostic lymphoma biopsy. The most strongly induced (miR-326) and suppressed (miR-375) plasma microRNA at diagnosis, when compared with healthy blood donors, were also substantially up- or down-regulated in plasma repository samples taken from several months to up to two years before the blood donors were diagnosed with B-cell lymphoma. Importantly, at these time points the donors had no signs of disease and felt healthy enough to donate blood. In conclusion, this first study of plasma microRNA profiles from apparently healthy individuals, taken several years before B-cell lymphoma diagnosis, suggests that plasma microRNA profiles may be predictive of lymphoma development.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 5
    In: Blood, American Society of Hematology, Vol. 112, No. 11 ( 2008-11-16), p. 2384-2384
    Abstract: During the recent years CHOP-14 based chemotherapy in combination with the monoclonal anti-CD20 antibody Rituximab has become the standard choice of treatment for non-localized, poor risk Diffuse Large B-Cell Lymphoma (DLBCL). The German NHL-B1 and -B2 trials have demonstrated favourable efficacy and safety. We, and others, have observed a relatively high frequency of severe toxicity, infections and malnutrition in very high-risk patients, responsible for increased morbidity during treatment. To our knowledge, no studies have evaluated QoL in patients treated with CHOP-14 based chemotherapy. The aim of this study was to prospectively evaluate whether QoL was affected in DLBCL patients treated with dose-dense CHOP-based chemotherapy. Health-related QoL was assessed using the validated EORTC QLQ-C30 (version 3) questionaire, which is a 30-item instrument developed specifically for use in international clinical cancer research. 26 patients with DLBCL (22 (85%) de novo and 4 (15%) transformed follicular lymphoma) were included. Median age was 59 years (27–78), 18 (69%) had CS III/IV disease, 14 (54%) extranodal involvement, 19 (73%) elevated LDH, 10 (39%) a Performance Score ≥2, i.e. 13 (50%) presented with IPI 3–5 disease. Furthermore, 7 (27%) had bone marrow involvement, 13 (50%) bulky disease and 18 (69%) B-symptoms. All patients received 6 or 8 cycles of CHOP-14 based chemotherapy, and 17 of the patients received Rituximab at day 1 of each cycle. The patients completed the QLQ-C30 questionaire at four predefined timepoints according to chemotherapy treatment: pre-treatment, mid-treatment (14 days after the 4th cycle), 14 days post-treatment and 3 months post-treatment. Patient scores were compared to scores from an age- and gender-adjusted reference population, and separately analyzed over time (using non-parametric statistical analyzes). At pre-treatment only global health status (p=0.008) and role functioning (p=0.049) were impaired compared to the reference population. During treatment, global health status (p=0.008), physical functioning (p & lt;0.001) and role functioning (p=0.003) were significantly decreased, and fatigue (p & lt;0.001), dyspnoea (p=0.028) and appetite loss (p=0.007) significantly increased. All six scales were normalized three months posttreatment. At three months post-treatment the patients generally scored equal with the reference population, and in fact significantly higher in emotional and social functioning, and significantly lower in all symptom scales except fatigue. EORTC QLQ-C30 scores (treatment vs. pre-treatment) QoL-scales Pre-treatment Mid-treatment 14 days post-treatment 3 months post-treatment (N=26) (N=26) (N=23) (N=24) Mean Mean differences (95%CI) Global health status/QoL Global health status/QoL 60 −4 (−16;−8) −9 (−20;2) +10 (0;21) Functional scales Physical functioning 79 −12 (−22;−2) −17 (−28;−6) +1 (−8;9) Role functioning 63 −19 (−36;−2) −20 (−38;−3) +7 (−9;23) Emotional functioning 74 +7 (0;14) +10 (0;19) +16 (7;24) Cognitive functioning 85 −8 (−16;1) −1 (−10;8) −1 (−11;10) Social functioning 81 −3 (−13;−8) −3 (−14;8) +8 (−5;21) Symptom scales/items Fatigue 41 +15 (2;28) +14 (1;26) −12 (−27;6) Nausea and vomiting 6 +4 (−4;13) −1 (−9;6) −6 (−14;1) Pain 19 −1 (−12;10) +1 (−8;11) −4 (−19;11) Dyspnoea 24 +8 (−6;21) +3 (−12;18) −11 (−26;4) Insomnia 31 −4 (−18;11) −12 (−25;2) −13 (−27;2) Appetite loss 24 +6 (−10;23) +10 (−11;31) −17 (−33;−1) Constipation 12 +4 (−11;18) −4 (−17;8) −10 (−19;0) Diarrhoea 5 +14 (3;25) +13 (3;23) +8 (−1;18) Financial difficulties 9 +3 (−7;12) +3 (−7;13) +1 (−13;15) Our study indicates, that disease-related symptoms are infrequent in these poor-risk DLBCL patients (according to pre-treatment scores), and that treatment-related symptoms are short-lived. QoL is affected during CHOP-14 based chemotherapy, but only temporarily. The treatment regimen is therefore applicable and safe with regard to QoL in this setting.
