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Biomedical subjects

W Hiddemann

Publications and source records attributed to W Hiddemann.

At least 55 records · Page 3Linked to original sources
PubMed2003

Subjective quality of life and sexual functioning after germ-cell tumour therapy.

PURPOSE: To evaluate the influence of germ-cell tumour therapy on sexual functioning and subjective quality of life (QL). To investigate the communication about sexual problems between patients, their partners, and doctors. In all, 474 patients treated for germ-cell tumours at the Department of Internal Medicine III, Ludwig-Maximilians-University Munich, from 1979 to 2000 were asked to complete a self-report questionnaire concerning psychosocial dimensions and subjective QL (QLS; Henrich and Herschbach, 2000). In total, 341 patients returned a completed questionnaire (response rate, 71.9%). The median age at survey was 41.9 years and the median follow-up period after therapy was 9.6 years. Persisting sexual sequelae were lower than in the current literature: decreased sexual desire (7.1%), erection (10.0%), orgasm (10.2%), ejaculation (28.8%), sexual activity (8.5%), and sexual satisfaction (4.8%). In QL the satisfaction with 'friends/acquaintances' (P<0.001) and 'family life/children' (P<0.001), is lower than in the healthy population. Correlations between functional scales and subjective QL were highly significant. There is a strong correlation between sexual satisfaction and global life satisfaction (Spearman's Rho: 0.48; P<0.01). A total of 61.4% of patients were not offered communication about sexual problems by their doctors and 21.2% were unable to talk with their partner about sexual issues. In conclusion, moderating psychosocial variables (e.g. personality factors, cognitive processes) should be investigated to clarify the relationship between life satisfaction (subjective QL) and functional impairments. Communication about sexual problems should be offered as a standard to patients treated for germ-cell tumours.

Adult↗
PubMed2003

Mantle cell lymphoma: established therapeutic options and future directions.

During the last few years, new insights into the biology of mantle cell lymphoma have been obtained. However, with a median survival of only 3 years, mantle cell lymphoma remains the lymphoma subtype with the poorest prognosis. At initial diagnosis most patients present with advanced Ann Arbor stage III or IV and conventional chemotherapy hardly alters the continuously declining survival curve. Recently, two prospective randomized studies of the German Low Grade Lymphoma Study Group (GLSG) clearly confirmed the superiority of a combined immunochemotherapy. In a randomized study of the European mantle cell lymphoma Network, consolidation with myeloablative radiochemotherapy followed by autologous stem cell transplantation improved the progression-free survival in patients younger than 65 years. However, relapses are still observed at a high frequency. Thus, new therapeutic strategies such as radioactively labeled antibodies or molecular targeting agents (e.g. Bortezomib or flavopiridol) are urgently warranted to further improve the clinical outcome of mantle cell lymphoma.

Antibodies, Monoclonal↗
PubMed2003

The long-term psychosocial effects of haematopoetic stem cell transplantation.

The purpose of this study was to identify long-term psychosocial effects of allogenic, syngenic and autologous haematopoetic stem cell transplantation (HSCT) on relevant parameters (physical performance, role and sexual functioning, intimate relationships, professional and social rehabilitation). A total of 163 patients, who had undergone an autologous (11.6%), syngenic (3.1%) or allogenic (85.3%) HSCT at the Department of Internal Medicine III, Ludwig-Maximilians-University, during a preceding 16-year period, were asked to complete the Herschbach Questionnaire on Stress in Cancer Patients in order to evaluate their current psychosocial distress status. An additional questionnaire for demographic data was used. Reduced quality of life as a result of HSCT is restored to its pre-HSCT level by most patients within 2 years after transplantation (no differences between groups transplanted 2-5, 6-9 or >10 years ago). The majority of patients had serious problems with "fitness" (24%), followed by problems with "pain" (17.2%) and "fear/emotional stress" (14.1%). Professional reintegration is an important factor in patients' well-being. However, 30.7% of these patients did not return to work at all. Unemployed patients had significantly higher scores for pain, anxiety, sleep disorders, depression, impairments in social functioning, partnership and family life. Only 9.8% of all patients took part in a psychotherapeutic programme and 39.3% in a rehabilitation programme. Identifying strategies for risk patients (e.g. lower education and married) need to be developed in order to optimize support for this group. Although some patients show a higher distress score in anxiety/fear and psychophysical performance, only 9.8% of all patients took advantage of available psychotherapy.

Adult↗
PubMed2003

New insights into the biology of acute myeloid leukemia and their impact on treatment.

Acute myeloid leukemia (AML) is a heterogeneous group of disorders that can be discriminated by morphology, immunophenotyping or more recently by cytogenetic and molecular techniques. By cytogenetics two major groups of AML can be discriminated: One group with detectable chromosomal aberrations accounting for approximately 52 % of all de novo AML and the second group without cytogenetically detectable karyotype abnormalities. In the first group two major subtypes can be further distinguished. The first group comprises AML with balanced aberrations mainly consisting in t(8;21), t(15;17) and inv(16). The second group comprizes cases with unbalanced aberrations including particularly 5q-, 17q- -5 and AML with complex karyotypes. AMLs with balanced aberrations have a good prognosis with long term survival being achieved in approximately 60 %-80 % of cases. AMLs with non-balanced aberrations on the other hand have a poor prognosis with only 10 %-15 % long-term survivors. AMLs with no detectable abnormalities or other cytogenetic aberrations comprise a group with an intermediate prognosis in which long term survival is achieved in approximately 25 %-30 % of cases. Biologically, AMLs with balanced aberrations regularly involve the deregulation of transcription factors resulting in an impairment of cell differentiation and proliferation. AMLs with unbalanced aberrations are mostly characterized by a loss of genetic material resulting in an alteration of cell cycle control and DNA repair. A new view on the biology of AML has recently been made possible through the analysis of gene expression profiles. This technique is still under investigation. First results, however, already show that gene expression patterns have a high diagnostic potential and allow to detect biology subgroups with a high accuracy. Furthermore, by this technique pathways can be identified that are altered in the leukemic process. Gene expression profiling therefore opens a new and exciting perspective in leukemia biology and therapy that may have substantial impact on the improvement of diagnosis and more importantly may guide therapeutic strategies.

