Publications by authors named "Jan Michel Heger"

Background: Limited real-world evidence is available for patients with diffuse large B-cell lymphoma (DLBCL) who received an autologous stem cell transplantation (ASCT) in Germany.

Objectives: This study aims to describe the real-world survival outcomes of patients with DLBCL who received ASCT in Germany after diagnosis.

Design: This study is a retrospective database analysis covering the period between 2010 and 2019.

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  • Current challenges in treating Hodgkin lymphoma (HL) include relapsed/refractory cases and long-term treatment toxicities, and genetic and TME analysis could improve risk assessment.
  • This study used circulating tumor DNA sequencing from 243 patients to identify and validate three distinct HL subtypes: inflammatory immune escape, virally-driven, and oncogene-driven HL, each with unique characteristics.
  • The findings suggest a noninvasive approach for personalized risk stratification and monitoring of minimal residual disease, which may help identify patients at high risk of relapse.*
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The overall prognosis of older patients with acute myeloid leukemia (AML) is dismal. Only a small subgroup experiences long-term survival. The discrimination between patients who are candidates for potentially curative approaches and those who are not is crucial since - in addition to differences in terms of AML-directed treatment - different policies concerning intensive care unit (ICU) admission and involvement of specialized palliative care (SPC) seem obvious.

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Objectives: To investigate characteristics and outcomes of critically ill cancer patients with marked hyperferritinemia.

Methods: A single-center retrospective analysis comprising cancer patients with a ferritin level >10.000 μg/L treated in the intensive care unit (ICU) between 2012 and 2022 was conducted.

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Although several promising approaches for the treatment of relapsed/refractory diffuse large B-cell lymphoma (rrDLBCL) have been approved recently, it remains unclear which patients will ultimately achieve long-term responses. Circulating tumor (ct)DNA sequencing has emerged as a valuable tool to assess minimal residual disease (MRD). Correlations between MRD and outcomes have been shown in previously untreated DLBCL, but data on the repeated assessment of MRD in the dynamic course of rrDLBCL is limited.

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Purpose: The emergence of chimeric antigen receptor (CAR) T-cell therapy fundamentally changed the management of individuals with relapsed and refractory large B-cell lymphoma (LBCL). However, real-world data have shown divergent outcomes for the approved products. The present study therefore set out to evaluate potential risk factors in a larger cohort.

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State-of-the-art response assessment of central nervous system lymphoma (CNSL) by magnetic resonance imaging is challenging and an insufficient predictor of treatment outcomes. Accordingly, the development of novel risk stratification strategies in CNSL is a high unmet medical need. We applied ultrasensitive circulating tumor DNA (ctDNA) sequencing to 146 plasma and cerebrospinal fluid (CSF) samples from 67 patients, aiming to develop an entirely noninvasive dynamic risk model considering clinical and molecular features of CNSL.

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A relevant proportion of patients with acute myeloid leukemia (AML) presenting with hyperleukocytosis are admitted to the intensive care unit (ICU). However, data on characteristics and outcomes of these patients are limited. We therefore conducted a single-center retrospective analysis including 69 consecutive AML patients with a white blood cell (WBC) count > 100.

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Article Synopsis
  • Hodgkin lymphoma primarily affects young adults and, while treatment outcomes can be positive, patients often face significant early and late toxicities that impact their quality of life.
  • Current methods for assessing patient risk and treatment response mainly rely on clinical features and imaging, which are not always effective at predicting disease progression.
  • This text discusses the potential of circulating tumor DNA sequencing to enhance risk assessment and tailor treatment approaches for patients with Hodgkin lymphoma.
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  • Diffuse large B-cell lymphoma (DLBCL) is a common form of non-Hodgkin lymphoma in Germany, but there is limited data on patient survival rates and treatment patterns.
  • Using a large database of German health insurance records, researchers analyzed the survival of nearly 2,500 newly diagnosed DLBCL patients from 2010 to 2019, noting treatment responses based on established guidelines.
  • The study found that most patients received Rituximab-based therapies, with a median overall survival of 96 months, but highlighted the need for better treatment options due to high mortality, particularly in elderly and relapsed patients.
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Background: Chimeric antigen receptor (CAR) T-cell therapy has improved the limited overall survival (OS) of patients with intensively pretreated diffuse large B-cell lymphoma (DLBCL). However, the potentially life-threatening toxicities of CAR T-cells and early relapses remain a challenge. As suggested by smaller monocentric analyses, radiotherapy (RT) in combination with CAR T-cells may have an immunomodulatory effect.