    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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  • 6
    Online Resource
    Online Resource
    American Society of Hematology ; 2004
    In:  Blood Vol. 104, No. 11 ( 2004-11-16), p. 3307-3307
    In: Blood, American Society of Hematology, Vol. 104, No. 11 ( 2004-11-16), p. 3307-3307
    Abstract: The outcome of advanced diffuse large cell B-cell lymphoma (DLBCL) has been improved by the “dose-densified” biweekly CHOP-14 regimen. The German NHL-B2 trial has demonstrated favourable efficacy and safety in elderly patients with performance status ≤ 3 and normal organ function. However, a considerable proportion of patients are not eligible for clinical trials due to high age, poor performance, concomitant disease and/or organ dysfunction. The efficacy and safety of CHOP-14 is unknown in this group of very poor risk patients. CHOP-14 was introduced as standard treatment for advanced DLBCL (CSII-IV and/or LDH above UNV and/or bulky tumor ≥ 7.5 cm) at our institution in 2002. Seventy consecutive patients with DLBCL have been treated with 6-8 series CHOP-14 in the period March 2002 to December 2003. Patients with residual disease following chemotherapy were subsequently treated with involved field radiation. In order to estimate the efficacy and safety of CHOP-14 in very poor risk patients, we divided this population into two cohorts; A: standard risk: pts. aged 60–75 years with PS ≤ 3 or pts. aged 〈 60 years regardless of PS and B: very poor risk: pts. aged 60–75 years with PS = 4 or pts. aged 〉 75 years regardless of PS. Patient characteristics Age PS ≥ LDH UNV Bulky CS III/IV Extranodal IPI 4–5 B-symptoms; A: 22/44 (50%), B: 15/26 (58%) A (n=44) 60 (26–73) 0 (0–4) 26 (59%) 19 (43%) 25 (57%) 24 (55%) 2 (5%) B (n=26) 76 (64–83) 2 (0–4) 22 (85%) 14 (54%) 21 (81%) 19 (73%) 17 (65%) The response rates in the two cohorts (A vs. B) were CR/Cru: 82% vs. 62% (p=0.06); PR: 2% vs. 8% (p=0.55); NC/PD: 11% vs. 8% (ns). Two year EFS was 66% vs. 37% (p=0.027) and the two year OS was 71% vs. 57% (p=0.04). Concerning toxicity 30/44 (68%) vs. 23/26 (88%) (p=0.08) required hospitalisation for one or more of the following reasons: 50% vs. 65% (p=0.21) due to infection; 9% vs. 15% (p=0.42) due to Pneumocystis Carinii pneumonia; 27% vs. 31% (p=0.75) due to reduced PS mainly caused by malnutrition. The median total number of days in hospital were 8 (1–162) vs. 39 (1–228) days (p=0.002). The therapy-associated deaths without progression were 2/44 (5%) in cohort A (1 cardiac arrest, 1 ileus) compared to 3/26 (12%) in cohort B (1 cardiac arrest, 1 PCP, 1 unknown) (ns). In 3 additional patients in cohort B, treatment was stopped early due to severe infection, resulting in progression and subsequently death. In general dose erosion was minimal, except for vincristin that was reduced due to neuropathy in 20/44 (45%) vs. 10/26 (38%) (p=0.57) of the patients after a median of 5 vs. 4 cycles. The median delay in treatment schedule (schedule erosion) was 8 days (0–95 days) vs. 14 days (0–67 days) (p=0.06). Given the dismal prognosis of the patients in cohort B, the two-year survival rate of 57% is encouraging. However, the increased toxicity with infections and malnutrition, warrants for careful attention to this high risk group of patients, preferably within clinical trials focused on prevention and treatment of infections, improvement of the nutritional status and quality of life.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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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. 108, No. 11 ( 2006-11-01), p. 2443-2443