Acute Disease↗
PubMed2002

Elevation of soluble tumor necrosis factor receptor II in non-febrile patients with acute myeloid leukemia.

BACKGROUND: Tumor necrosis factor alpha (TNF) and its cellular and soluble (s) receptors (TNF-R) are important mediators in acute myeloid leukemia (AML) and infectious complications during cytoreductive therapy. We investigated the serum concentrations of sTNF-RII in previously untreated patients with AML at the onset of cytoreductive therapy and in non-febrile chemotherapy-associated neutropenia. PATIENTS AND METHODS: Of 54 eligible patients with AML, serum concentrations of sTNF-RII could be evaluated in 25 non-neutropenic, non-febrile and in 11 neutropenic, non-febrile patients. RESULTS: At baseline, non-neutropenic, non-febrile AML patients showed high median serum sTNF-RII concentrations of 3,804 pg/mL. In neutropenia, there was a non-significant trend (p = 0.18) to lower median sTNF-RII levels of 3,246 pg/mL. CONCLUSIONS: Serum sTNF-RII concentrations in non-febrile AML patients before chemotherapy are in the range of levels reached in uncomplicated febrile episodes in otherwise healthy individuals. This must be taken into account when evaluating the cytokine profile for sepsis in patients with therapy-associated neutropenia. Concentrations are still elevated in neutropenia, suggesting that a normal number of leukocytes is not necessarily required for the activation of the TNF ligand/TNF receptor system in AML.

Adult↗
PubMed2002

[Increased response rate with rituximab in relapsed and refractory follicular and mantle cell lymphomas -- results of a prospective randomized study of the German Low-Grade Lymphoma Study Group].

BACKGROUND AND OBJECTIVE: Rituximab has shown a high activity in relapsed follicular lymphomas when given alone. Further on, phase-II-studies indicate that its addition to chemotherapy may improve the response rate substantially. However, so far, prospective randomized studies have not been available. PATIENTS AND METHODS: In 1998 the GLSG started a multicenter trial in patients with relapsed or refractory indolent lymphoma or mantle cell lymphoma. A fludarabine-containing regimen (FCM) was chosen for salvage therapy, with fludarabine 25 mg/m(2)/d 1-3, cyclophosphamide 200 mg/m(2) d 1-3 and mitoxantrone 8 mg/m(2) d 1. A total of four courses, every 4 weeks were given. Patients were prospectively randomized for FCM alone or the immunochemotherapy with R-FCM (375 mg/m(2) one day before FCM) RESULTS: About 147 randomized patients 93 had follicular, 40 mantle cell and 14 lymphoplasmocytic/-cytoid lymphoma. Statistical analysis was performed by sequential testing and indicated for 94 fully evaluable patients a significant advantage for the R-FCM-arm, with an overall response rate of 83 % as compared to 58%, when treated with FCM alone (CR: 35 % vs. 13 %). Similar improvements of remission rate were detected in the different lymphoma subgroups, especially in MCL (OR: 65 % vs. 33 %). Both treatment options were associated with hematological toxicities of grade III and IV, but well tolerated; infectious complications were rare, with no difference between the two treatment groups. CONCLUSION: This prospectively randomized trial demonstrates for the first time a significant improvement of the combined immunochemotherapy related to the remission rate in patients with relapsed or refractory indolent lymphoma.

Adult↗
PubMed2002

Soluble tumor necrosis factor receptor type II in the early diagnosis of fever in neutropenia.

Sepsis in chemotherapy-associated neutropenia is a major cause of mortality in the treatment of acute myeloid leukemia (AML). Early diagnosis of sepsis is crucial for patient survival. We analyzed the value of prospectively measuring serum concentrations of soluble tumor necrosis factor receptor type II (sTNF-RII) in patients with AML for early diagnosis of sepsis in neutropenia. Therefore, 54 adult patients with AML and neutropenia were followed around the onset of fever. A total of 59 febrile episodes were documented. We could not demonstrate a significant increase in sTNF-RII levels prior to fever. sTNF-RII concentrations were not predictive of the severity of a febrile episode. Based on these data, we cannot recommend the routine screening of sTNF-RII for early detection of septic complications in patients undergoing cytoreductive therapy of AML.

Acute Disease↗
PubMed2002

Transcription of AML1 in hematopoietic subfractions of normal adults.

The transcription factor AML1 (CBFA2) is indispensable for early fetal hematopoiesis, but also transactivates target genes which are important for further downstream hematopoiesis. However, little is known about the impact of AML1 on lineage-committed stages. We investigated the transcription of AML1 in subfractions of four normal adult bone marrow aspirates isolated by fluorescence-activated cell sorting. AML1 is transcribed in early (CD34+/CD38-) and late (CD34+/CD38+) hematopoietic progenitors, B-cell precursors (CD10+/CD19+) as well as in immature monocytes (CD14-/CD11c+), myeloid (CD15+/CD33+ and CD15+/CD33-) and erythroid (GPA+/CD3-/CD45-) cells, but not in T lymphocytes (GPA-/CD3+/CD45+). These data suggest that in adult hematopoiesis AML1 may be critically involved in differentiation of early hematopoietic progenitors, erythroid cells, and lymphoid precursors. These subfractions are interesting targets to study the importance of AML1 in definitive hematopoiesis.

Adult↗