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The introduction of chimeric antigen receptor (CAR) T-cell therapy has led to a fundamental shift in the management of relapsed and refractory large B-cell lymphoma. However, our understanding of risk factors associated with non-response is still insufficient and the search for predictive biomarkers continues. Some parameters measurable on F-fluorodeoxyglucose positron emission tomography (PET) may be of additional value in this context.

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Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin's lymphoma with increasing prevalence. Although the disease burden associated with DLBCL is high, only limited data on healthcare resource utilization (HCRU) and associated costs of German patients with DLBCL is available.

Methods: Using a large claims database of the German statutory health insurance with 6.

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  • High-dose chemotherapy and autologous stem cell transplantation (ASCT) can lead to serious complications, prompting ICU admissions; a study analyzed 79 patients who underwent these treatments.
  • Sepsis was the leading reason for ICU admission, affecting 68% of patients, with 29% requiring mechanical ventilation and 44% requiring vasopressors.
  • Overall survival rates were relatively positive, with 77.2% survival in the ICU and hospital, indicating that patients in this setting should receive ICU care rather than being excluded.
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  • The COVID-19 pandemic has significantly increased emotional and psychological stress on healthcare personnel, particularly in intensive care units.
  • Both physicians and nurses report high levels of stress, but nurses experience additional challenges related to organizational and physical demands.
  • The study's findings can guide future strategies to improve the working conditions and support for healthcare workers.
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Objectives: Patients with classical Hodgkin lymphoma (cHL) relapsing after second-line therapy have a dismal prognosis and novel approaches are required for this patient group. Based on promising (pre-)clinical data and the favourable toxicity profile, we performed a phase II clinical trial with the JAK inhibitor ruxolitinib in patients with relapsed or refractory cHL (r/r cHL).

Methods: Patients ≥18 years with histologically confirmed r/r cHL who failed second-line treatment were included.

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  • * In a study of 36 patients receiving high-dose melphalan before CAR T-cell therapy or allogeneic SCT, 66.7% showed a treatment response, with 39.4% experiencing partial remission and 27.73% achieving complete remission.
  • * Despite promising remission rates, the overall two-year survival was only 15.8%, largely due to high non-relapse mortality associated with intensive treatments, particularly in allogeneic SCT patients.
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Background: Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL) are aggressive B-cell non-Hodgkin lymphomas (B-NHL) with a generally favorable prognosis after immunochemotherapy. The outcome of BL is superior to DLBCL. In 2016, a distinct group of lymphomas displaying characteristics of both BL and DLBCL (high grade B-cell lymphoma, HGBL) was introduced into the WHO classification.

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Reinduction chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant (HDCT + ASCT) is second-line standard of care for transplant-eligible patients with relapsed/refractory classical Hodgkin lymphoma (r/r cHL) but has a high failure rate. Because response to reinduction is predictive of the outcome after HDCT + ASCT, we aimed to improve the standard dexamethasone, high-dose cytarabine and cisplatinum (DHAP) reinduction regimen by addition of the oral mammalian target of rapamycin inhibitor everolimus (everDHAP). Transplant-eligible patients aged 18-60 years with histologically confirmed r/r cHL were included in this experimental phase I/II trial.

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The prognosis of allogeneic stem cell transplant recipients admitted to the intensive care unit (ICU) has improved over the last decades. However, data focusing on patients treated in the ICU during the peri-transplant period are scarce. We therefore conducted an analysis comprising 70 patients who had allogeneic stem cell transplantation at the University Hospital Cologne between 2014 and 2020 and were admitted to the ICU between the initiation of conditioning therapy and day 30 after transplantation.

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Background: Primary central nervous system lymphoma (PCNSL) is a rare type of aggressive lymphoma of the central nervous system. Treatment strategies improved significantly over the past decades differ regionally but mainly consist of rituximab and high-dosed methotrexate (MTX)-based therapies.

Methods: We assessed clinical outcomes of 100 patients with newly diagnosed PCNSL between 2010-2020 at the University Hospital of Cologne, Germany.

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Follicular lymphoma is the most common subtype of the indolent non-Hodgkin lymphomas. Treatment usually consists of immuno-chemotherapy and results in long-lasting remissions in most cases. Progression-free survival with the second-generation anti-CD20 antibody obinutuzumab was shown to be better than with rituximab when given in combination with either bendamustine or anthracycline-based chemotherapy.

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