    Abstract: During the recent years CHOP-14/CHOEP-14 in combination with the monoclonal anti-CD20 antibody Rituximab has become the standard choice of treatment for non-localized, poor risk Diffuse Large B-Cell Lymphoma. We, and others, have observed a relative high incidence of opportunistic infections not normally associated with the short neutropenic periods of CHOP-based treatment. We therefore introduced a prospective risk-assessment study in February 2005. The aim of the study is to assess the degree of malnutrition and immunodeficiency that may be associated with bi-weekly regimens. This is a preliminary evaluation of the first 27 patients included. Median age was 60 (31–80), 21 (78%) had CS III/IV disease, 14 (52%) extranodal involvement, 19 (70%) elevated LDH, 9 (33%) a Performance Score ≥2, i.e.13 (48%) presented with IPI 3–5 disease. Furthermore, 7 (26%) had bone marrow involvement, 8 (30%) bulky disease and 17 (63%) B-symptoms. All patients received 6 or 8 cycles of CHOP-14/CHOEP-14, and 15 patients received Rituximab at day 1 of each cycle. Patients were examined four times: 1) before 1st cycle, 2) 14 days after 4th cycle, 3) 14 days after last cycle (i.e. 6th or 8th), and 4) 3 months after treatment. Examination included blood tests, bodyweight and DEXA-scans. 20 patients (74%) had a significant weight loss during treatment. However, 3/4 had regained normal weight three months later. Consistently, DEXA-scans demonstrated a significant reduction in total lean body mass in 12 (44%) patients. P-protein, p-albumin, and selected trace elements were decreased in about 1/4 of patients during treatment. However, most patients had significant declines in T-cell levels during treatment, and interestingly about 1/4 presented with very low T-cell levels at diagnosis. Thus, total CD3-count was low in 7 (26%) patients at diagnosis, and reduced under treatment in 23 (85%). Both CD4- and CD8-count was low in 6 patients at diagnosis, while CD4 was reduced under treatment in 24 and CD8 in 16 patients. Likewise, a significant decrease of IgA, IgM, and IgG subclasses developed during treatment (Table 1). We conclude that patients treated with bi-weekly CHOP-chemotherapy may develop severely decreased levels of T-cells and severe hypogammaglobulinemia, which may be related to an increased incidence of opportunistic infections such as PCP or CMV reactivation.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2006
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  • 8
    Online Resource
    Online Resource
    Wiley ; 2009
    In:  European Journal of Haematology Vol. 83, No. 2 ( 2009-08), p. 139-148
    In: European Journal of Haematology, Wiley, Vol. 83, No. 2 ( 2009-08), p. 139-148
    Abstract: Objectives:  Knowledge of health related quality of life of haematological patients is limited. This study aimed at investigating the prevalence and predictors of symptoms and problems in a representative sample of haematological patients in Denmark. Methods:  A random sample of patients with leukaemia, multiple myeloma and advanced lymphoma ( n  = 732) received the European Organisation for Research and Treatment of Cancer quality‐of‐life questionnaire (EORTC QLQ‐C30). Mean scores were calculated. In addition, scores were dichotomised using two thresholds: patients reporting at least ‘a little’ of each EORTC QLQ‐C30 symptom/problem were classified as having a ‘symptom/problem’, and patients reporting at least ‘quite a bit’ were classified as having a ‘severe symptom/problem’. Multiple logistic regression was used to identify predictors. Results:  In total, 470 (64%) patients participated. The most frequent symptoms/problems were fatigue (55%; severe 20%), reduced role function (49%; severe 23%), insomnia (46%; severe 15%), and pain (37%; severe 15%). Older patients and patients in active antineoplastic treatment had more symptoms and problems. There was only little evidence of social inequalities. Conclusion:  This is probably the first nationally representative study of symptoms and problems in haematological patients. These patients have symptoms/problems that deserve attention. Health related quality of life is an important issue in haematological malignancies.
    Type of Medium: Online Resource
    ISSN: 0902-4441 , 1600-0609
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2009
    detail.hit.zdb_id: 2027114-1
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  • 9
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 708-708
    Abstract: Introduction MicroRNAs are small regulatory RNAs which have been shown to be deregulated in a wide variety of human cancers, including different types of B-cell lymphoma. Circulating microRNAs can be isolated from plasma and are promising biomarkers for early detection of B-cell lymphomas. The Danish Blood Donor Study (DBDS) was initiated in 2010 and has currently enrolled more than 90,000 blood donors. Plasma repositories are kept from every blood donation allowing the study of biomarkers up to 5 years ahead of disease development. The aim of the present study was to determine whether it is possible to detect alterations in expression profile of specific microRNAs one year before diagnosis of B-cell lymphoma using plasma repositories from healthy blood donors. Methods The study was done on plasma samples taken at the time of diagnosis from 17 diffuse large B-cell lymphoma (DLBCL) patients and on plasma repository samples from 13 DBDS blood donors drawn up to more than a year before they were diagnosed with B-cell lymphoma. DBDS cases with B-cell lymphoma were identified among the first 40,000 participating donors using public registries and the diagnoses were confirmed by medical records (Table 1). The expression levels of 184 different circulating microRNAs were determined in plasma from the 17 DLBCL patients and 14 age-matched healthy controls in order to design a B-cell lymphoma specific microRNA panel. This custom microRNA panel was subsequently tested on plasma repository samples from the 13 cases of B-cell lymphoma and 14 age-matched healthy controls. All plasma samples from DBDS cases and controls were isolated, frozen, stored, and trawled the same way. Total RNA, including microRNAs, was extracted from plasma using MiRNeasy Serum/Plasma kit (Qiagen) and the expression levels were determined by Real Time RT-PCR using Serum/Plasma Focus microRNA PCR Panel (Exiqon) and Custom Pick- & -Mix microRNA PCR Panels (Exiqon). The relative expression levels of microRNA in plasma were analyzed using the ΔCt method. For normalization mir-23a and Let-7d-3p were used in addition to UniSP3 inter plate calibrator. Results 32 microRNAs were more than 3 fold up- or down-regulated in plasma when comparing patients with DLBCL to healthy blood donors. The following microRNA were most significantly down-regulated (mir-17-92 cluster, mir-10b, mir-190a, mir-346, mir-363, mir-205) or up-regulated (mir-326, mir-328, mir-33a) (Table 2). Applying the same microRNA profile in a customized panel to plasma samples from donors that were diagnosed with B-cell lymphoma revealed that the B-cell lymphoma specific pattern could be identified in all donor samples at the time of their last donation. Thus, B-cell lymphoma specific microRNAs were detected in plasma more than a year prior to diagnosis. Conclusion This first study of circulating microRNA in plasma taken from healthy individuals more than a year ahead of their diagnosis of B-cell lymphoma indicates that it is feasible to develop early and non-invasive tools for diagnosis of this disease. Table 1 Blood donors that developed B-cell lymphoma. Diagnosis Number of blood donors Interval between last donation and diagnosis (range in days) Follicular lymphoma 4 39 – 384 days DLBCL 8 56 – 698 days Hodgkin lymphoma 1 138 days Table 2 Up- and down-regulated microRNAs in plasma from DLBCL patients compared to healthy controls. MicroRNA Fold change P-Value hsa-miR-326 51,67547 1,00E-08 hsa-miR-92a-3p -5,03677 1,00E-08 hsa-miR-363-3p -7,80529 5,30E-08 hsa-miR-10b-5p -12,89477 7,90E-08 hsa-miR-19b-3p -5,14066 1,59E-07 hsa-miR-328 5,90068 3,73E-07 hsa-miR-205-5p -39,20498 4,12E-07 hsa-miR-19a-3p -4,97523 1,10E-06 hsa-miR-33a-5p 10,51611 3,04E-06 hsa-miR-190a -8,69103 2,69E-05 hsa-miR-20a-3p -10,94205 4,15E-05 Positive values indicate up-regulated and negative values down-regulated microRNAs. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 10
    In: Clinical Epigenetics, Springer Science and Business Media LLC, Vol. 8, No. 1 ( 2016-12)
    Type of Medium: Online Resource
    ISSN: 1868-7075 , 1868-7083
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2016
    detail.hit.zdb_id: 2553921-8
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